reporting qualitative research findings

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

• Knowledge Base
• Dissertation
• How to Write a Results Section | Tips & Examples

How to Write a Results Section | Tips & Examples

Published on August 30, 2022 by Tegan George . Revised on July 18, 2023.

A results section is where you report the main findings of the data collection and analysis you conducted for your thesis or dissertation . You should report all relevant results concisely and objectively, in a logical order. Don’t include subjective interpretations of why you found these results or what they mean—any evaluation should be saved for the discussion section .

Instantly correct all language mistakes in your text

Upload your document to correct all your mistakes in minutes

Table of contents

How to write a results section, reporting quantitative research results, reporting qualitative research results, results vs. discussion vs. conclusion, checklist: research results, other interesting articles, frequently asked questions about results sections.

When conducting research, it’s important to report the results of your study prior to discussing your interpretations of it. This gives your reader a clear idea of exactly what you found and keeps the data itself separate from your subjective analysis.

Here are a few best practices:

• Your results should always be written in the past tense.
• While the length of this section depends on how much data you collected and analyzed, it should be written as concisely as possible.
• Only include results that are directly relevant to answering your research questions . Avoid speculative or interpretative words like “appears” or “implies.”
• If you have other results you’d like to include, consider adding them to an appendix or footnotes.
• Always start out with your broadest results first, and then flow into your more granular (but still relevant) ones. Think of it like a shoe store: first discuss the shoes as a whole, then the sneakers, boots, sandals, etc.

Here's why students love Scribbr's proofreading services

Discover proofreading & editing

If you conducted quantitative research , you’ll likely be working with the results of some sort of statistical analysis .

Your results section should report the results of any statistical tests you used to compare groups or assess relationships between variables . It should also state whether or not each hypothesis was supported.

The most logical way to structure quantitative results is to frame them around your research questions or hypotheses. For each question or hypothesis, share:

• A reminder of the type of analysis you used (e.g., a two-sample t test or simple linear regression ). A more detailed description of your analysis should go in your methodology section.
• A concise summary of each relevant result, both positive and negative. This can include any relevant descriptive statistics (e.g., means and standard deviations ) as well as inferential statistics (e.g., t scores, degrees of freedom , and p values ). Remember, these numbers are often placed in parentheses.
• A brief statement of how each result relates to the question, or whether the hypothesis was supported. You can briefly mention any results that didn’t fit with your expectations and assumptions, but save any speculation on their meaning or consequences for your discussion  and conclusion.

A note on tables and figures

In quantitative research, it’s often helpful to include visual elements such as graphs, charts, and tables , but only if they are directly relevant to your results. Give these elements clear, descriptive titles and labels so that your reader can easily understand what is being shown. If you want to include any other visual elements that are more tangential in nature, consider adding a figure and table list .

As a rule of thumb:

• Tables are used to communicate exact values, giving a concise overview of various results
• Graphs and charts are used to visualize trends and relationships, giving an at-a-glance illustration of key findings

Don’t forget to also mention any tables and figures you used within the text of your results section. Summarize or elaborate on specific aspects you think your reader should know about rather than merely restating the same numbers already shown.

A two-sample t test was used to test the hypothesis that higher social distance from environmental problems would reduce the intent to donate to environmental organizations, with donation intention (recorded as a score from 1 to 10) as the outcome variable and social distance (categorized as either a low or high level of social distance) as the predictor variable.Social distance was found to be positively correlated with donation intention, t (98) = 12.19, p < .001, with the donation intention of the high social distance group 0.28 points higher, on average, than the low social distance group (see figure 1). This contradicts the initial hypothesis that social distance would decrease donation intention, and in fact suggests a small effect in the opposite direction.

Figure 1: Intention to donate to environmental organizations based on social distance from impact of environmental damage.

In qualitative research , your results might not all be directly related to specific hypotheses. In this case, you can structure your results section around key themes or topics that emerged from your analysis of the data.

For each theme, start with general observations about what the data showed. You can mention:

• Recurring points of agreement or disagreement
• Patterns and trends
• Particularly significant snippets from individual responses

Next, clarify and support these points with direct quotations. Be sure to report any relevant demographic information about participants. Further information (such as full transcripts , if appropriate) can be included in an appendix .

When asked about video games as a form of art, the respondents tended to believe that video games themselves are not an art form, but agreed that creativity is involved in their production. The criteria used to identify artistic video games included design, story, music, and creative teams.One respondent (male, 24) noted a difference in creativity between popular video game genres:

“I think that in role-playing games, there’s more attention to character design, to world design, because the whole story is important and more attention is paid to certain game elements […] so that perhaps you do need bigger teams of creative experts than in an average shooter or something.”

Responses suggest that video game consumers consider some types of games to have more artistic potential than others.

Your results section should objectively report your findings, presenting only brief observations in relation to each question, hypothesis, or theme.

It should not  speculate about the meaning of the results or attempt to answer your main research question . Detailed interpretation of your results is more suitable for your discussion section , while synthesis of your results into an overall answer to your main research question is best left for your conclusion .

Receive feedback on language, structure, and formatting

Professional editors proofread and edit your paper by focusing on:

• Academic style
• Vague sentences
• Style consistency

See an example

I have completed my data collection and analyzed the results.

I have included all results that are relevant to my research questions.

I have concisely and objectively reported each result, including relevant descriptive statistics and inferential statistics .

I have stated whether each hypothesis was supported or refuted.

I have used tables and figures to illustrate my results where appropriate.

All tables and figures are correctly labelled and referred to in the text.

There is no subjective interpretation or speculation on the meaning of the results.

You've finished writing up your results! Use the other checklists to further improve your thesis.

If you want to know more about AI for academic writing, AI tools, or research bias, make sure to check out some of our other articles with explanations and examples or go directly to our tools!

Research bias

• Survivorship bias
• Self-serving bias
• Availability heuristic
• Halo effect
• Hindsight bias
• Deep learning
• Generative AI
• Machine learning
• Reinforcement learning
• Supervised vs. unsupervised learning

 (AI) Tools

• Grammar Checker
• Paraphrasing Tool
• Text Summarizer
• AI Detector
• Plagiarism Checker
• Citation Generator

The results chapter of a thesis or dissertation presents your research results concisely and objectively.

In quantitative research , for each question or hypothesis , state:

• The type of analysis used
• Relevant results in the form of descriptive and inferential statistics
• Whether or not the alternative hypothesis was supported

In qualitative research , for each question or theme, describe:

• Recurring patterns
• Significant or representative individual responses
• Relevant quotations from the data

Don’t interpret or speculate in the results chapter.

Results are usually written in the past tense , because they are describing the outcome of completed actions.

The results chapter or section simply and objectively reports what you found, without speculating on why you found these results. The discussion interprets the meaning of the results, puts them in context, and explains why they matter.

In qualitative research , results and discussion are sometimes combined. But in quantitative research , it’s considered important to separate the objective results from your interpretation of them.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

George, T. (2023, July 18). How to Write a Results Section | Tips & Examples. Scribbr. Retrieved March 26, 2024, from https://www.scribbr.com/dissertation/results/

Is this article helpful?

Tegan George

Other students also liked, what is a research methodology | steps & tips, how to write a discussion section | tips & examples, how to write a thesis or dissertation conclusion, what is your plagiarism score.

How To Write The Results/Findings Chapter

For qualitative studies (dissertations & theses).

By: Jenna Crossley (PhD Cand). Expert Reviewed By: Dr. Eunice Rautenbach | August 2021

So, you’ve collected and analysed your qualitative data, and it’s time to write up your results chapter – exciting! But where do you start? In this post, we’ll guide you through the qualitative results chapter (also called the findings chapter), step by step.  

Overview: Qualitative Results Chapter

• What (exactly) the qualitative results chapter is
• What to include in your results chapter
• How to write up your results chapter
• A few tips and tricks to help you along the way

What exactly is the results chapter?

The results chapter in a dissertation or thesis (or any formal academic research piece) is where you objectively and neutrally present the findings of your qualitative analysis (or analyses if you used multiple qualitative analysis methods ). This chapter can sometimes be combined with the discussion chapter (where you interpret the data and discuss its meaning), depending on your university’s preference.  We’ll treat the two chapters as separate, as that’s the most common approach.

In contrast to a quantitative results chapter that presents numbers and statistics, a qualitative results chapter presents data primarily in the form of words . But this doesn’t mean that a qualitative study can’t have quantitative elements – you could, for example, present the number of times a theme or topic pops up in your data, depending on the analysis method(s) you adopt.

Adding a quantitative element to your study can add some rigour, which strengthens your results by providing more evidence for your claims. This is particularly common when using qualitative content analysis. Keep in mind though that qualitative research aims to achieve depth, richness and identify nuances , so don’t get tunnel vision by focusing on the numbers. They’re just cream on top in a qualitative analysis.

So, to recap, the results chapter is where you objectively present the findings of your analysis, without interpreting them (you’ll save that for the discussion chapter). With that out the way, let’s take a look at what you should include in your results chapter.

What should you include in the results chapter?

As we’ve mentioned, your qualitative results chapter should purely present and describe your results , not interpret them in relation to the existing literature or your research questions . Any speculations or discussion about the implications of your findings should be reserved for your discussion chapter.

In your results chapter, you’ll want to talk about your analysis findings and whether or not they support your hypotheses (if you have any). Naturally, the exact contents of your results chapter will depend on which qualitative analysis method (or methods) you use. For example, if you were to use thematic analysis, you’d detail the themes identified in your analysis, using extracts from the transcripts or text to support your claims.

While you do need to present your analysis findings in some detail, you should avoid dumping large amounts of raw data in this chapter. Instead, focus on presenting the key findings and using a handful of select quotes or text extracts to support each finding . The reams of data and analysis can be relegated to your appendices.

While it’s tempting to include every last detail you found in your qualitative analysis, it is important to make sure that you report only that which is relevant to your research aims, objectives and research questions .  Always keep these three components, as well as your hypotheses (if you have any) front of mind when writing the chapter and use them as a filter to decide what’s relevant and what’s not.

Need a helping hand?

How do I write the results chapter?

Now that we’ve covered the basics, it’s time to look at how to structure your chapter. Broadly speaking, the results chapter needs to contain three core components – the introduction, the body and the concluding summary. Let’s take a look at each of these.

Section 1: Introduction

The first step is to craft a brief introduction to the chapter. This intro is vital as it provides some context for your findings. In your introduction, you should begin by reiterating your problem statement and research questions and highlight the purpose of your research . Make sure that you spell this out for the reader so that the rest of your chapter is well contextualised.

The next step is to briefly outline the structure of your results chapter. In other words, explain what’s included in the chapter and what the reader can expect. In the results chapter, you want to tell a story that is coherent, flows logically, and is easy to follow , so make sure that you plan your structure out well and convey that structure (at a high level), so that your reader is well oriented.

The introduction section shouldn’t be lengthy. Two or three short paragraphs should be more than adequate. It is merely an introduction and overview, not a summary of the chapter.

Pro Tip – To help you structure your chapter, it can be useful to set up an initial draft with (sub)section headings so that you’re able to easily (re)arrange parts of your chapter. This will also help your reader to follow your results and give your chapter some coherence.  Be sure to use level-based heading styles (e.g. Heading 1, 2, 3 styles) to help the reader differentiate between levels visually. You can find these options in Word (example below).

Section 2: Body

Before we get started on what to include in the body of your chapter, it’s vital to remember that a results section should be completely objective and descriptive, not interpretive . So, be careful not to use words such as, “suggests” or “implies”, as these usually accompany some form of interpretation – that’s reserved for your discussion chapter.

The structure of your body section is very important , so make sure that you plan it out well. When planning out your qualitative results chapter, create sections and subsections so that you can maintain the flow of the story you’re trying to tell. Be sure to systematically and consistently describe each portion of results. Try to adopt a standardised structure for each portion so that you achieve a high level of consistency throughout the chapter.

For qualitative studies, results chapters tend to be structured according to themes , which makes it easier for readers to follow. However, keep in mind that not all results chapters have to be structured in this manner. For example, if you’re conducting a longitudinal study, you may want to structure your chapter chronologically. Similarly, you might structure this chapter based on your theoretical framework . The exact structure of your chapter will depend on the nature of your study , especially your research questions.

As you work through the body of your chapter, make sure that you use quotes to substantiate every one of your claims . You can present these quotes in italics to differentiate them from your own words. A general rule of thumb is to use at least two pieces of evidence per claim, and these should be linked directly to your data. Also, remember that you need to include all relevant results , not just the ones that support your assumptions or initial leanings.

In addition to including quotes, you can also link your claims to the data by using appendices , which you should reference throughout your text. When you reference, make sure that you include both the name/number of the appendix , as well as the line(s) from which you drew your data.

As referencing styles can vary greatly, be sure to look up the appendix referencing conventions of your university’s prescribed style (e.g. APA , Harvard, etc) and keep this consistent throughout your chapter.

Section 3: Concluding summary

The concluding summary is very important because it summarises your key findings and lays the foundation for the discussion chapter . Keep in mind that some readers may skip directly to this section (from the introduction section), so make sure that it can be read and understood well in isolation.

In this section, you need to remind the reader of the key findings. That is, the results that directly relate to your research questions and that you will build upon in your discussion chapter. Remember, your reader has digested a lot of information in this chapter, so you need to use this section to remind them of the most important takeaways.

Importantly, the concluding summary should not present any new information and should only describe what you’ve already presented in your chapter. Keep it concise – you’re not summarising the whole chapter, just the essentials.

Tips and tricks for an A-grade results chapter

Now that you’ve got a clear picture of what the qualitative results chapter is all about, here are some quick tips and reminders to help you craft a high-quality chapter:

• Your results chapter should be written in the past tense . You’ve done the work already, so you want to tell the reader what you found , not what you are currently finding .
• Make sure that you review your work multiple times and check that every claim is adequately backed up by evidence . Aim for at least two examples per claim, and make use of an appendix to reference these.
• When writing up your results, make sure that you stick to only what is relevant . Don’t waste time on data that are not relevant to your research objectives and research questions.
• Use headings and subheadings to create an intuitive, easy to follow piece of writing. Make use of Microsoft Word’s “heading styles” and be sure to use them consistently.
• When referring to numerical data, tables and figures can provide a useful visual aid. When using these, make sure that they can be read and understood independent of your body text (i.e. that they can stand-alone). To this end, use clear, concise labels for each of your tables or figures and make use of colours to code indicate differences or hierarchy.
• Similarly, when you’re writing up your chapter, it can be useful to highlight topics and themes in different colours . This can help you to differentiate between your data if you get a bit overwhelmed and will also help you to ensure that your results flow logically and coherently.

If you have any questions, leave a comment below and we’ll do our best to help. If you’d like 1-on-1 help with your results chapter (or any chapter of your dissertation or thesis), check out our private dissertation coaching service here or book a free initial consultation to discuss how we can help you.

Psst… there’s more (for free)

This post is part of our dissertation mini-course, which covers everything you need to get started with your dissertation, thesis or research project. 

You Might Also Like:

20 Comments

This was extremely helpful. Thanks a lot guys

Hi, thanks for the great research support platform created by the gradcoach team!

I wanted to ask- While “suggests” or “implies” are interpretive terms, what terms could we use for the results chapter? Could you share some examples of descriptive terms?

I think that instead of saying, ‘The data suggested, or The data implied,’ you can say, ‘The Data showed or revealed, or illustrated or outlined’…If interview data, you may say Jane Doe illuminated or elaborated, or Jane Doe described… or Jane Doe expressed or stated.

I found this article very useful. Thank you very much for the outstanding work you are doing.

What if i have 3 different interviewees answering the same interview questions? Should i then present the results in form of the table with the division on the 3 perspectives or rather give a results in form of the text and highlight who said what?

I think this tabular representation of results is a great idea. I am doing it too along with the text. Thanks

That was helpful was struggling to separate the discussion from the findings

this was very useful, Thank you.

Very helpful, I am confident to write my results chapter now.

It is so helpful! It is a good job. Thank you very much!

Very useful, well explained. Many thanks.

Hello, I appreciate the way you provided a supportive comments about qualitative results presenting tips

I loved this! It explains everything needed, and it has helped me better organize my thoughts. What words should I not use while writing my results section, other than subjective ones.

Thanks a lot, it is really helpful

Thank you so much dear, i really appropriate your nice explanations about this.

Thank you so much for this! I was wondering if anyone could help with how to prproperly integrate quotations (Excerpts) from interviews in the finding chapter in a qualitative research. Please GradCoach, address this issue and provide examples.

what if I’m not doing any interviews myself and all the information is coming from case studies that have already done the research.

Very helpful thank you.

This was very helpful as I was wondering how to structure this part of my dissertation, to include the quotes… Thanks for this explanation

This is very helpful, thanks! I am required to write up my results chapters with the discussion in each of them – any tips and tricks for this strategy?

Submit a Comment Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

• Print Friendly

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

Qualitative Data Analysis

23 Presenting the Results of Qualitative Analysis

Mikaila Mariel Lemonik Arthur

Qualitative research is not finished just because you have determined the main findings or conclusions of your study. Indeed, disseminating the results is an essential part of the research process. By sharing your results with others, whether in written form as scholarly paper or an applied report or in some alternative format like an oral presentation, an infographic, or a video, you ensure that your findings become part of the ongoing conversation of scholarship in your field, forming part of the foundation for future researchers. This chapter provides an introduction to writing about qualitative research findings. It will outline how writing continues to contribute to the analysis process, what concerns researchers should keep in mind as they draft their presentations of findings, and how best to organize qualitative research writing

As you move through the research process, it is essential to keep yourself organized. Organizing your data, memos, and notes aids both the analytical and the writing processes. Whether you use electronic or physical, real-world filing and organizational systems, these systems help make sense of the mountains of data you have and assure you focus your attention on the themes and ideas you have determined are important (Warren and Karner 2015). Be sure that you have kept detailed notes on all of the decisions you have made and procedures you have followed in carrying out research design, data collection, and analysis, as these will guide your ultimate write-up.

First and foremost, researchers should keep in mind that writing is in fact a form of thinking. Writing is an excellent way to discover ideas and arguments and to further develop an analysis. As you write, more ideas will occur to you, things that were previously confusing will start to make sense, and arguments will take a clear shape rather than being amorphous and poorly-organized. However, writing-as-thinking cannot be the final version that you share with others. Good-quality writing does not display the workings of your thought process. It is reorganized and revised (more on that later) to present the data and arguments important in a particular piece. And revision is totally normal! No one expects the first draft of a piece of writing to be ready for prime time. So write rough drafts and memos and notes to yourself and use them to think, and then revise them until the piece is the way you want it to be for sharing.

Bergin (2018) lays out a set of key concerns for appropriate writing about research. First, present your results accurately, without exaggerating or misrepresenting. It is very easy to overstate your findings by accident if you are enthusiastic about what you have found, so it is important to take care and use appropriate cautions about the limitations of the research. You also need to work to ensure that you communicate your findings in a way people can understand, using clear and appropriate language that is adjusted to the level of those you are communicating with. And you must be clear and transparent about the methodological strategies employed in the research. Remember, the goal is, as much as possible, to describe your research in a way that would permit others to replicate the study. There are a variety of other concerns and decision points that qualitative researchers must keep in mind, including the extent to which to include quantification in their presentation of results, ethics, considerations of audience and voice, and how to bring the richness of qualitative data to life.

Quantification, as you have learned, refers to the process of turning data into numbers. It can indeed be very useful to count and tabulate quantitative data drawn from qualitative research. For instance, if you were doing a study of dual-earner households and wanted to know how many had an equal division of household labor and how many did not, you might want to count those numbers up and include them as part of the final write-up. However, researchers need to take care when they are writing about quantified qualitative data. Qualitative data is not as generalizable as quantitative data, so quantification can be very misleading. Thus, qualitative researchers should strive to use raw numbers instead of the percentages that are more appropriate for quantitative research. Writing, for instance, “15 of the 20 people I interviewed prefer pancakes to waffles” is a simple description of the data; writing “75% of people prefer pancakes” suggests a generalizable claim that is not likely supported by the data. Note that mixing numbers with qualitative data is really a type of mixed-methods approach. Mixed-methods approaches are good, but sometimes they seduce researchers into focusing on the persuasive power of numbers and tables rather than capitalizing on the inherent richness of their qualitative data.

A variety of issues of scholarly ethics and research integrity are raised by the writing process. Some of these are unique to qualitative research, while others are more universal concerns for all academic and professional writing. For example, it is essential to avoid plagiarism and misuse of sources. All quotations that appear in a text must be properly cited, whether with in-text and bibliographic citations to the source or with an attribution to the research participant (or the participant’s pseudonym or description in order to protect confidentiality) who said those words. Where writers will paraphrase a text or a participant’s words, they need to make sure that the paraphrase they develop accurately reflects the meaning of the original words. Thus, some scholars suggest that participants should have the opportunity to read (or to have read to them, if they cannot read the text themselves) all sections of the text in which they, their words, or their ideas are presented to ensure accuracy and enable participants to maintain control over their lives.

Audience and Voice

When writing, researchers must consider their audience(s) and the effects they want their writing to have on these audiences. The designated audience will dictate the voice used in the writing, or the individual style and personality of a piece of text. Keep in mind that the potential audience for qualitative research is often much more diverse than that for quantitative research because of the accessibility of the data and the extent to which the writing can be accessible and interesting. Yet individual pieces of writing are typically pitched to a more specific subset of the audience.

Let us consider one potential research study, an ethnography involving participant-observation of the same children both when they are at daycare facility and when they are at home with their families to try to understand how daycare might impact behavior and social development. The findings of this study might be of interest to a wide variety of potential audiences: academic peers, whether at your own academic institution, in your broader discipline, or multidisciplinary; people responsible for creating laws and policies; practitioners who run or teach at day care centers; and the general public, including both people who are interested in child development more generally and those who are themselves parents making decisions about child care for their own children. And the way you write for each of these audiences will be somewhat different. Take a moment and think through what some of these differences might look like.

If you are writing to academic audiences, using specialized academic language and working within the typical constraints of scholarly genres, as will be discussed below, can be an important part of convincing others that your work is legitimate and should be taken seriously. Your writing will be formal. Even if you are writing for students and faculty you already know—your classmates, for instance—you are often asked to imitate the style of academic writing that is used in publications, as this is part of learning to become part of the scholarly conversation. When speaking to academic audiences outside your discipline, you may need to be more careful about jargon and specialized language, as disciplines do not always share the same key terms. For instance, in sociology, scholars use the term diffusion to refer to the way new ideas or practices spread from organization to organization. In the field of international relations, scholars often used the term cascade to refer to the way ideas or practices spread from nation to nation. These terms are describing what is fundamentally the same concept, but they are different terms—and a scholar from one field might have no idea what a scholar from a different field is talking about! Therefore, while the formality and academic structure of the text would stay the same, a writer with a multidisciplinary audience might need to pay more attention to defining their terms in the body of the text.

It is not only other academic scholars who expect to see formal writing. Policymakers tend to expect formality when ideas are presented to them, as well. However, the content and style of the writing will be different. Much less academic jargon should be used, and the most important findings and policy implications should be emphasized right from the start rather than initially focusing on prior literature and theoretical models as you might for an academic audience. Long discussions of research methods should also be minimized. Similarly, when you write for practitioners, the findings and implications for practice should be highlighted. The reading level of the text will vary depending on the typical background of the practitioners to whom you are writing—you can make very different assumptions about the general knowledge and reading abilities of a group of hospital medical directors with MDs than you can about a group of case workers who have a post-high-school certificate. Consider the primary language of your audience as well. The fact that someone can get by in spoken English does not mean they have the vocabulary or English reading skills to digest a complex report. But the fact that someone’s vocabulary is limited says little about their intellectual abilities, so try your best to convey the important complexity of the ideas and findings from your research without dumbing them down—even if you must limit your vocabulary usage.

When writing for the general public, you will want to move even further towards emphasizing key findings and policy implications, but you also want to draw on the most interesting aspects of your data. General readers will read sociological texts that are rich with ethnographic or other kinds of detail—it is almost like reality television on a page! And this is a contrast to busy policymakers and practitioners, who probably want to learn the main findings as quickly as possible so they can go about their busy lives. But also keep in mind that there is a wide variation in reading levels. Journalists at publications pegged to the general public are often advised to write at about a tenth-grade reading level, which would leave most of the specialized terminology we develop in our research fields out of reach. If you want to be accessible to even more people, your vocabulary must be even more limited. The excellent exercise of trying to write using the 1,000 most common English words, available at the Up-Goer Five website ( https://www.splasho.com/upgoer5/ ) does a good job of illustrating this challenge (Sanderson n.d.).

Another element of voice is whether to write in the first person. While many students are instructed to avoid the use of the first person in academic writing, this advice needs to be taken with a grain of salt. There are indeed many contexts in which the first person is best avoided, at least as long as writers can find ways to build strong, comprehensible sentences without its use, including most quantitative research writing. However, if the alternative to using the first person is crafting a sentence like “it is proposed that the researcher will conduct interviews,” it is preferable to write “I propose to conduct interviews.” In qualitative research, in fact, the use of the first person is far more common. This is because the researcher is central to the research project. Qualitative researchers can themselves be understood as research instruments, and thus eliminating the use of the first person in writing is in a sense eliminating information about the conduct of the researchers themselves.

But the question really extends beyond the issue of first-person or third-person. Qualitative researchers have choices about how and whether to foreground themselves in their writing, not just in terms of using the first person, but also in terms of whether to emphasize their own subjectivity and reflexivity, their impressions and ideas, and their role in the setting. In contrast, conventional quantitative research in the positivist tradition really tries to eliminate the author from the study—which indeed is exactly why typical quantitative research avoids the use of the first person. Keep in mind that emphasizing researchers’ roles and reflexivity and using the first person does not mean crafting articles that provide overwhelming detail about the author’s thoughts and practices. Readers do not need to hear, and should not be told, which database you used to search for journal articles, how many hours you spent transcribing, or whether the research process was stressful—save these things for the memos you write to yourself. Rather, readers need to hear how you interacted with research participants, how your standpoint may have shaped the findings, and what analytical procedures you carried out.

Making Data Come Alive

One of the most important parts of writing about qualitative research is presenting the data in a way that makes its richness and value accessible to readers. As the discussion of analysis in the prior chapter suggests, there are a variety of ways to do this. Researchers may select key quotes or images to illustrate points, write up specific case studies that exemplify their argument, or develop vignettes (little stories) that illustrate ideas and themes, all drawing directly on the research data. Researchers can also write more lengthy summaries, narratives, and thick descriptions.

Nearly all qualitative work includes quotes from research participants or documents to some extent, though ethnographic work may focus more on thick description than on relaying participants’ own words. When quotes are presented, they must be explained and interpreted—they cannot stand on their own. This is one of the ways in which qualitative research can be distinguished from journalism. Journalism presents what happened, but social science needs to present the “why,” and the why is best explained by the researcher.

So how do authors go about integrating quotes into their written work? Julie Posselt (2017), a sociologist who studies graduate education, provides a set of instructions. First of all, authors need to remain focused on the core questions of their research, and avoid getting distracted by quotes that are interesting or attention-grabbing but not so relevant to the research question. Selecting the right quotes, those that illustrate the ideas and arguments of the paper, is an important part of the writing process. Second, not all quotes should be the same length (just like not all sentences or paragraphs in a paper should be the same length). Include some quotes that are just phrases, others that are a sentence or so, and others that are longer. We call longer quotes, generally those more than about three lines long, block quotes , and they are typically indented on both sides to set them off from the surrounding text. For all quotes, be sure to summarize what the quote should be telling or showing the reader, connect this quote to other quotes that are similar or different, and provide transitions in the discussion to move from quote to quote and from topic to topic. Especially for longer quotes, it is helpful to do some of this writing before the quote to preview what is coming and other writing after the quote to make clear what readers should have come to understand. Remember, it is always the author’s job to interpret the data. Presenting excerpts of the data, like quotes, in a form the reader can access does not minimize the importance of this job. Be sure that you are explaining the meaning of the data you present.

A few more notes about writing with quotes: avoid patchwriting, whether in your literature review or the section of your paper in which quotes from respondents are presented. Patchwriting is a writing practice wherein the author lightly paraphrases original texts but stays so close to those texts that there is little the author has added. Sometimes, this even takes the form of presenting a series of quotes, properly documented, with nothing much in the way of text generated by the author. A patchwriting approach does not build the scholarly conversation forward, as it does not represent any kind of new contribution on the part of the author. It is of course fine to paraphrase quotes, as long as the meaning is not changed. But if you use direct quotes, do not edit the text of the quotes unless how you edit them does not change the meaning and you have made clear through the use of ellipses (…) and brackets ([])what kinds of edits have been made. For example, consider this exchange from Matthew Desmond’s (2012:1317) research on evictions:

The thing was, I wasn’t never gonna let Crystal come and stay with me from the get go. I just told her that to throw her off. And she wasn’t fittin’ to come stay with me with no money…No. Nope. You might as well stay in that shelter.

A paraphrase of this exchange might read “She said that she was going to let Crystal stay with her if Crystal did not have any money.” Paraphrases like that are fine. What is not fine is rewording the statement but treating it like a quote, for instance writing:

The thing was, I was not going to let Crystal come and stay with me from beginning. I just told her that to throw her off. And it was not proper for her to come stay with me without any money…No. Nope. You might as well stay in that shelter.

But as you can see, the change in language and style removes some of the distinct meaning of the original quote. Instead, writers should leave as much of the original language as possible. If some text in the middle of the quote needs to be removed, as in this example, ellipses are used to show that this has occurred. And if a word needs to be added to clarify, it is placed in square brackets to show that it was not part of the original quote.

Data can also be presented through the use of data displays like tables, charts, graphs, diagrams, and infographics created for publication or presentation, as well as through the use of visual material collected during the research process. Note that if visuals are used, the author must have the legal right to use them. Photographs or diagrams created by the author themselves—or by research participants who have signed consent forms for their work to be used, are fine. But photographs, and sometimes even excerpts from archival documents, may be owned by others from whom researchers must get permission in order to use them.

A large percentage of qualitative research does not include any data displays or visualizations. Therefore, researchers should carefully consider whether the use of data displays will help the reader understand the data. One of the most common types of data displays used by qualitative researchers are simple tables. These might include tables summarizing key data about cases included in the study; tables laying out the characteristics of different taxonomic elements or types developed as part of the analysis; tables counting the incidence of various elements; and 2×2 tables (two columns and two rows) illuminating a theory. Basic network or process diagrams are also commonly included. If data displays are used, it is essential that researchers include context and analysis alongside data displays rather than letting them stand by themselves, and it is preferable to continue to present excerpts and examples from the data rather than just relying on summaries in the tables.

If you will be using graphs, infographics, or other data visualizations, it is important that you attend to making them useful and accurate (Bergin 2018). Think about the viewer or user as your audience and ensure the data visualizations will be comprehensible. You may need to include more detail or labels than you might think. Ensure that data visualizations are laid out and labeled clearly and that you make visual choices that enhance viewers’ ability to understand the points you intend to communicate using the visual in question. Finally, given the ease with which it is possible to design visuals that are deceptive or misleading, it is essential to make ethical and responsible choices in the construction of visualization so that viewers will interpret them in accurate ways.

The Genre of Research Writing

As discussed above, the style and format in which results are presented depends on the audience they are intended for. These differences in styles and format are part of the genre of writing. Genre is a term referring to the rules of a specific form of creative or productive work. Thus, the academic journal article—and student papers based on this form—is one genre. A report or policy paper is another. The discussion below will focus on the academic journal article, but note that reports and policy papers follow somewhat different formats. They might begin with an executive summary of one or a few pages, include minimal background, focus on key findings, and conclude with policy implications, shifting methods and details about the data to an appendix. But both academic journal articles and policy papers share some things in common, for instance the necessity for clear writing, a well-organized structure, and the use of headings.

So what factors make up the genre of the academic journal article in sociology? While there is some flexibility, particularly for ethnographic work, academic journal articles tend to follow a fairly standard format. They begin with a “title page” that includes the article title (often witty and involving scholarly inside jokes, but more importantly clearly describing the content of the article); the authors’ names and institutional affiliations, an abstract , and sometimes keywords designed to help others find the article in databases. An abstract is a short summary of the article that appears both at the very beginning of the article and in search databases. Abstracts are designed to aid readers by giving them the opportunity to learn enough about an article that they can determine whether it is worth their time to read the complete text. They are written about the article, and thus not in the first person, and clearly summarize the research question, methodological approach, main findings, and often the implications of the research.

After the abstract comes an “introduction” of a page or two that details the research question, why it matters, and what approach the paper will take. This is followed by a literature review of about a quarter to a third the length of the entire paper. The literature review is often divided, with headings, into topical subsections, and is designed to provide a clear, thorough overview of the prior research literature on which a paper has built—including prior literature the new paper contradicts. At the end of the literature review it should be made clear what researchers know about the research topic and question, what they do not know, and what this new paper aims to do to address what is not known.

The next major section of the paper is the section that describes research design, data collection, and data analysis, often referred to as “research methods” or “methodology.” This section is an essential part of any written or oral presentation of your research. Here, you tell your readers or listeners “how you collected and interpreted your data” (Taylor, Bogdan, and DeVault 2016:215). Taylor, Bogdan, and DeVault suggest that the discussion of your research methods include the following:

• The particular approach to data collection used in the study;
• Any theoretical perspective(s) that shaped your data collection and analytical approach;
• When the study occurred, over how long, and where (concealing identifiable details as needed);
• A description of the setting and participants, including sampling and selection criteria (if an interview-based study, the number of participants should be clearly stated);
• The researcher’s perspective in carrying out the study, including relevant elements of their identity and standpoint, as well as their role (if any) in research settings; and
• The approach to analyzing the data.

After the methods section comes a section, variously titled but often called “data,” that takes readers through the analysis. This section is where the thick description narrative; the quotes, broken up by theme or topic, with their interpretation; the discussions of case studies; most data displays (other than perhaps those outlining a theoretical model or summarizing descriptive data about cases); and other similar material appears. The idea of the data section is to give readers the ability to see the data for themselves and to understand how this data supports the ultimate conclusions. Note that all tables and figures included in formal publications should be titled and numbered.

At the end of the paper come one or two summary sections, often called “discussion” and/or “conclusion.” If there is a separate discussion section, it will focus on exploring the overall themes and findings of the paper. The conclusion clearly and succinctly summarizes the findings and conclusions of the paper, the limitations of the research and analysis, any suggestions for future research building on the paper or addressing these limitations, and implications, be they for scholarship and theory or policy and practice.

After the end of the textual material in the paper comes the bibliography, typically called “works cited” or “references.” The references should appear in a consistent citation style—in sociology, we often use the American Sociological Association format (American Sociological Association 2019), but other formats may be used depending on where the piece will eventually be published. Care should be taken to ensure that in-text citations also reflect the chosen citation style. In some papers, there may be an appendix containing supplemental information such as a list of interview questions or an additional data visualization.

Note that when researchers give presentations to scholarly audiences, the presentations typically follow a format similar to that of scholarly papers, though given time limitations they are compressed. Abstracts and works cited are often not part of the presentation, though in-text citations are still used. The literature review presented will be shortened to only focus on the most important aspects of the prior literature, and only key examples from the discussion of data will be included. For long or complex papers, sometimes only one of several findings is the focus of the presentation. Of course, presentations for other audiences may be constructed differently, with greater attention to interesting elements of the data and findings as well as implications and less to the literature review and methods.

Concluding Your Work

After you have written a complete draft of the paper, be sure you take the time to revise and edit your work. There are several important strategies for revision. First, put your work away for a little while. Even waiting a day to revise is better than nothing, but it is best, if possible, to take much more time away from the text. This helps you forget what your writing looks like and makes it easier to find errors, mistakes, and omissions. Second, show your work to others. Ask them to read your work and critique it, pointing out places where the argument is weak, where you may have overlooked alternative explanations, where the writing could be improved, and what else you need to work on. Finally, read your work out loud to yourself (or, if you really need an audience, try reading to some stuffed animals). Reading out loud helps you catch wrong words, tricky sentences, and many other issues. But as important as revision is, try to avoid perfectionism in writing (Warren and Karner 2015). Writing can always be improved, no matter how much time you spend on it. Those improvements, however, have diminishing returns, and at some point the writing process needs to conclude so the writing can be shared with the world.

Of course, the main goal of writing up the results of a research project is to share with others. Thus, researchers should be considering how they intend to disseminate their results. What conferences might be appropriate? Where can the paper be submitted? Note that if you are an undergraduate student, there are a wide variety of journals that accept and publish research conducted by undergraduates. Some publish across disciplines, while others are specific to disciplines. Other work, such as reports, may be best disseminated by publication online on relevant organizational websites.

After a project is completed, be sure to take some time to organize your research materials and archive them for longer-term storage. Some Institutional Review Board (IRB) protocols require that original data, such as interview recordings, transcripts, and field notes, be preserved for a specific number of years in a protected (locked for paper or password-protected for digital) form and then destroyed, so be sure that your plans adhere to the IRB requirements. Be sure you keep any materials that might be relevant for future related research or for answering questions people may ask later about your project.

And then what? Well, then it is time to move on to your next research project. Research is a long-term endeavor, not a one-time-only activity. We build our skills and our expertise as we continue to pursue research. So keep at it.

• Find a short article that uses qualitative methods. The sociological magazine Contexts is a good place to find such pieces. Write an abstract of the article.
• Choose a sociological journal article on a topic you are interested in that uses some form of qualitative methods and is at least 20 pages long. Rewrite the article as a five-page research summary accessible to non-scholarly audiences.
• Choose a concept or idea you have learned in this course and write an explanation of it using the Up-Goer Five Text Editor ( https://www.splasho.com/upgoer5/ ), a website that restricts your writing to the 1,000 most common English words. What was this experience like? What did it teach you about communicating with people who have a more limited English-language vocabulary—and what did it teach you about the utility of having access to complex academic language?
• Select five or more sociological journal articles that all use the same basic type of qualitative methods (interviewing, ethnography, documents, or visual sociology). Using what you have learned about coding, code the methods sections of each article, and use your coding to figure out what is common in how such articles discuss their research design, data collection, and analysis methods.
• Return to an exercise you completed earlier in this course and revise your work. What did you change? How did revising impact the final product?
• Find a quote from the transcript of an interview, a social media post, or elsewhere that has not yet been interpreted or explained. Write a paragraph that includes the quote along with an explanation of its sociological meaning or significance.

The style or personality of a piece of writing, including such elements as tone, word choice, syntax, and rhythm.

A quotation, usually one of some length, which is set off from the main text by being indented on both sides rather than being placed in quotation marks.

A classification of written or artistic work based on form, content, and style.

A short summary of a text written from the perspective of a reader rather than from the perspective of an author.

Social Data Analysis Copyright © 2021 by Mikaila Mariel Lemonik Arthur is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Am J Pharm Educ
• v.74(8); 2010 Oct 11

Presenting and Evaluating Qualitative Research

The purpose of this paper is to help authors to think about ways to present qualitative research papers in the American Journal of Pharmaceutical Education . It also discusses methods for reviewers to assess the rigour, quality, and usefulness of qualitative research. Examples of different ways to present data from interviews, observations, and focus groups are included. The paper concludes with guidance for publishing qualitative research and a checklist for authors and reviewers.

INTRODUCTION

Policy and practice decisions, including those in education, increasingly are informed by findings from qualitative as well as quantitative research. Qualitative research is useful to policymakers because it often describes the settings in which policies will be implemented. Qualitative research is also useful to both pharmacy practitioners and pharmacy academics who are involved in researching educational issues in both universities and practice and in developing teaching and learning.

Qualitative research involves the collection, analysis, and interpretation of data that are not easily reduced to numbers. These data relate to the social world and the concepts and behaviors of people within it. Qualitative research can be found in all social sciences and in the applied fields that derive from them, for example, research in health services, nursing, and pharmacy. 1 It looks at X in terms of how X varies in different circumstances rather than how big is X or how many Xs are there? 2 Textbooks often subdivide research into qualitative and quantitative approaches, furthering the common assumption that there are fundamental differences between the 2 approaches. With pharmacy educators who have been trained in the natural and clinical sciences, there is often a tendency to embrace quantitative research, perhaps due to familiarity. A growing consensus is emerging that sees both qualitative and quantitative approaches as useful to answering research questions and understanding the world. Increasingly mixed methods research is being carried out where the researcher explicitly combines the quantitative and qualitative aspects of the study. 3 , 4

Like healthcare, education involves complex human interactions that can rarely be studied or explained in simple terms. Complex educational situations demand complex understanding; thus, the scope of educational research can be extended by the use of qualitative methods. Qualitative research can sometimes provide a better understanding of the nature of educational problems and thus add to insights into teaching and learning in a number of contexts. For example, at the University of Nottingham, we conducted in-depth interviews with pharmacists to determine their perceptions of continuing professional development and who had influenced their learning. We also have used a case study approach using observation of practice and in-depth interviews to explore physiotherapists' views of influences on their leaning in practice. We have conducted in-depth interviews with a variety of stakeholders in Malawi, Africa, to explore the issues surrounding pharmacy academic capacity building. A colleague has interviewed and conducted focus groups with students to explore cultural issues as part of a joint Nottingham-Malaysia pharmacy degree program. Another colleague has interviewed pharmacists and patients regarding their expectations before and after clinic appointments and then observed pharmacist-patient communication in clinics and assessed it using the Calgary Cambridge model in order to develop recommendations for communication skills training. 5 We have also performed documentary analysis on curriculum data to compare pharmacist and nurse supplementary prescribing courses in the United Kingdom.

It is important to choose the most appropriate methods for what is being investigated. Qualitative research is not appropriate to answer every research question and researchers need to think carefully about their objectives. Do they wish to study a particular phenomenon in depth (eg, students' perceptions of studying in a different culture)? Or are they more interested in making standardized comparisons and accounting for variance (eg, examining differences in examination grades after changing the way the content of a module is taught). Clearly a quantitative approach would be more appropriate in the last example. As with any research project, a clear research objective has to be identified to know which methods should be applied.

Types of qualitative data include:

• Audio recordings and transcripts from in-depth or semi-structured interviews
• Structured interview questionnaires containing substantial open comments including a substantial number of responses to open comment items.
• Audio recordings and transcripts from focus group sessions.
• Field notes (notes taken by the researcher while in the field [setting] being studied)
• Video recordings (eg, lecture delivery, class assignments, laboratory performance)
• Case study notes
• Documents (reports, meeting minutes, e-mails)
• Diaries, video diaries
• Observation notes
• Press clippings
• Photographs

RIGOUR IN QUALITATIVE RESEARCH

Qualitative research is often criticized as biased, small scale, anecdotal, and/or lacking rigor; however, when it is carried out properly it is unbiased, in depth, valid, reliable, credible and rigorous. In qualitative research, there needs to be a way of assessing the “extent to which claims are supported by convincing evidence.” 1 Although the terms reliability and validity traditionally have been associated with quantitative research, increasingly they are being seen as important concepts in qualitative research as well. Examining the data for reliability and validity assesses both the objectivity and credibility of the research. Validity relates to the honesty and genuineness of the research data, while reliability relates to the reproducibility and stability of the data.

The validity of research findings refers to the extent to which the findings are an accurate representation of the phenomena they are intended to represent. The reliability of a study refers to the reproducibility of the findings. Validity can be substantiated by a number of techniques including triangulation use of contradictory evidence, respondent validation, and constant comparison. Triangulation is using 2 or more methods to study the same phenomenon. Contradictory evidence, often known as deviant cases, must be sought out, examined, and accounted for in the analysis to ensure that researcher bias does not interfere with or alter their perception of the data and any insights offered. Respondent validation, which is allowing participants to read through the data and analyses and provide feedback on the researchers' interpretations of their responses, provides researchers with a method of checking for inconsistencies, challenges the researchers' assumptions, and provides them with an opportunity to re-analyze their data. The use of constant comparison means that one piece of data (for example, an interview) is compared with previous data and not considered on its own, enabling researchers to treat the data as a whole rather than fragmenting it. Constant comparison also enables the researcher to identify emerging/unanticipated themes within the research project.

STRENGTHS AND LIMITATIONS OF QUALITATIVE RESEARCH

Qualitative researchers have been criticized for overusing interviews and focus groups at the expense of other methods such as ethnography, observation, documentary analysis, case studies, and conversational analysis. Qualitative research has numerous strengths when properly conducted.

Strengths of Qualitative Research

• Issues can be examined in detail and in depth.
• Interviews are not restricted to specific questions and can be guided/redirected by the researcher in real time.
• The research framework and direction can be quickly revised as new information emerges.
• The data based on human experience that is obtained is powerful and sometimes more compelling than quantitative data.
• Subtleties and complexities about the research subjects and/or topic are discovered that are often missed by more positivistic enquiries.
• Data usually are collected from a few cases or individuals so findings cannot be generalized to a larger population. Findings can however be transferable to another setting.

Limitations of Qualitative Research

• Research quality is heavily dependent on the individual skills of the researcher and more easily influenced by the researcher's personal biases and idiosyncrasies.
• Rigor is more difficult to maintain, assess, and demonstrate.
• The volume of data makes analysis and interpretation time consuming.
• It is sometimes not as well understood and accepted as quantitative research within the scientific community
• The researcher's presence during data gathering, which is often unavoidable in qualitative research, can affect the subjects' responses.
• Issues of anonymity and confidentiality can present problems when presenting findings
• Findings can be more difficult and time consuming to characterize in a visual way.

PRESENTATION OF QUALITATIVE RESEARCH FINDINGS

The following extracts are examples of how qualitative data might be presented:

Data From an Interview.

The following is an example of how to present and discuss a quote from an interview.

The researcher should select quotes that are poignant and/or most representative of the research findings. Including large portions of an interview in a research paper is not necessary and often tedious for the reader. The setting and speakers should be established in the text at the end of the quote.

The student describes how he had used deep learning in a dispensing module. He was able to draw on learning from a previous module, “I found that while using the e learning programme I was able to apply the knowledge and skills that I had gained in last year's diseases and goals of treatment module.” (interviewee 22, male)

This is an excerpt from an article on curriculum reform that used interviews 5 :

The first question was, “Without the accreditation mandate, how much of this curriculum reform would have been attempted?” According to respondents, accreditation played a significant role in prompting the broad-based curricular change, and their comments revealed a nuanced view. Most indicated that the change would likely have occurred even without the mandate from the accreditation process: “It reflects where the profession wants to be … training a professional who wants to take on more responsibility.” However, they also commented that “if it were not mandated, it could have been a very difficult road.” Or it “would have happened, but much later.” The change would more likely have been incremental, “evolutionary,” or far more limited in its scope. “Accreditation tipped the balance” was the way one person phrased it. “Nobody got serious until the accrediting body said it would no longer accredit programs that did not change.”

Data From Observations

The following example is some data taken from observation of pharmacist patient consultations using the Calgary Cambridge guide. 6 , 7 The data are first presented and a discussion follows:

Pharmacist: We will soon be starting a stop smoking clinic. Patient: Is the interview over now? Pharmacist: No this is part of it. (Laughs) You can't tell me to bog off (sic) yet. (pause) We will be starting a stop smoking service here, Patient: Yes. Pharmacist: with one-to-one and we will be able to help you or try to help you. If you want it. In this example, the pharmacist has picked up from the patient's reaction to the stop smoking clinic that she is not receptive to advice about giving up smoking at this time; in fact she would rather end the consultation. The pharmacist draws on his prior relationship with the patient and makes use of a joke to lighten the tone. He feels his message is important enough to persevere but he presents the information in a succinct and non-pressurised way. His final comment of “If you want it” is important as this makes it clear that he is not putting any pressure on the patient to take up this offer. This extract shows that some patient cues were picked up, and appropriately dealt with, but this was not the case in all examples.

Data From Focus Groups

This excerpt from a study involving 11 focus groups illustrates how findings are presented using representative quotes from focus group participants. 8

Those pharmacists who were initially familiar with CPD endorsed the model for their peers, and suggested it had made a meaningful difference in the way they viewed their own practice. In virtually all focus groups sessions, pharmacists familiar with and supportive of the CPD paradigm had worked in collaborative practice environments such as hospital pharmacy practice. For these pharmacists, the major advantage of CPD was the linking of workplace learning with continuous education. One pharmacist stated, “It's amazing how much I have to learn every day, when I work as a pharmacist. With [the learning portfolio] it helps to show how much learning we all do, every day. It's kind of satisfying to look it over and see how much you accomplish.” Within many of the learning portfolio-sharing sessions, debates emerged regarding the true value of traditional continuing education and its outcome in changing an individual's practice. While participants appreciated the opportunity for social and professional networking inherent in some forms of traditional CE, most eventually conceded that the academic value of most CE programming was limited by the lack of a systematic process for following-up and implementing new learning in the workplace. “Well it's nice to go to these [continuing education] events, but really, I don't know how useful they are. You go, you sit, you listen, but then, well I at least forget.”

The following is an extract from a focus group (conducted by the author) with first-year pharmacy students about community placements. It illustrates how focus groups provide a chance for participants to discuss issues on which they might disagree.

Interviewer: So you are saying that you would prefer health related placements? Student 1: Not exactly so long as I could be developing my communication skill. Student 2: Yes but I still think the more health related the placement is the more I'll gain from it. Student 3: I disagree because other people related skills are useful and you may learn those from taking part in a community project like building a garden. Interviewer: So would you prefer a mixture of health and non health related community placements?

GUIDANCE FOR PUBLISHING QUALITATIVE RESEARCH

Qualitative research is becoming increasingly accepted and published in pharmacy and medical journals. Some journals and publishers have guidelines for presenting qualitative research, for example, the British Medical Journal 9 and Biomedcentral . 10 Medical Education published a useful series of articles on qualitative research. 11 Some of the important issues that should be considered by authors, reviewers and editors when publishing qualitative research are discussed below.

Introduction.

A good introduction provides a brief overview of the manuscript, including the research question and a statement justifying the research question and the reasons for using qualitative research methods. This section also should provide background information, including relevant literature from pharmacy, medicine, and other health professions, as well as literature from the field of education that addresses similar issues. Any specific educational or research terminology used in the manuscript should be defined in the introduction.

The methods section should clearly state and justify why the particular method, for example, face to face semistructured interviews, was chosen. The method should be outlined and illustrated with examples such as the interview questions, focusing exercises, observation criteria, etc. The criteria for selecting the study participants should then be explained and justified. The way in which the participants were recruited and by whom also must be stated. A brief explanation/description should be included of those who were invited to participate but chose not to. It is important to consider “fair dealing,” ie, whether the research design explicitly incorporates a wide range of different perspectives so that the viewpoint of 1 group is never presented as if it represents the sole truth about any situation. The process by which ethical and or research/institutional governance approval was obtained should be described and cited.

The study sample and the research setting should be described. Sampling differs between qualitative and quantitative studies. In quantitative survey studies, it is important to select probability samples so that statistics can be used to provide generalizations to the population from which the sample was drawn. Qualitative research necessitates having a small sample because of the detailed and intensive work required for the study. So sample sizes are not calculated using mathematical rules and probability statistics are not applied. Instead qualitative researchers should describe their sample in terms of characteristics and relevance to the wider population. Purposive sampling is common in qualitative research. Particular individuals are chosen with characteristics relevant to the study who are thought will be most informative. Purposive sampling also may be used to produce maximum variation within a sample. Participants being chosen based for example, on year of study, gender, place of work, etc. Representative samples also may be used, for example, 20 students from each of 6 schools of pharmacy. Convenience samples involve the researcher choosing those who are either most accessible or most willing to take part. This may be fine for exploratory studies; however, this form of sampling may be biased and unrepresentative of the population in question. Theoretical sampling uses insights gained from previous research to inform sample selection for a new study. The method for gaining informed consent from the participants should be described, as well as how anonymity and confidentiality of subjects were guaranteed. The method of recording, eg, audio or video recording, should be noted, along with procedures used for transcribing the data.

Data Analysis.

A description of how the data were analyzed also should be included. Was computer-aided qualitative data analysis software such as NVivo (QSR International, Cambridge, MA) used? Arrival at “data saturation” or the end of data collection should then be described and justified. A good rule when considering how much information to include is that readers should have been given enough information to be able to carry out similar research themselves.

One of the strengths of qualitative research is the recognition that data must always be understood in relation to the context of their production. 1 The analytical approach taken should be described in detail and theoretically justified in light of the research question. If the analysis was repeated by more than 1 researcher to ensure reliability or trustworthiness, this should be stated and methods of resolving any disagreements clearly described. Some researchers ask participants to check the data. If this was done, it should be fully discussed in the paper.

An adequate account of how the findings were produced should be included A description of how the themes and concepts were derived from the data also should be included. Was an inductive or deductive process used? The analysis should not be limited to just those issues that the researcher thinks are important, anticipated themes, but also consider issues that participants raised, ie, emergent themes. Qualitative researchers must be open regarding the data analysis and provide evidence of their thinking, for example, were alternative explanations for the data considered and dismissed, and if so, why were they dismissed? It also is important to present outlying or negative/deviant cases that did not fit with the central interpretation.

The interpretation should usually be grounded in interviewees or respondents' contributions and may be semi-quantified, if this is possible or appropriate, for example, “Half of the respondents said …” “The majority said …” “Three said…” Readers should be presented with data that enable them to “see what the researcher is talking about.” 1 Sufficient data should be presented to allow the reader to clearly see the relationship between the data and the interpretation of the data. Qualitative data conventionally are presented by using illustrative quotes. Quotes are “raw data” and should be compiled and analyzed, not just listed. There should be an explanation of how the quotes were chosen and how they are labeled. For example, have pseudonyms been given to each respondent or are the respondents identified using codes, and if so, how? It is important for the reader to be able to see that a range of participants have contributed to the data and that not all the quotes are drawn from 1 or 2 individuals. There is a tendency for authors to overuse quotes and for papers to be dominated by a series of long quotes with little analysis or discussion. This should be avoided.

Participants do not always state the truth and may say what they think the interviewer wishes to hear. A good qualitative researcher should not only examine what people say but also consider how they structured their responses and how they talked about the subject being discussed, for example, the person's emotions, tone, nonverbal communication, etc. If the research was triangulated with other qualitative or quantitative data, this should be discussed.

Discussion.

The findings should be presented in the context of any similar previous research and or theories. A discussion of the existing literature and how this present research contributes to the area should be included. A consideration must also be made about how transferrable the research would be to other settings. Any particular strengths and limitations of the research also should be discussed. It is common practice to include some discussion within the results section of qualitative research and follow with a concluding discussion.

The author also should reflect on their own influence on the data, including a consideration of how the researcher(s) may have introduced bias to the results. The researcher should critically examine their own influence on the design and development of the research, as well as on data collection and interpretation of the data, eg, were they an experienced teacher who researched teaching methods? If so, they should discuss how this might have influenced their interpretation of the results.

Conclusion.

The conclusion should summarize the main findings from the study and emphasize what the study adds to knowledge in the area being studied. Mays and Pope suggest the researcher ask the following 3 questions to determine whether the conclusions of a qualitative study are valid 12 : How well does this analysis explain why people behave in the way they do? How comprehensible would this explanation be to a thoughtful participant in the setting? How well does the explanation cohere with what we already know?

CHECKLIST FOR QUALITATIVE PAPERS

This paper establishes criteria for judging the quality of qualitative research. It provides guidance for authors and reviewers to prepare and review qualitative research papers for the American Journal of Pharmaceutical Education . A checklist is provided in Appendix 1 to assist both authors and reviewers of qualitative data.

ACKNOWLEDGEMENTS

Thank you to the 3 reviewers whose ideas helped me to shape this paper.

Appendix 1. Checklist for authors and reviewers of qualitative research.

Introduction

• □ Research question is clearly stated.
• □ Research question is justified and related to the existing knowledge base (empirical research, theory, policy).
• □ Any specific research or educational terminology used later in manuscript is defined.
• □ The process by which ethical and or research/institutional governance approval was obtained is described and cited.
• □ Reason for choosing particular research method is stated.
• □ Criteria for selecting study participants are explained and justified.
• □ Recruitment methods are explicitly stated.
• □ Details of who chose not to participate and why are given.
• □ Study sample and research setting used are described.
• □ Method for gaining informed consent from the participants is described.
• □ Maintenance/Preservation of subject anonymity and confidentiality is described.
• □ Method of recording data (eg, audio or video recording) and procedures for transcribing data are described.
• □ Methods are outlined and examples given (eg, interview guide).
• □ Decision to stop data collection is described and justified.
• □ Data analysis and verification are described, including by whom they were performed.
• □ Methods for identifying/extrapolating themes and concepts from the data are discussed.
• □ Sufficient data are presented to allow a reader to assess whether or not the interpretation is supported by the data.
• □ Outlying or negative/deviant cases that do not fit with the central interpretation are presented.
• □ Transferability of research findings to other settings is discussed.
• □ Findings are presented in the context of any similar previous research and social theories.
• □ Discussion often is incorporated into the results in qualitative papers.
• □ A discussion of the existing literature and how this present research contributes to the area is included.
• □ Any particular strengths and limitations of the research are discussed.
• □ Reflection of the influence of the researcher(s) on the data, including a consideration of how the researcher(s) may have introduced bias to the results is included.

Conclusions

• □ The conclusion states the main finings of the study and emphasizes what the study adds to knowledge in the subject area.

• Introduction for Types of Dissertations
• Overview of the Dissertation
• Self-Assessment Exercise
• What is a Dissertation Committee
• Different Types of Dissertations
• Introduction for Overview of the Dissertation Process
• Responsibilities: the Chair, the Team and You
• Sorting Exercise
• Stages of a Dissertation
• Managing Your Time
• Create Your Own Timeline
• Working with a Writing Partner
• Key Deadlines
• Self Assessment Exercise
• Additional Resources
• Purpose and Goals
• Read and Evaluate Chapter 1 Exemplars
• Draft an Introduction of the Study
• Outline the Background of the Problem
• Draft your Statement of the Problem
• Draft your Purpose of the Study
• Draft your Significance of the Study
• List the Possible Limitations and Delimitations
• Explicate the Definition of Terms
• Outline the Organization of the Study
• Recommended Resources and Readings
• Purpose of the Literature Review
• What is the Literature?
• Article Summary Table
• Writing a Short Literature Review
• Outline for Literature Review
• Synthesizing the Literature Review
• Purpose of the Methodology Chapter
• Topics to Include
• Preparing to Write the Methodology Chapter
• Confidentiality
• Building the Components for Chapter Three
• Preparing for Your Qualifying Exam (aka Proposal Defense)
• What is Needed for Your Proposal Defense?
• Submitting Your Best Draft
• Preparing Your Abstract for IRB
• Use of Self-Assessment
• Preparing Your PowerPoint
• During Your Proposal Defense
• After Your Proposal Defense
• Pre-observation – Issues to consider
• During Observations
• Wrapping Up
• Recommended Resources and Readings (Qualitative)
• Quantitative Data Collection
• Recommended Resources and Readings (Quantitative)
• Qualitative: Before you Start
• Qualitative: During Analysis
• Qualitative: After Analysis
• Qualitative: Recommended Resources and Readings
• Quantitative: Deciding on the Right Analysis
• Quantitative: Data Management and Cleaning
• Quantitative: Keep Track of your Analysis
• The Purpose of Chapter 4
• The Elements of Chapter 4
• Presenting Results (Quantitative)
• Presenting Findings (Qualitative)
• Chapter 4 Considerations
• The Purpose of Chapter 5
• Preparing Your Abstract for the Graduate School
• Draft the Introduction for Chapter 5
• Draft the Summary of Findings
• Draft Implications for Practice
• Draft your Recommendations for Research
• Draft your Conclusions
• What is Needed
• What Happens During the Final Defense?
• What Happens After the Final Defense?

Presenting Findings (Qualitative)  Topic 1:  Chapter 4

• Your findings should provide sufficient evidence from your data to support the  conclusions you have made. Evidence takes the form of quotations from interviews  and excerpts from observations and documents. 
• Ethically you have to make sure you have confidence in your findings and account  for counter-evidence (evidence that contradicts your primary finding) and not report  something that does not have sufficient evidence to back it up. 
• Your findings should be related back to your conceptual framework. 
• Your findings should be in response to the problem presented (as defined by the  research questions) and should be the “solution” or “answer” to those questions. 
• You should focus on data that enables you to answer your research questions, not  simply on offering raw data. 
• Qualitative research presents “best examples” of raw data to demonstrate an  analytic point, not simply to display data. 
• Numbers (descriptive statistics) help your reader understand how prevalent or  typical a finding is. Numbers are helpful and should not be avoided simply because  this is a qualitative dissertation. 

• Subject List
• Take a Tour
• For Authors
• Subscriber Services
• Publications
• African American Studies
• African Studies
• American Literature
• Anthropology
• Architecture Planning and Preservation
• Art History
• Atlantic History
• Biblical Studies
• British and Irish Literature
• Childhood Studies
• Chinese Studies
• Cinema and Media Studies
• Communication
• Criminology
• Environmental Science
• Evolutionary Biology
• International Law
• International Relations
• Islamic Studies
• Jewish Studies
• Latin American Studies
• Latino Studies
• Linguistics
• Literary and Critical Theory
• Medieval Studies
• Military History
• Political Science
• Public Health
• Renaissance and Reformation
• Social Work
• Urban Studies
• Victorian Literature
• Browse All Subjects

How to Subscribe

• Free Trials

In This Article Expand or collapse the "in this article" section Reporting Research Findings

Introduction.

• Reference Resources
• History and Trends
• Guidance on Reporting Quantitative Reports, Syntheses, and Meta-analyses
• Linguistic Analyses of Written Research Results
• Writing Review Articles
• Writing Qualitative Research
• Scientific Reviewing
• Rhetoric of Evidence-Based Management
• Research on Graphics Perception
• Statistical-Technological Trends

Related Articles Expand or collapse the "related articles" section about

About related articles close popup.

Lorem Ipsum Sit Dolor Amet

Vestibulum ante ipsum primis in faucibus orci luctus et ultrices posuere cubilia Curae; Aliquam ligula odio, euismod ut aliquam et, vestibulum nec risus. Nulla viverra, arcu et iaculis consequat, justo diam ornare tellus, semper ultrices tellus nunc eu tellus.

• Ethics in Research
• Research Methods

Other Subject Areas

Forthcoming articles expand or collapse the "forthcoming articles" section.

• Corporate Globalization
• Organization Design
• Organizational Learning and Knowledge Transfer
• Find more forthcoming articles...
• Export Citations
• Share This Facebook LinkedIn Twitter

Reporting Research Findings by James T. Austin LAST REVIEWED: 27 May 2020 LAST MODIFIED: 24 June 2020 DOI: 10.1093/obo/9780199846740-0032

Not all research culminates in publication. This updated article surveys themes in reporting research findings for scholars and students. As context, consider that investigations of organizational phenomena require a series of choices that are cast here as craft. Choices span primary, secondary, and synthesis designs across qualitative and quantitative traditions. Primary research is the traditional design, measurement, and analysis of collected data, while secondary research involves reanalysis of existing data sets (obtained from peers or repositories), and research synthesis involves narrative or quantitative aggregation of studies. This distinction also holds for the qualitative mode. Reporting research findings is important for dissemination and for synthesis and evidence-based management (EBM). Primarily, the importance lies in dissemination across conferences, journals, books, and increasingly digital media. Understanding and replication by outside scholars depend on complete and accurate reporting; this centrality to the research craft commands a learning-development focus. Within a communications paradigm, individuals or teams create or send a persuasive message and the reader or listener receives (or may choose not to receive) the message. Persuasion is targeted via rhetoric across writing and graphics. Although oral and written forms of dissemination dominate, data repositories are emerging. Two additional reasons for importance pertain to the accumulation of knowledge. One is research synthesis. Structuring knowledge through synthesis uses the results of individual studies as data, and the audience is scientists. Narrative and quantitative reviews depend on the completeness and accuracy of reported findings. A related source of importance pertains to evidence-based management at the interface of research and practice—translation of research findings into practices and bundles of practices that can be used by managers. Given that practicing managers appear to rely on obsolete knowledge (aka “fads, fashions, and folderol” as used by Dunnette), proponents of evidence-based management advocate that firms consider the adoption of evidence-based medicine (EBM). Communicating clearly and establishing a context of implementation to assist practitioners are essential for EBM (in parallel to research synthesis, for an audience of practitioners). This article organizes a range of resources on writing and reviewing articles across the taxonomy above. For completeness, this article includes citations for scientific graphics (tables, charts, figures, etc.) organized around conceptualizations of graphics and related guidance, research on perception of scientific graphics, and recent developments in computing technology. Especially relevant are software routines for interactive graphics based on “grammars.” While this article draws on work in management studies (organizational behavior and human resources), it necessarily searches beyond traditional boundaries for relevant insights.

There are sporadic specialized sources on reporting of research findings. On scholarly writing, Cummings and Frost 1995 is an influential analysis of the publishing system in the organizational sciences. Abelson 1995 defines rhetoric as styles of writing up results in psychology. Research synthesis writing is addressed comprehensively in Cooper, et al. 2009 (cited under Guidance on Reporting Quantitative Reports, Syntheses, and Meta-analyses ). There are two major standards available for research synthesis: Meta-Analysis Reporting Standards (MARS) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses ( PRISMA ).For graphics and quantitative studies, Tufte 2001 and Tukey 1977 are classics for guidance and perspective; others, including Cleveland 1985 , Kosslyn 2006 , Wainer 2000 (cited under History and Trends ), and Wilkinson 2005 , provide unique value. The work on maps in Börner 2015 is aptly named Atlas of Knowledge , while Grant 2019 provides a concise introduction to data visualization with a section on interactive graphics (a related instance is the class of data explorers used for large data sets as the Programme for International Student Assessment [PISA] and the National Assessment of Educational Progress [NAEP]—both large-scale testing programs). Sternberg and Sternberg 2010 is typical guidance offered to students and is not the only such resource. Many of these texts can be mined for dimensions to code the content and results of published organizational behavior and human resources research to facilitate critique A trio of books by Katy Börner ( Börner 2010 , Börner 2015 ) and colleagues ( Börner and Polley 2014 ) represents the newest in knowledge mapping. In addition, a rapidly emerging topic across science is the reproducibility and replicability of results—the consensus review published in 2019 by a committee of the National Academies of Science, Medicine, and Engineering provides an excellent overview.

Abelson, Robert P. Statistics as Principled Argument . Mahwah, NJ: Lawrence Erlbaum, 1995.

Describes magnitude-articulation-generality-interestingness-credibility (MAGIC) criteria to organize rhetoric in presenting research findings. Accepting statistics as an organizer of arguments using quantitative evidence allows identification of styles. Brash and stuffy are end points on a liberal-conservative style dimension. Management students and scholars could learn MAGIC for reporting quantitative findings; qualitative researchers might consider translation.

Börner, Katy. Atlas of Science: Visualizing What We Know . Cambridge, MA: Massachusetts Institute of Technology Press, 2010.

Books by Katy Börner show the potential and the practice of science and knowledge mapping. Atlas of Science (2010) presents three themes: power of maps (switching from geographic cartography to research-collaboration mapping), reference systems, and forecasts, as well as numerous examples.

Börner, Katy. Atlas of Knowledge: Anyone Can Map . Cambridge, MA: Massachusetts Institute of Technology Press, 2015.

Börner deftly gives readers principles for visualizing knowledge with more than forty large-scale and over a hundred small-scale color maps. Drives home the point that data literacy is as important as language literacy. She introduces a theoretical framework meant to guide readers through user and task analysis; data preparation, analysis, and visualization; visualization deployment; and the interpretation of science maps. Together with Börner 2010 and Börner and Polley 2014 , this trio provides levels of analysis from frameworks to workflow that support improved visualizations of science, knowledge, and interdisciplinary collaboration.

Börner, Katy, and David E. Polley. Visual Insights: A Practical Guide to Making Sense of Data . Cambridge, MA: Massachusetts Institute of Technology Press, 2014.

Along with Börner 2010 and Börner 2015 , a practical book by Börner and Polley based on the Information Visualization MOOC includes seven chapters—from a visualization framework through “when, where, what, and with whom” and dynamic visualizations—and concludes with chapters on case studies and discussion/outlook.

Cleveland, William S. The Elements of Graphing Data . Monterey, CA: Wadsworth Advanced Books and Software, 1985.

Cognitive science and statistical principles help dissect and improve graphics (a predecessor book from 1983 and articles that searched prestigious journals for common graphic errors are also useful). Based on extensive experience with AT&T data, the author distills and emphasizes procedural knowledge for constructing graphic displays.

Cummings, Larry L., and Peter J. Frost, eds. Publishing in the Organizational Sciences . 2d ed. Foundations of Organizational Science. Thousand Oaks, CA: SAGE, 1995.

This classic covers most aspects of publishing in organizational behavior and human resources (absent are emergent digital-technological issues). Organized into sections on perspectives on and realities of publishing, which are insightful for scholar and student alike. Benjamin Schneider’s ten propositions on “getting research published” end with practicing the skill of writing. This edition inaugurated the Foundations of Organizational Science series, and the 1985 edition is also useful.

Few, Stephen. Now You See It: Simple Visualization Techniques for Quantitative Analysis . Oakland, CA: Analytics, 2009.

Suggests that in a data-dense world, the human brain—and hence, visualization—is key to avoiding overload. Three sections, namely “Building Core Skills for Visual Analysis” and “Honing Skills,” each with six chapters plus a “Further Thoughts and Hopes” with eight promising trends, cover much ground. Based on quantitative preferences, the most substantive portion is contained in Part 2. The book ends with an excerpt from the poetry of T. S. Eliot.

Grant, Robert. Data Visualization: Charts, Maps and Interactive Graphics . Boca Raton, FL: CRC Press, 2019.

This author provides a vast range of examples of data visualization, mostly open source and with code available on a website . It provides a good mix of detail with sharing of tacit knowledge.

Kosslyn, Stephen M. Graph Design for the Eye and Mind . New York: Oxford University Press, 2006.

DOI: 10.1093/acprof:oso/9780195311846.001.0001

Based on sound cognitive science and ample research by the author, presents and elaborates eight principles of effective graph construction (summarized in pp. 5–20). Analyzes prominent guidance on graphics, Edward R. Tufte for example, and suggests flaws. that could lead to productive research.

Sternberg, Robert J., and Karin Sternberg The Psychologist’s Companion: A Guide to Writing Scientific Papers for Students and Researchers . 5th ed. Cambridge, UK: Cambridge University Press, 2010.

DOI: 10.1017/CBO9780511762024

Aligned to American Psychological Association (APA) style as a prototype of good practice in publishing; the author is a productive researcher and APA journal editor; thus tacit knowledge in this edition is well grounded and expressed. Represents a class of books on research communication. Some translation required to organizational behavior and human resources context. Comparable to Cooper 2010 (cited under Writing Review Articles ). Next edition will need to conform to the seventh edition of the Publication Manual of the American Psychological Association .

Tufte, Edward R. The Visual Display of Quantitative Information . 2d ed. Cheshire, CT: Graphics Press, 2001.

Revises a classic 1983 text in analytic design (Tufte’s preferred term); presents and expands on five core principles and coins numerous terms (“chartjunk” as well as “sparkline” and “data-ink ratios” are personal favorites). Critiqued for its advice, however, by other researchers on graphics ( Kosslyn 2006 ).

Tukey, John W. Exploratory Data Analysis . Reading, MA: Addison-Wesley, 1977.

A classic presenting Tukey’s data detective work rooted in his 1962 “The Future of Data Analysis” exposition ( Annals of Mathematical Statistics 33.1: 1–67). Premise is that exploratory data analysis (EDA) deserves status with confirmatory. Loaded with philosophy of EDA and tools—the stem leaf, box plot, and “five-number summary.” Graphic display and analysis are covered in the service of learning about data. A part of research craft to be honed post-schooling.

Wilkinson, Leland L. The Grammar of Graphics . 2d ed. New York: Springer-Verlag, 2005.

Cited by many, this conceptualization rooted in the work of Jacques Bertin extends work done with the Task Force on Statistical Reporting in 1999. Within an object-oriented design approach, the grammar consists of the rules and elements of graphics, for example, geoms, scales, and coordinates. Framework has been useful for deriving tools, such as Wilkinson’s GPL, Wickham’s ggplot2, and others.

back to top

Users without a subscription are not able to see the full content on this page. Please subscribe or login .

Oxford Bibliographies Online is available by subscription and perpetual access to institutions. For more information or to contact an Oxford Sales Representative click here .

• About Management »
• Meet the Editorial Board »
• Abusive Supervision
• Adverse Impact and Equal Employment Opportunity Analytics
• Alliance Portfolios
• Alternative Work Arrangements
• Applied Political Risk Analysis
• Approaches to Social Responsibility
• Assessment Centers: Theory, Practice and Research
• Attributions
• Authentic Leadership
• Bayesian Statistics
• Behavior, Organizational
• Behavioral Approach to Leadership
• Behavioral Theory of the Firm
• Between Organizations, Social Networks in and
• Brokerage in Networks
• Business and Human Rights
• Career Studies
• Career Transitions and Job Mobility
• Certified B Corporations and Benefit Corporations
• Charismatic and Innovative Team Leadership By and For Mill...
• Charismatic and Transformational Leadership
• Compensation, Rewards, Remuneration
• Competitive Dynamics
• Competitive Heterogeneity
• Competitive Intensity
• Computational Modeling
• Conditional Reasoning
• Conflict Management
• Considerate Leadership
• Corporate Philanthropy
• Corporate Social Performance
• Corporate Venture Capital
• Counterproductive Work Behavior (CWB)
• Cross-Cultural Communication
• Cross-Cultural Management
• Cultural Intelligence
• Culture, Organization
• Data Analytic Methods
• Decision Making
• Dynamic Capabilities
• Emotional Labor
• Employee Aging
• Employee Engagement
• Employee Ownership
• Employee Voice
• Empowerment, Psychological
• Entrepreneurial Firms
• Entrepreneurial Orientation
• Entrepreneurship
• Entrepreneurship, Corporate
• Entrepreneurship, Women’s
• Equal Employment Opportunity
• Faking in Personnel Selection
• Family Business, Managing
• Financial Markets in Organization Theory and Economic Soci...
• Findings, Reporting Research
• Firm Bribery
• First-Mover Advantage
• Fit, Person-Environment
• Forecasting
• Founding Teams
• Global Leadership
• Global Talent Management
• Goal Setting
• Grounded Theory
• Hofstedes Cultural Dimensions
• Human Capital Resource Pipelines
• Human Resource Management
• Human Resource Management, Strategic
• Human Resources, Global
• Human Rights
• Humanitarian Work Psychology
• Humility in Management
• Impression Management at Work
• Influence Strategies/Tactics in the Workplace
• Information Economics
• Innovative Behavior
• Intelligence, Emotional
• International Economic Development and SMEs
• International Economic Systems
• International Strategic Alliances
• Job Analysis and Competency Modeling
• Job Crafting
• Job Satisfaction
• Judgment and Decision Making in Teams
• Knowledge Sharing and Collaboration within and across Firm...
• Leader-Member Exchange
• Leadership Development
• Leadership Development and Organizational Change, Coaching...
• Leadership, Ethical
• Leadership, Global and Comparative
• Leadership, Strategic
• Learning by Doing in Organizational Activities
• Management History
• Management In Antiquity
• Managerial and Organizational Cognition
• Managerial Discretion
• Meaningful Work
• Multinational Corporations and Emerging Markets
• Neo-institutional Theory
• Neuroscience, Organizational
• New Ventures
• Organization Design, Global
• Organization Development and Change
• Organization Research, Ethnography in
• Organization Theory
• Organizational Adaptation
• Organizational Ambidexterity
• Organizational Behavior, Emotions in
• Organizational Citizenship Behaviors (OCBs)
• Organizational Climate
• Organizational Control
• Organizational Corruption
• Organizational Hybridity
• Organizational Identity
• Organizational Justice
• Organizational Legitimacy
• Organizational Networks
• Organizational Paradox
• Organizational Performance, Personality Theory and
• Organizational Responsibility
• Organizational Surveys, Driving Change Through
• Organizations, Big Data in
• Organizations, Gender in
• Organizations, Identity Work in
• Organizations, Political Ideology in
• Organizations, Social Identity Processes in
• Overqualification
• Paternalistic Leadership
• Pay for Skills, Knowledge, and Competencies
• People Analytics
• Performance Appraisal
• Performance Feedback Theory
• Planning And Goal Setting
• Proactive Work Behavior
• Psychological Contracts
• Psychological Safety
• Real Options Theory
• Recruitment
• Regional Entrepreneurship
• Reputation, Organizational Image and
• Research, Ethics in
• Research, Longitudinal
• Research Methods, Qualitative
• Resource Redeployment
• Resource-Dependence Theory
• Response Surface Analysis, Polynomial Regression and
• Role of Time in Organizational Studies
• Safety, Work Place
• Selection, Applicant Reactions to
• Self-Determination Theory for Work Motivation
• Self-Efficacy
• Self-Fulfilling Prophecy In Management
• Self-Management and Personal Agency
• Sensemaking in and around Organizations
• Service Management
• Shared Team Leadership
• Social Cognitive Theory
• Social Evaluation: Status and Reputation
• Social Movement Theory
• Social Ties and Network Structure
• Socialization
• Sports Settings in Management Research
• Stakeholders
• Status in Organizations
• Strategic Alliances
• Strategic Human Capital
• Strategy and Cognition
• Strategy Implementation
• Structural Contingency Theory/Information Processing Theor...
• Team Composition
• Team Conflict
• Team Design Characteristics
• Team Learning
• Team Mental Models
• Team Newcomers
• Team Performance
• Team Processes
• Teams, Global
• Technology and Innovation Management
• Technology, Organizational Assessment and
• the Workplace, Millennials in
• Theory X and Theory Y
• Time and Motion Studies
• Training and Development
• Training Evaluation
• Trust in Organizational Contexts
• Unobtrusive Measures
• Virtual Teams
• Whistle-Blowing
• Work and Family: An Organizational Science Overview
• Work Contexts, Nonverbal Communication in
• Work, Mindfulness at
• Workplace Aggression and Violence
• Workplace Coaching
• Workplace Commitment
• Workplace Gossip
• Workplace Meetings
• Workplace, Spiritual Leadership in the
• World War II, Management Research during
• Privacy Policy
• Cookie Policy
• Legal Notice
• Accessibility

Powered by:

• [66.249.64.20|45.133.227.243]
• 45.133.227.243

Enhancing the QUAlity and Transparency Of health Research

• Courses & events
• Librarian Network
• Search for reporting guidelines

Use your browser's Back button to return to your search results

Standards for reporting qualitative research: a synthesis of recommendations

Reporting guidelines for main study types, translations.

Some reporting guidelines are also available in languages other than English. Find out more in our Translations section .

• About the Library

For information about Library scope and content, identification of reporting guidelines and inclusion/exclusion criteria please visit About the Library .

Visit our Help page for information about searching for reporting guidelines and for general information about using our website.

Library index

• What is a reporting guideline?
• Browse reporting guidelines by specialty
• Reporting guidelines under development
• Translations of reporting guidelines
• EQUATOR Network reporting guideline manual
• Reporting guidelines for animal research
• Guidance on scientific writing
• Guidance developed by editorial groups
• Research funders’ guidance on reporting requirements
• Professional medical writing support
• Research ethics, publication ethics and good practice guidelines
• Links to other resources

Reporting Formative Qualitative Research to Support the Development of Quantitative Preference Study Protocols and Corresponding Survey Instruments: Guidelines for Authors and Reviewers

• Original Research Article
• Published: 16 December 2019
• Volume 13 , pages 121–136, ( 2020 )

Cite this article

• Ilene L. Hollin   ORCID: orcid.org/0000-0003-1405-8687 1 ,
• Benjamin M. Craig 2 ,
• Joanna Coast 3 ,
• Kathleen Beusterien 4 ,
• Caroline Vass 5 ,
• Rachael DiSantostefano 6 &
• Holly Peay 7  

2855 Accesses

96 Citations

23 Altmetric

Explore all metrics

Formative qualitative research is foundational to the methodological development process of quantitative health preference research (HPR). Despite its ability to improve the validity of the quantitative evidence, formative qualitative research is underreported.

To improve the frequency and quality of reporting, we developed guidelines for reporting this type of research. The guidelines focus on formative qualitative research used to develop robust and acceptable quantitative study protocols and corresponding survey instruments in HPR.

In December 2018, a steering committee was formed as a means to accumulate the expertise of the HPR community on the reporting guidelines (21 members, seven countries, multiple settings and disciplines). Using existing guidelines and examples, the committee constructed, revised, and refined the guidelines. The guidelines underwent beta testing by three researchers, and further revisions to the guidelines were made based on their feedback as well as on comments from members of the International Academy of Health Preference Research (IAHPR) and the editorial board of The Patient: Patient-Centered Outcomes Research .

The guidelines have five components: introductory material (4 domains), methods (12), results/findings (2), discussion (2), and other (2). They are concordant with existing guidelines, published examples, beta-testing results, and expert comments.

Conclusions

Publishing formative qualitative research is a necessary step toward strengthening the foundation of any quantitative study, enhancing the relevance of its preference evidence. The guidelines should aid researchers, reviewers, and regulatory agencies and promote transparency within HPR more broadly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Similar content being viewed by others

Qualitative Research: Ethical Considerations

How to use and assess qualitative research methods

Loraine Busetto, Wolfgang Wick & Christoph Gumbinger

STOPP/START criteria for potentially inappropriate prescribing in older people: version 3

Denis O’Mahony, Antonio Cherubini, … Denis Curtin

Data Availability

Data sharing is not applicable to this article because no datasets were generated or analyzed during the current study.

US Department of Health and Human Resources Food and Drug Administration. Patient-focused drug development: collecting comprehensive and representative input Guidance for industry, food and drug administration staff, and other stakeholders. Silver Spring; 2018.

21st Century Cures Act. H.R. 34, 114th congress. 2016. https://www.gpo.gov/fdsys/pkg/BILLS-114hr34enr/pdf/BILLS-114hr34enr.pdf . Accessed 30 Sept 2019.

Onwuegbuzie AJ, Bustamante RM, Nelson JA. Mixed research as a tool for developing quantitative instruments. J Mix Methods Res. 2010;4(1):56–78.

Google Scholar  

Soekhai V, de Bekker-Grob EW, Ellis A, Vass C. Discrete choice experiments in health economics: past, present and future. Pharmacoeconomics. 2019;37:201–26.

US Department of Health and Human Resources Food and Drug Administration. Patient preference information—submission, review in PMAs, HDE applications, and de novo requests, and inclusion in device labeling: draft guidance for industry, food and drug administration staff, and other stakeholders. Silver Spring, MD; 2015.

Bryman A. Social research methods. 2nd ed. Oxford: Oxford University Press; 2004.

Remler DK, Van Ryzin GG. Research methods in practice: Strategies for description and causation. Thousand Oaks: Sage Publications, Inc.; 2011.

Coast J. Qualitative methods for health economics. London: Rowman & Littlefield International; 2017.

US Department of Health and Human Resources Food and Drug Administration. Guidance for industry patient-reported outcome measures: use in medical product development to support labeling claims. Silver Spring, MD; 2009.

Magasi S, Ryan G, Revicki D, Lenderking W, Hays RD, Brod M, et al. Content validity of patient-reported outcome measures: perspectives from a PROMIS meeting. Qual Life Res. 2012;21(5):739–46.

PubMed   Google Scholar  

Coast J, Horrocks S. Developing attributes and levels for discrete choice experiments using qualitative methods. J Health Serv Res Policy. 2007;12(1):25–30.

Coast J, Al-Janabi H, Sutton EJ, Horrocks SA, Vosper AJ, Swancutt DR, et al. Using qualitative methods for attribute development for discrete choice experiments: issues and recommendations. Health Econ. 2012;21(6):730–41.

Vass C, Rigby D, Payne K. The role of qualitative research methods in discrete choice experiments. Med Decis Making. 2017;37(3):298–313.

PubMed   PubMed Central   Google Scholar  

Clark MD, Determann D, Petrou S, Moro D, de Bekker-Grob EW. Discrete choice experiments in health economics: a review of the literature. Pharmacoeconomics. 2014;32(9):883–902.

Louviere JJ, Lancsar E. Choice experiments in health: the good, the bad, the ugly and toward a brighter future. Health Econ Policy Law. 2009;4(Pt 4):527–46.

Louviere J, Hensher D, Swait J. Stated choice methods—analysis and application. Cambridge: Cambridge University; 2000.

Janssen EM, Bridges JFP. Art and science of instrument development for stated-preference methods. Patient. 2017;10(4):377–9.

Brod M, Tesler LE, Christensen TL. Qualitative research and content validity: developing best practices based on science and experience. Qual Life Res. 2009;18(9):1263–78.

Fargher EA, Eddy C, Newman W, Qasim F, Tricker K, Elliott RA, et al. Patients’ and healthcare professionals’ views on pharmacogenetic testing and its future delivery in the NHS. Pharmacogenomics. 2007;8(11):1511–9.

Payne K, Fargher EA, Roberts SA, Tricker K, Elliott RA, Ratcliffe J, et al. Valuing pharmacogenetic testing services: a comparison of patients’ and health care professionals’ preferences. Value Health. 2011;14(1):121–34.

Witter S, Ha BTT, Shengalia B, Vujicic M. Understanding the ‘four directions of travel’: qualitative research into the factors affecting recruitment and retention of doctors in rural Vietnam. Hum Resour Health. 2011;9(1):20.

Vujicic M, Shengelia B, Alfano M, Thu HB. Physician shortages in rural Vietnam: using a labor market approach to inform policy. Soc Sci Med. 2011;73(7):970–7.

Dancet EAF, Van Empel IWH, Rober P, Nelen WLDM, Kremer JAM, d’Hooghe TM. Patient-centred infertility care: a qualitative study to listen to the patient’s voice. Hum Reprod. 2011;26(4):827–33.

CAS   PubMed   Google Scholar  

van Empel IWH, Dancet EAF, Koolman XHE, Nelen WLDM, Stolk EA, Sermeus W, et al. Physicians underestimate the importance of patient-centredness to patients: a discrete choice experiment in fertility care. Hum Reprod. 2011;26(3):584–93.

Cohen DJ, Crabtree BF. Evaluative criteria for qualitative research in health care: controversies and recommendations. Ann Fam Med. 2008;6(4):331–9.

Coast J, McDonald R, Baker R. Issues arising from the use of qualitative methods in health economics. J Health Serv Res Policy. 2004;9(3):171–6.

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245–51.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.

Kitto SC, Chesters J, Grbich C. Quality in qualitative research. Med J Aust. 2008;188(4):243–6.

Hammarberg K, Kirkman M, de Lacey S. Qualitative research methods: when to use them and how to judge them. Hum Reprod. 2016;31(3):498–501.

Côté L, Turgeon J. Appraising qualitative research articles in medicine and medical education. 2005;27(1):71–5.

UK EQUATOR Centre. EQUATOR network: enhancing the QUAlity and transparency of health research. Center for Statistics in Medicine (CSM), NDORMS, University of Oxford. https://www.equator-network.org/ . Accessed 14 Jan 2019.

Springer. Additional information for authors. Spring. 2019. https://www.springer.com/adis/journal/40271 . Accessed 14 Jan 2019.

Danner M, Vennedey V, Hiligsmann M, Fauser S, Stock S. Focus groups in elderly ophthalmologic patients: setting the stage for quantitative preference elicitation. Patient. 2016;9(1):47–57.

de Bekker-Grob EW, Ryan M, Gerard K. Discrete choice experiments in health economics: a review of the literature. Health Econ. 2012;21(2):145–72.

Cheung KL, Wijnen BF, Hollin IL, Janssen EM, Bridges JF, Evers SM, et al. Using best-worst scaling to investigate preferences in health care. Pharmacoeconomics. 2016;34:1195–209. https://doi.org/10.1007/s40273-016-0429-5 .

Article   PubMed   PubMed Central   Google Scholar  

Kløjgaard ME, Bech M, Søgaard R. Designing a stated choice experiment: the value of a qualitative process. J Choice Model. 2012;5(2):1–18.

Coast J. Presenting and publishing qualitative research in health economics. In: Coast J, editor. Qualitative methods for health economics. London: Rowman & Littlefield International Ltd; 2017.

Hollin IL, Young C, Hanson C, Bridges JFP. Developing a patient-centered benefit-risk survey: a community-engaged process. Value Health. 2016;19(6):751–7.

Janssen EM, Segal JB, Bridges JF. A framework for instrument development of a choice experiment: an application to type 2 diabetes. Patient. 2016;9(5):465–79.

dosReis S, Castillo WC, Ross M, Fitz-Randolph M, Vaughn-Lee A, Butler B. Attribute development using continuous stakeholder engagement to prioritize treatment decisions: a framework for patient-centered research. Value Health. 2016;19(6):758–66.

Owen-Smith A, Coast J. Understanding sampling and recruitment. In: Coast J, editor. Qualitative methods for health economics. London: Rowman & Littlefield International; 2017.

Daly J, Willis K, Small R, Green J, Welch N, Kealy M, et al. A hierarchy of evidence for assessing qualitative health research. J Clin Epidemiol. 2007;60(1):43–9.

Patton M. Qualitative evaluation and research methods. 2nd ed. Newbury Park: Sage Publications; 1990.

Kerr C, Nixon A, Wild D. Assessing and demonstrating data saturation in qualitative inquiry supporting patient-reported outcomes research. Expert Rev Pharmacoecon Outcomes Res. 2010;10(3):269–81.

Federal Policy for the Protection of Human Subjects. 82 FR 7149. Jan 19, 2017. https://www.govinfo.gov/content/pkg/FR-2017-01-19/pdf/2017-01058.pdf . Accessed 30 Sept 2019.

Al-Janabi H, Coast J, Flynn TN. What do people value when they provide unpaid care for an older person? A meta-ethnography with interview follow-up. Soc Sci Med. 2008;67(1):111–21.

Abiiro GA, Leppert G, Mbera GB, Robyn PJ, De Allegri M. Developing attributes and attribute-levels for a discrete choice experiment on micro health insurance in rural Malawi. BMC Health Serv Res. 2014;14:235.

Sutton EJ, Coast J. Development of a supportive care measure for economic evaluation of end-of-life care using qualitative methods. Palliat Med. 2014;28(2):151–7.

Canaway A, Al-Janabi H, Kinghorn P, Bailey C, Coast J. Development of a measure (ICECAP-Close Person Measure) through qualitative methods to capture the benefits of end-of-life care to those close to the dying for use in economic evaluation. Palliat Med. 2017;31(1):53–62.

Stevens KJ. Working with children to develop dimensions for a preference-based, generic, pediatric, health-related quality-of-life measure. Qual Health Res. 2010;20(3):340–51.

Stevens K. Developing a descriptive system for a new preference-based measure of health-related quality of life for children. Qual Life Res. 2009;18(8):1105–13.

Ke KM, Mackichan F, Sandy JR, Ness AR, Hollingworth W. Parents’ perspectives on centralized cleft services for children: the development of a DCE questionnaire. Oral Dis. 2013;19(2):185–92.

Michaels-Igbokwe C, Lagarde M, Cairns J, Terris-Prestholt F. Using decision mapping to inform the development of a stated choice survey to elicit youth preferences for sexual and reproductive health and HIV services in rural Malawi. Soc Sci Med. 2014;105:93–102.

Beusterien K, Chan E, Such P, De Jong Laird A, Heres S, Amos K, et al. Development of a stated-preference instrument to prioritize treatment goals in recent onset schizophrenia. Curr Med Res Opin. 2017;33(12):2129–36.

Bridges JF, Gallego G, Kudo M, Okita K, Han KH, Ye SL, et al. Identifying and prioritizing strategies for comprehensive liver cancer control in Asia. BMC Health Serv Res. 2011;11(1):298.

Ryden A, Chen S, Flood E, Romero B, Grandy S. Discrete choice experiment attribute selection using a multinational interview study: treatment features important to patients with type 2 diabetes mellitus. Patient. 2017;10(4):475–87.

Gilbert C, Keay L, Palagyi A, Do VQ, McCluskey P, White A, et al. Investigation of attributes which guide choice in cataract surgery services in urban Sydney, Australia. Clin Exp Optom. 2018;101(3):363–71.

Staniszewska S, Brett J, Mockford C, Barber R. The GRIPP checklist: strengthening the quality of patient and public involvement reporting in research. Int J Technol Assess Health Care. 2011;27(04):391–9.

Staniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, et al. GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. BMJ. 2017;358:j3453.

CAS   PubMed   PubMed Central   Google Scholar  

Barbour RS. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ. 2001;322(7294):1115–7.

Lincoln YS. Emerging criteria for quality in qualitative and interpretive research. Qual Inq. 1995;1(3):275–89.

Download references

Acknowledgements

The authors of this manuscript are grateful to the members of the steering committee who commented on draft versions of this manuscript: Olalekan Lee Aiyegbusi, Esther de Bekker-Grob, Emuella Flood, Gisselle Gallego, Ellen Janssen, Rachel Milte, Axel Mühlbacher, Semra Ozdemir Van Dyk, Jason Ong, Thomas Poder, Fern Terris-Prestholt, and Albert Wu. The authors also wish to acknowledge Emily Mulivihill, who provided input on previous versions of this manuscript. The authors thank all members of the IAHPR and The Patient editorial board for their participation in this process. Finally, the authors acknowledge the authors who tested these guidelines and provided feedback: Richard De Abreu Lourenco, Maria McCarthy, Emily Holmes, and Seda Erdem.

Author information

Authors and affiliations.

Department of Health Services Administration and Policy, College of Public Health, Temple University, 1301 Cecil B. Moore Ave., Room 537, Philadelphia, PA, 19122, USA

Ilene L. Hollin

Department of Economics College of Arts and Sciences, University of South Florida, Tampa, FL, USA

Benjamin M. Craig

Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

Joanna Coast

Health Division, Kantar, New York, NY, USA

Kathleen Beusterien

Health Preference Assessment Group, RTI Health Solutions, Didsbury, Manchester, UK

Caroline Vass

Department of Epidemiology, Janssen R&D, LLC, Titusville, NJ, USA

Rachael DiSantostefano

RTI International, Research Triangle Park, NC, USA

You can also search for this author in PubMed   Google Scholar

Contributions

ILH made substantial contributions to the conception and design of the work, drafted the manuscript, revised the manuscript critically for intellectual content, and provided final approval of the manuscript. BMC made substantial contributions to the conception and design of the work, revised the manuscript critically, and provided final approval of the manuscript. JC, KB, CV, RD, and HP made substantial contributions to the design of the work, revised the manuscript critically, and provided final approval of the manuscript. All authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ilene L. Hollin .

Ethics declarations

No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of Interest

Ilene L. Hollin, Benjamin M. Craig, Joanna Coast, Kathleen Beusterien, Caroline Vass, Rachael DiSantostefano, and Holly Peay have no conflicts of interest that are directly relevant to the content of this article.

Additional information

This article is part of the topical collection “Formative qualitative evidence for health preference and outcomes research”.

Rights and permissions

Reprints and permissions

About this article

Hollin, I.L., Craig, B.M., Coast, J. et al. Reporting Formative Qualitative Research to Support the Development of Quantitative Preference Study Protocols and Corresponding Survey Instruments: Guidelines for Authors and Reviewers. Patient 13 , 121–136 (2020). https://doi.org/10.1007/s40271-019-00401-x

Download citation

Published : 16 December 2019

Issue Date : February 2020

DOI : https://doi.org/10.1007/s40271-019-00401-x

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Advertisement

• Find a journal
• Publish with us
• Track your research

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here .

Loading metrics

Open Access

Peer-reviewed

Research Article

Difficulties and challenges experienced by nurses in eldercare institutions in Albania: A qualitative content analysis

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Validation, Visualization, Writing – original draft

* E-mail: [email protected]

Affiliations Nursing Department, Health University of Applied Sciences Tyrol FH Gesundheit Tirol, Innsbruck, Austria, Department of Nursing Science and Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria

Roles Data curation, Investigation, Writing – original draft

Affiliation Nursing Department, University of Shkodra “Luigj Gurakuqi,” Shkoder, Albania

Roles Conceptualization, Data curation, Methodology, Software, Validation

Affiliation Department of History, Martin-Luther-Universität Halle/Wittenberg, Wittenberg, Germany

Roles Writing – review & editing

Affiliation Research and Innovation Unit, Health University of Applied Sciences Tyrol/FH Gesundheit Tirol, Innsbruck, Austria

• Nertila Podgorica, 
• Emiljano Pjetri, 
• Andreas W. Müller (M. A.), 
• Susanne Perkhofer

• Published: March 27, 2024
• https://doi.org/10.1371/journal.pone.0300774
• Reader Comments

Introduction

The global and Albanian populations of elderly people are steadily increasing. It is estimated that the number of elderly adults requiring care in Albania will rise from 90.9 thousand to 130.4 thousand by 2030. Despite the envisaged increase in the number and life expectancy of the elderly population in Albania, which will result in an increased demand for nursing care, little is known about the difficulties and challenges that nurses face while providing care for elderly Albanian individuals.

To explore the difficulties and challenges nurses experience while caring for elderly people in Albanian eldercare institutions.

The study employed a qualitative design using purposive sampling of 20 nurses in 8 eldercare institutions who participated in face-to-face semi-structured interviews. The audio-recorded interviews were transcribed and subsequently subjected to analysis using Graneheim and Lundman’s qualitative conventional content analysis. Data analysis was supported by the qualitative data analysis software MAXQDA 2020. The reporting of this study followed the consolidated criteria for reporting qualitative research (COREQ) checklist.

Five key categories emerged from data analysis: (1) professional difficulties, (2) educational difficulties, (3) relationship challenges, (4) increased mental stress, and (5) participation in advocacy. This study showed that nursing staff experienced many barriers, challenges, and unmet needs when implementing care for elderly people in long-term care facilities.

The findings indicate that nurses working in eldercare institutions faced significant challenges in caring for elderly people. Nurses need more legal, financial, educational, and emotional support. The study indicates that more organizational and national support is necessary for nursing staff to care for elderly people in eldercare Albanian institutions properly. Eldercare institution leaders need to recognize the importance of their role in overcoming the barriers and providing adequate support for their staff in caring for elderly people.

Citation: Podgorica N, Pjetri E, Müller (M. A.) AW, Perkhofer S (2024) Difficulties and challenges experienced by nurses in eldercare institutions in Albania: A qualitative content analysis. PLoS ONE 19(3): e0300774. https://doi.org/10.1371/journal.pone.0300774

Editor: Sylvester Chidi Chima, University of KwaZulu-Natal College of Health Sciences, SOUTH AFRICA

Received: March 25, 2022; Accepted: March 5, 2024; Published: March 27, 2024

Copyright: © 2024 Podgorica et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data cannot be shared publicly because of participants privacy.Data are available from the RCSEQ Privatuniversität UMIT GmbH und der fh Gesundheit Tirol 6060 Hall in Tirol, Eduard Wallnöfer-Zentrum 1 - TN: 0508648/3942, E: [email protected] Institutional Data Access / Ethics Committee (contact via [email protected] ) for researchers who meet the criteria for access to confidential data.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Albania is currently experiencing a rapid and irreversible aging of its population. According to a report by the Albanian Institute of Statistics, by 2031, the population will slightly decrease to 2.74 million, while the old-age dependency ratio is forecast to reach 32.7%. Furthermore, the number of persons aged 65 or older is expected to increase to 21.8% of the total population. Statistical data from the United Nations report that the population in Albania is expected to decrease to 2.42 million by 2050 and 1.94 million by 2070, and the elderly dependency ratio will increase to 40.7% by 2050 and 76.1% by 2070 [ 1 – 3 ]. It is estimated that the number of older people in Albania potentially in need of long-term care will increase from 90.9 thousand to 130.4 thousand by 2030 [ 1 , 3 , 4 ]. These statistical data show that the healthcare system in Albania is facing challenges and that there are difficulties and problems in the long-term care (LTC) system, which is still underdeveloped in Albania [ 1 , 5 ]. Albania currently lacks a formal LTC system [ 1 , 3 ], as there is no official definition of LTC. There are provisions for long-term care in various laws, such as healthcare, social welfare, and social security, but a proper system is not defined [ 1 , 6 ]. The Ministry of Health and Social Protection of Albania (MHSP) manages all these services. Elderly services are provided through social services in public service centers, such as community, residential, and regular or palliative day centers. These public services are financed from the state budget and municipal budgets; social services are provided in non-public service centers [ 5 , 7 – 10 ]. Nonetheless, these public service centers face limitations in capacity and capability to provide adequate eldercare. They serve different groups of people, including people over 60 who are disabled or chronically ill or who have been abandoned by their families. There are 39 residential centers for the elderly in Albania, of which 14 provide services in the Tirana district. In comparison, the remaining 25 offer services in Korça (6 centers), Shkodra (5 centers), Berat (3 centers), Durres, Vlorë and Elbasan (2 centers each), Lezhë, Dibër, Gjirokastër, Fier and Kukës (1 center each) [ 1 , 11 ]. The services for older people in these centers are guaranteed following the standards approved by the Albanian government: multidisciplinary teams assess the needs of older people and design and implement the time plan of individual interventions to meet the identified needs [ 4 , 5 , 10 ]. The staff of these centers is mainly composed of doctors and nurses. At the same time, there are only a few social workers and nursing assistants, even though the profession of social worker and nursing assistant is provided for in the authorized structure [ 3 , 4 ]. This occurs because neither university curricula nor training institutions in Albania provide adequate training for nursing assistants and social workers in caring for older people [ 8 , 9 ]. Nurses are considered the backbone of the healthcare system in providing essential healthcare services to the population. The knowledge, training, behavior, and care nurses provide significantly impact the quality of care, as studies indicate that care providers’ perspective influences the quality of care delivered to older individuals [ 12 ]. Nurses face various problems and difficulties when implementing nursing care and meeting their responsibilities to older people at eldercare institutions. These problems and challenges are related to the facilities’ physical environment and technical equipment, as well as the educational level of nurses [ 4 , 8 , 13 ]. The lack of staff training and a suitable environment is proven by the evidence to affect the quality of care provided to older people in eldercare facilities [ 9 ]. Empirical data revealed that nurses face difficulties in caring for the elderly due to communication and relationship issues with them, their relatives, or staff [ 8 , 10 , 14 ]. While working in LTC facilities, nurses care for people with dementia and other elderly with various health conditions who express uncertainty in decision-making regarding therapy or other decisions, especially at the end of their lives. As a result of being confronted with different moral dilemmas and being unable to protect older people, the nurses encounter various emotional problems [ 15 , 16 ]. These challenges intensify when elderly residents exhibit increased aggressive behavior, leading to psychological distress in nurses, reduced working hours, attrition from the profession, and, ultimately, a shortage of nurses [ 14 , 17 ]. In addition to the above issues, nurses working in LTC facilities confront many other difficulties and challenges in providing qualitative care to older people [ 14 ]. Since there is insufficient data on nurses’ challenges and difficulties while caring for older people in eldercare institutions in Albania, the evidence mentioned above comes mainly from studies conducted in other countries [ 1 , 9 , 14 ]. Most older individuals in Albania receive care from their families, particularly when they face serious illnesses or lose the ability to work [ 1 , 3 , 4 , 6 ]. Older individuals in Albania have been cared for by family members, with children taking on the responsibility until the end of their parents’ lives [ 8 ]. However, this traditional care system is undergoing a rapid transformation [ 10 ] due to increased life expectancy, low fertility, increased female employment, the migration wave, and changes in Albanian culture. These changes have heightened the demand for care in eldercare institutions, as older individuals have fewer opportunities to reside with their adult children. The swift pace of these changes has resulted in a dearth of studies examining the experiences of nurses and the difficulties they encounter in caring for the elderly within Albanian eldercare institutions. Only a few studies have identified the barriers that affect the care of older people in Albania.

Hence, this study explored the difficulties and challenges nurses experience while caring for elderly people in Albanian eldercare institutions.

Materials and methods

Study design and setting.

This qualitative study was conducted in 2019–2020 using the conventional content analysis approach. This method facilitates the depiction of experiences and the identification, summarization, and categorization of manifest and latent content within lived experiences [ 18 ]. Additionally, it aligns with the study’s objective, aiming to delve into the difficulties and challenges encountered by nurses providing care for elderly individuals in eldercare institutions in Albania.

Participants of this study were recruited from four different types of institutions, such as daily eldercare centers, public nursing homes, palliative care centers, and private nursing homes ( Table 1 ), as there is no infrastructure for a long-term care system in Albania [ 1 , 8 ].

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pone.0300774.t001

Study population and eligibility criteria

Nurses meeting the inclusion criteria were invited to participate in the research. The inclusion criteria comprised the nurses’ voluntary participation in the study, a minimum of one year of clinical work experience in providing care for older individuals in eldercare facilities, proficiency in Albanian communication, strong verbal skills, and the capability to articulate and share their experiences in detail. Before the researchers started interviewing, they tested the interview guide with two nurses to ensure the questions were clear, understandable, and easy to answer. These two nurses did not participate in the study, and their interviews were not included in the analysis.

Sampling procedure and sample size

A purposive sample of nurses was recruited through social contact with nurses and directors of each facility based on their potential to provide information about their nursing knowledge and experiences for the study [ 19 ]. The initial 30 contacts who met the inclusion criteria and were willing to describe their nursing experiences consistent with the purpose of the study received a consent form by mail or e-mail and were verbally informed about the project. Once the participants signed and accepted, the consent form was mailed to the principal investigators before the start of the interview. Of these nurses, only 20 were interviewed, and the sample size was determined based on the principles of saturation as proposed by Malterud et al. [ 20 ]. Sampling was discontinued when no new information was obtained from study participants. All nurses voluntarily participated and were free to stop or withdraw from participating at any time without negative consequences.

Data collection tool

A semi-structured interview guide was employed in this study, developed based on a review of the literature and modified to align with the specific objectives of the research [ 21 ]. The guide was used to collect detailed data regarding the difficulties and challenges nurses face when caring for the elderly living in eldercare institutions in Albania. An information sheet was used to manage the sociodemographic data of the study participants. The interview guide, initially prepared in English, underwent translation into Albanian (the national language) to ensure better understanding by the participants. To verify the appropriateness of the questions, a testing phase was conducted before the commencement of data collection.

Data collection procedure

After obtaining participants’ informed consent, data was collected through in-depth and semi-structured individual face-to-face interviews ( Table 2 ). The interviews, conducted by leading Albanian researchers (NP, EP) possessing a Ph.D. in nursing science and expertise in qualitative research, occurred between June 2019 and March 2020. Before the interviews, researchers communicated with participants, aiming to establish a friendly atmosphere. This involved introducing themselves, describing the study’s objectives and the reasons for their interest in the subject, and responding to possible questions from the participants. These efforts contributed to building a positive rapport and trust between researchers and participants. Additionally, participants received assurances regarding their freedom to answer questions and participate voluntarily, the confidentiality of their information, and the option to withdraw from the study at any point. Participants were given the autonomy to choose the location and timing of their interviews.

https://doi.org/10.1371/journal.pone.0300774.t002

Interviews were conducted without time constraints, scheduled outside regular working hours, in a separate room at the participant’s workplace, ensuring privacy with only the interviewer and participant present. The interview process continued until all relevant experiences of the participants had been fully explained, and comprehensive responses had been obtained from the interviewees. A digital audio recorder was used to record the interviews. In semi-structured interviews, the questions are not fixed and predetermined but evolved based on the interview process. Follow-up questions followed each interview to obtain further information or clarify the participants’ answers. The interviews were digitally recorded in Albanian, and researchers noted non-verbal data such as mood, tone of voice, facial expressions, and posture during the sessions. Interviews lasted 40–70 minutes and continued until saturation occurred after the 15th interview, but after coding these interviews, all authors agreed to conduct more interviews to ensure saturation [ 20 , 22 ]. The first 15 interviews were conducted between June and December 2019, two others in January 2020, and three additional interviews were conducted between February 27 and March 5, 2020, before the COVID-19 restrictions started in Albania. In all, 20 in-depth individual interviews with nurses were completed. There were no withdrawals from the study and no repetition of any interviews.

Data analysis

The data underwent analysis following Graneheim and Lundman’s qualitative conventional content analysis [ 22 ]. Data analysis began shortly after the first interview by manually transcribing the recorded audio data and typing it directly into the computer using Microsoft Word software. After anonymizing the transcriptions by removing personal identifiers and assigning unique identification numbers, the transcripts were reviewed for accuracy using spot-checking, taking a small set of transcripts (3 of 20) by the researchers who speak Albanian and English (NP; EP), who read and reread all the transcripts carefully and translated them afterward into English following Santos et al. [ 23 ] strategy for translating qualitative interviews and research reports which suggest having language experts on research teams and translation and back-translation issues directly considered within the team. A professional translator then checked the translated transcripts. The back translation was done again by the same researchers. In the next step, three researchers (NP, EP, and AM) repeated the reading of the transcripts with an open mind to gain an overall impression and a general understanding of each transcript. Transcribed and translated data sets were imported into MAXQDA 2020, a software supporting qualitative data organization and coding [ 24 ]. In the next step, open data coding began by carefully reading the data line-by-line, extracting and coding each word, phrase, or paragraph aligned with the study’s purpose. In the categorization phase, codes were consistently compared and ranked according to their affiliations, including their differences and similarities. Codes were then subcategorized, sorted, and combined into fewer, more comprehensive categories. To assign findings to the same category, researchers approached the text with a degree of interpretation (i.e., open to underlying meanings). The first and second authors did the coding and initial categorization independently, and the third did the validation and suggestions for changes. This iterative and non-linear process [ 18 , 25 ] moved between parts and the whole until no new codes or categories could be added. All subcategories and categories had been defined, and the final coding scheme was created by the first three authors, one of whom was a senior female researcher with a Ph.D. in nursing science and extensive experience in qualitative research, and the other two male authors, one of whom was a lecturer with a Ph.D. in nursing and the other an expert in qualitative research in social and medical sciences. The other authors then reviewed the coding scheme and agreed upon or discussed it until a consensus was reached.

To ensure the reliability of the findings, the authors discussed the meanings, subcategories, and categories that emerged from the analysis following the specific objectives of this study. Additionally, meetings with study participants were conducted to ensure accuracy, facilitate discussion, and seek consensus on the identified subcategories and categories [ 26 ]. Participants’ suggestions were considered, and adjustments were made as deemed appropriate. Consolidated Criteria for Reporting Qualitative Studies (COREQ) was used to provide a comprehensive report [ 27 ]. Finally, to ensure transparency [ 28 ], each subcategory was enhanced with citations. Each citation is in reference to the specific numbered interview. An example of the construction of the coding scheme is presented in Fig 1 .

https://doi.org/10.1371/journal.pone.0300774.g001

Ethical considerations

The Research Committees of two universities approved the ethical application for Scientific and Ethical Issues (RCSEQ, no. 2117) of the University of Medicine, Health and Technology (UMIT), Hall in Tirol, Austria, and the Ethical Committee, Faculty of Natural Sciences, Department of Nursing, University of Shkodra (Prot,no. 20/2. Dt. 12/04/2018) Shkoder Albania. The study was conducted following the tenets of the Declaration of Helsinki [ 29 ] and had the approval of the head of each institution. Confidentiality of the collected data was ensured, and written informed consent was obtained from all research participants. In addition, participants were free to decline participation or withdraw at any stage of the research process. All interviews were recorded with the permission of the participants, and all the audio files were securely stored in password-protected computers.

Demographic characteristics

The findings were extracted from the analysis of 20 in-depth individual interviews with nurses. The characteristics of the participants are presented in Table 3 .

https://doi.org/10.1371/journal.pone.0300774.t003

Five categories with fourteen corresponding subcategories were developed to capture nurses’ difficulties and challenges when caring for elderly people in different eldercare institutions in Albania ( Fig 2 ).

https://doi.org/10.1371/journal.pone.0300774.g002

Professional difficulties

Within the realm of professional challenges, nurses highlighted three primary subcategories: inadequate physical environment, insufficient material resources, and constraints related to time and staff. All participants consistently pointed out various obstacles when caring for older adults, such as a shortage of staff, an overwhelming number of residents, time constraints, limited space, and inappropriate structural conditions.

Inadequate physical environment.

One major issue highlighted by the nurses is the lack of suitable facilities in Albania, aside from private institutions, for providing essential care to the elderly. The environmental conditions within these institutions are not conducive for nurses to effectively carry out their responsibilities. The interviewed nurses work in nursing homes, daily elderly care centers, and palliative care centers. These institutions accommodate residents of various ages, many of whom suffer from mental illnesses or other health conditions.

In this study, certain participants shared challenges related to the physical design and layout of the ward environment, particularly in creating a familiar setting to address responsive behaviors in residents. “They want to stay in single rooms , but the center doesn’t have such conditions because of the lack of funds” (Participant 16). Participants stated that it was difficult to respect residents’ preferences and even intimacies who share rooms with other residents with dementia. “Because the facility does not have private rooms or good conditions , we respect their preferences as much as possible . Residents stay in double rooms . However , older residents with severe conditions like paralysis or advanced dementia have quads . Old females remain separated from the males , but their intimacy is maintained only when they go to the bathroom” (Participant 3).

Inadequate material resources.

The participants confronted the challenge of insufficient resources, hindering their ability to provide adequate care for the elderly. Nurses felt that they were pushing the limits of their patients’ safety due to the unavailability of the necessary equipment. They were also angry about the systematic factors that did not provide them with sufficient wages and the support that they needed. “There are even residents who drink and then get drunk . They are a problem , especially when working nights . Because our institution has no entertainment , they ask us to go out and play dominoes . They disturb others , or they even cause violence . This happens because we can’t do anything , and no one helps or supports us because of the disorganization and the lack of the necessary materials to offer a daily life to the residents“( Participant 4).

Insufficient time and staff.

The participants highlighted the challenge of inadequate staffing levels, with most expressing concerns about insufficient numbers of nurses and social workers per resident. “We can’t always give care when they need it . We don’t have enough staff in one shift“( Participant 8). “There should be more staff . One nurse has to do almost everything . With only one nurse and one care worker , there are thirty people” (Participant 5). Nurses reported difficulty caring for elderly people due to workload, too many residents, and lack of time and staff. “We were warned to take care of them . But it’s too tricky because two people can’t monitor fifty elderly people“( Participant 15). In addition, the lack of staff, time, and increased workload made it difficult for nurses to focus on qualitative care. Some reported feeling guilty about not being able to provide the best care for elderly people. “The most common problem is their need for attention and their wishes to be fulfilled . Considering the time and workload , we try to fulfil their wishes somehow” (Participant 18). “It is a challenge to listen to the old residents . The staff has to provide services to them . We don’t have enough time to make sure we’re doing right“( Participant 20). “Sometimes we feel guilty . But the negligence in the care of the older people happens because of the lack of staff . Because of the lack of funds , the staff is insufficient” (Participant 19).

Educational difficulties

Under this category, three major subcategories were identified to explain educational issues: lack of knowledge, inadequate education, and learning by doing.

Lack of knowledge.

The participants underscored a significant challenge related to the lack of knowledge in geriatric care, emphasizing that university curricula did not adequately equip them with expertise and specialization in caring for the elderly. “Even at the university , there was a lack of information about caring for older adults . Perhaps because we were the first generation , this may have happened . The university is not consolidated . We need to get knowledge , especially for older people with dementia , Parkinson’s , and all the other diseases . We need to be specialized senior nurses” (Participant 11). “We first participated in the first training regarding caring for older adults 20 years ago . We need to get trained and informed more” (Participant 14).

Insufficient education.

Participants highlighted a significant issue related to insufficient education in geriatric care, expressing concerns about the lack of training that can impact the quality of care provided to elderly residents. One nurse emphasized this challenge, stating, “I have not taken part in any training related to the care of the elderly . I have tried to find a course related to these issues , but the classes I have attended have not been helpful , considering my profession . However , we are more aware of what we should and shouldn’t do . Without information about such cases , you can even do things wrong . Even if we learn from our work , we still need proper training to fulfill our duties and protect our residents“( Participant 9). Participants advocated for continuous education not only for staff but also for the elderly residents. One participant expressed the need for training in caring for and communicating with older adults, emphasizing that this aspect had been neglected in the past: “I think the staff and the older people need to be trained in caring for and communicating with older adults , something which has never happened before” (Participant 11). Nurses asked for training in caring for elderly adults, especially dementia care. As one nurse noted, “We haven’t been trained on how to care for older adults or how to care for dementia . There is a lack of information in the college . It can improve the quality of care we give to the elderly and help us to be more confident and professional if we have knowledge and training about elderly care , especially dementia care” (Participant 1). The participants underscored the need for professional education to provide specialized care to elderly people, particularly those with dementia at different stages and symptoms. Despite attending some training sessions, they expressed a desire for more comprehensive education in caring for older adults. One nurse noted, “We’ve attended training on diagnosing the patient , but it wasn’t explicitly related to the elderly” (Participant 15). “ We recently attended a training on the standards we should meet , organized by two psychology professors . But we need more training in caring for older adults . The problem is that our institution does not offer proper care for the elderly , and we , the nurses , are not even specialized in caring for the elderly” (Participant 13).

Learning by doing.

A prevalent theme among participants was the concept of learning by doing, indicating that their knowledge and skills in caring for older adults were primarily acquired through practical experience rather than formal education. Participants acknowledged the valuable contributions of previous staff, emphasizing their higher education and multilingual abilities. One participant stated, “We also learned a lot from the previous staff . They had higher education and could speak many languages” (Participant 12). Nurses learned to solve unforeseen problems while caring for older adults without guidance or resources or only through their family education: “Human resources were too limited in terms of staff and professors . We learned by working , although we did not have enough information . I think we got something done” (Participant 2). “I don’t have any update on elderly care even though I have been working here for almost thirty years . We learn by working and practicing it daily” (Participant 4). “Rather than being trained in an institution , we have been working based on our family training” (Participant 2).

Relationship challenges

Many nurses cited staff-resident-family relationships as barriers to appropriate care for older adults. They emphasized the lack of communication and conflict between and among staff, residents, and families.

Lack of communication among staff and residents.

Numerous participants highlighted the communication challenges they face, particularly when interacting with elderly individuals diagnosed with dementia. While nurses acknowledged the importance of patience in these situations, time constraints often hindered their ability to engage in meaningful communication. The need to prioritize residents’ physical needs was emphasized by one participant, who stated, “I will listen to them , but if I am in charge of something else , I will tell them to wait if it is not urgent . Sometimes , they’re reasonable . Other times , they act like they don’t understand what I’m saying . We have to prioritize their physical needs” (Participant 9). The difficulties in communication were further compounded by the diverse range of residents with varying ages and health conditions. Instances of alcoholism, previous incarceration, and both physical and mental disabilities among residents contributed to communication problems. The nursing staff, despite facing these challenges, made efforts to adapt to the residents’ diverse needs. However, the complexity of their job increased when residents encountered problems among themselves, requiring intervention and separation. As described by one participant, “Some people here are alcoholics or have been in prison , as such we may have communication problems with them . We also have people with physical and mental disabilities . Even though it’s difficult , we try to adapt ourselves to them . In general , they’re not aggressive , but there are cases in which they have problems with each other . Sometimes , we have to intervene and separate them from each other” (Participant 8).

This theme underscores the intricate nature of communication challenges within eldercare institutions, emphasizing the diverse backgrounds and conditions of the residents that contribute to the complexity of interactions for nursing staff.

Communication among staff.

Regarding communication among staff members, most participants expressed overall positive communication within the team. However, some nurses acknowledged minor disagreements arising from different positions and cultural backgrounds. One nurse highlighted this aspect, stating, “In some ways , we face problems communicating with each other because we have different cultures and ways of caring for patients . I take care of them as a nurse . Another staff member helps as a caretaker” (Participant 17).

Meanwhile, communication between nurses and doctors was generally perceived as effective and correct. Nurses reported rarely experiencing conflicts with doctors, emphasizing that doctors typically make decisions and nurses follow their instructions. As described by one participant: “We never happen to conflict with the doctors , and we are better at communicating with them” (Participant 7). The collaborative dynamic between nurses and doctors contributes to the smooth functioning of the team.

Conflicts among staff and relatives.

Numerous participants highlighted challenges in communication and misunderstandings with the families of residents, particularly those with dementia. The participants expressed frustration by stating: “We sometimes have problems communicating with the families because they do not accept the situation of their relatives“( Participant 10). Conflicts with family members were reported, often stemming from dilemmas faced by relatives regarding the care of their loved ones. One respondent emphasized the complexities involved: “Sometimes the relatives are in a dilemma whether to do the right thing or not to bring their father or mother , so they often need us to listen or confirm when they’re right . There are cases in which family members impose things on the patients . For example , they force them to eat more than they want , which is a source of conflict for us” (Participant 2).

Increased mental stress

Nurses in this study mentioned their psychological stress while caring for elderly residents with various conditions. They emphasized the residents’ aggressive behavior and the nurses’ negative attitudes.

Aggressive behaviors of residents.

Participants recounted distressing experiences involving aggressive behaviors exhibited by residents and their families. One participant highlighted the challenge, stating, “There are cases when family members don’t cooperate with us and insult us . This makes our job even more difficult” (Participant 18). Despite understanding that aggressive behavior in elderly residents is often a consequence of dementia, nurses reported feeling hurt and demoralized. Instances of verbal insults, physical aggression, and biting were mentioned, creating emotional challenges for the nursing staff: “We care for elders and treat them like family members . Sometimes they insult us verbally and become aggressive . They hit us or bite us , and when they do that , we feel bad and insulted” (Participant 15). While acknowledging the difficulties, nurses emphasized the importance of effective communication in managing such situations. One nurse stressed: “I think it’s more important than anything else to be able to communicate . Every older resident has their character . Some seniors are grateful to us for our services .

On the other hand , some of them may throw food at our uniform if we don’t do what they want . Sometimes , there are even insults . But let’s not consider their abuses“( Participant 12). “Yes , sometimes we have aggressive residents . However , we do our best to calm them down through conversation . We try not to give them tranquilizers , but sometimes we have to use them and feel guilty about it … there is no other way” (Participant 6).

Nurses’ negative attitudes.

Most participants highlighted concerns about the negative attitudes exhibited by some nursing staff, emphasizing a lack of a sense of mission and emotional engagement. This was seen as a hindrance to holistic care, reducing care to mechanical and physical tasks. One participant stated: “In my opinion , the attitude of some of the nurses was wrong . They do not have a sense of mission or a sense of professional duty; they have no emotions” (Participant 1). “I have been working here for an extended period . Sometimes , it looks like I’m acting like a robot … When we care for residents with dementia , we have to talk to them more , listen to them , and give them some stimulation . Still , sometimes I feel pressured by the resident , relatives , or other staff . I change diapers , take residents to physiotherapy , and feed them lunch or dinner; lots of stress , that’s all . I’m sorry , but many residents need me to help them physically“( Participant 13).

Participation in advocacy

The participants indicated that they are often confronted with ethical issues when they advocate for their elderly residents. These are listed in three subcategories: ethical problems related to elder rights, futile nutrition and medications, and cultural influences.

Ethical problems related to elderly people’s rights.

Nurses highlighted ethical dilemmas related to older people’s rights, particularly in institutionalization cases where informed consent may be lacking. The challenge lies in the fact that many elderly individuals are institutionalized without being adequately informed or asked for their consent. Nurses expressed the difficulty of defending the rights of older people in such situations. According to one participant: “Most of them are here at the request of their family members . The family members often give them the wrong information by telling them that our center is a hospital . When we tell them the truth , they understand the reality as the days pass” (Participant 7). “Family members usually decide to bring their parents to our center . They may be abroad or busy with their work . But we can’t keep them against their will , so we also try to get their consent” (Participant 6). “The official document is part of every palliative care report . But we never use it because the resident is not informed , and we cannot do anything wrong . The older adult must be well informed about what he has and what we serve him . It’s the patient’s right to sign in , and he must accept everything with full awareness . We haven’t used an official document very often . Most colleagues do not know much about it“( Participant 11).

Futile nutrition and medication.

Feeding and futile therapies were other challenges expressed by the participants. Nurses said they often have to feed elderly people even when they do not want food. In some cases, family members insisted on providing food to unconscious patients, believing it would contribute to their well-being. “This happens because the patient is unconscious at the family member’s request in the last phase . There have been cases in the last days of life where patients have refused to eat . However , we must feed them , even though we cannot give them basic food , but bland food for better treatment” (Participant 17). “The relatives insist on giving the patient futile therapy until the last moment of his life , even though they know we don’t give curative therapy . The doctor must tell them what’s best . However , the relatives are supposed to decide . I always try to convince the families not to give the patient such things . They are worthless and only harm the patient . But if they still insist on it , I try to give the patient the minimum of the doctor’s prescribed treatment” (Participant 8).

In certain instances, nurses also argued that elderly residents receive futile therapy that may harm rather than benefit them. However, the decision lies with the family: “Some residents have dementia , crises , or emotional problems . If we consult the doctor , we can treat with or without the patient’s consent . This makes me feel horrible because I do nothing to advocate for my old resident” (Participant 19). “Older adult residents who have dementia are refusers of treatment . When this happens , we try to find ways to make it possible for them to receive the medication without consent . For example , we could give them the medicine in their food . I know this doesn’t seem right and has nothing to do with my role as advocator , but I am forced to do so ” (Participant 16).

Cultural aspects influence.

Nurses participating in the study highlighted significant challenges arising from cultural aspects that impact their ability to advocate for elderly residents in Albanian eldercare institutions. The participants expressed a sense of powerlessness in advocating for residents with no family to request visits to the facility. Moreover, cultural norms and taboos restrict the disclosure of significant health problems and diagnoses to elderly individuals, emphasizing the influence of societal beliefs on communication and decision-making in healthcare settings. “Nobody asks them if they want to come here . The government brings them here , and we have to accept them in our institution without any advocacy regarding information or other things” (Participant 13). “Based on the information we get , we try to be compassionate and polite . We are somehow restricted from discussing the pathology with the patient because of the taboos and mentality of our society . Patients often accept the information given to them by family members and do not ask many questions . This is a part of the culture in Albania . So , we give patients the news their relatives want them to know . We do nothing to protect the older adult residents here , which makes me feel terrible” (Participant 3). “Because the familiars insist on not telling them the truth , most of our residents do not have this information about their diagnosis . They ask us not to tell patients the truth . However , this phenomenon of not telling the truth about the diagnosis to the patient is part of the Albanian culture . It is considered a problem for us” (Participant 1).

This qualitative study sheds light on the multifaceted challenges faced by nurses in Albanian eldercare institutions, categorizing their experiences into five key areas. Following previous literature, these results showed that the work environment impacts nurses’ work and attitudes toward caring for older adults [ 30 , 31 ]. Likewise, in their studies, Rush et al. (2017), Adibelli & Kılıç (2013), and Kong et al. (2022) found that the physical work environment influenced the work of the nurse and their attitude toward caring for elderly people and their health [ 30 , 31 ]. According to this study’s findings, Albanian eldercare institution leaders, policymakers, and other stakeholders need to consider the importance of the physical environment, redesign the institutional setting to be more appropriate, and make the institution more home-like for elderly people. In an attempt to provide high-quality care, it is necessary to have enough nurses [ 14 , 31 ]. The participants in this study were overloaded with work and did not have enough time to care for the elderly because of inadequate standards and time to provide proper care. They reported feeling guilty for not providing the best care due to insufficient time and staff.

Similarly, Kang & Hur (2021) found that the shortage of nurses prevents communication and care for older persons, especially those with dementia [ 17 ]. The results of this study show that Albanian eldercare institutions need adequate staffing standards and financial support to implement appropriate care for elderly residents successfully. This study revealed that the participants had inadequate education and training in caring for the elderly, especially those with different mental and physical conditions. Most of the participants highlighted problems related to a lack of knowledge and skills in eldercare, especially in caring for older people with dementia. These results are reinforced by other authors’ findings, who emphasized the importance of staff and elderly education in elderly care in their studies [ 17 , 30 , 32 – 34 ]. Thus, to provide the best care for older people, the leaders of Albanian eldercare institutions and universities should provide continuous training on care for the elderly.

Adequate care requires excellent and healthy communication, mutual trust and understanding, and good teamwork and relationships [ 14 , 35 , 36 ]. Similarly to previous studies, this study found that nurses experienced relationship and communication difficulties with residents, especially those with dementia and their families [ 14 , 17 , 30 , 32 , 33 ]. These difficulties are mainly related to the Albanian culture, where families care for elderly people. Likewise, Adibelli & Kılıç (2013) and Nasrabadi et al. (2021) describe these difficulties as primarily related to cultural problems [ 30 , 37 ]. In addition, the nurse participants in this study reported issues of communication and relationships within the team. These findings support previous reports on the importance of communication, relationships, and collaboration while caring for elderly people [ 14 , 38 ]. Eldercare institution leaders need to recognize the importance of their role in team relationships and provide education and support to improve communication and relationships between staff, residents, and their families.

Another result showed that most of the nurses included in this study suffered from increased psychological stress when caring for elderly residents, especially those with various mental health problems, such as dementia. Emotional distress and stress were experiences of nurses whom the aggressive behavior of some residents with dementia had hurt. Adding to previous findings, participants in this study reported hurtful experiences while caring for some elderly people [ 14 , 17 , 35 ]. These experiences led to negative attitudes among nurses, who consistently said they were apathetic and mechanical in treating residents with dementia. They also had difficulty treating and respecting them as human beings. Accordingly, nurses who experienced aggressive behavior from elderly residents felt anxiety, frustration, and discomfort while caring for them, according to Kang & Hur’s (2021) meta-synthesis [ 17 ]. Consistent with Kang & Hur’s (2021) findings, participants in this study reported difficulty communicating with residents in the face of aggression. Therefore, measures such as using safety alarm devices and counseling programs to support nurses’ psychological and physical health should be taken to protect nurses facing emotional stress and provide qualitative care [ 14 , 17 ].

Another significant challenge described by participants was advocacy related to ethical issues in caring for older adults in long-term care facilities. They found it challenging to advocate for elderly residents regarding self-determination, truth-telling, and trust. Along the same lines, Arcadi & Ventimiglia (2017) and Luca et al. (2021) emphasized the need for nurses to develop a trusting relationship [ 16 , 39 ]. Participants in this study believed that advocacy skills are needed when ethical issues arise, such as when the needs of the elderly are not met or considered, as also mentioned by Josse-Eklund et al. (2014), when excessive or unnecessary therapy may occur against the expressed will of the patient, or when patients with dementia are unable to express their will regarding therapeutic decisions made by family members or physicians [ 40 ]. In such situations, participants emphasized that they cannot protect the rights of elderly residents, most of whom are placed in institutions against their will and without their consent. Family members make decisions, although older people have the right to information, choice, and approval following relevant regulations and laws [ 9 ]. Despite the various conflicts nurses can encounter with colleagues or families, the importance of nurses’ ability to guarantee and protect the rights and wishes of older people in the centers where they work has been described and highlighted in earlier studies [ 16 ]. Managers of facilities for eldercare should consider this fact, and more support should be provided. In addition, participants in this study believed that cultural aspects such as social relationships influence the views of the patient, family, and nurses on a clinical situation and cause different difficulties for nurses in caring for the elderly. Indeed, Vries et al. (2019) support these findings, arguing that cultural aspects such as ethnicity, religiosity, and spirituality, as well as the level of health literacy, greatly influence people’s decisions when making plans that consist not only of advanced directives for resuscitation but also wishes at the end of their lives [ 7 , 9 , 41 ]. In the present study, despite the different organizational contexts of the eight eldercare institutions, the participants described similar challenges in caring for elderly residents. The results of this study indicate that Albanian eldercare institutions / long-term care facilities need to develop a supportive organizational system and provide support for the successful implementation of elderly care. Furthermore, the Albanian government must offer more financial and legitimate aid for eldercare institutions.

Limitations and strengths

This study comes with some limitations commonly found in qualitative studies. Firstly, it relies predominantly on the perspectives of nurses, potentially limiting the exploration of broader frameworks and contextual conditions. Secondly, as a qualitative study, this study is limited in scope and relies on the subjective interpretations and decisions of the involved researchers. Additionally, the study is confined to eight eldercare institutions in three regions of Albania, which may restrict the generalizability of the findings to other contexts or countries.

Nevertheless, this is one of the few studies conducted in Albania regarding nursing staff challenges and difficulties in eldercare facilities. Thus, the current study creates an opportunity for further extensive national research into nurses’ knowledge, perception, attitude, and other relevant areas that may affect older people and their care in Albania. Future studies should consider the experience of all healthcare professionals involved in providing care to older people in all Albanian eldercare institutions.

In this study, a significant number of nurses highlighted substantial challenges in providing care to elderly patients. The key obstacles identified encompassed the absence of specialized long-term care infrastructure, insufficient social support and funding, inadequate knowledge and training in geriatric care, and the absence of clear policy guidelines for the care of older individuals. The findings underscore the urgent need for enhanced legal and financial support at the national level and economic and educational support at the facility level to enhance staffing conditions and the physical environment in long-term care facilities, thereby improving the overall care for older individuals. Establishing suitable long-term care environments across all regions, along with comprehensive guidelines, enhanced nurses’ knowledge, improved working conditions, and ongoing training are imperative. Initiatives should include reinforcing geriatric nursing programs in Albanian universities to adequately equip professionals in addressing the healthcare requirements of the elderly. Long-term care facilities should implement geriatric education at the facility level for staff and families, focusing on knowledge enrichment, improved communication skills, and ethical problem-solving practices. Leaders of these facilities play a pivotal role in recognizing and addressing the challenges faced by nurses, emphasizing their crucial contribution to ensuring quality care for older individuals.

Supporting information

https://doi.org/10.1371/journal.pone.0300774.s001

• 1. ILO. Long-term care for the elderly in Albania: Challenges and key policy issues. Budapest 2022[cited 2023 05.17]. https://www.ilo.org/wcmsp5/groups/public/—europe/—ro-geneva/—sro-budapest/documents/publication .
• 2. INSTAT. Projeksionet e popullsisë 2019–2031. Tirane, Albania 2019 [cited 2023 05.17]. https://www.instat.gov.al/media/5222/njoftim-per-media-projeksionet-e-popullsise-2019-2031.pdf .
• 3. Jorgoni EM, Enkelejd ESPN Thematic Report on Long-term-care for older people–Albania. Brussels: European Commission 2021 [cited 2023 05.17]. https://ec.europa.eu/social/main.jsp?catId=1135&langId=en .
• 4. Shehaj E. Performance of Western Balkan economies regarding the European Pillar of Social Rights. European Centre for Social Welfare Policy and Research 2020.
• 5. MoHSP. The National Action Plan on Aging 2020–2024. United Nations Population Fund (UNFPA) and Albanian Center for Population and Development (ACPD) 2019 [cited 2023 05.17]. https://acpd.org.al .
• View Article
• PubMed/NCBI
• Google Scholar
• 19. Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice: Lippincott Williams & Wilkins; 2012.
• 21. Polit D, Beck C. Basics of mixed methods research: Lippincott Williams & Wilkins; 2017.
• 24. MAXQDA transcription and coding software. [cited 2023 05.01]. https://www.maxqda.com/ .
• 28. Patton MQ. Qualitative research & evaluation methods: Integrating theory and practice: Sage publications; 2014.