BUILDING GREATER INSIGHT
THROUGH QUALITATIVE
RESEARCH
Publications gateway reference: 06757
05 | BITE-SIZE GUIDE TO PATIENT INSIGHT:
BUILDING GREATER
INSIGHT THROUGH
QUALITATIVE
RESEARCH
Qualitative research is an important area of work for NHS providers and
commissioners who want to plug gaps in insight into local healthcare
experience and needs, or to probe deeper into ndings from quantitative
surveys or other feedback-gathering tools.
This guide offers a basic introduction to qualitative research for those
undertaking or commissioning such insight work: what it is, what are its
strengths and limitations compared to quantitative research. It outlines
some methods, sampling techniques and ways to analyse the data.
What is qualitative research?
Qualitative research tends to be more exploratory in nature than
quantitative research (see below). It is used to gain understanding of
underlying reasons, opinions and motivations. It provides answers to
questions such as what does dignity and respect mean to people, why
did they use that service and not another and what might work better
for our users. It tends to be far less structured in form than quantitative
information using open-ended questions and allows the respondent(s) to
guide the process as much as the interviewer. Some common methods
include focus groups, in-depth interviews, deliberative events and
observational work.
Qualitative methods are often used alongside quantitative methods.
Quantitative methods, such as surveys, are often used to try and
establish how many people had a certain experience or how many
people hold a certain view. Qualitative research is used to answer
questions such as why people feel and think the way they do. It is a way
to understand their experiences and perspective. Some of our other
bite-size guides give information about this.
Advantages
This kind of research has a range of advantages:
Methods like interviews and focus groups let participants answer
questions in their own words and this can help us understand their
views. Asking “open-ended” questions can provide new perspectives as
respondents may bring up concerns or views not previously considered
but which could be crucial to understanding an issue.
Qualitative methods are exible and can be adapted by the researcher
during the course of the project. For example, the researcher can revise
the interview questions according to the ndings that emerged during
a rst round of interviews. Similarly, a focus group moderator or an
interviewer can follow up points raised in a discussion to probe with
further questions.
Some qualitative research methods such as interviews or focus groups
can be empowering for research participants, emphasising that they are
being listened to rather than feeling they are being asked about things
that someone else has decided are important.
The narratives collected through interviews can provide stories about
people’s experiences and, with consent, these can help illustrate
research conclusions in a more personal way. Research ndings can be
presented in the form of a report and can also be communicated using
videos. An example would be “Barbara’s story”.
Limitations
There are some limitations to qualitative research:
Qualitative methods offer insight into how individuals think and
feel about an issue but cannot tell you how many other people in the
population feel or think in these ways.
The ndings generated by qualitative research cannot be used to
measure performance or compare between different communities.
Different types of qualitative research
There are many different ways of gathering qualitative data, from in-depth
interviews and focus groups to analysing comments posted on websites
or social media platforms. A qualitative study might involve one of these
or, more usefully, a combination of them. Each method has its strengths
and weakness and the choice of most appropriate method depends on the
topic and the aims of the research.
Individual interviews
Interviews are a popular method in qualitative research because they
can offer a rich source of insight into people’s experiences, attitudes and
beliefs.
Semi-structured interviews – An interview guide is prepared ahead of
the interview but the researcher uses the guide exibly. The interviewer
usually asks open-ended questions which invite the interviewee to choose
how to respond. Interviewees are encouraged to elaborate on their
answers and the researcher may follow the direction of the conversation
and change the interview questions accordingly. Individual interviews
can be conducted face-to-face, online, over the telephone or via video
conference. Face-to-face interviews may take place in people’s own
homes, a private room or in a public place. Whatever the location or the
technology used, the researcher needs to ensure that the privacy of the
interviewee is maintained. This includes ensuring that the conversation
cannot be overhead by passers-by and that there are no other people
present in the room, unless the interviewee has consented and there is a
good reason, such as when a translator is needed.
Peer-to-peer interviewing – This type of interviewing involves recruiting
one or more group participants as researchers. After training, peer
researchers take up the role of interviewers in their group or community.
Because they are trusted members of the group being studied, peer
researchers are likely to elicit more open responses from the interviewees.
This can be particularly useful when researching marginalised groups.
Focus groups
A focus group is a small discussion group, normally six to ten people,
moderated by a researcher. The size of the group is important to gaining
a range of perspectives while giving everyone chance to take part. The
researcher can use tools and materials, such as sample documents
and case studies, to spark and steer discussion. Focus groups generate
interactive discussion between participants and this can produce different
responses from those that might be given in a one-to-one interview.
Focus groups can be particularly useful for:
Testing audience responses to campaign messages or images
Generating insight into users’ perspectives on services
Involving users in the development of new services
Interpreting evidence generated by quantitative data
The researcher can record the session using audio or video, or they can
take notes. It is worth thinking about whether you need a transcript to
analyse the data using computer software or whether notes of key points will
sufce. Participants should be made aware that the researcher is recording
the session or taking notes and should sign consent forms before the
session begins.
Ethnography
Ethnography is a research method involving a researcher observing people
in their daily lives for an extended period of time. Ethnography can be used
to study the day-to-day work of a GP practice or a hospital ward. In such
cases the ethnographer will observe the interactions between patients,
carers and staff for an extended period of time, varying from a few weeks
to a year or more. It is an excellent method to observe how people actually
behave in certain situations and this can complement evidence that is based
on people’s own accounts of their conduct gathered through surveys or
interviews.
Observations are usually recorded in “eld notes”, detailed descriptions of
what happened and in what context. A key principal is that the researcher
does not try to test a pre-formulated theory but instead draws their
conclusions from extensive observation over time.
Participatory research and co-production
There has been a growing uptake of what is known as “participatory
research” and co-production. This is a useful way to involve patients
and carers in the design of services. Key tips to ensuring successful co-
production include:
engage service users at the earliest stages of research or service design
ensure service users are equal partners involved in all stages of the project
ensure senior leaders champion the work
actively seek to include under-represented groups.
For more information about experience-based co-design, see information
from the Kings Fund and the British Medical Journal.
These techniques can have a positive and empowering impact on the lives
of the communities being studied, particularly when those involved are from
marginalised communities. In addition, users can offer extensive knowledge
gained through their own personal experience to inform how the research is
conducted. Another advantage is that they may be able to help get active
participation from people who would otherwise opt out.
Ethics when conducting research
The process of planning a research project should include careful
consideration of how to comply with relevant legislation and ethical codes
of practice. Data protection legislation applies to any data obtained during
the process of research.
In addition, there are well-established codes of practice that need to be
followed. One such practice is obtaining the informed consent of research
participants. Respondents are often provided with an information sheet
about the research and asked to sign a consent form. Extra care should
be taken to ensure appropriate procedures are in place when researching
vulnerable groups such as children, the elderly or mental health service
users.
In addition to data protection procedures, researchers need to ensure that
the anonymity of participants is maintained. This includes withholding any
information that might lead to the identication of participants unless they
have explicitly expressed a wish to be identied.
Sampling in qualitative research
Sampling is the term used by researchers to describe how they select the
people who will be invited to take part in the research.
Qualitative research does not involve large-scale random sampling that
is a key feature of quantitative research to ensure that it represents the
population being studied.
Sample sizes used in qualitative research are much smaller, but should be
set to help the researcher obtain relevant and diverse information on the
topic.
The most common sampling techniques used in qualitative research
include:
Purposive sampling
This involves deliberate selection of research participants based on
their relation to the research topic or because of certain demographic
characteristics. For example, a research project focusing on the
experiences of different groups of carers may include in the sample
participants who care for young children as well as participants who care
for elderly people or people with disabilities.
Quota sampling
This method involves determining in advance how many people with
certain characteristics will be selected to the sample. For example, it can
be decided that a sample will include a certain number of men and women,
different age groups, respondents from different income brackets or
occupations. This process is often used to generate a sample that broadly
corresponds to the population being studied.
Snowball sampling
In this technique, participants are recruited through pre-existing links
between group members. An initial contact who is a member of the group
being studied is identied. This member will refer the researcher onto
other contacts who in turn refer to others, creating a snowballing effect.
Because this technique relies on personal recommendation by members
of the group, it is often very useful in recruiting from marginalised groups
who might not normally engage with research. In order to reduce the risk
of researching a very narrow sub-group, it is advisable to nd several
contacts who can act as “snowballing” starting points to produce a more
diverse sample.
Analysing qualitative data
Not all qualitative research arises from interviews, group discussion or
observation. Other sources of qualitative data for analysis are collections of
existing texts or documents.
The advent of the internet and social media has led to the creation of a
wealth of textual sources including online reviews posted on websites such
as NHS Choices and comments posted on social media platforms such as
Facebook and Twitter.
Free-text comments collected through feedback tools such as the Friends
and Family Test, or through large-scale surveys, can also offer a rich
source of insight.
Whether the data was generated by the researcher or whether it was
created independently, the same broad principles apply to the analysis
of the data. Some researchers will choose to manually analyse data,
whereas others will make use of computer software packages. Manual
analysis of qualitative data can be done through using common software
such as Word or Excel.
There are a number of specialist software packages available to analyse
qualitative data and new ones are being developed that draw on machine
learning techniques.
There are different stages for conducting manual analysis of qualitative
data. This process should also guide the approach taken when using
software-aided analysis.
Stage 1 - Organise the data: Organise the data into a useable format
and structure, such as writing up interview notes or transcribing audio
recordings.
Stage 2 - Explore the data: Read through the data and begin to identify
potential themes.
Stage 3 - Code and classify: Code the data into any themes and sub-
themes that are either key areas of interest or that have been identied
through organising the data.
Stage 4 - Explore relationships: Look for similarities, differences, patterns and
associations between the different themes and sub-themes.
Stage 5 - Interpret the data: Develop possible explanations for the patterns
observed in the data.
Current use of qualitative data in the NHS
Qualitative data is used extensively across the NHS, with a growing
recognition of the benets of how it can be used to provide deep insight into
patients’ views, their experience of care and their outcomes. It is widely used
to inform quality improvements, design and delivery of services and safety
and quality policies.
National initiatives such as the Friends and Family Test websites such as NHS
Choices enable people to give qualitative feedback about the services they
receive, as do many national surveys on healthcare. At a local level, patients
can give qualitative feedback in a variety of ways including through patient
participation groups, complaints or comments on online platforms.
NHS England commissions qualitative research and uses qualitative data in
a variety of ways, including in the design and development of new policies, in
the delivery of national programmes, in evaluation of policies and initiatives
and in communications and campaign activities.
Qualitative research is an approach involving diverse methods to generate
trustworthy insight into the complex ways that people think and feel. Adding
information about WHY to that of HOW MANY enriches any insight data and
creates a much rmer foundation from which to make decisions about service
change and improvements.
This information can be made available in alterna-
tive formats, such as easy read or large print and
may be available in alternative languages upon
request. Please contact 0300 311 2233 or email
CONTACT US
This guide is part of a short series intended to help health-
care providers and commissioners to make greater use of
patient insight: http://www.england.nhs.uk/ourwork/in-
sight/insight-resources
The work is overseen by the Insight & Feedback Team.
Contact us at:
April 2017
