is qualitative research holistic

Qualitative Research: An Overview

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• Yanto Chandra 3 &
• Liang Shang 4  

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Qualitative research is one of the most commonly used types of research and methodology in the social sciences. Unfortunately, qualitative research is commonly misunderstood. In this chapter, we describe and explain the misconceptions surrounding qualitative research enterprise, why researchers need to care about when using qualitative research, the characteristics of qualitative research, and review the paradigms in qualitative research.

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Qualitative research is defined as the practice used to study things –– individuals and organizations and their reasons, opinions, and motivations, beliefs in their natural settings. It involves an observer (a researcher) who is located in the field , who transforms the world into a series of representations such as fieldnotes, interviews, conversations, photographs, recordings and memos (Denzin and Lincoln 2011 ). Many researchers employ qualitative research for exploratory purpose while others use it for ‘quasi’ theory testing approach. Qualitative research is a broad umbrella of research methodologies that encompasses grounded theory (Glaser and Strauss 2017 ; Strauss and Corbin 1990 ), case study (Flyvbjerg 2006 ; Yin 2003 ), phenomenology (Sanders 1982 ), discourse analysis (Fairclough 2003 ; Wodak and Meyer 2009 ), ethnography (Geertz 1973 ; Garfinkel 1967 ), and netnography (Kozinets 2002 ), among others. Qualitative research is often synonymous with ‘case study research’ because ‘case study’ primarily uses (but not always) qualitative data.

The quality standards or evaluation criteria of qualitative research comprises: (1) credibility (that a researcher can provide confidence in his/her findings), (2) transferability (that results are more plausible when transported to a highly similar contexts), (3) dependability (that errors have been minimized, proper documentation is provided), and (4) confirmability (that conclusions are internally consistent and supported by data) (see Lincoln and Guba 1985 ).

We classify research into a continuum of theory building — >   theory elaboration — >   theory testing . Theory building is also known as theory exploration. Theory elaboration refers to the use of qualitative data and a method to seek “confirmation” of the relationships among variables or processes or mechanisms of a social reality (Bartunek and Rynes 2015 ).

In the context of qualitative research, theory/ies usually refer(s) to conceptual model(s) or framework(s) that explain the relationships among a set of variables or processes that explain a social phenomenon. Theory or theories could also refer to general ideas or frameworks (e.g., institutional theory, emancipation theory, or identity theory) that are reviewed as background knowledge prior to the commencement of a qualitative research project.

For example, a qualitative research can ask the following question: “How can institutional change succeed in social contexts that are dominated by organized crime?” (Vaccaro and Palazzo 2015 ).

We have witnessed numerous cases in which committed positivist methodologists were asked to review qualitative papers, and they used a survey approach to assess the quality of an interpretivist work. This reviewers’ fallacy is dangerous and hampers the progress of a field of research. Editors must be cognizant of such fallacy and avoid it.

A social enterprises (SE) is an organization that combines social welfare and commercial logics (Doherty et al. 2014 ), or that uses business principles to address social problems (Mair and Marti 2006 ); thus, qualitative research that reports that ‘social impact’ is important for SEs is too descriptive and, arguably, tautological. It is not uncommon to see authors submitting purely descriptive papers to scholarly journals.

Some qualitative researchers have conducted qualitative work using primarily a checklist (ticking the boxes) to show the presence or absence of variables, as if it were a survey-based study. This is utterly inappropriate for a qualitative work. A qualitative work needs to show the richness and depth of qualitative findings. Nevertheless, it is acceptable to use such checklists as supplementary data if a study involves too many informants or variables of interest, or the data is too complex due to its longitudinal nature (e.g., a study that involves 15 cases observed and involving 59 interviews with 33 informants within a 7-year fieldwork used an excel sheet to tabulate the number of events that occurred as supplementary data to the main analysis; see Chandra 2017a , b ).

As mentioned earlier, there are different types of qualitative research. Thus, a qualitative researcher will customize the data collection process to fit the type of research being conducted. For example, for researchers using ethnography, the primary data will be in the form of photos and/or videos and interviews; for those using netnography, the primary data will be internet-based textual data. Interview data is perhaps the most common type of data used across all types of qualitative research designs and is often synonymous with qualitative research.

The purpose of qualitative research is to provide an explanation , not merely a description and certainly not a prediction (which is the realm of quantitative research). However, description is needed to illustrate qualitative data collected, and usually researchers describe their qualitative data by inserting a number of important “informant quotes” in the body of a qualitative research report.

We advise qualitative researchers to adhere to one approach to avoid any epistemological and ontological mismatch that may arise among different camps in qualitative research. For instance, mixing a positivist with a constructivist approach in qualitative research frequently leads to unnecessary criticism and even rejection from journal editors and reviewers; it shows a lack of methodological competence or awareness of one’s epistemological position.

Analytical generalization is not generalization to some defined population that has been sampled, but to a “theory” of the phenomenon being studied, a theory that may have much wider applicability than the particular case studied (Yin 2003 ).

There are different types of contributions. Typically, a researcher is expected to clearly articulate the theoretical contributions for a qualitative work submitted to a scholarly journal. Other types of contributions are practical (or managerial ), common for business/management journals, and policy , common for policy related journals.

There is ongoing debate on whether a template for qualitative research is desirable or necessary, with one camp of scholars (the pluralistic critical realists) that advocates a pluralistic approaches to qualitative research (“qualitative research should not follow a particular template or be prescriptive in its process”) and the other camps are advocating for some form of consensus via the use of particular approaches (e.g., the Eisenhardt or Gioia Approach, etc.). However, as shown in Table 1.1 , even the pluralistic critical realism in itself is a template and advocates an alternative form of consensus through the use of diverse and pluralistic approaches in doing qualitative research.

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Chandra, Y., Shang, L. (2019). Qualitative Research: An Overview. In: Qualitative Research Using R: A Systematic Approach. Springer, Singapore. https://doi.org/10.1007/978-981-13-3170-1_1

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Qualitative Research : Definition

Qualitative research is the naturalistic study of social meanings and processes, using interviews, observations, and the analysis of texts and images.  In contrast to quantitative researchers, whose statistical methods enable broad generalizations about populations (for example, comparisons of the percentages of U.S. demographic groups who vote in particular ways), qualitative researchers use in-depth studies of the social world to analyze how and why groups think and act in particular ways (for instance, case studies of the experiences that shape political views).   

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The word qualitative implies an emphasis on the qualities of entities and on processes and meanings that are not experimentally examined or measured [if measured at all] in terms of quantity, amount, intensity, or frequency. Qualitative researchers stress the socially constructed nature of reality, the intimate relationship between the researcher and what is studied, and the situational constraints that shape inquiry. Such researchers emphasize the value-laden nature of inquiry. They seek answers to questions that stress how social experience is created and given meaning. In contrast, quantitative studies emphasize the measurement and analysis of causal relationships between variables, not processes. Qualitative forms of inquiry are considered by many social and behavioral scientists to be as much a perspective on how to approach investigating a research problem as it is a method.

Denzin, Norman. K. and Yvonna S. Lincoln. “Introduction: The Discipline and Practice of Qualitative Research.” In The Sage Handbook of Qualitative Research . Norman. K. Denzin and Yvonna S. Lincoln, eds. 3 rd edition. (Thousand Oaks, CA: Sage, 2005), p. 10.

Characteristics of Qualitative Research

Below are the three key elements that define a qualitative research study and the applied forms each take in the investigation of a research problem.

• Naturalistic -- refers to studying real-world situations as they unfold naturally; non-manipulative and non-controlling; the researcher is open to whatever emerges [i.e., there is a lack of predetermined constraints on findings].
• Emergent -- acceptance of adapting inquiry as understanding deepens and/or situations change; the researcher avoids rigid designs that eliminate responding to opportunities to pursue new paths of discovery as they emerge.
• Purposeful -- cases for study [e.g., people, organizations, communities, cultures, events, critical incidences] are selected because they are “information rich” and illuminative. That is, they offer useful manifestations of the phenomenon of interest; sampling is aimed at insight about the phenomenon, not empirical generalization derived from a sample and applied to a population.

The Collection of Data

• Data -- observations yield a detailed, "thick description" [in-depth understanding]; interviews capture direct quotations about people’s personal perspectives and lived experiences; often derived from carefully conducted case studies and review of material culture.
• Personal experience and engagement -- researcher has direct contact with and gets close to the people, situation, and phenomenon under investigation; the researcher’s personal experiences and insights are an important part of the inquiry and critical to understanding the phenomenon.
• Empathic neutrality -- an empathic stance in working with study respondents seeks vicarious understanding without judgment [neutrality] by showing openness, sensitivity, respect, awareness, and responsiveness; in observation, it means being fully present [mindfulness].
• Dynamic systems -- there is attention to process; assumes change is ongoing, whether the focus is on an individual, an organization, a community, or an entire culture, therefore, the researcher is mindful of and attentive to system and situational dynamics.

The Analysis

• Unique case orientation -- assumes that each case is special and unique; the first level of analysis is being true to, respecting, and capturing the details of the individual cases being studied; cross-case analysis follows from and depends upon the quality of individual case studies.
• Inductive analysis -- immersion in the details and specifics of the data to discover important patterns, themes, and inter-relationships; begins by exploring, then confirming findings, guided by analytical principles rather than rules.
• Holistic perspective -- the whole phenomenon under study is understood as a complex system that is more than the sum of its parts; the focus is on complex interdependencies and system dynamics that cannot be reduced in any meaningful way to linear, cause and effect relationships and/or a few discrete variables.
• Context sensitive -- places findings in a social, historical, and temporal context; researcher is careful about [even dubious of] the possibility or meaningfulness of generalizations across time and space; emphasizes careful comparative case study analysis and extrapolating patterns for possible transferability and adaptation in new settings.
• Voice, perspective, and reflexivity -- the qualitative methodologist owns and is reflective about her or his own voice and perspective; a credible voice conveys authenticity and trustworthiness; complete objectivity being impossible and pure subjectivity undermining credibility, the researcher's focus reflects a balance between understanding and depicting the world authentically in all its complexity and of being self-analytical, politically aware, and reflexive in consciousness.

Berg, Bruce Lawrence. Qualitative Research Methods for the Social Sciences . 8th edition. Boston, MA: Allyn and Bacon, 2012; Denzin, Norman. K. and Yvonna S. Lincoln. Handbook of Qualitative Research . 2nd edition. Thousand Oaks, CA: Sage, 2000; Marshall, Catherine and Gretchen B. Rossman. Designing Qualitative Research . 2nd ed. Thousand Oaks, CA: Sage Publications, 1995; Merriam, Sharan B. Qualitative Research: A Guide to Design and Implementation . San Francisco, CA: Jossey-Bass, 2009.

Basic Research Design for Qualitative Studies

Unlike positivist or experimental research that utilizes a linear and one-directional sequence of design steps, there is considerable variation in how a qualitative research study is organized. In general, qualitative researchers attempt to describe and interpret human behavior based primarily on the words of selected individuals [a.k.a., “informants” or “respondents”] and/or through the interpretation of their material culture or occupied space. There is a reflexive process underpinning every stage of a qualitative study to ensure that researcher biases, presuppositions, and interpretations are clearly evident, thus ensuring that the reader is better able to interpret the overall validity of the research. According to Maxwell (2009), there are five, not necessarily ordered or sequential, components in qualitative research designs. How they are presented depends upon the research philosophy and theoretical framework of the study, the methods chosen, and the general assumptions underpinning the study. Goals Describe the central research problem being addressed but avoid describing any anticipated outcomes. Questions to ask yourself are: Why is your study worth doing? What issues do you want to clarify, and what practices and policies do you want it to influence? Why do you want to conduct this study, and why should the reader care about the results? Conceptual Framework Questions to ask yourself are: What do you think is going on with the issues, settings, or people you plan to study? What theories, beliefs, and prior research findings will guide or inform your research, and what literature, preliminary studies, and personal experiences will you draw upon for understanding the people or issues you are studying? Note to not only report the results of other studies in your review of the literature, but note the methods used as well. If appropriate, describe why earlier studies using quantitative methods were inadequate in addressing the research problem. Research Questions Usually there is a research problem that frames your qualitative study and that influences your decision about what methods to use, but qualitative designs generally lack an accompanying hypothesis or set of assumptions because the findings are emergent and unpredictable. In this context, more specific research questions are generally the result of an interactive design process rather than the starting point for that process. Questions to ask yourself are: What do you specifically want to learn or understand by conducting this study? What do you not know about the things you are studying that you want to learn? What questions will your research attempt to answer, and how are these questions related to one another? Methods Structured approaches to applying a method or methods to your study help to ensure that there is comparability of data across sources and researchers and, thus, they can be useful in answering questions that deal with differences between phenomena and the explanation for these differences [variance questions]. An unstructured approach allows the researcher to focus on the particular phenomena studied. This facilitates an understanding of the processes that led to specific outcomes, trading generalizability and comparability for internal validity and contextual and evaluative understanding. Questions to ask yourself are: What will you actually do in conducting this study? What approaches and techniques will you use to collect and analyze your data, and how do these constitute an integrated strategy? Validity In contrast to quantitative studies where the goal is to design, in advance, “controls” such as formal comparisons, sampling strategies, or statistical manipulations to address anticipated and unanticipated threats to validity, qualitative researchers must attempt to rule out most threats to validity after the research has begun by relying on evidence collected during the research process itself in order to effectively argue that any alternative explanations for a phenomenon are implausible. Questions to ask yourself are: How might your results and conclusions be wrong? What are the plausible alternative interpretations and validity threats to these, and how will you deal with these? How can the data that you have, or that you could potentially collect, support or challenge your ideas about what’s going on? Why should we believe your results? Conclusion Although Maxwell does not mention a conclusion as one of the components of a qualitative research design, you should formally conclude your study. Briefly reiterate the goals of your study and the ways in which your research addressed them. Discuss the benefits of your study and how stakeholders can use your results. Also, note the limitations of your study and, if appropriate, place them in the context of areas in need of further research.

Chenail, Ronald J. Introduction to Qualitative Research Design. Nova Southeastern University; Heath, A. W. The Proposal in Qualitative Research. The Qualitative Report 3 (March 1997); Marshall, Catherine and Gretchen B. Rossman. Designing Qualitative Research . 3rd edition. Thousand Oaks, CA: Sage, 1999; Maxwell, Joseph A. "Designing a Qualitative Study." In The SAGE Handbook of Applied Social Research Methods . Leonard Bickman and Debra J. Rog, eds. 2nd ed. (Thousand Oaks, CA: Sage, 2009), p. 214-253; Qualitative Research Methods. Writing@CSU. Colorado State University; Yin, Robert K. Qualitative Research from Start to Finish . 2nd edition. New York: Guilford, 2015.

Strengths of Using Qualitative Methods

The advantage of using qualitative methods is that they generate rich, detailed data that leave the participants' perspectives intact and provide multiple contexts for understanding the phenomenon under study. In this way, qualitative research can be used to vividly demonstrate phenomena or to conduct cross-case comparisons and analysis of individuals or groups.

Among the specific strengths of using qualitative methods to study social science research problems is the ability to:

• Obtain a more realistic view of the lived world that cannot be understood or experienced in numerical data and statistical analysis;
• Provide the researcher with the perspective of the participants of the study through immersion in a culture or situation and as a result of direct interaction with them;
• Allow the researcher to describe existing phenomena and current situations;
• Develop flexible ways to perform data collection, subsequent analysis, and interpretation of collected information;
• Yield results that can be helpful in pioneering new ways of understanding;
• Respond to changes that occur while conducting the study ]e.g., extended fieldwork or observation] and offer the flexibility to shift the focus of the research as a result;
• Provide a holistic view of the phenomena under investigation;
• Respond to local situations, conditions, and needs of participants;
• Interact with the research subjects in their own language and on their own terms; and,
• Create a descriptive capability based on primary and unstructured data.

Anderson, Claire. “Presenting and Evaluating Qualitative Research.” American Journal of Pharmaceutical Education 74 (2010): 1-7; Denzin, Norman. K. and Yvonna S. Lincoln. Handbook of Qualitative Research . 2nd edition. Thousand Oaks, CA: Sage, 2000; Merriam, Sharan B. Qualitative Research: A Guide to Design and Implementation . San Francisco, CA: Jossey-Bass, 2009.

Limitations of Using Qualitative Methods

It is very much true that most of the limitations you find in using qualitative research techniques also reflect their inherent strengths . For example, small sample sizes help you investigate research problems in a comprehensive and in-depth manner. However, small sample sizes undermine opportunities to draw useful generalizations from, or to make broad policy recommendations based upon, the findings. Additionally, as the primary instrument of investigation, qualitative researchers are often embedded in the cultures and experiences of others. However, cultural embeddedness increases the opportunity for bias generated from conscious or unconscious assumptions about the study setting to enter into how data is gathered, interpreted, and reported.

Some specific limitations associated with using qualitative methods to study research problems in the social sciences include the following:

• Drifting away from the original objectives of the study in response to the changing nature of the context under which the research is conducted;
• Arriving at different conclusions based on the same information depending on the personal characteristics of the researcher;
• Replication of a study is very difficult;
• Research using human subjects increases the chance of ethical dilemmas that undermine the overall validity of the study;
• An inability to investigate causality between different research phenomena;
• Difficulty in explaining differences in the quality and quantity of information obtained from different respondents and arriving at different, non-consistent conclusions;
• Data gathering and analysis is often time consuming and/or expensive;
• Requires a high level of experience from the researcher to obtain the targeted information from the respondent;
• May lack consistency and reliability because the researcher can employ different probing techniques and the respondent can choose to tell some particular stories and ignore others; and,
• Generation of a significant amount of data that cannot be randomized into manageable parts for analysis.

Research Tip

Human Subject Research and Institutional Review Board Approval

Almost every socio-behavioral study requires you to submit your proposed research plan to an Institutional Review Board. The role of the Board is to evaluate your research proposal and determine whether it will be conducted ethically and under the regulations, institutional polices, and Code of Ethics set forth by the university. The purpose of the review is to protect the rights and welfare of individuals participating in your study. The review is intended to ensure equitable selection of respondents, that you have met the requirements for obtaining informed consent , that there is clear assessment and minimization of risks to participants and to the university [read: no lawsuits!], and that privacy and confidentiality are maintained throughout the research process and beyond. Go to the USC IRB website for detailed information and templates of forms you need to submit before you can proceed. If you are  unsure whether your study is subject to IRB review, consult with your professor or academic advisor.

Chenail, Ronald J. Introduction to Qualitative Research Design. Nova Southeastern University; Labaree, Robert V. "Working Successfully with Your Institutional Review Board: Practical Advice for Academic Librarians." College and Research Libraries News 71 (April 2010): 190-193.

Another Research Tip

Finding Examples of How to Apply Different Types of Research Methods

SAGE publications is a major publisher of studies about how to design and conduct research in the social and behavioral sciences. Their SAGE Research Methods Online and Cases database includes contents from books, articles, encyclopedias, handbooks, and videos covering social science research design and methods including the complete Little Green Book Series of Quantitative Applications in the Social Sciences and the Little Blue Book Series of Qualitative Research techniques. The database also includes case studies outlining the research methods used in real research projects. This is an excellent source for finding definitions of key terms and descriptions of research design and practice, techniques of data gathering, analysis, and reporting, and information about theories of research [e.g., grounded theory]. The database covers both qualitative and quantitative research methods as well as mixed methods approaches to conducting research.

SAGE Research Methods Online and Cases

NOTE :  For a list of online communities, research centers, indispensable learning resources, and personal websites of leading qualitative researchers, GO HERE .

For a list of scholarly journals devoted to the study and application of qualitative research methods, GO HERE .

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Quantitative and Qualitative Research

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What is qualitative research?

Qualitative research is a process of naturalistic inquiry that seeks an in-depth understanding of social phenomena within their natural setting. It focuses on the "why" rather than the "what" of social phenomena and relies on the direct experiences of human beings as meaning-making agents in their every day lives. Rather than by logical and statistical procedures, qualitative researchers use multiple systems of inquiry for the study of human phenomena including biography, case study, historical analysis, discourse analysis, ethnography, grounded theory, and phenomenology.

University of Utah College of Nursing, (n.d.). What is qualitative research? [Guide] Retrieved from  https://nursing.utah.edu/research/qualitative-research/what-is-qualitative-research.php#what 

The following video will explain the fundamentals of qualitative research.

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Home » Qualitative Research – Methods, Analysis Types and Guide

Qualitative Research – Methods, Analysis Types and Guide

Table of Contents

Qualitative Research

Qualitative research is a type of research methodology that focuses on exploring and understanding people’s beliefs, attitudes, behaviors, and experiences through the collection and analysis of non-numerical data. It seeks to answer research questions through the examination of subjective data, such as interviews, focus groups, observations, and textual analysis.

Qualitative research aims to uncover the meaning and significance of social phenomena, and it typically involves a more flexible and iterative approach to data collection and analysis compared to quantitative research. Qualitative research is often used in fields such as sociology, anthropology, psychology, and education.

Qualitative Research Methods

Qualitative Research Methods are as follows:

One-to-One Interview

This method involves conducting an interview with a single participant to gain a detailed understanding of their experiences, attitudes, and beliefs. One-to-one interviews can be conducted in-person, over the phone, or through video conferencing. The interviewer typically uses open-ended questions to encourage the participant to share their thoughts and feelings. One-to-one interviews are useful for gaining detailed insights into individual experiences.

Focus Groups

This method involves bringing together a group of people to discuss a specific topic in a structured setting. The focus group is led by a moderator who guides the discussion and encourages participants to share their thoughts and opinions. Focus groups are useful for generating ideas and insights, exploring social norms and attitudes, and understanding group dynamics.

Ethnographic Studies

This method involves immersing oneself in a culture or community to gain a deep understanding of its norms, beliefs, and practices. Ethnographic studies typically involve long-term fieldwork and observation, as well as interviews and document analysis. Ethnographic studies are useful for understanding the cultural context of social phenomena and for gaining a holistic understanding of complex social processes.

Text Analysis

This method involves analyzing written or spoken language to identify patterns and themes. Text analysis can be quantitative or qualitative. Qualitative text analysis involves close reading and interpretation of texts to identify recurring themes, concepts, and patterns. Text analysis is useful for understanding media messages, public discourse, and cultural trends.

This method involves an in-depth examination of a single person, group, or event to gain an understanding of complex phenomena. Case studies typically involve a combination of data collection methods, such as interviews, observations, and document analysis, to provide a comprehensive understanding of the case. Case studies are useful for exploring unique or rare cases, and for generating hypotheses for further research.

Process of Observation

This method involves systematically observing and recording behaviors and interactions in natural settings. The observer may take notes, use audio or video recordings, or use other methods to document what they see. Process of observation is useful for understanding social interactions, cultural practices, and the context in which behaviors occur.

Record Keeping

This method involves keeping detailed records of observations, interviews, and other data collected during the research process. Record keeping is essential for ensuring the accuracy and reliability of the data, and for providing a basis for analysis and interpretation.

This method involves collecting data from a large sample of participants through a structured questionnaire. Surveys can be conducted in person, over the phone, through mail, or online. Surveys are useful for collecting data on attitudes, beliefs, and behaviors, and for identifying patterns and trends in a population.

Qualitative data analysis is a process of turning unstructured data into meaningful insights. It involves extracting and organizing information from sources like interviews, focus groups, and surveys. The goal is to understand people’s attitudes, behaviors, and motivations

Qualitative Research Analysis Methods

Qualitative Research analysis methods involve a systematic approach to interpreting and making sense of the data collected in qualitative research. Here are some common qualitative data analysis methods:

Thematic Analysis

This method involves identifying patterns or themes in the data that are relevant to the research question. The researcher reviews the data, identifies keywords or phrases, and groups them into categories or themes. Thematic analysis is useful for identifying patterns across multiple data sources and for generating new insights into the research topic.

Content Analysis

This method involves analyzing the content of written or spoken language to identify key themes or concepts. Content analysis can be quantitative or qualitative. Qualitative content analysis involves close reading and interpretation of texts to identify recurring themes, concepts, and patterns. Content analysis is useful for identifying patterns in media messages, public discourse, and cultural trends.

Discourse Analysis

This method involves analyzing language to understand how it constructs meaning and shapes social interactions. Discourse analysis can involve a variety of methods, such as conversation analysis, critical discourse analysis, and narrative analysis. Discourse analysis is useful for understanding how language shapes social interactions, cultural norms, and power relationships.

Grounded Theory Analysis

This method involves developing a theory or explanation based on the data collected. Grounded theory analysis starts with the data and uses an iterative process of coding and analysis to identify patterns and themes in the data. The theory or explanation that emerges is grounded in the data, rather than preconceived hypotheses. Grounded theory analysis is useful for understanding complex social phenomena and for generating new theoretical insights.

Narrative Analysis

This method involves analyzing the stories or narratives that participants share to gain insights into their experiences, attitudes, and beliefs. Narrative analysis can involve a variety of methods, such as structural analysis, thematic analysis, and discourse analysis. Narrative analysis is useful for understanding how individuals construct their identities, make sense of their experiences, and communicate their values and beliefs.

Phenomenological Analysis

This method involves analyzing how individuals make sense of their experiences and the meanings they attach to them. Phenomenological analysis typically involves in-depth interviews with participants to explore their experiences in detail. Phenomenological analysis is useful for understanding subjective experiences and for developing a rich understanding of human consciousness.

Comparative Analysis

This method involves comparing and contrasting data across different cases or groups to identify similarities and differences. Comparative analysis can be used to identify patterns or themes that are common across multiple cases, as well as to identify unique or distinctive features of individual cases. Comparative analysis is useful for understanding how social phenomena vary across different contexts and groups.

Applications of Qualitative Research

Qualitative research has many applications across different fields and industries. Here are some examples of how qualitative research is used:

• Market Research: Qualitative research is often used in market research to understand consumer attitudes, behaviors, and preferences. Researchers conduct focus groups and one-on-one interviews with consumers to gather insights into their experiences and perceptions of products and services.
• Health Care: Qualitative research is used in health care to explore patient experiences and perspectives on health and illness. Researchers conduct in-depth interviews with patients and their families to gather information on their experiences with different health care providers and treatments.
• Education: Qualitative research is used in education to understand student experiences and to develop effective teaching strategies. Researchers conduct classroom observations and interviews with students and teachers to gather insights into classroom dynamics and instructional practices.
• Social Work : Qualitative research is used in social work to explore social problems and to develop interventions to address them. Researchers conduct in-depth interviews with individuals and families to understand their experiences with poverty, discrimination, and other social problems.
• Anthropology : Qualitative research is used in anthropology to understand different cultures and societies. Researchers conduct ethnographic studies and observe and interview members of different cultural groups to gain insights into their beliefs, practices, and social structures.
• Psychology : Qualitative research is used in psychology to understand human behavior and mental processes. Researchers conduct in-depth interviews with individuals to explore their thoughts, feelings, and experiences.
• Public Policy : Qualitative research is used in public policy to explore public attitudes and to inform policy decisions. Researchers conduct focus groups and one-on-one interviews with members of the public to gather insights into their perspectives on different policy issues.

How to Conduct Qualitative Research

Here are some general steps for conducting qualitative research:

• Identify your research question: Qualitative research starts with a research question or set of questions that you want to explore. This question should be focused and specific, but also broad enough to allow for exploration and discovery.
• Select your research design: There are different types of qualitative research designs, including ethnography, case study, grounded theory, and phenomenology. You should select a design that aligns with your research question and that will allow you to gather the data you need to answer your research question.
• Recruit participants: Once you have your research question and design, you need to recruit participants. The number of participants you need will depend on your research design and the scope of your research. You can recruit participants through advertisements, social media, or through personal networks.
• Collect data: There are different methods for collecting qualitative data, including interviews, focus groups, observation, and document analysis. You should select the method or methods that align with your research design and that will allow you to gather the data you need to answer your research question.
• Analyze data: Once you have collected your data, you need to analyze it. This involves reviewing your data, identifying patterns and themes, and developing codes to organize your data. You can use different software programs to help you analyze your data, or you can do it manually.
• Interpret data: Once you have analyzed your data, you need to interpret it. This involves making sense of the patterns and themes you have identified, and developing insights and conclusions that answer your research question. You should be guided by your research question and use your data to support your conclusions.
• Communicate results: Once you have interpreted your data, you need to communicate your results. This can be done through academic papers, presentations, or reports. You should be clear and concise in your communication, and use examples and quotes from your data to support your findings.

Examples of Qualitative Research

Here are some real-time examples of qualitative research:

• Customer Feedback: A company may conduct qualitative research to understand the feedback and experiences of its customers. This may involve conducting focus groups or one-on-one interviews with customers to gather insights into their attitudes, behaviors, and preferences.
• Healthcare : A healthcare provider may conduct qualitative research to explore patient experiences and perspectives on health and illness. This may involve conducting in-depth interviews with patients and their families to gather information on their experiences with different health care providers and treatments.
• Education : An educational institution may conduct qualitative research to understand student experiences and to develop effective teaching strategies. This may involve conducting classroom observations and interviews with students and teachers to gather insights into classroom dynamics and instructional practices.
• Social Work: A social worker may conduct qualitative research to explore social problems and to develop interventions to address them. This may involve conducting in-depth interviews with individuals and families to understand their experiences with poverty, discrimination, and other social problems.
• Anthropology : An anthropologist may conduct qualitative research to understand different cultures and societies. This may involve conducting ethnographic studies and observing and interviewing members of different cultural groups to gain insights into their beliefs, practices, and social structures.
• Psychology : A psychologist may conduct qualitative research to understand human behavior and mental processes. This may involve conducting in-depth interviews with individuals to explore their thoughts, feelings, and experiences.
• Public Policy: A government agency or non-profit organization may conduct qualitative research to explore public attitudes and to inform policy decisions. This may involve conducting focus groups and one-on-one interviews with members of the public to gather insights into their perspectives on different policy issues.

Purpose of Qualitative Research

The purpose of qualitative research is to explore and understand the subjective experiences, behaviors, and perspectives of individuals or groups in a particular context. Unlike quantitative research, which focuses on numerical data and statistical analysis, qualitative research aims to provide in-depth, descriptive information that can help researchers develop insights and theories about complex social phenomena.

Qualitative research can serve multiple purposes, including:

• Exploring new or emerging phenomena : Qualitative research can be useful for exploring new or emerging phenomena, such as new technologies or social trends. This type of research can help researchers develop a deeper understanding of these phenomena and identify potential areas for further study.
• Understanding complex social phenomena : Qualitative research can be useful for exploring complex social phenomena, such as cultural beliefs, social norms, or political processes. This type of research can help researchers develop a more nuanced understanding of these phenomena and identify factors that may influence them.
• Generating new theories or hypotheses: Qualitative research can be useful for generating new theories or hypotheses about social phenomena. By gathering rich, detailed data about individuals’ experiences and perspectives, researchers can develop insights that may challenge existing theories or lead to new lines of inquiry.
• Providing context for quantitative data: Qualitative research can be useful for providing context for quantitative data. By gathering qualitative data alongside quantitative data, researchers can develop a more complete understanding of complex social phenomena and identify potential explanations for quantitative findings.

When to use Qualitative Research

Here are some situations where qualitative research may be appropriate:

• Exploring a new area: If little is known about a particular topic, qualitative research can help to identify key issues, generate hypotheses, and develop new theories.
• Understanding complex phenomena: Qualitative research can be used to investigate complex social, cultural, or organizational phenomena that are difficult to measure quantitatively.
• Investigating subjective experiences: Qualitative research is particularly useful for investigating the subjective experiences of individuals or groups, such as their attitudes, beliefs, values, or emotions.
• Conducting formative research: Qualitative research can be used in the early stages of a research project to develop research questions, identify potential research participants, and refine research methods.
• Evaluating interventions or programs: Qualitative research can be used to evaluate the effectiveness of interventions or programs by collecting data on participants’ experiences, attitudes, and behaviors.

Characteristics of Qualitative Research

Qualitative research is characterized by several key features, including:

• Focus on subjective experience: Qualitative research is concerned with understanding the subjective experiences, beliefs, and perspectives of individuals or groups in a particular context. Researchers aim to explore the meanings that people attach to their experiences and to understand the social and cultural factors that shape these meanings.
• Use of open-ended questions: Qualitative research relies on open-ended questions that allow participants to provide detailed, in-depth responses. Researchers seek to elicit rich, descriptive data that can provide insights into participants’ experiences and perspectives.
• Sampling-based on purpose and diversity: Qualitative research often involves purposive sampling, in which participants are selected based on specific criteria related to the research question. Researchers may also seek to include participants with diverse experiences and perspectives to capture a range of viewpoints.
• Data collection through multiple methods: Qualitative research typically involves the use of multiple data collection methods, such as in-depth interviews, focus groups, and observation. This allows researchers to gather rich, detailed data from multiple sources, which can provide a more complete picture of participants’ experiences and perspectives.
• Inductive data analysis: Qualitative research relies on inductive data analysis, in which researchers develop theories and insights based on the data rather than testing pre-existing hypotheses. Researchers use coding and thematic analysis to identify patterns and themes in the data and to develop theories and explanations based on these patterns.
• Emphasis on researcher reflexivity: Qualitative research recognizes the importance of the researcher’s role in shaping the research process and outcomes. Researchers are encouraged to reflect on their own biases and assumptions and to be transparent about their role in the research process.

Advantages of Qualitative Research

Qualitative research offers several advantages over other research methods, including:

• Depth and detail: Qualitative research allows researchers to gather rich, detailed data that provides a deeper understanding of complex social phenomena. Through in-depth interviews, focus groups, and observation, researchers can gather detailed information about participants’ experiences and perspectives that may be missed by other research methods.
• Flexibility : Qualitative research is a flexible approach that allows researchers to adapt their methods to the research question and context. Researchers can adjust their research methods in real-time to gather more information or explore unexpected findings.
• Contextual understanding: Qualitative research is well-suited to exploring the social and cultural context in which individuals or groups are situated. Researchers can gather information about cultural norms, social structures, and historical events that may influence participants’ experiences and perspectives.
• Participant perspective : Qualitative research prioritizes the perspective of participants, allowing researchers to explore subjective experiences and understand the meanings that participants attach to their experiences.
• Theory development: Qualitative research can contribute to the development of new theories and insights about complex social phenomena. By gathering rich, detailed data and using inductive data analysis, researchers can develop new theories and explanations that may challenge existing understandings.
• Validity : Qualitative research can offer high validity by using multiple data collection methods, purposive and diverse sampling, and researcher reflexivity. This can help ensure that findings are credible and trustworthy.

Limitations of Qualitative Research

Qualitative research also has some limitations, including:

• Subjectivity : Qualitative research relies on the subjective interpretation of researchers, which can introduce bias into the research process. The researcher’s perspective, beliefs, and experiences can influence the way data is collected, analyzed, and interpreted.
• Limited generalizability: Qualitative research typically involves small, purposive samples that may not be representative of larger populations. This limits the generalizability of findings to other contexts or populations.
• Time-consuming: Qualitative research can be a time-consuming process, requiring significant resources for data collection, analysis, and interpretation.
• Resource-intensive: Qualitative research may require more resources than other research methods, including specialized training for researchers, specialized software for data analysis, and transcription services.
• Limited reliability: Qualitative research may be less reliable than quantitative research, as it relies on the subjective interpretation of researchers. This can make it difficult to replicate findings or compare results across different studies.
• Ethics and confidentiality: Qualitative research involves collecting sensitive information from participants, which raises ethical concerns about confidentiality and informed consent. Researchers must take care to protect the privacy and confidentiality of participants and obtain informed consent.

Also see Research Methods

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Research Design Review

A discussion of qualitative & quantitative research design, a holistic approach to qualitative analysis.

A holistic approach to analysis acknowledges that (1) these unique contributions to our research are central to why we conduct qualitative research and (2) importantly, qualitative researchers owe it to their participants — who have given so much of themselves for our purposes — to maintain the integrity of their lived experiences.

How does the researcher do this?

At the conclusion of each IDI or focus group discussion, the interviewer or moderator should reflect on their understanding of what was learned from the participant(s). To do this, the researcher will use their notes and the audio and/or video recording of the session. It is useful to use Excel or something similar to log the key takeaways associated with the research objectives. By doing this exercise after each IDI or group discussion, the researcher is absorbing a complete “picture” of each participant’s or group’s attitudes, behaviors, and experiences. From there, the researcher can look across participants or groups to contrast and compare.

Crucially, however, the researcher is not necessarily contrasting and comparing simply based on the use of terminology or other obvious, manifest content. Instead, the researcher considers the entirety of what they have learned about each individual or group of participants as revealed in a combination of obvious, subtle, and contextual interconnections within the data.

This holistic approach begins in the beginning — before transcripts and coding — and, with concerted effort, is maintained throughout the analysis process.

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• Open access
• Published: 08 July 2023

Understanding geriatric models of care for older adults living with HIV: a scoping review and qualitative analysis

• Kristina Marie Kokorelias 1 , 2 , 3 ,
• Anna Grosse 1 , 4 ,
• Alice Zhabokritsky 5 , 6 , 7 &
• Luxey Sirisegaram 1 , 4  

BMC Geriatrics volume  23 , Article number:  417 ( 2023 ) Cite this article

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Advances in Human Immunodeficiency Virus (HIV) treatment have reduced mortality rates and consequently increased the number of individuals with HIV living into older age. Despite this, people aged 50 years and older have been left behind in recent HIV treatment and prevention campaigns, and a gold-standard model of care for this population has not yet been defined. Developing evidence-based geriatric HIV models of care can support an accessible, equitable, and sustainable HIV health care system that ensures older adults have access to care that meets their needs now and in the future.

Guided by Arksey & O’Malley (2005)’s methodological framework, a scoping review was conducted to determine the key components of, identify gaps in the literature about, and provide recommendations for future research into geriatric models of care for individuals with HIV. Five databases and the grey literature were systematically searched. The titles, abstracts and full texts of the search results were screened independently in duplicate. Data were analyzed using a qualitative case study and key component analysis approach to identify necessary model components.

5702 studies underwent title and abstract screening, with 154 entering full-text review. 13 peer-reviewed and 0 grey literature sources were included. Most articles were from North America. We identified three primary model of care components that may improve the successful delivery of geriatric care to people living with HIV: Collaboration and Integration; Organization of Geriatric Care; and Support for Holistic Care. Most articles included some aspects of all three components.

To provide effective geriatric care to older persons living with HIV, health services and systems are encouraged to use an evidence-based framework and should consider incorporating the distinct model of care characteristics that we have identified in the literature. However, there is limited data about models in developing countries and long-term care settings, and limited knowledge of the role of family, friends and peers in supporting the geriatric care of individuals living with HIV. Future evaluative research is encouraged to determine the impact of optimal components of geriatric models of care on patient outcomes.

Peer Review reports

Human immunodeficiency virus (HIV) continues to be characterized as one of the most prominent public health threats [ 1 ], although advances in antiretroviral therapy (ART) have reduced mortality rates and transformed HIV into a manageable, chronic disease [ 2 ]. The life expectancy for people living with HIV who have had early and sustained access to ART is now similar to that of HIV-negative populations [ 3 , 4 , 5 ]. Thus, there is now an increase in the number of individuals living with HIV into older age [ 6 ] and the number of older adults (aged ≥ 50 years [ 7 ]) living with HIV is expected to increase even further in the coming years [ 8 ]. The proportion of older adults living with HIV has nearly tripled since 2000 [ 9 ].

Older adults with HIV have an increased risk of dementia, diabetes, frailty, depression, osteoporosis, and some cancers, compared to those who are HIV negative [ 10 , 11 , 12 ]. Comorbidities commonly associated with ageing (e.g., diabetes) have been found to increase the risk of opportunistic infections (e.g., HIV-related concerns) in older adults with HIV [ 13 , 14 , 15 , 16 ]. Moreover, stigma is associated with higher rates of loneliness, social isolation and depression in the HIV population [ 17 ]. Despite their increased risk of poor health and social outcomes, older adults living with HIV face many challenges accessing appropriate health and social care, further exacerbating their poor health outcomes [ 18 ]. The stigma associated with HIV may result in a fear of disclosure that delays treatment [ 19 ], and individuals with HIV can feel discriminated against by healthcare providers, resulting in hesitation about or refusal to seek medical care [ 20 , 21 ]. Older adults also tend to not access social services designed for the HIV-infected population because of their own assumption that these programs are created only for younger individuals [ 22 ]. Consequently, HIV scholars have urged for a health and social care system where knowledge and communication about geriatric HIV care are encouraged amongst advocates who work directly with this population, such as geriatric healthcare workers [ 23 ].

Geriatric specialists have expertise in managing many comorbidities that share associations with both ageing and HIV, despite geriatricians being hesitant to take a prominent role in the care of HIV in older adults [ 24 ] due to a lack of experience and training [ 25 ]. While health policy reports a preference for general practice-based HIV care over specialist care [ 26 , 27 ], general practitioners may have a less nuanced understanding about the holistic care of an older adult with complex comorbidities, geriatric syndromes, and metabolic complications when compared with geriatricians [ 28 ]. The use of the Comprehensive Geriatric Assessment (CGA) has been explored, and may lead to improved health and social outcomes in the older adult-HIV population [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ], and may be used to measure outcomes in clinical trials that aim to improve the delivery of HIV care for the older adult-HIV population [ 36 ]. However, in the absence of specialized geriatric models of HIV care, many older adults with HIV fail to receive a CGA [ 37 , 38 ] and the recommendations from CGAs are rarely implemented due to a lack of feasibility following a geriatric consult for older adults with HIV [ 39 ].

Numerous models of care, defined as “the way health services are delivered” [ 40 ] (pg., 3), have been developed for older adults with HIV. Many involve geriatric specialists in HIV care, with geriatricians taking on various responsibilities ranging from consultation to leadership roles [ 36 , 41 ]. However, the gold-standard model of care for older adults living with HIV have not yet been defined [ 34 , 35 ], and geriatric care is often delivered by non-geriatric specialists [ 16 ]. Instead of examining models of care, recent literature reviews have tended to focus on the prevalence and experiences of older adults in HIV care [7, NaN], or the experiences of geriatricians [ 24 ]. As implementing geriatric models of HIV care into healthcare settings requires unique considerations [ 28 ], an improved understanding of existing models of care may inform best-practices. This approach has been done to inform the design and delivery of other models of healthcare [ 42 , 43 , 44 , 45 ]. Therefore, we conducted a scoping review of the existing evidence about geriatric models of care for older adults within the context of HIV. To our knowledge, this is the first review to systematically identify the core operational components of existing models of care specific to older adults living with HIV.

A scoping review was selected to map the available literature on geriatric models of care for older adults within the context HIV [ 46 ]. The protocol for our scoping review followed the well-established framework outlined by Arksey and O’Malley [ 46 ] and later refined by Levac et al. [ 47 ] and Colquhoun et al. [ 48 ]. The framework was selected as it provides guidance to ensure a rigorous scoping review approach utilizing a comprehensive search strategy [ 46 ]. Our protocol has been published elsewhere (blinded for review #1) but is briefly described within this section of the manuscript. There were no deviations from our protocol. The framework includes five steps: 1) identifying the research questions; 2) identifying relevant literature; 3) study selection; 4) charting the data; 5) collating, summarizing and reporting the results [ 46 ]. The optional sixth step of consulting with key stakeholders was not followed due to financial resource constraints. We briefly summarize each step and report our findings in accordance with The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews (PRISMA-Scr) [ 49 ] (see Supplemental Material A).

Step 1: Identifying the research questions

Our questions were developed to support a knowledge synthesis that could mobilize the current evidence into practice. Our study aimed to answer: What are the key components of the existing models of HIV care for older adults (aged ≥ 50 years [ 7 , 29 ])?

Step 2: Searching for relevant studies

To identify studies, we developed a comprehensive search strategy with an experienced medical information specialist (CDC) who first conducted the search in MEDLINE(R) ALL (in Ovid, including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily) and then translated it into NLM’s PubMed OVID Embase + Embase Classic, EBSCO’s CINAHL Complete, Clarivate’s Web of Science Core Collection, and Elsevier’s Scopus from the earliest record to 2022 (see Supplemental Material B for the full strategies ) . The search strategy was peer-reviewed according to the peer-review of electronic search strategy guidelines (the PRESS strategy) [ 50 ]. MeSH terms were used. All searches were limited to English language. The final searches were completed on Friday, October 21, 2022. Duplicates were removed using the Bramer method in EndNote [ 51 ]. Covidence was used to manage the review process, including the deduplication of database results [ 52 ].

Gray literature and non-indexed articles were searched for using Google Scholar, Open Grey, open Google searches and relevant websites, including the World Health Organization, UK National Research Register, CADTH’s “Grey Matters”, New York Academy of Medicine's Grey Literature Report, the Canadian Medical Association InfoBase and the National Institute for Heath and Care Excellence – Guidance. Similar search terms used in the scientific search were used. We also consulted with stakeholders of our research (i.e. geriatricians, infectious disease specialists) for any gray literature missed.

Step 3: Selecting studies

Three reviewers (LS, KMK and AG) independently screened article titles and abstracts (level 1-screening) and then full articles (level 2-screening) were screened in duplicate to identify potentially relevant studies. In both levels of screening, any disagreements were resolved through team-based discussion. Articles were included if they described an implemented model or models of care to treat older adults living with HIV exclusively (i.e., not as part of the treatment for multi-morbidity including HIV) and included a registered healthcare provider that specialized in geriatric care (e.g., gerontology social worker, geriatric clinical nurse specialist, geriatrician). Perspective (viewpoint) papers that describe implemented models of HIV care were also included. Book sections, theses, film broadcasts, abstracts without adequate data, and literature reviews were excluded. Articles were also excluded if they: (1) did not propose an original model of HIV care specifically for older adults (i.e., models of care for all adults or models that may include older adults), (2) focused on ethical issues or the theoretical understandings of HIV care or geriatric care, (3) focused on training healthcare providers on how to deliver HIV and/or geriatric care; and (4) described social support, rather than care in a clinical, health-care context. Forward and backward searching were conducted on the final full-text articles to ensure a broad search using EndNote and Citationchaser [ 53 , 54 ].

Step 4: Charting the data

The same three reviewers independently extracted data from the included studies using a data abstraction form that was developed and pilot tested by two researchers (LS and KMK). The data form was tested on five articles for consistency in understanding and ensuring that all relevant data was captured. No changes were made after comparing the pilot test results. The fields for abstraction included author last name, year, study type, setting, geographic location (country), methodology, characteristics of intervention (model of care) and delivery method, participant and provider characteristics, patient inclusion and exclusion criteria, desired outcomes (primary and secondary), results and key conclusions.

Step 5: Collating, summarizing and reporting the results

Data were analyzed using a systematic qualitative case study analytic approach [ 55 ]. First, each author reviewed the abstracted data and independently noted the core operational components (i.e., model structure and process for delivery) described in the models of care. Then the authors came together to list all the identified model components across the included articles, by exploring the similar and different terms to describe the same model components. Each model component was given a label and a definition. These components became the basis of codes that were then appropriately applied by one author (KMK) to each article using NVivo 12 software [ 56 ]. Next the coded data was reviewed by all authors to determine how each model of care described in the articles adhered or did not adhere to each of the particular model components (codes). The authors met weekly to discuss the process of adherence. This discussion process was informed by adherence analyses [ 57 ]. During this process, authors were encouraged to identify any components that were potentially originally overlooked. No additional suggestions were made on key model components. The model components adhered to across the articles and models of care formed the basis of the results.

After a comprehensive list of the identified model components had been determined, two authors (KMK and AG) went through each article and identified them as either adhering or not adhering to each particular characteristic component, as determined by written evidence within the articles. This was done by having the two authors each providing their vote (i.e., adhering or not) and then comparing the two scoring. Any uncertainty in adherence assignment or discrepancies in voting was resolved through discussion amongst all the investigators as done in other reviews with similar methodologies [ 42 ].

Step 6: Consultation

To further contribute to our component adherence, we shared our model components with the senior investigators of our peer-reviewed articles for feedback. We also asked the investigators to assess their level of agreement with our interpretations of their study's component adherence. Lastly, we asked authors to send along any studies that they believed would be relevant to our review. This was done via email by the first (KMK) and senior author (LS) in December 2022. After two months, we only received five replies from 13 potential authors (n = 5/13, 38%) and all five authors agreed with the adherence we provided their article with, suggesting an accurate adherence analysis. No investigators provided us with additional materials or feedback on the model components, rather just commenting on their article specifically.

The databases search yielded a total of 5699 unique citations, from which 151 articles were selected for full text review. Of these 151 articles, 12 peer-reviewed articles were included. An additional peer-reviewed article was obtained from hand searching. No grey literature was included. Thirteen articles were included in the final analysis (see Fig.  1 PRISMA flow chart).

PRISMA flow chat diagram

Most ( n  = 10/13, 77%) of the publication activity occurred in the United States (USA) [ 28 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ]. The remaining three articles ( n  = 3/13,23%) were from the United Kingdom (UK)[ 66 , 67 , 68 ]. Over half ( n  = 9/13,69%) of the articles were published in the last 5 years (2018–2023) [ 28 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. In published papers, the most common research methods were qualitative. The key description from these studies were abstracted and are summarized in Table 1 .

Patient population

Patients in the included models of care ranged from 48 [ 60 ]–87 years of age [ 67 ]. The number of patients served ranged from 76 [ 39 ] over 4 years to a maximum of 4000 at the time of data collection (period unspecified) [ 66 ]. Of those articles that reported sex ( n  = 9/13,69%), the majority described primarily male samples [ 39 , 60 , 61 , 62 , 63 , 64 , 65 , 68 ]. Articles that reported race/ethnicity ( n  = 7/13, 54%), described including participants who were mostly White [ 60 , 61 , 67 ] or African American [ 39 , 62 , 63 , 65 , 68 ]. These articles all included White individuals. Of the two ( n  = 2/13, 15%) studies that reported the median time since HIV diagnosis [ 39 ], the average was 12.5 [ 63 ]- 21.5 [ 39 ] years. Medicaid was used as the patients’ primary health insurance in the USA [ 39 , 61 , 62 ].

Key operational components of geriatric models of HIV care

The qualitative analysis identified three distinct model of care components, each with one or more sub-components. These components are listed and described in Table 2 . Table 3 also lists the articles adherent to each component. These model components entail: Collaboration and Integration; Organization of Geriatric Care; and Support for Holistic Care. These three components are described and are illustrated in Fig.  2 .

 Main Model Components

Model Component 1: Collaboration and integration

Eleven ( n  = 11/13, 85%) [ 28 , 39 , 41 , 59 , 60 , 61 , 64 , 65 , 66 , 67 , 68 ] articles described the importance of collaboration and integration for providers caring for older adults with HIV. Models of care frequently incorporated a team of multidisciplinary professionals from the health and social care sectors that were linked in with community supports to improve healthcare delivery for older adults with HIV.

i) Multidisciplinary care roles

Multidisciplinary teams supported the care of older adults living with HIV in all eleven articles that adhered to the Collaboration and Integration model component ( n  = 11/13, 85%). These articles described several provider roles, including designated HIV specialists (infectious diseases or internal medicine physicians) [ 39 , 41 , 60 , 61 , 65 , 66 , 67 , 68 ], geriatricians [ 39 , 41 , 60 , 61 , 64 , 65 , 67 , 68 ] and/or dual-trained HIV and geriatric physicians. Other physician roles included psychiatrists [ 39 ], endocrinologists [ 65 ], cardiologists [ 41 , 60 , 61 , 68 ] and medicine fellows [ 64 ]. Numerous nursing roles [ 41 , 59 , 60 , 61 , 64 , 65 ] were involved, such as HIV clinical nurse specialists [ 41 , 66 , 67 ] and nurse practioners [ 41 , 64 , 65 ]. Allied health professionals included dieticians [ 39 , 65 , 66 ]/ nutritionists[ 41 ], social workers[ 39 , 41 , 59 , 61 , 65 , 66 , 68 ], phsysiotherapists [ 41 , 59 , 66 ], occupational therapists [ 41 , 59 , 66 ], speech-language pathologists[ 59 ], counselors/therapists [ 59 ], homecare aides [ 59 ], clinical psychologists [ 65 , 66 ] and specialist pharmacists [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ].

In addition to healthcare providers, several models of care also included research team members (i.e. research coordinators [ 39 ], research assistants [ 39 ], graduate students in gerontology and epidemiology [ 41 ]), medical directors and administrative staff [ 59 , 61 ] (e.g., program coordinator[ 60 ], a gerontologist [i.e., non-clinician] [ 41 ]), chaplains [ 59 ] and volunteers [ 59 ]. Peer navigator roles were also described [ 28 , 41 , 65 , 68 ].

The key responsibilities of these providers differed between models of care and many had overlapping functions. Physicians [ 39 , 41 , 60 , 61 , 64 , 65 , 66 , 67 , 68 ] and nurses [ 41 , 59 , 60 , 61 , 64 , 65 ] were often responsible for overseeing and ensuring appropriate medical care, such as disease and symptom management. Other healthcare professional roles and designated navigation-specific roles [ 28 , 65 , 68 ], provided medication, rehabilitation [ 41 , 59 , 66 ], dietary [ 39 , 59 , 65 , 66 ], or emotional counseling to patients and caregivers [ 59 ]. Geriatricians, in particular, provided evidence-based, best-practice advice that was shared with patients’ primary care providers [ 39 , 41 , 60 , 61 , 64 , 65 , 67 , 68 ]. HIV specialists generally oversaw HIV-related treatments and community services [ 39 , 41 , 60 , 61 , 65 , 66 , 67 , 68 ]. Pharmacists often provided medication instructions and explained care protocols [ 41 , 60 , 65 , 66 , 67 ]. All care providers were described as providing informational and tangible (i.e., hands-on care) support. Administrative and research staff were responsible for documenting relevant information accurately [ 39 , 41 , 59 , 61 ]. Only one article mentioned the role of non-professional caregivers (i.e., spouse, partner, or friend) as part of the care team [ 59 ], in which they were described as providing much of the personal care involved in the home management of HIV [ 59 ].

Administrative team members and researchers support the collection of client information to systematically standardize clinical and research operations [ 39 , 41 , 59 , 60 , 61 ].

ii) Team-Based care

Ten articles ( n  = 10/13, 77%) described the team-based delivery of multidisciplinary care, which was facilitated by several different mechanisms. Informational continuity was identified as being vital in ensuring a consistent and coherent approach to the management of older adults’ evolving needs [ 67 ]. A shared electronic health record was found to enable team-based care, including the ability for multiple providers to chat in real-time [ 28 , 41 , 60 , 61 , 68 ]. Moreover, the multidisciplinary team would often meet to discuss each patient’s background, their outcome measures, current clinical problems, and anticipated needs [ 28 ]. Consequently, the team would facilitate the appropriate screenings through access to different providers, services, and resources [ 28 , 39 , 41 , 60 , 61 , 65 , 68 ]. Following a referral and initial clinical visit, the HIV-geriatric specialists would maintain communication with the primary care team [ 28 ], make recommendations based on the identified age-related needs for care [ 28 ], initiate referrals to other specialist care providers and communicate with community stakeholders to meet other needs [ 59 ]. Team-based care allowed for all members of the circle of care to have a comprehensive knowledge of patients’ health and social care needs (e.g., functional, cognitive) [ 28 ]. Results from retrospective medical and pharmacy chart reviews helped inform all team decisions [ 65 ]. When deemed necessary, the team would be able to create a new action plan [ 39 ] and determine follow-up [ 64 ]. Nurses who worked in case manager roles helped to facilitate this care by coordinating a comprehensive, holistic care plan in collaboration with the patient, caregiver(s), physician(s), and other members of the care team [ 59 ]. Team-based models of care were felt to improve the coordination of care [ 41 ].

iii) Community linkages

Nine articles ( n  = 9/13, 69%) described how the management of HIV in older adults involved active, collaborative partnerships between multidisciplinary healthcare providers and the various community resources available to individuals living with HIV. Models of care were often delivered in linkage with community resources (e.g., social groups) [ 41 ] and through community partners (e.g., volunteer organizations) [ 41 ]. Social workers often helped to facilitate community linkages [ 59 ], and grant-funding helped to pay for community services [ 65 ]. By working with community partners [ 41 ], models of care were able to deliver both nonclinical care [ 39 ] (e.g., peer support to decrease isolation and depression [ 41 ]), as well as clinical care [ 28 ] (e.g., care facilitated by a community nurse [ 39 ]). Community outreach also helped to foster friendships amongst older adults living with HIV through social and community-building activities including dinners, speeches, dances, and trips [ 59 ]. Local partner agencies assisted with meeting the housing needs for patients with marginal housing [ 61 ], and with the provision of legal services [ 61 ]. Partnering medical HIV-geriatric services with community services was thought to result in improved access to services [ 28 ], reduced social isolation [ 60 ], improved home safety management [ 59 ] and the provision of spiritual care such as priests, rabbis, or pastoral personnel [ 59 ].

Model Component 2: Organization of geriatric care

The specific organizational structure of each model of care varied, particularly as it related to staffing models, processes for access and referrals, and the implementation of evidence-based, best-practice care and follow-up. All articles adhered and contributed to this model component. Models of care were often delivered through clinics that were predominantly hospital-based (i.e., operating within a hospital) [ 39 , 60 , 61 , 65 , 66 , 67 ]. Additionally, geriatric clinics were outpatient clinics housed within existing HIV clinics [ 41 ] or community-based services providing home care [ 59 ]. Some models of care were able to be delivered virtually, either solely via phone [ 62 ] or in addition to in-person delivery [ 65 , 66 ]. Some clinics ran weekly [ 66 ], bi-weekly [ 65 ] or monthly [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ], whereas others were full-time [ 39 , 65 ].

i) Staffing models

Within the identified models of care, various staffing models were described. All articles contributed to this sub-component. The Geriatrician-Referral model included a geriatrician who consulted on patients [ 39 , 41 , 60 , 61 , 64 , 65 ] based on a referral from the primary care team (often an HIV provider [ 41 ]), according to the perceived need (e.g., cognitive concerns). Six articles ( n  = 6/13, 46%) adhered to this. The Joint-Clinic model involved a geriatrician and HIV physician who were present in a single, combined clinic [ 41 , 66 , 67 , 68 ]. Four articles ( n  = 4/13, 31%) adhered to this model. The HIV-Physician-led model involved staffing clinics with a HIV physician and clinical nurse specialist trained in geriatrics, without geriatrician involvement [ 65 , 66 ]. Two articles ( n  = 2/13, 15%) adhered to this model. A further staffing model, the Dual-Trained Provider model, involved a dually-trained HIV and geriatrics provider, as either a physician [ 41 , 68 ] or psychotherapist [ 62 , 63 ]. Four articles ( n  = 4/13, 31%) adhered to this model. The Nurse-led model, involved nurse-lead teams of allied health professionals [ 59 ]. Only one article ( n  = 1/13, 8%) adhered to this model [ 59 ].

i) Access and referrals

All articles described processes to ensure appropriate access to care, and thus contributed to this sub-component. Referrals and on-call services [ 59 ] were used to facilitate access to care [ 59 ]. In some models of care, older adults were only able to access geriatric services via a referral from their HIV primary care team [ 39 , 41 , 60 , 61 , 67 ], while in other models, referrals were triggered by a combination of age (i.e., 50 years of age or older) and need (e.g., complexity) [ 28 , 66 , 67 , 68 ]. The process of receiving geriatric care often began with an assessment of patients’ needs and functional status (e.g., cognition) [ 39 ] and the collection of demographic information (e.g., age, sex, race/ethnicity, HIV risk factors, marital status, insurance status [ 39 ])[ 28 , 61 , 65 ]. Provider referrals were often documented through tracking scheduled appointments [ 60 , 61 , 68 ], however, limitations of this method included HIV providers not remembering to refer [ 41 ] and patient barriers such as confusion over the need for the referral which may result in skipping geriatric appointments [ 41 ]. One model of care implemented patient reminders to help ensure appointments were attended [ 64 ]. Two articles ( n  = 2/13, 15%) relied on referrals through an AIDS service organization [ 62 , 63 ]Moreover, across the models, patients could choose to be referred to one service (e.g. cardiology clinic) or multiple (e.g., geriatrics clinic) [ 60 , 68 ]. Patients could choose to have follow up with the geriatrician[ 28 ] and/or be connected with a primary care provider [ 41 ]. Clinics have developed guidelines and policies to guide the operation of services [ 28 ].

ii) Implementation of evidence-based screening

All articles described the incorporation of gold-standard, evidence-based screening practices into their geriatric care. Mood symptoms were assessed using the Hospital Anxiety and Depression Scale [ 60 , 62 , 63 , 67 ], the Geriatric Depression Scale [ 62 , 63 ], the Older Peoples’ Quality of Life Questionnaire [ 67 ] and/or the Patient Health Questionnaire [ 39 ], while cognition was assessed using tools such as the Montreal Cognitive Assessment [ 60 ]. CGAs were followed up with direct actions such as counseling (e.g., about ageing) [ 28 , 39 , 60 ], assessments of comorbidities, age-appropriate preventative health screening[ 41 , 60 , 61 ], and pharmacist reviews targeting polypharmacy and drug safety [4, NaN]. In addition to the CGA, clinics offered British HIV Association (BHIVA)-recommended screening (i.e., guidelines for the management of HIV), an antiretroviral review, a functional review and full medication review [ 28 , 66 ]. Emotional support was monitored using the ‘Therapy Content Checklist’ [ 62 , 63 ]. The goal of using valid measurements was to promote best practice [ 59 ].

Model Component 3: Support for holistic care

As older persons are more likely to experience cumulative health challenges that affect their quality of life, models of care for people ageing with HIV have incorporated a comprehensive holistic management approach. All included articles adhered and contributed to this model component. Clinics provided care for patients with multimorbidity [ 60 , 61 , 66 , 67 ] and helped them to overcome socioeconomic challenges [ 41 ], substance use disorders [ 60 , 65 ] and social isolation [ 60 , 62 , 63 ] by understanding their backgrounds[ 41 ]. Physical health consultations considered cardiovascular disease, dental health, eye health and bone health[ 28 , 41 , 60 , 61 , 64 , 68 ] to address HIV and metabolic-related complications [ 41 ]. Care plans incorporated medication prescriptions [ 28 , 39 , 60 , 61 , 66 , 67 , 68 ], preventative screening [ 28 , 39 , 60 , 61 , 64 , 65 , 66 , 67 , 68 ], age-related disease processes (e.g., cognitive-testing) [ 28 , 39 , 41 , 59 , 60 , 61 , 64 , 65 , 66 , 67 , 68 ], psychosocial interventions to improve social networks and mental health [ 28 , 39 , 59 , 60 , 62 , 63 , 64 , 65 ], exercise and nutrition regimens [ 39 ] and behavioural health supports (e.g., smoking cessation, therapy) [ 28 , 39 , 59 , 60 , 61 , 62 , 63 , 64 , 67 ] to meet the holistic needs of each patient. Spiritual support delivered through religious leaders, mental health counselors/therapists, and emotional support volunteers was also offered [ 59 , 64 ].

i)Comprehensive geriatric assessment

Most models of care ( n  = 8/13,61.5%) involved a CGA [ 28 , 39 , 41 , 60 , 61 , 66 , 68 ] or utilized geriatric screening tools [ 65 ] to guide holistic care plans. Most CGAs were delivered by geriatricians who would write full consultation notes [ 39 , 60 , 61 ], although non-geriatrician health care providers were often trained to administer geriatric screening tests [ 41 , 64 ]. The CGA provided an overview of physical and mental health, as well as social support systems [ 39 ], using validated scales [ 39 ].

ii)Supporting self-management

The models of care in six articles ( n  = 6/13, 46%) aimed to support the self-management of older adults living with HIV. The goal of self-management was to enable patients to better manage their health outside of the clinic setting by involving older adults in medical decision-making [ 60 , 68 ] and managing their chronic illnesses [ 59 , 60 , 61 ]. Self-management involved education [ 39 , 59 , 60 , 65 ] and coaching [ 28 ] about health behaviours, guidance for choosing appropriate interventions [ 39 , 59 , 65 ] to improve a patient’s health status [ 28 , 65 ], and increased health care utilization to improve patient involvement in care [ 60 , 65 ]. Some models involved classes where older adults could learn about various health conditions [ 60 , 61 , 62 , 63 ]. Where self-management was not possible due to cognitive or functional impairments, healthcare professionals provided education to individuals’ social support networks such as to encourage their inclusion in care [ 39 , 59 ]. To evaluate self-management, some studies included surveys about knowledge in the evaluations of the clinic models [ 60 , 61 ].

Our scoping review of the literature identified thirteen articles describing geriatric models of care for older adults living with HIV. The identified models came from two countries, the USA and the United Kingdom, and incorporated screening for geriatric syndromes [ 28 , 39 , 41 , 60 , 61 , 65 , 66 , 68 ]. From these articles, we identified three overarching key model components: Collaboration and Integration; Organization of Geriatric Care; and Support for Holistic Care. The models of care were largely delivered by a consulting geriatrician [ 39 , 41 , 60 , 61 , 64 , 65 ] via a referral from an HIV provider [ 41 ], from a joint clinic model involving a geriatrician and HIV physician[ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ], or through a dually-trained HIV-geriatrics provider [ 41 , 62 , 63 , 68 ]. However, some models did not involve a geriatrician [59, NaN]. Table 4 summarizes the future recommendations from the included articles.

Our review identified that most models of geriatric-HIV care are delivered by multidisciplinary teams that facilitate integrated health and social care. Multidisciplinary providers who work in team-based care models have been shown to improve clinical outcomes among HIV patients [ 70 , 71 , 72 , 73 ]. This study provided examples of collaborations in which practitioners worked together to meet the diverse needs of patients. Our data expand this finding by suggesting that multidisciplinary care providers help to facilitate referrals to even more providers, particularly those working in community settings, to ensure care continuity and care coordination to meet holistic needs for support. However, it is important for future research to further understand what staffing model of multidisciplinary team care contributes best to the quadruple aim of optimizing health system performance (i.e., improving the individual experience of care; improving the health of populations; reducing the per capita cost of healthcare and creating better provider experiences [ 74 ]) and the limitations of the existing approaches. Moreover, given the shortage of geriatricians [ 45 ] to meet patient needs, it is important to consider the transferability of models that involve a geriatrician [ 39 , 41 , 60 , 61 , 64 , 65 ][ 66 , 67 , 68 ], or dually-trained HIV-geriatrics provider [ 41 , 62 , 63 , 68 ].

The increasing proportion of older adults living with multimorbidity, including HIV, has evoked calls for tailored geriatric services that respond to their evolving needs. Our results suggest that care delivery should address multiple complex and multidimensional aspects of health and wellness, including psychosocial needs such as strategies to reduce social isolation. However, none of the articles discussed the provision of palliative or hospice care. Palliative care has been posited to augment HIV patients’ health and social care outcomes [ 75 ]. Implementation science may help researchers identify how to implement novel palliative care interventions into exiting practices and support uptake and sustainability by considering why, how and in what circumstances barriers and facilitators may be present [ 76 ]. In addition, older adults were described as being decision makers in their care such as being able to choose the follow up services they receive [ 60 , 68 ]. While some programs sought the input of older adults (e.g., through focus groups, none explicitly mentioned partnering with older adults to co-design their models of HIV care. Other HIV interventions have included individuals living with HIV on their steering committees and in development teams, such that care meaningfully reflects their wishes and preferences [ 77 , 78 , 79 ]. These interventions do not include older adults. Future models of care may wish to engage older adults in co-design to conceptualize and brainstorm program delivery [ 80 , 81 ].

Our review identified several areas of research with limited information. Most literature was published in the USA. Only one article mentioned the role of family caregivers in the care of HIV [ 59 ]. However, individuals living with HIV may receive support from non-kin family caregivers, such as friends [ 82 ]. Research is needed to better understand how broader conceptualizations of family can be embedded into the multidisciplinary care teams to help facilitate family-centered care [ 43 , 83 ]. Moreover, none of the articles mentioned care being delivered in the context of nursing or long-term care homes, nor did they mention offered referrals to long-term care facilities or services. Research is needed to determine the optimal approach for delivering geriatric services in long-term care settings to older adults living with HIV. Strategies are also needed to effectively embed HIV care into the already overburdened and under-resourced long-term care sector. While telehealth has proven to be an effective strategy for delivering HIV care [ 84 , 85 ], particularly in rural and remote communities where specialists may not be readily available [ 86 ], additional research is needed to identify the best practices and limitations for delivering geriatric-focused models of care virtually. Lastly, no studies have evaluated how to best incorporate culturally-sensitive geriatric care across racial and ethnic groups [ 87 , 88 ]. Thus, more data are needed to develop culturally-informed models of care to better engage and care for diverse populations of older adults living with HIV, particularly for adults with certain racial and ethnic backgrounds who may face pervasive stigma for accessing HIV care [ 89 , 90 ].

Limitations

As with any review, our findings must be considered within the context of the limitations. Despite our best efforts (i.e., multiple databases, peer-reviewed strategy, screening in duplicate, bibliographic searches, contacting authors of the reviewed articles), we may have inadvertently missed potentially relevant articles. Moreover, we may have missed papers of programs not yet described in the literature, such as those recently funded or piloted. Similarly, we limited the inclusion criteria to studies available in English due to resource constraints (i.e., lack of funding to support translation) and, consequently, may have biased our included studies to those published in English-speaking countries [ 91 ]. However, the intention of scoping reviews is to provide an overview or “map” of the breadth of existing literature, and thus, future exploration is warranted that builds upon our search strategy. Studies focused on individuals with HIV, but did not include description of older adults living with co-morbidities that impair healthcare decision-making, such as dementia, making it difficult to comment about models of care for individuals who require decision-making support. Lastly, stakeholders in implementing, delivering and receiving models of care (e.g., individuals with HIV, policy-makers, healthcare professionals) were not involved in the study design nor analysis.

Conclusions

Our review suggests that novel models of geriatric care for older adults living with HIV should include collaboration and integration, an organization of care that considers appropriate and timely referrals, communication of medical information and the implementation of evidence-based recommendations, as well as a holistic understanding of the dimensions of care, such that they support self-management. This proposed geriatric-based model can provide the framework to inform future implementation science and evaluative research to support further refining and developing this model. However, further research is needed to inform models of geriatric-HIV care in long-term care settings. Given the increasing number of older adults living with HIV, the development of best-practice models of integrated care can hopefully guide healthcare professionals to provide optimal care in the context of the complexities of care for older adults with HIV.

Availability of data and materials

The analysis files and data used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Comprehensive Geriatric Assessment

Human Immunodeficiency Virus

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Acknowledgements

We would like to thank and acknowledge the contributions of Charmaine De Castro, Information Specialist at the Mount Sinai Hospital– Sinai Health System, for providing guidance on the search strategy development, and conducting the literature search. We would like to thank and acknowledge the contributions of the authors who replied to our emails for contributing to our analysis.

This work was supported by Sinai Health’s Healthy Ageing and Geriatrics Program Research Fund.

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All authors contributed to the project idea and initiated the project. KMK and LS conceptualized the study design. KMK wrote the first draft of this manuscript and revised the article during the review process. KMK and LS provided guidance to the Information Specialist with respect to the design of the search strategy. All authors finalized the literature search strategy. KMK piloted the search strategy. AG and LS were involved in editing and revising the manuscript. All authors approved the final version of the protocol and are accountable for all aspects of the work.

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Kokorelias, K.M., Grosse, A., Zhabokritsky, A. et al. Understanding geriatric models of care for older adults living with HIV: a scoping review and qualitative analysis. BMC Geriatr 23 , 417 (2023). https://doi.org/10.1186/s12877-023-04114-7

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Qualitative study.

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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 intervene or introduce treatments just like in quantitative research, qualitative research helps generate hypotheses as well as 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 stand-alone study, purely relying on qualitative data or it could be part of mixed-methods research that combines qualitative and quantitative data. This review introduces the readers to some basic concepts, definitions, terminology, and application of qualitative research.

Qualitative research at its core, ask 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 at hand, qualitative research design is often not linear in the same way quantitative design is. [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 difficult to accurately capture quantitatively, whereas a qualitative approach allows participants themselves to explain how, why, or what they were thinking, feeling, and experiencing at a certain 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 important 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, qualitative and quantitative work are not necessarily opposites nor are they incompatible. [4] While qualitative and quantitative approaches are different, they are not necessarily opposites, and they are 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 that there is 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 together.

Examples of Qualitative Research Approaches

Ethnography

Ethnography as a research design has its origins 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 with the aim of being able 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] As opposed to quantitative research which is deductive and tests or verifies an existing theory, grounded theory research is inductive and therefore lends itself to research that is aiming to study social interactions or experiences. [3] [2] In essence, Grounded Theory’s goal is to explain for example 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 defined as 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 quite similar, but upon careful examination, the differences can be seen. At its core, phenomenology looks to investigate experiences from the perspective of the individual. [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 whereas Phenomenology focuses on describing and explaining an event or phenomena 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 ‘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, in the hopes of creating 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 that underpin different approaches to research. Essentially, research paradigms are the ‘worldview’ that inform research. [4] It is valuable for researchers, both qualitative and quantitative, 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 ontology 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 the work researchers do. [2] It is important to understand the ontological and epistemological foundations of the research paradigm researchers are working within to allow for a full understanding of the approach being used and the assumptions that underpin the approach as a whole. Further, it is crucial that researchers 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 vs Postpositivist

To further understand qualitative research, we need to discuss positivist and postpositivist frameworks. Positivism is a philosophy that the scientific method can and should be applied to social as well as natural sciences. [4] Essentially, positivist thinking insists that the social sciences should use natural science methods in its research which stems from positivist ontology that there is an objective reality that exists that is fully 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 it 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 constructivist as well, meaning they think there is no objective external reality that exists but rather 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] Essentially, Constructivist thought focuses on how ‘reality’ is not a fixed certainty and experiences, interactions, and backgrounds give people a unique view of the world. Constructivism contends, unlike in positivist views, that there is not necessarily an ‘objective’ reality we all experience. This is the ‘relativist’ ontological view that reality and the world we live in 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 and can even change the role of the researcher themselves. [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 itself, as in postpositivist qualitative work? Understanding the philosophical base of the research undertaken allows researchers to fully understand the implications of their work and their role within the research, as well as reflect on their own 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 at play. The following are examples of participant sampling and selection: [7]

• Purposive sampling- selection based on the researcher’s rationale in terms of 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 is 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 a participant-observer to share the experiences of the subject or a non-participant or detached observer.

While quantitative research design prescribes a controlled environment for data collection, qualitative data collection may be in a central location or in the environment of the participants, 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 with the use of 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 also could be in the form of themes and theory or model development.

Dissemination

To standardize and facilitate the dissemination of qualitative research outcomes, the healthcare team can use two reporting standards. 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 wider range of qualitative research. [13]

Examples of Application

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 for a better understanding of what the numbers truly mean and their implications. The qualitative methods can then help clarify the quantitative data and also help refine the hypothesis for future research. Furthermore, with qualitative research researchers can explore subjects that are poorly studied with quantitative methods. These include opinions, individual's actions, and social science research.

A good 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 there are no omissions of part of the target population. A proper collection method should be selected which will help obtain the desired information without overly limiting the collected data because many times, the information sought is not well compartmentalized 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 both why teens start to smoke as well as 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 non-smokers). This survey provides specific numbers (ranked importance of each factor) and is thus a quantitative research tool.

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

The researcher can conduct interviews and/or focus groups (qualitative research) about what types and forms of peer pressure are commonly encountered, where the peer pressure comes from, and where smoking first starts. The researcher hypothetically finds that peer pressure often occurs after school at the local teen hangouts, mostly 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 of smoking. The researcher finds a local park where many local teenagers hang out and see that a shady, overgrown area of the park is where the smokers tend to hang out. The researcher notes the 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 of the park, 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 the 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 population their perceptions of the changes, what factors are still at play, as well as quantitative research that includes teen smoking rates in the community, the incidence of new teen smokers, among others. [14] [15]

Qualitative research functions as a standalone research design or in combination with quantitative research to enhance our understanding of the world. Qualitative research uses techniques including structured and unstructured interviews, focus groups, and participant observation to not only help generate hypotheses which 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 provides researchers with a way 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 different ways, including the criteria for evaluating them. There are four well-established criteria for evaluating quantitative data: internal validity, external validity, reliability, and objectivity. The correlating concepts in qualitative research are credibility, transferability, dependability, and confirmability. [4] [11] The corresponding quantitative and qualitative concepts can be seen below, with the quantitative concept is on the left, and the qualitative concept is 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 so should qualitative researchers 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 methods of data collection to increase the likelihood of getting a reliable and accurate result. In our above magic example, the result would be more reliable by also interviewing the magician, back-stage hand, and the person who "vanished." In qualitative research, triangulation can include using telephone surveys, in-person surveys, focus groups, and interviews as well as surveying an adequate cross-section of the target demographic.
• Peer examination: Results can be reviewed by a peer to ensure the data is consistent with the findings.

‘Thick’ or ‘rich’ description can be used to evaluate the transferability of qualitative research whereas using an indicator such as an audit trail might help with evaluating the dependability and confirmability.

• Thick or rich description 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 carried out. Thick descriptions are detailed enough to allow readers to draw conclusions and interpret the data themselves, 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 records of information should also be kept (e.g., surveys, notes, recordings).

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

• Hawthorne effect: The Hawthorne effect is the change in participant behavior when they know they are being observed. If a researcher was wanting to identify factors that contribute to employee theft and tells the employees they are going to watch them to see what factors affect employee theft, one would suspect employee behavior would change when they know they are being watched.
• Observer-expectancy effect: Some participants change their behavior or responses to satisfy the researcher's desired effect. This happens in an unconscious manner for the participant so it is important to eliminate or limit transmitting the researcher's views.
• Artificial scenario effect: Some qualitative research occurs in artificial scenarios and/or 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 research by itself or combined with 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 does not exist as an island apart from quantitative research, but as an integral part of research methods to be used for the understanding of the world around us. [17]

• Enhancing Healthcare Team Outcomes

Qualitative research is important for all members of the health care team 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 works, 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, health care 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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