Navigating the Virtual Landscape: Methodological Considerations for Qualitative Research in Long-Term Care

Abstract

With the COVID-19 pandemic halting all in-person research in March 2020, many researchers adopted virtual methods to continue their work amid this global crisis. As the pandemic persisted and the safety of participants and researchers remained a priority, virtual research grew in popularity for qualitative researchers. This in turn led to methodological insights on the application and advantages of conducting qualitative research using virtual methods. Virtual methods have been found to enhance participant comfort, facilitate open discussion of sensitive topics, alleviate fatigue in participants and researchers, and result in more engaging and focused interviews. While the body of evidence supporting virtual methods of data collection for nursing and other healthcare disciplines continues to grow, its application in the long-term care (LTC) setting remains underreported. In this paper, we discuss the virtual methods that we developed and implemented to successfully conduct a virtual qualitative single case study in a Canadian LTC home during the COVID-19 pandemic. Considerations from existing literature on virtual methods are discussed in parallel with strategies we implemented to successfully conduct a virtual study in LTC. This paper contributes to the growing body of literature on methodological insights into conducting virtual qualitative research in LTC. We provide evidence-based strategies for the virtual recruitment of study sites, study participants including residents, team members and families, and virtual data collection methods. These recommendations offer insights to overcome challenges and maximize the advantages of virtual methods, to enhance the quality and rigour of virtual qualitative research conducted within LTC settings.

Keywords

case study methods in qualitative inquiry virtual environments

Introduction

The COVID-19 pandemic sparked a global movement toward virtual research, resulting in an unprecedented and exponential increase in its popularity (Keen et al., 2022; Lobe et al., 2020; Schlegel et al., 2021). The accelerated application of virtual methods has had a significant impact on the acceptance of virtual methods in qualitative research due to the growing understanding and recognition of its advantages and the ability to ensure rigour outside of in-person approaches (Howlett, 2022; Pocock et al., 2021). Qualitative research is essential in nursing and health science as it helps us to understand individuals’ lived experiences, unforeseen conditions, and intersecting inequalities (Cookson & Fuentes, 2020; Webber-Ritchey et al., 2021). While is still widely acknowledged that in-person or traditional methods are the “gold standard” for qualitative research (Johnson et al., 2019; Roberts et al., 2021; Sy et al., 2020), recent publications have highlighted the potential advantages and increasing relevance of virtual methods for qualitative research (Keen et al., 2022; Pocock et al., 2021; Tungohan & Catungal, 2022; Varma et al., 2021).

By overcoming limitations often encountered in traditional research, such as geographical barriers, time constraints, and the need for physical presence, virtual methods offer the possibility of reaching populations that are not always accessible through in-person methods (Dubé et al., 2023; Keen et al., 2022). Additional advantages of virtual methods include a more comfortable and familiar environment for participants when participating virtually from home, and alleviating participation fatigue for all participants and researchers (Dodds & Hess, 2020; Keen et al., 2022; Roberts et al., 2021). Alleviating participation fatigue can result in more engaging and open responses during qualitative data collection, particularly for research involving sensitive topics such as end-of-life care (Dodds & Hess, 2020; Keen et al., 2022; Roberts et al., 2021). The application of virtual methods for qualitative research holds particular significance for nursing and healthcare research involving vulnerable populations, such as residents in long-term care (LTC) (Webber-Ritchey et al., 2021). During the COVID-19 pandemic and the subsequent outbreaks and lockdowns in LTC residents living in LTC homes were limited, and in some cases excluded, from participating in research (Teti et al., 2020; Webber-Ritchey et al., 2021). Virtual methods emerged as a valuable alternative in such circumstances, offering a means to facilitate participation in research and ensure that the voices and experiences of all populations are not overlooked due to the limitations of in-person or traditional research.

This paper explores the application of virtual methods for qualitative research in LTC based on our experience conducting a virtual qualitative single case study in LTC. Case study methodology is a form of qualitative research that involves an in-depth analysis of an individual or group while maintaining a holistic and real-world perspective of their environment (Yin, 2018). Case studies have become increasingly popular as a qualitative research methodology, as they enable researchers to examine a central phenomenon within a real-life context (Amerson, 2011; Yin, 2018). The purpose of our case study was to understand personal support workers’ (PSWs) role in end-of-life care in an LTC home. We defined the case as a single LTC home in Ontario, Canada.

Our study was conducted between January 2022 and December 2022. Due to the ongoing COVID-19 pandemic, the study was designed from conception to be a virtual study and was not pivoted from a traditional or in-person research study. Ethics approval was received from the University of Toronto’s Health Sciences Research Ethics Board. Data collection involved virtual interviews with LTC staff (i.e., administrators, managers, nursing staff and PSWs), family members, and residents, documentation data from public and private sources (such as internal policy documents, personal photos, job descriptions, etc.) and virtual observations of physical artifacts (such as sentimental pieces of clothing, books, or magazines, etc.). The first author led the study and conducted all data collection under the supervision of a doctoral research committee. As the primary researcher (hereafter researcher), her status as a Canadian, White, Settler, and female was reflected on using the Social Identity Map and reflexive journaling (Jacobson & Mustafa, 2019). The application of a reflexive journaling practice allowed her to reflect on her social position as an outsider to men and women employed in LTC homes and to reflect on meaningful connections she was able to establish with participants using virtual methods (Jacobson & Mustafa, 2019).

The lessons learned and methodological insights gained from conducting a virtual qualitative single case study in LTC are explored further in this paper in alignment with what is known in the literature about virtual methods. We specifically focus on virtual study sites and participant recruitment, as these methods presented notable challenges in our study. The practical strategies we implemented for virtual data collection and maintaining data quality and rigour are also discussed.

Discussion of Methodological Insights

Virtual Site Recruitment

What is Known

Virtual recruitment of a study site refers to the process of identifying and recruiting virtual gatekeeper(s) of potential research site(s) using virtual communication methods, rather than traditional in-person communication or networking methods (Schlegel et al., 2021). This approach typically involves the use of virtual communication methods, such as social media, virtual networking events (i.e., virtual conferences or webinars), and video conferences or emails to facilitate the introduction, communication and collaboration between the researchers and the gatekeeper(s) from the potential research site(s). Despite the growing interest in virtual methods in recent years, research is scarce on effective strategies and approaches that researchers might apply for the virtual recruitment of study sites in healthcare settings. In the absence of this research, some studies have reported the advantages of virtual participant recruitment methods (i.e., using digital technologies and communication methods) that could be applied to virtual recruitment methods for a study site(s) (Archibald et al., 2019; Dodds & Hess, 2020; Roberts et al., 2021; Schlegel et al., 2021). These advantages include a broad reach of all eligible sites across a large geographic area and enhanced speed at which recruitment can take place (Archibald et al., 2019; Dodds & Hess, 2020; Roberts et al., 2021; Schlegel et al., 2021).

Strategies Implemented

The recruitment of an LTC home or study site for this single case study was a significant challenge due to the COVID-19 pandemic and the associated staffing shortages occurring in LTC homes in Ontario during the time of recruitment. The rationale for applying a single-case approach was to capture a “common case”, which was operationally defined as an LTC home in Ontario of average size, ownership type, and that is operating in good standing as reported by the Ontario Ministry of Health and Long-term Care (Canadian Institute for Health Information, nd; Ministry of Long-Term Care, nd). Based on these criteria, an LTC home was eligible to participate if it was a medium, private for-profit LTC home in Ontario, and was operating in good standing for at least one year.

The initial strategy used to recruit a study site was to contact the Director of Care (DoC) at all 131 eligible LTC homes in Ontario by email using addresses that were publicly available through Ontario’s Minister of Long-Term Care public database of operational LTC homes in Ontario (Ministry of Long-Term Care, nd). Due to high employee turnover rates in LTC and the extreme workload caused by the COVID-19 pandemic (Canadian Institute for Health Information, 2021; Office of the Auditor General of Ontario, 2021), we were unsuccessful at recruiting a study site through email over the first 6 months. Our team met virtually to discuss recruitment challenges and subsequently adapted the recruitment strategy to contacting organizations in Ontario with ownership or management of multiple LTC homes (i.e., chained-owned, or operated LTC homes) rather than independently operated LTC homes, to recruit an LTC home through a parent organization or management corporation. Three organizations expressed interest in the research study, and subsequent meetings were held with these organizations and the researcher to share the purpose and requirements of the study. However, all organizations ultimately declined to participate due to the ongoing COVID-19 pandemic. This strategy of contacting parent organizations or management corporations was implemented from October 2021 to December 2021 before we reviewed the recruitment strategy again and decided to take a new approach. Our third approach to study site recruitment was to offer an honorarium for an LTC home as a token of appreciation for its staff participating in this research study. The addition of this honorarium significantly boosted LTC homes’ interest in participation and within 2 weeks of offering the honorarium to a small sample of 10 eligible study sites, a study site (LTC home) was successfully recruited in December 2021.

While the application of virtual recruitment methods allowed us to quickly contact all eligible LTC homes in Ontario, the disadvantages of impersonal communication (i.e., emailing publicly available contacts) seemed to outweigh the advantages. In total, it took approximately 8 months to successfully recruit an LTC home using virtual methods. While the timing of recruitment in relation to the COVID-19 pandemic was a significant factor that impacted the recruitment of a study site, the impersonal communication and challenges associated with developing and building relationships virtually with key decision makers or gatekeepers at the LTC homes were just as significant. Recommendations for future virtual recruitment of LTC homes as study sites include: (1) contacting potential study sites using multiple methods (i.e., telephone and email) and multiple channels (i.e., individual sites and parent/partner organizations); (2) establishing a strong rapport with the key decision makers or gatekeepers at the LTC home via consistent virtual communication (i.e., emails and video calls); (3) being flexible with the recruitment strategy and making adaptations when required, and finally; (4) consider offering an honorarium to the study site.

Participant Recruitment

What is Known

While numerous similarities exist between virtual and in-person qualitative research, including the fundamental research objectives and methodologies (Keen et al., 2022), the most significant way these methods differ is in the way the researcher interacts with the participants (Pocock et al., 2021). Virtual research requires qualitative researchers to recruit, develop a rapport and collect qualitative data only through online platforms or telephone communications (Sah et al., 2020).

Virtual recruitment of potential study participants is acknowledged as one of the primary challenges to virtual qualitative research (Schlegel et al., 2021). Virtual recruitment methods can make it difficult for researchers to reach participants with limited or no digital literacy (i.e., ability to communicate information using digital media platforms) or with limited or no digital profile (i.e., e-mail address or social media accounts), identify potential participants with a digital profile, develop a rapport with potential participants, and retain participants through data collection (Cornejo et al., 2023; Dodds & Hess, 2020; Dubé et al., 2023; Howlett, 2022; Roberts et al., 2021; Schlegel et al., 2021; Sy et al., 2020). Historically, there have also been many challenges associated with recruiting participants in LTC settings (i.e., residents, family members and staff) using non-virtual means due to their unwillingness to participate in research, staff time constraints, residents and family members’ ability to participate (e.g., health status), and family members’ conflicting schedule within data collection timeframes (Lam et al., 2018; Tzouvara et al., 2016; Williams, 1993). The COVID-19 pandemic further exacerbated these pre-existing constraints around recruiting residents, family members and LTC staff to participate in research due to the extended lockdown periods, concerns for residents’ safety and overwhelming demands on staff time (Sharma et al., 2022).

The main benefit of virtual recruitment is that recruitment material and communications can be easily and quickly distributed to a large number of individuals and at a low cost (Archibald et al., 2019; Dodds & Hess, 2020; Roberts et al., 2021; Schlegel et al., 2021). However, virtual recruitment requires potential participants to have access to a device (i.e., smartphone, tablet, or computer), access to the platform (i.e., e-mail, social media or virtual communications platforms such as Zoom or Microsoft Teams), access to the internet or telecommunications service provider, and to have an understanding of how to communicate using the virtual platforms (i.e., digital literacy) (Hall et al., 2021; Howlett, 2022; Lawrence, 2022; Lobe et al., 2020; Schlegel et al., 2021; Silva et al., 2018). It is imperative to acknowledge that access to the internet or telecommunication service providers is essential for all virtual communication methods, and therefore can be a significant barrier when conducting research on populations without access to such services (Silva et al., 2018). Due to these requirements, Sharma et al. (2022) have recommended that specific adaptations to standard practices are made when conducting virtual research with groups such as residents living in LTC. Adaptations may include the use of traditional recruitment strategies (e.g., physical posters or announcements in newspapers) be used in combination with virtual recruitment strategies (e.g., email communications), or leveraging pre-existing relationships with potential participants and an in-person liaison for recruitment of potential participants (Pocock et al., 2021; Sharma et al., 2022). Further, recommendations for successful recruitment in virtual research include reflecting and considering the “best fit” of the recruitment methods and technology based on the target population and research topic, increasing direct virtual communication with potential in-person liaisons for recruitment, utilizing multiple recruitment methods, extending recruitment timelines and over-recruiting to account for potential attrition of participants (Lawrence, 2022; Cornejo et al., 2023; Eigege et al., 2022; Lawrence, 2022; Li et al., 2022; Matthews et al., 2018; Morrison et al., 2020; Pocock et al., 2021; Schlegel et al., 2021; Sharma et al., 2022; Wilkerson et al., 2014). The “best fit” of the recruitment methods and technology involves assessing the target population(s) and selecting the most appropriate virtual platforms to facilitate engagement and participation (Pocock et al., 2021). Different populations may have varying levels of digital literacy, digital profiles, or access to technology and the internet, thus requiring the use of different recruitment methods that best suit their needs and abilities (Sah et al., 2020; Varma et al., 2021). Using multiple virtual recruitment methods such as social media, online newspapers or blog posts, email communications and presentations at virtual meetings can be beneficial. These approaches can be combined or blended with traditional recruitment methods, such as sending posters or recruitment flyers via email to be printed and distributed at a study site to help researchers reach a diverse sample of participants. However, despite recruiting through multiple virtual and blended methods, some groups with limited digital literacy or digital profiles can be difficult to reach. This places an increased importance on virtual communication with potential in-person liaisons for the recruitment of these populations. Increasing direct virtual communication with potential in-person liaisons for recruitment can be beneficial in building rapport and securing access to potential participants with limited or no digital profile (Pocock et al., 2021). Lastly, Li et al. (2022) have found that over-recruiting participants and contacting potential participants immediately after inquiring or enrolling in the study can support higher recruitment and retention rates in virtual research.

Strategies Implemented

Our study aimed to recruit residents, family members and staff (PSWs, nurses, managers, and administrators) from a single LTC home using virtual recruitment methods during the COVID-19 pandemic. When developing recruitment strategies, we had to account for the constraints of participant recruitment in LTC, taking into consideration that one of the participant groups we aimed to recruit (residents) had minimal or no digital presence and lacked access to the necessary devices for virtual research participation. To overcome these constraints, the researcher implemented the following practical strategies based on the literature: (1) implementing a combination of traditional and virtual recruitment methods; (2) identifying an in-person liaison(s) to facilitate traditional recruitment methods at the study site and to support the recruitment and participation of different participant groups with no or limited digital profiles and; (3) aligning the research study activities with the liaison(s)’ daily schedule and tasks.

During the initial phase of participant recruitment, we experienced the same recruitment constraints for family members and staff as qualitative researchers have historically reported in the LTC settings where family members declined to participate due to busy schedules and/or their deteriorating health, and staff declined to participate due to burnout, staffing challenges, and time constraints (Lam et al., 2018; Tzouvara et al., 2016; Williams, 1993). To support recruitment, the researcher engaged with the Assistant Director of Care (ADoC), and they agreed to facilitate the recruitment of all study participants (staff, residents, and family members) as the in-person liaison in the LTC home. The in-person liaison (ADoC) had previously worked as a frontline nurse in the LTC home and had established strong connections with the frontline nursing staff, as well as the residents and their families. The researcher had consistent communication with the in-person liaison through multiple methods (i.e., monthly Zoom calls, weekly email updates, and periodic phone calls when required) throughout the study to facilitate the recruitment of potential participants. Traditional recruitment methods (posters, announcements, and newsletter entries) were implemented at the study site through the in-person liaison. To decrease the workload burden on the liaison, we provided them with a verbal and email script to use when recruiting potential participants and electronic files of the traditional recruitment material. All recruitment material explained the study (including the study topic) and asked interested participants to either contact the researcher directly by telephone (call or text) or email or to permit the in-person liaison to share their contact information with the researcher. Including multiple contact options benefitted the different participant groups by allowing them to use their preferred method of communication to express an interest in the study.

To facilitate the recruitment of residents, the liaison introduced the researcher to the recreational therapist at the LTC home. The researcher met virtually with the liaison and the recreational therapist to review the study and it was suggested by the liaison that the recreational therapist would be the in-person liaison for recruitment and participation of residents. The recreational therapist was agreeable and was subsequently provided with resources to facilitate residents’ recruitment and participation in the study. Resources shared with the resident in-person liaison (recreational therapist) included an overview of the study, eligibility criteria for residents and a verbal recruitment script that explained the study and inquired about residents’ interest in participating. The researcher and resident in-person liaison worked together to align the recruitment and participation of residents to the recreational therapist’s daily tasks and schedule. This was done by recruiting residents to the study using the same process used to sign up residents for recreation activities. The virtual interviews were also hosted at the same time every day to ensure they did not conflict with the activity calendar. The recruitment strategy of using a liaison for different participant groups and aligning the research study with the in-person liaison’s (recreational therapist) daily schedule and tasks allowed the researcher to virtually recruit participants with no digital profile in a way that was manageable for the liaison’s (recreation therapist) work constraints (i.e., schedule and workload). The implementation of this strategy resulted in the efficient recruitment of residents, with more residents (n = 2) participating than was initially planned.

Data Collection

What is Known

Virtual data collection can be a cost- and time-efficient method for qualitative research to continue when in-person encounters are not permitted or feasible (Han et al., 2020; Pocock et al., 2021; Schlegel et al., 2021). These advantages may pertain to times of crisis such as the COVID-19 pandemic and may also be realized in situations where there are geographically distant communities or culturally and linguistically different communities with internet and technology access (Sah et al., 2020; Varma et al., 2021). Beyond these practical advantages, virtual data collection also reduces the burden for participants as they can participate from the comfort and safety of their own homes and allows participants to control their anonymity by turning off their video camera or removing their on-screen name (Sah et al., 2020; Varma et al., 2021). These same advantages to virtual data collection are also reported as challenges, as the presence of other individuals (i.e., family members or health care providers) in the participants’ home or room can breach confidentiality and privacy (Campbell, 2021; Schlegel et al., 2021; Varma et al., 2021). Logistical and methodological challenges with virtual qualitative data collection could also include potential technical and connectivity problems (such as poor internet, or audio and video functions not working), availability of or access to a device and the internet, limited ability for researchers to establish a rapport and build trust with participants, and the increased coordination required to obtain consent, collect data and provide a token of appreciation (if applicable) virtually (Dubé et al., 2023; Lobe et al., 2020; Sah et al., 2020; Schlegel et al., 2021; Valdez & Gubrium; 2020; Varma et al., 2021). These challenges can be further confounded by the physical or organizational constraints of LTC (i.e., limited private spaces and task-oriented schedules that do not allow for research participation); the unpredictable schedules of LTC staff and family members; participants with hearing impairments or other communication impairments; and technology constraints (i.e., poor internet connection or participants with limited knowledge and trust in technology) when conducting virtual research in this setting (Lam et al., 2018). Qualitative researchers must consider their target populations and implement mitigating strategies to ensure that the challenges associated with conducting virtual data collection do not outweigh the advantages (Lobe et al., 2020; Roberts et al., 2021).

The different virtual methods of qualitative data collection used in nursing and health research have continued to grow and expand in recent years (Salvador et al., 2020). Currently, virtual interviews using synchronous online audio-visual platforms (such as Zoom or Microsoft Teams) are the most popular method, however other methods such as telephone interviews, social media (i.e., Twitter, Facebook, and YouTube), online surveys and questionnaires, and online forums and blogs are gaining traction among qualitative researchers (Braun et al., 2021; Salvador et al., 2020; Tungohan & Catungal, 2022). Telephone interviews are the oldest method of virtual data collection and only support audio communication, thus non-verbal cues cannot be observed by the researcher (Thunberg & Arnell, 2022). The inability to observe verbal cues is commonly cited as a limitation for this form of virtual data collection as it is stated that the absence of verbal cues decreases researchers’ ability to establish a rapport with participants and can result in less rich data (Garbett & Mccormack, 2001; Opdenakker, 2006; Thunberg & Arnell, 2022). Rich data is achieved when the description and complexities of what is being studied are deeply understood by the researcher based on the context of the study (Given, 2008). Consequently, telephone interviews have historically been regarded as a data collection method only when necessary, and they are not seen as an equivalent replacement for face-to-face interviews (Garbett & Mccormack, 2001; Opdenakker, 2006). This notion that telephone interviews inherently result in less rich data due to the absence of non-verbal cues has been challenged in recent years, as some researchers now believe that the absence of non-verbal cues may encourage greater disclosure and thus lead to richer data (Mealer & Jones, 2014; Novick, 2008; Rahman, 2015).

Virtual interviews using synchronous online audio-visual platforms (such as Zoom or Microsoft Teams), more commonly known as video interviews, are versions of traditional in-person qualitative methods that use technology to replace face-to-face interactions. Video interviews provide researchers with a valuable opportunity to conduct data collection when they are not permitted to be in person, while still observing non-verbal cues conducted above the waist from participants (Keen et al., 2022; Khan & MacEachen, 2022; Lobe et al., 2020; Pocock et al., 2021; Roberts et al., 2021; Schlegel et al., 2021; Teti et al., 2020). Zoom and other video-conferencing platforms provide researchers with the ability to emulate natural conversation and establish a strong rapport with interview participants. (Archibald et al., 2019; Deakin & Wakefield, 2014; Keen et al., 2022; Nehls et al., 2015; Sy et al., 2020) Virtual interviews are also more accessible and affordable (i.e. reduced or no travel costs) for most research teams (Cornejo et al., 2023; Dubé et al., 2023; Khan & MacEachen, 2022). Research conducted specifically on video interviews has reported that previously identified barriers such as privacy breaches, poor audio and video quality, and inconsistent or delayed connectivity have significantly reduced the frequency and prevalence with the recent advancements and greater accessibility of video-conferencing technology that occurred during the COVID-19 pandemic (Archibald et al., 2019; Deakin & Wakefield, 2014; Weller, 2015). As such, video interviews are now emerging as the gold standard for virtual data collection in qualitative research. Video interviews have become especially pertinent for studies that explore sensitive subjects such as end-of-life, as recent findings have suggested that video interviews may supersede in-person interviews as participants have reported being more comfortable discussing sensitive topics leading to more in-depth and rich data collection (Peirson-Webber, 2021; Thunberg & Arnell, 2022; West et al., 2021).

Strategies Implemented

Data collection methods used for the virtual case study included: virtual telephone and video interviews with LTC staff (i.e., administrators, managers, nursing staff and PSWs), family members, and residents, documentation data from public and private sources (such as internal policies, personal photos, job descriptions etc.) and virtual observations of physical artifacts (Yin, 2018). Documentation data, archival records, and physical artifacts were collected and/or observed virtually from both public (i.e., public government sources) and private sources (i.e., from the LTC home and their residents, family members and staff) relevant to the case. To overcome the challenges associated with virtual data collection, as well as those challenges encountered as a result of collecting data in an LTC setting, the research team developed a detailed data collection protocol and met virtually throughout the study to discuss challenges as they emerged. As the study was designed as a virtual study, no major adaptations to the original data collection protocol were required. Minor adaptations to the protocol were made based on the specific workload, time and resource constraints faced by staff working in the LTC home. We worked with the DoC and ADoC on multiple occasions before and during the data collection phase to co-develop a data collection protocol that ensured privacy and confidentiality for all study participants as well as followed all privacy and data sharing protocols of the LTC home and the host academic institution. Contingency plans were developed, including scripts for the researcher to use if a virtual interview with a resident, family member or staff at the LTC home was interrupted. Interruptions most commonly occurred during the resident interviews and were caused by issues with the technology or internet connection, or by an individual at the LTC home entering the room where the interview was being conducted (i.e., a team member coming into the residents’ room). The success of collecting data virtually was greatly impacted by our initial decision to ensure the researcher’s strong proficiency and self-assurance with virtual communication platforms used in the data collection phase. This approach enabled them to immediately address any technical difficulties that occurred.

The researcher kept detailed notes on the methodological decisions made by the research team during the team meetings as these methodological decisions evolved into four concrete data collection strategies that were implemented by the researcher throughout the study. The four strategies were (1) exercising flexibility on the part of the researcher to accommodate unpredictable staff schedules; (2) providing the LTC home with multiple devices (i.e. tablets) with the required communication software (i.e. Zoom) installed to facilitate and provide access for participants to partake in the virtual study; (3) implementing a virtual data collection protocol to ensure privacy and confidentiality that also considers contingency plans to address technical problems; (4) ensuring that the researcher had a high level of comfort and confidence with the virtual communication platforms (Matthews et al., 2018; Morrison et al., 2020; Pocock et al., 2021).

During the study, staff frequently rescheduled their virtual interviews or requested participation in the study without prior scheduling, necessitating virtual interviews to be conducted in the early morning hours before the start of the staff’s shifts, during their lunch breaks, or in the evening as they were departing from work. Most staff and family member participants were comfortable with the technology used for this study (i.e., tablets) or were supported by the in-person liaisons to access the technology and participate in the study. However, PSW participants who contacted the researcher for an interview were either uncomfortable with the synchronous video platform and/or were unable to find a time during or after their scheduled shift to use the provided tablets to participate in the virtual interviews using the synchronous video platform. All PSW participants preferred to use their own devices (i.e., personal cell phones or home telephones) to participate in the study. This resulted in PSW participants carrying out other tasks during the interview (such as eating their lunch, commuting to or from work or preparing for a care task). All participants had the opportunity to participate during or outside of working hours. The impact of the COVID-19 pandemic on staffing and the PSW task-orientated nature of their role resulted in PSW participants being more challenged than any other team member to find dedicated time to participate in the study during work hours. To arrange for an interview, PSWs were most comfortable communicating over text messages, and due to the nature of their work, they were not able to provide the researcher with a scheduled time for the interview. PSW participants often provided the researcher with a date that they would call, and then would call during the day or evening when they were available either during or directly after their shift.

Data Quality

What is known

The quality of qualitative data collected using virtual methods is impacted by three main factors: the technology platform used, the researcher’s confidence and skill with technology, and the rapport developed between the researcher and participants (Davies et al., 2020; Hewson, 2017; Pocock et al., 2021; Weller, 2015, 2017). Extensive prior research has identified the disadvantages of virtual qualitative data collection methods that can compromise data quality including technology challenges, limited participant observation opportunities, and difficulty cultivating rapport with participants (Lobe et al., 2020; Sah et al., 2020; Schlegel et al., 2021; Varma et al., 2021). However, as virtual qualitative data collection increases in popularity, new research has emerged demonstrating the substantial richness of qualitative data collected using virtual methods that are comparable to in-person research. This may be due, in part, to improvements in online communication platforms and emerging evidence based on Novick’s (2008) proposition, that participants are more likely to disclose sensitive information when participating virtually (Johnson et al., 2019; Keen et al., 2022; Roberts et al., 2021; Sah et al., 2020; Varma et al., 2021). Furthermore, participating in research from a comfortable and familiar environment, such as a participant’s own home or personal room, has been found to increase their willingness to openly discuss sensitive subjects, including end-of-life care for themselves or their loved ones (Johnson et al., 2019; Novick, 2008).

Strategies Implemented

To ensure data quality, specific strategies were employed by the researcher when conducting virtual data collection. However, the overarching application of virtual methods for this study also supported data quality due to the sensitive topic of this research (end-of-life care) (Novick, 2008). The researcher was able to collect rich data from all participants, and resident participants in particular, as the virtual methods allowed participants to stay in their home environments during data collection (Johnson et al., 2019; Novick, 2008). Additional strategies implemented to ensure data quality included (2) the researcher selecting a technology platform that they and the in-person liaison were knowledgeable of and comfortable using, and (3) the researcher dedicating time before formal data collection (i.e., the virtual interview) with each participant to build a rapport. The deliberate choice of technology platforms that the researcher was knowledgeable of, and comfortable using, was crucial in ensuring an efficient data collection process. By being well-versed in the functionalities and features of the selected platform, the researcher was able to reduce the likelihood of technical difficulties that may interrupt or compromise the data collection process.

The dedicated time the researcher planned and prioritized before each virtual interview to connect with participants individually before commencing the formal data collection phase served as a valuable opportunity for the researcher to build rapport, foster trust, and establish a comfortable and supportive relationship with the participants. This dedicated time occurs naturally during in-person data collection as the interviewer and interviewee introduce themselves and prepare to start the interview. However, in the virtual world, introductions and conversations do not occur naturally, therefore the researcher must dedicate time to emulate these conversations and introductions virtually. To do this, the researcher began by introducing herself, providing information about her academic background, along with her role in the study and the purpose of the study. The researcher would continue and ask the participants if they had any questions or information they would like to share in response. By investing time and effort in getting to know the participants, the researcher created a safe and collaborative environment that encouraged participants to express their thoughts, feelings, and experiences openly and honestly during the subsequent data collection process. Staff and family member participants generally did not engage further past what information was provided by the researcher, and they stated that they were often busy with their schedules and workloads. However, resident participants took the opportunity to meaningfully engage with the researcher, and they stated that there were very limited planned activities at this time. A strong rapport was thus developed between the researcher and resident participants, evidenced by the residents’ willingness to share personal stories, express their thoughts and feelings openly, and actively participate in the research process.

Rigour

What is Known

Yin (2018) outlines four key principles of data collection in case study methodology to establish the validity of evidence including using multiple sources of evidence, creating a case study database, maintaining a chain of evidence and exercising care when using data from virtual sources. Limited literature exists on the methodological insights or considerations of conducting case studies virtually, however, the four principles outlined by Yin (2018) are applicable and highly relevant in ensuring validity (Roberts et al., 2021). The first principle, using multiple sources of evidence, becomes crucial in a virtual case study as the application of virtual methods inherently involves limitations around many of the commonly used sources, such as interviews and observation (Schlegel et al., 2021). Researchers must consider this limitation when selecting their virtual sources of evidence and select sources that will establish a holistic understanding and reduce the risk of bias associated with relying on a single source or perspective (Yin, 2018). Secondly, creating a case study database that is organized and easily accessible facilitates effective data management and ensures data integrity (Yin, 2018). This is critical for virtual case studies due to the vast amount of electronic or virtual data. Thirdly, researchers need to document and maintain a chain of evidence, including the eligibility criteria for study sites and participants, methods used for data collection, amendments made, and the steps taken to ensure data quality (Yin, 2018). This is critical to promote transparency in the research. The fourth principle, exercising care when using data from electronic sources, is particularly relevant in a virtual case study. By adhering to these principles within a virtual context, researchers can produce rigorous and credible evidence.

Strategies Implemented

Conducting a virtual case study required us to ensure that the principles of data validity were maintained. Given the barriers to conducting direct and participant observations in virtual research, we selected a wide range of virtual data collection methods from various sources, including virtual interviews, documentation data, archival records, and virtual observation of physical artifacts from participants. The researcher also took extensive field notes and participated in reflexive journaling during the recruitment and data collection phases to provide additional context and understanding as well as reflect on their position and subjectivities. The wide range of virtual data collection methods used was advantageous, as the researcher was able to collect rich data from multiple participants and in various formats in a way that was convenient for the residents, family members and staff to share. The inclusion of virtual documentation data and archival records meant that the ADoC and other staff could search their electronic files and share the requested documents with the researcher, reducing their burden for participating. Similarly, the inclusion of virtual observation of physical artifacts from participants meant that resident and family member participants could share items of significance during the video interviews. When conducting the video interviews, participants had the opportunity to share these items, enabling a deeper understanding of their experiences and perspectives. This produced a large dataset of electronic records including audio recordings, word documents, PDF files, pictures, PowerPoint presentations, and webpages.

To manage this large electronic dataset, and to be consistent with conventional case study research, a database was established and securely stored in accordance with the ethical guidelines of the University in which the lead investigator’s unit was situated. To address concerns surrounding the management and security of virtual data, the researcher monitored the University’s ethics board standards and the standard operating procedures of the study site (LTC home) for any updates or revisions pertaining to virtual data collection throughout the study. This large electronic data set also required the researcher to meticulously document the chain of evidence for all data, including file names, specific folder and drive locations and the dates files were obtained, to ensure the secure maintenance of evidence. A project management template in Microsoft Excel was utilized to document every step of the study, including actions such as receiving transcripts from the transcriptionist, to ensure that the chain of evidence was upheld and secured. This process required more time from the researcher but was crucial in keeping the data set organized.

We followed Yin’s (2018) principle of exercising care when using data from electronic sources. The researcher was cautious when collecting data from public sources such as websites or social media platforms, considering issues such as misinformation or outdated information. The virtual case study methods relied on using digital platforms and included online sources, therefore the researcher critically evaluated the credibility, reliability, and relevance of the data obtained. This was done by reviewing the data source and electronic file for potential biases and limitations. In summary, the strategies implemented to ensure rigour and validity for this virtual case study in LTC are to: (1) ensure that the researcher can dedicate additional time to develop and manage the data set and project management databases; (2) monitor the standards and policies of the applicable ethics board to ensure any policy changes to securely storing virtual data are implemented; and (3) exercise caution when using data from electronic sources and consider issues such as misinformation.

Limitations

This paper has some limitations. The strategies proposed in this paper are based on a single case study, with a small sample size. While the sample size did include residents, family members and staff, the number of family member participants was significantly lower than resident and staff participants. Additionally, the case (LTC home) for this study was in an urban geographical area, therefore some challenges for conducting virtual research in rural areas (such as internet availability or speed) were not experienced in this case study. Finally, this case study was qualitative, therefore specific strategies for conducting virtual mixed-method or multi-method research in the LTC setting were not explored in this paper.

Implications for Nursing Research

The application of virtual research in the LTC context presents unique opportunities for nursing and health researchers to explore groups (residents, family members and staff) in this context who may not be able or willing to participate in traditional research. Virtual research methods enable nursing and health researchers to continue conducting studies in the LTC setting with vulnerable participants, even when in-person research is not possible. This is particularly valuable during times of crisis or in remote geographical locations but is not exclusive to these situations. Future researchers should consider leveraging virtual methods to expand the scope and scale of their investigations and include diverse LTC populations from different geographic regions.

The strategies implemented in this virtual case study were synthesized in a Framework for Virtual Qualitative Research Methodology in LTC (Figure 1). Researchers can use this framework to help guide their virtual qualitative research in the LTC setting. Researchers should apply strategies to ensure that populations living and working in LTC contexts can participate in research. Future nursing research on virtual methods in the LTC setting should consider expanding on this framework (Figure 1) based on the integration of new technology (i.e., video surveillance technology) into virtual research and exploring participant groups (residents, family members and staff) experiences and perspectives of participating in virtual research. The evolution of technology and the LTC context will demand a continued expansion of the Framework for Virtual Qualitative Research Methodology in LTC (Figure 1). The expansion of this framework would benefit from the multifaceted experiences and perspectives of participant groups (residents, family members, and staff) who participate in virtual research. This extension beyond the current framework will not only expand our understanding of virtual research methods but also refine strategies to ensure inclusive, ethical, and impactful engagement within this crucial healthcare environment.

Figure 1.

Framework for virtual qualitative research methodology in LTC.

When considering the implication for nursing research, it is imperative to note that conducting virtual research in LTC comes with its own set of challenges, primarily due to the additional barriers to participation such as residents having no or a limited digital profile or staff not having the capacity in their roles to participate in research. To address these challenges, future nursing and health research should apply and further develop the Framework for Virtual Qualitative Research Methodology in LTC (Figure 1) to overcome barriers and ensure equitable participation for all groups within LTC. By blending traditional and virtual participant recruitment methods, over-recruiting participants, providing flexibility in data collection scheduling and providing the LTC home with additional support and resources to participate, LTC homes can successfully participate in virtual qualitative research studies. As technology progresses and familiarity with virtual methods grows, future researchers must continue to build on this framework by including lessons learned from future research studies conducted using virtual methods in LTC. The continued development of the Framework for Virtual Qualitative Research Methodology in LTC (Figure 1) will ensure that participants living and working in LTC have a continued ability to participate in research.

In conclusion, while the integration of virtual research in LTC settings presents boundless opportunities for nursing researchers, its successful implementation hinges upon a commitment to refine strategies, overcome challenges, and continuously adapt research methods to foster inclusive and meaningful research for all participants involved.

Supplementary Material

For any inquiries regarding research materials related to our paper, “Navigating the Virtual Landscape: Methodological Considerations for Qualitative Research in Long-Term Care,” we encourage you to reach out to the lead author.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research is financially supported by a Collaborative Research Grant from the Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), in collaboration with the University of Toronto’s Division of Palliative Medicine (DPM) and the University of Toronto’s Dalla Lana School of Public Health (DLSPH).

ORCID iD

Danielle T. Just

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