qualitative descriptive methods in health science research

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Qualitative Descriptive Methods in Health Science Research

Affiliations.

1 College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ, USA [email protected].
2 College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ, USA.
PMID: 26791375
PMCID: PMC7586301
DOI: 10.1177/1937586715614171

Objective: The purpose of this methodology paper is to describe an approach to qualitative design known as qualitative descriptive that is well suited to junior health sciences researchers because it can be used with a variety of theoretical approaches, sampling techniques, and data collection strategies.

Background: It is often difficult for junior qualitative researchers to pull together the tools and resources they need to embark on a high-quality qualitative research study and to manage the volumes of data they collect during qualitative studies. This paper seeks to pull together much needed resources and provide an overview of methods.

Methods: A step-by-step guide to planning a qualitative descriptive study and analyzing the data is provided, utilizing exemplars from the authors' research.

Results: This paper presents steps to conducting a qualitative descriptive study under the following headings: describing the qualitative descriptive approach, designing a qualitative descriptive study, steps to data analysis, and ensuring rigor of findings.

Conclusions: The qualitative descriptive approach results in a summary in everyday, factual language that facilitates understanding of a selected phenomenon across disciplines of health science researchers.

Keywords: qualitative analysis; qualitative descriptive; qualitative design; qualitative methodology; rigor.

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The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Example of an analytic memo used in qualitative description analysis.

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DOI: 10.1177/1937586715614171
Corpus ID: 206808341

Qualitative Descriptive Methods in Health Science Research

Karen Colorafi , B. Evans
Published in HERD 19 January 2016
HERD: Health Environments Research & Design Journal

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Qualitative description – the poor cousin of health research?

Mette Asbjoern Neergaard 1 ,
Frede Olesen 1 ,
Rikke Sand Andersen 1 &
Jens Sondergaard 2

BMC Medical Research Methodology volume 9 , Article number: 52 ( 2009 ) Cite this article

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The knowledge and use of qualitative description as a qualitative research approach in health services research is limited.

The aim of this article is to discuss the potential benefits of a qualitative descriptive approach, to identify its strengths and weaknesses and to provide examples of use.

Qualitative description is a useful qualitative method in much medical research if you keep the limitations of the approach in mind. It is especially relevant in mixed method research, in questionnaire development and in research projects aiming to gain firsthand knowledge of patients', relatives' or professionals' experiences with a particular topic. Another great advantage of the method is that it is suitable if time or resources are limited.

As a consequence of the growth in qualitative research in the health sciences, researchers sometimes feel obliged to designate their work as phenomenology, grounded theory, ethnography or a narrative study when in fact it is not. Qualitative description might be a useful alternative approach to consider.

Peer Review reports

The growth in qualitative health sciences research has led to the introduction of a vast array of qualitative methodologies, resulting in what Margarete Sandelowski has called 'methodological acrobatics' [ 1 ], meaning that researchers sometimes feel obliged to designate their work as phenomenology, grounded theory, ethnography or a narrative study when in fact it is not. This may result in 'posturing' and does not make any methodological or theoretical contributions. Furthermore, it may neglect the benefits of an alternative approach, namely qualitative description [ 1 ].

The knowledge and use of qualitative description (QD) as a qualitative research approach in health research is limited and is often criticised for being too simple and lacking rigour [ 1 , 2 ]. However, proper use of the method can provide useful data tailoring clinical interventions, scales, needs assessments and questionnaires in mixed method studies or in relation to small independent research projects [ 3 ].

The aim of this article is to discuss the potential benefits of a QD approach, to identify its strengths and weaknesses and to provide examples of use.

Qualitative and Quantitative Research

QD follows the tradition of qualitative research, i.e. an empirical method of investigation aiming to describe the informant's perception and experience of the world and its phenomena. Qualitative research is well suited for "why" , " how" and " what" questions about human behaviour, motives, views and barriers. Thus, with its mainly inductive approach qualitative research is suitable for problem identification, hypothesis generation, theory formation and concept development [ 4 ].

With their deductive approach quantitative methods are well suited for "when" , "how much" and "how many" questions and are therefore suitable for problem quantification and testing of theories, interventions and new treatments. It seems evident that qualitative and quantitative methods can supplement each other in analysing a research topic from different perspectives [ 4 ].

How does Qualitative Description differ from other qualitative methods?

Qualitative researchers in health sciences have diverse backgrounds; most of them are inspired by phenomenological and hermeneutical traditions, and their approach is mainly theory-driven [ 5 ], however QD is founded in existing knowledge, thoughtful linkages to the work of others in the field and clinical experience of the research-group. The various qualitative approaches focus on various phenomena and thus produce different results. Both description and interpretation are legitimate but they are tied to different conditions and interests [ 6 ].

QD differs from other qualitative methods in several ways. Firstly, in terms of analysis, the aim of QD is neither thick description (ethnography), theory development (grounded theory) nor interpretative meaning of an experience (phenomenology), but a rich, straight description of an experience or an event. This means that in the analytical process and presentation of data, researchers using QD stay closer to the data. Whereas other qualitative approaches often aim to develop concepts and analyse data in a reflective or interpretive interplay with existing theories, the final product of QD is a description of informants' experiences in a language similar to the informants' own language [ 1 , 3 ]. A central discussion related to QD is, however, whether 'pure description' in positivistic terms is possible. In line with Sandelowski, one could say that QD involves low-inference interpretation meaning that even though description is the aim of QD interpretation is always present. Hence, descriptions depend on the perceptions, inclinations, sensitivities and sensibilities of the describer [ 6 ].

Secondly, the interview guide used in QD is slightly more structured than in other qualitative methods although it is still modified and transformed as themes emerge during the analysis. The interview guide is typically based on expert knowledge to focus on areas that are either poorly understood in a health care context and/or potentially amenable to intervention.

On the other hand QD, as any other qualitative approach, may be inspired of other approaches and have textures from either phenomenological, grounded theory, ethnographic or narrative approaches [ 1 ]. These overtones in QD can be confusing to the untrained researcher and exactly lead one to claim using methods they are in fact not using.

Furthermore, QD should not be mistaken for interpretive description [ 3 , 7 ] or pattern analysis [ 3 ]. The main difference between QD and interpretive description lies in the data analysis, where interpretative description goes beyond mere description and aims to provide an in-depth conceptual description and understanding of a phenomenon, and QD stays closer to the data obtained. The analytic procedures in interpretive description capitalize on such processes as synthesizing, theorizing and recontextualizing rather than simply sorting and coding [ 7 , 8 ]. Pattern analysis seeks to describe patterns in data based on specific factors such as demographics, structural issues or socioeconomic status.

Design of a Qualitative Description study

The design features are only concisely summarised in this article. For a more thorough exposition we recommend the paper of Sandelowski [ 1 ]. The design issues of QD proposed by Sandelowski are seen in Table 1 [ 1 ]. However, these issues are not exhaustive or exclusive in any way, since the way to do QD remains flexible.

Theoretical framework

As mentioned above QD is probably the least theoretical of the qualitative approaches. QD is founded in existing knowledge, thoughtful linkages to the work of others in the field and clinical experience of the research-group

Any of the purposeful sampling techniques may be used in QD studies. Especially maximum variation sampling seems useful to get a broad insight into a subject.

Data collection

Usually semi-structured interviews with open-ended questions are used in QD. It can be individual and/or focus group interviews. Especially focus group interviews seem pertinent to get a broad insight into a subject.

Data analysis

The strategy of content analysis is used in QD and is common to many qualitative methods and is described in more detail in Table 2 [ 9 ].

In some QD studies 'Quasi-statistical' analysis methods are added using numbers to summarize data with descriptive statistics. In this way descriptive or interpretive validity is sought since most people would agree to the accurate accounting of events or meanings [ 1 ]. Reporting frequency of data bits is indeed a description and stays close to the data. However, 'Quasi-statistical' analysis methods do not stand alone as the result in a QD study and is merely a supplement to the content analysis.

Reporting the results

When reporting results in QD one stays close to the data and describes informants' experiences in a language similar to the informants' own language.

Strengths and weaknesses of Qualitative Description

All methods have limitations. QD is often criticised for being neither clear nor theory-based [ 2 ]. However, this criticism is only justified if QD is used for the wrong purposes.

QD should be the method of choice only when a description of a phenomenon is desired. In terms of analysis this imposes certain limitations, as the low-inference approach reduces the ability to speak in general terms. When data are neither generated nor interpreted on the basis of existing theories or knowledge of a given subject, only a descriptive summary can rightly be given. However, such summaries may yield the working hypotheses or key categories for future theory-based research [ 1 ].

Furthermore, QD has been criticised for its lack of rigour and for being flawed, when it comes to judging its credibility. However, it is possible to establish both rigour and credibility in QD. Milne and Oberlee talk about enhancing rigour in QD by focusing on the strategies seen in Table 3 ) [ 2 ]. All these criteria are important and overall in line with Guba and Lincoln's lasting argument that qualitative research (or naturalistic inquiry – as they call it) needs other criteria for meeting credibility than more positivistic approaches [ 10 ].

When analysing QD data, no theoretical strings are attached. This is positive in that the analysis stays close to the data and the informants' points of view. However, it may make the analytical process somewhat subjective as descriptions will always depend on the researcher's perceptions, inclinations, sensitivities, and sensibilities [ 1 ]. It is therefore important to reduce the subjective element by involving a group of researchers in the analytic process. The most important criteria to meet when using QD is therefore that of integrity [ 2 ] or neutrality [ 10 ].

As mentioned above, QD ties nicely in with quantitative data and is useful for mixed method inquiries since it is very suitable for intervention development or refinement, conceptual clarification underlying scale development and needs assessments, especially in vulnerable populations [ 3 ]. This seems to be a relevant approach in health services research where the patients' perspectives and evaluations are a quality goal in itself, since QD presents the facts from exactly the informants' points of view. Furthermore, it is a way of gaining a first insight into the informants' views of a particular, narrow topic.

Examples of QD applied in health services research

We applied QD in two studies. The first was a mixed method PhD study entitled "Palliative home care for cancer patients in Denmark – with a particular focus on the primary care sector, GPs and community nurses" . The aim was to investigate how palliative care was provided, what factors were involved in successful and unsuccessful palliative pathways, and what could be done to make improvements. Furthermore, we wanted to identify the statistically significant factors that seemed to be present in the successful and unsuccessful palliative pathways.

A combined QD and questionnaire study seemed very appropriate to achieve the aim. The QD-study yielded appropriate results for the development of the questionnaires, the planning of future palliative home care and research and, furthermore, enabled us to meet the deadline of the project (Neergaard MA et al. Shared care in basic level palliative home care – organizational and interpersonal challenges. A qualitative group interview study. Submitted to Fam Pract 2009) [ 11 ].

The other study was a small independent research project carried out by a General Practitioner (GP) as a mandatory part of the Nordic Specialist Course in Palliative Medicine. The GP had no research experience prior to carrying out the project. The GP was interested in how it would influence the spouse's experience of the palliative course of disease to be actively involved (administering and being in charge of oral or subcutaneous medication or assisting with the patient's personal hygiene) [ 12 ]. QD proved to be a successful method in more than one way. It was very easy to explain the step by step method to the GP as the project progressed, and it was easy to maintain focus on the specific topic of the study. Furthermore, the deadline of the project was again easily met in spite of the qualitative research approach.

Perspectives

QD is a useful method for many research questions in health care because it can help to focus on the experiences of patients, relatives and professionals and their views on the patient-professional interaction and the organisation of the health care system. The method can be learned and used by all medical professions without a formal theoretical education in qualitative research methods, however, it obviously needs to be supervised by a trained researcher.

It is always important to carefully consider which method to use prior to initiating the project. QD is a descriptive approach, and whenever a more in-depth theory-based analysis of a subject is needed, QD is not the right method. The strengths of QD are, however, evident in relation to mixed method research because a QD study conducted prior to the development of a questionnaire or an intervention can give very important, useful information. In relation to our mixed method study the QD study among other issues, revealed that problems with shared care were much larger in palliative home care than we had expected prior to our study. This gave us the opportunity to add this as an important theme in our questionnaire. Furthermore, QD turned out to be an appropriate qualitative method for a small interview study where we wanted to gain preliminary insight into a specific topic. Clinicians who want to carry out a small research project are often presented with a quantitative project, but by using QD for this assignment they will have an opportunity to stay close to patients' or families' views. Hence, using QD may also prove to be a useful method for recruiting and retaining clinicians in research.

It has been debated whether QD is a categorical or non-categorical alternative to other research methods. Sandelowski argues that it is a categorical alternative since it is an existing method, yet relatively unacknowledged, as opposed to being a new adaption of grounded theory, phenomenology or ethnography [ 1 ]. But no matter what point of view one has according to this debate, qualitative description is a useful qualitative method in much medical research if you keep the limitations of the approach in mind. It is especially relevant in mixed method research, in questionnaire development and in research projects aiming to gain firsthand knowledge of patients', relatives' or professionals' experiences with a particular topic. Another great advantage of the method is that it is suitable if time or resources are limited.

The growth in qualitative research in the health sciences has led to the introduction of a vast array of qualitative methodologies. As a consequence, researchers sometimes feel obliged to designate their work as phenomenology, grounded theory, ethnography or a narrative study when in fact it is not. A useful alternative approach, qualitative description, seems to have fallen into oblivion.

Abbreviations

Qualitative description

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Acknowledgements

The study was funded by The County of Aarhus, Denmark and The Danish National Research Foundation for Primary Care.

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Mette Asbjoern Neergaard, Frede Olesen & Rikke Sand Andersen

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Neergaard, M.A., Olesen, F., Andersen, R.S. et al. Qualitative description – the poor cousin of health research?. BMC Med Res Methodol 9 , 52 (2009). https://doi.org/10.1186/1471-2288-9-52

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qualitative descriptive methods in health science research

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Chapter 5: Qualitative descriptive research

Darshini Ayton

Learning outcomes

Upon completion of this chapter, you should be able to:

Identify the key terms and concepts used in qualitative descriptive research.
Discuss the advantages and disadvantages of qualitative descriptive research.

What is a qualitative descriptive study?

The key concept of the qualitative descriptive study is description.

Qualitative descriptive studies (also known as ‘exploratory studies’ and ‘qualitative description approaches’) are relatively new in the qualitative research landscape. They emerged predominantly in the field of nursing and midwifery over the past two decades. 1 The design of qualitative descriptive studies evolved as a means to define aspects of qualitative research that did not resemble qualitative research designs to date, despite including elements of those other study designs. 2

Qualitative descriptive studies describe phenomena rather than explain them. Phenomenological studies, ethnographic studies and those using grounded theory seek to explain a phenomenon. Qualitative descriptive studies aim to provide a comprehensive summary of events. The approach to this study design is journalistic, with the aim being to answer the questions who, what, where and how. 3

A qualitative descriptive study is an important and appropriate design for research questions that are focused on gaining insights about a poorly understood research area, rather than on a specific phenomenon. Since qualitative descriptive study design seeks to describe rather than explain, explanatory frameworks and theories are not required to explain or ‘ground’ a study and its results. 4 The researcher may decide that a framework or theory adds value to their interpretations, and in that case, it is perfectly acceptable to use them. However, the hallmark of genuine curiosity (naturalistic enquiry) is that the researcher does not know in advance what they will be observing or describing. 4 Because a phenomenon is being described, the qualitative descriptive analysis is more categorical and less conceptual than other methods. Qualitative content analysis is usually the main approach to data analysis in qualitative descriptive studies. 4 This has led to criticism of descriptive research being less sophisticated because less interpretation is required than with other qualitative study designs in which interpretation and explanation are key characteristics (e.g. phenomenology, grounded theory, case studies).

Diverse approaches to data collection can be utilised in qualitative description studies. However, most qualitative descriptive studies use semi-structured interviews (see Chapter 13) because they provide a reliable way to collect data. 3 The technique applied to data analysis is generally categorical and less conceptual when compared to other qualitative research designs (see Section 4). 2,3 Hence, this study design is well suited to research by practitioners, student researchers and policymakers. Its straightforward approach enables these studies to be conducted in shorter timeframes than other study designs. 3 Descriptive studies are common as the qualitative component in mixed-methods research ( see Chapter 11 ) and evaluations ( see Chapter 12 ), 1 because qualitative descriptive studies can provide information to help develop and refine questionnaires or interventions.

For example, in our research to develop a patient-reported outcome measure for people who had undergone a percutaneous coronary intervention (PCI), which is a common cardiac procedure to treat heart disease, we started by conducting a qualitative descriptive study. 5 This project was a large, mixed-methods study funded by a private health insurer. The entire research process needed to be straightforward and achievable within a year, as we had engaged an undergraduate student to undertake the research tasks. The aim of the qualitative component of the mixed-methods study was to identify and explore patients’ perceptions following PCI. We used inductive approaches to collect and analyse the data. The study was guided by the following domains for the development of patient-reported outcomes, according to US Food and Drug Administration (FDA) guidelines, which included:

Feeling: How the patient feels physically and psychologically after medical intervention
Function: The patient’s mobility and ability to maintain their regular routine
Evaluation: The patient’s overall perception of the success or failure of their procedure and their perception of what contributed to it. 5(p458)

We conducted focus groups and interviews, and asked participants three questions related to the FDA outcome domains:

From your perspective, what would be considered a successful outcome of the procedure?

Probing questions: Did the procedure meet your expectations? How do you define whether the procedure was successful?

How did you feel after the procedure?

Probing question: How did you feel one week after and how does that compare with how you feel now?

After your procedure, tell me about your ability to do your daily activities?

Prompt for activities including gardening, housework, personal care, work-related and family-related tasks.

Probing questions: Did you attend cardiac rehabilitation? Can you tell us about your experience of cardiac rehabilitation? What impact has medication had on your recovery?

What, if any, lifestyle changes have you made since your procedure? 5(p459)

Data collection was conducted with 32 participants. The themes were mapped to the FDA patient-reported outcome domains, with the results confirming previous research and also highlighting new areas for exploration in the development of a new patient-reported outcome measure. For example, participants reported a lack of confidence following PCI and the importance of patient and doctor communication. Women, in particular, reported that they wanted doctors to recognise how their experiences of cardiac symptoms were different to those of men.

The study described phenomena and resulted in the development of a patient-reported outcome measure that was tested and refined using a discrete-choice experiment survey, 6 a pilot of the measure in the Victorian Cardiac Outcomes Registry and a Rasch analysis to validate the measurement’s properties. 7

Advantages and disadvantages of qualitative descriptive studies

A qualitative descriptive study is an effective design for research by practitioners, policymakers and students, due to their relatively short timeframes and low costs. The researchers can remain close to the data and the events described, and this can enable the process of analysis to be relatively simple. Qualitative descriptive studies are also useful in mixed-methods research studies. Some of the advantages of qualitative descriptive studies have led to criticism of the design approach, due to a lack of engagement with theory and the lack of interpretation and explanation of the data. 2

Table 5.1. Examples of qualitative descriptive studies


	Hiller, 2021	Backman, 2019

	'To explore the experiences of these young people within the care system, particularly in relation to support-seeking and coping with emotional needs, to better understand feasible and acceptable ways to improve outcomes for these young people.' [abstract]	'To describe patients’ and informal caregivers’ perspectives on how to improve and monitor care during transitions from hospital to home in Ottawa Canada' [abstract]
	'1) where do young people in care seek support for emotional difficulties, both in terms of social support and professional services? (2) what do they view as barriers to seeking help? and (3) what coping strategies do they use when experiencing emotional difficulties?'	Not stated
	Young people in out-of-home care represent an under-researched group. A qualitative descriptive approach enabled exploration of their views, coping and wellbeing to inform approaches to improve formal and informal support.	Part of a larger study that aimed to prioritise components that most influence the development of successful interventions in care transition.
	Two local authorities in England	Canada
	Opportunity sampling was used used to invite participants from a large quantitative study to participate in an interview. Semi-structured interviews with 25 young people.	Semi-structured telephone interviews with 8 participants (2 patients; 6 family members) recruited by convenience sampling. Interviews ranged from 45–60 minutes were audio recorded.
	Reflexive thematic analysis	Thematic analysis
	Broader experience of being in care Centrality of social support to wellbeing, and mixed views on professional help Use of both adaptive and maladaptive day-to-day coping strategies	Need for effective communication between providers and patients or informal caregivers Need for improving key aspects of the discharge process Increasing patient and family involvement Suggestions on how to best monitor care transitions

Qualitative descriptive studies are gaining popularity in health and social care due to their utility, from a resource and time perspective, for research by practitioners, policymakers and researchers. Descriptive studies can be conducted as stand-alone studies or as part of larger, mixed-methods studies.

Bradshaw C, Atkinson S, Doody O. Employing a qualitative description approach in health care research. Glob Qual Nurs Res. 2017;4. doi:10.1177/2333393617742282
Lambert VA, Lambert CE. Qualitative descriptive research: an acceptable design. Pac Rim Int J Nurs Res Thail. 2012;16(4):255-256. Accessed June 6, 2023. https://he02.tci-thaijo.org/index.php/PRIJNR/article/download/5805/5064
Doyle L et al. An overview of the qualitative descriptive design within nursing research. J Res Nurs. 2020;25(5):443-455. doi:10.1177/174498711988023
Kim H, Sefcik JS, Bradway C. Characteristics of qualitative descriptive studies: a systematic review. Res Nurs Health. 2017;40(1):23-42. doi:10.1002/nur.21768
Ayton DR et al. Exploring patient-reported outcomes following percutaneous coronary intervention: a qualitative study. Health Expect. 2018;21(2):457-465. doi:10.1111/hex.1263
Barker AL et al. Symptoms and feelings valued by patients after a percutaneous coronary intervention: a discrete-choice experiment to inform development of a new patient-reported outcome. BMJ Open. 2018;8:e023141. doi:10.1136/bmjopen-2018-023141
Soh SE et al. What matters most to patients following percutaneous coronary interventions? a new patient-reported outcome measure developed using Rasch analysis. PLoS One. 2019;14(9):e0222185. doi:10.1371/journal.pone.0222185
Hiller RM et al. Coping and support-seeking in out-of-home care: a qualitative study of the views of young people in care in England. BMJ Open. 2021;11:e038461. doi:10.1136/bmjopen-2020-038461
Backman C, Cho-Young D. Engaging patients and informal caregivers to improve safety and facilitate person- and family-centered care during transitions from hospital to home – a qualitative descriptive study. Patient Prefer Adherence. 2019;13:617-626. doi:10.2147/PPA.S201054

Qualitative Research – a practical guide for health and social care researchers and practitioners Copyright © 2023 by Darshini Ayton is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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Qualitative vs. quantitative data in research: what's the difference?

If you're reading this, you likely already know the importance of data analysis. And you already know it can be incredibly complex.

At its simplest, research and it's data can be broken down into two different categories: quantitative and qualitative. But what's the difference between each? And when should you use them? And how can you use them together?

Understanding the differences between qualitative and quantitative data is key to any research project. Knowing both approaches can help you in understanding your data better—and ultimately understand your customers better. Quick takeaways:

Quantitative research uses objective, numerical data to answer questions like "what" and "how often." Conversely, qualitative research seeks to answer questions like "why" and "how," focusing on subjective experiences to understand motivations and reasons.

Quantitative data is collected through methods like surveys and experiments and analyzed statistically to identify patterns. Qualitative data is gathered through interviews or observations and analyzed by categorizing information to understand themes and insights.

Effective data analysis combines quantitative data for measurable insights with qualitative data for contextual depth.

What is quantitative data?

Qualitative and quantitative data differ in their approach and the type of data they collect.

Quantitative data refers to any information that can be quantified — that is, numbers. If it can be counted or measured, and given a numerical value, it's quantitative in nature. Think of it as a measuring stick.

Quantitative variables can tell you "how many," "how much," or "how often."

Some examples of quantitative data :

How many people attended last week's webinar?

How much revenue did our company make last year?

How often does a customer rage click on this app?

To analyze these research questions and make sense of this quantitative data, you’d normally use a form of statistical analysis —collecting, evaluating, and presenting large amounts of data to discover patterns and trends. Quantitative data is conducive to this type of analysis because it’s numeric and easier to analyze mathematically.

Computers now rule statistical analytics, even though traditional methods have been used for years. But today’s data volumes make statistics more valuable and useful than ever. When you think of statistical analysis now, you think of powerful computers and algorithms that fuel many of the software tools you use today.

Popular quantitative data collection methods are surveys, experiments, polls, and more.

Quantitative Data 101: What is quantitative data?

Take a deeper dive into what quantitative data is, how it works, how to analyze it, collect it, use it, and more.

Learn more about quantitative data →

What is qualitative data?

Unlike quantitative data, qualitative data is descriptive, expressed in terms of language rather than numerical values.

Qualitative data analysis describes information and cannot be measured or counted. It refers to the words or labels used to describe certain characteristics or traits.

You would turn to qualitative data to answer the "why?" or "how?" questions. It is often used to investigate open-ended studies, allowing participants (or customers) to show their true feelings and actions without guidance.

Some examples of qualitative data:

Why do people prefer using one product over another?

How do customers feel about their customer service experience?

What do people think about a new feature in the app?

Think of qualitative data as the type of data you'd get if you were to ask someone why they did something. Popular data collection methods are in-depth interviews, focus groups, or observation.

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What are the differences between qualitative vs. quantitative data?

When it comes to conducting data research, you’ll need different collection, hypotheses and analysis methods, so it’s important to understand the key differences between quantitative and qualitative data:

Quantitative data is numbers-based, countable, or measurable. Qualitative data is interpretation-based, descriptive, and relating to language.

Quantitative data tells us how many, how much, or how often in calculations. Qualitative data can help us to understand why, how, or what happened behind certain behaviors .

Quantitative data is fixed and universal. Qualitative data is subjective and unique.

Quantitative research methods are measuring and counting. Qualitative research methods are interviewing and observing.

Quantitative data is analyzed using statistical analysis. Qualitative data is analyzed by grouping the data into categories and themes.

As you can see, both provide immense value for any data collection and are key to truly finding answers and patterns.

More examples of quantitative and qualitative data

You’ve most likely run into quantitative and qualitative data today, alone. For the visual learner, here are some examples of both quantitative and qualitative data:

Quantitative data example

The customer has clicked on the button 13 times.

The engineer has resolved 34 support tickets today.

The team has completed 7 upgrades this month.

14 cartons of eggs were purchased this month.

Qualitative data example

My manager has curly brown hair and blue eyes.

My coworker is funny, loud, and a good listener.

The customer has a very friendly face and a contagious laugh.

The eggs were delicious.

The fundamental difference is that one type of data answers primal basics and one answers descriptively.

What does this mean for data quality and analysis? If you just analyzed quantitative data, you’d be missing core reasons behind what makes a data collection meaningful. You need both in order to truly learn from data—and truly learn from your customers.

What are the advantages and disadvantages of each?

Both types of data has their own pros and cons.

Advantages of quantitative data

It’s relatively quick and easy to collect and it’s easier to draw conclusions from.

When you collect quantitative data, the type of results will tell you which statistical tests are appropriate to use.

As a result, interpreting your data and presenting those findings is straightforward and less open to error and subjectivity.

Another advantage is that you can replicate it. Replicating a study is possible because your data collection is measurable and tangible for further applications.

Disadvantages of quantitative data

Quantitative data doesn’t always tell you the full story (no matter what the perspective).

With choppy information, it can be inconclusive.

Quantitative research can be limited, which can lead to overlooking broader themes and relationships.

By focusing solely on numbers, there is a risk of missing larger focus information that can be beneficial.

Advantages of qualitative data

Qualitative data offers rich, in-depth insights and allows you to explore context.

It’s great for exploratory purposes.

Qualitative research delivers a predictive element for continuous data.

Disadvantages of qualitative data

It’s not a statistically representative form of data collection because it relies upon the experience of the host (who can lose data).

It can also require multiple data sessions, which can lead to misleading conclusions.

The takeaway is that it’s tough to conduct a successful data analysis without both. They both have their advantages and disadvantages and, in a way, they complement each other.

Now, of course, in order to analyze both types of data, information has to be collected first.

Let's get into the research.

Quantitative and qualitative research

The core difference between qualitative and quantitative research lies in their focus and methods of data collection and analysis. This distinction guides researchers in choosing an appropriate approach based on their specific research needs.

Using mixed methods of both can also help provide insights form combined qualitative and quantitative data.

Best practices of each help to look at the information under a broader lens to get a unique perspective. Using both methods is helpful because they collect rich and reliable data, which can be further tested and replicated.

What is quantitative research?

Quantitative research is based on the collection and interpretation of numeric data. It's all about the numbers and focuses on measuring (using inferential statistics ) and generalizing results. Quantitative research seeks to collect numerical data that can be transformed into usable statistics.

It relies on measurable data to formulate facts and uncover patterns in research. By employing statistical methods to analyze the data, it provides a broad overview that can be generalized to larger populations.

In terms of digital experience data, it puts everything in terms of numbers (or discrete data )—like the number of users clicking a button, bounce rates , time on site, and more.

Some examples of quantitative research:

What is the amount of money invested into this service?

What is the average number of times a button was dead clicked ?

How many customers are actually clicking this button?

Essentially, quantitative research is an easy way to see what’s going on at a 20,000-foot view.

Each data set (or customer action, if we’re still talking digital experience) has a numerical value associated with it and is quantifiable information that can be used for calculating statistical analysis so that decisions can be made.

You can use statistical operations to discover feedback patterns (with any representative sample size) in the data under examination. The results can be used to make predictions , find averages, test causes and effects, and generalize results to larger measurable data pools.

Unlike qualitative methodology, quantitative research offers more objective findings as they are based on more reliable numeric data.

Quantitative data collection methods

A survey is one of the most common research methods with quantitative data that involves questioning a large group of people. Questions are usually closed-ended and are the same for all participants. An unclear questionnaire can lead to distorted research outcomes.

Similar to surveys, polls yield quantitative data. That is, you poll a number of people and apply a numeric value to how many people responded with each answer.

Experiments

An experiment is another common method that usually involves a control group and an experimental group . The experiment is controlled and the conditions can be manipulated accordingly. You can examine any type of records involved if they pertain to the experiment, so the data is extensive.

What is qualitative research?

Qualitative research does not simply help to collect data. It gives a chance to understand the trends and meanings of natural actions. It’s flexible and iterative.

Qualitative research focuses on the qualities of users—the actions that drive the numbers. It's descriptive research. The qualitative approach is subjective, too.

It focuses on describing an action, rather than measuring it.

Some examples of qualitative research:

The sunflowers had a fresh smell that filled the office.

All the bagels with bites taken out of them had cream cheese.

The man had blonde hair with a blue hat.

Qualitative research utilizes interviews, focus groups, and observations to gather in-depth insights.

This approach shines when the research objective calls for exploring ideas or uncovering deep insights rather than quantifying elements.

Qualitative data collection methods

An interview is the most common qualitative research method. This method involves personal interaction (either in real life or virtually) with a participant. It’s mostly used for exploring attitudes and opinions regarding certain issues.

Interviews are very popular methods for collecting data in product design .

Focus groups

Data analysis by focus group is another method where participants are guided by a host to collect data. Within a group (either in person or online), each member shares their opinion and experiences on a specific topic, allowing researchers to gather perspectives and deepen their understanding of the subject matter.

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So which type of data is better for data analysis?

So how do you determine which type is better for data analysis ?

Quantitative data is structured and accountable. This type of data is formatted in a way so it can be organized, arranged, and searchable. Think about this data as numbers and values found in spreadsheets—after all, you would trust an Excel formula.

Qualitative data is considered unstructured. This type of data is formatted (and known for) being subjective, individualized, and personalized. Anything goes. Because of this, qualitative data is inferior if it’s the only data in the study. However, it’s still valuable.

Because quantitative data is more concrete, it’s generally preferred for data analysis. Numbers don’t lie. But for complete statistical analysis, using both qualitative and quantitative yields the best results.

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A perfect digital customer experience is often the difference between company growth and failure. And the first step toward building that experience is quantifying who your customers are, what they want, and how to provide them what they need.

Access to product analytics is the most efficient and reliable way to collect valuable quantitative data about funnel analysis, customer journey maps , user segments, and more.

But creating a perfect digital experience means you need organized and digestible quantitative data—but also access to qualitative data. Understanding the why is just as important as the what itself.

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Ultimate Guide to Market Research
Descriptive Research

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Descriptive research: what it is and how to use it.

8 min read Understanding the who, what and where of a situation or target group is an essential part of effective research and making informed business decisions.

For example you might want to understand what percentage of CEOs have a bachelor’s degree or higher. Or you might want to understand what percentage of low income families receive government support – or what kind of support they receive.

Descriptive research is what will be used in these types of studies.

In this guide we’ll look through the main issues relating to descriptive research to give you a better understanding of what it is, and how and why you can use it.

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What is descriptive research?

Descriptive research is a research method used to try and determine the characteristics of a population or particular phenomenon.

Using descriptive research you can identify patterns in the characteristics of a group to essentially establish everything you need to understand apart from why something has happened.

Market researchers use descriptive research for a range of commercial purposes to guide key decisions.

For example you could use descriptive research to understand fashion trends in a given city when planning your clothing collection for the year. Using descriptive research you can conduct in depth analysis on the demographic makeup of your target area and use the data analysis to establish buying patterns.

Conducting descriptive research wouldn’t, however, tell you why shoppers are buying a particular type of fashion item.

Descriptive research design

Descriptive research design uses a range of both qualitative research and quantitative data (although quantitative research is the primary research method) to gather information to make accurate predictions about a particular problem or hypothesis.

As a survey method, descriptive research designs will help researchers identify characteristics in their target market or particular population.

These characteristics in the population sample can be identified, observed and measured to guide decisions.

Descriptive research characteristics

While there are a number of descriptive research methods you can deploy for data collection, descriptive research does have a number of predictable characteristics.

Here are a few of the things to consider:

Measure data trends with statistical outcomes

Descriptive research is often popular for survey research because it generates answers in a statistical form, which makes it easy for researchers to carry out a simple statistical analysis to interpret what the data is saying.

Descriptive research design is ideal for further research

Because the data collection for descriptive research produces statistical outcomes, it can also be used as secondary data for another research study.

Plus, the data collected from descriptive research can be subjected to other types of data analysis .

Uncontrolled variables

A key component of the descriptive research method is that it uses random variables that are not controlled by the researchers. This is because descriptive research aims to understand the natural behaviour of the research subject.

It’s carried out in a natural environment

Descriptive research is often carried out in a natural environment. This is because researchers aim to gather data in a natural setting to avoid swaying respondents.

Data can be gathered using survey questions or online surveys.

For example, if you want to understand the fashion trends we mentioned earlier, you would set up a study in which a researcher observes people in the respondent’s natural environment to understand their habits and preferences.

Descriptive research allows for cross sectional study

Because of the nature of descriptive research design and the randomness of the sample group being observed, descriptive research is ideal for cross sectional studies – essentially the demographics of the group can vary widely and your aim is to gain insights from within the group.

This can be highly beneficial when you’re looking to understand the behaviours or preferences of a wider population.

Descriptive research advantages

There are many advantages to using descriptive research, some of them include:

Cost effectiveness

Because the elements needed for descriptive research design are not specific or highly targeted (and occur within the respondent’s natural environment) this type of study is relatively cheap to carry out.

Multiple types of data can be collected

A big advantage of this research type, is that you can use it to collect both quantitative and qualitative data. This means you can use the stats gathered to easily identify underlying patterns in your respondents’ behaviour.

Descriptive research disadvantages

Potential reliability issues.

When conducting descriptive research it’s important that the initial survey questions are properly formulated.

If not, it could make the answers unreliable and risk the credibility of your study.

Potential limitations

As we’ve mentioned, descriptive research design is ideal for understanding the what, who or where of a situation or phenomenon.

However, it can’t help you understand the cause or effect of the behaviour. This means you’ll need to conduct further research to get a more complete picture of a situation.

Descriptive research methods

Because descriptive research methods include a range of quantitative and qualitative research, there are several research methods you can use.

Use case studies

Case studies in descriptive research involve conducting in-depth and detailed studies in which researchers get a specific person or case to answer questions.

Case studies shouldn’t be used to generate results, rather it should be used to build or establish hypothesis that you can expand into further market research .

For example you could gather detailed data about a specific business phenomenon, and then use this deeper understanding of that specific case.

Use observational methods

This type of study uses qualitative observations to understand human behaviour within a particular group.

By understanding how the different demographics respond within your sample you can identify patterns and trends.

As an observational method, descriptive research will not tell you the cause of any particular behaviours, but that could be established with further research.

Use survey research

Surveys are one of the most cost effective ways to gather descriptive data.

An online survey or questionnaire can be used in descriptive studies to gather quantitative information about a particular problem.

Survey research is ideal if you’re using descriptive research as your primary research.

Descriptive research examples

Descriptive research is used for a number of commercial purposes or when organisations need to understand the behaviours or opinions of a population.

One of the biggest examples of descriptive research that is used in every democratic country, is during elections.

Using descriptive research, researchers will use surveys to understand who voters are more likely to choose out of the parties or candidates available.

Using the data provided, researchers can analyse the data to understand what the election result will be.

In a commercial setting, retailers often use descriptive research to figure out trends in shopping and buying decisions.

By gathering information on the habits of shoppers, retailers can get a better understanding of the purchases being made.

Another example that is widely used around the world, is the national census that takes place to understand the population.

The research will provide a more accurate picture of a population’s demographic makeup and help to understand changes over time in areas like population age, health and education level.

Where Qualtrics helps with descriptive research

Whatever type of research you want to carry out, there’s a survey type that will work.

Qualtrics can help you determine the appropriate method and ensure you design a study that will deliver the insights you need.

Our experts can help you with your market research needs , ensuring you get the most out of Qualtrics market research software to design, launch and analyse your data to guide better, more accurate decisions for your organisation.

Related resources

Market intelligence 9 min read, qualitative research questions 11 min read, ethnographic research 11 min read, business research methods 12 min read, qualitative research design 12 min read, business research 10 min read, qualitative research interviews 11 min read, request demo.

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Personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery: a systematic synthesis of mixed methods research

Review Article
Published: 18 June 2024

Cite this article

Yaxin Bi 1 ,
Lijun He 1 ,
Fang Yan 1 ,
Yu Zhang 2 , 3 &
Ronghua Gong ORCID: orcid.org/0009-0001-2932-0599 1

To offer a holistic view of the personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery.

This systematic synthesis of mixed methods research involved a comprehensive search for articles in English databases, including PubMed, Cochrane Library, Web of Science, EBSCO, Scopus, and Embase, as well as Chinese databases. The search encompassed articles published from the inception of the database up to June 2023. Following the evaluation of literature quality and extraction of relevant information from the selected studies, data from both quantitative and qualitative studies were integrated. The extracted data were analyzed separately, and themes were identified and summarized to elucidate the factors influencing adherence to nutritional and dietary guidelines. The methodology adhered to the guidelines recommended by the Joanna Briggs Institute (JBI) for mixed methods systematic evaluations.

Three themes and their corresponding descriptive elements were identified, including: (1) Personal factors: subjective factors (attitude, capability, awareness, behaviors), objective factors (age, sex, work status, economic level, physical activity, dietary habits, weight change); (2) External factors: medication (quantity of pills, complexity of intake times, side effects, unpleasant smell or taste), surgery factor, social influences (family members, dietitians, and peers); (3) Psychological factors: self-efficacy, attachment anxiety, and mental health problems.

Conclusions

The synthesis provided a comprehensive overview of the factors influencing postoperative compliance of nutrition and diet among patients undergoing metabolic and bariatric surgery. It emphasizes the necessity for clinical staff to tailor interventions based on these diverse factors, as well as to attach importance to patients' mental health, giving multidimensional dietary guidance and health care.

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Data availability

Data collected and used in this review can be requested from the corresponding author.

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Y.X.B. designed the study, registered the study, performed database searches, compiled literature to be screened for study inclusion or exclusion, screened literature for study, extracted data, created figures and tables, and contributed to drafting the manuscript. L.J.H., Y.L., and F.Y. screened literature for study inclusion or exclusion, and extracted data from included articles. Y.Z. provided writing specifications of mix-method system review and research guidelines, and gave opinions in case of disagreement in data analysis. R.H.G. offered research directions, and writing modifications, and approved the submitted version of the manuscript.

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Bi, Y., He, L., Yan, F. et al. Personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery: a systematic synthesis of mixed methods research. Acta Diabetol (2024). https://doi.org/10.1007/s00592-024-02319-9

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Published: 13 June 2024

Infant feeding experiences among Indigenous communities in Canada, the United States, Australia, and Aotearoa: a scoping review of the qualitative literature

Hiliary Monteith 1 ,
Carly Checholik 2 ,
Tracey Galloway 2 ,
Hosna Sahak 1 ,
Amy Shawanda 3 ,
Christina Liu 1 &
Anthony J. G. Hanley 1 , 4 , 5

BMC Public Health volume 24 , Article number: 1583 ( 2024 ) Cite this article

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Metrics details

Although exclusive breastfeeding is recommended for the first six months of life, research suggests that breastfeeding initiation rates and duration among Indigenous communities differ from this recommendation. Qualitative studies point to a variety of factors influencing infant feeding decisions; however, there has been no collective review of this literature published to date. Therefore, the objective of this scoping review was to identify and summarize the qualitative literature regarding Indigenous infant feeding experiences within Canada, the United States, Australia, and Aotearoa.

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses- Scoping Reviews and the Joanna Briggs Institute Guidelines, in October 2020, Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for relevant papers focusing on Indigenous infant feeding experiences. Screening and full-text review was completed by two independent reviewers. A grey literature search was also conducted using country-specific Google searches and targeted website searching. The protocol is registered with the Open Science Framework and published in BMJ Open.

Forty-six papers from the five databases and grey literature searches were included in the final review and extraction. There were 18 papers from Canada, 11 papers in the US, 9 studies in Australia and 8 studies conducted in Aotearoa. We identified the following themes describing infant feeding experiences through qualitative analysis: colonization, culture and traditionality, social perceptions, family, professional influences, environment, cultural safety, survivance, establishing breastfeeding, autonomy, infant feeding knowledge , and milk substitutes , with family and culture having the most influence on infant feeding experiences based on frequency of themes.

Conclusions

This review highlights key influencers of Indigenous caregivers’ infant feeding experiences, which are often situated within complex social and environmental contexts with the role of family and culture as essential in supporting caregivers. There is a need for long-term follow-up studies that partner with communities to support sustainable policy and program changes that support infant and maternal health.

Peer Review reports

Introduction

Nutritional status is a key aspect of infant health with recommendations for exclusive breastfeeding for the first six months of life, which can also influence and be influenced by maternal health and wellbeing [ 1 , 2 ]. Breastfeeding has several benefits for the health and development of infants, including a reduced risk of ear and respiratory infections, obesity, asthma, skin conditions, childhood leukemia, and gastroenteritis [ 3 , 4 , 5 ]. It also supports bonding between the child and parent with improved intimacy [ 3 ]. Additionally, breastfeeding has several maternal physical and mental health benefits, including a reduced risk of breast and ovarian cancer, depression, and type 2 diabetes due to immunoprotective antibodies in breastmilk [ 3 ]. The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life and initiation within the first hour after birth; however, less than half of infants 0–6 months old are exclusively breastfed worldwide [ 6 ]. Many countries are not meeting the WHO recommendations, with notable differences between low, middle, and high-income countries [ 2 ]. Differences in breastfeeding initiation rates and duration have been observed between Indigenous and non-Indigenous groups, with 6–10% lower breastfeeding initiation rates and shorter duration for Indigenous peoples [ 7 , 8 , 9 ].

Despite the many benefits of breastfeeding, bottle feeding with milk substitutes is a common form of infant nutrition and its common usage is related to a multi-dimensional set of factors influencing infant feeding decision-making. Breastfeeding is considered a traditional practice within many Indigenous cultures; however, disruptions to traditional lifeways through colonization have influenced intergenerational knowledge sharing, particularly within high-income, settler states like Canada, the US, Australia, and Aotearoa (New Zealand) [ 10 ]. Rollins et al. [ 1 ] summarize factors that influence the global breastfeeding environment including the sociocultural and market contexts, the healthcare system and services, family and community settings, employment, and individual determinants like the mother and infant attributes. However, these core breastfeeding environments for general populations overlook key considerations for Indigenous communities given the unique historical, cultural, and socio-economic contexts specific to Indigenous groups [ 11 ].

Many studies to date have focused on quantitative infant feeding data, incorporating structured questionnaires that have provided some insight into breastfeeding barriers and enablers for Indigenous caregivers [ 7 , 12 , 13 , 14 ]. However, these studies are informed by specific research questions and do not capture important nuances that caregivers experience related to infant feeding. Qualitative research can enhance our understanding of phenomena by providing flexible means for participants to engage in the research topic of interest without the constraints of structured instruments, and can even transform the research by highlighting community needs [ 15 , 16 ]. Qualitative research can also have synergy with Indigenous methodologies, supporting the use of qualitative research with Indigenous communities [ 17 ]. Given the value of qualitative inquiry and breastfeeding as traditional practice for many Indigenous cultures, disrupted by colonial influences and the burden of conditions that breastfeeding has been shown to mitigate [ 3 , 5 , 10 , 11 , 16 , 17 ], it is imperative that we consider Indigenous caregiver infant feeding experiences and perspectives to understand what needs exist as defined by communities and caregivers. Therefore, the overall aim of this scoping review was to identify and summarize the qualitative literature on infant nutrition experiences to inform needs as expressed qualitatively by Indigenous caregivers in Canada, the US, Australia, and Aotearoa. These regions are included given the shared colonial influences on Indigenous peoples with overlapping outcomes on health [ 10 , 18 ]. This review will also assess the qualitative methodologies used to understand what can be learned to inform Indigenous infant feeding services, policies, and research gaps.

Protocol and registration

This scoping review adheres to guidelines from Tricco and colleagues’ [ 19 ] Preferred Reporting Items for Systematic Reviews and Meta-Analyses ( PRISMA) extension for scoping reviews , the Joanna Briggs Institute’s Reviewer’s Manual Chap. 11 [ 20 ], as well as Arksey & O’Malley’s [ 21 ] foundational article on scoping studies. The protocol for the review is registered with the Open Science Framework ( https://doi.org/10.17605/OSF.IO/J8ZW2 ) and published with BMJ Open [ 22 ].

Eligibility criteria

Works included in this review must have focused on Indigenous populations in Canada, the United States, Australia, and/or Aotearoa. These four countries share commonalities in that they are colonial countries in which Indigenous peoples face inequitable health outcomes [ 10 , 18 , 23 ]. The topic of interest for this review was caregivers’ experiences of infant feeding within one or more of these regions. “Caregivers” refer to individuals in the infants’ immediate familial and social circles who are directly responsible for the regular care of the infant. A broad definition of those involved in caregiving was used, recognizing that within many Indigenous communities, traditional adoption practices occur, or biological parents may not be the primary caregivers in part related to complex socio-ecological challenges. The experiences of healthcare professionals were not included as they were not considered “caregivers” by this definition. Works that discussed breastfeeding, as well as alternative forms of infant feeding, such as formula and cow’s milk, were included. Works that only focused on the introduction of solid foods were excluded. To capture caregivers’ experiences of infant feeding, qualitative and mixed-method studies that discussed experiences, perspectives, and/or practices as described by caregivers were included. Studies that used exclusively quantitative methods or that only described an outsider perspective (e.g. health professional) were excluded. Peer-reviewed journal articles and grey literature were included if they met the above criteria, were published in the English language, and were published after 1969 [ 22 ].

Various types of grey literature such as government documents, dissertations, and research reports by academic and non-academic institutions, including Indigenous organizations, were included. Media reports (including videos, news, and blogs) were excluded from the grey literature as they did not follow a research design with results that could be considered alongside the studies included in the review, hindering our ability to compare and critically analyze the results. Similarly, publications that consisted of only an abstract were excluded from both grey and database publications during full-text review as not enough information was present for analysis.

Information sources

The search strategy was created with guidance from a research librarian at the Gerstein Science Information Centre, University of Toronto. The complete search strategy can be found as supplementary material in our published protocol [ 22 ]. Search terms primarily included broad terminology for Indigenous peoples (e.g. Native American) rather than specific Nation names (e.g. Ojibwe) as this would have significantly extended the search term list while not resulting in additional sources given how sources are indexed within Library systems. A database and grey literature search were conducted for this scoping review, completed independently from one another until final data extraction when the data were combined for analysis. For both searches, the reviewers followed a step-by-step process of title and abstract screening, followed by full-text screening, and then data extraction.

The database search planning and calibration occurred in August and September of 2020, and all data were exported in English on October 20, 21, and 22 of 2020. Exportation occurred over three days given feasibility of exporting the high number of citations and time capacity of the reviewers. A total of 16734 relevant sources available in the following databases were included: Medline, Embase, CINAHL, PsycINFO, and Scopus. These databases were selected to ensure a broad range of research given the multidisciplinary nature of research on this topic. The grey literature search consisted of a targeted search of a variety of Indigenous focused websites specific to the four countries and a thorough Google search with each of the country-specific Google versions (Google.com.au, Google.co.nz, Google.ca, and Google.com) where the first 10 pages of results were reviewed (Supplementary File 1 ). Lastly, Indigenous Studies Portal (I-Portal) was searched as part of the grey literature as this database uses a different indexing system than other research databases. The Canadian Agency for Drugs and Technologies in Health (CADTH)’s “Grey Matters” checklist [ 24 ] was used in the planning and tracking of grey literature searches and findings.

The results of the database search including 16734 citations were uploaded to Covidence (Veritas Health Innovation Ltd., Melbourne, Australia), a data management platform for systematic and scoping reviews, where 3928 duplicates were automatically removed. The 284 results of the grey literature search were recorded on Google Sheets (Alphabet Inc. California, USA) and 146 duplicates were manually removed by the reviewers. Due to the large number of results retrieved in the database and grey literature search, a hand-search of reference lists was not conducted.

A list of key words developed by HM were searched on each site and can be found in Supplementary File 1 . The grey literature search was completed by HM, CC, and HS with all reviewers assigned to search a Country-specific Google database for one of the included countries. Using a template created by Stapleton [ 25 ] at the University of Waterloo based on methods described by Godin et al. [ 26 ], the reviewers kept track of which search terms were searched on the websites, the number of results retrieved, and the number of items screened and saved for further full-text analysis. If a website did not have a search bar, relevant tabs were examined for research, resources, and other publications. I-Portal was originally searched on August 15th, 2021 (yielding 10 results), however the search was revised to remove Indigenous search terms as the database was already Indigenous-specific. The search was repeated on August 18th, 2021, and yielded 77 additional results. The grey literature search was completed between May 25, 2021 – August 18, 2021. No search limitations or filters were used for the grey literature search or the database search.

The database abstract screening was initially completed by HM and CC starting in October 2020. They were then joined by HS and CL in February 2021. To ensure all reviewers had a shared understanding of the eligibility criteria, two search results were screened together and each reviewer discussed their reasoning for inclusion or exclusion. HM also hosted an introductory meeting to review the screening process using Covidence Software [ 27 ] in detail. All 12806 database results were saved in Covidence [ 27 ].

Abstract and full-text screening was completed in Covidence by two independent reviewers. Any conflicts at the screening stage were resolved by AH after all the results had been screened by two reviewers. Full-text screening was completed by HM, AH, and CC, and when conflicts arose, the reviewers met to discuss the difference in opinion until a consensus was reached. A third reviewer joined to offer impartial opinions for full-text conflicts.

Grey literature results were not imported to Covidence. Instead, the team used Google Sheets to organize the publications. Similar to the database review process, each study was screened by two independent reviewers and conflicts were resolved by a third party and discussed for consensus. Full-text review of the grey literature was completed by HM, AH, CC, and HS.

Data extraction and analysis

HM compiled a list of variables to extract (Supplementary File 2 ), and the data extraction was completed by HM, AH, and CC in Covidence for database results and Google Sheets for the grey literature. The extraction template was reviewed and tested by all three reviewers using the same two articles. Discussion about any areas of confusion followed by minor edits to the data extraction template were completed prior to extraction.

Only one reviewer extracted data from most publications, however in circumstances where an article was complex or data extraction was not clear given the format of the article, two reviewers extracted data from the publication. An additional subset of five publications were also randomly double-reviewed by HM to ensure consistency in data extraction. There were an additional two articles that were excluded at this step after review and discussion by AH and HM.

Review findings using the extraction template (supplementary file 2 ) were exported into Microsoft Excel (Microsoft Corporation, Washington, USA) and reviewed by HM. HM compiled all data and completed summary figures for variables of interest. The primary analysis consisted of a qualitative review of the included papers’ results and recommendations using a thematic synthesis informed by grounded theory and meta-ethnography, where the included papers are synthesized together, and interpreted using descriptive and analytical themes [ 28 ]. Similar to grounded theory, this process was inductive and identifies themes through comparisons. HM reviewed all extracted data from the excel files, coding for overlapping themes and taking notes throughout. The full-text of the extracted papers were then revisited to identify overall concepts, followed by descriptive themes. Categorization of descriptive themes was completed based on the results and interpretations of included papers. Descriptive themes were refined through additional comparisons between papers. The same analytical process was used for both database and grey literature results, and final analysis involved the integration of themes from the database and grey literature papers. Supplementary file 3 provides a summary table of the included papers in this scoping review.

Characteristics of included articles

Of the final sample of 46 articles from which data was extracted (Fig. 1 ), there were studies from each of the four countries, with the most studies (39%) published from Canada. In addition, this qualitative literature on infant feeding included several Indigenous groups within the four countries. The studies retained in this review included authors who identified as either Indigenous or non-Indigenous, and several did not mention positionality (Fig. 2 ). 13% more grey literature studies discussed positionality and had Indigenous sole authorship compared to the database papers. Regarding methodologies utilized, several described Indigenous methodologies and used thematic analysis as an analytic tool (Figs. 3 and 4 ). However, a third of the studies did not describe their theoretical foundations for the qualitative inquiry. Over 60% of the studies were published in the fields of public health and/or nursing as per the authors stated fields of study and/or the Journal’s field, and although there were studies published from 1984 to 2019, 50% of the retained papers were published after 2010.

PRISMA flow diagram for studies identified, screened, and included in this review from both database and grey literature searches. Note that records not retrived are those in which the full-text was not accessible. This diagram was created from the PRISMA 2020 statement [ 29 ]

Author positionality as described in the retained papers

Summary of analytic tools used in the retained studies

Summary of theoretical foundations informing the retained studies’ methodologies

Analysis revealed a variety of important themes that aligned with Indigenous and public health perspectives on health, including the socioecological model. There were twelve final overarching themes including colonization, social perceptions, family, professional influences, culture and traditionality , environment (i.e. built environment) , autonomy, survivance, infant feeding knowledge, cultural safety , milk substitutes , and establishing breastfeeding with evidence of connections among these themes. These themes are shown in Fig. 5 in a circular pattern where the themes intersect with the infant and caregiver represented at the centre. This model is conceptually aligned with that of Dodgson et al. [ 30 ], who considered the “contextual influences within the social structures of family and community, Ojibwe culture, and mainstream culture.”

Scoping review research model of themes

The twelve final themes are shown as the main influences on infant feeding experiences. The themes are arranged in a circular pattern with the infant and caregiver represented at the centre, emphasizing the connection between all of the themes

Theme one: colonization

There were 14 papers that discussed colonization of Indigenous peoples as a key factor influencing infant feeding decisions and experiences (Fig. 6 ) [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Colonization has meant the dispossession of land and limited access to culturally safe healthcare, malnutrition, and loss of language through residential schools, loss of culture and traditional knowledge through assimilation and separation of families, disrupting breastfeeding practices and limiting income for infant formula. Eni et al. [ 36 ] described the policies leading to evacuation from communities to tertiary-care hospitals for birthing as the medicalization of birthing practices, which creates various challenges for First Nations women in Canada. One participant also shared about the impacts of intergenerational trauma related to colonization on breastfeeding, ‘‘You can’t teach about breastfeeding technique and think things will change. It’s the spirit that’s been affected, our experience with trauma. Our women need to relearn how to bond with their children.’’.

A qualitative study with Aboriginal Australian first-time mothers noted the disruptions to breastfeeding practices over time, providing a historical chart detailing how infant feeding practices changed as a result of colonial influences [ 38 ]. Brittany Luby [ 39 ] described how hydroelectric flooding from 1900 to 1975 in Northwestern Ontario reduced breastfeeding practices for Anishinabek mothers and their infants. Although not all studies specifically discussed history and colonization, those that considered the broader historical context highlighted how important this issue is in understanding the factors that lead to infant feeding decisions, particularly those that do not align with breastfeeding as a traditional feeding practice.

Frequency of identified themes in the database papers and the grey literature

Theme two: culture and traditionality

Culture , including traditionality, was the second most described theme throughout all papers, identified both directly and indirectly in 31 papers (Fig. 6 ) [ 30 , 31 , 32 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ]. The Navajo Infant Feeding Project focused on cultural beliefs influencing infant feeding practices within three Navajo communities in the United States [ 48 ] and emphasized breastfeeding’s significance for nutritional, physical, and psychological health where mothers not only pass along physical health benefits, but also their wellbeing to their children. The Baby Teeth Talk Study in Cree communities in Northern Manitoba, Canada, has identified breastfeeding as a cultural intervention for the prevention of early childhood caries [ 52 ]. Several studies included a variety of generations in data collection, contributing to rich discussion of how breastfeeding rates and connection to traditionality has changed in some communities [ 48 , 57 , 64 , 65 ]. For example, grandmothers living on the Fort Peck Reservation in Montana, US, were interviewed about their perspectives on infant feeding [ 65 ]. In one of the ethnographic studies, there was a specific focus on the Ojibwe culture relating to infant feeding practices from the perspective of mothers, professionals who were also community members, and Elders [ 35 ]. This study emphasized the holistic and collective worldview of the community, influencing women’s roles within the family and how teachings were passed on from generation to generation [ 35 ]. This was considered to be important in influencing effective and culturally safe breastfeeding promotion. Within the Northwest Territories, Canada, Moffitt and Dickinson [ 53 ] supported breastfeeding knowledge translation tools for Tłı̨chǫ women with one of the themes focused on factors that “pull to breastfeeding,” including breastfeeding as a traditional feeding method. In general, Indigenous communities described breastfeeding as a cultural practice; however, how this is supported and the traditional knowledge surrounding this practice may differ from community to community. Therefore, health providers must be aware of community-specific protocols and support these within programs and recommendations.

Theme three: social perceptions

Societal influences are often considered alongside cultural perspectives of infant feeding; therefore, this theme was also commonly discussed in the papers retained in this scoping review (Fig. 6 ) [ 30 , 32 , 33 , 36 , 37 , 38 , 40 , 42 , 49 , 50 , 52 , 54 , 57 , 58 , 59 , 61 , 64 , 66 , 67 , 68 , 69 , 70 , 71 ]. In New South Wales, Australia, Aboriginal mothers and key informants noted the need for “a safe place to feed,” including concerns about the social acceptability to breastfeed in public [ 32 ]. Broader social “norms” are also discussed as influencing maternal behavior [ 68 ], and respondents in some studies expressed concern about judgements from others [ 32 , 36 ]. Tapera et al. [ 40 ] described concerns about social pressures and a lack of support with one grandparent sharing, “well here in New Zealand, I know we have a problem with this [breast-feeding], especially when mothers go out and they breast-feed their babies in public. There’s a lot of people that moan and groan about this.” Similarly, regarding social norms, a grandmother living in the US shared,

“a long time ago that, it [breastfeeding] was acceptable and nobody had any qualms about it but today, I mean you read continually about, people, mother’s tryin’ ta breastfeed and they’re being chased out a places or stores or people are rude about it […]. Society’s changed, you know, it’s […] society, has come to the point where it’s […] trying to tell us what’s the right way ta live what’s the right way ta raise our kids” [ 65 ].

Dodgson et al. [ 30 ] described how in an Ojibwe community in Minnesota, US, participants noted the dominant societal influences in contrast to community traditions, with women making an effort to engage in traditional practices. The sexualization of breasts in mainstream society sometimes influenced Indigenous mothers’ infant feeding experiences [ 36 ], although Ojibwe caregivers in Minnesota attributed shyness with breastfeeding to traditional value opposed to sexualization of breasts [ 30 ]. Eni et al. [ 36 ] included sexual objectification of the feminine body as a subtheme in their study, describing how this social perception damages maternal mental health, creating a barrier to breastfeeding. While shifting social norms is a significant challenge, breastfeeding supports can address concerns about the sexual objectification of breasts by creating safe spaces for parents to talk about the challenges and ensure that parents have access to mental health resources.

Theme four: family

Dodgson et al. [ 30 ] described family as a pattern that influences breastfeeding intersecting with the social structures of the community, culture, and the broader society. There were 33 other papers that described the influence of family on infant feeding practices making this the most discussed theme (Fig. 6 ) [ 30 , 31 , 32 , 33 , 36 , 38 , 39 , 40 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 53 , 54 , 55 , 57 , 58 , 59 , 60 , 61 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. Native American mothers living in six communities highlighted the importance of family as a key theme [ 47 ]. One mother shared, “For me, it’s my mom definitely [whose advice is most important] because she has had three kids and I lived with her or near her for all of my kids. So I’ve always gone to her first for advice.” This was echoed by many other participants with a paraprofessional adding, “family [advice is most important], because they are around their family most. And they always hear from their aunties, or from grandma, baby’s fussing, baby must be hungry, baby needs this and baby needs that.” The Baby Basket Program in Cape York, Australia identified that empowering families was the foundation of the program to ensure that mothers and their partners were equipped for the arrival of their babies [ 50 ]. Family often plays an integral role in supporting mothers in infant feeding practices. Bauer and Wright [ 45 ] note that even when mothers don’t have other supports or conditions in place to support breastfeeding, they may still choose to breastfeed if their family is supportive. However, when this support is lacking, mothers find it challenging to breastfeed [ 31 , 36 ]. Some studies identified the significance of family in the study design, integrating family caregiver perspectives in data collection [ 64 , 65 ]. Therefore, health programs and research studies should consider the role and experience of non-primary caregivers within family networks for infant and maternal health and nutrition.

Theme five: professional influences

This theme represents the influence of formal systems including healthcare professionals, health and social programs, child services, and the legal system. In total, there were 26 papers that referenced professional influences on infant feeding experiences (Fig. 6 ) [ 30 , 31 , 33 , 38 , 41 , 42 , 43 , 45 , 47 , 48 , 50 , 51 , 52 , 54 , 58 , 59 , 61 , 62 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. Some studies incorporate health workers as participants in data collection [ 47 , 50 , 65 ]. One health paraprofessional shares about some of the pressures experienced by mothers to formula feed, “sometimes hospitals and doctors want to push formula in bottles on moms [ 47 ].” One of the main themes in a study with Sioux and Assiniboine Nations in the US was the ‘ Overburdened Healthcare System’ , describing a lack of resources and infrastructure to support breastfeeding, including a subtheme of mistrust in the healthcare system due to previous negative experiences such as forced sterilization of Indigenous women [ 65 ]. However, some caregivers also expressed positive healthcare supports, “when I was at home, [clinic midwife] and [lactation consultant made home visits] … they encouraged me … And then it started getting a little bit better, but it was still a bit hard. Now he feeds pretty all right [ 73 ].” Professional influences on infant feeding are nuanced and may differ significantly within various contexts and individuals; therefore, tailored interventions are needed.

Theme six: environment

This theme represents the external variables within the built environment that influence decision making including work, school, remoteness, and cost of formula. Eighteen papers addressed this theme [ 30 , 31 , 44 , 45 , 46 , 47 , 48 , 49 , 51 , 53 , 58 , 59 , 66 , 67 , 68 , 70 , 71 , 72 ]. Wright et al. [ 74 ] specifically considered the challenge of breastfeeding with maternal employment among the Navajo population in the US. In Bauer and Wright’s [ 45 ] study that explored infant feeding decision models, they identified that work and school are part of the decision-making process on whether to breastfeeding or to use formula, but even when these environmental challenges are present they can be further influenced by other factors, like family . For example, a mother may choose to breastfeed and use a breast pump to navigate work/school schedules, but family members may recommend that they can incorporate formula; decision-making is not only about the main caregiver’s desires but can involve various decision-makers.

Theme seven: autonomy

This theme describes parents’ freedom to make infant feeding decisions that fit for them and their priorities. Maternal desire to breast- or bottle-feed was discussed in select papers in this review [ 45 , 51 ]. In addition, other papers describe parents’ freedom to do activities outside of infant feeding in the early months of baby’s life with discussion of time required to breastfeed or prepare bottles for feeding [ 31 , 58 , 72 , 74 ]. A key informant in a study with an Aboriginal community in Northern New South Wales, Australia, shares, “they want to breastfeed, but then it comes down to when they want to go out, or keep up with their man [ 32 ].” Some parents report that they experienced judgements from others or feel forced into making a specific decision on infant feeding method, highlighting a desire to have support and freedom to make their own decisions [ 36 , 56 ].

Theme eight: infant feeding knowledge

Several studies emphasize the importance of knowledge on infant feeding experiences, highlighting the value of infant feeding education, both within the overall healthcare system and from traditional teachings [ 30 , 32 , 35 , 40 , 42 , 43 , 47 , 52 , 57 , 58 , 62 , 64 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ]. Within the theme of addressing feeding challenges in one study [ 66 ], a caregiver shared how knowledge helped her to work through a challenge,

“He did start fussing at about 6 weeks and that was kind of hard because I thought, ‘No, I have got this perfect now, and he has started to muck up’. But then I read, because I had those booklets and I read that sometimes they — at a certain point — they get a bit fussy and you just have to work through it. [Ml7]” [ 66 ].

Traditional breastfeeding knowledge is important for many communities; one Anishinaabe community knowledge keeper shared that “breast milk is a gift and a medicine a mother gives her child” [ 35 ]. This study also discusses feeding patterns as shared by Elders and traditional teachers. Traditional knowledge considers holistic perspectives of health where caregivers are also focused on the baby’s spiritual wellbeing [ 48 , 56 ].

Theme nine: milk substitutes

Bottle feeding (formula or canned milk) and solid foods are described in several papers as alternatives or complements to breastfeeding [ 31 , 33 , 34 , 37 , 39 , 47 , 48 , 49 , 51 , 52 , 53 , 58 , 66 , 67 , 74 , 75 ]. In Neander and Morse’s [ 37 ] study with a Cree community in Alberta, Canada, bottle feedings were offered particularly when mothers felt that they were not producing adequate milk supply to meet the baby’s nutritional needs. Insufficient milk supply is echoed as a concern in several other papers resulting in complementary bottle feeding or weaning [ 48 , 51 , 56 , 66 , 67 ]. A Māori father shares,

“about the second week, baby just wanted more food. She (partner) would end her day and baby was just hungry. We had to [give her] the bottle and then she would be finally satisfied. It wasn’t that she made a choice. Baby was actually demanding more and more and she couldn’t produce it. (First-time father, mid 20’s) [ 56 ].”

This theme particularly overlaps with autonomy as parents balance infant feeding decisions with breastmilk supply, work, school, and other personal commitments.

Theme ten: cultural safety

Indigenous caregivers interact with a variety of health services postnatally; however, there is a need to address cultural safety within the healthcare system. Twelve retained papers highlighted this theme either directly as one of their themes or as part of another theme (Fig. 6 ) [ 30 , 31 , 44 , 47 , 50 , 64 , 66 , 67 , 69 , 71 , 73 , 74 ]. One health worker in Victoria, Australia, shared,

“I can’t say often enough or long enough, loud enough the ideal for children 0–8 is to have access to maternal and child health. You might say ‘oh yes, they’ve got access to mainstream and they’re culturally going to put up a few Indigenous prints in their rooms’ It’s not the same. Our families are telling us with their feet it’s not the same.”

Mothers expressed a desire for more traditional infant feeding knowledge within services and culturally relevant supports [ 47 , 64 ]. A study that focused on a baby basket program to support families in a Murri (Local Australian Aboriginal Group) Way identified how important culturally safe language and relationships are for families,

“…the nurse is also learning what the best way is to approach a family and what the wording has to be, what the languaging is around things, what the traditional words are for Indigenous language and are appropriate for use in certain circumstances” [ 50 ].

Theme eleven: survivance

Indigenous caregivers experience a variety of hardships; however, through resistance and survival, they practice cultural revitalization [ 76 ]. This theme is discussed in 15 papers and is often described through a lens of maternal mental health (Fig. 6 ) [ 30 , 31 , 33 , 43 , 53 , 54 , 57 , 58 , 59 , 63 , 64 , 66 , 68 , 36 , 74 ]. Some parents express feelings of guilt for the challenges they encounter, which can further contribute to negative emotions [ 58 ]. Maternal mental and emotional health can impact infant feeding experiences,

“…sometimes people’s psychological health, mental health is more of a risk factor, you know if you’re not sleeping and you’re bordering on depression and you’re not coping well and you can’t get the baby to latch and you’re constantly feeling like a failure and you can’t get out of that rut, is it worth it?…People have to decide that for themselves. (Key Informant #5)” [ 33 ].

A grandmother in the Northwest Territories of Canada noted the disembodiment caused by residential schools as expressed as a disconnection between physical experiences and relationships,

“You know in those days, I mean residential school. In those days, they never did talk about their body parts because I think they were too ashamed [of your body] to say to your kids. I never did hear it [breastfeeding] from my sisters or nobody in the family. They were so private (L151-156)” [ 57 ].

Traumatic experiences, like residential schools, can have a lasting impact on how caregivers navigate motherhood and infant feeding, and the support they receive from family members.

Theme twelve: establishing breastfeeding

There are several practical challenges that mothers encounter while breastfeeding like pain, latching issues, and low milk supply, discussed in 11 of the studies (Fig. 6 ) [ 48 , 51 , 54 , 56 , 58 , 61 , 66 , 68 , 71 , 72 ]. A mother shared,

“He wouldn’t latch on all the time, like, the nurses and stuff tried to help me but then it would be all frustrating…. He didn’t really know what to do. He tried and then they gave him formula. He really loved it. [MI5]” [ 66 ].

Although these challenges are most discussed at the beginning of breastfeeding, sometimes concerns arise when babies are older.

“Yeah it was 8 or 9 months after she was born. After a while there was too much pressure on me. She was getting up all through the night and she would eat and eat and eat and not get full…” [ 33 ].

Overall, many caregivers reported that breastfeeding is difficult; therefore, supports that consider the variety of challenges that can arise are needed.

Study recommendations

The studies included in this review were published over three decades starting in 1984 until 2019 and were completed with various Indigenous communities in four countries. We anticipated that earlier work would demonstrate markedly different infant feeding recommendations than more recent research; however, this was not necessarily the case. For example, cultural safety is a more recent discussion within the health literature; however, although we see some discussion of this in more recent studies, studies in the 80’s and 90’s also highlight the importance of incorporating traditional teaching and consulting community members [ 37 , 48 ]. Therefore, supporting Indigenous self-determination where health professionals provide culturally appropriate care is essential.

In addition to topics related to cultural safety, various studies highlight a need for community-driven and local knowledge to inform programs and policies related to infant nutrition [ 31 , 47 , 57 , 64 , 75 ]. Several studies also focus on infant feeding specific programs and behavioral changes in their recommendations [ 47 , 50 , 65 ]; however, many of these studies also highlight the need to expand beyond the individual’s role in decision making and address the broader social and environmental factors such as the workplace, healthcare infrastructure, social perceptions, among others, that influence infant feeding decisions. For example, Eni et al. [ 36 ] note that there are a complexity of factors resulting in various breastfeeding environments. These structural, social and cultural contexts are discussed throughout several of the grey literature texts as well [ 32 , 33 ]. It is also important to note that in the most recently published database paper, maternal mental health is directly addressed in the recommendations and this is the only paper with this focus for next steps [ 65 ]. Interventions that target socio-ecological factors based on the included papers’ recommendations for infant feeding are summarized in Fig. 7 .

(Adapted from Rollins et al. 2016)

The components of Indigenous infant feeding environments informed by community-based interventions

This scoping review presents and summarizes the findings reporting Indigenous infant feeding experiences within the qualitative literature in Canada, the US, Australia, and Aotearoa. Twelve themes were identified which summarize the literature including culture and traditionality , colonization, family, environment, social perceptions, professional influences, milk substitutes, breastfeeding initiation, cultural safety, survivance, infant feeding knowledge, and autonomy. The most prevalent themes discussed by caregivers and researchers in the included papers were family and culture/traditionality . The frequency of these two themes highlight the significant impact of family and culture/traditionality on infant nutrition decision-making for Indigenous caregivers and overlaps with components of the socio-ecological model [ 77 ]. This focus on family and culture/traditionality also emphasizes the importance of familial relationships and a collective mentality within traditional life ways for many Indigenous communities in these regions on infant nutrition and care practices.

In their informative global breastfeeding paper, Rollins and colleagues’ [ 1 ] conceptualize the components that contribute to the breastfeeding environment at multiple levels, overlapping with the social determinants of health. In this review, we observed that caregivers report similar components of the breastfeeding environment; however, these components seem to be described collectively, rather than as separate contexts. This is evident in the recommendations proposed by authors with a large focus on local and community-specific leadership, multidisciplinary interventions, and cultural safety in response to historical traumas, particularly within the healthcare system (Fig. 7 ). This aligns with Indigenous epistemology with an emphasis on the collective and interconnectedness of all things where power is manifested together, not over one another, and is based in local land-based knowledge [ 78 , 79 ].

A primary recommendation echoed within many of these studies was the need for community engagement in program and policy development [ 34 , 47 , 50 , 64 ]. This may need to be expanded upon to support Indigenous self-determination of policy and programs related to infant feeding where community members are not only engaged but leading the way forward in maternal and infant health. It is important to note that there have been changes over time in how these recommendations and perspectives are discussed and the role of the health professional, particularly related to cultural safety. For example, although similar concepts are discussed in Neander and Morse’s paper published in 1989, ‘cultural safety’ is not used as the terminology, which has been expanded upon in recent years by Indigenous and non-Indigenous scholars [ 37 , 80 , 81 ].

Related to this focus on health professionals and cultural safety, it’s important to distinguish that in many of the positive experiences expressed by participants in the studies, these interactions seemed to be primarily with professionals interacting closely with families. For example, midwives, who make home visits, were often included as part of positive experiences. In the literature, there is an emphasis on including practitioners who can build strong relationships with families through home visits and regular community engagement in routine services, which supports cultural safety within the healthcare system [ 82 , 83 ]. Health professional regulatory bodies should consider implementing practice competencies that support professionals to build and navigate strong and ethical relationships with clients/patients. Similarly, healthcare settings that serve Indigenous peoples should consider processes and therefore, facility infrastructures that enable close family-client-professional interactions. An example of this implementation with positive client experiences is the Toronto Birthing Centre, which uses an Indigenous framework and has birthing rooms with space for family [ 84 ].

The studies in this review are written within various fields of research; therefore, there were differences in methodological reporting. Future qualitative work should be thorough in reporting theoretical foundations to provide clarity of how the analyses and overall projects are approached (Fig. 4 ) [ 85 ]. Given the limited studies that report author/researcher positionality (Fig. 2 ), this may be an important addition in forthcoming work as a means of respecting Indigenous and qualitative literature conventions where we recognize that positionality influences ontological origins [ 86 ]. We challenge the academy to recognize that Indigenous and local knowledges are required within Indigenous health research and dissemination practices, while acknowledging our own limitation in this review of a single country authorship team.

This systematic scoping review utilized a rigorous search strategy that limited the possibility of missing relevant publications; however, it was time intensive. PRISMA-ScR guidelines were followed with two independent reviewers at each stage, enabling reproducibility of this review. The inclusion of the grey literature is a strength in this study as it captured important papers that were not published in peer-reviewed journals, often from Indigenous authors and communities (many of which were graduate dissertations), which was a priority in this review. A possible limitation is the exclusion of work that only discussed the introduction to solid foods; it is possible that this excluded an important conversation about the differences of introducing solids, like traditional foods from an Indigenous group’s perspective. In addition, the topic of this review is multidisciplinary; therefore, it is possible that although effort was made to include a broad range of research field databases in the search, relevant sources may have been missed.

In conclusion, this scoping review highlights important considerations for infant feeding environments within Indigenous communities with a focus on family and culture. Based on caregiver experiences, Indigenous breastfeeding supports must be community led with a focus on local capacity and traditional teachings. An emphasis on an intergenerational perspective that considers structural and systems approaches including cultural safety within healthcare, addressing maternal mental health, and consideration of sustainability over time is encouraged. Future work should focus on these key areas through strength-based research approaches, grounded in strong relationships and long-term follow-up.

Data availability

All data generated or analysed during this study are available from the corresponding author on reasonable request.

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Acknowledgements

We wish to acknowledge the important contribution of Halima Abubakar in the review process. Given the knowledge specific to Indigenous communities discussed in this scoping review and out of respect for Indigenous research conventions, the authors position themselves within the research to explain the lens from which they approach and understand the research process. TG and AH are non-Indigenous scholars and faculty members based at the University of Toronto, which rests on lands that are the traditional home of the Huron-Wendat, the Seneca, and the Mississaugas of the Credit. All other authors have had student or supporting roles throughout this work and situate themselves as follows: HM is a settler of Scottish, Irish, French, German, and English ancestry residing in Haudenosaunee and Anishinaabe territory, which is part of the dish with one spoon agreement; CC is a settler living in Treaty 7 Territory, with ancestral roots in Germany, Scotland, and the Ukraine; AS is an Odawa Kwe from Wikwemikong, Manitoulin Island, Ontario. Currently, residing in the Tiohtià:ke in Kanien’kéha unceded territory; and HS is living in Treaty 13 territory with ancestral roots in Afghanistan. The remaining co-authors identify as non-Indigenous scholars.

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As the first author, HM conceptualized this work and provided leadership throughout. She participated in every aspect of this review, wrote the initial manuscript, and completed revisions. CC contributed to the screening and full text review of this work. She also contributed to the analysis, and the writing and review of the manuscript. TG supported the protocol of this review and provided guidance throughout analysis. She also contributed to the final manuscript. HS supported screening and full text review. She also provided edits for the manuscript. AS provided feedback on the analysis for this review and contributed to the writing of the manuscript. CL supported screening of papers and provided edits to the final manuscript. AH provided guidance throughout the duration of this review, supported decision making, and provided edits on the manuscript. All authors approved the final manuscript.

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Monteith, H., Checholik, C., Galloway, T. et al. Infant feeding experiences among Indigenous communities in Canada, the United States, Australia, and Aotearoa: a scoping review of the qualitative literature. BMC Public Health 24 , 1583 (2024). https://doi.org/10.1186/s12889-024-19060-1

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v.56(1); 2023 Jan

Qualitative Research in Healthcare: Necessity and Characteristics

1 Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

2 Ulsan Metropolitan City Public Health Policy’s Institute, Ulsan, Korea

3 Department of Nursing, Chung-Ang University, Seoul, Korea

Eun Young Choi

4 College of Nursing, Sungshin Women’s University, Seoul, Korea

Seung Gyeong Jang

5 Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea

Quantitative and qualitative research explore various social phenomena using different methods. However, there has been a tendency to treat quantitative studies using complicated statistical techniques as more scientific and superior, whereas relatively few qualitative studies have been conducted in the medical and healthcare fields. This review aimed to provide a proper understanding of qualitative research. This review examined the characteristics of quantitative and qualitative research to help researchers select the appropriate qualitative research methodology. Qualitative research is applicable in following cases: (1) when an exploratory approach is required on a topic that is not well known, (2) when something cannot be explained fully with quantitative research, (3) when it is necessary to newly present a specific view on a research topic that is difficult to explain with existing views, (4) when it is inappropriate to present the rationale or theoretical proposition for designing hypotheses, as in quantitative research, and (5) when conducting research that requires detailed descriptive writing with literary expressions. Qualitative research is conducted in the following order: (1) selection of a research topic and question, (2) selection of a theoretical framework and methods, (3) literature analysis, (4) selection of the research participants and data collection methods, (5) data analysis and description of findings, and (6) research validation. This review can contribute to the more active use of qualitative research in healthcare, and the findings are expected to instill a proper understanding of qualitative research in researchers who review qualitative research reports and papers.

Graphical abstract

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INTRODUCTION

The definition of research varies among studies and scholars, and it is difficult to devise a single definition. The Oxford English Dictionary defines research as “a careful study of a subject, especially in order to discover new facts or information about it” [ 1 ], while Webster’s Dictionary defines research as “studious inquiry or examination - especially: investigation or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or laws in the light of new facts, or practical application of such new or revised theories or laws” [ 2 ]. Moreover, research is broadly defined as the process of solving unsolved problems to broaden human knowledge [ 3 ]. A more thorough understanding of research can be gained by examining its types and reasons for conducting it.

The reasons for conducting research may include practical goals, such as degree attainment, job promotion, and financial profit. Research may be based on one’s own academic curiosity or aspiration or guided by professors or other supervisors. Academic research aims can be further divided into the following: (1) accurately describing an object or phenomenon, (2) identifying general laws and establishing well-designed theories for understanding and explaining a certain phenomenon, (3) predicting future events based on laws and theories, and (4) manipulating causes and conditions to induce or prevent a phenomenon [ 3 ].

The appropriate type of research must be selected based on the purpose and topic. Basic research has the primary purpose of expanding the existing knowledge base through new discoveries, while applied research aims to solve a real problem. Descriptive research attempts to factually present comparisons and interpretations of findings based on analyses of the characteristics, progression, or relationships of a certain phenomenon by manipulating the variables or controlling the conditions. Experimental or analytical research attempts to identify causal relationships between variables through experiments by arbitrarily manipulating the variables or controlling the conditions [ 3 ]. In addition, research can be quantitative or qualitative, depending on the data collection and analytical methods. Quantitative research relies on statistical analyses of quantitative data obtained primarily through investigation and experiment, while qualitative research uses specific methodologies to analyze qualitative data obtained through participant observations and in-depth interviews. However, as these types of research are not polar opposites and the criteria for classifying research types are unclear, there is some degree of methodological overlap.

What is more important than differentiating types of research is identifying the appropriate type of research to gain a better understanding of specific questions and improve problems encountered by people in life. An appropriate research type or methodology is essential to apply findings reliably. However, quantitative research based on the philosophical ideas of empiricism and positivism has been the mainstay in the field of healthcare, with academic advancement achieved through the application of various statistical techniques to quantitative data [ 4 ]. In particular, there has been a tendency to treat complicated statistical techniques as more scientific and superior, with few qualitative studies in not only clinical medicine, but also primary care and social medicine, which are relatively strongly influenced by the social sciences [ 5 , 6 ].

Quantitative and qualitative research use different ways of exploring various social phenomena. Both research methodologies can be applied individually or in combination based on the research topic, with mixed quantitative and qualitative research methodologies becoming more widespread in recent years [ 7 ]. Applying these 2 methods through a virtuous cycle of integration from a complementary perspective can provide a more accurate understanding of human phenomena and solutions to real-world problems.

This review aimed to provide a proper understanding of qualitative research to assist researchers in selecting the appropriate research methodology. Specifically, this review examined the characteristics of quantitative and qualitative research, the applicability of qualitative research, and the data sources collected and analyzed in qualitative research.

COMPARISON OF QUALITATIVE AND QUANTITATIVE RESEARCH

A clearer understanding of qualitative research can be obtained by comparing qualitative and quantitative research, with which people are generally familiar [ 8 , 9 ]. Quantitative research focuses on testing the validity of hypotheses established by the researcher to identify the causal relationships of a specific phenomenon and discovering laws to predict that phenomenon ( Table 1 ). Therefore, it emphasizes controlling the influence of variables that may interfere with the process of identifying causality and laws. In contrast, qualitative research aims to discover and explore new hypotheses or theories based on a deep understanding of the meaning of a specific phenomenon. As such, qualitative research attempts to accept various environmental factors naturally. In quantitative research, importance is placed on the researcher acting as an outsider to take an objective view by keeping a certain distance from the research subject. In contrast, qualitative research encourages looking inside the research subjects to understand them deeply, while also emphasizing the need for researchers to take an intersubjective view that is formed and shared based on a mutual understanding with the research subjects.

Comparison of methodological characteristics between quantitative research and qualitative research

Characteristics	Quantitative research	Qualitative research
Research purpose	Test the validity of the hypotheses established by the researcher to identify the causal relationships and laws of the phenomenon and predict the phenomenon	Discover and explore new hypotheses or theories based on a deep understanding of the meaning of the phenomenon
Perspective on variables	View factors other than the variables of interest as factors to be controlled and minimize the influence of confounding factors	View factors as natural and accept assessments in a natural environment
Research view	Objective, outsider view	Intersubjective, insider view
Data used	Quantifiable, measurable data	Narrative data that can be expressed by words, images and so on
Data collection method	Primarily questionnaire surveys or tests	Primarily participant observation, in-depth interviews, and focus group discussions
Nature of data and depth of analysis	Focus on superficial aspects of the phenomenon by using reliable data obtained through repeated measurements	The aim is to identify the specific contents, dynamics, and processes inherent within the phenomenon and situation using deep and rich data
Strengths and weaknesses	High reliability and generalizability	High validity
Strengths and weaknesses	Difficulties with in-depth analysis of dynamic phenomena that cannot be expressed by numbers alone; difficulties in interpreting the results analyzed by numbers	Weak generalizability; interjection of subjectivity of the researcher is inevitable

The data used in quantitative research can be expressed as numerical values, and data accumulated through questionnaire surveys and tests are often used in analyses. In contrast, qualitative research uses narrative data with words and images collected through participant observations, in-depth interviews, and focus group discussions used in the analyses. Quantitative research data are measured repeatedly to enhance their reliability, while the analyses of such data focus on superficial aspects of the phenomenon of interest. Qualitative research instead focuses on obtaining deep and rich data and aims to identify the specific contents, dynamics, and processes inherent within the phenomenon and situation.

There are clear distinctions in the advantages, disadvantages, and goals of quantitative and qualitative research. On one hand, quantitative research has the advantages of reliability and generalizability of the findings, and advances in data collection and analysis methods have increased reliability and generalizability. However, quantitative research presents difficulties with an in-depth analysis of dynamic phenomena that cannot be expressed by numbers alone and interpreting the results analyzed in terms numbers. On the other hand, qualitative research has the advantage of validity, which refers to how accurately or appropriately a phenomenon was measured. However, qualitative research also has the disadvantage of weak generalizability, which determines whether an observed phenomenon applies to other cases.

APPLICATIONS OF QUALITATIVE RESEARCH AND ITS USEFULNESS IN THE HEALTHCARE FIELD

Qualitative research cannot be the solution to all problems. A specific methodology should not be applied to all situations. Therefore, researchers need to have a good understanding of the applicability of qualitative research. Generally, qualitative research is applicable in following cases: (1) when an exploratory approach is required on a topic that is not well known, (2) when something cannot be explained fully with quantitative research, (3) when it is necessary to newly present a specific view on a research topic that is difficult to explain with existing views, (4) when it is inappropriate to present the rationale or theoretical proposition for designing hypotheses, as in quantitative research, and (5) when conducting research that requires detailed descriptive writing with literary expressions [ 7 ]. In particular, qualitative research is useful for opening new fields of research, such as important topics that have not been previously examined or whose significance has not been recognized. Moreover, qualitative research is advantageous for examining known topics from a fresh perspective.

In the healthcare field, qualitative research is conducted on various topics considering its characteristics and strengths. Quantitative research, which focuses on hypothesis validation, such as the superiority of specific treatments or the effectiveness of specific policies, and the generalization of findings, has been the primary research methodology in the field of healthcare. Qualitative research has been mostly applied for studies such as subjective disease experiences and attitudes with respect to health-related patient quality of life [ 10 - 12 ], experiences and perceptions regarding the use of healthcare services [ 13 - 15 ], and assessments of the quality of care [ 16 , 17 ]. Moreover, qualitative research has focused on vulnerable populations, such as the elderly, children, disabled [ 18 - 20 ], minorities, and socially underprivileged with specific experiences [ 21 , 22 ].

For instance, patient safety is considered a pillar of quality of care, which is an aspect of healthcare with increasing international interest. The ultimate goal of patient safety research should be the improvement of patient safety, for which it is necessary to identify the root causes of potential errors and adverse events. In such cases, qualitative rather than quantitative research is often required. It is also important to identify whether there are any barriers when applying measures for enhancing patient safety to clinical practice. To identify such barriers, qualitative research is necessary to observe healthcare workers directly applying the solutions step-by-step during each process, determine whether there are difficulties in applying the solutions to relevant stakeholders, and ask how to improve the process if there are difficulties.

Patient safety is a very broad topic, and patient safety issues could be categorized into preventing, recognizing, and responding to patient safety issues based on related metrics [ 23 ]. Responding to issues that pertain to the handling of patient safety incidents that have already occurred has received relatively less interest than other categories of research on this topic, particularly in Korea. Until 2017, almost no research was conducted on the experiences of and difficulties faced by patients and healthcare workers who have been involved in patient safety incidents. This topic can be investigated using qualitative research.

A study in Korea investigated the physical and mental suffering experienced during the process of accepting disability and medical litigation by a patient who became disabled due to medical malpractice [ 21 ]. Another qualitative case study was conducted with participants who lost a family member due to a medical accident and identified psychological suffering due to the incident, as well as secondary psychological suffering during the medical litigation process, which increased the expandability of qualitative research findings [ 24 ]. A quantitative study based on these findings confirmed that people who experienced patient safety incidents had negative responses after the incidents and a high likelihood of sleep or eating disorders, depending on their responses [ 25 ].

A study that applied the grounded theory to examine the second victim phenomenon, referring to healthcare workers who have experienced patient safety incidents, and presented the response stages experienced by second victims demonstrated the strength of qualitative research [ 26 ]. Subsequently, other studies used questionnaire surveys on physicians and nurses to quantify the physical, mental, and work-related difficulties experienced by second victims [ 27 , 28 ]. As such, qualitative research alone can produce significant findings; however, combining quantitative and qualitative research produces a synergistic effect. In the healthcare field, which remains unfamiliar with qualitative research, combining these 2 methodologies could both enhance the validity of research findings and facilitate open discussions with other researchers [ 29 ].

In addition, qualitative research has been used for diverse sub-topics, including the experiences of patients and guardians with respect to various diseases (such as cancer, myocardial infarction, chronic obstructive pulmonary disease, depression, falls, and dementia), awareness of treatment for diabetes and hypertension, the experiences of physicians and nurses when they come in contact with medical staff, awareness of community health environments, experiences of medical service utilization by the general public in medically vulnerable areas, the general public’s awareness of vaccination policies, the health issues of people with special types of employment (such as delivery and call center workers), and the unmet healthcare needs of persons with vision or hearing impairment.

GENERAL WORKFLOW OF QUALITATIVE RESEARCH

Rather than focusing on deriving objective information, qualitative research aims to discern the quality of a specific phenomenon, obtaining answers to “why” and “how” questions. Qualitative research aims to collect data multi-dimensionally and provide in-depth explanations of the phenomenon being researched. Ultimately, the purpose of qualitative research is set to help researchers gain an understanding of the research topic and reveal the implications of the research findings. Therefore, qualitative research is generally conducted in the following order: (1) selection of a research topic and question, (2) selection of a theoretical framework and methods, (3) literature analysis, (4) selection of the research participants (or participation target) and data collection methods, (5) data analysis and description of findings, and (6) research validation ( Figure 1 ) [ 30 ]. However, unlike quantitative research, in which hypothesis setting and testing take place unidirectionally, a major characteristic of qualitative research is that the process is reversible and research methods can be modified. In other words, the research topic and question could change during the literature analysis process, and theoretical and analytical methods could change during the data collection process.

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General workflow of qualitative research.

Selection of a Research Topic and Question

As with any research, the first step in qualitative research is the selection of a research topic and question. Qualitative researchers can select a research topic based on their interests from daily life as a researcher, their interests in issues within the healthcare field, and ideas from the literature, such as academic journals. The research question represents a more specific aspect of the research topic. Before specifically starting to conduct research based on a research topic, the researcher should clarify what is being researched and determine what research would be desirable. When selecting a research topic and question, the research should ask: is the research executable, are the research topic and question worth researching, and is this a research question that a researcher would want to research?

Selection of Theoretical Framework and Methods

A theoretical framework refers to the thoughts or attitudes that a researcher has about the phenomenon being researched. Selecting the theoretical framework first could help qualitative researchers not only in selecting the research purpose and problem, but also in carrying out various processes, including an exploration of the precedent literature and research, selection of the data type to be collected, data analysis, and description of findings. In qualitative research, theoretical frameworks are based on philosophical ideas, which affect the selection of specific qualitative research methods. Representative qualitative research methods include the grounded theory, which is suitable for achieving the goal of developing a theory that can explain the processes involved in the phenomenon being researched; ethnographic study, which is suitable for research topics that attempt to identify and interpret the culture of a specific group; phenomenology, which is suitable for research topics that attempt to identify the nature of research participants’ experiences or the phenomenon being researched; case studies, which aim to gain an in-depth understanding of a case that has unique characteristics and can be differentiated from other cases; action research, which aims to find solutions to problems faced by research participants, with the researchers taking the same position as the participants; and narrative research, which is suitable for research topics that attempt to interpret the entire life or individual experiences contained within the stories of research participants. Other methodologies include photovoice research, consensual qualitative research, and auto-ethnographic research.

Literature Analysis

Literature analysis results can be helpful in specifically selecting the research problem, theoretical framework, and research methods. The literature analysis process compels qualitative researchers to contemplate the new knowledge that their research will add to the academic field. A comprehensive literature analysis is encouraged both in qualitative and quantitative research, and if the prior literature related to the subject to be studied is insufficient, it is sometimes evaluated as having low research potential or research value. Some have claimed that a formal literature review should not be performed before the collection of field data, as it could create bias, thereby interfering with the investigation. However, as the qualitative research process is cyclic rather than unidirectional, the majority believes that a literature review can be performed at any time. Moreover, an ethical review prior to starting the research is a requirement; therefore, the research protocol must be prepared and submitted for review and approval prior to conducting the research. To prepare research protocols, the existing literature must be analyzed at least to a certain degree. Nonetheless, qualitative researchers must keep in mind that their emotions, bias, and expectations may interject themselves during the literature review process and should strive to minimize any bias to ensure the validity of the research.

Selection of the Research Participants and Data Collection Methods

The subjects of qualitative research are not necessarily humans. It is more important to find the research subject(s) from which the most in-depth answers to the research problem can be obtained. However, the subjects in most qualitative studies are humans, as most research question focus on humans. Therefore, it is important to obtain research participants with sufficient knowledge, experience, and attitudes to provide the most appropriate answers to the research question. Quantitative research, which views generalizability as a key research goal, emphasizes the selection of research participants (i.e., the research sample that can represent the study’s population of interest), whereas qualitative research emphasizes finding research participants who can best describe and demonstrate the phenomenon of interest.

In qualitative research, the participant selection method is referred to as purposeful sampling (or purposive sampling), which can be divided into various types. Sampling methods have various advantages, disadvantages, and characteristics. For instance, unique sampling (extreme case sampling) has the advantage of being able to obtain interesting research findings by researching phenomena that have previously received little or no interest, and the disadvantage of deriving research findings that are interesting to only some readers if the research is conducted on an overly unique situation. Maximum variation sampling, also referred to as theoretical sampling, is commonly used in qualitative research based on the grounded theory. Selecting the appropriate participant sampling method that suits the purpose of research is crucial ( Table 2 ).

Sampling methods of selecting research participants in qualitative research

Sampling method	Explanation
Typical sampling	Selecting the most typical environment and people for the research topic
Unique sampling (extreme case sampling)	Selecting unique and uncommon situations or subjects who satisfy the research purpose
Maximum variation sampling	Selecting subjects showing maximum variation with a target population
Convenience sampling	Selecting subjects who can be sampled most conveniently considering practical limitations, such as funding, time, and location
Snowballing sampling	Selecting key research participants who satisfy the criteria established by the researcher and using their recommendations to recruit additional research participants

Once the researcher has decided how to select study participants, the data collection methods must be determined. Just as with participant sampling, various data collection methods are available, all of which have various advantages and disadvantages; therefore, the method must be selected based on the research question and circumstances. Unlike quantitative research, which usually uses a single data source and data collection method, the use of multiple data sources and data collection methods is encouraged in qualitative research [ 30 ]. Using a single data source and data collection method could cause data collection to be skewed by researcher bias; therefore, using multiple data sources and data collection methods is ideal. In qualitative research, the following data types are commonly used: (1) interview data obtained through one-on-one in-depth interviews and focus group discussions, (2) observational data from various observation levels, (3) documented data collected from personal or public documents, and (4) image data, such as photographs and videos.

Interview data are the most commonly used data source in qualitative research [ 31 ]. In qualitative research, an interview refers to communication that takes place based on a clear sense of purpose of acquiring certain information, unlike conversations that typically take place in daily life. The level of data acquired through interviews varies significantly depending on the researcher’s personal qualifications and abilities, as well as his or her level of interest and knowledge regarding the research topic. Therefore, interviewers must be trained to go beyond simply identifying the clearly expressed experiences of research participants to exploring their inner experiences and emotions [ 32 ]. Interview data can be classified based on the level of structuralization of the data collection method, sample size, and interview method. The characteristics of each type of interview are given in Table 3 .

Detailed types of interview methods according to the characteristics of in-depth interviews and focus group discussion

Classification	Specific method	Characteristics
Level of structuralization	Structured interview	Data are collected by asking closed questions in the order provided by highly specific interview guidelines
		Useful for asking questions without omitting any details that should be checked with each research participant
		Leaves little room for different interpretations of the participant’s responses or expressing original thoughts
	Semi-structured interview	Between a structured and unstructured interview; interview guidelines are developed in advance, but the questions are not strictly set and may vary
		The most widely used data collection method in qualitative research, as it allows interviews to be conducted flexibly depending on the characteristics and responses of the participants
		Researcher bias may influence the interview process
	Unstructured interview	The interview is conducted like a regular conversation, with extremely minimal prior information about the research topic and adherence to interview guidelines to exclude the intention for acquiring information needed for the research
		Can obtain rich and realistic meaning and experiences of the research participants
		The quality of information acquired and length (duration) of interview may vary depending on the competency of the interviewer, such as conversational skills and reasoning ability
Sample size	One-on-one in-depth interview	Excluding cases in which a guardian must accompany the research participant, such elderly or frail patients and children, a single participant discusses the research topic with one to two researchers during each interview session
		This data collection method is recommended for research topics that are difficult to discuss with others and suitable for obtaining in-depth opinions and experiences from individual participants
		The range of information that can be acquired may vary depending on the conversational skills and interview experience of the interviewer and requires a relatively large amount of effort to collect sufficient data
	Focus group discussion	At least 2 (generally 4–8) participants discuss the research topic during each interview session led by the researcher
		This method is effective when conducting interviews with participants who may be more willing to open up about themselves in a group setting than when alone, such as children and adolescents
		Richer experiences and opinions can be derived by promoting interaction within the group
		While it can be an effective data collection method, there may be some limitations in the depth of the interview; some participants may feel left out or not share their opinion if 1 or 2 participants dominate the discussion
Interview method	Face-to-face	The interviewer personally meets with the research participant to conduct the interview
		It is relatively easy to build rapport between the research participant and interviewer; can respond properly to the interview process by identifying non-verbal messages
		Cannot conduct interviews with research participants who are difficult to meet face-to-face
	Non-face-to-face	Interview between the interviewer and research participant is conducted through telephone, videoconferencing, or email
		Suitable data collection method for topics that deal with political or ethical matters or intimate personal issues; in particular, email interviews allow sufficient time for the research participant to think before responding
		It is not easy to generate interactions between the research participant and interviewer; in particular, it is difficult to obtain honest experiences through email interviews, and there is the possibility of misinterpreting the responses

Observations, which represent a key data collection method in anthropology, refer to a series of actions taken by the researcher in search of a deep understanding by systematically examining the appearances of research participants that take place in natural situations [ 33 ]. Observations can be categorized as participant and non-participant, insider and outsider, disguised and undisguised, short- and long-term, and structured and unstructured. However, a line cannot be drawn clearly to differentiate these categories, and the degree of each varies along a single spectrum. Therefore, it is necessary for a qualitative researcher to select the appropriate data collection method based on the circumstances and characteristics of the research topic.

Various types of document data can be used in qualitative research. Personal documents include diaries, letters, and autobiographies, while public documents include legal documents, public announcements, and civil documents. Online documents include emails and blog or bulletin board postings, while other documents include graffiti. All these document types may be used as data sources in qualitative research. In addition, image data acquired by the research participant or researcher, such as photographs and videos, serve as useful data sources in qualitative research. Such data sources are relatively objective and easily accessible, while they contain a significant amount of qualitative meaning despite the low acquisition cost. While some data may have been collected for research purposes, other data may not have been originally produced for research. Therefore, the researcher must not distort the original information contained in the data source and must verify the accuracy and authenticity of the data source in advance [ 30 ].

This review examined the characteristics of qualitative research to help researchers select the appropriate qualitative research methodology and identify situations suitable for qualitative research in the healthcare field. In addition, this paper analyzed the selection of the research topic and problem, selection of the theoretical framework and methods, literature analysis, and selection of the research participants and data collection methods. A forthcoming paper will discuss more specific details regarding other qualitative research methodologies, such as data analysis, description of findings, and research validation. This review can contribute to the more active use of qualitative research in the healthcare field, and the findings are expected to instill a proper understanding of qualitative research in researchers who review and judge qualitative research reports and papers.

Ethics Statement

Since this study used secondary data source, we did not seek approval from the institutional review board. We also did not have to ask for the consent of the participants.

Acknowledgments

CONFLICT OF INTEREST

The authors have no conflicts of interest associated with the material presented in this paper.

AUTHOR CONTRIBUTIONS

Conceptualization: Pyo J, Lee W, Choi EY, Jang SG, Ock M. Data curation: Pyo J, Ock M. Formal analysis: Pyo J, Ock M. Funding acquisition: None. Validation: Lee W, Choi EY, Jang SG. Writing - original draft: Pyo J, Ock M. Writing - review & editing: Pyo J, Lee W, Choi EY, Jang SG, Ock M.

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Qualitative Descriptive Methods in Health Science Research
Describing the Qualitative Descriptive Approach. In two seminal articles, Sandelowski promotes the mainstream use of qualitative description (Sandelowski, 2000, 2010) as a well-developed but unacknowledged method which provides a "comprehensive summary of an event in the every day terms of those events" (Sandelowski, 2000, p. 336).Such studies are characterized by lower levels of ...
Qualitative Descriptive Methods in Health Science Research
Objective: The purpose of this methodology paper is to describe an approach to qualitative design known as qualitative descriptive that is well suited to junior health sciences researchers because it can be used with a variety of theoretical approaches, sampling techniques, and data collection strategies. Background: It is often difficult for junior qualitative researchers to pull together the ...
Qualitative Descriptive Methods in Health Science Research
1. Abstract. Objective: The purpose of this methodology paper is to describe an approach to qualitative design. known as qualitative descriptive that is well suited to junior health sciences ...
Qualitative Methods in Health Care Research
Significance of Qualitative Research. The qualitative method of inquiry examines the 'how' and 'why' of decision making, rather than the 'when,' 'what,' and 'where.'[] Unlike quantitative methods, the objective of qualitative inquiry is to explore, narrate, and explain the phenomena and make sense of the complex reality.Health interventions, explanatory health models, and medical-social ...
Qualitative Description as an Introductory Method to Qualitative
Qualitative Description (QD) emerges as a pivotal introductory method in qualitative research for master's-level students and research trainees. Its principal strength lies in its straightforward, adaptable approach that emphasizes direct descriptions of experiences and events, staying close to the data. ... Qualitative descriptive methods in ...
An overview of the qualitative descriptive design within nursing research
Methods in qualitative descriptive research. As with any research study, the application of descriptive methods will emerge in response to the aims and objectives, which will influence the sampling, data collection and analysis phases of the study. ... Nursing & Health Sciences 15: 398-405. [Google Scholar] Ward K, Gott M, Hoare K. (2015 ...
Qualitative Descriptive Methods in Health Science Research
An approach to qualitative design known as qualitative descriptive that is well suited to junior health sciences researchers because it can be used with a variety of theoretical approaches, sampling techniques, and data collection strategies is described. Objective: The purpose of this methodology paper is to describe an approach to qualitative design known as qualitative descriptive that is ...
PDF Qualitative Descriptive Methods in Health Science Research
qualitative descriptive, qualitative methodology, rigor, qualitative design, qualitative analysis There is an explosion in qualitative methodolo- gies among health science researchers because
Employing a Qualitative Description Approach in Health Care Research
A qualitative descriptive approach does not require the researcher to move as far from the data and does not require a highly abstract rendering of data compared with other ... Colorafi K. J., Evans B. (2016). Qualitative descriptive methods in health science research. HERD: Health Environments Research & Design Journal, 9(4), 16-25. Crossref. ISI.
Qualitative Descriptive Methods in Health Science Research
The purpose of this methodology paper is to describe an approach to qualitative design known as qualitative descriptive that is well suited to junior health sciences researchers because it can be used with a variety of theoretical approaches, sampling techniques, and data collection strategies.
Characteristics of Qualitative Descriptive ...
Characteristics of Qualitative Descriptive Studies: A Systematic Review. Hyejin Kim ... Qualitative description (QD) is a term that is widely used to describe qualitative studies of health care and nursing-related phenomena. ... we identified characteristics of methods and findings reported in research articles published in 2014 whose authors ...
Qualitative description
The knowledge and use of qualitative description as a qualitative research approach in health services research is limited. The aim of this article is to discuss the potential benefits of a qualitative descriptive approach, to identify its strengths and weaknesses and to provide examples of use. Qualitative description is a useful qualitative method in much medical research if you keep the ...
Characteristics of Qualitative Descriptive Studies: A Systematic Review
Qualitative description (QD) is a label used in qualitative research for studies which are descriptive in nature, particularly for examining health care and nursing-related phenomena (Polit & Beck, 2009, 2014).QD is a widely cited research tradition and has been identified as important and appropriate for research questions focused on discovering the who, what, and where of events or ...
Chapter 5: Qualitative descriptive research
For example, in our research to develop a patient-reported outcome measure for people who had undergone a percutaneous coronary intervention (PCI), which is a common cardiac procedure to treat heart disease, we started by conducting a qualitative descriptive study. 5 This project was a large, mixed-methods study funded by a private health ...
descriptive qualitative approach: Topics by Science.gov
Employing a Qualitative Description Approach in Health Care Research.. PubMed. Bradshaw, Carmel; Atkinson, Sandra; Doody, Owen. 2017-01-01. A qualitative description design is particularly relevant where information is required directly from those experiencing the phenomenon under investigation and where time and resources are limited. Nurses and midwives often have clinical questions suitable ...
An overview of the qualitative descriptive design within nursing research
This paper provides an overview of qualitative descriptive research, orientates to the underlying philosophical perspectives and key characteristics that define this approach and identifies the implications for healthcare practice and policy. ... Bishop FL (2015) Using mixed methods in health research: Benefits and challenges. British Journal ...
qualitative descriptive method: Topics by Science.gov
Qualitative Descriptive Methods in Health Science Research.. PubMed. Colorafi, Karen Jiggins; Evans, Bronwynne. 2016-07-01. The purpose of this methodology paper is to describe an approach to qualitative design known as qualitative descriptive that is well suited to junior health sciences researchers because it can be used with a variety of theoretical approaches, sampling techniques, and data ...
Qualitative vs. Quantitative Data in Research: The Difference
Qualitative research focuses on the qualities of users—the actions that drive the numbers. It's descriptive research. The qualitative approach is subjective, too. It focuses on describing an action, rather than measuring it. Some examples of qualitative research: The sunflowers had a fresh smell that filled the office.
Employing a Qualitative Description Approach in Health Care Research
A qualitative descriptive approach does not require the researcher to move as far from the data and does not require a highly abstract rendering of data compared with other ... Qualitative descriptive methods in health science research. HERD: Health Environments Research & Design Journal, 9 (4), 16-25. [PMC free article] [Google ...
Descriptive Research
Descriptive research design. Descriptive research design uses a range of both qualitative research and quantitative data (although quantitative research is the primary research method) to gather information to make accurate predictions about a particular problem or hypothesis. As a survey method, descriptive research designs will help ...
Personal, external, and psychological factors influencing ...
Aims To offer a holistic view of the personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery. Methods This systematic synthesis of mixed methods research involved a comprehensive search for articles in English databases, including PubMed, Cochrane Library, Web of Science, EBSCO, Scopus, and Embase, as well as ...
How to use and assess qualitative research methods
Abstract. This paper aims to provide an overview of the use and assessment of qualitative research methods in the health sciences. Qualitative research can be defined as the study of the nature of phenomena and is especially appropriate for answering questions of why something is (not) observed, assessing complex multi-component interventions ...
Qualitative Descriptive Methods in Health Science Research
The purpose of this methodology paper is to describe an approach to qualitative design known as qualitative descriptive that is well suited to junior health sciences researchers because it can be used with a variety of theoretical approaches, sampling techniques, and data collection strategies.
Infant feeding experiences among Indigenous ...
Background Although exclusive breastfeeding is recommended for the first six months of life, research suggests that breastfeeding initiation rates and duration among Indigenous communities differ from this recommendation. Qualitative studies point to a variety of factors influencing infant feeding decisions; however, there has been no collective review of this literature published to date ...
Qualitative Descriptive Methods in Health Science Research
Search life-sciences literature (Over 40 million articles, preprints and more)
Qualitative Research in Healthcare: Necessity and Characteristics
Quantitative and qualitative research explore various social phenomena using different methods. However, there has been a tendency to treat quantitative studies using complicated statistical techniques as more scientific and superior, whereas relatively few qualitative studies have been conducted in the medical and healthcare fields.
Exploring how the design and provision of digital self-management
Understanding and improving the adoption of effective self-management technologies arguably has the potential to reduce strain on health and social care and help address inequity in health outcomes. 13,14 Recent scoping reviews reflect a growing interest in understanding barriers and facilitators to the use of technologies by older adults for a range of conditions, 10 for health promotion and ...

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