Qualitative Methods: What Are They and Why Use Them?

Health Services Research, Dec, 1999 by Shoshanna Sofaer

Objective. To provide an overview of reasons why qualitative methods have been used and can be used in health services and health policy research, to describe a range of specific methods, and to give examples of their application.

Data Sources. Classic and contemporary descriptions of the underpinnings and applications of qualitative research methods and studies that have used such methods to examine important health services and health policy issues.

Principal Findings. Qualitative research methods are valuable in providing rich descriptions of complex phenomena; tracking unique or unexpected events; illuminating the experience and interpretation of events by actors with widely differing stakes and roles; giving voice to those whose views are rarely heard; conducting initial explorations to develop theories and to generate and even test hypotheses; and moving toward explanations. Qualitative and quantitative methods can be complementary, used in sequence or in tandem. The best qualitative research is systematic and rigorous, and it seeks to reduce bias and error and to identify evidence that disconfirms initial or emergent hypotheses.

Conclusions. Qualitative methods have much to contribute to health services and health policy research, especially as such research deals with rapid change and develops a more fully integrated theory base and research agenda. However, the field must build on the best traditions and techniques of qualitative methods and must recognize that special training and experience are essential to the application of these methods.

Key Words. Qualitative research methods, case study research, key informant interviews, focus group research, participant observation

Behind every quantity there must lie a quality.

Gertrude Jaeger Selznick, Ph.D.

The field of health services research is young. Its multi-disciplinary practitioners have borrowed conceptual frameworks and data collection and analytic methods from a wide range of social and behavioral sciences, as well as from public health and medicine. Many health services and health policy researchers have used qualitative methods, either alone or in combination with quantitative approaches. As the epigram (from a lecture by a revered epistemologist, sociologist, and survey researcher) indicates, quantification, which facilitates access to powerful statistical tools, must rest on prior work on conceptualization and operationalization, and on valid and reliable measurement (e.g., see Babbie 1998). Qualitative methods have the potential to contribute significantly to the development of meaningful "quantities"; however, they have inherent as well as instrumental value. Some phenomena, including historical events, are so unusual that by the time one has a way to quantify them, they have either changed or d isappeared. [1] Quantification is an excellent way to "slice up" phenomena so that they become manageable and discrete elements of an overall conceptual framework or analytic plan. Everything has the defects of its qualities, however, and the defect of quantification is that it does not always support, as well as qualitative work, the understanding of complex, dynamic, and multi-dimensional "wholes" (Patton 1975).

In addition, the state-of-the-art of quantification is mixed across potentially important independent and dependent variables. If we focus research only on what we already know how to quantify, indeed only on that which can ultimately be reliably quantified, we risk ignoring factors that are more significant in explaining important realities and relationships. Qualitative methods help provide rich descriptions of phenomena. They enhance understanding of the context of events as well as the events themselves. The use of these methods tends to enhance peripheral vision, which is especially important at the early stages of inquiry, as noted further on. In addition, qualitative methods can indeed help to identify patterns and configurations among variables and to make distinctions. Thus, qualitative research not only serves the desire to describe; it also helps move inquiry toward more meaningful explanations.

For all of these reasons, the use of qualitative methods is growing in health services and health policy research (Bowling 1997). Unfortunately, however, we need to appreciate more fully the differences between systematic, rigorous, well-designed qualitative research and well-intentioned but poorly implemented attempts to supplement quantification with more open-ended interviews. Paradoxically, many decry qualitative methods as inherently biased because these methods depend so much on the perspective and skills of the researcher, while others assume that qualitative research can be carried out by anyone regardless of their training, knowledge, and experience.

This article explores the reasons why and the situations where it is appropriate to use qualitative methods, and it discusses some common uses of these methods in health services and health policy research. It presents a spectrum of qualitative methods that reflect the various ways in which they can be used. It closes with a few examples of qualitative research to illustrate the points.