limitations of qualitative and quantitative research methods

Qualitative vs Quantitative Research Methods & Data Analysis

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

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What is the difference between quantitative and qualitative?

The main difference between quantitative and qualitative research is the type of data they collect and analyze.

Quantitative research collects numerical data and analyzes it using statistical methods. The aim is to produce objective, empirical data that can be measured and expressed in numerical terms. Quantitative research is often used to test hypotheses, identify patterns, and make predictions.

Qualitative research , on the other hand, collects non-numerical data such as words, images, and sounds. The focus is on exploring subjective experiences, opinions, and attitudes, often through observation and interviews.

Qualitative research aims to produce rich and detailed descriptions of the phenomenon being studied, and to uncover new insights and meanings.

Quantitative data is information about quantities, and therefore numbers, and qualitative data is descriptive, and regards phenomenon which can be observed but not measured, such as language.

What Is Qualitative Research?

Qualitative research is the process of collecting, analyzing, and interpreting non-numerical data, such as language. Qualitative research can be used to understand how an individual subjectively perceives and gives meaning to their social reality.

Qualitative data is non-numerical data, such as text, video, photographs, or audio recordings. This type of data can be collected using diary accounts or in-depth interviews and analyzed using grounded theory or thematic analysis.

Qualitative research is multimethod in focus, involving an interpretive, naturalistic approach to its subject matter. This means that qualitative researchers study things in their natural settings, attempting to make sense of, or interpret, phenomena in terms of the meanings people bring to them. Denzin and Lincoln (1994, p. 2)

Interest in qualitative data came about as the result of the dissatisfaction of some psychologists (e.g., Carl Rogers) with the scientific study of psychologists such as behaviorists (e.g., Skinner ).

Since psychologists study people, the traditional approach to science is not seen as an appropriate way of carrying out research since it fails to capture the totality of human experience and the essence of being human.  Exploring participants’ experiences is known as a phenomenological approach (re: Humanism ).

Qualitative research is primarily concerned with meaning, subjectivity, and lived experience. The goal is to understand the quality and texture of people’s experiences, how they make sense of them, and the implications for their lives.

Qualitative research aims to understand the social reality of individuals, groups, and cultures as nearly as possible as participants feel or live it. Thus, people and groups are studied in their natural setting.

Some examples of qualitative research questions are provided, such as what an experience feels like, how people talk about something, how they make sense of an experience, and how events unfold for people.

Research following a qualitative approach is exploratory and seeks to explain ‘how’ and ‘why’ a particular phenomenon, or behavior, operates as it does in a particular context. It can be used to generate hypotheses and theories from the data.

Qualitative Methods

There are different types of qualitative research methods, including diary accounts, in-depth interviews , documents, focus groups , case study research , and ethnography.

The results of qualitative methods provide a deep understanding of how people perceive their social realities and in consequence, how they act within the social world.

The researcher has several methods for collecting empirical materials, ranging from the interview to direct observation, to the analysis of artifacts, documents, and cultural records, to the use of visual materials or personal experience. Denzin and Lincoln (1994, p. 14)

Here are some examples of qualitative data:

Interview transcripts : Verbatim records of what participants said during an interview or focus group. They allow researchers to identify common themes and patterns, and draw conclusions based on the data. Interview transcripts can also be useful in providing direct quotes and examples to support research findings.

Observations : The researcher typically takes detailed notes on what they observe, including any contextual information, nonverbal cues, or other relevant details. The resulting observational data can be analyzed to gain insights into social phenomena, such as human behavior, social interactions, and cultural practices.

Unstructured interviews : generate qualitative data through the use of open questions.  This allows the respondent to talk in some depth, choosing their own words.  This helps the researcher develop a real sense of a person’s understanding of a situation.

Diaries or journals : Written accounts of personal experiences or reflections.

Notice that qualitative data could be much more than just words or text. Photographs, videos, sound recordings, and so on, can be considered qualitative data. Visual data can be used to understand behaviors, environments, and social interactions.

Qualitative Data Analysis

Qualitative research is endlessly creative and interpretive. The researcher does not just leave the field with mountains of empirical data and then easily write up his or her findings.

Qualitative interpretations are constructed, and various techniques can be used to make sense of the data, such as content analysis, grounded theory (Glaser & Strauss, 1967), thematic analysis (Braun & Clarke, 2006), or discourse analysis.

For example, thematic analysis is a qualitative approach that involves identifying implicit or explicit ideas within the data. Themes will often emerge once the data has been coded .

Key Features

• Events can be understood adequately only if they are seen in context. Therefore, a qualitative researcher immerses her/himself in the field, in natural surroundings. The contexts of inquiry are not contrived; they are natural. Nothing is predefined or taken for granted.
• Qualitative researchers want those who are studied to speak for themselves, to provide their perspectives in words and other actions. Therefore, qualitative research is an interactive process in which the persons studied teach the researcher about their lives.
• The qualitative researcher is an integral part of the data; without the active participation of the researcher, no data exists.
• The study’s design evolves during the research and can be adjusted or changed as it progresses. For the qualitative researcher, there is no single reality. It is subjective and exists only in reference to the observer.
• The theory is data-driven and emerges as part of the research process, evolving from the data as they are collected.

Limitations of Qualitative Research

• Because of the time and costs involved, qualitative designs do not generally draw samples from large-scale data sets.
• The problem of adequate validity or reliability is a major criticism. Because of the subjective nature of qualitative data and its origin in single contexts, it is difficult to apply conventional standards of reliability and validity. For example, because of the central role played by the researcher in the generation of data, it is not possible to replicate qualitative studies.
• Also, contexts, situations, events, conditions, and interactions cannot be replicated to any extent, nor can generalizations be made to a wider context than the one studied with confidence.
• The time required for data collection, analysis, and interpretation is lengthy. Analysis of qualitative data is difficult, and expert knowledge of an area is necessary to interpret qualitative data. Great care must be taken when doing so, for example, looking for mental illness symptoms.

Advantages of Qualitative Research

• Because of close researcher involvement, the researcher gains an insider’s view of the field. This allows the researcher to find issues that are often missed (such as subtleties and complexities) by the scientific, more positivistic inquiries.
• Qualitative descriptions can be important in suggesting possible relationships, causes, effects, and dynamic processes.
• Qualitative analysis allows for ambiguities/contradictions in the data, which reflect social reality (Denscombe, 2010).
• Qualitative research uses a descriptive, narrative style; this research might be of particular benefit to the practitioner as she or he could turn to qualitative reports to examine forms of knowledge that might otherwise be unavailable, thereby gaining new insight.

What Is Quantitative Research?

Quantitative research involves the process of objectively collecting and analyzing numerical data to describe, predict, or control variables of interest.

The goals of quantitative research are to test causal relationships between variables , make predictions, and generalize results to wider populations.

Quantitative researchers aim to establish general laws of behavior and phenomenon across different settings/contexts. Research is used to test a theory and ultimately support or reject it.

Quantitative Methods

Experiments typically yield quantitative data, as they are concerned with measuring things.  However, other research methods, such as controlled observations and questionnaires , can produce both quantitative information.

For example, a rating scale or closed questions on a questionnaire would generate quantitative data as these produce either numerical data or data that can be put into categories (e.g., “yes,” “no” answers).

Experimental methods limit how research participants react to and express appropriate social behavior.

Findings are, therefore, likely to be context-bound and simply a reflection of the assumptions that the researcher brings to the investigation.

There are numerous examples of quantitative data in psychological research, including mental health. Here are a few examples:

Another example is the Experience in Close Relationships Scale (ECR), a self-report questionnaire widely used to assess adult attachment styles .

The ECR provides quantitative data that can be used to assess attachment styles and predict relationship outcomes.

Neuroimaging data : Neuroimaging techniques, such as MRI and fMRI, provide quantitative data on brain structure and function.

This data can be analyzed to identify brain regions involved in specific mental processes or disorders.

For example, the Beck Depression Inventory (BDI) is a clinician-administered questionnaire widely used to assess the severity of depressive symptoms in individuals.

The BDI consists of 21 questions, each scored on a scale of 0 to 3, with higher scores indicating more severe depressive symptoms. 

Quantitative Data Analysis

Statistics help us turn quantitative data into useful information to help with decision-making. We can use statistics to summarize our data, describing patterns, relationships, and connections. Statistics can be descriptive or inferential.

Descriptive statistics help us to summarize our data. In contrast, inferential statistics are used to identify statistically significant differences between groups of data (such as intervention and control groups in a randomized control study).

• Quantitative researchers try to control extraneous variables by conducting their studies in the lab.
• The research aims for objectivity (i.e., without bias) and is separated from the data.
• The design of the study is determined before it begins.
• For the quantitative researcher, the reality is objective, exists separately from the researcher, and can be seen by anyone.
• Research is used to test a theory and ultimately support or reject it.

Limitations of Quantitative Research

• Context: Quantitative experiments do not take place in natural settings. In addition, they do not allow participants to explain their choices or the meaning of the questions they may have for those participants (Carr, 1994).
• Researcher expertise: Poor knowledge of the application of statistical analysis may negatively affect analysis and subsequent interpretation (Black, 1999).
• Variability of data quantity: Large sample sizes are needed for more accurate analysis. Small-scale quantitative studies may be less reliable because of the low quantity of data (Denscombe, 2010). This also affects the ability to generalize study findings to wider populations.
• Confirmation bias: The researcher might miss observing phenomena because of focus on theory or hypothesis testing rather than on the theory of hypothesis generation.

Advantages of Quantitative Research

• Scientific objectivity: Quantitative data can be interpreted with statistical analysis, and since statistics are based on the principles of mathematics, the quantitative approach is viewed as scientifically objective and rational (Carr, 1994; Denscombe, 2010).
• Useful for testing and validating already constructed theories.
• Rapid analysis: Sophisticated software removes much of the need for prolonged data analysis, especially with large volumes of data involved (Antonius, 2003).
• Replication: Quantitative data is based on measured values and can be checked by others because numerical data is less open to ambiguities of interpretation.
• Hypotheses can also be tested because of statistical analysis (Antonius, 2003).

Antonius, R. (2003). Interpreting quantitative data with SPSS . Sage.

Black, T. R. (1999). Doing quantitative research in the social sciences: An integrated approach to research design, measurement and statistics . Sage.

Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology . Qualitative Research in Psychology , 3, 77–101.

Carr, L. T. (1994). The strengths and weaknesses of quantitative and qualitative research : what method for nursing? Journal of advanced nursing, 20(4) , 716-721.

Denscombe, M. (2010). The Good Research Guide: for small-scale social research. McGraw Hill.

Denzin, N., & Lincoln. Y. (1994). Handbook of Qualitative Research. Thousand Oaks, CA, US: Sage Publications Inc.

Glaser, B. G., Strauss, A. L., & Strutzel, E. (1968). The discovery of grounded theory; strategies for qualitative research. Nursing research, 17(4) , 364.

Minichiello, V. (1990). In-Depth Interviewing: Researching People. Longman Cheshire.

Punch, K. (1998). Introduction to Social Research: Quantitative and Qualitative Approaches. London: Sage

Further Information

• Designing qualitative research
• Methods of data collection and analysis
• Introduction to quantitative and qualitative research
• Checklists for improving rigour in qualitative research: a case of the tail wagging the dog?
• Qualitative research in health care: Analysing qualitative data
• Qualitative data analysis: the framework approach
• Using the framework method for the analysis of
• Qualitative data in multi-disciplinary health research
• Content Analysis
• Grounded Theory
• Thematic Analysis

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Quantitative vs. Qualitative Research in Psychology

Anabelle Bernard Fournier is a researcher of sexual and reproductive health at the University of Victoria as well as a freelance writer on various health topics.

Emily is a board-certified science editor who has worked with top digital publishing brands like Voices for Biodiversity, Study.com, GoodTherapy, Vox, and Verywell.

• Key Differences

Quantitative Research Methods

Qualitative research methods.

• How They Relate

In psychology and other social sciences, researchers are faced with an unresolved question: Can we measure concepts like love or racism the same way we can measure temperature or the weight of a star? Social phenomena⁠—things that happen because of and through human behavior⁠—are especially difficult to grasp with typical scientific models.

At a Glance

Psychologists rely on quantitative and quantitative research to better understand human thought and behavior.

• Qualitative research involves collecting and evaluating non-numerical data in order to understand concepts or subjective opinions.
• Quantitative research involves collecting and evaluating numerical data. 

This article discusses what qualitative and quantitative research are, how they are different, and how they are used in psychology research.

Qualitative Research vs. Quantitative Research

In order to understand qualitative and quantitative psychology research, it can be helpful to look at the methods that are used and when each type is most appropriate.

Psychologists rely on a few methods to measure behavior, attitudes, and feelings. These include:

• Self-reports , like surveys or questionnaires
• Observation (often used in experiments or fieldwork)
• Implicit attitude tests that measure timing in responding to prompts

Most of these are quantitative methods. The result is a number that can be used to assess differences between groups.

However, most of these methods are static, inflexible (you can't change a question because a participant doesn't understand it), and provide a "what" answer rather than a "why" answer.

Sometimes, researchers are more interested in the "why" and the "how." That's where qualitative methods come in.

Qualitative research is about speaking to people directly and hearing their words. It is grounded in the philosophy that the social world is ultimately unmeasurable, that no measure is truly ever "objective," and that how humans make meaning is just as important as how much they score on a standardized test.

Used to develop theories

Takes a broad, complex approach

Answers "why" and "how" questions

Explores patterns and themes

Used to test theories

Takes a narrow, specific approach

Answers "what" questions

Explores statistical relationships

Quantitative methods have existed ever since people have been able to count things. But it is only with the positivist philosophy of Auguste Comte (which maintains that factual knowledge obtained by observation is trustworthy) that it became a "scientific method."

The scientific method follows this general process. A researcher must:

• Generate a theory or hypothesis (i.e., predict what might happen in an experiment) and determine the variables needed to answer their question
• Develop instruments to measure the phenomenon (such as a survey, a thermometer, etc.)
• Develop experiments to manipulate the variables
• Collect empirical (measured) data
• Analyze data

Quantitative methods are about measuring phenomena, not explaining them.

Quantitative research compares two groups of people. There are all sorts of variables you could measure, and many kinds of experiments to run using quantitative methods.

These comparisons are generally explained using graphs, pie charts, and other visual representations that give the researcher a sense of how the various data points relate to one another.

Basic Assumptions

Quantitative methods assume:

• That the world is measurable
• That humans can observe objectively
• That we can know things for certain about the world from observation

In some fields, these assumptions hold true. Whether you measure the size of the sun 2000 years ago or now, it will always be the same. But when it comes to human behavior, it is not so simple.

As decades of cultural and social research have shown, people behave differently (and even think differently) based on historical context, cultural context, social context, and even identity-based contexts like gender , social class, or sexual orientation .

Therefore, quantitative methods applied to human behavior (as used in psychology and some areas of sociology) should always be rooted in their particular context. In other words: there are no, or very few, human universals.

Statistical information is the primary form of quantitative data used in human and social quantitative research. Statistics provide lots of information about tendencies across large groups of people, but they can never describe every case or every experience. In other words, there are always outliers.

Correlation and Causation

A basic principle of statistics is that correlation is not causation. Researchers can only claim a cause-and-effect relationship under certain conditions:

• The study was a true experiment.
• The independent variable can be manipulated (for example, researchers cannot manipulate gender, but they can change the primer a study subject sees, such as a picture of nature or of a building).
• The dependent variable can be measured through a ratio or a scale.

So when you read a report that "gender was linked to" something (like a behavior or an attitude), remember that gender is NOT a cause of the behavior or attitude. There is an apparent relationship, but the true cause of the difference is hidden.

Pitfalls of Quantitative Research

Quantitative methods are one way to approach the measurement and understanding of human and social phenomena. But what's missing from this picture?

As noted above, statistics do not tell us about personal, individual experiences and meanings. While surveys can give a general idea, respondents have to choose between only a few responses. This can make it difficult to understand the subtleties of different experiences.

Quantitative methods can be helpful when making objective comparisons between groups or when looking for relationships between variables. They can be analyzed statistically, which can be helpful when looking for patterns and relationships.

Qualitative data are not made out of numbers but rather of descriptions, metaphors, symbols, quotes, analysis, concepts, and characteristics. This approach uses interviews, written texts, art, photos, and other materials to make sense of human experiences and to understand what these experiences mean to people.

While quantitative methods ask "what" and "how much," qualitative methods ask "why" and "how."

Qualitative methods are about describing and analyzing phenomena from a human perspective. There are many different philosophical views on qualitative methods, but in general, they agree that some questions are too complex or impossible to answer with standardized instruments.

These methods also accept that it is impossible to be completely objective in observing phenomena. Researchers have their own thoughts, attitudes, experiences, and beliefs, and these always color how people interpret results.

Qualitative Approaches

There are many different approaches to qualitative research, with their own philosophical bases. Different approaches are best for different kinds of projects. For example:

• Case studies and narrative studies are best for single individuals. These involve studying every aspect of a person's life in great depth.
• Phenomenology aims to explain experiences. This type of work aims to describe and explore different events as they are consciously and subjectively experienced.
• Grounded theory develops models and describes processes. This approach allows researchers to construct a theory based on data that is collected, analyzed, and compared to reach new discoveries.
• Ethnography describes cultural groups. In this approach, researchers immerse themselves in a community or group in order to observe behavior.

Qualitative researchers must be aware of several different methods and know each thoroughly enough to produce valuable research.

Some researchers specialize in a single method, but others specialize in a topic or content area and use many different methods to explore the topic, providing different information and a variety of points of view.

There is not a single model or method that can be used for every qualitative project. Depending on the research question, the people participating, and the kind of information they want to produce, researchers will choose the appropriate approach.

Interpretation

Qualitative research does not look into causal relationships between variables, but rather into themes, values, interpretations, and meanings. As a rule, then, qualitative research is not generalizable (cannot be applied to people outside the research participants).

The insights gained from qualitative research can extend to other groups with proper attention to specific historical and social contexts.

Relationship Between Qualitative and Quantitative Research

It might sound like quantitative and qualitative research do not play well together. They have different philosophies, different data, and different outputs. However, this could not be further from the truth.

These two general methods complement each other. By using both, researchers can gain a fuller, more comprehensive understanding of a phenomenon.

For example, a psychologist wanting to develop a new survey instrument about sexuality might and ask a few dozen people questions about their sexual experiences (this is qualitative research). This gives the researcher some information to begin developing questions for their survey (which is a quantitative method).

After the survey, the same or other researchers might want to dig deeper into issues brought up by its data. Follow-up questions like "how does it feel when...?" or "what does this mean to you?" or "how did you experience this?" can only be answered by qualitative research.

By using both quantitative and qualitative data, researchers have a more holistic, well-rounded understanding of a particular topic or phenomenon.

Qualitative and quantitative methods both play an important role in psychology. Where quantitative methods can help answer questions about what is happening in a group and to what degree, qualitative methods can dig deeper into the reasons behind why it is happening. By using both strategies, psychology researchers can learn more about human thought and behavior.

Gough B, Madill A. Subjectivity in psychological science: From problem to prospect . Psychol Methods . 2012;17(3):374-384. doi:10.1037/a0029313

Pearce T. “Science organized”: Positivism and the metaphysical club, 1865–1875 . J Hist Ideas . 2015;76(3):441-465.

Adams G. Context in person, person in context: A cultural psychology approach to social-personality psychology . In: Deaux K, Snyder M, eds. The Oxford Handbook of Personality and Social Psychology . Oxford University Press; 2012:182-208.

Brady HE. Causation and explanation in social science . In: Goodin RE, ed. The Oxford Handbook of Political Science. Oxford University Press; 2011. doi:10.1093/oxfordhb/9780199604456.013.0049

Chun Tie Y, Birks M, Francis K. Grounded theory research: A design framework for novice researchers .  SAGE Open Med . 2019;7:2050312118822927. doi:10.1177/2050312118822927

Reeves S, Peller J, Goldman J, Kitto S. Ethnography in qualitative educational research: AMEE Guide No. 80 . Medical Teacher . 2013;35(8):e1365-e1379. doi:10.3109/0142159X.2013.804977

Salkind NJ, ed. Encyclopedia of Research Design . Sage Publishing.

Shaughnessy JJ, Zechmeister EB, Zechmeister JS.  Research Methods in Psychology . McGraw Hill Education.

By Anabelle Bernard Fournier Anabelle Bernard Fournier is a researcher of sexual and reproductive health at the University of Victoria as well as a freelance writer on various health topics.

23 Advantages and Disadvantages of Qualitative Research

Investigating methodologies. Taking a closer look at ethnographic, anthropological, or naturalistic techniques. Data mining through observer recordings. This is what the world of qualitative research is all about. It is the comprehensive and complete data that is collected by having the courage to ask an open-ended question.

Print media has used the principles of qualitative research for generations. Now more industries are seeing the advantages that come from the extra data that is received by asking more than a “yes” or “no” question.

The advantages and disadvantages of qualitative research are quite unique. On one hand, you have the perspective of the data that is being collected. On the other hand, you have the techniques of the data collector and their own unique observations that can alter the information in subtle ways.

That’s why these key points are so important to consider.

What Are the Advantages of Qualitative Research?

1. Subject materials can be evaluated with greater detail. There are many time restrictions that are placed on research methods. The goal of a time restriction is to create a measurable outcome so that metrics can be in place. Qualitative research focuses less on the metrics of the data that is being collected and more on the subtleties of what can be found in that information. This allows for the data to have an enhanced level of detail to it, which can provide more opportunities to glean insights from it during examination.

2. Research frameworks can be fluid and based on incoming or available data. Many research opportunities must follow a specific pattern of questioning, data collection, and information reporting. Qualitative research offers a different approach. It can adapt to the quality of information that is being gathered. If the available data does not seem to be providing any results, the research can immediately shift gears and seek to gather data in a new direction. This offers more opportunities to gather important clues about any subject instead of being confined to a limited and often self-fulfilling perspective.

3. Qualitative research data is based on human experiences and observations. Humans have two very different operating systems. One is a subconscious method of operation, which is the fast and instinctual observations that are made when data is present. The other operating system is slower and more methodical, wanting to evaluate all sources of data before deciding. Many forms of research rely on the second operating system while ignoring the instinctual nature of the human mind. Qualitative research doesn’t ignore the gut instinct. It embraces it and the data that can be collected is often better for it.

4. Gathered data has a predictive quality to it. One of the common mistakes that occurs with qualitative research is an assumption that a personal perspective can be extrapolated into a group perspective. This is only possible when individuals grow up in similar circumstances, have similar perspectives about the world, and operate with similar goals. When these groups can be identified, however, the gathered individualistic data can have a predictive quality for those who are in a like-minded group. At the very least, the data has a predictive quality for the individual from whom it was gathered.

5. Qualitative research operates within structures that are fluid. Because the data being gathered through this type of research is based on observations and experiences, an experienced researcher can follow-up interesting answers with additional questions. Unlike other forms of research that require a specific framework with zero deviation, researchers can follow any data tangent which makes itself known and enhance the overall database of information that is being collected.

6. Data complexities can be incorporated into generated conclusions. Although our modern world tends to prefer statistics and verifiable facts, we cannot simply remove the human experience from the equation. Different people will have remarkably different perceptions about any statistic, fact, or event. This is because our unique experiences generate a different perspective of the data that we see. These complexities, when gathered into a singular database, can generate conclusions with more depth and accuracy, which benefits everyone.

7. Qualitative research is an open-ended process. When a researcher is properly prepared, the open-ended structures of qualitative research make it possible to get underneath superficial responses and rational thoughts to gather information from an individual’s emotional response. This is critically important to this form of researcher because it is an emotional response which often drives a person’s decisions or influences their behavior.

8. Creativity becomes a desirable quality within qualitative research. It can be difficult to analyze data that is obtained from individual sources because many people subconsciously answer in a way that they think someone wants. This desire to “please” another reduces the accuracy of the data and suppresses individual creativity. By embracing the qualitative research method, it becomes possible to encourage respondent creativity, allowing people to express themselves with authenticity. In return, the data collected becomes more accurate and can lead to predictable outcomes.

9. Qualitative research can create industry-specific insights. Brands and businesses today need to build relationships with their core demographics to survive. The terminology, vocabulary, and jargon that consumers use when looking at products or services is just as important as the reputation of the brand that is offering them. If consumers are receiving one context, but the intention of the brand is a different context, then the miscommunication can artificially restrict sales opportunities. Qualitative research gives brands access to these insights so they can accurately communicate their value propositions.

10. Smaller sample sizes are used in qualitative research, which can save on costs. Many qualitative research projects can be completed quickly and on a limited budget because they typically use smaller sample sizes that other research methods. This allows for faster results to be obtained so that projects can move forward with confidence that only good data is able to provide.

11. Qualitative research provides more content for creatives and marketing teams. When your job involves marketing, or creating new campaigns that target a specific demographic, then knowing what makes those people can be quite challenging. By going through the qualitative research approach, it becomes possible to congregate authentic ideas that can be used for marketing and other creative purposes. This makes communication between the two parties to be handled with more accuracy, leading to greater level of happiness for all parties involved.

12. Attitude explanations become possible with qualitative research. Consumer patterns can change on a dime sometimes, leaving a brand out in the cold as to what just happened. Qualitative research allows for a greater understanding of consumer attitudes, providing an explanation for events that occur outside of the predictive matrix that was developed through previous research. This allows the optimal brand/consumer relationship to be maintained.

What Are the Disadvantages of Qualitative Research?

1. The quality of the data gathered in qualitative research is highly subjective. This is where the personal nature of data gathering in qualitative research can also be a negative component of the process. What one researcher might feel is important and necessary to gather can be data that another researcher feels is pointless and won’t spend time pursuing it. Having individual perspectives and including instinctual decisions can lead to incredibly detailed data. It can also lead to data that is generalized or even inaccurate because of its reliance on researcher subjectivisms.

2. Data rigidity is more difficult to assess and demonstrate. Because individual perspectives are often the foundation of the data that is gathered in qualitative research, it is more difficult to prove that there is rigidity in the information that is collective. The human mind tends to remember things in the way it wants to remember them. That is why memories are often looked at fondly, even if the actual events that occurred may have been somewhat disturbing at the time. This innate desire to look at the good in things makes it difficult for researchers to demonstrate data validity.

3. Mining data gathered by qualitative research can be time consuming. The number of details that are often collected while performing qualitative research are often overwhelming. Sorting through that data to pull out the key points can be a time-consuming effort. It is also a subjective effort because what one researcher feels is important may not be pulled out by another researcher. Unless there are some standards in place that cannot be overridden, data mining through a massive number of details can almost be more trouble than it is worth in some instances.

4. Qualitative research creates findings that are valuable, but difficult to present. Presenting the findings which come out of qualitative research is a bit like listening to an interview on CNN. The interviewer will ask a question to the interviewee, but the goal is to receive an answer that will help present a database which presents a specific outcome to the viewer. The goal might be to have a viewer watch an interview and think, “That’s terrible. We need to pass a law to change that.” The subjective nature of the information, however, can cause the viewer to think, “That’s wonderful. Let’s keep things the way they are right now.” That is why findings from qualitative research are difficult to present. What a research gleans from the data can be very different from what an outside observer gleans from the data.

5. Data created through qualitative research is not always accepted. Because of the subjective nature of the data that is collected in qualitative research, findings are not always accepted by the scientific community. A second independent qualitative research effort which can produce similar findings is often necessary to begin the process of community acceptance.

6. Researcher influence can have a negative effect on the collected data. The quality of the data that is collected through qualitative research is highly dependent on the skills and observation of the researcher. If a researcher has a biased point of view, then their perspective will be included with the data collected and influence the outcome. There must be controls in place to help remove the potential for bias so the data collected can be reviewed with integrity. Otherwise, it would be possible for a researcher to make any claim and then use their bias through qualitative research to prove their point.

7. Replicating results can be very difficult with qualitative research. The scientific community wants to see results that can be verified and duplicated to accept research as factual. In the world of qualitative research, this can be very difficult to accomplish. Not only do you have the variability of researcher bias for which to account within the data, but there is also the informational bias that is built into the data itself from the provider. This means the scope of data gathering can be extremely limited, even if the structure of gathering information is fluid, because of each unique perspective.

8. Difficult decisions may require repetitive qualitative research periods. The smaller sample sizes of qualitative research may be an advantage, but they can also be a disadvantage for brands and businesses which are facing a difficult or potentially controversial decision. A small sample is not always representative of a larger population demographic, even if there are deep similarities with the individuals involve. This means a follow-up with a larger quantitative sample may be necessary so that data points can be tracked with more accuracy, allowing for a better overall decision to be made.

9. Unseen data can disappear during the qualitative research process. The amount of trust that is placed on the researcher to gather, and then draw together, the unseen data that is offered by a provider is enormous. The research is dependent upon the skill of the researcher being able to connect all the dots. If the researcher can do this, then the data can be meaningful and help brands and progress forward with their mission. If not, there is no way to alter course until after the first results are received. Then a new qualitative process must begin.

10. Researchers must have industry-related expertise. You can have an excellent researcher on-board for a project, but if they are not familiar with the subject matter, they will have a difficult time gathering accurate data. For qualitative research to be accurate, the interviewer involved must have specific skills, experiences, and expertise in the subject matter being studied. They must also be familiar with the material being evaluated and have the knowledge to interpret responses that are received. If any piece of this skill set is missing, the quality of the data being gathered can be open to interpretation.

11. Qualitative research is not statistically representative. The one disadvantage of qualitative research which is always present is its lack of statistical representation. It is a perspective-based method of research only, which means the responses given are not measured. Comparisons can be made and this can lead toward the duplication which may be required, but for the most part, quantitative data is required for circumstances which need statistical representation and that is not part of the qualitative research process.

The advantages and disadvantages of qualitative research make it possible to gather and analyze individualistic data on deeper levels. This makes it possible to gain new insights into consumer thoughts, demographic behavioral patterns, and emotional reasoning processes. When a research can connect the dots of each information point that is gathered, the information can lead to personalized experiences, better value in products and services, and ongoing brand development.

André Queirós Higher Polytechnic Institute of Gaya, V. N. Gaia, Portugal

Daniel Faria Higher Polytechnic Institute of Gaya, V. N. Gaia, Portugal

Fernando Almeida Faculty of Engineering of Oporto University, INESC TEC, Porto, Portugal

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Understanding the Difference Between Qualitative and Quantitative Research

Understanding the difference between qualitative and quantitative research. Explore the 'why' and 'how' of research methodologies to select the most appropriate approach. Master these methods for academic excellence. Click here to enhance your

Research plays a crucial role in expanding our knowledge and understanding of various phenomena. When embarking on a research journey, one of the fundamental decisions researchers face is choosing between qualitative and quantitative research methodologies. Qualitative research focuses on exploring and understanding the ‘why’ and ‘how’ of a particular issue, delving into the depth of human experiences and behaviors. On the other hand, quantitative research emphasizes measurement and quantification, seeking to establish patterns and relationships through numerical data analysis. Understanding the nuances and distinctions between these two approaches is essential for researchers to select the most appropriate methodology based on their research questions and objectives. This introduction sets the stage for a deeper exploration into the differences between qualitative and quantitative research, shedding light on their unique characteristics, applications, and implications in the realm of academic and scientific inquiry.

Key Characteristics of Qualitative Research

Qualitative research focuses on observing and describing a phenomenon to gain a deeper understanding of a subject. It is used to generate hypotheses for further studies and is explanatory in nature. Qualitative data is unstructured, subjective, individualized, and personalized. This type of data allows for flexibility and a more in-depth exploration of the research topic. Examples of qualitative research methods include interviews, observations, and case studies. Qualitative data can be collected from diary accounts, interviews, or other sources and is often analyzed using grounded theory or thematic analysis.

Key Characteristics of Quantitative Research

Quantitative research deals with quantity, hence, this research type is concerned with numbers and statistics to prove or disapprove theories or hypothesis. In contrast, qualitative research is all about quality – characteristics, unquantifiable features, and meanings to seek deeper understanding of behavior and phenomenon. These two methodologies serve complementary roles in the research process, each offering unique insights and methods suited to different research questions and objectives.

Quantitative research is for testing hypotheses and measuring relationships between variables. It follows the process of objectively collecting data and analyzing it numerically, to determine and control variables of interest. This type of research aims to test causal relationships between variables and provide generalized results. These results determine if the theory proposed for the research study could be accepted or rejected. Quantitative research is used when a research study needs to confirm or test a theory or a hypothesis. When a research study is focused on measuring and quantifying data, using a quantitative approach is appropriate. It is often used in fields such as economics, marketing, or biology, where researchers are interested in studying trends and relationships between variables.

Many data collection methods can be either qualitative or quantitative. For example, in surveys, observational studies, or case studies, your data can be represented as numbers (e.g., using rating scales or counting frequencies) or as words (e.g., with open-ended questions or descriptions of what you observe).

Research Methodologies

When it comes to research methodologies, understanding the differences between qualitative and quantitative research is crucial.

Qualitative Research

Qualitative research focuses on capturing in-depth perspectives through methods like: – Interviews – Focus groups – Content analysis – Observation studies – Ethnography.

Quantitative Research

On the other hand, quantitative research generates numerical data through structured surveys and statistical analysis.

• Qualitative Research: Explores subjective experiences.
• Quantitative Research: Measures and quantifies data.

Both approaches have their benefits and limitations, making it essential to choose the right method based on the research objectives.

Applications of Qualitative and Quantitative Research

Quantitative research is a methodology that provides support when you need to draw general conclusions from your research and predict outcomes. These methods are designed to collect numerical data that can be used to measure variables. The resulting quantitative data should be structured and statistical to present objective and conclusive findings, relying on systematically analyzed data collection. Quantitative research is for testing hypotheses and measuring relationships between variables. It follows the process of objectively collecting data and analyzing it numerically, to determine and control variables of interest. This type of research aims to test causal relationships between variables and provide generalized results. These results determine if the theory proposed for the research study could be accepted or rejected. Quantitative research is used when a research study needs to confirm or test a theory or a hypothesis. When a research study is focused on measuring and quantifying data, using a quantitative approach is appropriate. It is often used in fields such as economics, marketing, or biology, where researchers are interested in studying trends and relationships between variables.

Qualitative research observes and describes a phenomenon to gain a deeper understanding of a subject. It is also used to generate hypotheses for further studies. In general, qualitative research is explanatory and helps understand how an individual perceives non-numerical data, like video, photographs, or audio recordings. The qualitative data is collected from diary accounts or interviews and analyzed by grounded theory or thematic analysis. Best practices of each help to look at the information under a broader lens to get a unique perspective. Using both methods is helpful because they collect rich and reliable data, which can be further tested and replicated.

In the realm of academic research, understanding the distinction between qualitative and quantitative methodologies is paramount. While qualitative research delves into the depth of human experiences, quantitative research focuses on numerical data and statistical analysis. Both approaches offer unique insights and play crucial roles in advancing knowledge in various fields. To excel in academia, mastering these research methods is essential. For further guidance on enhancing your research writing skills, including crafting effective scientific abstracts, visit. How to Write a Scientific Abstract And take your academic writing to the next level.

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The Importance of Literature Review in Research

The Importance of Literature Review in Research: Discover how a well-conducted literature review enhances credibility, guides research direction, and contributes to the existing body of knowledge. Click here to learn more.

Unlock Advanced AI Features with the Professional Avidnote Plan

The topic title is: Unlock Advanced AI Features with the Professional Avidnote Plan

The blog is:

Unlock the full potential of artificial intelligence with the Professional Avidnote Plan

Dive into a world where cutting-edge AI features are at your fingertips, revolutionizing the way you work and interact with your data. With the Professional Avidnote Plan, you can harness the power of advanced AI algorithms to streamline your workflow, gain valuable insights, and make data-driven decisions with confidence. Say goodbye to manual processes and hello to automation, predictive analytics, and personalized recommendations tailored to your needs. Elevate your productivity, efficiency, and innovation with a plan designed to empower you in today’s fast-paced digital landscape. Experience the future of AI technology with the Professional Avidnote Plan and take your projects to new heights.

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Avidnote offers a range of tailored plans to meet specific requirements, each varying in AI utilization, storage capacity, and support levels. The Free Plan includes 5,000 AI-generated words, AI research templates, AI writing, AI reading (10 times), AI analysis, AI coding, export as PDF/Word, automatic transcription (2 hours), and 300 MB storage. For more advanced features, the Professional Plan at $19 per month provides 100,000 AI-generated words per month, unlimited AI reading, 10 hours of AI transcription, and 5 GB of storage. Avidnote’s AI is customized for researchers, offering advanced search functionality, collaboration tools, preset AI templates, and a tagging system for source categorization. The Premium Plan at $59 per month offers even more AI usage, transcription, and storage. Users can cancel their plans anytime, with no commitments. Avidnote’s focus on enhancing research endeavors through AI makes it a valuable tool for academic and professional work.

Different Pricing Tiers and Features

Avidnote offers three pricing plans tailored to meet varying needs. The Free Plan includes 5,000 AI-generated words, AI research templates, and 300 MB storage. The Professional Plan, priced at $19 per month, provides 100,000 AI-generated words, unlimited AI reading, and 5 GB storage. For those seeking more AI usage, transcription, and storage, the Premium Plan at $59 per month offers 1 million AI-generated words and 20 GB storage. Each plan ensures data privacy and allows for easy cancellation. Avidnote’s AI functionalities include advanced search, collaboration features, preset AI templates, and a tagging system for source categorization, making it a comprehensive tool for researchers.

Comparison of Free, Professional, and Premium Plans

When comparing Avidnote’s Free, Professional, and Premium plans, it becomes evident that each plan caters to different user needs. The Free Plan offers 5,000 AI-generated words, basic AI functionalities, and 300 MB storage. In contrast, the Professional Plan, priced at $19 per month, provides more advanced features like unlimited AI reading, 100,000 AI-generated words, and 5 GB storage. For users seeking the most comprehensive AI usage, transcription, and storage, the Premium Plan at $59/month is recommended. Avidnote’s tailored plans aim to meet the specific requirements of researchers, offering advanced search functionality, collaboration features, and preset AI templates for efficient academic and professional work.

Tailored AI Functionalities for Researchers

Avidnote offers tailored AI functionalities for researchers through its diverse pricing plans. The platform provides varying levels of AI utilization, storage capacity, and support to meet specific research requirements. With advanced search functionality, researchers can navigate the vast online information landscape efficiently. Avidnote’s plans cater to different needs, from the Free Plan with 5,000 AI-generated words and 300 MB storage to the Professional Plan at $19 per month, offering 100,000 AI-generated words, unlimited AI reading, and 5 GB storage. The Premium Plan, priced at $59 per month, provides even more AI capabilities. Avidnote’s focus on customization, collaboration features, preset AI templates, and a tagging system for source categorization makes it a valuable tool for academic and professional research endeavors.

Unlocking Advanced AI Capabilities with Avidnote

Unlocking Advanced AI Capabilities with Avidnote: Avidnote offers a free version with limited features, while upgrading to a paid plan provides unlimited access to its AI functionality. Avidnote’s AI-powered capabilities include efficient note-taking, research paper structuring, content improvement, advanced search functionality, collaboration features, and preset AI templates. By tailoring its AI to meet the specific needs of researchers, Avidnote streamlines the research process, saving time on manual tasks like proofreading and editing. The tool allows users to focus on the big picture while maintaining accuracy and professionalism. With pricing plans ranging from a Free Plan to a Premium Plan, Avidnote ensures data privacy and the flexibility to cancel anytime. It’s important to note that Avidnote’s AI output should be used as a supplement to research, with users rewriting and adding proper sources for original work. Unlock superior writing efficiency with Avidnote’s AI-driven assistance.

AI-Powered Research Assistance

AI-Powered Research Assistance Avidnote, an AI-powered tool, offers researchers a way to streamline their work and gain valuable insights. The free version provides limited features, while upgrading to a paid plan unlocks unlimited access to AI functionality. Avidnote stands out with efficient note-taking, research paper structuring, and content improvement features tailored to meet researchers’ needs. By eliminating manual proofreading and editing, Avidnote saves time, allowing researchers to focus on the big picture. Its advanced search functionality filters out irrelevant sources, making information retrieval efficient. Avidnote’s collaboration features and user-friendly interface enhance teamwork. With pricing plans ranging from a free version to paid options offering increased AI capabilities, Avidnote caters to various research needs. However, users are advised not to submit AI-generated content as original work but rather use it as a supplement to their research.

Enhancing Writing Efficiency with AI

Enhancing Writing Efficiency with AI Research plays a vital role in advancing knowledge across various fields, yet the process can be time-consuming. AI tools like Avidnote offer a solution to streamline research tasks and gain valuable insights. Avidnote’s AI capabilities include efficient note-taking, research paper structuring, and content improvement features tailored to meet researchers’ specific needs. By automating proofreading and editing tasks, Avidnote saves time, allowing researchers to focus on the core aspects of their work. The tool’s advanced search function filters out irrelevant sources, providing users with valuable information. Additionally, Avidnote facilitates collaboration among researchers, making it ideal for group projects. With preset AI templates and a tagging system for source categorization, Avidnote stands out as a comprehensive tool for academic and professional work. While the Free Plan offers limited features, upgrading to the Professional or Premium Plan unlocks more advanced functionalities and storage options. It’s important to note that Avidnote’s AI output should be used as a supplement to research, not as original work. Overall, Avidnote enhances writing efficiency by providing AI-driven assistance while ensuring data privacy and flexibility for users.

Maintaining Data Privacy and Flexibility

Maintaining Data Privacy and Flexibility In the realm of research, Avidnote’s AI tool offers a free version with limited features, while upgrading to a paid plan unlocks unlimited access to its functionalities. Research, a fundamental aspect of knowledge discovery and field advancement, can be arduous and time-consuming. AI tools like Avidnote streamline research processes, providing valuable insights to researchers. Avidnote’s AI capabilities include efficient note-taking, research paper structuring, content enhancement, and advanced search features tailored to meet researchers’ specific needs. By automating proofreading and editing tasks, Avidnote saves time, allowing researchers to focus on the core aspects of their work. Moreover, the tool facilitates collaboration and categorization of sources, making it a comprehensive solution for academic and professional endeavors. Avidnote ensures data privacy across its pricing plans, offering flexibility and the ability to cancel anytime. It’s essential to remember that while Avidnote’s AI aids in writing efficiency, its output should supplement research and not be submitted as original work.

Utilizing Avidnote for Efficient Research Workflows

Avidnote is a powerful tool designed to enhance research workflows by offering advanced features tailored to the needs of researchers. By eliminating manual proofreading and editing tasks, Avidnote saves valuable time, allowing users to focus on the core aspects of their research projects. Its AI-powered search engine filters out irrelevant sources, providing users with only the most valuable information. Additionally, Avidnote facilitates collaboration among users, making it ideal for group projects and research teams. With preset AI templates, tagging systems for source categorization, and various pricing plans to choose from, Avidnote stands out as a comprehensive tool for academic and professional work.

Streamlining Research Processes with AI

Avidnote, an AI-powered tool, revolutionizes research processes by eliminating manual proofreading and editing, saving valuable time for researchers to focus on the core aspects of their work. With advanced search capabilities, Avidnote filters out irrelevant sources, streamlining information retrieval. Its collaboration features make it ideal for group projects, while its tailored AI templates cater specifically to researchers’ needs. Offering three pricing plans, including a Free Plan with essential AI features and a Professional Plan with expanded capabilities, Avidnote enhances research efficiency and effectiveness.

Collaboration and Organization Features

Avidnote is a powerful tool that revolutionizes research processes by offering advanced features for organization and collaboration. By automating proofreading and editing tasks, Avidnote saves valuable time, allowing users to focus on the core aspects of their research. Its AI-powered search engine filters out irrelevant sources, providing users with the most valuable resources. Avidnote’s collaboration capabilities make it ideal for group projects and research teams. Additionally, the tool offers preset AI templates, tagging systems for source categorization, and three pricing plans tailored to different user needs.

Time-Saving Benefits of AI in Research

Avidnote, an AI-powered tool, revolutionizes research processes by offering advanced features that save valuable time for researchers. By automating proofreading and editing tasks, Avidnote allows users to focus on the core aspects of their research, enhancing productivity and maintaining a high level of accuracy and professionalism. Its AI capabilities enable efficient organization and management of research materials, facilitating easy access to relevant information. With advanced search functionality, Avidnote filters out irrelevant sources, streamlining the research process. Additi

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CRO Guide   >  Chapter 3.1

Qualitative Research: Definition, Methodology, Limitation, Examples

Qualitative research is a method focused on understanding human behavior and experiences through non-numerical data. Examples of qualitative research include:

• One-on-one interviews,
• Focus groups, Ethnographic research,
• Case studies,
• Record keeping,
• Qualitative observations

In this article, we’ll provide tips and tricks on how to use qualitative research to better understand your audience through real world examples and improve your ROI. We’ll also learn the difference between qualitative and quantitative data.

Table of Contents

Marketers often seek to understand their customers deeply. Qualitative research methods such as face-to-face interviews, focus groups, and qualitative observations can provide valuable insights into your products, your market, and your customers’ opinions and motivations. Understanding these nuances can significantly enhance marketing strategies and overall customer satisfaction.

What is Qualitative Research

Qualitative research is a market research method that focuses on obtaining data through open-ended and conversational communication. This method focuses on the “why” rather than the “what” people think about you. Thus, qualitative research seeks to uncover the underlying motivations, attitudes, and beliefs that drive people’s actions. 

Let’s say you have an online shop catering to a general audience. You do a demographic analysis and you find out that most of your customers are male. Naturally, you will want to find out why women are not buying from you. And that’s what qualitative research will help you find out.

In the case of your online shop, qualitative research would involve reaching out to female non-customers through methods such as in-depth interviews or focus groups. These interactions provide a platform for women to express their thoughts, feelings, and concerns regarding your products or brand. Through qualitative analysis, you can uncover valuable insights into factors such as product preferences, user experience, brand perception, and barriers to purchase.

Types of Qualitative Research Methods

1. one-on-one interviews.

• A company might conduct interviews to understand why a product failed to meet sales expectations.
• A researcher might use interviews to gather personal stories about experiences with healthcare.

2. Focus groups

• A focus group could be used to test reactions to a new product concept.
• Marketers might use focus groups to see how different demographic groups react to an advertising campaign.

3. Ethnographic research

• A study of workplace culture within a tech startup.
• Observational research in a remote village to understand local traditions.

4. Case study research

• Analyzing a single school’s innovative teaching method.
• A detailed study of a patient’s medical treatment over several years.

H3: 5. Record keeping

• Historical research using old newspapers and letters.
• A study on policy changes over the years by examining government records.

6. Qualitative observation

• Sight : Observing the way customers visually interact with product displays in a store to understand their browsing behaviors and preferences.
• Smell : Noting reactions of consumers to different scents in a fragrance shop to study the impact of olfactory elements on product preference.
• Touch : Watching how individuals interact with different materials in a clothing store to assess the importance of texture in fabric selection.
• Taste : Evaluating reactions of participants in a taste test to identify flavor profiles that appeal to different demographic groups.
• Hearing : Documenting responses to changes in background music within a retail environment to determine its effect on shopping behavior and mood.

Qualitative Research Real World Examples

1. online grocery shop with a predominantly male audience, 2. software company launching a new product, 3. alan pushkin’s “god’s choice: the total world of a fundamentalist christian school”, 4. understanding buyers’ trends, 5. determining products/services missing from the market, real-time customer lifetime value (clv) benchmark report.

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Qualitative Research Approaches

• Narrative : This method focuses on individual life stories to understand personal experiences and journeys. It examines how people structure their stories and the themes within them to explore human existence. For example, a narrative study might look at cancer survivors to understand their resilience and coping strategies.
• Phenomenology : attempts to understand or explain life experiences or phenomena; It aims to reveal the depth of human consciousness and perception, such as by studying the daily lives of those with chronic illnesses.
• Grounded theory : investigates the process, action, or interaction with the goal of developing a theory “grounded” in observations and empirical data. 
• Ethnography : describes and interprets an ethnic, cultural, or social group;
• Case study : examines episodic events in a definable framework, develops in-depth analyses of single or multiple cases, and generally explains “how”. An example might be studying a community health program to evaluate its success and impact.

How to Analyze Qualitative Data

1. data collection, 2. data preparation, 3. familiarization.

• Descriptive Coding : Summarize the primary topic of the data.
• In Vivo Coding : Use language and terms used by the participants themselves.
• Process Coding : Use gerunds (“-ing” words) to label the processes at play.
• Emotion Coding : Identify and record the emotions conveyed or experienced.

5. Thematic Development

6. interpreting the data, 7. validation, 8. reporting, limitations of qualitative research, 1. it’s a time-consuming process, 2. you can’t verify the results of qualitative research, 3. it’s a labor-intensive approach, 4. it’s difficult to investigate causality, 5. qualitative research is not statistically representative, quantitative vs. qualitative research.

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Nature of Data:

• Quantitative research : Involves numerical data that can be measured and analyzed statistically.
• Qualitative research : Focuses on non-numerical data, such as words, images, and observations, to capture subjective experiences and meanings.

Research Questions:

• Quantitative research : Typically addresses questions related to “how many,” “how much,” or “to what extent,” aiming to quantify relationships and patterns.
• Qualitative research: Explores questions related to “why” and “how,” aiming to understand the underlying motivations, beliefs, and perceptions of individuals.

Data Collection Methods:

• Quantitative research : Relies on structured surveys, experiments, or observations with predefined variables and measures.
• Qualitative research : Utilizes open-ended interviews, focus groups, participant observations, and textual analysis to gather rich, contextually nuanced data.

Analysis Techniques:

• Quantitative research: Involves statistical analysis to identify correlations, associations, or differences between variables.
• Qualitative research: Employs thematic analysis, coding, and interpretation to uncover patterns, themes, and insights within qualitative data.

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Access, acceptance and adherence to cancer prehabilitation: a mixed-methods systematic review

• Open access
• Published: 06 May 2024

Cite this article

You have full access to this open access article

• Tessa Watts 1 ,
• Nicholas Courtier 1 ,
• Sarah Fry 1 ,
• Nichola Gale 1 ,
• Elizabeth Gillen 1 ,
• Grace McCutchan 1 ,
• Manasi Patil 1 ,
• Tracy Rees 1 ,
• Dominic Roche 1 ,
• Sally Wheelwright 2 &
• Jane Hopkinson 1  

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The purpose of this systematic review is to better understand access to, acceptance of and adherence to cancer prehabilitation.

MEDLINE, CINAHL, PsychINFO, Embase, Physiotherapy Evidence Database, ProQuest Medical Library, Cochrane Library, Web of Science and grey literature were systematically searched for quantitative, qualitative and mixed-methods studies published in English between January 2017 and June 2023. Screening, data extraction and critical appraisal were conducted by two reviewers independently using Covidence™ systematic review software. Data were analysed and synthesised thematically to address the question ‘What do we know about access, acceptance and adherence to cancer prehabilitation, particularly among socially deprived and minority ethnic groups?’

The protocol is published on PROSPERO CRD42023403776

Searches identified 11,715 records, and 56 studies of variable methodological quality were included: 32 quantitative, 15 qualitative and nine mixed-methods. Analysis identified facilitators and barriers at individual and structural levels, and with interpersonal connections important for prehabilitation access, acceptance and adherence. No study reported analysis of facilitators and barriers to prehabilitation specific to people from ethnic minority communities. One study described health literacy as a barrier to access for people from socioeconomically deprived communities.

Conclusions

There is limited empirical research of barriers and facilitators to inform improvement in equity of access to cancer prehabilitation.

Implications for Cancer Survivors

To enhance the inclusivity of cancer prehabilitation, adjustments may be needed to accommodate individual characteristics and attention given to structural factors, such as staff training. Interpersonal connections are proposed as a fundamental ingredient for successful prehabilitation.

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Introduction

Prehabilitation is a core component of supportive care for health and well-being during cancer survivorship. It aims to improve cancer treatment outcomes and long-term health by preparing people awaiting cancer treatments, not only surgery, through support for physical activity, nutrition and emotional well-being either alone or in combination, and from the point of diagnosis [ 1 ]. Growing international evidence indicates that, in specific cancers, engagement with either uni or multimodal prehabilitation interventions can improve individuals’ pre-treatment functional capacity [ 2 , 3 ], reduce treatment-related complications [ 4 , 5 , 6 ], ease anxiety [ 7 ] and enhance post-treatment recovery [ 8 , 9 ]. As the evidence base develops and momentum for prehabilitation grows, the need to embed prehabilitation as the standard of care across different cancers has been recognised [ 10 , 11 , 12 ]. In some regions, multimodal prehabilitation is now offered as the standard of care in certain cancers, particularly lung [ 13 ] and colorectal [ 14 ].

Internationally, there are persistent health disparities following cancer treatment. Treatment and survival outcomes are poor among people from socioeconomically deprived communities and some minority ethnic groups compared to socioeconomically advantaged and majority groups [ 15 , 16 , 17 ]. To ease the overall social and economic impact of cancer on individuals and society, and to reduce the societal and healthcare costs of suboptimal treatment outcomes, it is important to identify the facilitators of and barriers to individuals’ engagement with interventions. People from socioeconomically deprived communities and some minority ethnic groups are known to be underserved in prehabilitation interventions [ 1 , 18 ]. Accordingly, to better understand reasons for informed action, this mixed-methods systematic review aims to identify, critically appraise and synthesise international empirical evidence of the facilitators of and barriers to access, acceptance  and adherence of cancer prehabilitation. For this review, prehabilitation is defined as proactive and preventative for all cancer treatments (not only surgery and including neoadjuvant) and includes interventions to support physical activity, nutritional intake or psychological well-being, alone or together, carried out at any time before a course of treatment begins.

Review question

What is known about access, acceptance and adherence to cancer prehabilitation, particularly among socially deprived and minority ethnic groups?

The systematic review was informed by the Joanna Briggs Institute (JBI) mixed-methods systematic reviews (MMSR) methodology [ 19 ]. A convergent, integrated approach to data synthesis and integration was adopted [ 19 , 20 ]. The review was registered in PROSPERO CRD42023403776) on 3 March 2023 and is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines [ 21 ]. Ethical approval was not required.

Database searches

In collaboration with a specialist health service systematic review librarian, the search strategy was developed using medical subject headings (MeSH) and keywords including and relating to cancer, prehabilitation, inequity, inequality, socioeconomic deprivation, ethnic groups and health services accessibility, and then tested and refined. The electronic databases Ovid SP MEDLINE, CINAHL via EBSCO host, PsycINFO, Ovid SP EMBASE, Ovid Emcare, Allied and Complementary Medicine (AMED), Physiotherapy Evidence Database (PEDRo) and Cochrane Central were systematically searched by EG for studies published in English between January 2017 and May 2023. The search strategy was tailored for each database and detailed in online resource (Supplementary information 1 ). Supplementary searches of grey literature using the Overton, Dimensions and Proquest dissertation and theses databases (PQDT), and relevant organisational websites were conducted. Reference lists of papers retrieved for full review were scrutinised for potentially useful papers not identified through the database searches.

Selection criteria

The PICO framework was used to guide inclusion criteria on population (P), Intervention (I), comparators (C) and outcomes (O) and context (Co). It enabled identification of primary qualitative, quantitative and mixed-methods research studies about prehabilitation, published in peer-reviewed journals. Eligibility criteria were used during study selection to screen this body of literature for empirical data about barriers and facilitators of prehabilitation. Non-empirical, opinion pieces, theoretical and methodological articles, reviews and editorials were excluded, as were studies involving children, adolescents and focusing on end-of-life care.

Study selection

All search results were stored in Endnote™. Following deduplication, results were imported into Covidence™ systematic review management software. For study selection, standardised systematic review methods [ 22 ] were used. All project team members were involved in study screening and selection. Firstly, two reviewers independently screened all returned titles and abstracts. Based on eligibility and relevance, these were sifted into ‘yes’, ‘no’ or ‘maybe’ categories. Disagreements were resolved by a third reviewer. Where a definite decision could not be made, full text was retrieved and assessed. Secondly, full text of all potentially relevant abstracts was retrieved and independently assessed for inclusion by two reviewers against the eligibility criteria. Arbitration by an independent reviewer in the event of disagreement was not required at this stage. Reasons for exclusion at full text review were recorded.

Quality assessment

Two reviewers independently assessed the quality of included studies via Covidence ™ using the Mixed Methods Appraisal Tool (MMAT) version 18 [ 23 ]. The MMAT was constructed specifically for quality appraisal in mixed studies reviews and is widely used [ 23 , 24 ]. Within a single tool, Version 18 of the MMAT can be used to appraise the methodological quality of five broad categories of study design, namely qualitative, randomised controlled trials, non-randomised, quantitative descriptive and mixed methods studies. The MMAT comprises two screening questions to establish whether or not the quality appraisal should proceed and 25 core questions: five criteria which mostly relate to the appropriateness of study design and approaches to sampling, data collection and analysis relevant to each of the five study designs [ 23 ]. Each criterion is assessed as being met (Yes) or not (No). There is also scope to indicate uncertainty. A third reviewer independently moderated all quality assessments for accuracy.

Data extraction

Two reviewers independently extracted data systematically via Covidence™ using an adapted, piloted JBI mixed-methods data extraction form. Information extracted included study author, aim, year and country of publication, setting, intervention type, design, sample, data collection, analysis, data relating to prehabilitation facilitators and barriers and, as relevant, data on intervention for support of access, acceptance or adherence to prehabilitation. A third reviewer cross-checked the data extraction tables independently for accuracy and completeness.

Data synthesis and integration

All extracted findings were imported into Microsoft Excel. Quantitative data were ‘qualitised’ into textual descriptions of quantitative results to enable assimilation with qualitative data [ 25 ]. To analyse and synthesise all findings, thematic synthesis [ 26 , 27 ] was used. Thematic analysis is an established process involving the identification and development of patterns and analytic themes in primary research data. Two reviewers coded the findings and then grouped related codes into preliminary descriptive themes which captured patterns across the data describing barriers to and facilitators of cancer prehabilitation [ 26 ]. Preliminary themes were discussed with a third reviewer. Themes were then further combined and synthesised to generate three overarching analytical themes relative to the review question [ 26 ].

Figure 1 shows the PRISMA flow chart of search results. Following the first and second round screening, 56 papers published between 2017 and 2023 were included: 33 quantitative; 14 qualitative and nine mixed methods.

PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources. *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). **If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/

A synopsis of study characteristics and the quality appraisal outcomes is found in Table 1 . Brief narrative summaries of the included papers’ findings of relevance to the review question, namely access, acceptance and adherence of prehabilitation interventions, are provided in the online supplementary information (supplementary information 2 ).

Study characteristics

Of the 32 quantitative studies reviewed, there were eight randomised controlled trials, two single-arm multi-centre trials, seven cohort studies and one cross-sectional survey. Others were pilot ( n = 3), feasibility ( n = 7), observational ( n = 1) and prevalence ( n = 1) studies, with one non-randomised trial and one audit. Qualitative studies ( n = 15) mainly used a broad qualitative approach ( n = 12), one used phenomenology, one participatory action research and one used a cross-sectional survey. Nine studies used mixed methods.

Study populations

The majority of included studies were conducted in Europe ( n = 33) (UK ( n = 19), Netherlands ( n = 4), Denmark ( n = 3), Spain ( n = 1), France ( n =1), Portugal ( n = 1), Belgium ( n = 1), Slovenia ( n = 1), Norway ( n = 1) and Sweden ( n = 1)). Eleven were conducted in North America (Canada ( n = 8), United States ( n =3)), and eight were from Australia. The remaining studies were from Japan ( n = 1) and China ( n =1), and two studies were conducted across two countries, Australia and New Zealand and the UK and Norway. Studies focused on prehabilitation in different settings including hospitals ( n = 12), local communities (including universities and local gymnasiums), individuals’ homes ( n = 14) and outdoors ( n = 1). Ten studies reported a hybrid, home and hospital approach to prehabilitation, whilst digital prehabilitation was reported in nine studies. Fifty-three studies were conducted in a range of cancers. Of these, 41 reported data for a single cancer site: colorectal ( n = 11); gastrointestinal ( n = 9); lung ( n = 7); haematology ( n= 4); breast ( n = 3); head and neck ( n =2); bladder ( n = 2) prostate ( n =1) and a range of abdominal surgeries ( n = 3). In 12 studies, cancer sites were pooled. Three studies focused on healthcare professionals ( n = 2) and key stakeholders ( n = 1).

Methodological quality

There was considerable variation in the methodological quality of the 56 studies included. Twelve studies, 10 qualitative and two quantitative, satisfied all the MMAT criteria [ 23 ]. Fourteen studies, nine mixed methods, two qualitative and three quantitative, satisfied just one or two criteria. Thus, data were extracted from a body of literature where one-fifth (21%) of publications were about research of the highest quality, defined as having met 100% of the MMAT criteria [ 23 ]. Detailed results of the MMAT quality assessments are found in supplementary information (supplementary information 3 ).

Thematic synthesis

The thematic synthesis identified three cross-cutting analytic themes. As illustrated in Figure 2 , these themes reflected individual, structural and interpersonal facilitators of and barriers to access, acceptability and adherence of cancer prehabilitation:

Overarching themes

Theme 1 The influence of individual drivers of cancer prehabilitation engagement

Theme 2 Providing acceptable cancer prehabilitation service and interventions

Theme 3 Interpersonal support – the unifying golden thread

Interpersonal support was the unifying golden thread as it facilitated the fit between the individual and the structural for access to, acceptance of and adherence to prehabilitation.

Theme 1. The influence of individual drivers of cancer prehabilitation engagement

Factors at the level of the individual were found to shape prehabilitation access, acceptance and adherence. These included perceived need and benefits, motivations, health status and everyday practicalities.

The perceived need for and potential benefits of prehabilitation

A key stimulus for accessing and adhering to cancer prehabilitation was a belief that engagement might confer benefit. Influences included clinicians’ prehabilitation endorsement and encouragement [ 12 , 13 , 42 , 52 , 55 , 59 , 60 , 65 , 66 , 71 ], positive prior personal experiences of routine physical activities [ 60 , 69 , 70 , 77 ] and weight loss programmes [ 77 ], other patients’ support [ 12 , 71 ] and the perceived need to improve personal fitness [ 60 , 63 ]. Some participants in UK-based studies believed they had a social responsibility to engage in prehabilitation [ 63 , 64 ] as enhanced fitness would benefit healthcare services financially [ 12 , 64 ].

The money, the cost per night in the hospital, goodness knows how much that costs and the follow-up with all the doctors, the dieticians and everyone else behind (….). It’s (prehabilitation) saving the NHS thousands and thousands of pounds of money ([ 64 ] p.4).

Several studies indicated some individuals perceived prehabilitation to be beneficial in that interventions provided a welcome distraction from their illness and situation [ 64 , 72 , 74 ]. Benefit was understood in terms of being psychologically and physically prepared for cancer treatments, potentially enhancing post-treatment recovery and survival [ 12 , 55 , 60 , 63 , 64 , 66 , 67 , 68 , 70 , 71 , 74 ].

I benefited a lot from it because it caught me in that time just after diagnosis when things were pretty scary and pretty awful and I felt like it was one of the key pieces of my plan for positivity during this whole thing, because it was setting a tone for recovery ([ 74 ] p. 8)

Yet, it was also clear that some individuals were disinterested in engaging with prehabilitation [ 56 , 58 , 66 , 74 , 80 ]. Some studies suggested a connection between imminent surgery and patients’ perceptions of little benefit of prehabilitation in the short timescales [ 47 , 54 , 63 , 69 , 77 , 79 ]. Some individuals felt that making additional hospital visits for prehabilitation was onerous [ 54 ]. Others were unaccustomed to or did not want to exercise [ 36 , 70 ] or perceived exercise as demanding [ 41 ], particularly when combined with cancer treatment [ 51 ]. Some considered their existing fitness levels [ 61 , 63 ] and diet [ 61 ] sufficient. A sense of low perceived benefit of or need for prehabilitation meant it was considered a low priority [ 36 ].

Personal motivators

A cancer diagnosis [ 71 , 77 ] conjoined with the desire to improve fitness [ 63 , 64 , 72 ], survive surgery [ 63 , 64 ] and to be present for and enjoy their families [ 64 ] were influential motivators for individuals’ proactively effecting lifestyle change and thus engagement with prehabilitation. Having accessed prehabilitation, exercise logs and diaries [ 64 , 68 , 74 ], personal goal setting [ 61 , 64 , 71 ], progress self-monitoring [ 61 , 64 , 68 , 71 , 77 ], activity tracking and objective feedback [ 56 , 60 ] motivated individuals to maintain participation. They inspired them to remain on track, enabled them to realise their progress, build self-efficacy for prehabilitation adherence [ 60 , 70 , 73 , 76 , 77 ] and, through a process of cognitive reframing, regain a sense of control [ 71 ].

Now I have a feeling of control over my body . . . I don’t want cancer to define me. [ 71 ]

Nonetheless, one study reported that motivation to access prehabilitation may be negatively affected by low levels of health literacy, which is associated with socioeconomic deprivation [ 46 ]. Furthermore, sustaining motivation to continue prehabilitation could be challenging [ 43 , 45 , 58 , 64 , 70 , 74 ], especially when faced with unanticipated setbacks such as delayed surgery [ 57 ] or insufficient peer support [ 64 ].

The enduring problems of health limitations

Individuals’ physical and psychological health status influenced prehabilitation access and adherence, particularly when there was a perception of insufficient on-going professional [ 61 , 72 , 73 ] and family support [ 31 ], and interventions were located away from home. Pancreatic cancer [ 33 ] adversely affected individuals’ access to prehabilitation. Furthermore, physical health problems limited some individuals’ ability to travel and thus access hospital-based prehabilitation [ 54 , 59 , 71 ]. Symptoms experienced and perceived health status influenced individuals’ prehabilitation adherence. Reported adherence barriers included physical symptoms [ 61 , 67 , 70 , 72 , 73 , 81 ] such as fatigue [ 45 , 50 , 57 , 70 , 73 ], pain [ 40 , 45 , 57 , 59 , 70 , 71 , 73 ], digestive problems [ 30 , 35 , 39 , 47 , 55 , 67 ] and feeling unwell [ 40 , 43 , 64 , 79 ]. In addition, functional limitations [ 63 , 70 ] associated with comorbidities [ 31 , 37 , 40 , 49 , 51 , 57 , 64 , 70 , 77 ], disease status [ 37 , 41 ], pre-surgery neoadjuvant treatments [ 37 , 53 , 64 , 70 , 81 ] and mental health problems [ 35 , 39 ] were all reported to negatively affect individuals’ ability to engage with and adhere to prehabilitation, particularly in terms of physical activities.

Several studies reported that psychological distress had a negative effect on prehabilitation access and adherence [ 59 , 61 , 70 , 73 ]. Described by a participant in one study [ 63 ] as ‘dark moments’, as anxiety and stress were often connected with attending hospitals [ 71 ]. In addition, several studies reported that individuals felt overwhelmed, both generally [ 42 , 57 , 74 ] and emotionally [ 12 , 70 ], in advance of their treatments. Information overload [ 62 ] and competing personal matters which required their attention pre-treatment [ 70 , 80 ] contributed to the sense of feeling overwhelmed.

The challenges of everyday life

Across studies, insufficient time for prehabilitation was frequently reported [ 40 , 50 , 51 , 55 , 58 , 66 , 71 , 72 , 74 , 77 , 78 ]. Some individuals described competing priorities in the short space of time between diagnosis and treatment [ 49 , 57 , 59 , 70 , 79 ]. This was partly due to putting affairs in order, prioritising family time [ 61 ] or treatments being scheduled earlier than originally planned [ 35 , 54 , 55 ]. Others were constrained by their employment [ 51 , 70 , 73 , 80 ] and family responsibilities, including caring for other family members [ 55 , 58 , 70 ]. Additional barriers to prehabilitation engagement included geographical distance to hospitals delivering prehabilitation [ 28 , 32 , 41 , 51 , 54 , 57 , 63 , 74 ]; transport difficulties [ 29 , 49 , 51 , 54 , 58 , 60 , 66 , 79 ] and associated financial costs [ 51 , 66 , 71 ]; inclement weather, particularly in relation to prehabilitation with outdoor exercise components [ 45 , 57 , 64 , 70 , 73 , 74 ]; low digital literacy [ 34 , 42 , 76 ]; restricted or limited access to and problems with technology [ 42 , 56 , 76 , 80 ], notably broadband [ 45 , 79 ] and experiencing physical discomfort with exercise equipment [ 60 , 64 ].

Theme 2. Providing acceptable cancer prehabilitation service and interventions

The prehabilitation environment, mode of delivery (which might be technological) and the perceived utility of interventions were important facilitators of access [ 34 , 48 , 57 , 66 , 71 , 75 , 80 ] and adherence [ 36 , 45 , 48 , 61 ] and influenced acceptance [ 36 , 52 , 61 , 64 , 69 , 71 , 77 , 80 , 81 ].

The value of home-based prehabilitation

Home-based prehabilitation interventions with remote professional supervision and support were accepted for their convenience [ 38 , 74 ], capacity to motivate [ 38 , 61 , 64 , 73 ] and build self-efficacy [ 40 , 61 , 64 , 73 ] and perceived benefit [ 40 , 69 , 74 ]. Specifically, individuals reported that home-based prehabilitation enabled them to integrate interventions into their everyday lives [ 61 , 64 ]. Exercising in the safe, private, space of home was enjoyable [ 36 , 66 ], could help with overcoming self-consciousness and engendered a sense of control [ 61 , 64 ].

I couldn’t go to the gym any longer. I can’t very well be running out to the toilet the whole time. So, I had to find something else, so it was that [static bike at home]. ([ 61 ] p. 206) …I don’t want to do it [prehabilitation] in a hospital because I think it then becomes really competitive. And people are, like, if they can’t do it, they feel…. They would feel like, ‘Oh, I’m not strong enough…’ you know what I mean. It might depress them. Whereas if you do it in the house, you can do it at your own pace, there’s nobody watching over you and everything. [ 64 ]

Home-based prehabilitation interventions were important facilitators of access [ 48 , 66 ] and adherence [ 36 , 48 , 61 ]. The provision of portable exercise equipment such as resistance bands enabled sustained adherence, particularly when individuals were temporarily away from home [ 74 ]. Some individuals welcomed the freedom and flexibility of home-based prehabilitation [ 72 ]. Yet despite being provided with resources to monitor [ 34 , 42 , 52 , 64 , 66 , 76 ], supplement and continue physical activity at home [ 48 , 63 , 66 , 74 , 77 ], insufficient in-person healthcare professional engagement and encouragement could mean adherence was often difficult to monitor [ 69 , 81 ] and sustained intervention adherence could be challenging [ 28 , 63 , 64 ] and afforded a low priority by individuals [ 61 , 72 , 73 ].

There had to be real pressure, there really had! And then if suddenly they were not around (the health professionals), then I’m not sure I’d finish it. That’s how I am. You have to keep an eye on me. [ 72 ]

Navigating the technological space of tele-prehabilitation

Sometimes referred to as ‘tele’ or ‘digital’-prehabilitation, technology-based uni and multimodal home-based prehabilitation capitalised on internet and/or telephone communication services and was delivered using smartphones, videos, wearable technology, tablets, mobile applications, video platforms and secure video conferencing [ 34 , 36 , 42 , 45 , 56 , 70 , 71 , 76 , 80 ]. In terms of acceptability, individuals perceived home-based, tele-prehabilitation programmes as accessible, particularly during the SARS-CoV-2 pandemic [ 34 , 71 , 80 ]:

Having prehabilitation outside of the hospital setting made things easier. I wasn’t feeling good with the pain and couldn’t travel too far. Could also do it in my own time ([ 71 ] p. 646)

Home-based tele-rehabilitation was also perceived as motivating [ 36 , 45 , 56 , 76 ], conferred benefit [ 34 , 36 , 45 , 56 , 80 ], particularly when personalised [ 34 , 45 , 56 , 71 ] and reduced transport-associated costs [ 80 ].

Sustained tele-prehabilitation engagement was aided by the provision of smartphones [ 56 , 76 ], tablets with relevant applications and content downloaded [ 34 ], training watches [ 34 , 56 , 76 ], supplementary information and alternate web browser pathways for those without access to or with low digital literacy [ 42 ] and integrated digital training and support during the intervention’s implementation [ 34 , 36 , 42 ].

I would not have been able to endure the treatments and the surgery thereafter had it not been for the continuous support I was receiving through the digital platform. [ 34 ]

Reported barriers were primarily intervention specific. They included technical [ 45 , 80 ] and device connectivity issues [ 34 , 76 ], broadband and website interface problems, particularly for individuals unaccustomed to using technology [ 45 ]. Negative views of mobile mindfulness apps [ 56 ] and equipment aesthetics [ 76 ] were also described.

The perceived utility of prehabilitation interventions

Interventions that were perceived as being accessible in terms of their user-friendliness [ 34 , 56 , 74 , 76 ] and appropriately designed to meet individuals’ needs, preferences and capabilities in terms of their structure [ 40 , 52 , 60 , 68 , 74 , 77 , 78 ], notably coherence [ 36 , 38 , 45 , 75 , 76 ] and components [ 38 , 54 , 55 , 64 , 69 , 74 ], including nutritional supplements [ 44 , 54 , 55 , 67 ], enhanced acceptability. The acceptability of prehabilitation interventions was reflected in the expressions of gratitude [ 12 ] and the positive ways in which interventions were variously described by individuals in some studies [ 12 , 38 , 58 , 64 , 74 ] as ‘excellent’, ‘very good’, ‘great’, ‘brilliant’, ‘hugely beneficial’ and ‘fun’. Some would even recommend home-based prehabilitation to people preparing for cancer treatments [ 52 , 63 , 68 , 74 ]. However, one study [ 42 ] reported that unfamiliarity with the English language had a negative impact on access, whilst in another study [ 56 ], individuals reported adhering to protein targets challenging.

At an individual level, the availability [ 61 ] and extent of integrated healthcare professional supervision and support was perceived to enable intervention access [ 75 ] and adherence [ 42 , 60 , 61 , 64 , 66 , 68 , 69 , 74 , 78 ], particularly when this was personalised [ 34 , 45 , 56 , 65 , 68 , 71 , 78 ]. Unpalatable nutritional interventions had a negative effect on intervention adherence [ 30 , 50 ], and it was reported that inspiratory muscle training devices could be difficult for individuals to use [ 38 ].

Healthcare professionals reported organisational barriers to implementation, and thus individuals’ access to, acceptance of and adherence with prehabilitation. These barriers included workforce capacity limitations [ 12 , 65 , 75 , 79 , 81 ], including insufficient embedded specialist prehabilitation professionals [ 69 , 81 ], delayed or insufficient referral to prehabilitation [ 33 , 44 , 63 ], disconnect in cross-boundary systematic service delivery and communication [ 12 , 28 , 75 , 81 ], inadequate funding [ 12 , 65 , 79 , 81 ] and awareness of local prehabilitation provision, uncertainty regarding what constitutes prehabilitation among some healthcare professionals [ 28 , 79 , 81 ] and space and time constraints [ 69 , 81 ] together with insufficient equipment [ 28 ] in hospital settings to deliver interventions [ 81 ].

Theme 3. Interpersonal support: the unifying golden thread

Across the studies reviewed, the unifying golden thread was interpersonal support, for this was an important, valued enabler of prehabilitation access [ 64 ] acceptance and adherence. It was reported that interpersonal support was derived from family and friends [ 12 , 45 , 60 , 61 , 64 , 70 , 73 ], prehabilitation healthcare professionals [ 42 , 51 , 55 , 60 , 61 , 63 , 64 , 66 , 69 , 71 , 75 , 78 ], prehabilitation peers [ 51 , 59 ], volunteers [ 79 ] and in-person and online peer support groups [ 71 , 79 ]. When embedded within interventions, a network of interpersonal support helped to sustain prehabilitation adherence, particularly in relation to physical activity [ 59 , 60 , 68 , 72 , 79 ]. During what could be challenging times, the interpersonal support experienced during prehabilitation enhanced interventions’ acceptability [ 52 , 60 , 63 , 68 ].

The active involvement of family during physical activities such as walking and exercise routines was reported to generate a sense of companionship, encouragement and motivational and psychological support [ 34 , 60 , 61 , 64 , 70 , 71 , 77 ]. In these ways, prehabilitation interventions with embedded family support enhanced their acceptability [ 52 ].

My wife did the same ones with me so there were two of us doing the same stuff. We did the walks together. Then we would both do the exercises. So that was good company. [ 64 ]

Findings reported in one study [ 31 ] indicated that living alone could have a negative effect on prehabilitation adherence.

The acceptability of prehabilitation interventions was enhanced by relevant healthcare professionals’ supportive dialogue in the shape of information, personalised encouragement, validation and timely, constructive feedback on individuals’ engagement, progress and performance [ 69 , 77 ], signposting to other support services [ 63 ] and broader emotional support [ 77 ]. In addition to sustaining prehabilitation behaviours through collaboration, activation and motivational support [ 60 , 61 , 71 , 72 , 77 , 78 ], healthcare professionals’ presence instilled a sense of trust [ 71 ], comfort [ 51 ] and safety [ 38 , 62 , 63 ] and reduced feelings of social isolation [ 71 ]. The need for and importance of supportive dialogue with healthcare professionals during prehabilitation was identified by participants in one study investigating individuals’ experiences of multimodal prehabilitation delivered via a leaflet and with no embedded healthcare professional support [ 73 ].

I have only been a number. Like I was a garden shovel with a barcode that you scanned at the cash register. There is no one who thinks about what this means for one’s self-understanding–- just to be regarded as a disease [...] There is no one asking about the human being behind it. It is insane [ 73 ]

For some participants, peer support in the shape of information sharing was beneficial and enabled prehabilitation access [ 63 , 71 ]. Integrated group or one to one peer support was reported to enhance an intervention’s acceptability [ 12 , 63 ]. In part, this was because individuals did not always want to engage their families, and peer support reduced their sense of isolation [ 71 ]. Peer support was reported to be beneficial in terms of interaction with others in a similar situation, thereby lending individuals’ social, emotional and motivational support, enabling them to remain on track with their prehabilitation programme [ 51 , 59 , 64 , 66 , 71 ].

Exercising in a group motivates. Let new patients exercise with other patients who are further along and have more experience exercising. They (experienced patients) can then tell them, Yes, you will get muscle aches, but they will subside too. [ 59 ]

It was clear from some studies that the absence of peer support in prehabilitation interventions was lamented [ 64 , 71 ], with some participants exercising agency and accessing online patient forums to derive required support [ 71 ].

This review reports findings from across the globe regarding facilitators of and barriers to access, acceptance and adherence of cancer prehabilitation. The findings draw attention to cross-cutting themes at individual and structural levels and interpersonal factors that connect the levels. As illuminated in Fig. 2 , the multifaceted facilitators and barriers underscore the complexity of cancer prehabilitation access, acceptance and adherence.

This review found interpersonal connections, support either directly obtained from peers, family, healthcare professionals or via digital connectivity, can facilitate a fit between the individual factors and structural factors that affect engagement with prehabilitation. Examples include encouragement from a spouse willing to engage in a recommended physical activity with the patient, practical help with digital technology, peer support during group prehabilitation and health professional supervision. Support through these interpersonal connections may be a core ingredient for successful access, acceptance and adherence. This proposition should now be explored and tested. There may be sub-groups with need or preference for certain sources of interpersonal support. Our review was designed to find out ‘what is known about access, acceptance and adherence to cancer prehabilitation, particularly among socially deprived and minority ethnic groups’ because of the known benefits from prehab for post treatment recovery [ 8 , 9 ]. It found no empirically based analysis of prehabilitation access, acceptance or adherence by people from these groups.

The individual and structural context

This review revealed individual factors enabling or impeding prehabilitation access, acceptance and adherence include personal beliefs and understandings about potential harms or benefits; motivations, for example finding enjoyment in participation; health status and everyday practicalities such as time and transport availability. Structural factors identified included the availability of knowledgeable and supportive health professionals and/or people affected by cancer’ service organisation, such as the availability of a prehabilitation multidisciplinary team and the place and space of service delivery, for example, if it was available in the community.

Individual and structural level factors affecting access to cancer treatment and care are widely reported [ 82 , 83 , 84 , 85 ]. Some are proposed to be modifiable for improved health outcomes in groups at risk of poor health because of poverty and/or discrimination based on age, race, ethnicity or gender [ 84 ]. The findings of the review are consistent with this wider literature on service access, acceptance and adherence. It is notable that although our search was designed to identify all literature about access, acceptance and adherence to cancer prehabilitation from 2017 to 2023, we found no analysis of structural differences. The differential experience of people from structurally vulnerable groups, for example, those who are socioeconomically deprived or from minority communities, had not been considered. Yet, evidence indicates that cancer rehabilitation services are underutilised by people from socioeconomically deprived communities [ 86 , 87 ] and ethnic minorities [ 88 ]. We also know patient engagement with prehabilitation is variable [ 89 ], and third sector organisations claim people from socioeconomically deprived communities, which include people from some ethnic minorities, are underserved by prehabilitation services [ 1 ]. Exploration and understanding of difference in prehabilitation experiences across social groups is needed if support for access, acceptance and adherence is to achieve equity in health outcomes.

Interpersonal connections linking individual experience and structural context

This review identified that it was people, namely peers, family members and friends, who, through their support, influenced the extent to which individual and structural level factors were obstacles or enablers of prehabilitation. In the relational space between individual experience and the infrastructure in place to enable prehabilitation, these people were supportive actors, influencing individuals’ access to, acceptance of and adherence to prehabilitation.

International studies have revealed that interpersonal support is related to mental and physical health. Low perceived social support has been shown to be associated with mental and physical health problems [ 90 ]. In the USA, a high level of perceived social support was found more likely in women and young people and low level of perceived social support more likely for those living in poverty [ 90 ]. Loneliness has been proposed the mediating factor between socioeconomic status and health in a Norwegian population-based study of people aged over 40 years [ 91 ]. Two explanations were suggested. Firstly, people with few social contacts have low levels of physical activity. Secondly, people with poor physical or emotional health are more likely to have low self-esteem and self-efficacy in self-care, which is associated with less successful occupational career and low socioeconomic status and thus fewer social contact resources to manage health [ 91 ].

This review supports an argument that interpersonal connections can be important for prehabilitation access, acceptance and adherence. It found evidence of relationships with family, peers and cancer care staff influencing access to, acceptance of, and adherence to prehabilitation. Perceived social support may have a key role in successful prehabilitation. This proposition should be further explored, paying attention to the known relationship between social support and socioeconomic status in other contexts and the potential for this to be an explanation of any observed difference in access across socioeconomic groups.

Technology as interpersonal connection?

An interesting finding is of data showing some people find web-based resources and/or online help to satisfy their prehabilitation information and support needs. These people experienced interpersonal connection through technology. An online survey among 1037 adults (18+) in the UK found that 80% of those with a long-term condition used technology for managing their health, a majority for seeking information whilst a third used wearable technology or apps. Those most likely to use technologies were younger and/or of high socioeconomic status, leading the authors to caution completely digital approaches because of the potential to exclude some groups from the care they need [ 92 ]. Arguably, technology may provide a partial solution to enabling successful prehabilitation.

What this review adds

Our finding of structural and individual level factors affecting access to, acceptance of and adherence to prehabilitation is consistent with Levesque et al.’s [ 93 ] socioecological model of access to health services. Levesque et al.’s [ 93 ] model sets out access as a process with five dimensions of accessibility (approachability; acceptability; availability and accommodation; affordability; appropriateness) and five corresponding abilities of populations (ability to perceive; ability to seek; ability to reach; ability to pay; ability to engage). The model enables attention to social, service organisation and person-centred factors that influence access. However, the model does not address the relational dimensions derived from our data analysis, i.e. how person-centred and structural factors interrelate for better or poorer service access. Based on our findings, an important ingredient for improving access to prehabilitation may be attention to what happens in the relational space connecting these factors. Voorhees et al. [ 94 ] interpreted findings of participatory research about access to general practice and claimed it is the human abilities of workforce and clients that are an important yet absent consideration in Levesque’s model. They argued that staff training and support for human interaction were needed. We agree. In addition, and based on our analysis, we also consider important the network of interactions between patient and others. Understanding the nature and mechanisms of these interactions may be important for health equity in prehabilitation.

Strengths and limitations

A strength of this review is that established, rigorous systematic review processes were followed to identify and select relevant peer-reviewed literature. Methods and thematic synthesis procedures were reported explicitly, providing an audit trail for dependability. To maximise study identification, the detailed and comprehensive search strategy was developed with the assistance of an expert information specialist, and the review was conducted by a multidisciplinary team with a minimum of two reviewers engaged in the screening and extracting process. Searches were limited from 2017 to 2023 and published in the English language. By limiting the search dates in this way, we have ensured that the evidence assessed has context and relevance to current policy and practices. This systematic review, as a result, provides an overarching picture and holistic understanding of access, acceptance and adherence to cancer prehabilitation. However, this review is not without its limitations. It is possible that some potentially useful studies, notably those not published in the English language have been omitted. Furthermore, we did not take account of study quality in our analysis. To reduce the risk of selection bias, studies were included irrespective of their methodological quality assessment. However, this means that some low quality evidence has been included, and this is a limitation to the credibility of the analysis. Nevertheless, there is some consistency between studies and across international healthcare settings. This does indicate a level of trustworthiness in the review findings. The review was of mixed cancer sites. Cancer site along with its symptoms and treatment-related problems may affect access, acceptance and adherence to prehabilitation. As the body of literature about engagement with prehabilitation grows, further work will be warranted to investigate cancer site–specific factors affecting inclusion in prehabilitation.

ThQueryere is limited empirical study of barriers and facilitators to inform improvement in equity of access to cancer prehabilitation. To enhance the inclusivity of cancer prehabilitation, adjustments may be needed to accommodate individual preferences and characteristics, such as comorbidity, and attention given to structural factors, such as staff training. Based on our findings, we propose interpersonal connections as a fundamental core ingredient for facilitation of prehabilitation access, acceptance and adherence.

Systematic review registration

This systematic review was registered in PROSPERO (CRD42023403776)

Data Availability

All data generated for this review are included in the manuscript and/or the supplementary files.

Macmillan Cancer Support. Prehabilitation for people with cancer: Principles and guidance for prehabilitation within the management and support of people with cancer. Macmillan Cancer Support. 2020. http://www.macmillan.org.uk/healthcare-professionals/news-and-resources/guides/principles-and-guidance-forprehabilitation . Accessed 03 Mar 2023.

Waterland JL, McCourt O, Edbrooke L, Granger CL, Ismail H, Riedel B, Denehy L. Efficacy of prehabilitation including exercise on postoperative outcomes following abdominal cancer surgery: a systematic review and meta-analysis Front Surg. 2021;19(8):628848. https://doi.org/10.3389/fsurg.2021.628848 .

Falz R, Bischoff C, Thieme R, Lässing J, Mehdorn M, Stelzner S, Busse M, Gockel I. Effects and duration of exercise-based prehabilitation in surgical therapy of colon and rectal cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol. 2022;148(9):2187–213. https://doi.org/10.1007/s00432-022-04088-w .

Article   PubMed   PubMed Central   Google Scholar  

Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, Moriarty J, Wilson F. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis. Surgery. 2016;160(5):1189–201. https://doi.org/10.1016/j.surg.2016.05.014 .

Article   PubMed   Google Scholar  

Halliday LJ, Doganay E, Wynter-Blyth VA, Hanna GB, Moorthy K. The impact of prehabilitation on post-operative outcomes in oesophageal cancer surgery: a propensity score matched comparison. J Gastrointest Surg. 2021;25(11):2733–41. https://doi.org/10.1007/s11605-020-04881-3 .

Heil TC, Verdaasdonk EGG, Maas HAAM, van Munster BC, Rikkert MGMO, de Wilt JHW, Melis RJF. Improved postoperative outcomes after prehabilitation for colorectal cancer surgery in older patients: an emulated target trial. Ann Surg Oncol. 2023;30(1):244–54. https://doi.org/10.1245/s10434-022-12623-9 .

Scriney A, Russell A, Loughney L, Gallagher P, Boran L. The impact of prehabilitation interventions on affective and functional outcomes for young to midlife adult cancer patients: a systematic review. Psychooncology. 2022;31(12):2050–62. https://doi.org/10.1002/pon.6029 .

Michael CM, Lehrer EJ, Schmitz KH, Zaorsky NG. Prehabilitation exercise therapy for cancer: a systematic review and meta-analysis. Cancer Med. 2021;10(13):4195–205. https://doi.org/10.1002/cam4.4021 .

Minnella EM, Awasthi R, Bousquet-Dion G, Ferreira V, Austin B, Audi C, Tanguay S, Aprikian A, Carli F, Kassouf W. Multimodal prehabilitation to enhance functional capacity following radical cystectomy: a randomized controlled trial. Eur Urol Focus. 2021;7(1):132–8. https://doi.org/10.1016/j.euf.2019.05.016 .

Stout NL, Silver JK, Baima J, Knowlton SE, Hu X. Prehabilitation: an emerging standard in exercise Oncology. In: Schmitz K, editor. Exercise Oncology. Switzerland AG: Springer International Publishing; 2020. p. 111–43.

Chapter   Google Scholar  

Moore J, Merchant Z, Rowlinson K, McEwan K, Evison M, Faulkner G, Sultan J, McPhee JS, Steele J. Implementing a system-wide cancer prehabilitation programme: the journey of Greater Manchester's Prehab4cancer. Eur J Surg Oncol. 2021; 47(3 Pt A):524-532 https://doi.org/10.1016/j.ejso.2020.04.042

Bingham SL, Small S, Sempl CJ. A qualitative evaluation of a multi-modal cancer prehabilitation programme for colorectal, head and neck and lung cancer patients. PLoS One. 2023;18(10):e0277589. https://doi.org/10.1371/journal.pone.0277589 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Bradley P, Marchant Z, Rowlinson-Groves K, Taylor M, Moore J, Evison M. Feasibility and outcomes of a real-world regional lung prehabilitation programme in the UK. Br J Anaesth. 2023;130(1):e47-e55 https://doi.org/10.1016/j.bja.2022.05.034

Sabajo CR, Ten Cate DWG, Heijmans MHM, Koot CTG, van Leeuwen LVL, Slooter GD. Prehabilitation in colorectal cancer surgery improves outcome and reduces hospital costs. Eur J Surg Oncol. 2024;50(1):107302. https://doi.org/10.1016/j.ejso.2023.107302 .

Ammitzbøll G, Levinsen AKG, Kjær TK, Ebbestad FE, Horsbøl TA, Saltbæk L, Badre-Esfahani SK, Joensen A, Kjeldsted E, Halgren Olsen M, Dalton SO. Socioeconomic inequality in cancer in the Nordic countries. A systematic review. Acta Oncol. 2022;61(11):1317–31. https://doi.org/10.1080/0284186X.2022.2143278 .

Boujibar F, Bonnevie T, Debeaumont D, Bubenheim M, Cuvellier A, Peillon C, Gravier FE, Baste JM. Impact of prehabilitation on morbidity and mortality after pulmonary lobectomy by minimally invasive surgery: a cohort study. J Thorac Dis. 2018; 10(4):2240-2248. https://doi.org/10.21037/jtd.2018.03.161

Giaquinto AN, Miller KD, Tossas KY, Winn RA, Jemal A, Siegel RL. Cancer statistics for African American/Black People. CA Cancer J Clin. 2022;72(3):202-229. https://doi.org/10.3322/caac.21718

Lee D, Wang A, Augustin B, Buajitti E, Tahasildar B, Carli F, Gillis C. Socioeconomic status influences participation in cancer prehabilitation and preparation for surgical recovery: a pooled retrospective analysis using a validated area-level socioeconomic status metric. Eur J Surg Oncol. 2023;49(2):512–20. https://doi.org/10.1016/j.ejso.2022.10.023 .

Lizorando L, Stern C, Carrier J, Godfrey C, Rieger K, Salmond S, Apostolo J, Kirkpatrick P, Loveday H (2020) Mixed methods systematic reviews. In: Aromataris E, Munn Z, editors. JBI manual for evidence synthesis. JBI. 2020. https://doi.org/10.46658/JBIMES-20-09

Hong QN, Pluye P, Bujold M, Wassef M. Convergent and sequential synthesis designs: implications for conducting and reporting systematic reviews of qualitative and quantitative evidence. Syst Rev. 2017;6(1):61. https://doi.org/10.1186/s13643-017-0454-2 .

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;29(372):n71. https://doi.org/10.1136/bmj.n71 .

Article   Google Scholar  

Centre for Reviews & Dissemination. CRD’s guidance on undertaking reviews in health care. York: University of York; 2009.

Google Scholar  

Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, Gagnon MP, Griffiths F, Nicolau B, O’Cathain A, Rousseau MC, Vedel I, Pluye P. The mixed methods appraisal tool (MMAT) version 2018 for information professionals and researchers. Education for Information. 2018;34:285–91. https://doi.org/10.3233/EFI-180221 .

Pace R, Pluye P, Bartlett G, Macaulay AC, Salsberg J, Jagosh J, Seller R. Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review. Int J Nurs Stud. 2012;49(1):47–53. https://doi.org/10.1016/j.ijnurstu.2011.07.002 .

Stern C, Lizarondo L, Carrier J, Godfrey C, Rieger K, Salmond S, Apóstolo J, Kirkpatrick P, Loveday H. Methodological guidance for the conduct of mixed methods systematic reviews. JBI Evid Synth. 2020;18(10):2108–18.

Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45. https://doi.org/10.1186/1471-2288-8-45 .

Thomas J, O’Mara-Eves A, Harden A, Newman M. Synthesis methods for combining and configuring textual or mixed methods data. In: Gough D, Oliver S, Thomas J, editors. An introduction to systematic reviews. London: Sage Publishing; 2017. p. 181–209.

PREPARE-ABC Trial Collaborative SupPoRtive Exercise Programmes for Accelerating REcovery after major ABdominal Cancer surgery trial (PREPARE-ABC). Pilot phase of a multicentre randomised controlled trial. Colorectal Dis. 2021;23(11):3008-3022. https://doi.org/10.1111/codi.15856

Argudo N, Rodó-Pin A, Martínez-Llorens J, Marco E, Visa L, Messaggi-Sartor M, Balañá-Corberó A, Ramón JM, Rodríguez-Chiaradía DA, Grande L, Pera M. Feasibility, tolerability, and effects of exercise-based prehabilitation after neoadjuvant therapy in esophagogastric cancer patients undergoing surgery: an interventional pilot study. Dis Esophagus. 2021; 34(4):doaa086. https://doi.org/10.1093/dote/doaa086

Burden ST, Gibson DJ, Lal S, Hill J, Pilling M, Soop M, Ramesh A, Todd C. Pre-operative oral nutritional supplementation with dietary advice versus dietary advice alone in weight-losing patients with colorectal cancer: single-blind randomized controlled trial. J Cachexia Sarcopenia Muscle. 2017;8(3):437–46. https://doi.org/10.1002/jcsm.12170 .

Catho H, Guigard S, Toffart AC, Frey G, Chollier T, Brichon PY, Roux JF, Sakhri L, Bertrand D, Aguirre C, Gorain S, Wuyam B, Arbib F, Borel JC. What are the barriers to the completion of a home-based rehabilitation programme for patients awaiting surgery for lung cancer: a prospective observational study. BMJ Open. 2021;11(2):e041907. https://doi.org/10.1136/bmjopen-2020-041907 .

Crowe J, Francis JJ, Edbrooke L, Loeliger J, Joyce T, Prickett C, Martin A, Khot A, Denehy L; Centre for Prehabilitation Peri-operative Care (CPPOC). Impact of an allied health prehabilitation service for haematologic patients receiving high-dose chemotherapy in a large cancer centre. Support Care Cancer. 2022; 30(2):1841-1852. https://doi.org/10.1007/s00520-021-06607-w

Deftereos I, Yeung JM, Arslan J, Carter VM, Isenring E, Kiss N, On Behalf Of The Nourish Point Prevalence Study Group. Preoperative nutrition intervention in patients undergoing resection for upper gastrointestinal cancer: results from the Multi-Centre NOURISH Point Prevalence Study Nutrients. 2021;13(9):3205. https://doi.org/10.3390/nu13093205

Drummond K, Lambert G, Tahasildar B, Carli F. Successes and challenges of implementing teleprehabilitation for onco-surgical candidates and patients’ experience: a retrospective pilot-cohort study. Sci Rep. 2022;12(1):6775. https://doi.org/10.1038/s41598-022-10810-y .

Ferreira V, Lawson C, Carli F, Scheede-Bergdahl C, Chevalier S. Feasibility of a novel mixed-nutrient supplement in a multimodal prehabilitation intervention for lung cancer patients awaiting surgery: a randomized controlled pilot trial. Int J Surg. 2021;93:106079. https://doi.org/10.1016/j.ijsu.2021.106079 .

Franssen RFW, Bongers BC, Vogelaar FJ, Janssen-Heijnen MLG. Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study. Perioper Med (Lond). 2022;11(1):28. https://doi.org/10.1186/s13741-022-00260-5 .

Halliday LJ, Doganay E, Wynter-Blyth V, Osborn H, Buckley J, Moorthy K. Adherence to pre-operative exercise and the response to prehabilitation in oesophageal cancer patients. J Gastrointest Surg. 2021;25(4):890–9. https://doi.org/10.1007/s11605-020-04561-2 .

Karlsson E, Farahnak P, Franzén E, Nygren-Bonnier M, Dronkers J, van Meeteren N, Rydwik E. Feasibility of preoperative supervised home-based exercise in older adults undergoing colorectal cancer surgery - a randomized controlled design. PLoS One. 2019;14(7):e0219158. https://doi.org/10.1371/journal.pone.0219158 .

Lawson C, Ferreira V, Carli F, Chevalier S. Effects of multimodal prehabilitation on muscle size, myosteatosis, and dietary intake of surgical patients with lung cancer - a randomized feasibility study. Appl Physiol Nutr Metab. 2021;46(11):1407–16. https://doi.org/10.1139/apnm-2021-0249 .

Article   CAS   PubMed   Google Scholar  

Machado P, Pimenta S, Garcia AL, Nogueira T, Silva S, Oliveiros B, Martins RA, Cruz J. Home-based preoperative exercise training for lung cancer patients undergoing surgery: a feasibility trial. J Clin Med. 2023;12(8):2971. https://doi.org/10.3390/jcm12082971 .

Minnella EM, Baldini G, Quang ATL, Bessissow A, Spicer J, Carli F. Prehabilitation in thoracic cancer surgery: from research to standard of care. J Cardiothorac Vasc Anesth. 2021;35(11):3255–64. https://doi.org/10.1053/j.jvca.2021.02.049 .

Moorthy K, Halliday LJ, Noor N, Peters CJ, Wynter-Blyth V, Urch CE. Feasibility of implementation and the impact of a digital prehabilitation service in patients undergoing treatment for oesophago-gastric cancer. Curr Oncol. 2023;30(2):1673–82. https://doi.org/10.3390/curroncol30020128 .

Naito T, Mitsunaga S, Miura S, Tatematsu N, Inano T, Mouri T, Tsuji T, Higashiguchi T, Inui A, Okayama T, Yamaguchi T, Morikawa A, Mori N, Takahashi T, Strasser F, Omae K, Mori K, Takayama K. Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer. J Cachexia Sarcopenia Muscle. 2019;10(1):73–83. https://doi.org/10.1002/jcsm.12351 .

Paynter E, Whelan E, Curnuck C, Dhaliwal S, Sherriff J. Pre-operative immunonutrition therapy in upper gastrointestinal cancer patients: postoperative outcomes and patient acceptance. AMJ. 2017;10(6):466–473. https://doi.org/10.21767/AMJ.2017.2962

Piraux E, Caty G, Reychler G, Forget P, Deswysen Y. Feasibility and preliminary effectiveness of a tele-prehabilitation program in esophagogastric cancer patients. J Clin Med. 2020;9(7):2176. https://doi.org/10.3390/jcm9072176 .

Qin PP, Jin JY, Min S, Wang WJ, Shen YW. Association between health literacy and enhanced recovery after surgery protocol adherence and postoperative outcomes among patients undergoing colorectal cancer surgery: a prospective cohort study. Anesth Analg. 2022;134(2):330–40. https://doi.org/10.1213/ANE.0000000000005829 .

Rupnik E, Skerget M, Sever M, Zupan IP, Ogrinec M, Ursic B, Kos N, Cernelc P, Zver S. Feasibility and safety of exercise training and nutritional support prior to haematopoietic stem cell transplantation in patients with haematologic malignancies. BMC Cancer. 2020;20(1):1142. https://doi.org/10.1186/s12885-020-07637-z .

Santa Mina D, Hilton WJ, Matthew AG, Awasthi R, Bousquet-Dion G, Alibhai SMH, Au D, Fleshner NE, Finelli A, Clarke H, Aprikian A, Tanguay S, Carli F. Prehabilitation for radical prostatectomy: a multicentre randomized controlled trial. Surg Oncol. 2018;27(2):289–98. https://doi.org/10.1016/j.suronc.2018.05.010 .

Shukla A, Granger CL, Wright GM, Edbrooke L, Denehy L. Attitudes and perceptions to prehabilitation in lung cancer. Integr Cancer Ther. 2020;19:1534735420924466. https://doi.org/10.1177/1534735420924466 .

Solheim TS, Laird BJA, Balstad TR, Stene GB, Bye A, Johns N, Pettersen CH, Fallon M, Fayers P, Fearon K, Kaasa S. A randomized phase II feasibility trial of a multimodal intervention for the management of cachexia in lung and pancreatic cancer. J Cachexia Sarcopenia Muscle. 2017;8(5):778–88. https://doi.org/10.1002/jcsm.12201 .

Stalsberg R, Bertheussen GF, Børset H, Thomsen SN, Husøy A, Flote VG, Thune I, Lundgren S. Do breast cancer patients manage to participate in an outdoor, tailored, physical activity program during adjuvant breast cancer treatment, independent of health and socio-demographic characteristics? J Clin Med. 2022;11(3):843. https://doi.org/10.3390/jcm11030843 .

Steffens D, Young J, Beckenkamp PR, Ratcliffe J, Rubie F, Ansari N, Pillinger N, Koh C, Munoz PA, Solomon M. Feasibility and acceptability of a preoperative exercise program for patients undergoing major cancer surgery: results from a pilot randomized controlled trial. Pilot Feasibility Stud. 2021;7(1):27. https://doi.org/10.1186/s40814-021-00765-8 .

Thoft-Jensen B, Jensen JB, Love-Retinger N, Bowker M, Retinger C, Dalbagni G. Implementing a multimodal prehabilitation program to radical cystectomy in a comprehensive cancer center: a pilot study to assess feasibility and outcomes. Urol Nurs. 2019;39(6):303–13. https://doi.org/10.7257/1053-816x.2019.39.6.303 .

Tweed TTT, Sier MAT, Van Bodegraven AA, Van Nie NC, Sipers WMWH, Boerma EG, Stoot JHMB. Feasibility and efficiency of the BEFORE (Better Exercise and Food, Better Recovery) prehabilitation program. Nutrients. 2021;13(10):3493. https://doi.org/10.3390/nu13103493 .

van Rooijen SJ, Molenaar CJL, Schep G, van Lieshout RHMA, Beijer S, Dubbers R, Rademakers N, Papen-Botterhuis NE, van Kempen S, Carli F, Roumen RMH, Slooter GD. Making patients fit for surgery: introducing a four pillar multimodal prehabilitation program in colorectal cancer. Am J Phys Med Rehabil. 2019;98(10):888–96. https://doi.org/10.1097/PHM.0000000000001221 .

Waller E, Sutton P, Rahman S, Allen J, Saxton J, Aziz O. Prehabilitation with wearables versus standard of care before major abdominal cancer surgery: a randomised controlled pilot study (trial registration: NCT04047524). Surg Endosc. 2022;36(2):1008–17. https://doi.org/10.1007/s00464-021-08365-6 .

Waterland JL, Ismail H, Granger CL, Patrick C, Denehy L, Riedel B; Centre for Prehabilitation and Perioperative Care. Prehabilitation in high-risk patients scheduled for major abdominal cancer surgery: a feasibility study. Perioper Med.2022;11(1):32. https://doi.org/10.1186/s13741-022-00263-2

Wu F, Laza-Cagigas R, Pagarkar A, Olaoke A, El Gammal M, Rampal T. The feasibility of prehabilitation as part of the breast cancer treatment pathway. PM R. 2021;13(11):1237–46. https://doi.org/10.1002/pmrj.12543 .

Agasi-Idenburg CS, Zuilen MK, Westerman MJ, Punt CJA, Aaronson NK, Stuiver MM. “I am busy surviving” - views about physical exercise in older adults scheduled for colorectal cancer surgery. J Geriatr Oncol. 2020;11(3):444–50. https://doi.org/10.1016/j.jgo.2019.05.001 .

Banerjee S, Semper K, Skarparis K, Naisby J, Lewis L, Cucato G, Mills R, Rochester M, Saxton J. Patient perspectives of vigorous intensity aerobic interval exercise prehabilitation prior to radical cystectomy: a qualitative focus group study. Disabil Rehabil. 2021;43(8):1084–91. https://doi.org/10.1080/09638288.2019.1651907 .

Beck A, Thaysen HV, Soegaard CH, Blaakaer J, Seibaek L. Investigating the experiences, thoughts, and feelings underlying and influencing prehabilitation among cancer patients: a qualitative perspective on the what, when, where, who, and why. Disabil Rehabil. 2022;44(2):202–9. https://doi.org/10.1080/09638288.2020.1762770 .

Brady GC, Goodrich J, Roe JWG. Using experience-based co-design to improve the pre-treatment care pathway for people diagnosed with head and neck cancer. Support Care Cancer. 2020;28(2):739–45. https://doi.org/10.1007/s00520-019-04877-z .

Collaço N, Henshall C, Belcher E, Canavan J, Merriman C, Mitchell J, Watson E. Patients’ and healthcare professionals’ views on a pre- and post-operative rehabilitation programme (SOLACE) for lung cancer: a qualitative study. J Clin Nurs. 2022;31(1–2):283–93. https://doi.org/10.1111/jocn.15907 .

Cooper M, Chmelo J, Sinclair RCF, Charman S, Hallsworth K, Welford J, Phillips AW, Greystoke A, Avery L. Exploring factors influencing uptake and adherence to a home-based prehabilitation physical activity and exercise intervention for patients undergoing chemotherapy before major surgery (ChemoFit): a qualitative study. BMJ Open. 2022;12(9):e062526. https://doi.org/10.1136/bmjopen-2022-062526 .

Daun JT, Twomey R, Dort JC, Capozzi LC, Crump T, Francis GJ, Matthews TW, Chandarana SP, Hart RD, Schrag C, Matthews J, McKenzie CD, Lau H, Culos-Reed SN. A Qualitative study of patient and healthcare provider perspectives on building multiphasic exercise prehabilitation into the surgical care pathway for head and neck cancer. Curr Oncol. 2022;29(8):5942–54. https://doi.org/10.3390/curroncol29080469 .

Ferreira V, Agnihotram RV, Bergdahl A, van Rooijen SJ, Awasthi R, Carli F, Scheede-Bergdahl C. Maximizing patient adherence to prehabilitation: what do the patients say? Support Care Cancer. 2018;26(8):2717–23. https://doi.org/10.1007/s00520-018-4109-1 .

Hogan SE, Solomon MJ, Carey SK. Exploring reasons behind patient compliance with nutrition supplements before pelvic exenteration surgery. Support Care Cancer. 2019;27(5):1853–60. https://doi.org/10.1007/s00520-018-4445-1 .

McCourt O, Fisher A, Land J, Ramdharry G, Roberts AL, Bekris G, Yong. “What I wanted to do was build myself back up and prepare”: qualitative findings from the PERCEPT trial of prehabilitation during autologous stem cell transplantation in myeloma. BMC Cancer. 2023;23(1):348. https://doi.org/10.1186/s12885-023-10799-1

Murdoch J, Varley A, McCulloch J, Jones M, Thomas LB, Clark A, Stirling S, Turner D, Swart AM, Dresser K, Howard G, Saxton J, Hernon J. Implementing supportive exercise interventions in the colorectal cancer care pathway: a process evaluation of the PREPARE-ABC randomised controlled trial. BMC Cancer. 2021;21(1):1137. https://doi.org/10.1186/s12885-021-08880-8 .

Sun V, Raz DJ, Kim JY, Melstrom L, Hite S, Varatkar G, Fong Y. Barriers and facilitators of adherence to a perioperative physical activity intervention for older adults with cancer and their family caregivers. J Geriatr Oncol. 2020;11(2):256–62. https://doi.org/10.1016/j.jgo.2019.06.003 .

Wu F, Laza-Cagigas R, Rampal T. Understanding patients’ experiences and perspectives of tele-prehabilitation: a qualitative study to inform service design and delivery. Clin Pract. 2022;12(4):640–52. https://doi.org/10.3390/clinpract12040067 .

Beck A, Vind Thaysen H, Hasselholt Soegaard C, Blaakaer J, Seibaek L. What matters to you? An investigation of patients’ perspectives on and acceptability of prehabilitation in major cancer surgery. Eur J Cancer Care. 2021;30(6): e13475. https://doi.org/10.1111/ecc.13475 .

Beck A, Vind Thaysen H, Hasselholt Soegaard C, Blaakaer J, Seibaek L. Prehabilitation in cancer care: patients’ ability to prepare for major abdominal surgery. Scand J Caring Sci. 2021;35(1):143–55. https://doi.org/10.1111/scs .

Brahmbhatt P, Sabiston CM, Lopez C, Chang E, Goodman J, Jones J, McCready D, Randall I, Rotstein S, Santa Mina D. Feasibility of prehabilitation prior to breast cancer surgery: a mixed-methods study. Front Oncol. 2020;10:571091. https://doi.org/10.3389/fonc.2020.571091 .

Deftereos I, Hitch D, Butzkueven S, Carter V, Fetterplace K, Fox K, Ottaway A, Pierce K, Steer B, Varghese J, Kiss N, Yeung JM. Implementing a standardised perioperative nutrition care pathway in upper gastrointestinal cancer surgery: a mixed-methods analysis of implementation using the Consolidated Framework for Implementation Research. BMC Health Serv Res. 2022;22(1):256. https://doi.org/10.1186/s12913-022-07466-9 .

Low CA, Danko M, Durica KC, Kunta AR, Mulukutla R, Ren Y, Bartlett DL, Bovbjerg DH, Dey AK, Jakicic JM. A real-time mobile intervention to reduce sedentary behavior before and after cancer surgery: usability and feasibility study. JMIR Perioper Med. 2020;3(1):e17292. https://doi.org/10.2196/17292 .

Macleod M, Steele RJC, O’Carroll RE, Wells M, Campbell A, Sugden JA, Rodger J, Stead M, McKell J, Anderson AS. Feasibility study to assess the delivery of a lifestyle intervention (TreatWELL) for patients with colorectal cancer undergoing potentially curative treatment. BMJ Open. 2018;8(6):e021117. https://doi.org/10.1136/bmjopen-2017-021117 .

Mawson S, Keen C, Skilbeck J, Ross H, Smith L, Dixey J, Walters SJ, Simpson R, Greenfield DM, Snowden JA. Feasibility and benefits of a structured prehabilitation programme prior to autologous stem cell transplantation (ASCT) in patients with myeloma; a prospective feasibility study. Physiotherapy. 2021;113:88–99. https://doi.org/10.1016/j.physio.2021.08.001 .

Provan D, McLean G, Moug SJ, Phillips I, Anderson AS. Prehabilitation services for people diagnosed with cancer in Scotland-Current practice, barriers and challenges to implementation. Surgeon. 2022;20(5):284–90. https://doi.org/10.1016/j.surge.2021.08.005 .

Waterland JL, Chahal R, Ismail H, Sinton C, Riedel B, Francis JJ, Denehy L. Implementing a telehealth prehabilitation education session for patients preparing for major cancer surgery. BMC Health Serv Res. 2021;21(1):443. https://doi.org/10.1186/s12913-021-06437-w .

Robinson R, Crank H, Humphreys H, Fisher P, Greenfield DM. Time to embed physical activity within usual care in cancer services: a qualitative study of cancer healthcare professionals’ views at a single centre in England. Disabil Rehabil. 2023;45(21):3484–92. https://doi.org/10.1080/09638288.2022.2134468 .

Hewitt M, Simone JC. Ensuring access to cancer care. In: Hewit M, Simone JC, editors. Ensuring Quality Cancer Care. Washingon: National Academy Press; 1999. p. 46–78.

Dunn JG, Garvey PC, Valery D, Ball KM, Fong S, Vinod DL, O’Connell SK, Chambers. Barriers to lung cancer care: health professionals’ perspectives. Support Care Cancer. 2017;25:497–504. https://doi.org/10.1007/s00520-016-3428-3

Bourgeois A, Horrill TC, Mollison A, Lambert LK, Stajduhar KI. Barriers to cancer treatment and care for people experiencing structural vulnerability: a secondary analysis of ethnographic data. Int J Equity in Health. 2023;22:58 https://doi.org/10.1186/s12939-023-01860-3

Pearson SA, Taylor S, Marsden A, Dalton O’Reilly J, Krishan A, Howell S, Yorke J. Geographic and sociodemographic access to systemic anticancer therapies for secondary breast cancer: a systematic review. Systematic Reviews. 2024;13:35 https://doi.org/10.1186/s13643-023-02382-3

Oksbjerg Dalton S, Halgren Olsen M, Moustsen IR, Wedell Andersen C, Vibe-Petersen J, Johansen C. Socioeconomic position, referral and attendance to rehabilitation after a cancer diagnosis: a population-based study in Copenhagen, Denmark 2010-2015. Acta Oncol. 201;58(5):730-736. https://doi.org/10.1080/0284186X.2019.1582800

Ross L, Petersen MA, Johnsen AT, Lundstrøm LH, Groenvold M. Are different groups of cancer patients offered rehabilitation to the same extent? A report from the population-based study “The Cancer Patient’s World.” Support Care Cancer. 2012;20(5):1089–100. https://doi.org/10.1007/s00520-011-1189-6 .

Kristiansen M, Adamsen L, Piil K, Halvorsen I, Nyholm N, Hendriksen C. A three-year national follow-up study on the development of community-level cancer rehabilitation in Denmark. Scand J Public Health. 2019;47(5):511–8. https://doi.org/10.1177/1403494817746535 .

Provan D, McLean G, Moug SJ, Phillips I, Anderson AS. Prehabilitation services for people diagnosed with cancer in Scotland - current practice, barriers and challenges to implementation. Surgeon. 2022;20(5):284–90. https://doi.org/10.1016/j.surge.2021.08.005 .

Moak ZB, Agrawal A. The association between perceived interpersonal social support and physical and mental health: results from the National Epidemiological Survey on Alcohol and Related Conditions. J Public Health (Oxf). 2010;32(2):191–201. https://doi.org/10.1093/pubmed/fdp093 .

Aartsen M, Veenstra M, Hansen T. Social pathways to health: On the mediating role of the social network in the relation between socio-economic position and health. SSM Popul Health. 2017;3:419–26. https://doi.org/10.1016/j.ssmph.2017.05.006 .

NHS Confederation in partnership with Google Health. Patient empowerment: what is the role of technology in transforming care? NHS Confederation. 2023.  http://www.nhsconfed.org/publications/patientempowerment-what-role-technology-transforming-care#:~:text=Ensuring%20digital%20access%20and%20inclusion,-There%20are%20disparitiestext=Adopting%20a%20digitalfirst%20approach,and%20centre%20of%20the%20design . Accessed 25 Jan 2024.

Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18. https://doi.org/10.1186/1475-9276-12-18 .

Voorhees J, Bailey S, Waterman H, Checkland K. Accessing primary care and the importance of ‘human fit’: a qualitative participatory case study. Br J Gen Pract. 2022;72(718):e342–50. https://doi.org/10.3399/BJGP.2021.0375 .

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Qualitative study.

Steven Tenny ; Janelle M. Brannan ; Grace D. Brannan .

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• Introduction

Qualitative research is a type of research that explores and provides deeper insights into real-world problems. [1] Instead of collecting numerical data points or intervening or introducing treatments just like in quantitative research, qualitative research helps generate hypothenar to further investigate and understand quantitative data. Qualitative research gathers participants' experiences, perceptions, and behavior. It answers the hows and whys instead of how many or how much. It could be structured as a standalone study, purely relying on qualitative data, or part of mixed-methods research that combines qualitative and quantitative data. This review introduces the readers to some basic concepts, definitions, terminology, and applications of qualitative research.

Qualitative research, at its core, asks open-ended questions whose answers are not easily put into numbers, such as "how" and "why." [2] Due to the open-ended nature of the research questions, qualitative research design is often not linear like quantitative design. [2] One of the strengths of qualitative research is its ability to explain processes and patterns of human behavior that can be difficult to quantify. [3] Phenomena such as experiences, attitudes, and behaviors can be complex to capture accurately and quantitatively. In contrast, a qualitative approach allows participants themselves to explain how, why, or what they were thinking, feeling, and experiencing at a particular time or during an event of interest. Quantifying qualitative data certainly is possible, but at its core, qualitative data is looking for themes and patterns that can be difficult to quantify, and it is essential to ensure that the context and narrative of qualitative work are not lost by trying to quantify something that is not meant to be quantified.

However, while qualitative research is sometimes placed in opposition to quantitative research, where they are necessarily opposites and therefore "compete" against each other and the philosophical paradigms associated with each other, qualitative and quantitative work are neither necessarily opposites, nor are they incompatible. [4] While qualitative and quantitative approaches are different, they are not necessarily opposites and certainly not mutually exclusive. For instance, qualitative research can help expand and deepen understanding of data or results obtained from quantitative analysis. For example, say a quantitative analysis has determined a correlation between length of stay and level of patient satisfaction, but why does this correlation exist? This dual-focus scenario shows one way in which qualitative and quantitative research could be integrated.

Qualitative Research Approaches

Ethnography

Ethnography as a research design originates in social and cultural anthropology and involves the researcher being directly immersed in the participant’s environment. [2] Through this immersion, the ethnographer can use a variety of data collection techniques to produce a comprehensive account of the social phenomena that occurred during the research period. [2] That is to say, the researcher’s aim with ethnography is to immerse themselves into the research population and come out of it with accounts of actions, behaviors, events, etc, through the eyes of someone involved in the population. Direct involvement of the researcher with the target population is one benefit of ethnographic research because it can then be possible to find data that is otherwise very difficult to extract and record.

Grounded theory

Grounded Theory is the "generation of a theoretical model through the experience of observing a study population and developing a comparative analysis of their speech and behavior." [5] Unlike quantitative research, which is deductive and tests or verifies an existing theory, grounded theory research is inductive and, therefore, lends itself to research aimed at social interactions or experiences. [3] [2] In essence, Grounded Theory’s goal is to explain how and why an event occurs or how and why people might behave a certain way. Through observing the population, a researcher using the Grounded Theory approach can then develop a theory to explain the phenomena of interest.

Phenomenology

Phenomenology is the "study of the meaning of phenomena or the study of the particular.” [5] At first glance, it might seem that Grounded Theory and Phenomenology are pretty similar, but the differences can be seen upon careful examination. At its core, phenomenology looks to investigate experiences from the individual's perspective. [2] Phenomenology is essentially looking into the "lived experiences" of the participants and aims to examine how and why participants behaved a certain way from their perspective. Herein lies one of the main differences between Grounded Theory and Phenomenology. Grounded Theory aims to develop a theory for social phenomena through an examination of various data sources. In contrast, Phenomenology focuses on describing and explaining an event or phenomenon from the perspective of those who have experienced it.

Narrative research

One of qualitative research’s strengths lies in its ability to tell a story, often from the perspective of those directly involved in it. Reporting on qualitative research involves including details and descriptions of the setting involved and quotes from participants. This detail is called a "thick" or "rich" description and is a strength of qualitative research. Narrative research is rife with the possibilities of "thick" description as this approach weaves together a sequence of events, usually from just one or two individuals, hoping to create a cohesive story or narrative. [2] While it might seem like a waste of time to focus on such a specific, individual level, understanding one or two people’s narratives for an event or phenomenon can help to inform researchers about the influences that helped shape that narrative. The tension or conflict of differing narratives can be "opportunities for innovation." [2]

Research Paradigm

Research paradigms are the assumptions, norms, and standards underpinning different research approaches. Essentially, research paradigms are the "worldviews" that inform research. [4] It is valuable for qualitative and quantitative researchers to understand what paradigm they are working within because understanding the theoretical basis of research paradigms allows researchers to understand the strengths and weaknesses of the approach being used and adjust accordingly. Different paradigms have different ontologies and epistemologies. Ontology is defined as the "assumptions about the nature of reality,” whereas epistemology is defined as the "assumptions about the nature of knowledge" that inform researchers' work. [2] It is essential to understand the ontological and epistemological foundations of the research paradigm researchers are working within to allow for a complete understanding of the approach being used and the assumptions that underpin the approach as a whole. Further, researchers must understand their own ontological and epistemological assumptions about the world in general because their assumptions about the world will necessarily impact how they interact with research. A discussion of the research paradigm is not complete without describing positivist, postpositivist, and constructivist philosophies.

Positivist versus postpositivist

To further understand qualitative research, we must discuss positivist and postpositivist frameworks. Positivism is a philosophy that the scientific method can and should be applied to social and natural sciences. [4] Essentially, positivist thinking insists that the social sciences should use natural science methods in their research. It stems from positivist ontology, that there is an objective reality that exists that is wholly independent of our perception of the world as individuals. Quantitative research is rooted in positivist philosophy, which can be seen in the value it places on concepts such as causality, generalizability, and replicability.

Conversely, postpositivists argue that social reality can never be one hundred percent explained, but could be approximated. [4] Indeed, qualitative researchers have been insisting that there are “fundamental limits to the extent to which the methods and procedures of the natural sciences could be applied to the social world,” and therefore, postpositivist philosophy is often associated with qualitative research. [4] An example of positivist versus postpositivist values in research might be that positivist philosophies value hypothesis-testing, whereas postpositivist philosophies value the ability to formulate a substantive theory.

Constructivist

Constructivism is a subcategory of postpositivism. Most researchers invested in postpositivist research are also constructivist, meaning they think there is no objective external reality that exists but instead that reality is constructed. Constructivism is a theoretical lens that emphasizes the dynamic nature of our world. "Constructivism contends that individuals' views are directly influenced by their experiences, and it is these individual experiences and views that shape their perspective of reality.” [6]  constructivist thought focuses on how "reality" is not a fixed certainty and how experiences, interactions, and backgrounds give people a unique view of the world. Constructivism contends, unlike positivist views, that there is not necessarily an "objective"reality we all experience. This is the ‘relativist’ ontological view that reality and our world are dynamic and socially constructed. Therefore, qualitative scientific knowledge can be inductive as well as deductive.” [4]

So why is it important to understand the differences in assumptions that different philosophies and approaches to research have? Fundamentally, the assumptions underpinning the research tools a researcher selects provide an overall base for the assumptions the rest of the research will have. It can even change the role of the researchers. [2] For example, is the researcher an "objective" observer, such as in positivist quantitative work? Or is the researcher an active participant in the research, as in postpositivist qualitative work? Understanding the philosophical base of the study undertaken allows researchers to fully understand the implications of their work and their role within the research and reflect on their positionality and bias as it pertains to the research they are conducting.

Data Sampling 

The better the sample represents the intended study population, the more likely the researcher is to encompass the varying factors. The following are examples of participant sampling and selection: [7]

• Purposive sampling- selection based on the researcher’s rationale for being the most informative.
• Criterion sampling selection based on pre-identified factors.
• Convenience sampling- selection based on availability.
• Snowball sampling- the selection is by referral from other participants or people who know potential participants.
• Extreme case sampling- targeted selection of rare cases.
• Typical case sampling selection based on regular or average participants. 

Data Collection and Analysis

Qualitative research uses several techniques, including interviews, focus groups, and observation. [1] [2] [3] Interviews may be unstructured, with open-ended questions on a topic, and the interviewer adapts to the responses. Structured interviews have a predetermined number of questions that every participant is asked. It is usually one-on-one and appropriate for sensitive topics or topics needing an in-depth exploration. Focus groups are often held with 8-12 target participants and are used when group dynamics and collective views on a topic are desired. Researchers can be participant-observers to share the experiences of the subject or non-participants or detached observers.

While quantitative research design prescribes a controlled environment for data collection, qualitative data collection may be in a central location or the participants' environment, depending on the study goals and design. Qualitative research could amount to a large amount of data. Data is transcribed, which may then be coded manually or using computer-assisted qualitative data analysis software or CAQDAS such as ATLAS.ti or NVivo. [8] [9] [10]

After the coding process, qualitative research results could be in various formats. It could be a synthesis and interpretation presented with excerpts from the data. [11] Results could also be in the form of themes and theory or model development.

Dissemination

The healthcare team can use two reporting standards to standardize and facilitate the dissemination of qualitative research outcomes. The Consolidated Criteria for Reporting Qualitative Research or COREQ is a 32-item checklist for interviews and focus groups. [12] The Standards for Reporting Qualitative Research (SRQR) is a checklist covering a more comprehensive range of qualitative research. [13]

Applications

Many times, a research question will start with qualitative research. The qualitative research will help generate the research hypothesis, which can be tested with quantitative methods. After the data is collected and analyzed with quantitative methods, a set of qualitative methods can be used to dive deeper into the data to better understand what the numbers truly mean and their implications. The qualitative techniques can then help clarify the quantitative data and also help refine the hypothesis for future research. Furthermore, with qualitative research, researchers can explore poorly studied subjects with quantitative methods. These include opinions, individual actions, and social science research.

An excellent qualitative study design starts with a goal or objective. This should be clearly defined or stated. The target population needs to be specified. A method for obtaining information from the study population must be carefully detailed to ensure no omissions of part of the target population. A proper collection method should be selected that will help obtain the desired information without overly limiting the collected data because, often, the information sought is not well categorized or obtained. Finally, the design should ensure adequate methods for analyzing the data. An example may help better clarify some of the various aspects of qualitative research.

A researcher wants to decrease the number of teenagers who smoke in their community. The researcher could begin by asking current teen smokers why they started smoking through structured or unstructured interviews (qualitative research). The researcher can also get together a group of current teenage smokers and conduct a focus group to help brainstorm factors that may have prevented them from starting to smoke (qualitative research).

In this example, the researcher has used qualitative research methods (interviews and focus groups) to generate a list of ideas of why teens start to smoke and factors that may have prevented them from starting to smoke. Next, the researcher compiles this data. The research found that, hypothetically, peer pressure, health issues, cost, being considered "cool," and rebellious behavior all might increase or decrease the likelihood of teens starting to smoke.

The researcher creates a survey asking teen participants to rank how important each of the above factors is in either starting smoking (for current smokers) or not smoking (for current nonsmokers). This survey provides specific numbers (ranked importance of each factor) and is thus a quantitative research tool.

The researcher can use the survey results to focus efforts on the one or two highest-ranked factors. Let us say the researcher found that health was the primary factor that keeps teens from starting to smoke, and peer pressure was the primary factor that contributed to teens starting smoking. The researcher can go back to qualitative research methods to dive deeper into these for more information. The researcher wants to focus on keeping teens from starting to smoke, so they focus on the peer pressure aspect.

The researcher can conduct interviews and focus groups (qualitative research) about what types and forms of peer pressure are commonly encountered, where the peer pressure comes from, and where smoking starts. The researcher hypothetically finds that peer pressure often occurs after school at the local teen hangouts, mostly in the local park. The researcher also hypothetically finds that peer pressure comes from older, current smokers who provide the cigarettes.

The researcher could further explore this observation made at the local teen hangouts (qualitative research) and take notes regarding who is smoking, who is not, and what observable factors are at play for peer pressure to smoke. The researcher finds a local park where many local teenagers hang out and sees that the smokers tend to hang out in a shady, overgrown area of the park. The researcher notes that smoking teenagers buy their cigarettes from a local convenience store adjacent to the park, where the clerk does not check identification before selling cigarettes. These observations fall under qualitative research.

If the researcher returns to the park and counts how many individuals smoke in each region, this numerical data would be quantitative research. Based on the researcher's efforts thus far, they conclude that local teen smoking and teenagers who start to smoke may decrease if there are fewer overgrown areas of the park and the local convenience store does not sell cigarettes to underage individuals.

The researcher could try to have the parks department reassess the shady areas to make them less conducive to smokers or identify how to limit the sales of cigarettes to underage individuals by the convenience store. The researcher would then cycle back to qualitative methods of asking at-risk populations their perceptions of the changes and what factors are still at play, and quantitative research that includes teen smoking rates in the community and the incidence of new teen smokers, among others. [14] [15]

Qualitative research functions as a standalone research design or combined with quantitative research to enhance our understanding of the world. Qualitative research uses techniques including structured and unstructured interviews, focus groups, and participant observation not only to help generate hypotheses that can be more rigorously tested with quantitative research but also to help researchers delve deeper into the quantitative research numbers, understand what they mean, and understand what the implications are. Qualitative research allows researchers to understand what is going on, especially when things are not easily categorized. [16]

• Issues of Concern

As discussed in the sections above, quantitative and qualitative work differ in many ways, including the evaluation criteria. There are four well-established criteria for evaluating quantitative data: internal validity, external validity, reliability, and objectivity. Credibility, transferability, dependability, and confirmability are the correlating concepts in qualitative research. [4] [11] The corresponding quantitative and qualitative concepts can be seen below, with the quantitative concept on the left and the qualitative concept on the right:

• Internal validity: Credibility
• External validity: Transferability
• Reliability: Dependability
• Objectivity: Confirmability

In conducting qualitative research, ensuring these concepts are satisfied and well thought out can mitigate potential issues from arising. For example, just as a researcher will ensure that their quantitative study is internally valid, qualitative researchers should ensure that their work has credibility. 

Indicators such as triangulation and peer examination can help evaluate the credibility of qualitative work.

• Triangulation: Triangulation involves using multiple data collection methods to increase the likelihood of getting a reliable and accurate result. In our above magic example, the result would be more reliable if we interviewed the magician, backstage hand, and the person who "vanished." In qualitative research, triangulation can include telephone surveys, in-person surveys, focus groups, and interviews and surveying an adequate cross-section of the target demographic.
• Peer examination: A peer can review results to ensure the data is consistent with the findings.

A "thick" or "rich" description can be used to evaluate the transferability of qualitative research, whereas an indicator such as an audit trail might help evaluate the dependability and confirmability.

• Thick or rich description:  This is a detailed and thorough description of details, the setting, and quotes from participants in the research. [5] Thick descriptions will include a detailed explanation of how the study was conducted. Thick descriptions are detailed enough to allow readers to draw conclusions and interpret the data, which can help with transferability and replicability.
• Audit trail: An audit trail provides a documented set of steps of how the participants were selected and the data was collected. The original information records should also be kept (eg, surveys, notes, recordings).

One issue of concern that qualitative researchers should consider is observation bias. Here are a few examples:

• Hawthorne effect: The effect is the change in participant behavior when they know they are being observed. Suppose a researcher wanted to identify factors that contribute to employee theft and tell the employees they will watch them to see what factors affect employee theft. In that case, one would suspect employee behavior would change when they know they are being protected.
• Observer-expectancy effect: Some participants change their behavior or responses to satisfy the researcher's desired effect. This happens unconsciously for the participant, so it is essential to eliminate or limit the transmission of the researcher's views.
• Artificial scenario effect: Some qualitative research occurs in contrived scenarios with preset goals. In such situations, the information may not be accurate because of the artificial nature of the scenario. The preset goals may limit the qualitative information obtained.
• Clinical Significance

Qualitative or quantitative research helps healthcare providers understand patients and the impact and challenges of the care they deliver. Qualitative research provides an opportunity to generate and refine hypotheses and delve deeper into the data generated by quantitative research. Qualitative research is not an island apart from quantitative research but an integral part of research methods to understand the world around us. [17]

• Enhancing Healthcare Team Outcomes

Qualitative research is essential for all healthcare team members as all are affected by qualitative research. Qualitative research may help develop a theory or a model for health research that can be further explored by quantitative research. Much of the qualitative research data acquisition is completed by numerous team members, including social workers, scientists, nurses, etc. Within each area of the medical field, there is copious ongoing qualitative research, including physician-patient interactions, nursing-patient interactions, patient-environment interactions, healthcare team function, patient information delivery, etc. 

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Disclosure: Steven Tenny declares no relevant financial relationships with ineligible companies.

Disclosure: Janelle Brannan declares no relevant financial relationships with ineligible companies.

Disclosure: Grace Brannan declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Tenny S, Brannan JM, Brannan GD. Qualitative Study. [Updated 2022 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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