What Makes a Good Qualitative Research Article?

Abstract

Qualitative research is a heterogeneous field that has grown over the past century to encompass many types of inquiry. It originated based on the premise that there are aspects of human behavior, experience, and relationships that cannot be fully captured through quantitative study.¹ Accordingly, qualitative research aims to document how phenomena of interest are perceived or understood by individuals. Since the 1970s, it has increased in acceptance among the health sciences, with the emergence of entire journals devoted solely to qualitative research articles. Today, qualitative research is utilized in many fields such as sociology, psychology, education, nursing, and marketing.

Qualitative research encompasses many theoretical orientations and a wide range of related methods, which may be characterized by these common features: (1) studying the meaning of people's lives under real world conditions; (2) representing the views and perspectives of people in a study; (3) covering the contextual conditions within which people live; (4) contributing insights into existing or emerging concepts that may help to explain human social behavior; and (5) striving to use multiple sources of evidence rather than relying on a single source.² Quantitative and qualitative methods can be complementary,³ and many research designs utilize mixed methods.

In qualitative studies, nonnumerical data are collected with flexible, open-ended techniques such as observation or interviews, which may be conducted individually with key informants, in focus groups, or both. Data are often transcribed, coded, and analyzed, sometimes using specialized software that aids in organizing what is usually a large volume of information. Qualitative researchers become immersed in the data, carefully reviewing the information, searching for common concepts, ideas, and patterns, which may be grouped into higher-order themes. Data collection and analysis continue, often running concurrently, until no new ideas emerge from the data, known as data saturation. Qualitative data may also include visual images, such as with PhotoVoice, a participatory methodology by which people can identify and represent their community through photography.⁴

Qualitative research can be helpful in the early stages of inquiry when not enough information has been established to initiate a quantitative study, or when the phenomenon of interest is not easily quantified. One health-related phenomenon of interest is weight loss surgery, which can have a major impact on many aspects of health and quality of life. Recent qualitative studies have focused on patients' perceptions of waiting for bariatric surgery,⁵ expectations for surgery,⁶ postsurgery barriers to exercise,⁷ postsurgery grazing,⁸ and perceptions of postsurgery outcomes.⁹ Results of these studies add to the quantitative evidence base.

For example, in a quantitative article, Bond et al.¹⁰ reported that “lack of time” was the only frequently cited barrier to physical activity in a sample of bariatric surgery patients. A subsequent qualitative study also showed that the most frequently reported barrier to exercise was time (reported by 28% of patients).⁷ However, when individual barriers in that study were organized into categories, the most frequently reported barrier was patient motivation (reported by 78%). These results suggest that evidence-based interventions for increasing postsurgery exercise may need to target both motivational and time barriers.

There has been debate about how to establish the methodological quality of a qualitative research article. In quantitative studies, the Consolidated Standards of Reporting Trials (CONSORT), a checklist and set of recommendations for reporting randomized controlled trials^11,12 is widely endorsed by the biomedical community. A comparable set of criteria for qualitative research is the Consolidated Criteria for Reporting Qualitative Research (COREQ), a 32-item checklist for interviews and focus groups.¹³ Endorsed by many journals, it requires qualitative researchers to report on three domains: (1) the research team and reflexivity of the researcher; (2) study design, including methodological framework, sampling, and data collection methods; and (3) data analysis and findings, including information about the number of coders, how themes were derived, and whether participants provided feedback on the study findings.¹³ (Please see Table 1 for criteria.) Both CONSORT and COREQ, for quantitative and qualitative studies respectively, focus on increased transparency for reporting research in the service of improving academic rigor.

Table 1.

Consolidated Criteria for Reporting Qualitative Studies (COREQ): 32-Item Checklist (Adapted from Tong, Sainsbury & Craig, Int J Qual Health Care, 2007¹³)

No.	Item	Guide questions/description
Domain 1: Research team and reflexivity
Personal characteristics
1.	Interviewer/facilitator	Which author(s) conducted the interview or focus group?
2.	Credentials	What were the researcher's credentials (e.g., PhD, MD, DO)?
3.	Occupation	What was their occupation at the time of the study?
4.	Gender	Was the researcher male or female?
5.	Experience and training	What experience or training did the researcher have?
Relationship with participants
6.	Relationship established	Was a relationship established prior to study commencement?
7.	Participant knowledge of the interviewer	What did the participants know about the researcher (e.g., personal goals, reasons for doing the research)?
8.	Interviewer characteristics	What characteristics were reported about the interviewer/facilitator (e.g., bias, assumptions, reasons and interests in the research topic)?
Domain 2: Study design
Theoretical framework
9.	Methodological orientation and theory	What methodological orientation was stated to underpin the study (e.g., grounded theory, discourse analysis, ethnography, phenomenology, content analysis)?
Participant selection
10.	Sampling	How were participants selected (e.g., purposive, convenience, consecutive, snowball)?
11.	Method of approach	How were participants approached (e.g., face-to-face, telephone, mail, e-mail)?
12.	Sample size	How many participants were in the study?
13.	Nonparticipation	How many people refused to participate or dropped out? Reasons?
Setting
14.	Setting of data collection	Where were the data collected (e.g., home, clinic, workplace)?
15.	Presence of nonparticipants	Was anyone else present besides the participants and researchers?
16.	Description of sample	What are the important characteristics of the sample (e.g., demographic data, date)?
Data collection
17.	Interview guide	Were questions, prompts, and/or guides provided by the authors? Was it pilot tested?
18.	Repeat interviews	Were repeat interviews carried out? If yes, how many?
19.	Audio/visual recording	Did the research use audio or visual recording to collect the data?
20.	Field notes	Were field notes made during and/or after the interview or focus group?
21.	Duration	What was the duration of the interviews or focus group?
22.	Data saturation	Was data saturation discussed?
23.	Transcripts returned	Were transcripts returned to participants for comment and/or correction?
Domain 3: Analysis and findings
Data analysis
24.	Number of data coders	How many data coders coded the data?
25.	Description of the coding tree	Did authors provide a description of the coding tree?
26.	Derivation of themes	Were themes identified in advance or derived from the data?
27.	Software	What software, if applicable, was used to manage the data?
28.	Participant checking	Did participants provide feedback on the findings?
Reporting
29.	Quotations presented	Were participant quotations presented to illustrate the themes / findings? Was each quotation identified (e.g., participant number)?
30.	Data and findings consistent	Was there consistency between the data presented and the findings?
31.	Clarity of major themes	Were major themes clearly presented in the findings?
32.	Clarity of minor themes	Is there a description of diverse cases or discussion of minor themes?

Other elements of rigorous qualitative studies include: (1) trustworthiness of the data, established through strategies such as developing a meaningful relationship with the participants so that they are comfortable sharing information; (2) confirmability, or consistency in decisions that are made during data collection and analysis, often demonstrated through an audit trail; (3) transferability of the findings to a different group or setting, established through external checks whereby the themes of a study are described to a new group of similar individuals to determine their agreement; and (4) credibility, or confidence in the truth of the findings, established with techniques such as triangulation, which involves using more than one type of data or method to verify results.¹⁴

In summary, a good qualitative research article can provide rich information to help us understand the experiences of patients. Indeed, there is increasing appreciation of the need to incorporate patient perspectives in biomedical research. For example, the Patient-Centered Outcomes Research Institute (PCORI) was established to improve health and healthcare by funding research that is guided by patients, caregivers, and other stakeholders. PCORI presents a welcome opportunity for incorporating qualitative methods in clinical research studies. We think that qualitative methods are ideally suited to increasing the relevance of research to underserved and vulnerable patients, including those affected by severe obesity.

Footnotes

Disclosure Statement

No competing financial interests exist.

References

Streubert Speziale

, Carpenter

. Qualitative Research in Nursing: Advancing the Humanistic Imperative, third ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2003:19.

Yin

. What is qualitative research—and why might you consider doing such research? In: Qualitative Research From Start to Finish. New York: Guilford Press, 2011:3–23.

Malterud

. Qualitative research: standards, challenges, and guidelines. Lancet, 2001; 358:483–488.

Wang

, Burris

. PhotoVoice: concept, methodology, and use for participatory needs assessment. Health Educ Behav, 1997; 24:369–387.

Gregory

. Patients' perceptions of waiting for bariatric surgery: a qualitative study. Int J Equity Health, 2013; 12:86.

da Silva , da Costa

. Obesity and treatment meanings in bariatric surgery candidates: a qualitative study. Obes Surg, 2012; 22:1714–1722.

Peacock

, Sloan

, Cripps

. A qualitative analysis of bariatric patients' post-surgical barriers to exercise. Obes Surg, 2014. 24:292–298.

Zunker

, Karr

, Saunders

, Mitchell

. Eating behaviors post-bariatric surgery: a qualitative study of grazing. Obes Surg, 2012; 22:1225–1231.

Magdaleno

, Chaim

, Pareja

, Turato

. The psychology of bariatric patient: what replaces obesity? A qualitative research with Brazilian women. Obes Surg, 2011; 21:336–339.

10.

Bond

, Thomas

, Ryder

. Ecological momentary assessment of the relationship between intention and physical activity behavior in bariatric surgery patients. Int J Behav Med, 2013; 20:82–87.

11.

Schulz

, Altman

, Moher

, for the CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ, 2010; 340:c332.

12.

Moher

, Hopewell

, Schulz

, Montori

, Gøtzsche

, Devereaux

, et al., for the CONSORT Group. CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trial. BMJ, 2010; 340:c869.

13.

Tong

, Sainsbury

, Craig

. Consolidated criteria for reporting qualitative research (COREQ); a 32-item checklist for interviews and focus groups. Int J Qual Health Care, 2007; 19:349–357.

14.

Rebar

, Gersch

, Macnee

, McCabe

. Understanding Nursing Research: Using Research in Evidence-Based Practice. Philadelphia, PA: Lippincott Williams & Wilkins, 2011:371–376.