Exploring Qualitative Research

Qualitative Research Design

The purpose of the inquiry and research question(s) determine which research design is selected However, researchers have two choices; they can follow strict traditional methodologies for each research design or consider using multiple methodological perspectives from various research designs tailored to their needs.¹

A qualitative descriptive research design is frequently selected to explore a phenomenon (experience) that has little theoretical or practical knowledge in the literature.¹² The purpose of this design is to provide descriptions of experiences and perceptions of the participants, with little or no interpretation by the researcher, to begin to understand an experience within the context of everyday life. This research design is evident in an inquiry to explore practitioners’ experiences with dental hygiene diagnosis while providing patient care.¹³ The findings help practitioners understand the essential nature of this step in the dental hygiene process of care and how this step facilitates the formulation of dental hygiene care plans.

A qualitative case study research design is an in-depth study of a phenomenon in its real-life context centered on an event, activity, setting or a one single case or multiple cases.¹⁴ A case(s) is defined by specific boundaries related to time and activities. A descriptive case study seeks to describe a phenomenon in detail in its real-world context; whereas, an explanatory design determines causal factors, the why and how, to explain a particular phenomenon. An exploratory case study examines a phenomenon or identifies new research questions which fuel future research studies. For instance, a multiple case study based on several dental hygiene programs throughout the U.S. explored educators’ experiences with designing learning methods and encountering challenges when implementing a teledentistry program into the curricula.¹⁵ Educators who are interested in incorporating a teledentistry program benefit from these results.

The purpose of an ethnological research design is to understand a phenomenon study from the perspective of a cultural or social group to determine shared patterns of perspectives, behaviors and actions.² A cultural group might share common gender, age or racial/ethnic characteristics; however, other considerations are social groups including members of a healthcare discipline, professional association, or community group or people a particular setting such as a geographic location or healthcare setting. The ethnographic research design was implemented to explore barriers of persons who did not have a dental home and relied on urgent care for dental needs.¹⁶ These findings help practitioners understand the complex, constantly changing barriers that accumulate over time and worsen.

A phenomenology research design seeks to describe the essence or meaning of a phenomenon according to people’s lived experiences from their perspective.² Understanding what was experienced and how it was experienced help healthcare providers understand and learn from the experiences of others. An example of this research design is evident in the inquiry to explore dental hygienists’ experiences providing restorative patient care.¹⁷ The results help practitioners and educators understand what and how these experiences encouraged or detracted from providing restorative care.

The most complex research design is grounded theory, the purpose of which is to create a theory grounded in the data. In 1967, Glaser and Strauss published the original grounded theory methods, which have been criticized for being very close to the quantitative research paradigm.¹⁸ Therefore, a more current approach is based on constructivism that studies a phenomenon with emphasis placed on the experiences of the participants and the meaning of those experiences.¹⁹ The purpose of constructivist grounded theory is to understand the phenomenon, not to explain it as in traditional grounded theory. The resulting theory is an interpretive theory based on the co-created reality of the participants’ experiences and the researcher’s interpretation. The Synergy in Social Action Theory was created based on this research design.¹¹

Qualitative Data Collection Methods

The sampling method must be determined to select participants who have experiences with the phenomenon to inform data collection. Establishing inclusion and exclusion criteria are valuable for deciding what characteristics are critical for participants to possess and those criteria disqualifying participants from the study. Creating a screening questionnaire to collect demographic data, as well as determine participants’ eligibility is important before arranging interviews. The criteria are critical for selecting a sample composed of participants who can inform data collection and answer the research question(s). Purposive sampling is a method whereby the research intentionally selects participants based on their experiences and characteristics.²⁰ Once an initial group is recruited, snowball sampling is another strategy that asks participants to refer additional potential participants who they believe meet the inclusion criteria.²⁰ Maximum variation is commonly applied to sampling methods to gain diverse perspectives based on varied contexts of experiences.¹⁸ Specific characteristics are considered such as gender, age, years in practice and type of practice. The sample size is not predetermined; data collection continues until saturation. Saturation is determined when no new information or insights are gathered during data collection.¹⁹

The application to the Internal Review Board (IRB) must specify participant recruitment procedures, informed consent protocol, and actions to protect the confidentiality and anonymity of the sample. A common practice is having participants select a pseudonym, which is used during the interview and on the transcript in place of the participant’s real name. Approval from the IRB must be received before recruitment commences.

Because researchers are also the data collection instrument, the researchers must engage in reflexivity to identify their experiences, perspectives, culture, and values that might potentially influence data collection and interpretation during analysis.¹² Reflexivity requires an examination of the researcher’s past experiences and how these experiences shape their interpretations during the inquiry.¹² Researchers need to Identify these potential sources of bias and be mindful to minimize their influence during data collection and analysis.

The method for collecting data needs to be determined. Choices are individual interviews, focus group discussions, observation, and document and image analysis. According to a scoping review, interviews and focus groups are most frequently used in dental research.²¹ Researchers frequently conduct semi-structured interviews. They ask open-ended questions to direct the interview process and ask follow-up questions to gain an in-depth understanding of the phenomenon from the participants’ perspectives.

Focus groups are another common data collection method. A moderator conducts the discussion by asking open-ended questions. Groups generally consist of 5-8 people and for qualitative studies, three separate groups are recommended.²² The benefit of data collection is that the interaction among the participants influences each individual’s responses. Collected data can be compared among groups to determine patterns of experiences, feelings, opinions, and perspectives.

Preparing an interview guide with open-ended questions and follow-up questions has multiple benefits as part of the research methods. The guide is useful to the IRB to review for human subject protection and to approve of the protocol. Second, the guide can be emailed to the participants a week in advance to assist participants in thinking about and preparing their responses. The third benefit is ensuring all questions are asked during the data collection session.

Conducting a pilot study with at least one participant is useful for the researcher to determine whether the questions elicit relevant data to answer the research question(s). Choices for data collection sessions include in-person, telephone or an online meeting platform such as Zoom (San Jose, CA, USA).

Each interview or focus group session is audio-recorded and transcribed using the participants’ pseudonyms. Audio and video files can be transcribed by the researcher or through services offered through a company. Zoom features can be set to generate a transcript. The written data must be checked for accuracy by listening to the interview by one or more researchers.

Qualitative Data Analysis

Coding procedures involve organizing the concrete statements made by participants to understand their viewpoints, actions, and situations surrounding the phenomenon.¹⁹ After each interview, data are analyzed. A constant comparative approach is used to compare each interview with subsequent data and codes.¹⁸ This strategy is useful for determining similarities and differences in the analyzed data to provide support, expand or challenge existing codes and themes. Researchers continually make revisions to the codes and themes based on these comparisons.

Some researchers prefer to use qualitative coding software to analyze data such as Dedoose (Los Angeles, CA, USA) or NVivo (Denver, CO, USA). Considerations for selecting a specific software program include availability of a free trial, affordability, and intuitiveness for use.

The purpose of the first coding procedure, initial coding, is to deconstruct the qualitative data into the smallest elements possible for individual words, lines or sentences, sections, and incidents. This procedure creates codes that define the participants’ experiences.¹⁹ Initial codes might be modified as the researcher engages in the comparative method of determining similarities and differences in the data among the participants.¹⁹

During focused coding, the second coding procedure, the open codes are reconstructed into conceptual categories or themes thereby raising the abstract level of the analysis.¹⁹ Codes determined to be the most significant by comparing the interview data, are elevated and explain large amounts of data. Categories can become subcategories as they are grouped together to form a larger category.

Grounded theory analysis requires one additional coding procedure, theoretical coding, to help the researcher conceptualize how categories are related.¹⁹ This conceptualization helps the researcher move the analysis in a theoretical direction.

Presentation of the Results

Preparing the manuscript can be overwhelming; however, the Standards for Reporting Qualitative Research (SRQR) provide useful guidance.²³ Qualitative researchers are often challenged to present the results based on the word count limits imposed by journals. When preparing the manuscript write the Introduction and Methods sections very succinctly and save as many words as possible for the Results and Discussion sections.

The introduction is a concise literature review of what is known regarding the phenomenon and why it is important; this section should not be the same depth as a thesis chapter. Additionally, the purpose of the research must be clearly stated. The methods section details the IRB approval, research design, sampling methods, protocol for implementation, and the data analysis plan.

In the results section, the findings can be organized and reported as subsections representing themes or research questions. Each theme is supported by evidence in the form of direct quotations to demonstrate the trustworthiness of data analysis. In the results narrative, two quotes are usually included that best represent the theme; however, other relevant quotes can be added to a table to help the reader understand the complexity and scope of the theme. Quotes should be selected that help the reader understand the relationship between the results and the interpretation that is presented in the discussion section. Another consideration is giving voice to all participants by including quotes from all participants to enhance the trustworthiness of the results.

Editing quotes to eliminate irrelevant information is acceptable as long as the original experience or meaning expressed by participants remains unchanged.²⁴ For example, removing filler words such as um, so, you know or repeated phrases in the same quote is acceptable. A long quote can be condensed by eliminating irrelevant information and using three ellipses to signal part of the sentence was removed and four ellipses when sentences of a passage are omitted. Brackets mean words or phrases were added to quotes to make the meaning understandable to the reader.

Generally, data presented in the tables are not included in the word limit; therefore, consider adding results to tables. For instance, demographic data can be presented in totals and percentages for participant characteristics relevant to the study (e.g., age, gender, education level, years in practice). Figures are useful for visually representing the relationship between themes and subthemes or determining a sequence of a process.

Discussion of the Findings

The first topic to address in the discussion section is a clear and concise statement of the key findings in general terms. Second, the findings of the study are interpreted to explain the meaning of the participants’ experiences represented in the results. Results are not repeated in this section and no additional results should be presented. Third, the findings are situated within the existing literature. Results are compared with previous studies to determine similarities and differences to explain why the findings are important within the context of what is currently known about the phenomenon.

Two additional topics are included in the discussion; the study limitations and recommendations for future research. The limitations are weaknesses in the methodology, which potentially influenced the findings. Assessing the shortcomings in an honest fashion strengthens the manuscript before journal reviewers’ comment on these flaws. Last, discuss suggestions for addressing new or expanded ways to study the phenomenon.