4. Qualitative research approaches
Key points
• Although quantitative research has a long history as the ‘brand leader’ in health care research, qualitative and quantitative research approaches do different jobs and answer different types of questions.
• Qualitative research is concerned with illuminating the interpretations and meanings people give to features in their life, including those relating to pregnancy, birth and parenthood. This leads to a more holistic and person-centred approach to generating knowledge than does quantitative research.
• Three major categories or traditions within qualitative research are ethnographic, phenomenological and grounded theory. However, many other different approaches exist. All have in common an attempt to present situations through the eyes of those involved. This means that researchers must try to avoid enforcing their preconceived ideas on the processes of data collection and analysis. The issues and themes should emerge from the data collected and be directed and controlled as much as possible by those supplying those insights.
• Qualitative research is frequently characterised by a close relationship between the researcher and those participating in the study. Indeed, to a very large extent the researcher is the tool of data collection in qualitative research whose social skills are paramount to effective data collection.
• Issues relating to rigour and ethical considerations are just as important in this type of research as in quantitative research.
• Feminist approaches to research contain many of the characteristics of qualitative methods. Feminist research seeks to improve the situation of women disadvantaged by their position as women within health care arenas.
• It is easy for some people to dismiss qualitative research if they have used criteria only relevant to critiquing quantitative research. Knowledge of the principles of qualitative research is fundamental to an accurate critique of such studies.
• Midwives need an understanding of both types of research in order to take a balanced approach to evidence-based practice.
Research comes in many shapes, sizes and ‘brands’. As indicated inChapter 2, one common broad categorisation is the distinction between quantitative and qualitative research approaches. These terms are associated with the types of data produced by each category; however, a more fundamental difference is the researcher’s beliefs concerning the nature of research, and the principles they should follow in completing it.
As the majority of research used in evidence-based practice is quantitative, the aim of this chapter is to provide a balance between these two approaches by concentrating on qualitative research. It will extend the discussion on these two approaches inChapter 2by examining some of the main differences between quantitative and qualitative research, and describe three major types of qualitative designs. The importance of feminist approaches to midwifery will also be emphasised and its relationship to qualitative approaches outlined.
The development of health care knowledge has traditionally been associated with the ‘scientific’ image of research. This is particularly true of research used in evidence-based practice, which has focused largely on quantitative research, frequently in the form of randomised control trials (RCTs). This leaves qualitative research with many challenges, as it has not developed a similar strong position in health service decision making. In the past, the distinction between ‘hard’ and ‘soft’ data, and talk of a quantitative/qualitative ‘divide’ has exacerbated the view that qualitative research is in some way inferior to quantitative. Mauk (2009), for instance, points out that as a result of the principles of evidence-based practice, qualitative research is considered to be far less compelling than quantitative, which is seen as more objective methods and therefore ‘sound’.
In reality, it is far better to see these as two distinct research approaches or ‘research paradigms’. A paradigm, as we saw in Chapter 2, is a view and set of principles about the nature of something, like research, that shapes how people see and understand things related to that concept. In research, it influences the different ways researches who adopt either a quantitative or qualitative paradigm see the nature of research, its purpose and the role of the researcher.
Each research paradigm can be seen to answer different types of questions; with both having an equal part to play in developing midwifery knowledge and practice. This is emphasised by Roberts and DiCenso (2008) who point out that no one research approach has precedent over another; it is the research question that should dictate the approach chosen. Particularly in midwifery, there are so many questions where best practice can be informed by research that focuses on understandings, interpretations and experiences, and which are more appropriate to a qualitative approach.
How does qualitative research differ from quantitative? The key difference is that qualitative research does not concentrate on the measurement of clinical outcomes; instead, it explores human experiences and processes, including those of midwives, and our understanding of health and illness issues from the perspective of those involved. Examples include women’s experiences of Caesarian section (Fenwick et al. 2009) and midwives’ interpretation of ‘good’ leadership and ‘good’ midwifery (Byrom and Downe 2010). Is this knowledge important to us? How can it not be? We need to understand how people experience health care if we are to provide a meaningful, sensitive and appropriate response to health needs. Pregnancy, birth and childcare are all extremely personal experiences, so any research approach that values human experience will be compatible with a profession that emphasises individuality, and an empowering approach to care. Qualitative research, then, is an appropriate choice in exploring some of the important issues facing midwifery.
The conclusion to be drawn from this is that all midwives need to be familiar with both quantitative and qualitative approaches to research if they are to demonstrate evidence-based practice. Qualitative approaches balance the narrow focus of quantitative research by examining the bigger picture, and the more human side of service provision. According to Houser (2008), it does have an important role to play in evidence-based practice, as it helps to determine the needs, preferences and motives of those receiving health care. The following section examines some of the major differences between the two major approaches of quantitative and qualitative methods.
The contrast between quantitative and qualitative research
Qualitative research is a broad term covering a number of different but related approaches to research. Burns and Grove (2009: 51) provide the following helpful description of it:
Qualitative research is a systematic, subjective approach used to describe life experiences and give them significance. It is a way to gain insights through discovering meanings. These insights are obtained not through establishing causality but through improving our comprehension of the whole.
This emphasises that, like quantitative research, it is carried out in an organised and methodical way, but it contrasts with quantitative approaches in that its subject matter is human experiences, particularly the way in which people make sense of the things that happen to them. For this reason, qualitative research is sometimes referred to as ‘constructivist research’, as it is based on the belief that how we see things ‘constructs’ how we experience our reality or world, and these interpretations give it meaning (Houser 2008). Researchers using this approach try to identify these ways of constructing reality from the things that people say and do. Polit and Beck (2008) elaborate on this by outlining some of the key characteristics of qualitative approaches (see Box 4.1).
BOX 4.1
Characteristics of qualitative approaches to research
Qualitative design:
Often involves a merging together of various data collection strategies (i.e. triangulation);
Is flexible and elastic, capable of adjusting to what is being learned during the course of data collection;
Tends to be holistic, striving for an understanding of the whole;
Requires the researcher to become intensely involved, usually remaining in the field for lengthy periods of time;
Requires the researcher to become the research instrument; and
Requires ongoing analysis of the data to formulate subsequent strategies and to determine when fieldwork is done.
Polit and Beck 2008: 219.
As these characteristics are important in understanding the differences between quantitative and qualitative research, they require further elaboration, as their meaning is not always clear. One way of simplifying matters is by demonstrating how the two approaches differ in the following three phases:
• planning,
• data collection, including role of the researcher and the nature of the relationship with those involved,
• analysis and interpretation of the results.
Planning
Perhaps the most important characteristic of qualitative research is the holistic approach that attempts to provide a total picture of individuals or group and their life experiences and beliefs. This is in contrast to isolating a single biophysical entity such as heart rate or blood pressure. This holistic approach of qualitative research is necessary if it is to discover how people interpret life events and give them meaning within their life. To achieve this, the researcher’s exploration takes into account a broad outline of people’s lives and cultural influences that may affect behaviour and beliefs and so allow the researcher to contextualise the topic and their findings (Holloway and Wheeler 2010). As a consequence, the research question will be broader than that found in quantitative research so that it can capture the bigger picture. The research process followed in qualitative research is also less structured and more flexible to adapt to new ideas and insights as they grow and develop throughout the study.
These features have considerable implications for the planning process, which tends to be shorter than in quantitative research. For example, less time is devoted to a comprehensive literature review. In the past, some qualitative researchers avoided a literature review in case it led to the analysis being ‘contaminated’ by previous research knowledge. However, this is less often followed now as the researcher should ensure the study has not already been undertaken, and consulting the literature will provide a broad understanding of concepts that may be related to the study (Holloway and Wheeler 2010). However, the literature should not ‘direct’ or ‘influence’ the path of the research. In qualitative research, the literature is used as part of data analysis where it is used as a way of confirming the credibility of the researcher’s interpretations and descriptions of behaviour. This information will appear along with the data in the findings section. In contrast, quantitative studies do not include the literature in the results section, although it will appear in the discussion section.
A further planning stage distinction is that the qualitative researcher does not develop a structured tool of data collection based on the literature review, or use a tool that has been validated in previous research. This is because the researcher attempts to keep an open mind on what may be important within the study. The implication of this is that it is not possible to carry out a pilot study in the same way as in quantitative research, as there is no highly structured research tool to test for consistency and accuracy. Each interview or period of observation will be different and not standardised as in quantitative research, which seeks to ensure consistency.
Data collection
In this phase of the research, the researcher may use more than one method of data collection to examine the concept of interest in the process of triangulation. Triangulation can include different research approaches or samples; here the term is used to describe the use of more than one tool of data collection in a study. Triangulation is a common feature of qualitative research where it is used to consolidate or confirm the picture emerging from one tool of data collection.
One of the clearest differences between the two research approaches is the way the researcher forms a relationship with the sample during data collection. As the aim of the research is to gain an understanding and insight into human behaviour, there is a social closeness in the relationship between the researcher and the participants. This mainly develops over a sustained time period not characterised by the quick interview or the faceless questionnaire approach. Traditionally, in quantitative research there is a belief that the researcher should keep a social distance from the subjects of the research to avoid undue influence on the results. Although the quantitative researcher supports the idea of maintaining a ‘rapport’ with subjects, this does not relate to the same level of intimacy and closeness evident in many examples of qualitative research. This takes on a particular significance where both the researcher and participants are female. The more intimate, flexible, and more reciprocal the relationship between both parties in qualitative research is in harmony with the philosophy of feminist research, the more there is an attempt to minimise any inequalities in power between the researcher and participants. This balance in the relationship is crucial in feminist research, which aims to give women’s experiences a voice and where the goal of the research is to empower women (Holloway and Wheeler 2010).
This means that the researcher must have a great deal of personal awareness of the relationship with subjects where this may have influenced the findings. This is referred to as reflexivity, where the researcher considers the extent to which he or she may have shaped the findings as part of the process of data collection (Houser 2008). The impact of the researcher on data gathering has led commentators such as Holloway and Wheeler (2010) to describe the researcher in qualitative research as the tool of data collection or research instrument, in that the researcher makes decisions on what should be regarded as data and what should be highlighted through the analysis and presentation of findings.
Data analysis and interpretation
Visually, one of the clearest differences between quantitative and qualitative research is the form of data presentation; the former is presented using numbers and analysed statistically, and the latter using words in the form of direct quotations and descriptions of activities and is analysed through the researcher’s interpretation of emerging themes, although computer software can also be used as part of this process.
The sequence of events between data gathering and analysis is also different. Unlike quantitative research where the process of analysis starts once data collection has finished, in qualitative research data gathering and data analysis are carried out at the same time. Fieldwork may stop when the researcher feels that no new themes or elements are emerging and ‘data saturation’ has been reached, that is, when further data collection would be redundant.
Analysis in qualitative research is characterised by an inductive approach rather than a deductive one. This means that the researcher takes the individual elements emerging from the analysis and gradually builds up a picture to provide a broad explanation of what may be happening. In contrast, the quantitative researcher starts with general principles, often in the form of a theory or hypothesis, and examines the individual units of data to either confirm or reject that theory or hypothesis.
It is not an exaggeration then, to say that in so many aspects of the research process, the two approaches of quantitative and qualitative are worlds apart. This is illustrated in Table 4.1, which illustrates some of the major differences. The following section examines some of the more popular qualitative approaches to illustrate the qualitative approach further.
| Characteristic | Quantitative | Qualitative |
|---|---|---|
| Focus | Narrow and specific | Holistic and general |
| Research question | Precisely worded | Broadly worded |
| Type of evidence | Objective | Subjective |
| Belief about reality and research activity | The social world is similar to other ‘sciences’ and open to measurement by the researcher Reality is ‘out there’ and objective | The social world can only be known through an individual’s experience and understanding of it Reality is inside all of us |
| Researcher’s relationship to subjects | Detached to ensure it does not influence subjects, although rapport sought | More equal and reciprocal relationship characterised by social warmth |
| Review of the literature | Critical to the development of the process | Can be used to provide a broad picture, but often used to support findings It is included as part of written report. |
| Planning | Carried out in depth | High level of planning avoided so as to reduce preconceived ideas about the nature of the topic |
| Tool of data collection | Emphasis on accuracy and consistency, to ensure reliability and validity | As the tool is used flexibly and continually developing, it is impossible to pilot to determine consistency and accuracy |
| Sample size | Emphasis on large numbers to reduce bias and to allow statistical procedures | Small numbers but appropriate experience explored |
| Sample referred to as | Subjects | ‘Informants’ or ‘participants’ to avoid dehumanising |
| Analytical approach | Deductive | Inductive |
| Data | Numeric | Words |
| Data gathering | Extensive to gain maximum coverage | Intensive to gain maximum depth and rich, ‘thick’ data |
| Product of data analysis | Referred to as ‘results’ | Referred to as ‘findings’, although some publications use the term ‘results’ |
| Generalisability | Major concern to achieve this to a high level | Not a major concern, low level achieved |
| Ethical concerns | High, particularly where an intervention is invasive | High, harm is concerned with psychological and social elements and the protection of human dignity |
| Methodological concerns | Reliability, validity and bias | Trustworthiness, in the form of credibility, dependability, confirmability and transferability |
| Emphasis on rigour | High | High |
| Application to evidence-based practice | Highly rated, notably in the form of RCTs | Presently low acceptability, increasing emphasis on user views and experiences may change this |
| Applicability to midwifery practice | High | High |
Qualitative research designs
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