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Methodology or method? A critical review of qualitative case study reports

Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services ( n= 12), social sciences and anthropology ( n= 7), or methods ( n= 15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.

Case study research is an increasingly popular approach among qualitative researchers (Thomas, 2011 ). Several prominent authors have contributed to methodological developments, which has increased the popularity of case study approaches across disciplines (Creswell, 2013b ; Denzin & Lincoln, 2011b ; Merriam, 2009 ; Ragin & Becker, 1992 ; Stake, 1995 ; Yin, 2009 ). Current qualitative case study approaches are shaped by paradigm, study design, and selection of methods, and, as a result, case studies in the published literature vary. Differences between published case studies can make it difficult for researchers to define and understand case study as a methodology.

Experienced qualitative researchers have identified case study research as a stand-alone qualitative approach (Denzin & Lincoln, 2011b ). Case study research has a level of flexibility that is not readily offered by other qualitative approaches such as grounded theory or phenomenology. Case studies are designed to suit the case and research question and published case studies demonstrate wide diversity in study design. There are two popular case study approaches in qualitative research. The first, proposed by Stake ( 1995 ) and Merriam ( 2009 ), is situated in a social constructivist paradigm, whereas the second, by Yin ( 2012 ), Flyvbjerg ( 2011 ), and Eisenhardt ( 1989 ), approaches case study from a post-positivist viewpoint. Scholarship from both schools of inquiry has contributed to the popularity of case study and development of theoretical frameworks and principles that characterize the methodology.

The diversity of case studies reported in the published literature, and on-going debates about credibility and the use of case study in qualitative research practice, suggests that differences in perspectives on case study methodology may prevent researchers from developing a mutual understanding of practice and rigour. In addition, discussion about case study limitations has led some authors to query whether case study is indeed a methodology (Luck, Jackson, & Usher, 2006 ; Meyer, 2001 ; Thomas, 2010 ; Tight, 2010 ). Methodological discussion of qualitative case study research is timely, and a review is required to analyse and understand how this methodology is applied in the qualitative research literature. The aims of this study were to review methodological descriptions of published qualitative case studies, to review how the case study methodological approach was applied, and to identify issues that need to be addressed by researchers, editors, and reviewers. An outline of the current definitions of case study and an overview of the issues proposed in the qualitative methodological literature are provided to set the scene for the review.

Definitions of qualitative case study research

Case study research is an investigation and analysis of a single or collective case, intended to capture the complexity of the object of study (Stake, 1995 ). Qualitative case study research, as described by Stake ( 1995 ), draws together “naturalistic, holistic, ethnographic, phenomenological, and biographic research methods” in a bricoleur design, or in his words, “a palette of methods” (Stake, 1995 , pp. xi–xii). Case study methodology maintains deep connections to core values and intentions and is “particularistic, descriptive and heuristic” (Merriam, 2009 , p. 46).

As a study design, case study is defined by interest in individual cases rather than the methods of inquiry used. The selection of methods is informed by researcher and case intuition and makes use of naturally occurring sources of knowledge, such as people or observations of interactions that occur in the physical space (Stake, 1998 ). Thomas ( 2011 ) suggested that “analytical eclecticism” is a defining factor (p. 512). Multiple data collection and analysis methods are adopted to further develop and understand the case, shaped by context and emergent data (Stake, 1995 ). This qualitative approach “explores a real-life, contemporary bounded system (a case ) or multiple bounded systems (cases) over time, through detailed, in-depth data collection involving multiple sources of information … and reports a case description and case themes ” (Creswell, 2013b , p. 97). Case study research has been defined by the unit of analysis, the process of study, and the outcome or end product, all essentially the case (Merriam, 2009 ).

The case is an object to be studied for an identified reason that is peculiar or particular. Classification of the case and case selection procedures informs development of the study design and clarifies the research question. Stake ( 1995 ) proposed three types of cases and study design frameworks. These include the intrinsic case, the instrumental case, and the collective instrumental case. The intrinsic case is used to understand the particulars of a single case, rather than what it represents. An instrumental case study provides insight on an issue or is used to refine theory. The case is selected to advance understanding of the object of interest. A collective refers to an instrumental case which is studied as multiple, nested cases, observed in unison, parallel, or sequential order. More than one case can be simultaneously studied; however, each case study is a concentrated, single inquiry, studied holistically in its own entirety (Stake, 1995 , 1998 ).

Researchers who use case study are urged to seek out what is common and what is particular about the case. This involves careful and in-depth consideration of the nature of the case, historical background, physical setting, and other institutional and political contextual factors (Stake, 1998 ). An interpretive or social constructivist approach to qualitative case study research supports a transactional method of inquiry, where the researcher has a personal interaction with the case. The case is developed in a relationship between the researcher and informants, and presented to engage the reader, inviting them to join in this interaction and in case discovery (Stake, 1995 ). A postpositivist approach to case study involves developing a clear case study protocol with careful consideration of validity and potential bias, which might involve an exploratory or pilot phase, and ensures that all elements of the case are measured and adequately described (Yin, 2009 , 2012 ).

Current methodological issues in qualitative case study research

The future of qualitative research will be influenced and constructed by the way research is conducted, and by what is reviewed and published in academic journals (Morse, 2011 ). If case study research is to further develop as a principal qualitative methodological approach, and make a valued contribution to the field of qualitative inquiry, issues related to methodological credibility must be considered. Researchers are required to demonstrate rigour through adequate descriptions of methodological foundations. Case studies published without sufficient detail for the reader to understand the study design, and without rationale for key methodological decisions, may lead to research being interpreted as lacking in quality or credibility (Hallberg, 2013 ; Morse, 2011 ).

There is a level of artistic license that is embraced by qualitative researchers and distinguishes practice, which nurtures creativity, innovation, and reflexivity (Denzin & Lincoln, 2011b ; Morse, 2009 ). Qualitative research is “inherently multimethod” (Denzin & Lincoln, 2011a , p. 5); however, with this creative freedom, it is important for researchers to provide adequate description for methodological justification (Meyer, 2001 ). This includes paradigm and theoretical perspectives that have influenced study design. Without adequate description, study design might not be understood by the reader, and can appear to be dishonest or inaccurate. Reviewers and readers might be confused by the inconsistent or inappropriate terms used to describe case study research approach and methods, and be distracted from important study findings (Sandelowski, 2000 ). This issue extends beyond case study research, and others have noted inconsistencies in reporting of methodology and method by qualitative researchers. Sandelowski ( 2000 , 2010 ) argued for accurate identification of qualitative description as a research approach. She recommended that the selected methodology should be harmonious with the study design, and be reflected in methods and analysis techniques. Similarly, Webb and Kevern ( 2000 ) uncovered inconsistencies in qualitative nursing research with focus group methods, recommending that methodological procedures must cite seminal authors and be applied with respect to the selected theoretical framework. Incorrect labelling using case study might stem from the flexibility in case study design and non-directional character relative to other approaches (Rosenberg & Yates, 2007 ). Methodological integrity is required in design of qualitative studies, including case study, to ensure study rigour and to enhance credibility of the field (Morse, 2011 ).

Case study has been unnecessarily devalued by comparisons with statistical methods (Eisenhardt, 1989 ; Flyvbjerg, 2006 , 2011 ; Jensen & Rodgers, 2001 ; Piekkari, Welch, & Paavilainen, 2009 ; Tight, 2010 ; Yin, 1999 ). It is reputed to be the “the weak sibling” in comparison to other, more rigorous, approaches (Yin, 2009 , p. xiii). Case study is not an inherently comparative approach to research. The objective is not statistical research, and the aim is not to produce outcomes that are generalizable to all populations (Thomas, 2011 ). Comparisons between case study and statistical research do little to advance this qualitative approach, and fail to recognize its inherent value, which can be better understood from the interpretive or social constructionist viewpoint of other authors (Merriam, 2009 ; Stake, 1995 ). Building on discussions relating to “fuzzy” (Bassey, 2001 ), or naturalistic generalizations (Stake, 1978 ), or transference of concepts and theories (Ayres, Kavanaugh, & Knafl, 2003 ; Morse et al., 2011 ) would have more relevance.

Case study research has been used as a catch-all design to justify or add weight to fundamental qualitative descriptive studies that do not fit with other traditional frameworks (Merriam, 2009 ). A case study has been a “convenient label for our research—when we ‘can't think of anything ‘better”—in an attempt to give it [qualitative methodology] some added respectability” (Tight, 2010 , p. 337). Qualitative case study research is a pliable approach (Merriam, 2009 ; Meyer, 2001 ; Stake, 1995 ), and has been likened to a “curious methodological limbo” (Gerring, 2004 , p. 341) or “paradigmatic bridge” (Luck et al., 2006 , p. 104), that is on the borderline between postpositivist and constructionist interpretations. This has resulted in inconsistency in application, which indicates that flexibility comes with limitations (Meyer, 2001 ), and the open nature of case study research might be off-putting to novice researchers (Thomas, 2011 ). The development of a well-(in)formed theoretical framework to guide a case study should improve consistency, rigour, and trust in studies published in qualitative research journals (Meyer, 2001 ).

Assessment of rigour

The purpose of this study was to analyse the methodological descriptions of case studies published in qualitative methods journals. To do this we needed to develop a suitable framework, which used existing, established criteria for appraising qualitative case study research rigour (Creswell, 2013b ; Merriam, 2009 ; Stake, 1995 ). A number of qualitative authors have developed concepts and criteria that are used to determine whether a study is rigorous (Denzin & Lincoln, 2011b ; Lincoln, 1995 ; Sandelowski & Barroso, 2002 ). The criteria proposed by Stake ( 1995 ) provide a framework for readers and reviewers to make judgements regarding case study quality, and identify key characteristics essential for good methodological rigour. Although each of the factors listed in Stake's criteria could enhance the quality of a qualitative research report, in Table I we present an adapted criteria used in this study, which integrates more recent work by Merriam ( 2009 ) and Creswell ( 2013b ). Stake's ( 1995 ) original criteria were separated into two categories. The first list of general criteria is “relevant for all qualitative research.” The second list, “high relevance to qualitative case study research,” was the criteria that we decided had higher relevance to case study research. This second list was the main criteria used to assess the methodological descriptions of the case studies reviewed. The complete table has been preserved so that the reader can determine how the original criteria were adapted.

Framework for assessing quality in qualitative case study research.

Adapted from Stake ( 1995 , p. 131).

Study design

The critical review method described by Grant and Booth ( 2009 ) was used, which is appropriate for the assessment of research quality, and is used for literature analysis to inform research and practice. This type of review goes beyond the mapping and description of scoping or rapid reviews, to include “analysis and conceptual innovation” (Grant & Booth, 2009 , p. 93). A critical review is used to develop existing, or produce new, hypotheses or models. This is different to systematic reviews that answer clinical questions. It is used to evaluate existing research and competing ideas, to provide a “launch pad” for conceptual development and “subsequent testing” (Grant & Booth, 2009 , p. 93).

Qualitative methods journals were located by a search of the 2011 ISI Journal Citation Reports in Social Science, via the database Web of Knowledge (see m.webofknowledge.com). No “qualitative research methods” category existed in the citation reports; therefore, a search of all categories was performed using the term “qualitative.” In Table II , we present the qualitative methods journals located, ranked by impact factor. The highest ranked journals were selected for searching. We acknowledge that the impact factor ranking system might not be the best measure of journal quality (Cheek, Garnham, & Quan, 2006 ); however, this was the most appropriate and accessible method available.

International Journal of Qualitative Studies on Health and Well-being.

Search strategy

In March 2013, searches of the journals, Qualitative Health Research , Qualitative Research , and Qualitative Inquiry were completed to retrieve studies with “case study” in the abstract field. The search was limited to the past 5 years (1 January 2008 to 1 March 2013). The objective was to locate published qualitative case studies suitable for assessment using the adapted criterion. Viewpoints, commentaries, and other article types were excluded from review. Title and abstracts of the 45 retrieved articles were read by the first author, who identified 34 empirical case studies for review. All authors reviewed the 34 studies to confirm selection and categorization. In Table III , we present the 34 case studies grouped by journal, and categorized by research topic, including health sciences, social sciences and anthropology, and methods research. There was a discrepancy in categorization of one article on pedagogy and a new teaching method published in Qualitative Inquiry (Jorrín-Abellán, Rubia-Avi, Anguita-Martínez, Gómez-Sánchez, & Martínez-Mones, 2008 ). Consensus was to allocate to the methods category.

Outcomes of search of qualitative methods journals.

In Table III , the number of studies located, and final numbers selected for review have been reported. Qualitative Health Research published the most empirical case studies ( n= 16). In the health category, there were 12 case studies of health conditions, health services, and health policy issues, all published in Qualitative Health Research . Seven case studies were categorized as social sciences and anthropology research, which combined case study with biography and ethnography methodologies. All three journals published case studies on methods research to illustrate a data collection or analysis technique, methodological procedure, or related issue.

The methodological descriptions of 34 case studies were critically reviewed using the adapted criteria. All articles reviewed contained a description of study methods; however, the length, amount of detail, and position of the description in the article varied. Few studies provided an accurate description and rationale for using a qualitative case study approach. In the 34 case studies reviewed, three described a theoretical framework informed by Stake ( 1995 ), two by Yin ( 2009 ), and three provided a mixed framework informed by various authors, which might have included both Yin and Stake. Few studies described their case study design, or included a rationale that explained why they excluded or added further procedures, and whether this was to enhance the study design, or to better suit the research question. In 26 of the studies no reference was provided to principal case study authors. From reviewing the description of methods, few authors provided a description or justification of case study methodology that demonstrated how their study was informed by the methodological literature that exists on this approach.

The methodological descriptions of each study were reviewed using the adapted criteria, and the following issues were identified: case study methodology or method; case of something particular and case selection; contextually bound case study; researcher and case interactions and triangulation; and, study design inconsistent with methodology. An outline of how the issues were developed from the critical review is provided, followed by a discussion of how these relate to the current methodological literature.

Case study methodology or method

A third of the case studies reviewed appeared to use a case report method, not case study methodology as described by principal authors (Creswell, 2013b ; Merriam, 2009 ; Stake, 1995 ; Yin, 2009 ). Case studies were identified as a case report because of missing methodological detail and by review of the study aims and purpose. These reports presented data for small samples of no more than three people, places or phenomenon. Four studies, or “case reports” were single cases selected retrospectively from larger studies (Bronken, Kirkevold, Martinsen, & Kvigne, 2012 ; Coltart & Henwood, 2012 ; Hooghe, Neimeyer, & Rober, 2012 ; Roscigno et al., 2012 ). Case reports were not a case of something, instead were a case demonstration or an example presented in a report. These reports presented outcomes, and reported on how the case could be generalized. Descriptions focussed on the phenomena, rather than the case itself, and did not appear to study the case in its entirety.

Case reports had minimal in-text references to case study methodology, and were informed by other qualitative traditions or secondary sources (Adamson & Holloway, 2012 ; Buzzanell & D'Enbeau, 2009 ; Nagar-Ron & Motzafi-Haller, 2011 ). This does not suggest that case study methodology cannot be multimethod, however, methodology should be consistent in design, be clearly described (Meyer, 2001 ; Stake, 1995 ), and maintain focus on the case (Creswell, 2013b ).

To demonstrate how case reports were identified, three examples are provided. The first, Yeh ( 2013 ) described their study as, “the examination of the emergence of vegetarianism in Victorian England serves as a case study to reveal the relationships between boundaries and entities” (p. 306). The findings were a historical case report, which resulted from an ethnographic study of vegetarianism. Cunsolo Willox, Harper, Edge, ‘My Word’: Storytelling and Digital Media Lab, and Rigolet Inuit Community Government (2013) used “a case study that illustrates the usage of digital storytelling within an Inuit community” (p. 130). This case study reported how digital storytelling can be used with indigenous communities as a participatory method to illuminate the benefits of this method for other studies. This “case study was conducted in the Inuit community” but did not include the Inuit community in case analysis (Cunsolo Willox et al., 2013 , p. 130). Bronken et al. ( 2012 ) provided a single case report to demonstrate issues observed in a larger clinical study of aphasia and stroke, without adequate case description or analysis.

Case study of something particular and case selection

Case selection is a precursor to case analysis, which needs to be presented as a convincing argument (Merriam, 2009 ). Descriptions of the case were often not adequate to ascertain why the case was selected, or whether it was a particular exemplar or outlier (Thomas, 2011 ). In a number of case studies in the health and social science categories, it was not explicit whether the case was of something particular, or peculiar to their discipline or field (Adamson & Holloway, 2012 ; Bronken et al., 2012 ; Colón-Emeric et al., 2010 ; Jackson, Botelho, Welch, Joseph, & Tennstedt, 2012 ; Mawn et al., 2010 ; Snyder-Young, 2011 ). There were exceptions in the methods category ( Table III ), where cases were selected by researchers to report on a new or innovative method. The cases emerged through heuristic study, and were reported to be particular, relative to the existing methods literature (Ajodhia-Andrews & Berman, 2009 ; Buckley & Waring, 2013 ; Cunsolo Willox et al., 2013 ; De Haene, Grietens, & Verschueren, 2010 ; Gratton & O'Donnell, 2011 ; Sumsion, 2013 ; Wimpenny & Savin-Baden, 2012 ).

Case selection processes were sometimes insufficient to understand why the case was selected from the global population of cases, or what study of this case would contribute to knowledge as compared with other possible cases (Adamson & Holloway, 2012 ; Bronken et al., 2012 ; Colón-Emeric et al., 2010 ; Jackson et al., 2012 ; Mawn et al., 2010 ). In two studies, local cases were selected (Barone, 2010 ; Fourie & Theron, 2012 ) because the researcher was familiar with and had access to the case. Possible limitations of a convenience sample were not acknowledged. Purposeful sampling was used to recruit participants within the case of one study, but not of the case itself (Gallagher et al., 2013 ). Random sampling was completed for case selection in two studies (Colón-Emeric et al., 2010 ; Jackson et al., 2012 ), which has limited meaning in interpretive qualitative research.

To demonstrate how researchers provided a good justification for the selection of case study approaches, four examples are provided. The first, cases of residential care homes, were selected because of reported occurrences of mistreatment, which included residents being locked in rooms at night (Rytterström, Unosson, & Arman, 2013 ). Roscigno et al. ( 2012 ) selected cases of parents who were admitted for early hospitalization in neonatal intensive care with a threatened preterm delivery before 26 weeks. Hooghe et al. ( 2012 ) used random sampling to select 20 couples that had experienced the death of a child; however, the case study was of one couple and a particular metaphor described only by them. The final example, Coltart and Henwood ( 2012 ), provided a detailed account of how they selected two cases from a sample of 46 fathers based on personal characteristics and beliefs. They described how the analysis of the two cases would contribute to their larger study on first time fathers and parenting.

Contextually bound case study

The limits or boundaries of the case are a defining factor of case study methodology (Merriam, 2009 ; Ragin & Becker, 1992 ; Stake, 1995 ; Yin, 2009 ). Adequate contextual description is required to understand the setting or context in which the case is revealed. In the health category, case studies were used to illustrate a clinical phenomenon or issue such as compliance and health behaviour (Colón-Emeric et al., 2010 ; D'Enbeau, Buzzanell, & Duckworth, 2010 ; Gallagher et al., 2013 ; Hooghe et al., 2012 ; Jackson et al., 2012 ; Roscigno et al., 2012 ). In these case studies, contextual boundaries, such as physical and institutional descriptions, were not sufficient to understand the case as a holistic system, for example, the general practitioner (GP) clinic in Gallagher et al. ( 2013 ), or the nursing home in Colón-Emeric et al. ( 2010 ). Similarly, in the social science and methods categories, attention was paid to some components of the case context, but not others, missing important information required to understand the case as a holistic system (Alexander, Moreira, & Kumar, 2012 ; Buzzanell & D'Enbeau, 2009 ; Nairn & Panelli, 2009 ; Wimpenny & Savin-Baden, 2012 ).

In two studies, vicarious experience or vignettes (Nairn & Panelli, 2009 ) and images (Jorrín-Abellán et al., 2008 ) were effective to support description of context, and might have been a useful addition for other case studies. Missing contextual boundaries suggests that the case might not be adequately defined. Additional information, such as the physical, institutional, political, and community context, would improve understanding of the case (Stake, 1998 ). In Boxes 1 and 2 , we present brief synopses of two studies that were reviewed, which demonstrated a well bounded case. In Box 1 , Ledderer ( 2011 ) used a qualitative case study design informed by Stake's tradition. In Box 2 , Gillard, Witt, and Watts ( 2011 ) were informed by Yin's tradition. By providing a brief outline of the case studies in Boxes 1 and 2 , we demonstrate how effective case boundaries can be constructed and reported, which may be of particular interest to prospective case study researchers.

Article synopsis of case study research using Stake's tradition

Ledderer ( 2011 ) used a qualitative case study research design, informed by modern ethnography. The study is bounded to 10 general practice clinics in Denmark, who had received federal funding to implement preventative care services based on a Motivational Interviewing intervention. The researcher question focussed on “why is it so difficult to create change in medical practice?” (Ledderer, 2011 , p. 27). The study context was adequately described, providing detail on the general practitioner (GP) clinics and relevant political and economic influences. Methodological decisions are described in first person narrative, providing insight on researcher perspectives and interaction with the case. Forty-four interviews were conducted, which focussed on how GPs conducted consultations, and the form, nature and content, rather than asking their opinion or experience (Ledderer, 2011 , p. 30). The duration and intensity of researcher immersion in the case enhanced depth of description and trustworthiness of study findings. Analysis was consistent with Stake's tradition, and the researcher provided examples of inquiry techniques used to challenge assumptions about emerging themes. Several other seminal qualitative works were cited. The themes and typology constructed are rich in narrative data and storytelling by clinic staff, demonstrating individual clinic experiences as well as shared meanings and understandings about changing from a biomedical to psychological approach to preventative health intervention. Conclusions make note of social and cultural meanings and lessons learned, which might not have been uncovered using a different methodology.

Article synopsis of case study research using Yin's tradition

Gillard et al. ( 2011 ) study of camps for adolescents living with HIV/AIDs provided a good example of Yin's interpretive case study approach. The context of the case is bounded by the three summer camps of which the researchers had prior professional involvement. A case study protocol was developed that used multiple methods to gather information at three data collection points coinciding with three youth camps (Teen Forum, Discover Camp, and Camp Strong). Gillard and colleagues followed Yin's ( 2009 ) principles, using a consistent data protocol that enhanced cross-case analysis. Data described the young people, the camp physical environment, camp schedule, objectives and outcomes, and the staff of three youth camps. The findings provided a detailed description of the context, with less detail of individual participants, including insight into researcher's interpretations and methodological decisions throughout the data collection and analysis process. Findings provided the reader with a sense of “being there,” and are discovered through constant comparison of the case with the research issues; the case is the unit of analysis. There is evidence of researcher immersion in the case, and Gillard reports spending significant time in the field in a naturalistic and integrated youth mentor role.

This case study is not intended to have a significant impact on broader health policy, although does have implications for health professionals working with adolescents. Study conclusions will inform future camps for young people with chronic disease, and practitioners are able to compare similarities between this case and their own practice (for knowledge translation). No limitations of this article were reported. Limitations related to publication of this case study were that it was 20 pages long and used three tables to provide sufficient description of the camp and program components, and relationships with the research issue.

Researcher and case interactions and triangulation

Researcher and case interactions and transactions are a defining feature of case study methodology (Stake, 1995 ). Narrative stories, vignettes, and thick description are used to provoke vicarious experience and a sense of being there with the researcher in their interaction with the case. Few of the case studies reviewed provided details of the researcher's relationship with the case, researcher–case interactions, and how these influenced the development of the case study (Buzzanell & D'Enbeau, 2009 ; D'Enbeau et al., 2010 ; Gallagher et al., 2013 ; Gillard et al., 2011 ; Ledderer, 2011 ; Nagar-Ron & Motzafi-Haller, 2011 ). The role and position of the researcher needed to be self-examined and understood by readers, to understand how this influenced interactions with participants, and to determine what triangulation is needed (Merriam, 2009 ; Stake, 1995 ).

Gillard et al. ( 2011 ) provided a good example of triangulation, comparing data sources in a table (p. 1513). Triangulation of sources was used to reveal as much depth as possible in the study by Nagar-Ron and Motzafi-Haller ( 2011 ), while also enhancing confirmation validity. There were several case studies that would have benefited from improved range and use of data sources, and descriptions of researcher–case interactions (Ajodhia-Andrews & Berman, 2009 ; Bronken et al., 2012 ; Fincham, Scourfield, & Langer, 2008 ; Fourie & Theron, 2012 ; Hooghe et al., 2012 ; Snyder-Young, 2011 ; Yeh, 2013 ).

Study design inconsistent with methodology

Good, rigorous case studies require a strong methodological justification (Meyer, 2001 ) and a logical and coherent argument that defines paradigm, methodological position, and selection of study methods (Denzin & Lincoln, 2011b ). Methodological justification was insufficient in several of the studies reviewed (Barone, 2010 ; Bronken et al., 2012 ; Hooghe et al., 2012 ; Mawn et al., 2010 ; Roscigno et al., 2012 ; Yeh, 2013 ). This was judged by the absence, or inadequate or inconsistent reference to case study methodology in-text.

In six studies, the methodological justification provided did not relate to case study. There were common issues identified. Secondary sources were used as primary methodological references indicating that study design might not have been theoretically sound (Colón-Emeric et al., 2010 ; Coltart & Henwood, 2012 ; Roscigno et al., 2012 ; Snyder-Young, 2011 ). Authors and sources cited in methodological descriptions were inconsistent with the actual study design and practices used (Fourie & Theron, 2012 ; Hooghe et al., 2012 ; Jorrín-Abellán et al., 2008 ; Mawn et al., 2010 ; Rytterström et al., 2013 ; Wimpenny & Savin-Baden, 2012 ). This occurred when researchers cited Stake or Yin, or both (Mawn et al., 2010 ; Rytterström et al., 2013 ), although did not follow their paradigmatic or methodological approach. In 26 studies there were no citations for a case study methodological approach.

The findings of this study have highlighted a number of issues for researchers. A considerable number of case studies reviewed were missing key elements that define qualitative case study methodology and the tradition cited. A significant number of studies did not provide a clear methodological description or justification relevant to case study. Case studies in health and social sciences did not provide sufficient information for the reader to understand case selection, and why this case was chosen above others. The context of the cases were not described in adequate detail to understand all relevant elements of the case context, which indicated that cases may have not been contextually bounded. There were inconsistencies between reported methodology, study design, and paradigmatic approach in case studies reviewed, which made it difficult to understand the study methodology and theoretical foundations. These issues have implications for methodological integrity and honesty when reporting study design, which are values of the qualitative research tradition and are ethical requirements (Wager & Kleinert, 2010a ). Poorly described methodological descriptions may lead the reader to misinterpret or discredit study findings, which limits the impact of the study, and, as a collective, hinders advancements in the broader qualitative research field.

The issues highlighted in our review build on current debates in the case study literature, and queries about the value of this methodology. Case study research can be situated within different paradigms or designed with an array of methods. In order to maintain the creativity and flexibility that is valued in this methodology, clearer descriptions of paradigm and theoretical position and methods should be provided so that study findings are not undervalued or discredited. Case study research is an interdisciplinary practice, which means that clear methodological descriptions might be more important for this approach than other methodologies that are predominantly driven by fewer disciplines (Creswell, 2013b ).

Authors frequently omit elements of methodologies and include others to strengthen study design, and we do not propose a rigid or purist ideology in this paper. On the contrary, we encourage new ideas about using case study, together with adequate reporting, which will advance the value and practice of case study. The implications of unclear methodological descriptions in the studies reviewed were that study design appeared to be inconsistent with reported methodology, and key elements required for making judgements of rigour were missing. It was not clear whether the deviations from methodological tradition were made by researchers to strengthen the study design, or because of misinterpretations. Morse ( 2011 ) recommended that innovations and deviations from practice are best made by experienced researchers, and that a novice might be unaware of the issues involved with making these changes. To perpetuate the tradition of case study research, applications in the published literature should have consistencies with traditional methodological constructions, and deviations should be described with a rationale that is inherent in study conduct and findings. Providing methodological descriptions that demonstrate a strong theoretical foundation and coherent study design will add credibility to the study, while ensuring the intrinsic meaning of case study is maintained.

The value of this review is that it contributes to discussion of whether case study is a methodology or method. We propose possible reasons why researchers might make this misinterpretation. Researchers may interchange the terms methods and methodology, and conduct research without adequate attention to epistemology and historical tradition (Carter & Little, 2007 ; Sandelowski, 2010 ). If the rich meaning that naming a qualitative methodology brings to the study is not recognized, a case study might appear to be inconsistent with the traditional approaches described by principal authors (Creswell, 2013a ; Merriam, 2009 ; Stake, 1995 ; Yin, 2009 ). If case studies are not methodologically and theoretically situated, then they might appear to be a case report.

Case reports are promoted by university and medical journals as a method of reporting on medical or scientific cases; guidelines for case reports are publicly available on websites ( http://www.hopkinsmedicine.org/institutional_review_board/guidelines_policies/guidelines/case_report.html ). The various case report guidelines provide a general criteria for case reports, which describes that this form of report does not meet the criteria of research, is used for retrospective analysis of up to three clinical cases, and is primarily illustrative and for educational purposes. Case reports can be published in academic journals, but do not require approval from a human research ethics committee. Traditionally, case reports describe a single case, to explain how and what occurred in a selected setting, for example, to illustrate a new phenomenon that has emerged from a larger study. A case report is not necessarily particular or the study of a case in its entirety, and the larger study would usually be guided by a different research methodology.

This description of a case report is similar to what was provided in some studies reviewed. This form of report lacks methodological grounding and qualities of research rigour. The case report has publication value in demonstrating an example and for dissemination of knowledge (Flanagan, 1999 ). However, case reports have different meaning and purpose to case study, which needs to be distinguished. Findings of our review suggest that the medical understanding of a case report has been confused with qualitative case study approaches.

In this review, a number of case studies did not have methodological descriptions that included key characteristics of case study listed in the adapted criteria, and several issues have been discussed. There have been calls for improvements in publication quality of qualitative research (Morse, 2011 ), and for improvements in peer review of submitted manuscripts (Carter & Little, 2007 ; Jasper, Vaismoradi, Bondas, & Turunen, 2013 ). The challenging nature of editor and reviewers responsibilities are acknowledged in the literature (Hames, 2013 ; Wager & Kleinert, 2010b ); however, review of case study methodology should be prioritized because of disputes on methodological value.

Authors using case study approaches are recommended to describe their theoretical framework and methods clearly, and to seek and follow specialist methodological advice when needed (Wager & Kleinert, 2010a ). Adequate page space for case study description would contribute to better publications (Gillard et al., 2011 ). Capitalizing on the ability to publish complementary resources should be considered.

Limitations of the review

There is a level of subjectivity involved in this type of review and this should be considered when interpreting study findings. Qualitative methods journals were selected because the aims and scope of these journals are to publish studies that contribute to methodological discussion and development of qualitative research. Generalist health and social science journals were excluded that might have contained good quality case studies. Journals in business or education were also excluded, although a review of case studies in international business journals has been published elsewhere (Piekkari et al., 2009 ).

The criteria used to assess the quality of the case studies were a set of qualitative indicators. A numerical or ranking system might have resulted in different results. Stake's ( 1995 ) criteria have been referenced elsewhere, and was deemed the best available (Creswell, 2013b ; Crowe et al., 2011 ). Not all qualitative studies are reported in a consistent way and some authors choose to report findings in a narrative form in comparison to a typical biomedical report style (Sandelowski & Barroso, 2002 ), if misinterpretations were made this may have affected the review.

Case study research is an increasingly popular approach among qualitative researchers, which provides methodological flexibility through the incorporation of different paradigmatic positions, study designs, and methods. However, whereas flexibility can be an advantage, a myriad of different interpretations has resulted in critics questioning the use of case study as a methodology. Using an adaptation of established criteria, we aimed to identify and assess the methodological descriptions of case studies in high impact, qualitative methods journals. Few articles were identified that applied qualitative case study approaches as described by experts in case study design. There were inconsistencies in methodology and study design, which indicated that researchers were confused whether case study was a methodology or a method. Commonly, there appeared to be confusion between case studies and case reports. Without clear understanding and application of the principles and key elements of case study methodology, there is a risk that the flexibility of the approach will result in haphazard reporting, and will limit its global application as a valuable, theoretically supported methodology that can be rigorously applied across disciplines and fields.

Conflict of interest and funding

The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

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5 Types of Qualitative Methods

But just as with quantitative methods, there are actually many varieties of qualitative methods.

Similar to the way you can group usability testing methods , there are also a number of ways to segment qualitative methods.

A popular and helpful categorization separate qualitative methods into five groups: ethnography, narrative, phenomenological, grounded theory, and case study. John Creswell outlines these five methods in Qualitative Inquiry and Research Design .

While the five methods generally use similar data collection techniques (observation, interviews, and reviewing text), the purpose of the study differentiates them—something similar with different types of usability tests . And like classifying different usability studies, the differences between the methods can be a bit blurry. Here are the five qualitative methods in more detail.

1. Ethnography

Ethnographic research is probably the most familiar and applicable type of qualitative method to UX professionals. In ethnography, you immerse yourself in the target participants’ environment to understand the goals, cultures, challenges, motivations, and themes that emerge. Ethnography has its roots in cultural anthropology where researchers immerse themselves within a culture, often for years! Rather than relying on interviews or surveys, you experience the environment first hand, and sometimes as a “participant observer.”

For example, one way of uncovering the unmet needs of customers is to “ follow them home ” and observe them as they interact with the product. You don’t come armed with any hypotheses to necessarily test; rather, you’re looking to find out how a product is used.

2. Narrative

The narrative approach weaves together a sequence of events, usually from just one or two individuals to form a cohesive story. You conduct in-depth interviews, read documents, and look for themes; in other words, how does an individual story illustrate the larger life influences that created it. Often interviews are conducted over weeks, months, or even years, but the final narrative doesn’t need to be in chronological order. Rather it can be presented as a story (or narrative) with themes, and can reconcile conflicting stories and highlight tensions and challenges which can be opportunities for innovation.

For example, a narrative approach can be an appropriate method for building a persona . While a persona should be built using a mix of methods—including segmentation analysis from surveys—in-depth interviews with individuals in an identified persona can provide the details that help describe the culture, whether it’s a person living with Multiple Sclerosis, a prospective student applying for college, or a working mom.

3. Phenomenological

When you want to describe an event, activity, or phenomenon, the aptly named phenomenological study is an appropriate qualitative method. In a phenomenological study, you use a combination of methods, such as conducting interviews, reading documents, watching videos, or visiting places and events, to understand the meaning participants place on whatever’s being examined. You rely on the participants’ own perspectives to provide insight into their motivations.

Like other qualitative methods, you don’t start with a well-formed hypothesis. In a phenomenological study, you often conduct a lot of interviews, usually between 5 and 25 for common themes , to build a sufficient dataset to look for emerging themes and to use other participants to validate your findings.

For example, there’s been an explosion in the last 5 years in online courses and training. But how do students engage with these courses? While you can examine time spent and content accessed using log data and even assess student achievement vis-a-vis in-person courses, a phenomenological study would aim to better understand the students experience and how that may impact comprehension of the material.

4. Grounded Theory

Whereas a phenomenological study looks to describe the essence of an activity or event, grounded theory looks to provide an explanation or theory behind the events. You use primarily interviews and existing documents to build a theory based on the data. You go through a series of open and axial coding techniques to identify themes and build the theory. Sample sizes are often also larger—between 20 to 60—with these studies to better establish a theory. Grounded theory can help inform design decisions by better understanding how a community of users currently use a product or perform tasks.

For example, a grounded theory study could involve understanding how software developers use portals to communicate and write code or how small retail merchants approve or decline customers for credit.

5. Case Study

Made famous by the Harvard Business School, even mainly quantitative researchers can relate to the value of the case study in explaining an organization, entity, company, or event. A case study involves a deep understanding through multiple types of data sources. Case studies can be explanatory, exploratory, or describing an event. The annual CHI conference has a peer-reviewed track dedicated to case studies.

For example, a case study of how a large multi-national company introduced UX methods into an agile development environment would be informative to many organizations.

The table below summarizes the differences between the five qualitative methods.

You might also be interested in

Inquiry & Research: The 5 Inquiry Pathways: Case Study

• Getting Started
• Positionality & Reflexivity
• Ontology and Epistemology
• Research And Politics
• Appraising Empirical Research - Decision Tree
• Quantitative Validity and Reliability
• Qualitative Trustworthiness
• Qualitative Research Design
• Arts-Based Inquiry
• Autoethnography
• Content Analysis
• Critical Incident
• Ethnography
• Grounded Theory
• Situational Analysis
• Phenomenological Inquiry
• Narrative Inquiry
• Interviewing and Coding
• Thematic Analysis
• Quantitative Research Designs
• Scales and Measures
• Statistics, Modules, and SPSS
• Survey Research
• Critical Quantitative
• Multiple Methods Research Design
• Action Research
• Appreciative Inquiry
• Mixed Methods Research
• Critical Methods

Antioch Program Resource Tabs -- Resources available through the University or Primary GSLC Materials

• Dissertations- Single Cases
• Dissertations- Multiple Cases

Definitions

Selected Bibliographic Resources

• Book Chapters

Video Bank Tabs -- Externally developed videos

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Stake Case Studies in Qualitative Inquiry

Stake, R. (2003). Case studies. In N. K. Denzin & Y. S. Lincoln (Eds.), Strategies of qualitative inquiry (2nd Ed.) (pp. 134 - 164). Thousand Oaks, CA: Sage.

Identification of the Case

• Cases cannot be too broad. They are specific and bounded. Cases have patterns.
• The focus is understanding the complexity of the case.
• "...each case study is a concentrated inquiry into a single case (p. 136)."

Intrinsic and Instrumental Interest in Cases

• Intrinsic case study: A case study is intrinsic "...if it is undertaken because, first and last, the researcher wants better understanding of this particular case (p. 136)." The motivation is personal.
• Instrumental case study: A case study is instrumental "...if a particular case is examined mainly to provide insight into an issue or to redraw a generalization (p. 137)." An instrumental case study takes a supportive role to deepen our understanding of a larger issue. 
• Collective case study is the study of multiple cases to understand a phenomenon.

Study of the Particular

• The nature of case study does not lend itself to generalizability unless it is a collective case study.
• Since the goal of case study is to seek particularity: "The search for particularity competes with the search for generalizability (p. 140)."
• "Their designs aim the inquiry toward understanding of what is important about that case within its own world, which is seldom the same as the worlds of researchers and theorists (p. 140)."
• Case studies, as a form of qualitative research are contextually based, which cannot and should not be avoided.
• The conceptual structure of case study is thematic and the research questions should reflect this structure.
• The researcher decides what and how the (case) story is told: "More will be pursued than was volunteered. Less will be reported than was learned (p. 144)."
• A case must be understood, and it is this necessity to understand that determines the amount included in the telling.
• External political forces, such as funding agencies, audience, and promotion, influenced the amount included in the telling.

Learning From the Particular Case

• Two ways to tell or teach a case: "Teaching didactically, the researcher teaches what he or she has learned. Arranging for what educationists call discovery learning, the researcher provides material for readers to learn, on their own, things the teacher does not know as well as those he or she does know (p. 145)."
• Naturalistic generalization: "Enduring meanings come from encounter, and are modified and reinforced by repeated encounter (p. 145)."
• During reading, the reader unconsciously connects the case to previous cases in order to compare and generalize. "People find in case reports certain insights into the human condition, even while being well aware of the atypicality of the case. They may be too quick to accept the insight. The case researcher needs to provide grounds for validating both the observation and generalization (p. 147)."
• Triangulation
• Comparison can detract from the case's particularity.
• "Readers with intrinsic interest in the case learn more of it directly from the description, not ignoring comparisons with other cases but not concentrating on comparisons (p. 147)."
• ""The conceptions of most naturalistic, holistic, ethnographic, phenomenological case studies need accurate description and subjective, yet disciplined, interpretation; a respect and curiosity for culturally different perceptions of phenomena; and empathic representation of local settings - all blending (perhaps clumped) within a constructivist epistemology (p. 149)."

Arrangements for the Study

• Case study work is reflective
• "When the case is too large for one researcher to know well or for a collective case study, teaming is an important option. The method requires integrated, holistic comprehension of the case, but in the larger studies, no one individual can handle the complexity (p. 151)."

Case Selection

• The selected case should contain a balance between typicality and opportunity to learn.
• Atypicality trumps typicality because the opportunity to learn is greater than the tie to representativeness.
• To select a case, identify attributes of interest first. 
• Selection should ensure variety without compromising.
• "Qualitative researchers are guests in the private spaces of the world. Their manners should be good and their code of ethics strict (p. 154)."
• 1. Bounding the case, conceptualizing the object of study;
• 2. Selecting phenomena, themes, or issues - that is, the research questions - to emphasize;
• 3. Seeking patterns of data to develop the issues;
• 4. Triangulating key observations and bases for interpretation; 
• 5. Selecting alternative interpretations to pursue;
• 6. Developing assertions or generalizations about the case (p. 155)."
• "Case studies are of value for refining theory and suggesting complexities for further investigation, as well as helping to establish the limits of generalizability (p. 156)."

Qualitative Research in Corporate Communication

A blogs@baruch site, chapter 4: five qualitative approaches to inquiry.

In this chapter Creswell guides novice researchers (us) as we work through the early stages of selecting a qualitative research approach. The text outlines the origins, uses, features, procedures and potential challenges of each approach and provides a great overview. Why identify our approach to qualitative inquiry now? To offer a way of organizing our ideas and to ground them in the scholarly literature (69). The author includes a chart on page 104 that provides a convenient comparison of major features.

The 5 approaches are NARRATIVE RESEARCH, PHENOMENOLOGY, GROUNDED RESEARCH, ETHNOGRAPHY, and CASE STUDY.

NARRATIVE RESEARCH

In contrast to the other approaches, narrative can be a research method or an area of study in and of itself. Creswell focuses on the former, and defines it as a study of experiences “as expressed in lived and told stories of individuals” (70). This approach emerged out of a literary, storytelling tradition and has been used in many social science disciplines.

Narrative researchers collect stories, documents, and group conversations about the lived and told experiences of one or two individuals. They record the stories using interview, observation, documents and images and then report the experiences and chronologically order the meaning of those experiences. Other defining features are available on p. 72.

These are the primary types of narrative:

• Biographical study, writing and recording the experiences of another person’s life.
• Autoethnography, in which the writing and recording is done by the subject of the study (e.g., in a journal).
• Life history, portraying one person’s entire life.
• Oral history, reflections of events, their causes and effects.

For all of the research approaches, Creswell first recommends determining if the particular approach is an appropriate tool for your research question. In this case, narrative research methodology doesn’t follow a rigid process but is described as informal gathering of data.

The author provides recommendations for methodologies on pps 74-76 and introduces two interesting concepts unique to narrative research: 1) Restorying is the process of gathering stories, analyzing them for key elements, then rewriting (restorying) to position them within a chronological sequence. 2) Creswell describes a collaboration that occurs between participants and researchers during the collection of stories in which both gain valuable life insight as a result of the process.

Narrative research involves collecting extensive information from participants; this is its primary challenge. But ethical issues surrounding the stories may present weightier difficulties, such as questions of the story’s ownership, how to handle varied impressions of its veracity, and managing conflicting information. For further reading on the activities of narrative researchers Creswell recommends Clandinin and Connelly’s Narrative Inquiry (2000).

PHENOMENOLOGY

Phenomenology is a way to study an idea or concept that holds a common meaning for a small group (3-15) of individuals. The approach centers around lived experiences of a particular phenomenon, such as grief, and guides researchers to distill individual experiences to an essential concept. Phenomenological research generally hones in on a single concept or idea in a narrow setting such as “professional growth” or “caring relationship.”

The evolution of phenomenology from its philosophical roots with Heidegger’s and Sartre’s writing often emerges in current researchers’ exploration of the ideas (77). In contrast to the other four approaches, phenomenology’s tradition is important for establishing themes in the data. In addition to its relationship to philosophy, another key phenomenology feature is bracketing, a process by which the researcher identifies and sets aside any personal experience with the phenomena under study (78).

Phenomenology has two main subsets. Hermeneutic, by which a researcher first follows his/her own abiding concern or interest in a phenomenon; then reflects upon the essential themes that constitute the nature of this lived experience; describex the phenomenon; crafts an interpretation and finally mediates the different resultant meanings. The second type, transcendental, is more empirical and focused on a data analysis method outlined on page 80.

Cresswell favors a systematic methodology outlined by Moustakas (1994) in which participants are asked two broad, general questions: 1) What have you experienced in terms of the phenomenon? 2) What context of situations have typically influenced your experiences of the phenomenon? For some researchers, the author believes phenomenology may be too structured. He also mentions the additional challenge of identifying a sample of participants who share the same phenomenon experience.

Creswell recommends two sources for further reading on phenomenology: Moustakas’s Phenomenological Research Methods (1994) and van Manen’s Researching Lived Experience: Human Science for an Action Sensitive Pedagogy (1990).

GROUNDED THEORY RESEARCH

Grounded theory seeks to generate or discover a theory-a general explanation– for a social process, action or interaction shaped by the views of participants (p. 83). One key factor in grounded theory is that it does not come “off the shelf” but is “grounded” from data collected from a large sample. Creswell recommends an approach to this qualitative research prescribed by Corbin & Strauss (2007).

The author describes several defining features of grounded theory research (85). The first is that it focuses on a process or actions that has “movement” over time. Two examples of processes provided include the development of a general education program or “supporting faculty become good researchers.” An important aspect of data collection in this research is “memoing.” In which the researcher “writes down ideas as data are collected and analyzed,” usually from interviews.

Data collection is best be described as a “zigzag” process of going out to the field to gather information and then back to the office to analyze it and back out to the field. The author discusses various ways of coding the information into major categories of information (p. 86).

Another approach to grounded theory is that of Charmaz (2006). Creswell notes that Charmaz “places more emphasis on the views, values, belief, feelings, assumptions and ideologies of individuals than on the methods of research.” (p. 87)

The author states that this is a good design to use when there isn’t a theory available to “explain or understand a process.” (p. 88). Creswell further notes that the research question will focus on “understanding how individuals experience the process and identify steps in the process” that can often involve 20 to 60 interviews.

Some challenges in using this design is that the researcher must set aside “theoretical ideas or notions so that the analytic, substantive theory can emerge.” (p. 89) It is also important that the researcher understand that the primary outcome of this research is a “theory with specific components: a central phenomenon, causal conditions, strategies, conditions and context, and consequences,” according to Corbin & Strauss’ (p. 90). However, if a researcher wants a less structured approach the Charmaz (2006) method is recommended.

ETHNOGRAPHIC RESEARCH

Ethnography is a qualitative research design in which the unit of analysis is typically greater than 20 participants and focuses on an “entire culture-sharing group.” (Harris, 1968). In this approach, the “research describes and interprets the shared and learned patterns of values, behaviors, beliefs, and language” of the group. The method involves extended observations through “participant observation, in which the researcher is immersed in the day-to-day lives of the people and observes and interviews the group participants.” (p. 90).

Creswell notes that there is a lack of orthodoxy in ethnographic research with many pluralistic approaches. He lists a number of other researchers (p.91) but states that he draws on Fetterman’s (2009) and Wolcott’s (2008a) approaches in this text.

Some defining features of ethnographic research are listed on pages 91 and 92. They include that: it “focuses on developing a complex, complete description of the culture of a group, a culture-sharing group;” that ethnography however “is not the study of a culture, but a study of the social behaviors of an identifiable group of people;” that the group “has been intact and interacting for long enough to develop discernable working patterns,” and that ethnographers start with a theory drawn from “cognitive science to understand belief and ideas” or materialist theories (Marxism, acculturation, innovation, etc.)

Some types of ethnographies include “confessional ethnography, life history, autoethnography, feminist ethnography, visual ethnography,”etc., however, Creswell emphasizes two popular forms. The first is the realist ethnography-used by cultural anthropologists, it is “an objective account of a situation, typically written in the third-person point of view and reporting objectively on the information learned from participants.” (p. 93). The second is the critical ethnography in which the author advocates for groups marginalized in society (Thomas, 1993). This type of research is typically conducted by “politically minded individuals who seek through their research, to speak out against inequality and domination” (Carspecken & Apple, 1992). (p. 94).

The procedures for conducting an ethnography are listed on p. 94-96. One key element in these procedures is the gathering of information where the group works or lives through fieldwork (Wolcott, 2008a); and respecting the daily lives of these individuals at the site of study. Some key challenges in this type of research are that one must have an “understanding of cultural anthropology, the meaning of a social-cultural system, and the concepts typically explored by those studying cultures. Also, data collection requires a lot of time on the field. (p. 96)

CASE STUDY RESEARCH

In case study research, defined as the “the study of a case within a real-life contemporary context or setting” Creswell takes the perspective that such research “is a methodology: a type of design in qualitative research that may be an object of study, as well as a product of inquiry.” Further, case studies have bounded systems, are detailed and use multiple sources of information (p. 97). Creswell references the work of Stake (1995) and Yin (2009) because of their systematic handling of the subject.

The author draws attention to several features of the case study approach, but emphasizes a critical element “is to define a case that can be bounded or described within certain parameters, such as a specific place and time.” Other components of the research method include its intent-which may take the form of intrinsic case study or instrumental case study (p. 98); its reliance on in-depth understanding; and its utilization of case descriptions, themes or specific situations. Finally, researchers typically conclude case studies with “assertions” from their learning (p. 99).

The text touches on several types of case studies that can be differentiated by size, activity or intent and that can involve single or multiple cases (p.99). In instances of collective case study design where the researcher may use multiple case studies to examine one issue, the text recommends Yin (2009) logic of replication be used. Creswell goes on to point out that if the researcher wishes to generalize from findings, care needs to be taken to select representative cases. This could be useful, time-saving information for class members considering this method.

In outlining procedures for conducting a case study (p.100), Creswell recommends “that investigators first consider what type of case study is most promising and useful” and advocates cases that show different perspectives on a problem, process or event.” Data analysis can be holistic (considering the entire case) or embedded (using specific aspects of the case).

Some of the challenges of case study research are determining the scope of the research and deciding on the bounded system and determining whether to study the case itself or how the case illustrates an issue. In the instance of multiple cases, the author makes the somewhat counter intuitive assertion that “the study of more than one case dilutes the overall analysis” (p. 101).

THE FIVE APPROACHES COMPARED

Creswell gives an overview of the commonality of the five research methods (p. 102) before explaining key differences among more similar seeming types of research, e.g. narrative research, ethnography. Here the author underlines that “the types of data one would collect and analyze would differ considerably.” He uses the example of the study of a single individual to make his argument, recommending narrative research instead of ethnography, which has a broader scope and case study, which may involve multiple cases.

In considering differences, Creswell puts forth that the research methods accomplish divergent goals, have different origins and employ distinct methods of analyzing data – the author underlines the data analysis stage as being the most exaggerated point of difference (p. 103). The final product, “the result of each approach, the written report, takes shape from all the processes before it.

In Table 4.1 (p. 104) Creswell provides a framework table that contrasts the characteristics of the five qualitative approaches. Given its stated suitability for both “journal-article length study” and dissertation or book-length work, class members may find it a handy reference for the mini study assignment and beyond.

Tricia Chambers, Eric Lugo, Kathryn Lineberger

8 thoughts on “ CHAPTER 4: Five Qualitative Approaches to Inquiry ”

I plan to use Narrative Research in my paper. It would be nice if I can know some recording skills of group conversation. I agree, Hui! There were none detailed in this chapter though. ~KL Haha, guess I can get some from google then.

For the mini-study, I’m hoping to use narrative research. Initially, I was planning on it as well as content analysis for my thesis in the fall, but after reading this chapter, I have some more work to do! Phenomenology or grounded theory might be better suited for what I want to accomplish. Needless to say, this chapter review got me thinking!

It seems to me that my area of interest might be carried out best with an ethnographic study. Since I want to look at communicators in the performing arts industry, I think that fits the description of a culture sharing group. The method also seems to fit what I would hope to do for my study, observe participants in their workplace and conduct interviews.

However, I would like to look more into the idea of overlapping approaches because I think it would also be interesting to look at specific PR campaigns or marketing campaigns carried out by my participants and this would likely fall under the case-study approach.

This chapter is definitely most useful for the initial phase of the research paper. For my research, I want to look into understanding consumer behavior and specific aspects of a company’s behavior/marketing tactics (maybe CSR) that affects its brand perception (using Dole Food Company). In taking this direction for my study, I think I’m stuck somewhere between phenomenology or ethnographic research.

I think my research might align more with phenomenography, because I don’t know if I’ll exactly be looking into any specific subcultures as ethnographic research does.

This chapter definitely got me thinking about what I’d like to accomplish with my mini-study and later on my thesis. What I’ve been exposed to the most in the corporate communications program are case studies because they’re part of learning. Logically it seems that Phenomenology or Ethnographic research is where my research idea will lead me, but I’m still in the phase of getting a refined research question of out my bigger ideas. At least now I know the routes I can go.

I would like to know if the five categories of the attributes related to illness representation were defined through the research, or beforehand? You mention the researchers were able to use these attributes to formulate their hypothesis and I was wondering if it was defined by them then how would this effect results because I think I want to define some factors myself, but I don’t want to introduce any bias? Should I even worry about this?

Hi Sheena, you might ask the Chapter 5 team about this. ~KL

That was a great break down of the different types of studies presented in the book. This was very helpful to me as I was unsure of what type of study I was going to do, but after reading this summary I have a much better idea. I want to study putting loved ones in a nursing home versus seeking out home-based alternatives, and I think a phenomenological study is where I am leaning towards.

I feel strongly pulled to the phenomenological framework, even though it’s definition is causing me the most confusion! I Anti-corporate sentiment is a human experience, and I think it would be interesting to find a small group of anarchists or anti-capitalists or just young people who participated in the Occupy movement and understand their concept of this phenomena.

I will need to determine whether a phenomenological study allows for methods interpretation outside interviews or focus groups. I feel that much of what I am studying is a phenomenon perpetuated by the media, and I would like to incorporate content analysis and document research into my analysis.

Comments are closed.

Qualitative Data Analysis Methods

In the following, we will discuss basic approaches to analyzing data in all six of the acceptable qualitative designs.

After reviewing the information in this document, you will be able to:

• Recognize the terms for data analysis methods used in the various acceptable designs.
• Recognize the data preparation tasks that precede actual analysis in all the designs.
• Understand the basic analytic methods used by the respective qualitative designs.
• Identify and apply the methods required by your selected design.

Terms Used in Data Analysis by the Six Designs

Each qualitative research approach or design has its own terms for methods of data analysis:

• Ethnography—uses modified thematic analysis and life histories.
• Case study—uses description, categorical aggregation, or direct interpretation.
• Grounded theory—uses open, axial, and selective coding (although recent writers are proposing variations on those basic analysis methods).
• Phenomenology—describes textures and structures of the essential meaning of the lived experience of the phenomenon
• Heuristics—patterns, themes, and creative synthesis along with individual portraits.
• Generic qualitative inquiry—thematic analysis, which is really a foundation for all the other analytic methods. Thematic analysis is the starting point for the other five, and the endpoint for generic qualitative inquiry. Because it is the basic or foundational method, we'll take it first.

Preliminary Tasks in Analysis in all Methods

In all the approaches—case study, grounded theory, generic inquiry, and phenomenology—there are preliminary tasks that must be performed prior to the analysis itself. For each, you will need to:

• Arrange for secure storage of original materials. Storage should be secure and guaranteed to protect the privacy and confidentiality of the participants' information and identities.
• Transcribe interviews or otherwise transform raw data into usable formats.
• Make master copies and working copies of all materials. Master copies should be kept securely with the original data. Working copies will be marked up, torn apart, and used heavily: make plenty.
• Arrange secure passwords or other protection for all electronic data and copies.
• When ready to begin, read all the transcripts repeatedly—at least three times—for a sense of the whole. Don't force it—allow the participants' words to speak to you.

These tasks are done in all forms of qualitative analysis. Now let's look specifically at generic qualitative inquiry.

Data Analysis in Generic Qualitative Inquiry: Thematic Analysis

The primary tool for conducting the analysis of data when using the generic qualitative inquiry approach is thematic analysis, a flexible analytic method for deriving the central themes from verbal data. A thematic analysis can also be used to conduct analysis of the qualitative data in some types of case study.

Thematic analysis essentially creates theme-statements for ideas or categories of ideas (codes) that the researcher extracts from the words of the participants.

There are two main types of thematic analysis:

• Inductive thematic analysis, in which the data are interpreted inductively, that is, without bringing in any preselected theoretical categories.
• Theoretical thematic analysis, in which the participants' words are interpreted according to categories or constructs from the existing literature.

Analytic Steps in Thematic Analysis: Reading

Remember that the last preliminary task listed above was to read the transcripts for a sense of the whole. In this discussion, we'll assume you're working with transcribed data, usually from interviews. You can apply each step, with changes, to any kind of qualitative data. Now, before you start analyzing, take the first transcript and read it once more, as often as necessary, for a sense of what this participant told you about the topic of your study. If you're using other sources of data, spend time with them holistically.

Thematic Analysis: Steps in the Process

When you have a feel for the data,

• Underline any passages (phases, sentences, or paragraphs) that appear meaningful to you. Don't make any interpretations yet! Review the underlined data.
• Decide if the underlined data are relevant to the research question and cross out or delete all data unrelated to the research question. Some information in the transcript may be interesting but unrelated to the research question.
• Create a name or "code" for each remaining underlined passage (expressions or meaning units) that focus on one single idea. The code should be:
• Briefer than the passage, should
• Sum up its meaning, and should be
• Supported by the meaning unit (the participant's words).
• Find codes that recur; cluster these together. Now begin the interpretation, but only with the understanding that the codes or patterns may shift and change during the process of analysis.
• After you have developed the clusters or patterns of codes, name each pattern. The pattern name is a theme. Use language supported by the original data in the language of your discipline and field.
• Write a brief description of each theme. Use brief direct quotations from the transcript to show the reader how the patterns emerged from the data.
• Compose a paragraph integrating all the themes you developed from the individual's data.
• Repeat this process for each participant, the "within-participant" analysis.
• Finally, integrate all themes from all participants in "across-participants" analysis, showing what general themes are found across all the data.

Some variation of thematic analysis will appear in most of the other forms of qualitative data analysis, but the other methods tend to be more complex. Let's look at them one at a time. If you are already clear as to which approach or design your study will use, you can skip to the appropriate section below.

Ethnographic Data Analysis

Ethnographic data analysis relies on a modified thematic analysis. It is called modified because it combines standard thematic analysis as previously described for interview data with modified thematic methods applied to artifacts, observational notes, and other non-interview data.

Depending on the kinds of data to be interpreted (for instance pictures and historical documents) Ethnographers devise unique ways to find patterns or themes in the data. Finally, the themes must be integrated across all sources and kinds of data to arrive at a composite thematic picture of the culture.

(Adapted from Bogdan and Taylor, 1975; Taylor and Bogdan, 1998; Aronson, 1994.)

Data Analysis in Grounded Theory

Going beyond the descriptive and interpretive goals of many other qualitative models, grounded theory's goal is building a theory. It seeks explanation, not simply description.

It uses a constant comparison method of data analysis that begins as soon as the researcher starts collecting data. Each data collection event (for example, an interview) is analyzed immediately, and later data collection events can be modified to seek more information on emerging themes.

In other words, analysis goes on during each step of the data collection, not merely after data collection.

The heart of the grounded theory analysis is coding, which is analogous to but more rigorous than coding in thematic analysis.

Coding in Grounded Theory Method

There are three different types of coding used in a sequential manner.

• The first type of coding is open coding, which is like basic coding in thematic analysis. During open coding, the researcher performs:
• A line-by-line analysis (or sentence or paragraph analysis) of the data.
• Labels and categorizes the dimensions or aspects of the phenomenon being studied.
• The researcher also uses memos to describe the categories that are found.
• The second type of coding is axial coding, which involves finding links between categories and subcategories found in the open coding.
• The open codes are examined for their relationships: cause and effect, co-occurrence, and so on.
• The goal here is to picture how the various dimensions or categories of data interact with one another in time and space.
• The third type of coding is selective coding, which identifies a core category and relates the categories subsidiary to this core.
• Selective coding selects the main phenomenon, (core category) around which subsidiary phenomena, (all other categories) are grouped, arranging the groupings, studying the results, and rearranging where the data require it.

The Final Stages of Grounded Theory Analysis, after Coding

From selective coding, the grounded theory researcher develops:

• A model of the process, which is the description of which actions and interactions occur in a sequence or series.
• A transactional system, which is the description of how the interactions of different events explain the phenomenon being investigated.
• Finally, A conditional matrix is diagrammed to help consider the conditions and consequences related to the phenomenon under study.

These three essentially tell the story of the outcome of the research, in other words, the description of the process by which the phenomenon seems to happen, the transactional system supporting it, and the conditional matrix that pictures the explanation of the phenomenon are the findings of a grounded theory study.

(Adapted from Corbin and Strauss, 2008; Strauss and Corbin, 1990, 1998.)

Data Analysis in Qualitative Case Study: Background

There are a few points to consider in analyzing case study data:

• Analysis can be:
• Holistic—the entire case.
• Embedded—a specific aspect of the case.
• Multiple sources and kinds of data must be collected and analyzed.
• Data must be collected, analyzed, and described about both:
• The contexts of the case (its social, political, economic contexts, its affiliations with other organizations or cases, and so on).
• The setting of the case (geography, location, physical grounds, or set-up, business organization, etc.).

Qualitative Case Study Data Analysis Methods

Data analysis is detailed in description and consists of an analysis of themes. Especially for interview or documentary analysis, thematic analysis can be used (see the section on generic qualitative inquiry). A typical format for data analysis in a case study consists of the following phases:

• Description: This entails developing a detailed description of each instance of the case and its setting. The words "instance" and "case" can be confusing. Let's say we're conducting a case study of gay and lesbian members of large urban evangelical Christian congregations in the Southeast. The case would be all such people and their congregations. Instances of the case would be any individual person or congregation. In this phase, all the congregations (the settings) and their larger contexts would be described in detail, along with the individuals who are interviewed or observed.
• Categorical Aggregation: This involves seeking a collection of themes from the data, hoping that relevant meaning about lessons to be learned about the case will emerge. Using our example, a kind of thematic analysis from all the data would be performed, looking for common themes.
• Direct Interpretation: By looking at the single instance or member of the case and drawing meaning from it without looking for multiple instances, direct interpretation pulls the data apart and puts it together in more meaningful ways. Here, the interviews with all the gay and lesbian congregation members would be subjected to thematic analysis or some other form of analysis for themes.
• Within-Case Analysis: This would identify the themes that emerge from the data collected from each instance of the case, including connections between or among the themes. These themes would be further developed using verbatim passages and direct quotation to elucidate each theme. This would serve as the summary of the thematic analysis for each individual participant.
• Cross-Case Analysis: This phase develops a thematic analysis across cases as well as assertions and interpretations of the meaning of the themes emerging from all participants in the study.
• Interpretive Phase: In the final phase, this is the creation of naturalistic generalizations from the data as a whole and reporting on the lesson learned from the case study.

(Adapted from Creswell, 1998; Stake, 1995.)

Data Analysis in Phenomenological Research

There are a few existing models of phenomenological research, and they each propose slightly different methods of data analysis. They all arrive at the same goal, however. The goal of phenomenological analysis is to describe the essence or core structures and textures of some conscious psychological experience. One such model, empirical, was developed at Duquesne University. This method of analysis consists of five essential steps and represents the other variations well. Whichever model is chosen, those wishing to conduct phenomenological research must choose a model and abide by its procedures. Empirical phenomenology is presented as an example.

• Sense of the whole. One reads the entire description in order to get a general sense of the whole statement. This often takes a few readings, which should be approached contemplatively.
• Discrimination of meaning units. Once the sense of the whole has been grasped, the researcher returns to the beginning and reads through the text once more, delineating each transition in meaning.
• The researcher adopts a psychological perspective to do this. This means that the researcher looks for shifts in psychological meaning.
• The researcher focuses on the phenomenon being investigated. This means that the researcher keeps in mind the study's topic and looks for meaningful passages related to it.
• The researcher next eliminates redundancies and unrelated meaning units.
• Transformation of subjects' everyday expressions (meaning units) into psychological language. Once meaning units have been delineated,
• The researcher reflects on each of the meaning units, which are still expressed in the concrete language of the participants, and describes the essence of the statement for the participant.
• The researcher makes these descriptions in the language of psychological science.
• Synthesis of transformed meaning units into a consistent statement of the structure of the experience.
• Using imaginative variation on these transformed meaning units, the researcher discovers what remains unchanged when variations are imaginatively applied, and
• From this develops a consistent statement regarding the structure of the participant's experience.
• The researcher completes this process for each transcript in the study.
• Final synthesis. Finally, the researcher synthesizes all of the statements regarding each participant's experience into one consistent statement that describes and captures [of] the essence of the experience being studied.

(Adapted from Giorgi, 1985, 1997; Giorgi and Giorgi, 2003.)

Data Analysis in Heuristics

Six steps typically characterize the heuristic process of data analysis, consisting of:

• Initial engagement.
• Incubation.
• Illumination.
• Explication.

To start, place all the material drawn from one participant before you (recordings, transcriptions, journals, notes, poems, artwork, and so on). This material may either be data gathered by self-search or by interviews with co-researchers.

• Immerse yourself fully in the material until you are aware of and understand everything that is before you.
• Incubate the material. Put the material aside for a while. Let it settle in you. Live with it but without particular attention or focus. Return to the immersion process. Make notes where they would enable you to remember or classify the material. Continue this rhythm of working with the data and resting until an illumination or essential configuration emerges. From your core or global sense, list the essential components or patterns and themes that characterize the fundamental nature and meaning of the experience. Reflectively study the patterns and themes, dwell inside them, and develop a full depiction of the experience. The depiction must include the essential components of the experience.
• Illustrate the depiction of the experience with verbatim samples, poems, stories, or other materials to highlight and accentuate the person's lived experience.
• Return to the raw material of your co-researcher (participant). Does your depiction of the experience fit the data from which you have developed it? Does it contain all that is essential?
• Develop a full reflective depiction of the experience, one that characterizes the participant's experience reflecting core meanings for the individuals as a whole. Include in the depiction, verbatim samples, poems, stories, and the like to highlight and accentuate the lived nature of the experience. This depiction will serve as the creative synthesis, which will combine the themes and patterns into a representation of the whole in an aesthetically pleasing way. This synthesis will communicate the essence of the lived experience under inquiry. The synthesis is more than a summary: it is like a chemical reaction, a creation anew.
• Return to the data and develop a portrait of the person in such a way that the phenomenon and the person emerge as real.

(Adapted from Douglass and Moustakas, l985; Moustakas, 1990.)

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Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and theory for developing grounded theory (2nd ed.). Thousand Oaks, CA: Sage.

Taylor, S. J., & Bogdan, R. (1998). Introduction to qualitative research methods: A guidebook and resource (3rd ed.). New York: Wiley.

Doc. reference: phd_t3_u06s6_qualanalysis.html

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Qualitative Research – Methods, Analysis Types and Guide

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Qualitative Research

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

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

Qualitative Research Methods

Qualitative Research Methods are as follows:

One-to-One Interview

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

Focus Groups

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

Ethnographic Studies

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

Text Analysis

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

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

Process of Observation

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

Record Keeping

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

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

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

Qualitative Research Analysis Methods

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

Thematic Analysis

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

Content Analysis

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

Discourse Analysis

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

Grounded Theory Analysis

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

Narrative Analysis

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

Phenomenological Analysis

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

Comparative Analysis

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

Applications of Qualitative Research

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

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

How to Conduct Qualitative Research

Here are some general steps for conducting qualitative research:

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

Examples of Qualitative Research

Here are some real-time examples of qualitative research:

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

Purpose of Qualitative Research

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

Qualitative research can serve multiple purposes, including:

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

When to use Qualitative Research

Here are some situations where qualitative research may be appropriate:

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

Characteristics of Qualitative Research

Qualitative research is characterized by several key features, including:

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

Advantages of Qualitative Research

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

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

Limitations of Qualitative Research

Qualitative research also has some limitations, including:

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

Also see Research Methods

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Quantitative vs. Qualitative Research Design: Understanding the Differences

As a future professional in the social and education landscape, research design is one of the most critical strategies that you will master to identify challenges, ask questions and form data-driven solutions to address problems specific to your industry. 

Many approaches to research design exist, and not all work in every circumstance. While all data-focused research methods are valid in their own right, certain research design methods are more appropriate for specific study objectives.

Unlock our resource to learn more about jump starting a career in research design — Research Design and Data Analysis for the Social Good .

We will discuss the differences between quantitative (numerical and statistics-focused) and qualitative (non-numerical and human-focused) research design methods so that you can determine which approach is most strategic given your specific area of graduate-level study. 

Understanding Social Phenomena: Qualitative Research Design

Qualitative research focuses on understanding a phenomenon based on human experience and individual perception. It is a non-numerical methodology relying on interpreting a process or result. Qualitative research also paves the way for uncovering other hypotheses related to social phenomena. 

In its most basic form, qualitative research is exploratory in nature and seeks to understand the subjective experience of individuals based on social reality.

Qualitative data is…

• often used in fields related to education, sociology and anthropology; 
• designed to arrive at conclusions regarding social phenomena; 
• focused on data-gathering techniques like interviews, focus groups or case studies; 
• dedicated to perpetuating a flexible, adaptive approach to data gathering;
• known to lead professionals to deeper insights within the overall research study.

You want to use qualitative data research design if:

• you work in a field concerned with enhancing humankind through the lens of social change;
• your research focuses on understanding complex social trends and individual perceptions of those trends;
• you have interests related to human development and interpersonal relationships.

Examples of Qualitative Research Design in Education

Here are just a few examples of how qualitative research design methods can impact education:

Example 1: Former educators participate in in-depth interviews to help determine why a specific school is experiencing a higher-than-average turnover rate compared to other schools in the region. These interviews help determine the types of resources that will make a difference in teacher retention. 

Example 2: Focus group discussions occur to understand the challenges that neurodivergent students experience in the classroom daily. These discussions prepare administrators, staff, teachers and parents to understand the kinds of support that will augment and improve student outcomes.

Example 3: Case studies examine the impacts of a new education policy that limits the number of teacher aids required in a special needs classroom. These findings help policymakers determine whether the new policy affects the learning outcomes of a particular class of students.

Interpreting the Numbers: Quantitative Research Design

Quantitative research tests hypotheses and measures connections between variables. It relies on insights derived from numbers — countable, measurable and statistically sound data. Quantitative research is a strategic research design used when basing critical decisions on statistical conclusions and quantifiable data.

Quantitative research provides numerical-backed quantifiable data that may approve or discount a theory or hypothesis.

Quantitative data is…

• often used in fields related to education, data analysis and healthcare; 
• designed to arrive at numerical, statistical conclusions based on objective facts;
• focused on data-gathering techniques like experiments, surveys or observations;
• dedicated to using mathematical principles to arrive at conclusions;
• known to lead professionals to indisputable observations within the overall research study.

You want to use quantitative data research design if:

• you work in a field concerned with analyzing data to inform decisions;
• your research focuses on studying relationships between variables to form data-driven conclusions;
• you have interests related to mathematics, statistical analysis and data science.

Examples of Quantitative Research Design in Education

Here are just a few examples of how quantitative research design methods may impact education:

Example 1: Researchers compile data to understand the connection between class sizes and standardized test scores. Researchers can determine if and what the relationship is between smaller, intimate class sizes and higher test scores for grade-school children using statistical and data analysis.

Example 2: Professionals conduct an experiment in which a group of high school students must complete a certain number of community service hours before graduation. Researchers compare those students to another group of students who did not complete service hours — using statistical analysis to determine if the requirement increased college acceptance rates.

Example 3: Teachers take a survey to examine an education policy that restricts the number of extracurricular activities offered at a particular academic institution. The findings help better understand the far-reaching impacts of extracurricular opportunities on academic performance.

Making the Most of Research Design Methods for Good: Vanderbilt University’s Peabody College

Vanderbilt University's Peabody College of Education and Human Development offers a variety of respected, nationally-recognized graduate programs designed with future agents of social change in mind. We foster a culture of excellence and compassion and guide you to become the best you can be — both in the classroom and beyond.

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Explore our monthly publication — Ideas in Action — for an inside look at how Peabody College translates discoveries into action.

Please click below to explore a few of the graduate degrees offered at Peabody College:

• Child Studies M.Ed. — a rigorous Master of Education degree that prepares students to examine the developmental, learning and social issues concerning children and that allows students to choose from one of two tracks (the Clinical and Developmental Research Track or the Applied Professional Track).
• Cognitive Psychology in Context M.S. — an impactful Master of Science program that emphasizes research design and statistical analysis to understand cognitive processes and real-world applications best, making it perfect for those interested in pursuing doctoral studies in cognitive science.
• Education Policy M.P.P — an analysis-focused Master of Public Policy program designed for future leaders in education policy and practice, allowing students to specialize in either K-12 Education Policy, Higher Education Policy or Quantitative Methods in Education Policy. 
• Quantitative Methods M.Ed. — a data-driven Master of Education degree that teaches the theory and application of quantitative analysis in behavioral, social and educational sciences.

Connect with the Community of Professionals Seeking to Enhance Humankind at Peabody College

At Peabody College, we equip you with the marketable, transferable skills needed to secure a valuable career in education and beyond. You will emerge from the graduate program of your choice ready to enhance humankind in more meaningful ways than you could have imagined.

If you want to develop the sought-after skills needed to be a force for change in the social and educational spaces, you are in the right place .

We invite you to request more information ; we will connect you with an admissions professional who can answer all your questions about choosing one of these transformative graduate degrees at Peabody College. You may also take this opportunity to review our admissions requirements and start your online application today. 

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How to write qualitative research questions.

11 min read Here’s how to write effective qualitative research questions for your projects, and why getting it right matters so much.

What is qualitative research?

Qualitative research is a blanket term covering a wide range of research methods and theoretical framing approaches. The unifying factor in all these types of qualitative study is that they deal with data that cannot be counted. Typically this means things like people’s stories, feelings, opinions and emotions , and the meanings they ascribe to their experiences.

Qualitative study is one of two main categories of research, the other being quantitative research. Quantitative research deals with numerical data – that which can be counted and quantified, and which is mostly concerned with trends and patterns in large-scale datasets.

What are research questions?

Research questions are questions you are trying to answer with your research. To put it another way, your research question is the reason for your study, and the beginning point for your research design. There is normally only one research question per study, although if your project is very complex, you may have multiple research questions that are closely linked to one central question.

A good qualitative research question sums up your research objective. It’s a way of expressing the central question of your research, identifying your particular topic and the central issue you are examining.

Research questions are quite different from survey questions, questions used in focus groups or interview questions. A long list of questions is used in these types of study, as opposed to one central question. Additionally, interview or survey questions are asked of participants, whereas research questions are only for the researcher to maintain a clear understanding of the research design.

Research questions are used in both qualitative and quantitative research , although what makes a good research question might vary between the two.

In fact, the type of research questions you are asking can help you decide whether you need to take a quantitative or qualitative approach to your research project.

Discover the fundamentals of qualitative research

Quantitative vs. qualitative research questions

Writing research questions is very important in both qualitative and quantitative research, but the research questions that perform best in the two types of studies are quite different.

Quantitative research questions

Quantitative research questions usually relate to quantities, similarities and differences.

It might reflect the researchers’ interest in determining whether relationships between variables exist, and if so whether they are statistically significant. Or it may focus on establishing differences between things through comparison, and using statistical analysis to determine whether those differences are meaningful or due to chance.

• How much? This kind of research question is one of the simplest. It focuses on quantifying something. For example:

How many Yoruba speakers are there in the state of Maine?

• What is the connection?

This type of quantitative research question examines how one variable affects another.

For example:

How does a low level of sunlight affect the mood scores (1-10) of Antarctic explorers during winter?

• What is the difference? Quantitative research questions in this category identify two categories and measure the difference between them using numerical data.

Do white cats stay cooler than tabby cats in hot weather?

If your research question fits into one of the above categories, you’re probably going to be doing a quantitative study.

Qualitative research questions

Qualitative research questions focus on exploring phenomena, meanings and experiences.

Unlike quantitative research, qualitative research isn’t about finding causal relationships between variables. So although qualitative research questions might touch on topics that involve one variable influencing another, or looking at the difference between things, finding and quantifying those relationships isn’t the primary objective.

In fact, you as a qualitative researcher might end up studying a very similar topic to your colleague who is doing a quantitative study, but your areas of focus will be quite different. Your research methods will also be different – they might include focus groups, ethnography studies, and other kinds of qualitative study.

A few example qualitative research questions:

• What is it like being an Antarctic explorer during winter?
• What are the experiences of Yoruba speakers in the USA?
• How do white cat owners describe their pets?

Qualitative research question types

Marshall and Rossman (1989) identified 4 qualitative research question types, each with its own typical research strategy and methods.

• Exploratory questions

Exploratory questions are used when relatively little is known about the research topic. The process researchers follow when pursuing exploratory questions might involve interviewing participants, holding focus groups, or diving deep with a case study.

• Explanatory questions

With explanatory questions, the research topic is approached with a view to understanding the causes that lie behind phenomena. However, unlike a quantitative project, the focus of explanatory questions is on qualitative analysis of multiple interconnected factors that have influenced a particular group or area, rather than a provable causal link between dependent and independent variables.

• Descriptive questions

As the name suggests, descriptive questions aim to document and record what is happening. In answering descriptive questions , researchers might interact directly with participants with surveys or interviews, as well as using observational studies and ethnography studies that collect data on how participants interact with their wider environment.

• Predictive questions

Predictive questions start from the phenomena of interest and investigate what ramifications it might have in the future. Answering predictive questions may involve looking back as well as forward, with content analysis, questionnaires and studies of non-verbal communication (kinesics).

Why are good qualitative research questions important?

We know research questions are very important. But what makes them so essential? (And is that question a qualitative or quantitative one?)

Getting your qualitative research questions right has a number of benefits.

• It defines your qualitative research project Qualitative research questions definitively nail down the research population, the thing you’re examining, and what the nature of your answer will be.This means you can explain your research project to other people both inside and outside your business or organisation. That could be critical when it comes to securing funding for your project, recruiting participants and members of your research team, and ultimately for publishing your results. It can also help you assess right the ethical considerations for your population of study.
• It maintains focus Good qualitative research questions help researchers to stick to the area of focus as they carry out their research. Keeping the research question in mind will help them steer away from tangents during their research or while they are carrying out qualitative research interviews. This holds true whatever the qualitative methods are, whether it’s a focus group, survey, thematic analysis or other type of inquiry.That doesn’t mean the research project can’t morph and change during its execution – sometimes this is acceptable and even welcome – but having a research question helps demarcate the starting point for the research. It can be referred back to if the scope and focus of the project does change.
• It helps make sure your outcomes are achievable

Because qualitative research questions help determine the kind of results you’re going to get, it helps make sure those results are achievable. By formulating good qualitative research questions in advance, you can make sure the things you want to know and the way you’re going to investigate them are grounded in practical reality. Otherwise, you may be at risk of taking on a research project that can’t be satisfactorily completed.

Developing good qualitative research questions

All researchers use research questions to define their parameters, keep their study on track and maintain focus on the research topic. This is especially important with qualitative questions, where there may be exploratory or inductive methods in use that introduce researchers to new and interesting areas of inquiry. Here are some tips for writing good qualitative research questions.

1. Keep it specific

Broader research questions are difficult to act on. They may also be open to interpretation, or leave some parameters undefined.

Strong example: How do Baby Boomers in the USA feel about their gender identity?

Weak example: Do people feel different about gender now?

2. Be original

Look for research questions that haven’t been widely addressed by others already.

Strong example: What are the effects of video calling on women’s experiences of work?

Weak example: Are women given less respect than men at work?

3. Make it research-worthy

Don’t ask a question that can be answered with a ‘yes’ or ‘no’, or with a quick Google search.

Strong example: What do people like and dislike about living in a highly multi-lingual country?

Weak example: What languages are spoken in India?

4. Focus your question

Don’t roll multiple topics or questions into one. Qualitative data may involve multiple topics, but your qualitative questions should be focused.

Strong example: What is the experience of disabled children and their families when using social services?

Weak example: How can we improve social services for children affected by poverty and disability?

4. Focus on your own discipline, not someone else’s

Avoid asking questions that are for the politicians, police or others to address.

Strong example: What does it feel like to be the victim of a hate crime?

Weak example: How can hate crimes be prevented?

5. Ask something researchable

Big questions, questions about hypothetical events or questions that would require vastly more resources than you have access to are not useful starting points for qualitative studies. Qualitative words or subjective ideas that lack definition are also not helpful.

Strong example: How do perceptions of physical beauty vary between today’s youth and their parents’ generation?

Weak example: Which country has the most beautiful people in it?

Related resources

Primary vs secondary research 14 min read, business research methods 12 min read, ethnographic research 11 min read, business research 10 min read, qualitative research design 12 min read, qualitative vs quantitative research 13 min read, video in qualitative research 10 min read, request demo.

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NOTE: This is the second session (July 16-17) for this workshop.  The May 28-29 session is full. 

This 2-day (12-hour) workshop provides an overview of how qualitative researchers think (research design) and what they do (research methods). Participants will gain hands-on experience with qualitative research by working through exercises related to their own current, past, or possible future projects. Group experiences are punctuated by brief discussions of key ideas in qualitative research. Topics covered in this workshop include research ethics, the philosophical underpinnings of qualitative methods, common qualitative approaches, observation, interviews, focus groups, media-based qualitative methods, qualitative data analysis, and writing about qualitative findings. This workshop is suitable for those with limited exposure to qualitative research or with current qualitative work that they wish to refine further.

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Dr. Alexandra Lauterbach is an Associate Professor of special education in the College of Education at the University of Massachusetts Amherst. Within special education, Dr. Lauterbach’s scholarship centers on effective literacy instruction for students with high incidence disabilities, and effective professional development for teachers of such students. More broadly, Dr. Lauterbach’s research is dedicated to developing and applying innovative qualitative research methods, both to inform research and practice within special education and other fields. She has served as a qualitative consultant on projects funded by the Institute of Education Sciences, and had her own work funded by the Office of Special Education and Rehabilitation Services and the Massachusetts Department of Education. Dr. Lauterbach’s research has been published in Learning Disabilities Quarterly, Journal of Learning Disabilities, The Qualitative Report, and the Annals of Dyslexia . She has used multiple methodologies in her own work, including phenomenology, ethnography, case study, grounded theory, and mixed methods, and enjoys teaching others about using a variety of methodologies in their own work. 

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ORIGINAL RESEARCH article

The intersection of promotion policies, research habitus, and capital distribution: a qualitative case study of two higher education contexts in the united arab emirates.

• Director of Institutional Effectiveness and Accreditation, Sharjah Maritime Academy, Sharjah, United Arab Emirates

Introduction: Career advancement must be based on merit, according to the universal norm. However, faculty members continue to express their dissatisfaction with the existing promotion policies and practices, highlighting issues like ambiguity, lack of transparency, inconsistent implementation, and the overall fairness of the evaluation process. This study aimed to explore the intersections of promotion policies with the research habitus and the distribution of different forms of capital in two higher education institutes in the United Arab Emirates.

Methods: Data were gathered from a purposively selected sample of faculty members using semi-structured interviews in addition to key policy documents at both institutes.

Results and discussion: Using Bourdieu’s notion of habitus, capital, and field, the study identified key characteristics of the research habitus and how it shapes perceptions towards aspects of competitiveness and collegiality as practiced in the research world. The study also examined potential relationships between research habitus and promotion policies. Finally, the study explored capital distribution in the research field and identified some of the undisclosed aspects of the promotion world, highlighting areas like prior education, affiliations, professional experience, cultural background, ethnicity, and social networks as some of the factors that may play a role in the promotion outcomes. The findings of the study can be used to offer an additional layer of understanding some hidden rules of academic research fields and capital distribution in light of institutional policy development and enactment. Such understanding can be used to make recommendations on how existing challenges can be addressed to improve perceptions of the clarity and fairness of faculty promotion policies and encourage more transparent practices.

1 Introduction

It is universally accepted that promotion is one of the main indicators of a faculty member’s progression in the academic world. According to Young (2006) , it is arguably the most important incentive used by higher education institutes to encourage their faculty. Moreover, Hanley and Forkenbrock (2006) claimed that the university’s stringent promotion and reward system has been the main driver for faculty excellence. Therefore, the employment and advancement of exceptional professors are essential to an academic institution’s overall success ( Albatch, 2008 ). From an academic or faculty member’s point of view, getting a promotion to a professorship is a remarkable achievement that elevates his or her status in the academic field ( Azman et al., 2016 ). Barrow and Grant (2018) identify promotion as a compelling moment of academic subject formation where, in order to participate, individuals must account for themselves as promotion-worthy through presenting a comprehensive dossier in response to a detailed set of norms.

In the past few decades, education systems around the globe have adapted to political, governmental, and market factors. One of the key results of these changes is that faculty performance is being increasingly evaluated based on quantitative results ( Heffernan, 2017 ). As a result, universities and colleges responded to the requirements of neoliberalism by establishing a competitive atmosphere that included responsibility toward their sponsors and regulators ( Ward, 2012 ). This has resulted in a system for faculty hiring, grading, and advancement that resembles a tournament ( Musselin, 2005 ). By comparing faculty members’ outputs, this tournament-like system of marking allegedly aims at boosting productivity, encouraging competition, and refining selectivity.

Evaluating faculty is crucial to promoting faculty development but changes to the evaluation criteria may have jeopardized this aim. Market liberalism emphasized faculty productivity and efficiency ( Soudien et al., 2013 ), fostering a “performativity” culture. Soudien et al. (2013) define “performativity” as a formalized system to monitor and assess faculty effectiveness. Neoliberalism’s market-based principles affected economic, social, and cultural realms, and the need for economic efficiency changed higher education managerial ideologies and practices ( Saunders, 2010 ). The identities and goals of teachers and students have changed as higher education has adapted to neoliberal practices and ideology ( Saunders, 2010 ). Measurable outputs have replaced open intellectual study and discussion in professional society ( Olssen and Peters, 2005 ). Neoliberal principles and market logic have indirectly impacted faculty promotion, citing a decline in academic reasoning and academic values due to market competition ( Levin et al., 2020 ).

Given the dynamic changes in academia, such as the rise of open-access journals, preprint servers, and the negative impact of the COVID-19 pandemic, various parties, including academics, are now examining the effectiveness of conventional methods used for faculty promotion ( Schimanski and Alperin, 2018 ). According to Faria et al. (2013) , academic promotion has always been a highly debated subject, with discussions typically focusing on efficacy, excellence, fairness, and quality. Sutherland (2017) highlights that research output is the primary criterion for evaluating academics for distinguished faculty appointments, promotions, honors, and rewards. Most of the institutions are still utilizing simple, easily quantifiable metrics such as the journal impact factor (JIF) or the number of publications as an indicator for research output ( McKiernan et al. (2019) . Inconsistent evaluation of research-related standards, giving more weight to research than to instruction, and quantity versus quality issues have been a few of the most common difficulties associated with promotion policies.

Another significant obstacle is the widespread belief that the promotion procedure in general, and research outcome evaluation in particular, cannot be democratic or transparent ( Omar et al., 2015 ). For instance, the Pharmacy Faculty Demographics and Salaries report published by the American Association of Colleges and of Pharmacy (2023) cites that women are disproportionately present in lower-ranking roles such as instructor and assistant professor, whereas they are underrepresented in higher-ranking jobs like senior and administrative roles. Most universities have official regulations and procedures for their promotion processes. However, there is frequently considerable subjectivity in terms of how these guidelines are interpreted and enacted. Promotions are always open to subjectivity and bias, and there are often no normative rules for an institution’s decision-making powers ( Omar et al., 2015 ). Consequently, the way each department or unit within an institutional practice applies its promotion strategy may differ significantly.

In light of these complexities, many faculty members may feel compelled to assert their merit or aggressively refute negative stereotypes ( Durodoye et al., 2019 ). For instance, Kulp et al. (2021) highlight that a large body or research points out that mid-career faculty members deal with a variety of demands and stressors that impact both their likelihood of being promoted to full professor and their level of job satisfaction. One of these pressing demands faced by faculty is to continuously seek to achieve an appropriate balance between their teaching, research, and community service duties to align with their professional goals and to meet institutional needs and curricular requirements. The distribution of these efforts is largely impacted by the institutional culture, which also has a large influence on faculty recruitment and retention as well as promotion and tenure ( Blakely et al., 2023 ). Thus, an efficient and fair system for appointing and promoting faculty members is essential for enhancing the overall well-being of scholars and fostering a thriving academic environment at any educational institution.

Based on his research, Pierre Bourdieu proposed a social theory that classified people into “fields,” “capital,” and “habitus.” In any society, there are numerous fields, each with its own set of norms and expectations ( Bourdieu, 1989 ). Bourdieu regularly used metaphors to explain his ideas, and the term ‘field’ is derived from the tournament field. In football, different experiences, opportunities, and skills have brought each player to the field, and everyone’s past has shaped who they are today as competing footballers ( Bourdieu, 1990 ). Referring to the tournament-like model described earlier where faculty members compete to achieve promotion, Bourdieu’s concept of field seems particularly appropriate in the context of this study. Academics acquire the norms of the field as they progress through their careers as students, mentees, and full-fledged faculty members.

An individual’s capital can be broken down into subcategories, including economic, cultural, and social capital. A person’s economic wealth is the amount of money at their disposal. This may be related to one’s job or one’s family’s wealth ( Bourdieu, 1995 ). On the other hand, language, educational attainment, and involvement in peer cultures are all examples of one’s cultural capital. Access to culture may be influenced by an individual’s economic capital and vice versa. Social capital is the sum of an individual’s social networks. It can refer to being able to use these networks to advance one’s career, but simply belonging to a network is also advantageous. The ability of someone’s capital to reveal information about their past and, in turn, predict their future is a key feature of all types of capital. As a result, there are obvious connections between all kinds of capital and the “structured” and “structuring” events that give rise to their habitus. Second, capital, according to Bourdieu, draws more capital. For instance, if a child’s family’s financial capital is transformed into cultural capital as a result of the child attending outstanding schools, that cultural capital may then be transformed back into financial capital as the child embarks on a financially rewarding career at a later stage of his/her life ( Grenfell and James, 1998 ).

How do people in such a restricted social framework as academia be true to who they are? Bourdieu used the term “habitus” to describe this sense of physical and psychological identity that each of us has in the spaces we occupy. By “habitus,” Bourdieu (1994) means the sum of the experiences, interactions, and impressions that have formed one’s personality, outlook, and values throughout their lifetime. Therefore, habitus forms the properties that combine to form the structured and structuring structure of an individual. Habitus also affects how people interact with the outside world, causing them to adopt particular attitudes, values, and behaviors. As Bourdieu said, it is because of his own habitus that ‘I either see or do not see certain things in a given situation. And depending on whether I see these things or not, I shall be incited by my habitus to do or not do certain things’ ( Schaffer, 2016 ).

Therefore, our habitus cover everything we do, whether or not we are consciously aware of them at the time. Since we are continually evaluating ourselves to others, we are also able to spot habitus in those around us. Education, family upbringing, and social connections all play a role in shaping the professional messages we absorb and convey ( Bourdieu, 1995 ). According to Bourdieu, our connections to others, both below and above us, are as important to our achievement as the work we put in on our own ( Bourdieu, 1998 ). A stable and consistent academic hierarchy is maintained by the interplay between habitus, capital, and field norms ( Bourdieu, 1998 ). Power is not usurped before it has been earned through the traditional rites of passage of faculty promotion, which is why “knowing one’s position” is crucial. This entails working tirelessly at teaching, researching, and writing in order to position oneself as a deserving applicant for inclusion in the academically elite society.

Bourdieu insists that a habitus is first and foremost a conceptual tool for use in an empirical study rather than a concept to be debated in texts ( Reay, 2004 ). Habitus offers a strategy for investigating ‘the experience of social agents and the objective structures which make this experience feasible’ all at once ( Bourdieu, 1988 ). Incorporating habitus as a theoretical framework suggests that studies will consider factors beyond those being studied directly. Bourdieu’s approach stresses how “the structure of those worlds is already predefined by broader racial, gender, and class relations,” highlighting the importance of seeing people as actively engaged in creating their social worlds ( Bourdieu and Wacquant, 1992 ). Although Bourdieu’s theories of habitus, capital, and field can be explained independently of universities or any educational establishment, it is important to note that he was a university professor who interacted with his colleagues and students. Bourdieu’s main work, Homo Academicus, is an application of his theories to the context of higher education ( Heffernan, 2021 ).

Of relevance to this study, Bourdieu’s key concepts and multi-method approach continue to function as a theoretical toolbox for present studies addressing the complexities of career trajectories in higher education. For example, Gander (2022) used Bourdieu’s theory as an integrative framework for career theory, where career stories from university professional staff were analyzed using the lens of The Holistic Career Framework. Smith and Walker (2021) utilized Bourdieu’s analytical framework in an exploratory study that analyzed the role descriptors and promotion criteria of mid-sized United Kingdom universities, citing significant disparities in the job titles within education-oriented career paths, the definitions of scholarship, the anticipated impact, and the connection between scholarship and pedagogic research. Stavrou (2022) investigated the intersection of a knowledge structure with a graduate’s social class by using Bourdieu’s theory to demonstrate how, in each field of study, specific forms of social inequality operate, affecting transitions from higher education to work in increasingly competitive and precarious labor markets. Last but not least, Fudiyartanto and Stahl (2023) explored the role of symbolic capital associated with the training received at the graduate level in informing how academics navigate their careers and how they advance professionally in the context of the Indonesian higher education.

Moreover, Bourdieu’s notions of habitus, capital and filed have been used in higher education research to address areas like inequality and social justice ( Birtwell et al., 2020 ; Bülbül, 2020 ; Jayakumar and Page, 2021 ; Reay, 2021 ; Hassan, 2022 ; Kovács and Pusztai, 2023 ), pedagogy and curriculum reform ( Annala et al., 2020 ; Hindhede and Højbjerg, 2020 ), and learner pathways and mobility ( Katartzi and Hayward, 2019 ).

Based on the above, I decided to investigate the intersection of faculty promotion policies and research conceptions, perceptions, and norms using semi-structured interviews with a purposively selected sample of faculty members from two higher education institutes in the United Arab Emirates. In addition, the study utilized content analysis to offer a careful examination of key policy documents at both institutes. In particular, the theoretical lens of Pierre Bourdieu’s theory of practice was used to answer the following research questions:

• What are the key characteristics of the research habitus at the two institutes as perceived by the participants in this study?

• To what extent does the research habitus at each institute reflect the promotion policy implemented?

• How are economic, social, and cultural capital distributed in different fields of faculty promotion represented by the two institutes? And what are the implications of such distributions for promotion policies and practice?

The study aimed to offer conceptual significance in terms of offering an additional layer of understanding of how different academic research fields can have different rules considering institutional policy development and enactment. Bourdieu’s views adopt a fatalist approach where life is almost predictable, and the future is pre-determined upon birth. In essence, this seems to challenge the core aspect of promotion policies, where the future (e.g., potential promotion) is determined by merit and hard work (e.g., research excellence). Therefore, Bourdieusian analysis seemed like an interesting choice, in my view, to investigate promotion policies and practices.

The study also shed light on some of the hidden forms and perceived values of different capital and how they come to play in the power dynamics associated with faculty promotion. Additionally, the study can hold applied significance by identifying some of the sources of tension between decision-makers and faculty members and how existing challenges can be addressed to improve perceptions of the clarity and fairness of faculty promotion policies and promote more transparent practices.

2 Materials and methods

2.1 research position.

A researcher’s epistemological and ontological assumptions must be firmly established as they are underpinned by implicit assumptions that highlight the various ways in which people perceive and construct the world ( Silverman, 2013 ).

The theoretical foundation of Bourdieu’s work is built around a critical social structure that sees society as a field of conflict and dominance molded by symbolic power dynamics. Therefore, this study adopts a critical realist ontology that acknowledges the existence of objective social structures and processes that function independently of individual consciousness while remaining open to interpretation and challenge. While recognizing that social structures like habitus and capital are always subject to interpretation and challenge, critical realism enables us to recognize their objective existence. This indicates that while objective social structures influence people’s actions and views, people also have the power to question and alter these structures.

The study adopts a constructivist stance from an epistemological standpoint, acknowledging that knowledge is created through interactions between people and their environments. When comparing subjectivism and objectivism, constructivism can be seen as a compromise. It recognizes that knowledge is constructed in part based on the individual’s subjective experiences and interpretations of the world (such as their perceptions and reflections on past promotional experiences) and in part based on the objective features of the environment (such as their access to economic and cultural resources). By implication, this view holds that reality is not static but rather open to discussion and change.

2.2 Context

This study was conducted on two higher education institutes in the United Arab Emirates with different academic scopes and contexts. The first institute (herein referred to as Institute X) is a purely academic, research-intense university offering programs to almost 13,000 students at the Bachelor, Master, and Ph.D. levels through nine Colleges. The university has more than 600 faculty members holding the titles of Professor, Associate Professor, and Assistant Professor. The second institute (herein referred to as Institute Y), on the other hand, is considered one of the largest applied higher education institutes in the region offering mostly diploma and bachelor programs in six disciplines to more than 23,000 students across the country. The institute currently has more than 1,200 faculty members.

Institute X has seven strategic objectives covering areas like developing successful future-ready learners, contributing actively to the goals of sustainable development, and fostering national and international partnerships that contribute to the promotion of the university’s reputation and its global standing. Of particular interest to this study is the second strategic goal: Impactful Research and Innovation. Through this goal, Institute X strives to ‘use the University’s research and innovation capabilities to find novel and sustainable solutions to future challenges and enhancing the global competitiveness of the University.’ The university prioritizes seven key area of strategic importance, namely renewable energy, transportation, education, health, technology, water resources and space exploration. As per their website, the university currently has 9 research centers, 2 virtual research institutes, 1 science and innovation park, 590 ongoing research projects, 550 international research grants, and 471 labs.

As per Institute Y, its strategic plan highlights 5 objectives addressing empowering students, offering quality programs, providing quality services, among others. Although no objective directly spells out research, the fifth objective pertains to embedding an innovation culture in the institutional environment. Operationally, this objective is primarily assumed through the Center for Excellence and Research and Training. The center’s homepage identifies applied research as ‘a catalyst to technology-based innovation by converting technology into business incubating opportunities and graduating sustainable companies.’ Institute Y has 3 large innovation and entrepreneurial incubators, which are dynamic environments equipped virtual reality devices, high bandwidth interconnectivity, and fitted with industry scale and high caliber equipment such as the Computer Numerical Control (CNC) machines and virtual reality devices. They cover distinctive areas including design and media, programming and computing, intelligence augmentation, fabrication, business and entrepreneurship, and future industry to support student startups.

In terms of the promotion policies, Institute X identifies academic research, teaching and advising, and community service as the promotion as the promotion criteria, with 60% weight allocated to research. Institute Y, on the other hand, lists teaching, scholarship, service, and collegiality as its promotion criteria, with no specific weight assigned to research. Institute X requires 5 publications to be promoted to Associate Professor, and 8 to be promoted to Full Professor. Institute Y requires 4 publications and 6 publications to be promoted to Associate Professor and Full Professor, respectively. Table 1 offers details of the two promotion policies.

Table 1 . Description of the promotion policies at each institute.

Both institutes are licensed by the UAE’s Commission for Academic Accreditation (CAA) and therefore are required to demonstrate full compliance with the national policies and regulations in terms of promotion and research expectations. According to the Commission for Academic Accreditation (2019) standards for licensure and program, institutions shall “define their expectations for faculty research and scholarly activity, and embodies these in appointment criteria, faculty performance evaluations and criteria for promotion.” That said, the way these national policies are enacted could be different considering the clear difference in the universities’ mandates and contexts.

2.3 The sample selected

The sample for this study was selected using a snowballing approach, a technique particularly useful in reaching participants who are closely connected through professional networks. Initially, a few full -time faculty members who spent at least 5 years at their current institute and who applied at least once for promotion were identified and interviewed. These initial participants were then asked to recommend other colleagues who meet the same selection criteria and could provide valuable insights into the study. The sample reached a point of saturation after interviewing 16 faculty members. Saturation was achieved when no new or relevant information emerged from the interviews, indicating that the data collected was comprehensive and sufficient to address the research questions.

The respondents were comprised of 63% males and 38% females. In terms of ranking, 38% of the participants were assistant professors, 38% were associate professors, and 25% were full professors. The results also showed that 19% of the sample had 5–9 years of experience, 38% had 10–14 years of experience, 31% had 15–19 years of experience, and 13% had 20 or more years of experience. All faculty members contacted accepted to participate in the study.

2.4 The types of data collected and analyzed

This was a non-experimental, descriptive qualitative study where data was collected using semi-structured interviews and document review. The study utilized an inductive approach to coding and analysis, in which the researcher attempts to make meaning of the data without the influence of preconceived notions, allowing the data to speak for themselves through a bottom-up analytical approach ( Wyse et al., 2017 ). As highlighted by Hillebrand and Berg (2000) , inductive coding works well with single cases or when one wants to explore a phenomenon.

Thematic analysis was used to sort and categorize data to make meaning of the participant’s responses during the interviews. Following a process of transcription and familiarization, sub-codes were identified and grouped together using a codebook to form codes, which, ultimately, were used to identify patterns in the data that will be presented as themes. Classical analysis as described by Leech and Onwuegbuzie (2007) was used where I counted how often a code was used to assist in determining which codes are most important. Finally, I moved from a semantic analysis (description of data) to a latent level analysis where data were interpreted to facilitate answering the research questions.

Similarly, an inductive conventional content analysis was conducted for coding and analysis of the faculty promotion policies, faculty handbooks, and faculty promotion records. Using a commercial Computer Assisted Qualitative Data Analysis software, the process included data collection, developing an e-codebook, determining coding rules, iteration on the coding rules, data analysis, and interpretation of the results.

That said, the research design proposed for this study comes with a set of limitations. For instance, participants might tend to provide answers they think the researcher would want to hear. There is also the risk of being disadvantaged or penalized in case their identities are exposed. This could have implications for the reliability of the data gathered from the semi-structured interviews. Another limitation could be attributed to the sample size and the extent to which the findings of this study could be generalized to a larger context. Thus, until the study is replicated at a larger scale, its findings shall be considered indicative rather than conclusive.

Table 2 offers a summary of some of the key methodological decisions for this study.

Table 2 . Summary of some of the key methodological decisions.

In an attempt to address the first research question, semi-structured interviews were conducted with 8 faculty members from each university. The aim was to understand the key characteristics of their research habitus: the history/background of the faculty members in addition to their perceived values, norms, and practices in the research field.

3.1 Identifying the key characteristics of the research habitus at the two institutes as perceived by the participants in this study

When asked about their perception of their past and current (structured) circumstances that probably lead them to become researchers, most of the participants from Institute X cited coming from middle-class families, with a few describing their background as ‘wealthy’. One of the respondents stated:

We had a steady income; I do not recall my family going through financial challenges. Nothing was extravagant or over the top… just a normal standard of living like most of my other friends at that time.

When discussing academic background, most of the participants from Institute X highlighted that they graduated what could be described as highly ranked or esteemed schools:

My father was a university professor, so he was very particular about our education. His university would allow us to study for free, but he refused. He gave me three options to choose from. All were top schools. The same thing (happened) with my brothers and sister.

On the other hand, there seemed to be a much wider variety in terms of social status and educational background for faculty members from Institute Y. One participant mentioned:

I come from a family of the labour class. My father was a farmer and my mother had to take care of seven children. Not all of us went to school. My brothers preferred to help Dad but I wanted to get a university degree, create something better for myself and my future family. It was the only way out.

Discussions about the more recent and future (structuring) structures of the participants and their implications on their identity as researchers revealed another noticeable difference between participants from Institute X and their counterparts from Institute Y. While all faculty from Institute X stated that they have been considering themselves as established researchers before joining their current institute, the majority of faculty members from institute Y believed that their journey as researchers took off at the current institute:

I was never asked to produce papers before. Only here. I think it is one of the requirements of the regulator. I have four papers so far, in 2 years, which is good. It’s more than many of my colleagues.

In contrast, a faculty member from Institute X stated:

I was recruited because of my research portfolio. It’s been my bread and butter for the past 15 years. It is who I am, what defines me as an academician. Now I bring this experience to help my graduate students do the same. Our role is to create knowledge.

Discussions with faculty members from University X revealed competitiveness as a key descriptor of their research culture. Terms like ‘tough’, ‘fierce’, ‘challenging’, ‘stand out’, and ‘proving worth’ with frequently used:

Have you seen the research expectations guidelines? It’s survival of the fittest. No one will tell you this, but I know some people who left because of this. They simply could not cope. It’s a tough job, very stressful, but it’s also what brings to the university its reputation, its elite status.

Another faculty from University X mentioned:

I used to do a lot of collaborative research in the past… Not anymore. If I am to invest in research, I would rather be the first or the only author. Everyone is doing research and you need to stand out. It looks better on your promotion portfolio.

On the other hand, a main theme emerging from discussions on values and norms with faculty members from University Y was collegiality and collaborative work in research:

We all come from the same sector, even those teaching in different programs. We speak the same language, understand each other. It makes it easier to work on projects together. I do not have time to work on a paper alone. It benefits all when we cooperate in research.

Another common theme extracted from the interviewees from University Y was a sense of confusion about their own roles due to the multiple responsibilities and expectations. For examples, one faculty member stated:

I think most of us are suffering from some sort of identity crisis. My classes, all the committees, the short (vocational) courses, and then research. Who are we in all of this? This is not about the faculty only; it is the entire institution. We need to know who we are first.

3.2 Exploring how research habitues at each institute reflect the research policies

Answering the second research question required conducting content analysis to examine the promotion policies and relevant documents at both institutes, identify the key areas of similarities and differences, and finally investigate whether any points of connection exist with the research habitus.

The content review aimed to aid in identifying possible points of connection between the promotion policies and the research habitus of the faculty members at each institute. Perhaps one of the main observations is the emphasis on collaborative research and how it possibly reflected on the faculty members’ perceptions and values of collegiality in research. Although both institutes make general references to collaborative research in different sections of their documents, only Institute Y includes collaborative research (under ‘Collegiality’) as part of the promotion criteria. Institute X only seems to refer to collaborative research to highlight that it is given less weight compared to single-author publications during the review process. As implied by the faculty responses when discussing their research habitus, faculty members from Institute Y described their research culture as collaborative and expressed high regard for collegiality in research.

A second observation was triggered by the fact that several participants from Institute Y were holders of an Assistant Professor rank. A look at the institutional documents revealed that a starking 53% of the entire faculty population were ranked as Assistant Professors, compared to 29% of faculty members from Institute X holding the same rank.

In an attempt to explore further possible connections, I opted to examine the faculty promotion trends at each institute. A look at relevant institutional documents and reports highlighted a stark difference between the two institutes. For Institute A, the promotion rates in the past 5 years ranged from 36 to 41%. On the other hand, the promotion rates at Institute Y ranged from 12 to 18% for the same period.

3.3 Investigating how are economic, social, and cultural capital are distributed in different fields of faculty promotion

In order to address the third research question, data were collected from the semi-structured interviews with the participants in this study.

Discussions with the faculty members indicated a strong emphasis on social capital in academic promotions. Several participants identified their educational background as an essential component of their professional identity and a priced asset when it comes to different forms of evaluations, including promotions. One faculty member stated:

My master’s is from Oxford while my Ph.D. is from Nottingham. Of course, it matters. Education is an investment for life, it stays with you forever. Today I carry this badge with a lot of pride. I’ve been there, among the best, and I’ve passed and now I’m here. I see how people panic about equivalencies with every performance evaluation. I’ve never had such problems.

One reoccurring theme pertained to the perceived negative impact of cultural background and ethnicity on their promotions:

I happen to come from a poor country. In my village, those who make it to high school are considered high achievers. I had to work so hard to make it, be where I am today. Because of that, some people think I should feel so lucky to be where I am today. Like I do not deserve a promotion no matter what I do. It’s like a dead end. This is not fair, I worked harder than most to be here, I still do, but they do not see it that way.

One female participant of African ethnicity also highlighted:

You think my skin colour does not matter? Who are we fooling? I walk into a room with my (African country) accent and they stop listening. You think when me and someone with (stereotypical description of a white male) apply for promotion. They choose me? It’s not how the world works.

There seemed to be an agreement on how access to financial capital could impact promotion outcomes, with the majority of faculty members highlighting either how the financial status of their families played a role in their education (subsequently supporting their promotion applications) or, perhaps more directly, how access to research grants supported their stance:

I got promoted (to a Professorial rank) last year and I feel a big part of it was the (name of prestigious grant). It is not only the amount, It is the fact that a team of experts agreed that my research deserved it. The announcement has been on the University’s website for months. I am sure the promotion committee did not miss that.

While looking at the demographics, it was observed that the majority of the expats from other Arab countries (i.e., excluding UAE nationals), felt that their limited access to financial funds at some point in their lives harmed their career trajectories.

Lastly, a few participants stressed the importance of being socially connected in improving the chances of a successful promotion:

You do not see those things when you first join. It takes a while. It is not necessarily a bad thing, not like favouritism or something like that. It’s like… they just need to remember your face. I think it’s called personal branding; I came to learn about it the hard way. Now I know that whoever is on the (promotion) committee, at least a few of them will recognize me.

Others also discussed how participating in formal and informal conferences and other venues can help:

The most important part of attending conferences is networking. The sessions are important but getting to meet the right people, it’s like getting membership in the elite club. Our sector is very specific, you know? We know each other now. We meet at conferences, discuss collaborations, and sometimes even review each other’s application forms (for promotion as part of external peer review).

4 Discussion

This study aimed to investigate the intersection of faculty promotion policies and research conceptions, perceptions, and norms as revealed by interviews and policy documents from two higher education institutes in the UAE.

4.1 The characteristics of the research habitus

While faculty from Institute X identified several similar characters when describing their habitus, there seemed to be a wider variety in terms of social status and educational background for faculty members from Institute Y. Additionally, it became clear that faculty members from institute X identified themselves as experienced researchers, with several participants from Institute Y being relatively new to the research world. This could be reflective of the hiring policies and priorities of the two institutions. As a research-intensive institution of higher education, Institute X may have prioritized the employment of faculty members with solid research experience and a more uniform academic profile. In contrast, perhaps the applied nature of Institute Y also led to recruiting faculty members who spent a large portion of their professional career in the fields as practitioners and only became academicians at a later stage of their lives. The demographics and requirements of Institute Y’s student body may also be a contributing factor to the institution’s more diverse faculty backgrounds. Applied colleges, including the one investigated in this study, typically serve a more diverse student population with a broad range of academic backgrounds and experiences, which may necessitate faculty members with diverse backgrounds and skills to meet their requirements. Occasionally, Bourdieu appears to be implying uniformity. In other cases, he emphasizes the uniqueness of each individual’s habitus while acknowledging the variety that exists even among people of the same culture. As individuals’ social paths vary from one another, so do their habitus, both within and across social groups ( Reay, 2004 ).

These results may imply that Institute X faculty members with similar habitus and academic backgrounds may have a clearer route for promotion within the institution, as their research-oriented profile aligns with the institution’s priorities. Faculty members from Institute Y, on the other hand, may face more challenges in terms of career advancement and promotion because their backgrounds may not match as neatly with the institution’s objectives. It is essential to note, however, that diversity in faculty backgrounds can offer benefits to the institution, such as a broader range of perspectives, experiences, and skills. As a result, both institutes should weigh the advantages and disadvantages of their respective hiring policies and work to develop a fair and transparent promotion system that acknowledges and rewards various forms of capital and habitus.

When comparing the two institutes, faculty members from Institute X would describe their habitus as highly competitive where individual faculty need to prove their worth to survive, while their counterparts from Institute Y seemed to have a higher value for aspects of collaboration and collegiality. This may be attributed to several factors. For example, individual achievement and research output may be prioritized as main criteria for promotion and career advancement at Institute X. Faculty members may feel compelled to compete with one another to gain recognition and progress in their careers in this environment. This competitive environment can foster an individualistic culture in which faculty members are solely concerned with their own research objectives and interests. Institute Y, on the other hand, may value collaboration and collegiality as important components of their academic programs. This environment values collaboration and a shared sense of ownership over student learning outcomes. As a result, faculty members may believe that their success is inextricably linked to the success of their co-workers and the institution.

4.2 Research habitues and promotion policies

A comparison of the promotion policies adopted by each institute revealed more similarities than differences. Both institutes consider research contribution a key component of the review criteria for promotion, albeit Institute X allocates a weighted average of 60% and sets higher expectations for research in terms of the number of papers required and years of experience in the current rank. This could explain why most faculty members described their research habitus as competitive, fierce, and overly challenging. As discussed earlier, the neoliberalism ideology continues to play a key role in shaping academic policies, leading to a tournament-like system ( Musselin, 2005 ) for faculty employment, evaluation, and promotion. The faculty review tournament model works by comparing teachers’ outputs, which motivates them to work harder so that they can rise in the ranks. Only applicants with more outstanding outputs than other applicable faculty are promoted, even if they meet the evaluation requirements for the jobs at the next level. Although typically linked to the economic field, neoliberalism uses institutions to change social and cultural norms and values, making economic principles the cornerstone of social structures and processes ( Olssen and Peters, 2005 ; Ward, 2012 ). Smith and Coel (2018) suggested that teachers are unintentionally breeding hostility by fostering an atmosphere where aggression is rewarded, competition is celebrated, and short-term success is prioritized over long-term goals. Therefore, while encouraging outstanding performance, institutions shall pay close attention to the possible emergence of negative practices associated with tournament-like structures and competition.

On the other hand, the research habitus of Institute Y seems to be more aligned with the values of collegial work highlighted in the adopted promotion policy. That said, it shall be noted that collegiality, although generally favored, has been associated with a few challenges in recent years regarding promotion criteria ( Fogg, 2002 ). Collegiality, as described by Bourdieu (1988) , is a desire for group members to exhibit comparable traits and behaviors. For example, a new lecturer needs to assess the norms of the department and, at the very least, appear to conform to them in order to make a smooth transition into the group’s everyday life. In a university or any other workplace, new hires should be appreciated for the fresh perspectives they offer that can help a department grow beyond its current capabilities, as Bonner (2004) points out. Thus, it would be imperative to ensure that collegiality is not overshadowing the individuality and professional identities of those who are expected to broaden the scope of work in terms of research and scholarly activities.

Moreover, while teaching, research/scholarly achievement, and service have historically been the primary criteria for promotions, the inclusion of collegiality introduces new levels of ambiguity and the possibility of discrimination ( DiGiorgio, 2010 ). Due to the subjective nature of the evaluation process and the lack of clear policies on evaluative criteria in universities, it becomes acceptable to attribute one’s inadequacy to a lack of collegiality or even merit, and evidence can be made or tweaked to support this claim ( Trower, 1999 ).

Further examination of the institutional documents and reports revealed a stark difference between the two institutes in terms of recent promotion trends. For Institute X, the promotion rates in the past 5 years ranged from 36 to 41%. On the other hand, the promotion rates at Institute Y ranged from 12 to 18% for the same period. This could raise questions on why, despite the relatively less challenging research requirements, faculty at Institute Y has had such a low promotion rate. One possible reason could be the relatively short experience with research due to spending big positions in their careers as practitioners and industry experts rather than traditional academicians. Many professors in their late careers at new universities were hired primarily for their teaching abilities, as pointed out by Hazelkorn and Moynihan (2010) . The challenge for them is to participate in and meet the requirements for professional education and research endeavors. Bourdieu used the metaphor of a “fish in the water” to explain how one’s habitus and capital can enable success in a particular field ( Bourdieu, 1990 ). In the realm of applied research, professors whose primary asset is their years of professional expertise report feeling underappreciated. Although some are highly regarded as industry experts, these faculties do not feel like ‘fish in water’. That said, this remains an assumption until further substantiated. The promotion process is nothing short of complex and several other factors could impact its outcomes.

It is also possible that the use of clear weighted averages for each promotion criteria, including research output, at Institute X may be more transparent and structured, which could make it easier for faculty members to understand what is required to achieve promotion. The unspecified weight allocated to research productivity could arguably have led to the reported confusion and uncertainty among faculty members about what is expected of them. This lack of clarity could contribute to the lower promotion rates at Institute Y.

What could be the negative implications of these findings? The lower promotion rates at Institute Y could lead to demotivation and a sense of frustration among faculty members who feel that their contributions are not being adequately recognized. This could lead to higher turnover rates and a loss of talent at the institution. At Institute X, the higher promotion rates may lead to a culture of individualism and competition, which could hinder collaboration and interdisciplinary research.

Therefore, it is essential for institutions to review and revise their promotion policies to ensure that they are clear, transparent, and equitable in terms of future promotion trajectories for faculty members at each institute. Establishing mentoring programs and providing opportunities for professional development could also assist faculty members in understanding what is required for promotion. In addition, institutions could consider revising their promotion criteria to better reflect the nature of their academic programs and the institution’s culture and values.

4.3 Capital distribution and its implications on promotion practices

The last section of the study was allocated to investigate the interplay of different types of capital and how their distribution can impact promotion outcomes. In particular, most participants in this study perceived cultural capital as a main contributor to their research identities and career trajectories. There seemed to be close connections between cultural and economic capital. Faculty members who came from families with stable access to income carried on to join the highly-ranked institution in an example of economic capital transforming to cultural, and at a later stage, institutional capital.

The connection between economic and cultural capital may have significant implications for the fairness and transparency of promotion policies and practices. Individuals who lack access to economic capital may be at a disadvantage if cultural capital is perceived, whether consciously or unconsciously, as a prerequisite for academic success and career advancement. Individuals from specific socioeconomic origins may be underrepresented in higher education institutions, resulting in a lack of diversity and representation in the academic workforce.

In addition, if promotion policies and practices heavily rely on cultural capital, there is a danger of perpetuating existing power dynamics and reproducing inequalities. Regardless of their research output or merit, faculty members from prestigious institutions or with prior connections to influential individuals in the field may have an advantage over others. This can create a situation in which the promotion process is not transparent or merit-based, leading to frustration and dissatisfaction among faculty members as well as potential negative effects on the culture of the institution.

Consequently, institutions of higher education should strive to cultivate a more equitable and inclusive environment in which all faculty members have access to resources and opportunities to develop their cultural capital. This can be accomplished through targeted support programs, mentorship opportunities, and recruitment pool diversification initiatives. In addition, promotion policies and practices should emphasize merit-based evaluations of research output and influence. Such measures can contribute to the development of a more diverse and inclusive academic community, in which individuals from various backgrounds and experiences can contribute to the advancement of knowledge and scholarship.

Perhaps expectedly, different distributions of cultural capital also meant that different faculty members felt the promotion process was not as fair and transparent as it should be. Issues of skin color, ethnicity, and gender bias were raised at different stages of the interviews, with some participants still believing promotion decisions remain to favor those of certain ethnicity and cultural backgrounds. Undoubtedly, the is a serious concern that suggests that there may be biases in place that are hindering the progress of certain individuals, regardless of their qualifications and merits.

One potential explanation for this bias is that the promotion committees themselves may be lacking in diversity, making decisions that favor people from specific cultural and ethnic backgrounds. Furthermore, informal networks and relationships may influence decision-making, producing a “glass ceiling” effect for certain groups of people. Not only would this have a negative impact on individual faculty members’ career paths, but it could also contribute to a lack of diversity in the academic community. This can lead to a homogeneous academic culture that lacks innovation and inclusivity, eventually impeding the institution’s overall growth and development.

To address these issues, it is critical to include measures in the promotion process that encourage diversity and inclusivity. This can be accomplished by ensuring that promotion committees are diverse and representative of the institution’s staff, as well as by setting clear, transparent, and impartial promotion criteria. Additionally, training for promotion committees to help them spot and mitigate potential biases in the decision-making process may be helpful.

In order to better the promotion process, it is crucial to foster a culture of openness and transparency in which faculty members are encouraged to share their insights and criticism. For example, faculty members can be provided with opportunities to share their research and accomplishments with the larger academic community. In addition, regular channels for feedback and communication between faculty members and promotion committees can be established. Previous research has shown that when faculty members have a more positive view of the promotion process, they are more invested in their jobs, happier in their careers overall, and less likely to leave their positions ( Ambrose and Cropanzano, 2003 ). Whether the academic system and its means of evaluating the worth of its faculty’s contributions have kept pace with societal goals like ensuring equal opportunities for employment and career advancement regardless of gender, ethnicity, or other personal characteristics is a question that López et al. (2018) concluded deserves more attention.

Another issue raised was some faculty members’ confusion about their professional identities as a result of the multiple roles, expectations, and requirements for promotion. One potential source of this confusion is the institute’s lack of clear communication and rules on promotion criteria and faculty member expectations. This lack of clarity can lead to ambiguity in faculty members’ duties and standards, making it difficult for them to align their efforts with promotion requirements. As a result, faculty members who prioritize teaching may feel undervalued and underappreciated during the promotion process, as their efforts toward teaching and the impact they have on students may not be adequately recognized or rewarded. This can result in a lack of motivation and work dissatisfaction, which can have a negative impact on teaching quality and overall institutional performance.

This has been of particular concern to those who perceive teaching as their main function in higher education. External accountability means that institutions are tasked with providing a foundation of evidence for quality teaching, conducting collaborative research, and engaging with the research community. At the same time, they must strive to develop highly skilled and employable graduates ( Kyvik and Lepori, 2010 ). It is difficult for educational organizations to find common ground between the academic, research, and professional spheres. This could explain why some participants in this study have referred to an identity crisis at both the personal and organizational levels as a result of the divergent standards, norms, and practices of these multiple worlds ( McNamara, 2010 ). Individuals who are repositioning themselves toward numerous academic orientations and merging collectivizes may experience identity confusion as outlined by Melles (2011) .

Institutes can mitigate this by incorporating teaching-focused promotion criteria that recognize the efforts of faculty members who value teaching. To reduce ambiguity and confusion, faculty members can be provided with clear communication and instructions on the promotion process and criteria. Furthermore, institutes can offer faculty members professional development opportunities to help them improve their teaching skills and build their teaching-focused promotion criteria. Higher education institutes can promote a culture of teaching excellence and ensure the fair and transparent promotion of all faculty members by recognizing and rewarding the efforts of faculty members who prioritize teaching.

5 Conclusion and recommendations

This study aimed at exploring the intersections of faculty promotion, research habitus, and capital distribution. In an attempt to achieve this goal, it examined the research habitus from two higher education institutions in the UAE; one was traditionally academic while the other was more applied. While comparing research habitus to the institutional promotion policies, the study explained certain values, perceptions, and practices related to the competitiveness of the research habitus as well as the collaborative nature and overall collegiality as practiced in the research world. Finally, the study explored some of the hidden rules of the promotion world, highlighting areas like background education, professional experience, cultural background, ethnicity, and social networks as some of the factors that may play a role in the promotion outcomes.

Several recommendations can be made based on the study’s findings to address the issues found. Firstly, it is critical to acknowledge the role of habitus and capital in shaping views in the research world. This can be accomplished through education and training programs aimed at creating a more collaborative and inclusive research culture that values various forms of capital and encourages diverse research practices.

Second, promotion policies should be reviewed and revised to ensure that they are transparent, equitable, and consistent with the research culture’s values. This could entail revising promotion criteria, establishing clear performance metrics, and establishing chances for mentoring and professional growth.

Third, it is critical to handle the unknown variables that could impact promotion outcomes, such as prior education, affiliations, professional experience, cultural background, ethnicity, and social networks. This can be accomplished by diversifying promotion committees, developing clear guidelines for assessing applicants, and providing opportunities for networking and community building.

Fostering cultures of diversity and inclusion is also essential. Creating opportunities for underrepresented groups, encouraging diversity in hiring and promotion, and ensuring that policies and practices are inclusive and equitable are all examples of such measures. It is critical to realize that diversity and inclusion are not only moral imperatives, but also critical factors in fostering innovation and improving research quality. We can help to ensure that all researchers have equal opportunities to contribute to the advancement of knowledge and make significant contributions to society by encouraging a more diverse and inclusive research culture.

In conclusion, it is critical to realize that addressing these problems will necessitate a collaborative effort from all research stakeholders, including researchers, policymakers, and institutional leaders. A collaborative and multidisciplinary strategy that emphasizes transparency, fairness, and inclusivity is critical for developing a more equitable and effective research culture that values diverse forms of capital and promotes the growth and development of all researchers.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Author contributions

AE developed its conception and design. AE organized the database, conducted the interviews, performed the analysis, and wrote all sections of the manuscript. The author performed several revisions of the manuscript and finalized the submitted version.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Conflict of interest

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

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Keywords: promotion policies, research culture, habitus, capital, higher education

Citation: Elhakim A (2024) The intersection of promotion policies, research habitus, and capital distribution: a qualitative case study of two higher education contexts in the United Arab Emirates. Front. Educ . 9:1237459. doi: 10.3389/feduc.2024.1237459

Received: 09 June 2023; Accepted: 03 July 2024; Published: 12 July 2024.

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Copyright © 2024 Elhakim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Ahmed Elhakim, [email protected]

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Strategic participant recruitment: How to find the best qualitative research participants

When recruiting participants for marketing research projects, you must implement strategies to narrow down your target group. Online screeners, phone or video calls and short assignments are some of the ways to decide which participants would work best for the research project.

Recruiting strategies and their benefits  

Editor’s note: This is an edited version of an article that originally appeared under the title “ Enhancing Qualitative Research Through Strategic Participant Recruitment .”

The success of qualitative research hinges on the quality of the data derived from a well-chosen group of participants. Given the smaller sample sizes and the detailed insights required, the selection process is crucial. It is important to remember that a one-size-fits-all approach to recruitment does not work; each study demands a tailored strategy to meet its unique needs effectively.

This article will explore a range of recruitment strategies and highlight the benefits of each method and their contribution to securing a pool of participants that can provide the most valuable and actionable insights.

Online screening surveys: How to narrow your potential marketing research participants

Online screening surveys serve as an initial filter in the participant recruitment process, utilizing a carefully crafted set of questions to assess eligibility and interest in the study. These surveys are designed to efficiently process a large volume of responses, enabling researchers to quickly compile a pool of candidates who preliminarily meet the study’s requirements.

The benefits of online screening surveys

You get a broad reach.

Online screening surveys offer you the ability to cast a wide net, attracting a substantial number of potential participants, which is essential for finding a diverse and suitable pool of candidates.

Automated quality controls

Fraud detection technology (e.g., digital fingerprinting), advanced algorithms and other in-survey checks can be implemented to identify and eliminate responses from bots or fraudulent entries, ensuring the integrity of the candidate pool.

Comprehensive screening

Surveys collect a wide range of data from participants’ demographics, experiences and characteristics, facilitating a targeted selection process based on specific study criteria in a short amount of time. 

Informative for participants

Surveys also function as a medium to communicate study details to potential participants, setting expectations right from the start. 

Efficient consent process

The online format allows for the early collection of consent forms, streamlining administrative procedures and ensuring ethical compliance. 

Refining and filtering respondents

They are effective in sifting through the initial volume of respondents to identify those who preliminarily qualify for the next stages of the recruitment process. 

Convenience for research participants 

Surveys enable participants to complete screenings at their convenience, enhancing accessibility and participation by allowing engagement from any location with internet access.

Conducting phone and video interviews

Phone and/or video interviews serve as a critical next step in the recruitment process. A phone interview consists of a direct phone conversation between the recruitment team and a prospective participant. A video interview entails a virtual “face-to-face” interaction between a member of the recruitment team and the research candidate. Both methods involve direct communication with potential participants to verify their eligibility and help gather deeper insights. 

The benefits of phone and video interviews

Survey response verification.

These interviews help validate the information provided by respondents in the screening survey, ensuring the accuracy of participant data. 

In-depth probing

Recruiters can delve into participants’ responses, probing for detailed answers and assessing articulation levels.

Comprehensive participant evaluation

Allows the recruitment team to conduct a comprehensive assessment, aiding in the selection of the most suitable participants. 

Improving participant engagement

Participants can ask the recruitment team questions during these interviews, fostering engagement and enhancing their comfort level with the research process.

Verification of participant legitimacy

Recruiters can authenticate participant identity and credentials, ensuring the integrity of the selection process.

Detailed exploration, getting clarification

The interactive nature of these interviews allows recruiters to delve into more detailed answers, providing deeper insights into participants’ suitability.

Building rapport with research participants

These interviews are particularly effective in building rapport with candidates, especially in studies involving children, which strengthens the relationship between participants and researchers.

Authenticating the materials submitted 

Participants provide documentation to validate their eligibility for a study. This documentation may include employment verification, screenshot verification and video/photo submissions to confirm ownership/use of a product.

The benefits of authenticating submissions

Ensures validity of participant information.

This adds an additional layer of verification, ensuring that participants possess the necessary qualifications to participate in the study. For example, if a study requires participants from a certain industry, participants can submit proof of employment (i.e., LinkedIn page, work ID, etc.) to verify that they work in the required industry.

Essential for specific criteria

Proof submissions are indispensable for studies with highly specific requirements and help guarantee that participants meet the predefined eligibility criteria. 

Seamless integration

Proof submissions can be integrated into an online screening survey, streamlining the participant verification process. 

Pre-assignments: Assign short and simple tasks

Involve short tasks completed by potential participants before project selection. These tasks may include providing written responses to questions or submitting photos or videos.

The benefits  of pre-assignments

Task familiarization.

Pre-assignments mirror tasks participants will encounter if selected, familiarizing them with the research process.

Preparation opportunity

Participants can engage with the research topic beforehand, aiding in their preparation for the session. 

Evaluation resource

Responses to pre-assignments offer valuable insights into candidates’ suitability for the project, aiding in selection. 

Moderator familiarization

Moderators can review pre-assignment responses to familiarize themselves with participants before sessions, optimizing research time.

Time efficiency

Pre-assignments streamline session preparation by eliminating the need for redundant data collection during sessions, allowing moderators to focus on research.

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Research: How Family Motivates People to Do Their Best Work

• Lauren C. Howe
• Jochen I. Menges

Work and family are often seen as competing for an employee’s time and energy — but that’s the wrong way to think about it.

Family is one of the most important things in most people’s lives, across cultures and geographies. Yet, the idea that family can be motivational at work has been overlooked. Instead, in the past, family has been mostly seen as competing with work for an employee’s finite resources, like their time and energy. A large body of research on work-family conflict drew on this notion and illustrated how work and family domains create conflicting demands and interfere with one another. And yet, there’s another growing body of research that finds that family can play a role in motivation at work, boosting employees’ performance and inspiring them to do their best. This article focuses on that body of research, and discusses how organizations that embrace family at work stand to benefit from attracting and retaining employees who are highly motivated and engaged.

Tennis star Serena Williams recently unveiled her next endeavor after leaving the courts behind: her new brand, Wyn Beauty. Like the decision to retire from tennis to focus on family, Williams’ choice to focus on beauty is a family affair. As Williams put it: “Motherhood has allowed me to look at beauty through the eyes of my daughter, Olympia. We’re always experimenting with makeup together, and I think about how these moments will be part of both of our beauty journeys… I also hope my daughters see how many different passions I have — from tennis to beauty — and learn that they can lead dynamic careers and lives across their many interests.”

• Lauren C. Howe is an Associate Professor in Management at the University of Zurich. As a member of the Center for Leadership in the Future of Work , she focuses on how human aspects, such as mindsets, socioemotional skills, and social relationships play a role in the changing world of work.
• Jochen I. Menges is a Professor of Leadership and Human Resource Management at the University of Zurich, the Director of the Center for Leadership in the Future of Work, and a co-founder of the Global HR Valley®, a growing people innovation ecosystem. He studies how people can feel and do their best at work, today and tomorrow. Jochen is also a faculty member at Cambridge Judge Business School.

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Three Approaches to Case Study Methods in Education: Yin, Merriam, and Stake

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• DOI: 10.36367/ntqr.20.2.2024.e1010
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EXPLORING BEYOND CONVENTIONAL BOUNDARIES: BODY MAPPING AS A DATA COLLECTION TECHNIQUE IN QUALITATIVE RESEARCH

• Patricia López Estrada , Jonathan Elizondo-Mejías
• Published in New Trends in Qualitative… 4 July 2024
• Education, Sociology
• New Trends in Qualitative Research

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• Open access
• Published: 11 July 2024

Challenges of pre-hospital emergency care at Addis Ababa Fire and Disaster Risk Management Commission, Addis Ababa, Ethiopia: a qualitative study

• Feleku Yimer Seid 1 ,
• Birhanu Chekol Gete 1 &
• Amanuel Sisay Endeshaw 2  

BMC Health Services Research volume  24 , Article number:  803 ( 2024 ) Cite this article

Metrics details

A challenge to pre-hospital emergency care is any barrier or obstacle that impedes quality pre-hospital care or impacts community pre-hospital utilization. The Addis Ababa Fire and Disaster Risk Management Commission (AAFDRMC) provides pre-hospital emergency services in Addis Ababa, Ethiopia. These services operate under a government-funded organization that delivers free emergency services, including out-of-hospital medical care and transportation to the most appropriate health facility. This study aimed to assess the challenges of pre-hospital emergency care at the Addis Ababa Fire and Disaster Risk Management Commission in Addis Ababa, Ethiopia.

A qualitative descriptive study was conducted from November 20 to December 4, 2022. Data were collected through in-depth, semi-structured interviews with 21 experienced individuals in the field of pre-hospital emergency care, who were selected using purposeful sampling. A thematic analysis method was used to analyze the data.

This study includes twenty-one participants working at the Addis Ababa Fire and Disaster Risk Management Commission. Three major themes emerged. The themes that arose were the participants’ perspectives on the challenges of pre-hospital emergency care in Addis Ababa, Ethiopia.

Conclusion and recommendation

The Fire and Disaster Risk Management Commission faces numerous challenges in providing quality pre-hospital emergency care in Addis Ababa. Respondents stated that infrastructure, communication, and resources were the main causes of pre-hospital emergency care challenges. There has to be more focus on emergency management in light of infrastructure reform, planning, staff training, and education, recruiting additional professional power, improving communication, and making pre-hospital emergency care an independent organization in the city.

Peer Review reports

EMS (Emergency Medical Service) systems provide a community’s gateway to acute and emergency medical care for members of the public with time-sensitive conditions, critical illnesses, and injuries. [ 1 ] The actions taken to provide medical care are time-dependent, starting with the site of the injury (scene), ambulance transportation, and medical facility treatment. [ 2 ]

Pre-hospital emergency medical care has many challenges, including unpredictable patient profiles, emergency conditions, and care administration in a non-medical area. The process before medical interventions, such as justice, stigmatization, dangerous situations, and safe driving; the treatment process, such as triage, refusal of treatment or transport, and informed consent; and the end of life and care are all ethical aspects of pre-hospital emergency medicine challenges. [ 3 , 4 , 5 ]

Pre-hospital emergency transportation initiatives and interventions, which include different transportation modes and financial supply, have been implemented in different low and middle-income countries (LMICs) [ 5 , 6 ] by government and nongovernment or private organizations to improve emergency medical transportation and to tackle treatment delay challenges related to the absence effective mode of transportation in pre-hospital care. [ 7 ]

In recent years, low-income countries, including Ethiopia, have been suffering from a double burden of communicable and non-communicable diseases, necessitating emergency care for managing injury and chronic disease complications simultaneously. [ 8 , 9 ] Reports noted that implementing emergency care systems can reduce mortality and disability-adjusted life years (DALYs) by 45% and 35%, respectively, in LMICs. [ 10 ]

Pre-hospital emergency care services in LMICs are hampered by a variety of issues, such as distance, fuel costs, nonfunctioning ambulances, unaffordable ambulances, inaccessible ambulances, poorly managed ambulance systems, poor network or communications, lack of awareness of the programmed, use of traditional modes of transportation, perceived response times, and other misconceptions. [ 11 , 12 ]

The availability and efficacy of an adequate pre-hospital care system in Ethiopia are minimal. However, timely access to health facilities during emergency cases is a crucial element in emergency conditions, and using an appropriate pre-hospital transportation mode has contributed to the reduction of mortality by preventing a delay in treatment. [ 13 , 14 ] In Addis Ababa city, organizations such as the Red Cross, Addis Ababa Fire and Disaster Risk Management Commission (AAFDRMC), and other private institutions provide pre-hospital medical services for emergency patients or laboring pregnant women. [ 15 , 16 ] The AAFDRMC is responsible for providing pre-hospital emergency services in Addis Ababa, Ethiopia. These services operate under a government-funded organization that delivers free emergency services, including out-of-hospital medical care and transportation to the most appropriate health facility. The AAFDRMC has one central dispatch center for fire and pre-hospital services, eight ambulance stations, and about 32 ambulances. The authority provides free pre-hospital care, including scene-to-health facility and inter-facility transfers, with care providers being nurses with short-term pre-hospital patient care training. The AAFDRMC also aims to improve health facilities’ response capacity and preparedness to cope with the challenges at the time of a disaster, such as mass-casualty incidents (MCIs), by implementing emergency and disaster preparedness plans.

In Ethiopia and other Sub-Saharan countries, providing pre-hospital care is beset by various challenges that impede its effectiveness. [ 17 ] These include a dearth of Emergency Medical Technicians (EMTs) and certified professional paramedics, inadequately trained ambulance crews, and a suboptimal ambulance system. These challenges further complicate the referral process, leading to patients with emergency cases being transported via ineffective modes of transportation. Those results increase the likelihood of disability, increase the severity of pain, increase the failure rate of rescue, contribute to treatment delay, and result in high morbidity and mortality. [ 15 ]

Very few studies have been conducted on pre-hospital emergency care service delivery in Ethiopia. Understanding emergency care service delivery challenges is essential to monitor, evaluate, and implement programs to improve pre-hospital emergency care. This study was intended to explore the challenges of pre-hospital emergency medical care at the AAFDRMC in Addis Ababa, Ethiopia.

Materials and methods

Study design, area, and period.

An institutional-based qualitative descriptive study was conducted at the Addis Ababa Fire and Disaster Risk Management Commission (AAFDRMC), Addis Ababa, Ethiopia, from November 20 to December 4, 2022.

Addis Ababa is the capital city of Ethiopia. The city has over five million people across eleven sub-cities and over a hundred woredas. The city is located at the heart of the country, at an altitude ranging from 2,100 m at Akaki in the south to 3,000 m at Entoto Hill in the north. Pre-hospital medical service is given by the AAFDRMC, the Ethiopian Red Cross Society, the Addis Ababa branch (ERCS), and a few private, for-profit pre-hospital service-giving organizations, including Tebita Ambulance. The AAFDRMC was established in 1934 G.C. to prevent and control fire and related accidents. In 2008, it started to provide pre-hospital care to the community. It has more than 160 emergency care providers and nine stations, of which the main branch is in the Arada sub-city.

This study is reported per the Consolidated criteria for reporting qualitative research (COREQ) Checklists. [ 18 ]

Participant recruitment

All healthcare professionals, dispatch center workers, ambulance drivers, and case team managers working at AAFDRMC with experience of at least one year were eligible to be included in this study. Emergency healthcare providers who were unavailable during data collection and supportive staff who did not have direct involvement or contact with the emergency care process were excluded.

Participants were recruited using a maximum variation purposive sampling technique, which was used across the different groups of participants to provide a realistic perspective concerning the pre-hospital emergency care challenges. The endpoint for sample selection was information saturation, meaning that further data collection failed to provide additional information or new codes were not developed. The study’s participants were twenty-one AAFDRMC workers, all with at least a year prior experience in pre-hospital emergency care.

Data collection

Development of an interview guide.

Data were collected using in-depth, semi-structured interviews with participants regarding the process of EMS in the affected area. An interview guide was prepared after reviewing different literature and reviewed by experts in the field of pre-hospital emergency care. It was initially written in English, then translated into Amharic, and then back to English to ensure consistency. (Supplementary Information 1 )

Training of interviewers

In-depth interviews were conducted by two healthcare providers (emergency nurses) from St. Paul Hospital Millennium Medical College who have experience in pre-hospital medical care for more than a year. A one-day simulation-based training session regarding the interview guide and ethics of qualitative research interviews was given to the data collectors, and the research team closely supervised them.

Interview process

Interviews with the participants started with their experience regarding pre-hospital emergency care, and according to the interview guidelines, general open-ended questions were asked, for instance, “Describe an infrastructure problem when you participated in pre-hospital emergency response.” Then, depending on the context of the responses, the interviewer continued with probe questions such as “Could you explain more?”

The time and location of the interviews were arranged by agreement with the participants. A total of 21 in-depth interviews were conducted. The interviews varied in length from 31 to 62 min. Interviews were digitally recorded with the informed consent of participants, and the recordings were transcribed verbatim.

Study participants were informed of their right to withdraw from the study at any point. Participants were assigned pseudonym identifiers to ensure anonymity in the research report and any publications. Identifying information was removed from transcripts before analysis.

Transcription and translation of the data

The data collectors transcribed the audio recordings to the local language, Amharic. To minimize errors and ensure faithfulness to the original recordings, a second data collector reviewed a random selection of transcripts for accuracy To ensure the truthfulness of the transcription process, we presented the transcribed document to the first five participants to check for accuracy. Any discrepancies or missing information identified by the participants were addressed and corrected in the transcripts.

Following participant verification, the Amharic transcripts were translated into English by a professional translator experienced in qualitative research. The translator ensured a conceptually accurate rendering of the data while preserving the original meaning and intent of the participants’ words.

Data storage

Digital recordings were stored securely on encrypted storage devices. Transcripts were stored electronically on password-protected computers or with access restricted to the research team. Paper copies of transcripts were kept in locked cabinets.

Data analysis

We applied a thematic analysis method, described by Braun and Clarke, to identify, examine, and report patterns within the data to find themes. [ 19 ] Two researchers (FY and BC) performed coding, and the discrepancies raised were handled by discussion. Coding frames were generated after repeated line-by-line reading of the interview transcript. Generated codes and collated them into categories, further refined and organized into potential themes that directly corresponded to the pre-hospital emergency care challenges. Open Code 4.03 software was used in the coding process, enabling the application of clearly defined coding criteria, minimizing ambiguity and enhancing the reliability of the coding scheme.

Trustworthiness was ensured by incorporating various components at each stage of the analysis. Credibility was maintained by faithfully representing the participants’ words and perspectives in the final report. Dependability was established through a detailed description of the research methods, facilitating study replication. Conformability was achieved by assuming a follower role during interviews, allowing participants to shape the discussions, and seeking clarification when needed. Transferability was demonstrated by providing sufficient details about the study site, participants, and data collection methods, allowing readers to assess the potential applicability of the findings to other contexts.

Twenty-one people were interviewed, of which 67% (14/21) were females, consisting of 13 ambulance nurses, two dispatchers, two ambulance drivers, three case team managers, and one pre-hospital manager. The participants ranged in age from 26 to 59 years, averaging 42.5 (S.D. ±7.60) years. (Table  1 ).

Pre-hospital emergency medical care challenges were classified under three main themes, including challenges related to infrastructure, communication, and resources for pre-hospital care. (Supplementary Information 2 )

Theme 1: challenges relating to infrastructure

Difficulty to access was because of the geographical condition of the city, the lack of emergency roads in the city, poor road conditions and poor road networks, sharing roads between the public and emergency vehicles, increased travel distance (wide coverage area of branches), a lack of road signs, eroded terrain, and narrow roads. Seasonal difficulties were commonly reported, such as difficulty passing through roads during the rainy season, traffic crowds, and insufficient ambulances at a branch.

“…Especially around 12 hr. post meridian (pm) local time , it is difficult to arrive at the scene due to traffic congestion , a lack of emergency roads , and narrow roads; as a result , the patient receives emergency care for a longer period ”. p01 (Ambulance nurse) “…During the rainy season , roads around the city’s outskirts become very muddy or are destroyed by floods , making timely access to the scene difficult”. p07 (Ambulance driver) “…Due to the lack of a different route for ambulances and low community awareness regarding the use of an ambulance , it is difficult to reach the site quickly when an emergency call comes in.” p17 (Ambulance driver) “…The Kaity Fire and Emergency Rescue Branch has a large catchment area. Referral hospitals are located far from health facilities , and the institution has only two ambulances for its large catchment area , making it difficult to address many calls in the short time interval available. For example , the Trunesh Beijing Hospital is far from the Catholic and Bisrate Gabriel referral catchment areas; these health facilities and emergency patients deteriorate during the journey” p15 (Ambulance case team manager) “…The shortage of trained paramedic professionals and EMT staff , as well as the ineffective distribution of emergency pre-hospital centers , are major challenges that this center faces and must be addressed as soon as possible.” p20 (Ambulance case team manager)

Most participants also mentioned infrastructural problems within the Addis Ababa Fire and Risk Management Commission that can affect the proper delivery of pre-hospital care. The problem includes no appropriate ambulance entrance and standing area at local health facilities. Some hospital lifts are crowded and far from ambulance standing areas to transfer patients. Participants reported that the liaison of some hospital areas are hidden and far from the emergency room and labor and delivery rooms, and wheelchair or stretcher roads were poorly constructed.

“…When we arrive at the hospital , there is no ambulance standing area. The corridors are not conducive to riding stretchers… The liaison room is hidden and difficult to find… This causes a delay in handing over the patient on time”. p6 (Ambulance nurse)

In a fire and emergency rescue commission institution, infrastructure challenges include no appropriate standing place for ambulances, no shower room, no laundry service room, no appropriate pits to store wastes and no incineration places, no properly prepared area for ambulance washing, and no nursing station near the site of an ambulance standing place.

“… In our branch , there is no properly prepared ambulance standing area , and the ambulance is exposed to the sun at its standing area throughout the day , making the interior of the ambulance very hot. And after we leave the hospitals , cleaning the ambulance is difficult because there is no ambulance washing area , nurse’s shower room , or laundry service”. p13 (Ambulance Nurse)

Theme 2: challenges relating to communication

Based on the participants’ views, several challenges were pointed out regarding communication. Because the line is free to call, many people continuously call from the community for joking or fake calls. Misinformative incoming phone calls, such as calling ambulances for non-emergency cases, misinformation about the case, misinformation about the scene, not purely heard calls, and false callings were also common.

“… Many calls come in , especially at night , and when I answer them , most are dropped , or I do not know where they are from… Some are for making fun of and insulting others… Some make false calls , making the line busy for true callers”. p10 (Dispatcher)

Another participant from the dispatch center also stated regarding prank calls below

“One of the most common challenges is that some people call our emergency phone numbers and report false signs and symptoms , wasting the staff’s time and energy.” p12 (Dispatcher)

At the dispatch center, a communication gap identified was misinformation about the type of case, place of call, and catchment area. Since dispatchers are not health professionals and lack skills, they cannot correctly understand medical terms and not forward detailed information to ambulance nurses. The dispatch center forwarded the message to the ambulance nurse after holding it for many reasons; local health facilities and the community also did not correctly tell the status of the patient and type of case when they were communicating with the dispatch person or ambulance nurse, and large areas were not covered because there was no network (telecommunication problem) and there were limitations in radio communications.

“…Always , there is a conflict between the ambulance nurse and local health facility staff because , when they make the call , they do not forward the type of case and status of the patient correctly to the dispatch centers , and vital signs are not correctly recorded”. p5 (Ambulance nurse) “Most of the time , the dispatcher has incorrect information about the citation and type of call , and they transfer the call to the ambulance nurse very late… As a result of not being psychologically and materially prepared to handle emergency situations correctly”. p14 (Ambulance nurse)

Shortage of communication technology equipment was also one of the major issues within the institution. There are no GPS and GIS technologies in dispatch or ambulance to identify where the call came from and where the ambulance was reported in adequate communication radios, which are very old and outdated.

“…We frequently become perplexed when we are dispatched on a mission since Addis Ababa lacks a reliable GPS system. We are unsure of the best and closest route to take to reach the victims”. p03 (Ambulance case team manager) “…We only have one communication radio on each of our two operational ambulances. If a call comes from anywhere and one ambulance goes , the left ambulance cannot hear any call or communication from the dispatch center. At this time , we use our phone , which is very late for communication”. p8 (Ambulance nurse)

Regarding inter-liaison communication, there was poor or no clear communication between liaisons at health facilities about the case and status of the patient prior to the call to dispatch centers.

“…When we arrived at the hospital , there was little or no communication between the referring health facility and the catchment hospital… Emergency department staff are not voluntary in handing over patients , and we make calls to the command post… This prolongs the patient’s access to care”. p09 (Ambulance Nurse)

Theme 3: challenges relating to resources

Lack of medical commodities like a shortage of ambulances, modernized ambulances, insufficient portable oxygen, defective vital sign materials, insufficient emergency equipment, and, in some cases, a lack of emergency medication (refill problem) are frequently cited challenges.

“…When receiving emergency patients from a health facility , monitoring their vital signs is extremely difficult due to nonfunctional or a lack of vital sign monitoring materials. And no adequate emergency medication in the ambulance…” p04 (Ambulance nurse)

Regarding infection prevention, medical materials challenges include the lack of adequate personal protective equipment (PPE), such as gowns and inappropriate gown colors that do not show contamination. Whole covers, face shields, head covers, gloves, boots, eye goggles, and aprons were reported.

“…You do not receive fluid-proof PPE , such as eye goggles. Even if we are handling trauma cases and patients with highly contagious diseases… The majority of what is available to you are cloth uniforms…” p11 (Ambulance nurse)

Inadequate funding for personal protective equipment in pre-hospital emergency rooms has become a major issue.

“There is insufficient personal protective equipment due to insufficient funds allocated to this center. Given that all EMS personnel are at the forefront of the fight against the most infectious diseases such as tuberculosis , HIV/AIDS , and COVID-19 , and are in direct contact with patients , we should not be subjected to such stresses and challenges.” p21 (Ambulance nurse)

In respect to sanitization and hygiene materials, inadequate sanitizer, alcohol, and bleach were reported.

“…In pre-hospital emergencies , since cross-contamination is very high in the ambulance system , infection prevention activity is mandatory , but we do not get any alcohol for hand rubs. There is no place prepared to clean an ambulance and stretcher following a trauma arrival…” p02 (Ambulance nurse).

From the point of view of our participant, financial constraints were the most common problem which can hinder the service. There are not enough year budgets, the pre-hospital does not have its own budget, and any material for service is decided through a process or discussion that takes a long time. Sometimes the commission’s top executives ignore the requested budget or provide a very small budget for purchasing materials.

“…There is no independent budget for pre-hospital care… To buy emergency medication and materials , after many challenges and a long time , you get little response or no response at all since they ignore the pre-hospital service… and this makes it difficult to give quality pre-hospital emergency care…” p19 (Pre-hospital care manager).

According to the participants, human resource/staff-related challenges most commonly highlighted were only a few diploma/degree nurses, no physicians, no paramedic professionals, no training programs to keep educational levels up to date, no training center, no detailed training if new epidemics emerge, no library to read, no internet access, no procedure room to improve skills, no research center in the institution, lack of career development, and no risk payment.

“…I work as an ambulance nurse. I have six years of experience as a diploma nurse… there is the possibility of further education…The top managers decided that a diploma or level 4 nurse is enough to give pre-hospital care… no B.Sc. nurse , no trained paramedics at all… Despite the fact that there is an emergency , an epidemic case , and no training…” p18 (Ambulance nurse).

We work in a shifting program with no duty Monday through Friday. “ It is known that working in pre-hospital emergencies has a higher risk of infection and life-threatening injuries… However , there is still a payment risk…” p16 (Ambulance nurse) .

The adverse chain of management includes a lack of collaboration and participation with other organizations; every activity in pre-hospital emergency medical care is only controlled by the top managers of the commissioner, who are nonprofessionals, and middle and bottom managers have no independent decision-making activity.

“… Pre-hospital care is dependent on the commission , and this makes the pre-hospital service poorly developed and addresses community emergency calls easily” p19 (Pre-hospital care manager) .

The capacity of emergency care services is typically insufficient during severe emergencies and disasters, and local community resources are likely to be overwhelmed. [ 20 ] Emergency care may not be available, especially in the early hours following an emergency. [ 21 , 22 ] In this case, the public’s involvement in delivering first aid may be crucial. In response, some organizations around the world have recently offered civilian-based pre-hospital guidelines, public education, and exercises for communities. [ 23 ] Based on participants’ experiences, the results of this study showed that infrastructure plays a vital role in hospital and pre-hospital emergency medical services. In Addis Abeba City, infrastructure issues such as poor road construction and networks, geographic problems, a lack of emergency roads, seasonal problems, traffic jams, and narrow roads are frequently blamed for causing delays or making access to accident scenes or hospitals difficult. Other infrastructure issues with local health facility distance include inadequate ambulance parking, lift issues, and a lack of a liaison room. These factors have also been reported in previous studies in Iran. [ 2 , 24 ]

Focusing on the challenges relating to communication, an inappropriate telecommunication system, a communication gap or miscommunication, false calling, inadequate communication radios, being nonprofessional dispatchers, a lack of Geographic Information Systems (GIS) and Global Positioning Systems (GPS), and poor communication between and within facilities are important factors that affect it. Various studies have recommended several enhancements to improve communication and situational awareness in emergency response systems. These include modernizing infrastructures, implementing clear and standardized communication protocols, providing training programs for dispatchers, and incorporating GIS and (GPS). [ 24 , 25 , 26 , 27 , 28 ]

Regarding the challenges relating to resources for pre-hospital care, insufficient professional staffing, not enough ambulances and EMS centers, non-paramedic activities and a lack of motivation among some EMS personnel, a lack of resources at EMS dispatch centers, non-health professionals at the dispatch center, and insufficient nurses for substitution are essential barriers. This finding is consistent with the findings of another study. [ 24 , 25 , 29 , 30 ] Related studies have recognized the significant stress experienced by paramedics and EMTs, resulting in a lack of motivation to perform their duties effectively. To combat this issue, it has been suggested that investing in staff well-being through competitive salaries, providing opportunities for career development, and fostering a supportive work environment can help alleviate these challenges. [ 31 , 32 ]

The participants in this study indicated that pre-hospital emergency care was a neglected part of service in the Addis Ababa Fire and Emergency Rescue Commission. The organization’s structural management is entirely non-health professional, resulting in nonprofessional decisions that result in service flaws and poor response. This result is consistent with the study conducted in Gabon [ 3 ]. Establishing advisory boards with a strong representation of clinical professionals like paramedics, emergency physicians, and nurses, creating joint committees, improving communication channels, and considering qualified paramedics or emergency medical professionals in leadership positions is paramount to addressing the abovementioned challenges. [ 33 , 34 ] The participant also demonstrated challenge-related education, such as a lack of training and no opportunity for advancement, resulting in poor staff knowledge. According to the study participants, most Addis Ababa EMS providers have inadequate skills in handling new epidemic emergency cases. Past studies supported this result. [ 24 , 25 , 35 ] Emergency care cross-contamination in the ambulance system is very high, and infection prevention activity is mandatory. From many participants’ points of view, infection prevention and control factors, including lack of PPE, a uniform for a new employee, a shower room, an ambulance washing place, and adequate solutions and detergents, are the main challenges to preventing infection, which was supported by a study conducted in Gabon and Jimma. [ 3 , 35 ]

To the best of our knowledge, this is a novel study exploring the challenges of pre-hospital emergency medical care in Addis Ababa, Ethiopia, which will significantly impact plans to improve the quality of pre-hospital care. As a limitation of this study due to financial constraints, we did not conduct a focused group discussion, which might have provided a better understanding of pre-hospital medical care challenges.

Conclusion and recommendations

The findings of this study revealed that the pre-hospital emergency care provided by the Addis Ababa Fire and Disaster Risk Management Commission in previous emergencies was chaotic. It faces several challenges that limit its ability to provide quality emergency care, including traffic congestion, a lack of an emergency road, a significant communication gap, a lack of professional power, and a lack of medical materials.

The establishment of a formal pre-hospital care system and the establishment of pre-hospital emergency care as an independent organization in the city, investment in infrastructure and infrastructure reform, staff training and education, recruiting additional professional power, public awareness campaigns, and more widely available emergency medical training are all viable solutions to the current barriers to access. Further studies should also be conducted using a multi-center approach that includes the views of different stakeholder groups.

Data availability

Data and materials will be shared upon reasonable request.

Abbreviations

Addis Ababa Fire and Disaster Risk Management Commission

Emergency Medical Services

Emergency Medical Technician

Low- and Middle-Income Countries

Non-Governmental Organization

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Acknowledgements

We thank the employees of the Addis Ababa Fire and Disaster Risk Management Commission for their help throughout data collection.

This research received financial aid from Saint Paul’s Hospital Millennium Medical College. The funder has no role in the study design, analysis, and interpretation of data.

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Feleku Yimer Seid & Birhanu Chekol Gete

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F.Y designed the study, analysed the data and drafted the manuscript. B.C and A.S were involved in the design, analysis of the data, drafting of the manuscript and critically reviewing the article. All authors read and approved the final manuscript.

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Seid, F.Y., Gete, B.C. & Endeshaw, A.S. Challenges of pre-hospital emergency care at Addis Ababa Fire and Disaster Risk Management Commission, Addis Ababa, Ethiopia: a qualitative study. BMC Health Serv Res 24 , 803 (2024). https://doi.org/10.1186/s12913-024-11292-6

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Received : 26 January 2024

Accepted : 08 July 2024

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DOI : https://doi.org/10.1186/s12913-024-11292-6

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