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Quantitative and Qualitative Research

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What is qualitative research?

Qualitative research is a process of naturalistic inquiry that seeks an in-depth understanding of social phenomena within their natural setting. It focuses on the "why" rather than the "what" of social phenomena and relies on the direct experiences of human beings as meaning-making agents in their every day lives. Rather than by logical and statistical procedures, qualitative researchers use multiple systems of inquiry for the study of human phenomena including biography, case study, historical analysis, discourse analysis, ethnography, grounded theory, and phenomenology.

University of Utah College of Nursing, (n.d.). What is qualitative research? [Guide] Retrieved from  https://nursing.utah.edu/research/qualitative-research/what-is-qualitative-research.php#what 

The following video will explain the fundamentals of qualitative research.

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What Is Naturalistic Observation?

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Amy Morin, LCSW, is a psychotherapist and international bestselling author. Her books, including "13 Things Mentally Strong People Don't Do," have been translated into more than 40 languages. Her TEDx talk,  "The Secret of Becoming Mentally Strong," is one of the most viewed talks of all time.

Illustration by Brianna Gilmartin, Verywell

• How Naturalistic Observation Works
• Pros and Cons
• Data Collection Methods

How Often Is Data Collected?

Naturalistic observation is a research method that involves observing subjects in their natural environment. This approach is often used by psychologists and other social scientists. It is a form of qualitative research , which focuses on collecting, evaluating, and describing non-numerical data.

It can be useful if conducting lab research would be unrealistic, cost-prohibitive, or would unduly affect the subject's behavior. The goal of naturalistic observation is to observe behavior as it occurs in a natural setting without interference or attempts to manipulate variables.

This article discusses how naturalistic observation works and the pros and cons of doing this type of research. It also covers how data is collected and examples of when this method might be used in psychology research.

How Does Naturalistic Observation Work?

People do not necessarily behave in a lab setting the way they would in a natural environment. Researchers sometimes want to observe their subject's behavior as it happens ("in the wild," so to speak). Psychologists can get a better idea of how and why people react the way that they do by watching how they respond to situations and stimuli in real life.

Naturalistic observation is different than structured observation because it involves looking at a subject's behavior as it occurs in a natural setting, with no attempts at intervention on the part of the researcher.

For example, a researcher interested in aspects of classroom behavior (such as the interactions between students or teacher-student dynamics) might use naturalistic observation as part of their research.

Performing these observations in a lab would be difficult because it would involve recreating a classroom environment. This would likely influence the behavior of the participants, making it difficult to generalize the observations made.

By observing the subjects in their natural setting (the classroom where they work and learn), the researchers can more fully observe the behavior they are interested in as it occurs in the real world.

Naturalistic Observation Pros and Cons 

Like other research methods, naturalistic observation has advantages and disadvantages.

More realistic

More affordable

Can detect patterns

Inability to manipulate or control variables

Cannot explain why behaviors happen

Risk of observer bias

An advantage of naturalistic observation is that it allows the investigators to directly observe the subject in a natural setting. The method gives scientists a first-hand look at social behavior and can help them notice things that they might never have encountered in a lab setting.

The observations can also serve as inspiration for further investigations. The information gleaned from naturalistic observation can lead to insights that can be used to help people overcome problems and lead to healthier, happier lives.

Other advantages of naturalistic observation include:

• Allows researchers to study behaviors or situations that cannot be manipulated in a lab due to ethical concerns . For example, it would be unethical to study the effects of imprisonment by actually confining subjects. But researchers can gather information by using naturalistic observation in actual prison settings.
• Can support the external validity of research . Researchers might believe that the findings of a lab study can be generalized to a larger population, but that does not mean they would actually observe those findings in a natural setting. They may conduct naturalistic observation to make that confirmation.

Naturalistic observation can be useful in many cases, but the method also has some downsides. Some of these include:

• Inability to draw cause-and-effect conclusions : The biggest disadvantage of naturalistic observation is that determining the exact cause of a subject's behavior can be difficult.
• Lack of control : Another downside is that the experimenter cannot control for outside variables .
• Lack of validity : While the goal of naturalistic observation is to get a better idea of how it occurs in the real world, experimental effects can still influence how people respond. The Hawthorne effect and other demand characteristics can play a role in people altering their behavior simply because they know they are being observed.
• Observer bias : The biases of the people observing the natural behaviors can influence the interpretations that experimenters make.

It is also important to note that naturalistic observation is a type of correlational research (others include surveys and archival research). A correlational study is a non-experimental approach that seeks to find statistical relationships between variables. Naturalistic observation is one method that can be used to collect data for correlational studies.

While such methods can look at the direction or strength of a relationship between two variables, they cannot determine if one causes the other. As the saying goes, correlation does not imply causation.

Data Collection Methods 

Researchers use different techniques to collect and record data from naturalistic observation. For example, they might write down how many times a certain behavior occurred in a specific period of time or take a video recording of subjects.

• Audio or video recordings : Depending on the type of behavior being observed, the researchers might also decide to make audio or videotaped recordings of each observation session. They can then later review the recordings.
• Observer narrative : The observer might take notes during the session that they can refer back to. They can collect data and discern behavior patterns from these notes.
• Tally counts : The observer writes down when and how many times certain behaviors occurred.

It is rarely practical—or even possible—to observe  every  moment of a subject's life. Therefore, researchers often use sampling to gather information through naturalistic observation.

The goal is to make sure that the sample of data is representative of the subject's overall behavior. A representative sample is a selection that accurately depicts the characteristics that are present in the total subject of interest. A  representative sample  can be obtained through:

• Time sampling : This involves taking samples at different intervals of time (random or systematic). For example, a researcher might observe a person in the workplace to notice how frequently they engage in certain behaviors and to determine if there are patterns or trends.
• Situation sampling : This type of sampling involves observing behavior in different situations and settings. An example of this would be observing a child in a classroom, home, and community setting to determine if certain behaviors only occur in certain settings.
• Event sampling : This approach involves observing and recording each time an event happens. This allows the researchers to better identify patterns that might be present. For example, a researcher might note every time a subject becomes agitated. By noting the event and what was occurring around the time of each event, researchers can draw inferences about what might be triggering those behaviors.

Examples of Naturalistic Observation

Imagine that you want to study risk-taking behavior in teenagers. You might choose to observe behavior in different settings, such as a sledding hill, a rock-climbing wall, an ice-skating rink, and a bumper car ride. After you operationally define "risk-taking behavior," you would observe your teen subjects in these settings and record every incidence of what you have defined as risky behavior.

Famous examples of naturalistic observations include Charles Darwin's journey aboard the  HMS Beagle , which served as the basis for his theory of natural selection, and Jane Goodall's work studying the behavior of chimpanzees in their natural habitat.

Naturalistic observation can play an important role in the research process. It offers a number of advantages, including often being more affordable and less intrusive than other types of research.

In some cases, researchers may utilize naturalistic observation as a way to learn more about something that is happening in a certain population. Using this information, they can then formulate a hypothesis that can be tested further.

Mehl MR, Robbins ML, Deters FG. Naturalistic observation of health-relevant social processes: the electronically activated recorder methodology in psychosomatics . Psychosom Med. 2012;74(4):410-7. doi:10.1097/PSY.0b013e3182545470

U.S. National Library of Medicine. Rewriting the book of nature - Darwin and the Beagle voyage .

Angrosino MV. Naturalistic Observation . Left Coast Press.

DiMercurio A, Connell JP, Clark M, Corbetta D. A naturalistic observation of spontaneous touches to the body and environment in the first 2 months of life . Front Psychol . 2018;9:2613. doi:10.3389/fpsyg.2018.02613

Pierce K, Pepler D. A peek behind the fence: observational methods 25 years later . In: Smith PK, Norman JO, eds. The Wiley Blackwell Handbook of Bullying. 1st ed . Wiley; 2021:215-232. doi:10.1002/9781118482650.ch12

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Qualitative Research : Definition

Qualitative research is the naturalistic study of social meanings and processes, using interviews, observations, and the analysis of texts and images.  In contrast to quantitative researchers, whose statistical methods enable broad generalizations about populations (for example, comparisons of the percentages of U.S. demographic groups who vote in particular ways), qualitative researchers use in-depth studies of the social world to analyze how and why groups think and act in particular ways (for instance, case studies of the experiences that shape political views).   

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20.2.1   Definition of qualitative research

Qualitative researchers study things in their natural settings, attempting to make sense of, or to interpret, phenomena in terms of the meanings people bring to them (Denzin 1994) . Qualitative research is intended to penetrate to the deeper significance that the subject of the research ascribes to the topic being researched. It involves an interpretive, naturalistic approach to its subject matter and gives priority to what the data contribute to important research questions or existing information.

Within health care an understanding of the value of evidence from qualitative research to systematic reviews must consider the varied and diffuse nature of evidence (Popay 1998b, Pearson 2005). Qualitative research encompasses a range of philosophies, research designs and specific techniques including in-depth qualitative interviews; participant and non-participant observation; focus groups; document analyses; and a number of other methods of data collection (Pope 2006). Given this range of data types, there are also diverse methodological and theoretical approaches to study design and data analysis such as phenomenology; ethnography; grounded theory; action research; case studies; and a number of others. Theory and the researchers’ perspective also play a key role in qualitative data analysis and in the bases on which generalizations to other contexts may be made.

Within the empirical sciences, the standing of a given theory or hypothesis is entirely dependent upon the quantity and character of the evidence in its favour. It is the relative weight of supporting evidence that allows us to choose between competing theories. Within the natural sciences, knowledge generation involves testing a hypothesis or a set of hypotheses by deriving consequences from it and then testing whether those consequences hold true by experiment and observation.

Health professionals seek evidence to substantiate the worth of a very wide range of activities and interventions and thus the type of evidence needed depends on the nature of the activity and its purpose. For many research questions, for example, those about parental beliefs and childhood vaccination (Mills 2005a, Mills 2005b) , qualitative research is an appropriate and desirable methodology.

What is Qualitative in Qualitative Research

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• Volume 42 , pages 139–160, ( 2019 )

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What is qualitative research? If we look for a precise definition of qualitative research, and specifically for one that addresses its distinctive feature of being “qualitative,” the literature is meager. In this article we systematically search, identify and analyze a sample of 89 sources using or attempting to define the term “qualitative.” Then, drawing on ideas we find scattered across existing work, and based on Becker’s classic study of marijuana consumption, we formulate and illustrate a definition that tries to capture its core elements. We define qualitative research as an iterative process in which improved understanding to the scientific community is achieved by making new significant distinctions resulting from getting closer to the phenomenon studied. This formulation is developed as a tool to help improve research designs while stressing that a qualitative dimension is present in quantitative work as well. Additionally, it can facilitate teaching, communication between researchers, diminish the gap between qualitative and quantitative researchers, help to address critiques of qualitative methods, and be used as a standard of evaluation of qualitative research.

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What is Qualitative in Research

Unsettling definitions of qualitative research, what is “qualitative” in qualitative research why the answer does not matter but the question is important.

Avoid common mistakes on your manuscript.

If we assume that there is something called qualitative research, what exactly is this qualitative feature? And how could we evaluate qualitative research as good or not? Is it fundamentally different from quantitative research? In practice, most active qualitative researchers working with empirical material intuitively know what is involved in doing qualitative research, yet perhaps surprisingly, a clear definition addressing its key feature is still missing.

To address the question of what is qualitative we turn to the accounts of “qualitative research” in textbooks and also in empirical work. In his classic, explorative, interview study of deviance Howard Becker ( 1963 ) asks ‘How does one become a marijuana user?’ In contrast to pre-dispositional and psychological-individualistic theories of deviant behavior, Becker’s inherently social explanation contends that becoming a user of this substance is the result of a three-phase sequential learning process. First, potential users need to learn how to smoke it properly to produce the “correct” effects. If not, they are likely to stop experimenting with it. Second, they need to discover the effects associated with it; in other words, to get “high,” individuals not only have to experience what the drug does, but also to become aware that those sensations are related to using it. Third, they require learning to savor the feelings related to its consumption – to develop an acquired taste. Becker, who played music himself, gets close to the phenomenon by observing, taking part, and by talking to people consuming the drug: “half of the fifty interviews were conducted with musicians, the other half covered a wide range of people, including laborers, machinists, and people in the professions” (Becker 1963 :56).

Another central aspect derived through the common-to-all-research interplay between induction and deduction (Becker 2017 ), is that during the course of his research Becker adds scientifically meaningful new distinctions in the form of three phases—distinctions, or findings if you will, that strongly affect the course of his research: its focus, the material that he collects, and which eventually impact his findings. Each phase typically unfolds through social interaction, and often with input from experienced users in “a sequence of social experiences during which the person acquires a conception of the meaning of the behavior, and perceptions and judgments of objects and situations, all of which make the activity possible and desirable” (Becker 1963 :235). In this study the increased understanding of smoking dope is a result of a combination of the meaning of the actors, and the conceptual distinctions that Becker introduces based on the views expressed by his respondents. Understanding is the result of research and is due to an iterative process in which data, concepts and evidence are connected with one another (Becker 2017 ).

Indeed, there are many definitions of qualitative research, but if we look for a definition that addresses its distinctive feature of being “qualitative,” the literature across the broad field of social science is meager. The main reason behind this article lies in the paradox, which, to put it bluntly, is that researchers act as if they know what it is, but they cannot formulate a coherent definition. Sociologists and others will of course continue to conduct good studies that show the relevance and value of qualitative research addressing scientific and practical problems in society. However, our paper is grounded in the idea that providing a clear definition will help us improve the work that we do. Among researchers who practice qualitative research there is clearly much knowledge. We suggest that a definition makes this knowledge more explicit. If the first rationale for writing this paper refers to the “internal” aim of improving qualitative research, the second refers to the increased “external” pressure that especially many qualitative researchers feel; pressure that comes both from society as well as from other scientific approaches. There is a strong core in qualitative research, and leading researchers tend to agree on what it is and how it is done. Our critique is not directed at the practice of qualitative research, but we do claim that the type of systematic work we do has not yet been done, and that it is useful to improve the field and its status in relation to quantitative research.

The literature on the “internal” aim of improving, or at least clarifying qualitative research is large, and we do not claim to be the first to notice the vagueness of the term “qualitative” (Strauss and Corbin 1998 ). Also, others have noted that there is no single definition of it (Long and Godfrey 2004 :182), that there are many different views on qualitative research (Denzin and Lincoln 2003 :11; Jovanović 2011 :3), and that more generally, we need to define its meaning (Best 2004 :54). Strauss and Corbin ( 1998 ), for example, as well as Nelson et al. (1992:2 cited in Denzin and Lincoln 2003 :11), and Flick ( 2007 :ix–x), have recognized that the term is problematic: “Actually, the term ‘qualitative research’ is confusing because it can mean different things to different people” (Strauss and Corbin 1998 :10–11). Hammersley has discussed the possibility of addressing the problem, but states that “the task of providing an account of the distinctive features of qualitative research is far from straightforward” ( 2013 :2). This confusion, as he has recently further argued (Hammersley 2018 ), is also salient in relation to ethnography where different philosophical and methodological approaches lead to a lack of agreement about what it means.

Others (e.g. Hammersley 2018 ; Fine and Hancock 2017 ) have also identified the treat to qualitative research that comes from external forces, seen from the point of view of “qualitative research.” This threat can be further divided into that which comes from inside academia, such as the critique voiced by “quantitative research” and outside of academia, including, for example, New Public Management. Hammersley ( 2018 ), zooming in on one type of qualitative research, ethnography, has argued that it is under treat. Similarly to Fine ( 2003 ), and before him Gans ( 1999 ), he writes that ethnography’ has acquired a range of meanings, and comes in many different versions, these often reflecting sharply divergent epistemological orientations. And already more than twenty years ago while reviewing Denzin and Lincoln’ s Handbook of Qualitative Methods Fine argued:

While this increasing centrality [of qualitative research] might lead one to believe that consensual standards have developed, this belief would be misleading. As the methodology becomes more widely accepted, querulous challengers have raised fundamental questions that collectively have undercut the traditional models of how qualitative research is to be fashioned and presented (1995:417).

According to Hammersley, there are today “serious treats to the practice of ethnographic work, on almost any definition” ( 2018 :1). He lists five external treats: (1) that social research must be accountable and able to show its impact on society; (2) the current emphasis on “big data” and the emphasis on quantitative data and evidence; (3) the labor market pressure in academia that leaves less time for fieldwork (see also Fine and Hancock 2017 ); (4) problems of access to fields; and (5) the increased ethical scrutiny of projects, to which ethnography is particularly exposed. Hammersley discusses some more or less insufficient existing definitions of ethnography.

The current situation, as Hammersley and others note—and in relation not only to ethnography but also qualitative research in general, and as our empirical study shows—is not just unsatisfactory, it may even be harmful for the entire field of qualitative research, and does not help social science at large. We suggest that the lack of clarity of qualitative research is a real problem that must be addressed.

Towards a Definition of Qualitative Research

Seen in an historical light, what is today called qualitative, or sometimes ethnographic, interpretative research – or a number of other terms – has more or less always existed. At the time the founders of sociology – Simmel, Weber, Durkheim and, before them, Marx – were writing, and during the era of the Methodenstreit (“dispute about methods”) in which the German historical school emphasized scientific methods (cf. Swedberg 1990 ), we can at least speak of qualitative forerunners.

Perhaps the most extended discussion of what later became known as qualitative methods in a classic work is Bronisław Malinowski’s ( 1922 ) Argonauts in the Western Pacific , although even this study does not explicitly address the meaning of “qualitative.” In Weber’s ([1921–-22] 1978) work we find a tension between scientific explanations that are based on observation and quantification and interpretative research (see also Lazarsfeld and Barton 1982 ).

If we look through major sociology journals like the American Sociological Review , American Journal of Sociology , or Social Forces we will not find the term qualitative sociology before the 1970s. And certainly before then much of what we consider qualitative classics in sociology, like Becker’ study ( 1963 ), had already been produced. Indeed, the Chicago School often combined qualitative and quantitative data within the same study (Fine 1995 ). Our point being that before a disciplinary self-awareness the term quantitative preceded qualitative, and the articulation of the former was a political move to claim scientific status (Denzin and Lincoln 2005 ). In the US the World War II seem to have sparked a critique of sociological work, including “qualitative work,” that did not follow the scientific canon (Rawls 2018 ), which was underpinned by a scientifically oriented and value free philosophy of science. As a result the attempts and practice of integrating qualitative and quantitative sociology at Chicago lost ground to sociology that was more oriented to surveys and quantitative work at Columbia under Merton-Lazarsfeld. The quantitative tradition was also able to present textbooks (Lundberg 1951 ) that facilitated the use this approach and its “methods.” The practices of the qualitative tradition, by and large, remained tacit or was part of the mentoring transferred from the renowned masters to their students.

This glimpse into history leads us back to the lack of a coherent account condensed in a definition of qualitative research. Many of the attempts to define the term do not meet the requirements of a proper definition: A definition should be clear, avoid tautology, demarcate its domain in relation to the environment, and ideally only use words in its definiens that themselves are not in need of definition (Hempel 1966 ). A definition can enhance precision and thus clarity by identifying the core of the phenomenon. Preferably, a definition should be short. The typical definition we have found, however, is an ostensive definition, which indicates what qualitative research is about without informing us about what it actually is :

Qualitative research is multimethod in focus, involving an interpretative, naturalistic approach to its subject matter. This means that qualitative researchers study things in their natural settings, attempting to make sense of, or interpret, phenomena in terms of the meanings people bring to them. Qualitative research involves the studied use and collection of a variety of empirical materials – case study, personal experience, introspective, life story, interview, observational, historical, interactional, and visual texts – that describe routine and problematic moments and meanings in individuals’ lives. (Denzin and Lincoln 2005 :2)

Flick claims that the label “qualitative research” is indeed used as an umbrella for a number of approaches ( 2007 :2–4; 2002 :6), and it is not difficult to identify research fitting this designation. Moreover, whatever it is, it has grown dramatically over the past five decades. In addition, courses have been developed, methods have flourished, arguments about its future have been advanced (for example, Denzin and Lincoln 1994) and criticized (for example, Snow and Morrill 1995 ), and dedicated journals and books have mushroomed. Most social scientists have a clear idea of research and how it differs from journalism, politics and other activities. But the question of what is qualitative in qualitative research is either eluded or eschewed.

We maintain that this lacuna hinders systematic knowledge production based on qualitative research. Paul Lazarsfeld noted the lack of “codification” as early as 1955 when he reviewed 100 qualitative studies in order to offer a codification of the practices (Lazarsfeld and Barton 1982 :239). Since then many texts on “qualitative research” and its methods have been published, including recent attempts (Goertz and Mahoney 2012 ) similar to Lazarsfeld’s. These studies have tried to extract what is qualitative by looking at the large number of empirical “qualitative” studies. Our novel strategy complements these endeavors by taking another approach and looking at the attempts to codify these practices in the form of a definition, as well as to a minor extent take Becker’s study as an exemplar of what qualitative researchers actually do, and what the characteristic of being ‘qualitative’ denotes and implies. We claim that qualitative researchers, if there is such a thing as “qualitative research,” should be able to codify their practices in a condensed, yet general way expressed in language.

Lingering problems of “generalizability” and “how many cases do I need” (Small 2009 ) are blocking advancement – in this line of work qualitative approaches are said to differ considerably from quantitative ones, while some of the former unsuccessfully mimic principles related to the latter (Small 2009 ). Additionally, quantitative researchers sometimes unfairly criticize the first based on their own quality criteria. Scholars like Goertz and Mahoney ( 2012 ) have successfully focused on the different norms and practices beyond what they argue are essentially two different cultures: those working with either qualitative or quantitative methods. Instead, similarly to Becker ( 2017 ) who has recently questioned the usefulness of the distinction between qualitative and quantitative research, we focus on similarities.

The current situation also impedes both students and researchers in focusing their studies and understanding each other’s work (Lazarsfeld and Barton 1982 :239). A third consequence is providing an opening for critiques by scholars operating within different traditions (Valsiner 2000 :101). A fourth issue is that the “implicit use of methods in qualitative research makes the field far less standardized than the quantitative paradigm” (Goertz and Mahoney 2012 :9). Relatedly, the National Science Foundation in the US organized two workshops in 2004 and 2005 to address the scientific foundations of qualitative research involving strategies to improve it and to develop standards of evaluation in qualitative research. However, a specific focus on its distinguishing feature of being “qualitative” while being implicitly acknowledged, was discussed only briefly (for example, Best 2004 ).

In 2014 a theme issue was published in this journal on “Methods, Materials, and Meanings: Designing Cultural Analysis,” discussing central issues in (cultural) qualitative research (Berezin 2014 ; Biernacki 2014 ; Glaeser 2014 ; Lamont and Swidler 2014 ; Spillman 2014). We agree with many of the arguments put forward, such as the risk of methodological tribalism, and that we should not waste energy on debating methods separated from research questions. Nonetheless, a clarification of the relation to what is called “quantitative research” is of outmost importance to avoid misunderstandings and misguided debates between “qualitative” and “quantitative” researchers. Our strategy means that researchers, “qualitative” or “quantitative” they may be, in their actual practice may combine qualitative work and quantitative work.

In this article we accomplish three tasks. First, we systematically survey the literature for meanings of qualitative research by looking at how researchers have defined it. Drawing upon existing knowledge we find that the different meanings and ideas of qualitative research are not yet coherently integrated into one satisfactory definition. Next, we advance our contribution by offering a definition of qualitative research and illustrate its meaning and use partially by expanding on the brief example introduced earlier related to Becker’s work ( 1963 ). We offer a systematic analysis of central themes of what researchers consider to be the core of “qualitative,” regardless of style of work. These themes – which we summarize in terms of four keywords: distinction, process, closeness, improved understanding – constitute part of our literature review, in which each one appears, sometimes with others, but never all in the same definition. They serve as the foundation of our contribution. Our categories are overlapping. Their use is primarily to organize the large amount of definitions we have identified and analyzed, and not necessarily to draw a clear distinction between them. Finally, we continue the elaboration discussed above on the advantages of a clear definition of qualitative research.

In a hermeneutic fashion we propose that there is something meaningful that deserves to be labelled “qualitative research” (Gadamer 1990 ). To approach the question “What is qualitative in qualitative research?” we have surveyed the literature. In conducting our survey we first traced the word’s etymology in dictionaries, encyclopedias, handbooks of the social sciences and of methods and textbooks, mainly in English, which is common to methodology courses. It should be noted that we have zoomed in on sociology and its literature. This discipline has been the site of the largest debate and development of methods that can be called “qualitative,” which suggests that this field should be examined in great detail.

In an ideal situation we should expect that one good definition, or at least some common ideas, would have emerged over the years. This common core of qualitative research should be so accepted that it would appear in at least some textbooks. Since this is not what we found, we decided to pursue an inductive approach to capture maximal variation in the field of qualitative research; we searched in a selection of handbooks, textbooks, book chapters, and books, to which we added the analysis of journal articles. Our sample comprises a total of 89 references.

In practice we focused on the discipline that has had a clear discussion of methods, namely sociology. We also conducted a broad search in the JSTOR database to identify scholarly sociology articles published between 1998 and 2017 in English with a focus on defining or explaining qualitative research. We specifically zoom in on this time frame because we would have expect that this more mature period would have produced clear discussions on the meaning of qualitative research. To find these articles we combined a number of keywords to search the content and/or the title: qualitative (which was always included), definition, empirical, research, methodology, studies, fieldwork, interview and observation .

As a second phase of our research we searched within nine major sociological journals ( American Journal of Sociology , Sociological Theory , American Sociological Review , Contemporary Sociology , Sociological Forum , Sociological Theory , Qualitative Research , Qualitative Sociology and Qualitative Sociology Review ) for articles also published during the past 19 years (1998–2017) that had the term “qualitative” in the title and attempted to define qualitative research.

Lastly we picked two additional journals, Qualitative Research and Qualitative Sociology , in which we could expect to find texts addressing the notion of “qualitative.” From Qualitative Research we chose Volume 14, Issue 6, December 2014, and from Qualitative Sociology we chose Volume 36, Issue 2, June 2017. Within each of these we selected the first article; then we picked the second article of three prior issues. Again we went back another three issues and investigated article number three. Finally we went back another three issues and perused article number four. This selection criteria was used to get a manageable sample for the analysis.

The coding process of the 89 references we gathered in our selected review began soon after the first round of material was gathered, and we reduced the complexity created by our maximum variation sampling (Snow and Anderson 1993 :22) to four different categories within which questions on the nature and properties of qualitative research were discussed. We call them: Qualitative and Quantitative Research, Qualitative Research, Fieldwork, and Grounded Theory. This – which may appear as an illogical grouping – merely reflects the “context” in which the matter of “qualitative” is discussed. If the selection process of the material – books and articles – was informed by pre-knowledge, we used an inductive strategy to code the material. When studying our material, we identified four central notions related to “qualitative” that appear in various combinations in the literature which indicate what is the core of qualitative research. We have labeled them: “distinctions”, “process,” “closeness,” and “improved understanding.” During the research process the categories and notions were improved, refined, changed, and reordered. The coding ended when a sense of saturation in the material arose. In the presentation below all quotations and references come from our empirical material of texts on qualitative research.

Analysis – What is Qualitative Research?

In this section we describe the four categories we identified in the coding, how they differently discuss qualitative research, as well as their overall content. Some salient quotations are selected to represent the type of text sorted under each of the four categories. What we present are examples from the literature.

Qualitative and Quantitative

This analytic category comprises quotations comparing qualitative and quantitative research, a distinction that is frequently used (Brown 2010 :231); in effect this is a conceptual pair that structures the discussion and that may be associated with opposing interests. While the general goal of quantitative and qualitative research is the same – to understand the world better – their methodologies and focus in certain respects differ substantially (Becker 1966 :55). Quantity refers to that property of something that can be determined by measurement. In a dictionary of Statistics and Methodology we find that “(a) When referring to *variables, ‘qualitative’ is another term for *categorical or *nominal. (b) When speaking of kinds of research, ‘qualitative’ refers to studies of subjects that are hard to quantify, such as art history. Qualitative research tends to be a residual category for almost any kind of non-quantitative research” (Stiles 1998:183). But it should be obvious that one could employ a quantitative approach when studying, for example, art history.

The same dictionary states that quantitative is “said of variables or research that can be handled numerically, usually (too sharply) contrasted with *qualitative variables and research” (Stiles 1998:184). From a qualitative perspective “quantitative research” is about numbers and counting, and from a quantitative perspective qualitative research is everything that is not about numbers. But this does not say much about what is “qualitative.” If we turn to encyclopedias we find that in the 1932 edition of the Encyclopedia of the Social Sciences there is no mention of “qualitative.” In the Encyclopedia from 1968 we can read:

Qualitative Analysis. For methods of obtaining, analyzing, and describing data, see [the various entries:] CONTENT ANALYSIS; COUNTED DATA; EVALUATION RESEARCH, FIELD WORK; GRAPHIC PRESENTATION; HISTORIOGRAPHY, especially the article on THE RHETORIC OF HISTORY; INTERVIEWING; OBSERVATION; PERSONALITY MEASUREMENT; PROJECTIVE METHODS; PSYCHOANALYSIS, article on EXPERIMENTAL METHODS; SURVEY ANALYSIS, TABULAR PRESENTATION; TYPOLOGIES. (Vol. 13:225)

Some, like Alford, divide researchers into methodologists or, in his words, “quantitative and qualitative specialists” (Alford 1998 :12). Qualitative research uses a variety of methods, such as intensive interviews or in-depth analysis of historical materials, and it is concerned with a comprehensive account of some event or unit (King et al. 1994 :4). Like quantitative research it can be utilized to study a variety of issues, but it tends to focus on meanings and motivations that underlie cultural symbols, personal experiences, phenomena and detailed understanding of processes in the social world. In short, qualitative research centers on understanding processes, experiences, and the meanings people assign to things (Kalof et al. 2008 :79).

Others simply say that qualitative methods are inherently unscientific (Jovanović 2011 :19). Hood, for instance, argues that words are intrinsically less precise than numbers, and that they are therefore more prone to subjective analysis, leading to biased results (Hood 2006 :219). Qualitative methodologies have raised concerns over the limitations of quantitative templates (Brady et al. 2004 :4). Scholars such as King et al. ( 1994 ), for instance, argue that non-statistical research can produce more reliable results if researchers pay attention to the rules of scientific inference commonly stated in quantitative research. Also, researchers such as Becker ( 1966 :59; 1970 :42–43) have asserted that, if conducted properly, qualitative research and in particular ethnographic field methods, can lead to more accurate results than quantitative studies, in particular, survey research and laboratory experiments.

Some researchers, such as Kalof, Dan, and Dietz ( 2008 :79) claim that the boundaries between the two approaches are becoming blurred, and Small ( 2009 ) argues that currently much qualitative research (especially in North America) tries unsuccessfully and unnecessarily to emulate quantitative standards. For others, qualitative research tends to be more humanistic and discursive (King et al. 1994 :4). Ragin ( 1994 ), and similarly also Becker, ( 1996 :53), Marchel and Owens ( 2007 :303) think that the main distinction between the two styles is overstated and does not rest on the simple dichotomy of “numbers versus words” (Ragin 1994 :xii). Some claim that quantitative data can be utilized to discover associations, but in order to unveil cause and effect a complex research design involving the use of qualitative approaches needs to be devised (Gilbert 2009 :35). Consequently, qualitative data are useful for understanding the nuances lying beyond those processes as they unfold (Gilbert 2009 :35). Others contend that qualitative research is particularly well suited both to identify causality and to uncover fine descriptive distinctions (Fine and Hallett 2014 ; Lichterman and Isaac Reed 2014 ; Katz 2015 ).

There are other ways to separate these two traditions, including normative statements about what qualitative research should be (that is, better or worse than quantitative approaches, concerned with scientific approaches to societal change or vice versa; Snow and Morrill 1995 ; Denzin and Lincoln 2005 ), or whether it should develop falsifiable statements; Best 2004 ).

We propose that quantitative research is largely concerned with pre-determined variables (Small 2008 ); the analysis concerns the relations between variables. These categories are primarily not questioned in the study, only their frequency or degree, or the correlations between them (cf. Franzosi 2016 ). If a researcher studies wage differences between women and men, he or she works with given categories: x number of men are compared with y number of women, with a certain wage attributed to each person. The idea is not to move beyond the given categories of wage, men and women; they are the starting point as well as the end point, and undergo no “qualitative change.” Qualitative research, in contrast, investigates relations between categories that are themselves subject to change in the research process. Returning to Becker’s study ( 1963 ), we see that he questioned pre-dispositional theories of deviant behavior working with pre-determined variables such as an individual’s combination of personal qualities or emotional problems. His take, in contrast, was to understand marijuana consumption by developing “variables” as part of the investigation. Thereby he presented new variables, or as we would say today, theoretical concepts, but which are grounded in the empirical material.

Qualitative Research

This category contains quotations that refer to descriptions of qualitative research without making comparisons with quantitative research. Researchers such as Denzin and Lincoln, who have written a series of influential handbooks on qualitative methods (1994; Denzin and Lincoln 2003 ; 2005 ), citing Nelson et al. (1992:4), argue that because qualitative research is “interdisciplinary, transdisciplinary, and sometimes counterdisciplinary” it is difficult to derive one single definition of it (Jovanović 2011 :3). According to them, in fact, “the field” is “many things at the same time,” involving contradictions, tensions over its focus, methods, and how to derive interpretations and findings ( 2003 : 11). Similarly, others, such as Flick ( 2007 :ix–x) contend that agreeing on an accepted definition has increasingly become problematic, and that qualitative research has possibly matured different identities. However, Best holds that “the proliferation of many sorts of activities under the label of qualitative sociology threatens to confuse our discussions” ( 2004 :54). Atkinson’s position is more definite: “the current state of qualitative research and research methods is confused” ( 2005 :3–4).

Qualitative research is about interpretation (Blumer 1969 ; Strauss and Corbin 1998 ; Denzin and Lincoln 2003 ), or Verstehen [understanding] (Frankfort-Nachmias and Nachmias 1996 ). It is “multi-method,” involving the collection and use of a variety of empirical materials (Denzin and Lincoln 1998; Silverman 2013 ) and approaches (Silverman 2005 ; Flick 2007 ). It focuses not only on the objective nature of behavior but also on its subjective meanings: individuals’ own accounts of their attitudes, motivations, behavior (McIntyre 2005 :127; Creswell 2009 ), events and situations (Bryman 1989) – what people say and do in specific places and institutions (Goodwin and Horowitz 2002 :35–36) in social and temporal contexts (Morrill and Fine 1997). For this reason, following Weber ([1921-22] 1978), it can be described as an interpretative science (McIntyre 2005 :127). But could quantitative research also be concerned with these questions? Also, as pointed out below, does all qualitative research focus on subjective meaning, as some scholars suggest?

Others also distinguish qualitative research by claiming that it collects data using a naturalistic approach (Denzin and Lincoln 2005 :2; Creswell 2009 ), focusing on the meaning actors ascribe to their actions. But again, does all qualitative research need to be collected in situ? And does qualitative research have to be inherently concerned with meaning? Flick ( 2007 ), referring to Denzin and Lincoln ( 2005 ), mentions conversation analysis as an example of qualitative research that is not concerned with the meanings people bring to a situation, but rather with the formal organization of talk. Still others, such as Ragin ( 1994 :85), note that qualitative research is often (especially early on in the project, we would add) less structured than other kinds of social research – a characteristic connected to its flexibility and that can lead both to potentially better, but also worse results. But is this not a feature of this type of research, rather than a defining description of its essence? Wouldn’t this comment also apply, albeit to varying degrees, to quantitative research?

In addition, Strauss ( 2003 ), along with others, such as Alvesson and Kärreman ( 2011 :10–76), argue that qualitative researchers struggle to capture and represent complex phenomena partially because they tend to collect a large amount of data. While his analysis is correct at some points – “It is necessary to do detailed, intensive, microscopic examination of the data in order to bring out the amazing complexity of what lies in, behind, and beyond those data” (Strauss 2003 :10) – much of his analysis concerns the supposed focus of qualitative research and its challenges, rather than exactly what it is about. But even in this instance we would make a weak case arguing that these are strictly the defining features of qualitative research. Some researchers seem to focus on the approach or the methods used, or even on the way material is analyzed. Several researchers stress the naturalistic assumption of investigating the world, suggesting that meaning and interpretation appear to be a core matter of qualitative research.

We can also see that in this category there is no consensus about specific qualitative methods nor about qualitative data. Many emphasize interpretation, but quantitative research, too, involves interpretation; the results of a regression analysis, for example, certainly have to be interpreted, and the form of meta-analysis that factor analysis provides indeed requires interpretation However, there is no interpretation of quantitative raw data, i.e., numbers in tables. One common thread is that qualitative researchers have to get to grips with their data in order to understand what is being studied in great detail, irrespective of the type of empirical material that is being analyzed. This observation is connected to the fact that qualitative researchers routinely make several adjustments of focus and research design as their studies progress, in many cases until the very end of the project (Kalof et al. 2008 ). If you, like Becker, do not start out with a detailed theory, adjustments such as the emergence and refinement of research questions will occur during the research process. We have thus found a number of useful reflections about qualitative research scattered across different sources, but none of them effectively describe the defining characteristics of this approach.

Although qualitative research does not appear to be defined in terms of a specific method, it is certainly common that fieldwork, i.e., research that entails that the researcher spends considerable time in the field that is studied and use the knowledge gained as data, is seen as emblematic of or even identical to qualitative research. But because we understand that fieldwork tends to focus primarily on the collection and analysis of qualitative data, we expected to find within it discussions on the meaning of “qualitative.” But, again, this was not the case.

Instead, we found material on the history of this approach (for example, Frankfort-Nachmias and Nachmias 1996 ; Atkinson et al. 2001), including how it has changed; for example, by adopting a more self-reflexive practice (Heyl 2001), as well as the different nomenclature that has been adopted, such as fieldwork, ethnography, qualitative research, naturalistic research, participant observation and so on (for example, Lofland et al. 2006 ; Gans 1999 ).

We retrieved definitions of ethnography, such as “the study of people acting in the natural courses of their daily lives,” involving a “resocialization of the researcher” (Emerson 1988 :1) through intense immersion in others’ social worlds (see also examples in Hammersley 2018 ). This may be accomplished by direct observation and also participation (Neuman 2007 :276), although others, such as Denzin ( 1970 :185), have long recognized other types of observation, including non-participant (“fly on the wall”). In this category we have also isolated claims and opposing views, arguing that this type of research is distinguished primarily by where it is conducted (natural settings) (Hughes 1971:496), and how it is carried out (a variety of methods are applied) or, for some most importantly, by involving an active, empathetic immersion in those being studied (Emerson 1988 :2). We also retrieved descriptions of the goals it attends in relation to how it is taught (understanding subjective meanings of the people studied, primarily develop theory, or contribute to social change) (see for example, Corte and Irwin 2017 ; Frankfort-Nachmias and Nachmias 1996 :281; Trier-Bieniek 2012 :639) by collecting the richest possible data (Lofland et al. 2006 ) to derive “thick descriptions” (Geertz 1973 ), and/or to aim at theoretical statements of general scope and applicability (for example, Emerson 1988 ; Fine 2003 ). We have identified guidelines on how to evaluate it (for example Becker 1996 ; Lamont 2004 ) and have retrieved instructions on how it should be conducted (for example, Lofland et al. 2006 ). For instance, analysis should take place while the data gathering unfolds (Emerson 1988 ; Hammersley and Atkinson 2007 ; Lofland et al. 2006 ), observations should be of long duration (Becker 1970 :54; Goffman 1989 ), and data should be of high quantity (Becker 1970 :52–53), as well as other questionable distinctions between fieldwork and other methods:

Field studies differ from other methods of research in that the researcher performs the task of selecting topics, decides what questions to ask, and forges interest in the course of the research itself . This is in sharp contrast to many ‘theory-driven’ and ‘hypothesis-testing’ methods. (Lofland and Lofland 1995 :5)

But could not, for example, a strictly interview-based study be carried out with the same amount of flexibility, such as sequential interviewing (for example, Small 2009 )? Once again, are quantitative approaches really as inflexible as some qualitative researchers think? Moreover, this category stresses the role of the actors’ meaning, which requires knowledge and close interaction with people, their practices and their lifeworld.

It is clear that field studies – which are seen by some as the “gold standard” of qualitative research – are nonetheless only one way of doing qualitative research. There are other methods, but it is not clear why some are more qualitative than others, or why they are better or worse. Fieldwork is characterized by interaction with the field (the material) and understanding of the phenomenon that is being studied. In Becker’s case, he had general experience from fields in which marihuana was used, based on which he did interviews with actual users in several fields.

Grounded Theory

Another major category we identified in our sample is Grounded Theory. We found descriptions of it most clearly in Glaser and Strauss’ ([1967] 2010 ) original articulation, Strauss and Corbin ( 1998 ) and Charmaz ( 2006 ), as well as many other accounts of what it is for: generating and testing theory (Strauss 2003 :xi). We identified explanations of how this task can be accomplished – such as through two main procedures: constant comparison and theoretical sampling (Emerson 1998:96), and how using it has helped researchers to “think differently” (for example, Strauss and Corbin 1998 :1). We also read descriptions of its main traits, what it entails and fosters – for instance, an exceptional flexibility, an inductive approach (Strauss and Corbin 1998 :31–33; 1990; Esterberg 2002 :7), an ability to step back and critically analyze situations, recognize tendencies towards bias, think abstractly and be open to criticism, enhance sensitivity towards the words and actions of respondents, and develop a sense of absorption and devotion to the research process (Strauss and Corbin 1998 :5–6). Accordingly, we identified discussions of the value of triangulating different methods (both using and not using grounded theory), including quantitative ones, and theories to achieve theoretical development (most comprehensively in Denzin 1970 ; Strauss and Corbin 1998 ; Timmermans and Tavory 2012 ). We have also located arguments about how its practice helps to systematize data collection, analysis and presentation of results (Glaser and Strauss [1967] 2010 :16).

Grounded theory offers a systematic approach which requires researchers to get close to the field; closeness is a requirement of identifying questions and developing new concepts or making further distinctions with regard to old concepts. In contrast to other qualitative approaches, grounded theory emphasizes the detailed coding process, and the numerous fine-tuned distinctions that the researcher makes during the process. Within this category, too, we could not find a satisfying discussion of the meaning of qualitative research.

Defining Qualitative Research

In sum, our analysis shows that some notions reappear in the discussion of qualitative research, such as understanding, interpretation, “getting close” and making distinctions. These notions capture aspects of what we think is “qualitative.” However, a comprehensive definition that is useful and that can further develop the field is lacking, and not even a clear picture of its essential elements appears. In other words no definition emerges from our data, and in our research process we have moved back and forth between our empirical data and the attempt to present a definition. Our concrete strategy, as stated above, is to relate qualitative and quantitative research, or more specifically, qualitative and quantitative work. We use an ideal-typical notion of quantitative research which relies on taken for granted and numbered variables. This means that the data consists of variables on different scales, such as ordinal, but frequently ratio and absolute scales, and the representation of the numbers to the variables, i.e. the justification of the assignment of numbers to object or phenomenon, are not questioned, though the validity may be questioned. In this section we return to the notion of quality and try to clarify it while presenting our contribution.

Broadly, research refers to the activity performed by people trained to obtain knowledge through systematic procedures. Notions such as “objectivity” and “reflexivity,” “systematic,” “theory,” “evidence” and “openness” are here taken for granted in any type of research. Next, building on our empirical analysis we explain the four notions that we have identified as central to qualitative work: distinctions, process, closeness, and improved understanding. In discussing them, ultimately in relation to one another, we make their meaning even more precise. Our idea, in short, is that only when these ideas that we present separately for analytic purposes are brought together can we speak of qualitative research.

Distinctions

We believe that the possibility of making new distinctions is one the defining characteristics of qualitative research. It clearly sets it apart from quantitative analysis which works with taken-for-granted variables, albeit as mentioned, meta-analyses, for example, factor analysis may result in new variables. “Quality” refers essentially to distinctions, as already pointed out by Aristotle. He discusses the term “qualitative” commenting: “By a quality I mean that in virtue of which things are said to be qualified somehow” (Aristotle 1984:14). Quality is about what something is or has, which means that the distinction from its environment is crucial. We see qualitative research as a process in which significant new distinctions are made to the scholarly community; to make distinctions is a key aspect of obtaining new knowledge; a point, as we will see, that also has implications for “quantitative research.” The notion of being “significant” is paramount. New distinctions by themselves are not enough; just adding concepts only increases complexity without furthering our knowledge. The significance of new distinctions is judged against the communal knowledge of the research community. To enable this discussion and judgements central elements of rational discussion are required (cf. Habermas [1981] 1987 ; Davidsson [ 1988 ] 2001) to identify what is new and relevant scientific knowledge. Relatedly, Ragin alludes to the idea of new and useful knowledge at a more concrete level: “Qualitative methods are appropriate for in-depth examination of cases because they aid the identification of key features of cases. Most qualitative methods enhance data” (1994:79). When Becker ( 1963 ) studied deviant behavior and investigated how people became marihuana smokers, he made distinctions between the ways in which people learned how to smoke. This is a classic example of how the strategy of “getting close” to the material, for example the text, people or pictures that are subject to analysis, may enable researchers to obtain deeper insight and new knowledge by making distinctions – in this instance on the initial notion of learning how to smoke. Others have stressed the making of distinctions in relation to coding or theorizing. Emerson et al. ( 1995 ), for example, hold that “qualitative coding is a way of opening up avenues of inquiry,” meaning that the researcher identifies and develops concepts and analytic insights through close examination of and reflection on data (Emerson et al. 1995 :151). Goodwin and Horowitz highlight making distinctions in relation to theory-building writing: “Close engagement with their cases typically requires qualitative researchers to adapt existing theories or to make new conceptual distinctions or theoretical arguments to accommodate new data” ( 2002 : 37). In the ideal-typical quantitative research only existing and so to speak, given, variables would be used. If this is the case no new distinction are made. But, would not also many “quantitative” researchers make new distinctions?

Process does not merely suggest that research takes time. It mainly implies that qualitative new knowledge results from a process that involves several phases, and above all iteration. Qualitative research is about oscillation between theory and evidence, analysis and generating material, between first- and second -order constructs (Schütz 1962 :59), between getting in contact with something, finding sources, becoming deeply familiar with a topic, and then distilling and communicating some of its essential features. The main point is that the categories that the researcher uses, and perhaps takes for granted at the beginning of the research process, usually undergo qualitative changes resulting from what is found. Becker describes how he tested hypotheses and let the jargon of the users develop into theoretical concepts. This happens over time while the study is being conducted, exemplifying what we mean by process.

In the research process, a pilot-study may be used to get a first glance of, for example, the field, how to approach it, and what methods can be used, after which the method and theory are chosen or refined before the main study begins. Thus, the empirical material is often central from the start of the project and frequently leads to adjustments by the researcher. Likewise, during the main study categories are not fixed; the empirical material is seen in light of the theory used, but it is also given the opportunity to kick back, thereby resisting attempts to apply theoretical straightjackets (Becker 1970 :43). In this process, coding and analysis are interwoven, and thus are often important steps for getting closer to the phenomenon and deciding what to focus on next. Becker began his research by interviewing musicians close to him, then asking them to refer him to other musicians, and later on doubling his original sample of about 25 to include individuals in other professions (Becker 1973:46). Additionally, he made use of some participant observation, documents, and interviews with opiate users made available to him by colleagues. As his inductive theory of deviance evolved, Becker expanded his sample in order to fine tune it, and test the accuracy and generality of his hypotheses. In addition, he introduced a negative case and discussed the null hypothesis ( 1963 :44). His phasic career model is thus based on a research design that embraces processual work. Typically, process means to move between “theory” and “material” but also to deal with negative cases, and Becker ( 1998 ) describes how discovering these negative cases impacted his research design and ultimately its findings.

Obviously, all research is process-oriented to some degree. The point is that the ideal-typical quantitative process does not imply change of the data, and iteration between data, evidence, hypotheses, empirical work, and theory. The data, quantified variables, are, in most cases fixed. Merging of data, which of course can be done in a quantitative research process, does not mean new data. New hypotheses are frequently tested, but the “raw data is often the “the same.” Obviously, over time new datasets are made available and put into use.

Another characteristic that is emphasized in our sample is that qualitative researchers – and in particular ethnographers – can, or as Goffman put it, ought to ( 1989 ), get closer to the phenomenon being studied and their data than quantitative researchers (for example, Silverman 2009 :85). Put differently, essentially because of their methods qualitative researchers get into direct close contact with those being investigated and/or the material, such as texts, being analyzed. Becker started out his interview study, as we noted, by talking to those he knew in the field of music to get closer to the phenomenon he was studying. By conducting interviews he got even closer. Had he done more observations, he would undoubtedly have got even closer to the field.

Additionally, ethnographers’ design enables researchers to follow the field over time, and the research they do is almost by definition longitudinal, though the time in the field is studied obviously differs between studies. The general characteristic of closeness over time maximizes the chances of unexpected events, new data (related, for example, to archival research as additional sources, and for ethnography for situations not necessarily previously thought of as instrumental – what Mannay and Morgan ( 2015 ) term the “waiting field”), serendipity (Merton and Barber 2004 ; Åkerström 2013 ), and possibly reactivity, as well as the opportunity to observe disrupted patterns that translate into exemplars of negative cases. Two classic examples of this are Becker’s finding of what medical students call “crocks” (Becker et al. 1961 :317), and Geertz’s ( 1973 ) study of “deep play” in Balinese society.

By getting and staying so close to their data – be it pictures, text or humans interacting (Becker was himself a musician) – for a long time, as the research progressively focuses, qualitative researchers are prompted to continually test their hunches, presuppositions and hypotheses. They test them against a reality that often (but certainly not always), and practically, as well as metaphorically, talks back, whether by validating them, or disqualifying their premises – correctly, as well as incorrectly (Fine 2003 ; Becker 1970 ). This testing nonetheless often leads to new directions for the research. Becker, for example, says that he was initially reading psychological theories, but when facing the data he develops a theory that looks at, you may say, everything but psychological dispositions to explain the use of marihuana. Especially researchers involved with ethnographic methods have a fairly unique opportunity to dig up and then test (in a circular, continuous and temporal way) new research questions and findings as the research progresses, and thereby to derive previously unimagined and uncharted distinctions by getting closer to the phenomenon under study.

Let us stress that getting close is by no means restricted to ethnography. The notion of hermeneutic circle and hermeneutics as a general way of understanding implies that we must get close to the details in order to get the big picture. This also means that qualitative researchers can literally also make use of details of pictures as evidence (cf. Harper 2002). Thus, researchers may get closer both when generating the material or when analyzing it.

Quantitative research, we maintain, in the ideal-typical representation cannot get closer to the data. The data is essentially numbers in tables making up the variables (Franzosi 2016 :138). The data may originally have been “qualitative,” but once reduced to numbers there can only be a type of “hermeneutics” about what the number may stand for. The numbers themselves, however, are non-ambiguous. Thus, in quantitative research, interpretation, if done, is not about the data itself—the numbers—but what the numbers stand for. It follows that the interpretation is essentially done in a more “speculative” mode without direct empirical evidence (cf. Becker 2017 ).

Improved Understanding

While distinction, process and getting closer refer to the qualitative work of the researcher, improved understanding refers to its conditions and outcome of this work. Understanding cuts deeper than explanation, which to some may mean a causally verified correlation between variables. The notion of explanation presupposes the notion of understanding since explanation does not include an idea of how knowledge is gained (Manicas 2006 : 15). Understanding, we argue, is the core concept of what we call the outcome of the process when research has made use of all the other elements that were integrated in the research. Understanding, then, has a special status in qualitative research since it refers both to the conditions of knowledge and the outcome of the process. Understanding can to some extent be seen as the condition of explanation and occurs in a process of interpretation, which naturally refers to meaning (Gadamer 1990 ). It is fundamentally connected to knowing, and to the knowing of how to do things (Heidegger [1927] 2001 ). Conceptually the term hermeneutics is used to account for this process. Heidegger ties hermeneutics to human being and not possible to separate from the understanding of being ( 1988 ). Here we use it in a broader sense, and more connected to method in general (cf. Seiffert 1992 ). The abovementioned aspects – for example, “objectivity” and “reflexivity” – of the approach are conditions of scientific understanding. Understanding is the result of a circular process and means that the parts are understood in light of the whole, and vice versa. Understanding presupposes pre-understanding, or in other words, some knowledge of the phenomenon studied. The pre-understanding, even in the form of prejudices, are in qualitative research process, which we see as iterative, questioned, which gradually or suddenly change due to the iteration of data, evidence and concepts. However, qualitative research generates understanding in the iterative process when the researcher gets closer to the data, e.g., by going back and forth between field and analysis in a process that generates new data that changes the evidence, and, ultimately, the findings. Questioning, to ask questions, and put what one assumes—prejudices and presumption—in question, is central to understand something (Heidegger [1927] 2001 ; Gadamer 1990 :368–384). We propose that this iterative process in which the process of understanding occurs is characteristic of qualitative research.

Improved understanding means that we obtain scientific knowledge of something that we as a scholarly community did not know before, or that we get to know something better. It means that we understand more about how parts are related to one another, and to other things we already understand (see also Fine and Hallett 2014 ). Understanding is an important condition for qualitative research. It is not enough to identify correlations, make distinctions, and work in a process in which one gets close to the field or phenomena. Understanding is accomplished when the elements are integrated in an iterative process.

It is, moreover, possible to understand many things, and researchers, just like children, may come to understand new things every day as they engage with the world. This subjective condition of understanding – namely, that a person gains a better understanding of something –is easily met. To be qualified as “scientific,” the understanding must be general and useful to many; it must be public. But even this generally accessible understanding is not enough in order to speak of “scientific understanding.” Though we as a collective can increase understanding of everything in virtually all potential directions as a result also of qualitative work, we refrain from this “objective” way of understanding, which has no means of discriminating between what we gain in understanding. Scientific understanding means that it is deemed relevant from the scientific horizon (compare Schütz 1962 : 35–38, 46, 63), and that it rests on the pre-understanding that the scientists have and must have in order to understand. In other words, the understanding gained must be deemed useful by other researchers, so that they can build on it. We thus see understanding from a pragmatic, rather than a subjective or objective perspective. Improved understanding is related to the question(s) at hand. Understanding, in order to represent an improvement, must be an improvement in relation to the existing body of knowledge of the scientific community (James [ 1907 ] 1955). Scientific understanding is, by definition, collective, as expressed in Weber’s famous note on objectivity, namely that scientific work aims at truths “which … can claim, even for a Chinese, the validity appropriate to an empirical analysis” ([1904] 1949 :59). By qualifying “improved understanding” we argue that it is a general defining characteristic of qualitative research. Becker‘s ( 1966 ) study and other research of deviant behavior increased our understanding of the social learning processes of how individuals start a behavior. And it also added new knowledge about the labeling of deviant behavior as a social process. Few studies, of course, make the same large contribution as Becker’s, but are nonetheless qualitative research.

Understanding in the phenomenological sense, which is a hallmark of qualitative research, we argue, requires meaning and this meaning is derived from the context, and above all the data being analyzed. The ideal-typical quantitative research operates with given variables with different numbers. This type of material is not enough to establish meaning at the level that truly justifies understanding. In other words, many social science explanations offer ideas about correlations or even causal relations, but this does not mean that the meaning at the level of the data analyzed, is understood. This leads us to say that there are indeed many explanations that meet the criteria of understanding, for example the explanation of how one becomes a marihuana smoker presented by Becker. However, we may also understand a phenomenon without explaining it, and we may have potential explanations, or better correlations, that are not really understood.

We may speak more generally of quantitative research and its data to clarify what we see as an important distinction. The “raw data” that quantitative research—as an idealtypical activity, refers to is not available for further analysis; the numbers, once created, are not to be questioned (Franzosi 2016 : 138). If the researcher is to do “more” or “change” something, this will be done by conjectures based on theoretical knowledge or based on the researcher’s lifeworld. Both qualitative and quantitative research is based on the lifeworld, and all researchers use prejudices and pre-understanding in the research process. This idea is present in the works of Heidegger ( 2001 ) and Heisenberg (cited in Franzosi 2010 :619). Qualitative research, as we argued, involves the interaction and questioning of concepts (theory), data, and evidence.

Ragin ( 2004 :22) points out that “a good definition of qualitative research should be inclusive and should emphasize its key strengths and features, not what it lacks (for example, the use of sophisticated quantitative techniques).” We define qualitative research as an iterative process in which improved understanding to the scientific community is achieved by making new significant distinctions resulting from getting closer to the phenomenon studied. Qualitative research, as defined here, is consequently a combination of two criteria: (i) how to do things –namely, generating and analyzing empirical material, in an iterative process in which one gets closer by making distinctions, and (ii) the outcome –improved understanding novel to the scholarly community. Is our definition applicable to our own study? In this study we have closely read the empirical material that we generated, and the novel distinction of the notion “qualitative research” is the outcome of an iterative process in which both deduction and induction were involved, in which we identified the categories that we analyzed. We thus claim to meet the first criteria, “how to do things.” The second criteria cannot be judged but in a partial way by us, namely that the “outcome” —in concrete form the definition-improves our understanding to others in the scientific community.

We have defined qualitative research, or qualitative scientific work, in relation to quantitative scientific work. Given this definition, qualitative research is about questioning the pre-given (taken for granted) variables, but it is thus also about making new distinctions of any type of phenomenon, for example, by coining new concepts, including the identification of new variables. This process, as we have discussed, is carried out in relation to empirical material, previous research, and thus in relation to theory. Theory and previous research cannot be escaped or bracketed. According to hermeneutic principles all scientific work is grounded in the lifeworld, and as social scientists we can thus never fully bracket our pre-understanding.

We have proposed that quantitative research, as an idealtype, is concerned with pre-determined variables (Small 2008 ). Variables are epistemically fixed, but can vary in terms of dimensions, such as frequency or number. Age is an example; as a variable it can take on different numbers. In relation to quantitative research, qualitative research does not reduce its material to number and variables. If this is done the process of comes to a halt, the researcher gets more distanced from her data, and it makes it no longer possible to make new distinctions that increase our understanding. We have above discussed the components of our definition in relation to quantitative research. Our conclusion is that in the research that is called quantitative there are frequent and necessary qualitative elements.

Further, comparative empirical research on researchers primarily working with ”quantitative” approaches and those working with ”qualitative” approaches, we propose, would perhaps show that there are many similarities in practices of these two approaches. This is not to deny dissimilarities, or the different epistemic and ontic presuppositions that may be more or less strongly associated with the two different strands (see Goertz and Mahoney 2012 ). Our point is nonetheless that prejudices and preconceptions about researchers are unproductive, and that as other researchers have argued, differences may be exaggerated (e.g., Becker 1996 : 53, 2017 ; Marchel and Owens 2007 :303; Ragin 1994 ), and that a qualitative dimension is present in both kinds of work.

Several things follow from our findings. The most important result is the relation to quantitative research. In our analysis we have separated qualitative research from quantitative research. The point is not to label individual researchers, methods, projects, or works as either “quantitative” or “qualitative.” By analyzing, i.e., taking apart, the notions of quantitative and qualitative, we hope to have shown the elements of qualitative research. Our definition captures the elements, and how they, when combined in practice, generate understanding. As many of the quotations we have used suggest, one conclusion of our study holds that qualitative approaches are not inherently connected with a specific method. Put differently, none of the methods that are frequently labelled “qualitative,” such as interviews or participant observation, are inherently “qualitative.” What matters, given our definition, is whether one works qualitatively or quantitatively in the research process, until the results are produced. Consequently, our analysis also suggests that those researchers working with what in the literature and in jargon is often called “quantitative research” are almost bound to make use of what we have identified as qualitative elements in any research project. Our findings also suggest that many” quantitative” researchers, at least to some extent, are engaged with qualitative work, such as when research questions are developed, variables are constructed and combined, and hypotheses are formulated. Furthermore, a research project may hover between “qualitative” and “quantitative” or start out as “qualitative” and later move into a “quantitative” (a distinct strategy that is not similar to “mixed methods” or just simply combining induction and deduction). More generally speaking, the categories of “qualitative” and “quantitative,” unfortunately, often cover up practices, and it may lead to “camps” of researchers opposing one another. For example, regardless of the researcher is primarily oriented to “quantitative” or “qualitative” research, the role of theory is neglected (cf. Swedberg 2017 ). Our results open up for an interaction not characterized by differences, but by different emphasis, and similarities.

Let us take two examples to briefly indicate how qualitative elements can fruitfully be combined with quantitative. Franzosi ( 2010 ) has discussed the relations between quantitative and qualitative approaches, and more specifically the relation between words and numbers. He analyzes texts and argues that scientific meaning cannot be reduced to numbers. Put differently, the meaning of the numbers is to be understood by what is taken for granted, and what is part of the lifeworld (Schütz 1962 ). Franzosi shows how one can go about using qualitative and quantitative methods and data to address scientific questions analyzing violence in Italy at the time when fascism was rising (1919–1922). Aspers ( 2006 ) studied the meaning of fashion photographers. He uses an empirical phenomenological approach, and establishes meaning at the level of actors. In a second step this meaning, and the different ideal-typical photographers constructed as a result of participant observation and interviews, are tested using quantitative data from a database; in the first phase to verify the different ideal-types, in the second phase to use these types to establish new knowledge about the types. In both of these cases—and more examples can be found—authors move from qualitative data and try to keep the meaning established when using the quantitative data.

A second main result of our study is that a definition, and we provided one, offers a way for research to clarify, and even evaluate, what is done. Hence, our definition can guide researchers and students, informing them on how to think about concrete research problems they face, and to show what it means to get closer in a process in which new distinctions are made. The definition can also be used to evaluate the results, given that it is a standard of evaluation (cf. Hammersley 2007 ), to see whether new distinctions are made and whether this improves our understanding of what is researched, in addition to the evaluation of how the research was conducted. By making what is qualitative research explicit it becomes easier to communicate findings, and it is thereby much harder to fly under the radar with substandard research since there are standards of evaluation which make it easier to separate “good” from “not so good” qualitative research.

To conclude, our analysis, which ends with a definition of qualitative research can thus both address the “internal” issues of what is qualitative research, and the “external” critiques that make it harder to do qualitative research, to which both pressure from quantitative methods and general changes in society contribute.

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Acknowledgements

Financial Support for this research is given by the European Research Council, CEV (263699). The authors are grateful to Susann Krieglsteiner for assistance in collecting the data. The paper has benefitted from the many useful comments by the three reviewers and the editor, comments by members of the Uppsala Laboratory of Economic Sociology, as well as Jukka Gronow, Sebastian Kohl, Marcin Serafin, Richard Swedberg, Anders Vassenden and Turid Rødne.

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Aspers, P., Corte, U. What is Qualitative in Qualitative Research. Qual Sociol 42 , 139–160 (2019). https://doi.org/10.1007/s11133-019-9413-7

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• Introduction

Qualitative research is a type of research that explores and provides deeper insights into real-world problems. [1] Instead of collecting numerical data points or intervening or introducing treatments just like in quantitative research, qualitative research helps generate hypothenar to further investigate and understand quantitative data. Qualitative research gathers participants' experiences, perceptions, and behavior. It answers the hows and whys instead of how many or how much. It could be structured as a standalone study, purely relying on qualitative data, or part of mixed-methods research that combines qualitative and quantitative data. This review introduces the readers to some basic concepts, definitions, terminology, and applications of qualitative research.

Qualitative research, at its core, asks open-ended questions whose answers are not easily put into numbers, such as "how" and "why." [2] Due to the open-ended nature of the research questions, qualitative research design is often not linear like quantitative design. [2] One of the strengths of qualitative research is its ability to explain processes and patterns of human behavior that can be difficult to quantify. [3] Phenomena such as experiences, attitudes, and behaviors can be complex to capture accurately and quantitatively. In contrast, a qualitative approach allows participants themselves to explain how, why, or what they were thinking, feeling, and experiencing at a particular time or during an event of interest. Quantifying qualitative data certainly is possible, but at its core, qualitative data is looking for themes and patterns that can be difficult to quantify, and it is essential to ensure that the context and narrative of qualitative work are not lost by trying to quantify something that is not meant to be quantified.

However, while qualitative research is sometimes placed in opposition to quantitative research, where they are necessarily opposites and therefore "compete" against each other and the philosophical paradigms associated with each other, qualitative and quantitative work are neither necessarily opposites, nor are they incompatible. [4] While qualitative and quantitative approaches are different, they are not necessarily opposites and certainly not mutually exclusive. For instance, qualitative research can help expand and deepen understanding of data or results obtained from quantitative analysis. For example, say a quantitative analysis has determined a correlation between length of stay and level of patient satisfaction, but why does this correlation exist? This dual-focus scenario shows one way in which qualitative and quantitative research could be integrated.

Qualitative Research Approaches

Ethnography

Ethnography as a research design originates in social and cultural anthropology and involves the researcher being directly immersed in the participant’s environment. [2] Through this immersion, the ethnographer can use a variety of data collection techniques to produce a comprehensive account of the social phenomena that occurred during the research period. [2] That is to say, the researcher’s aim with ethnography is to immerse themselves into the research population and come out of it with accounts of actions, behaviors, events, etc, through the eyes of someone involved in the population. Direct involvement of the researcher with the target population is one benefit of ethnographic research because it can then be possible to find data that is otherwise very difficult to extract and record.

Grounded theory

Grounded Theory is the "generation of a theoretical model through the experience of observing a study population and developing a comparative analysis of their speech and behavior." [5] Unlike quantitative research, which is deductive and tests or verifies an existing theory, grounded theory research is inductive and, therefore, lends itself to research aimed at social interactions or experiences. [3] [2] In essence, Grounded Theory’s goal is to explain how and why an event occurs or how and why people might behave a certain way. Through observing the population, a researcher using the Grounded Theory approach can then develop a theory to explain the phenomena of interest.

Phenomenology

Phenomenology is the "study of the meaning of phenomena or the study of the particular.” [5] At first glance, it might seem that Grounded Theory and Phenomenology are pretty similar, but the differences can be seen upon careful examination. At its core, phenomenology looks to investigate experiences from the individual's perspective. [2] Phenomenology is essentially looking into the "lived experiences" of the participants and aims to examine how and why participants behaved a certain way from their perspective. Herein lies one of the main differences between Grounded Theory and Phenomenology. Grounded Theory aims to develop a theory for social phenomena through an examination of various data sources. In contrast, Phenomenology focuses on describing and explaining an event or phenomenon from the perspective of those who have experienced it.

Narrative research

One of qualitative research’s strengths lies in its ability to tell a story, often from the perspective of those directly involved in it. Reporting on qualitative research involves including details and descriptions of the setting involved and quotes from participants. This detail is called a "thick" or "rich" description and is a strength of qualitative research. Narrative research is rife with the possibilities of "thick" description as this approach weaves together a sequence of events, usually from just one or two individuals, hoping to create a cohesive story or narrative. [2] While it might seem like a waste of time to focus on such a specific, individual level, understanding one or two people’s narratives for an event or phenomenon can help to inform researchers about the influences that helped shape that narrative. The tension or conflict of differing narratives can be "opportunities for innovation." [2]

Research Paradigm

Research paradigms are the assumptions, norms, and standards underpinning different research approaches. Essentially, research paradigms are the "worldviews" that inform research. [4] It is valuable for qualitative and quantitative researchers to understand what paradigm they are working within because understanding the theoretical basis of research paradigms allows researchers to understand the strengths and weaknesses of the approach being used and adjust accordingly. Different paradigms have different ontologies and epistemologies. Ontology is defined as the "assumptions about the nature of reality,” whereas epistemology is defined as the "assumptions about the nature of knowledge" that inform researchers' work. [2] It is essential to understand the ontological and epistemological foundations of the research paradigm researchers are working within to allow for a complete understanding of the approach being used and the assumptions that underpin the approach as a whole. Further, researchers must understand their own ontological and epistemological assumptions about the world in general because their assumptions about the world will necessarily impact how they interact with research. A discussion of the research paradigm is not complete without describing positivist, postpositivist, and constructivist philosophies.

Positivist versus postpositivist

To further understand qualitative research, we must discuss positivist and postpositivist frameworks. Positivism is a philosophy that the scientific method can and should be applied to social and natural sciences. [4] Essentially, positivist thinking insists that the social sciences should use natural science methods in their research. It stems from positivist ontology, that there is an objective reality that exists that is wholly independent of our perception of the world as individuals. Quantitative research is rooted in positivist philosophy, which can be seen in the value it places on concepts such as causality, generalizability, and replicability.

Conversely, postpositivists argue that social reality can never be one hundred percent explained, but could be approximated. [4] Indeed, qualitative researchers have been insisting that there are “fundamental limits to the extent to which the methods and procedures of the natural sciences could be applied to the social world,” and therefore, postpositivist philosophy is often associated with qualitative research. [4] An example of positivist versus postpositivist values in research might be that positivist philosophies value hypothesis-testing, whereas postpositivist philosophies value the ability to formulate a substantive theory.

Constructivist

Constructivism is a subcategory of postpositivism. Most researchers invested in postpositivist research are also constructivist, meaning they think there is no objective external reality that exists but instead that reality is constructed. Constructivism is a theoretical lens that emphasizes the dynamic nature of our world. "Constructivism contends that individuals' views are directly influenced by their experiences, and it is these individual experiences and views that shape their perspective of reality.” [6]  constructivist thought focuses on how "reality" is not a fixed certainty and how experiences, interactions, and backgrounds give people a unique view of the world. Constructivism contends, unlike positivist views, that there is not necessarily an "objective"reality we all experience. This is the ‘relativist’ ontological view that reality and our world are dynamic and socially constructed. Therefore, qualitative scientific knowledge can be inductive as well as deductive.” [4]

So why is it important to understand the differences in assumptions that different philosophies and approaches to research have? Fundamentally, the assumptions underpinning the research tools a researcher selects provide an overall base for the assumptions the rest of the research will have. It can even change the role of the researchers. [2] For example, is the researcher an "objective" observer, such as in positivist quantitative work? Or is the researcher an active participant in the research, as in postpositivist qualitative work? Understanding the philosophical base of the study undertaken allows researchers to fully understand the implications of their work and their role within the research and reflect on their positionality and bias as it pertains to the research they are conducting.

Data Sampling 

The better the sample represents the intended study population, the more likely the researcher is to encompass the varying factors. The following are examples of participant sampling and selection: [7]

• Purposive sampling- selection based on the researcher’s rationale for being the most informative.
• Criterion sampling selection based on pre-identified factors.
• Convenience sampling- selection based on availability.
• Snowball sampling- the selection is by referral from other participants or people who know potential participants.
• Extreme case sampling- targeted selection of rare cases.
• Typical case sampling selection based on regular or average participants. 

Data Collection and Analysis

Qualitative research uses several techniques, including interviews, focus groups, and observation. [1] [2] [3] Interviews may be unstructured, with open-ended questions on a topic, and the interviewer adapts to the responses. Structured interviews have a predetermined number of questions that every participant is asked. It is usually one-on-one and appropriate for sensitive topics or topics needing an in-depth exploration. Focus groups are often held with 8-12 target participants and are used when group dynamics and collective views on a topic are desired. Researchers can be participant-observers to share the experiences of the subject or non-participants or detached observers.

While quantitative research design prescribes a controlled environment for data collection, qualitative data collection may be in a central location or the participants' environment, depending on the study goals and design. Qualitative research could amount to a large amount of data. Data is transcribed, which may then be coded manually or using computer-assisted qualitative data analysis software or CAQDAS such as ATLAS.ti or NVivo. [8] [9] [10]

After the coding process, qualitative research results could be in various formats. It could be a synthesis and interpretation presented with excerpts from the data. [11] Results could also be in the form of themes and theory or model development.

Dissemination

The healthcare team can use two reporting standards to standardize and facilitate the dissemination of qualitative research outcomes. The Consolidated Criteria for Reporting Qualitative Research or COREQ is a 32-item checklist for interviews and focus groups. [12] The Standards for Reporting Qualitative Research (SRQR) is a checklist covering a more comprehensive range of qualitative research. [13]

Applications

Many times, a research question will start with qualitative research. The qualitative research will help generate the research hypothesis, which can be tested with quantitative methods. After the data is collected and analyzed with quantitative methods, a set of qualitative methods can be used to dive deeper into the data to better understand what the numbers truly mean and their implications. The qualitative techniques can then help clarify the quantitative data and also help refine the hypothesis for future research. Furthermore, with qualitative research, researchers can explore poorly studied subjects with quantitative methods. These include opinions, individual actions, and social science research.

An excellent qualitative study design starts with a goal or objective. This should be clearly defined or stated. The target population needs to be specified. A method for obtaining information from the study population must be carefully detailed to ensure no omissions of part of the target population. A proper collection method should be selected that will help obtain the desired information without overly limiting the collected data because, often, the information sought is not well categorized or obtained. Finally, the design should ensure adequate methods for analyzing the data. An example may help better clarify some of the various aspects of qualitative research.

A researcher wants to decrease the number of teenagers who smoke in their community. The researcher could begin by asking current teen smokers why they started smoking through structured or unstructured interviews (qualitative research). The researcher can also get together a group of current teenage smokers and conduct a focus group to help brainstorm factors that may have prevented them from starting to smoke (qualitative research).

In this example, the researcher has used qualitative research methods (interviews and focus groups) to generate a list of ideas of why teens start to smoke and factors that may have prevented them from starting to smoke. Next, the researcher compiles this data. The research found that, hypothetically, peer pressure, health issues, cost, being considered "cool," and rebellious behavior all might increase or decrease the likelihood of teens starting to smoke.

The researcher creates a survey asking teen participants to rank how important each of the above factors is in either starting smoking (for current smokers) or not smoking (for current nonsmokers). This survey provides specific numbers (ranked importance of each factor) and is thus a quantitative research tool.

The researcher can use the survey results to focus efforts on the one or two highest-ranked factors. Let us say the researcher found that health was the primary factor that keeps teens from starting to smoke, and peer pressure was the primary factor that contributed to teens starting smoking. The researcher can go back to qualitative research methods to dive deeper into these for more information. The researcher wants to focus on keeping teens from starting to smoke, so they focus on the peer pressure aspect.

The researcher can conduct interviews and focus groups (qualitative research) about what types and forms of peer pressure are commonly encountered, where the peer pressure comes from, and where smoking starts. The researcher hypothetically finds that peer pressure often occurs after school at the local teen hangouts, mostly in the local park. The researcher also hypothetically finds that peer pressure comes from older, current smokers who provide the cigarettes.

The researcher could further explore this observation made at the local teen hangouts (qualitative research) and take notes regarding who is smoking, who is not, and what observable factors are at play for peer pressure to smoke. The researcher finds a local park where many local teenagers hang out and sees that the smokers tend to hang out in a shady, overgrown area of the park. The researcher notes that smoking teenagers buy their cigarettes from a local convenience store adjacent to the park, where the clerk does not check identification before selling cigarettes. These observations fall under qualitative research.

If the researcher returns to the park and counts how many individuals smoke in each region, this numerical data would be quantitative research. Based on the researcher's efforts thus far, they conclude that local teen smoking and teenagers who start to smoke may decrease if there are fewer overgrown areas of the park and the local convenience store does not sell cigarettes to underage individuals.

The researcher could try to have the parks department reassess the shady areas to make them less conducive to smokers or identify how to limit the sales of cigarettes to underage individuals by the convenience store. The researcher would then cycle back to qualitative methods of asking at-risk populations their perceptions of the changes and what factors are still at play, and quantitative research that includes teen smoking rates in the community and the incidence of new teen smokers, among others. [14] [15]

Qualitative research functions as a standalone research design or combined with quantitative research to enhance our understanding of the world. Qualitative research uses techniques including structured and unstructured interviews, focus groups, and participant observation not only to help generate hypotheses that can be more rigorously tested with quantitative research but also to help researchers delve deeper into the quantitative research numbers, understand what they mean, and understand what the implications are. Qualitative research allows researchers to understand what is going on, especially when things are not easily categorized. [16]

• Issues of Concern

As discussed in the sections above, quantitative and qualitative work differ in many ways, including the evaluation criteria. There are four well-established criteria for evaluating quantitative data: internal validity, external validity, reliability, and objectivity. Credibility, transferability, dependability, and confirmability are the correlating concepts in qualitative research. [4] [11] The corresponding quantitative and qualitative concepts can be seen below, with the quantitative concept on the left and the qualitative concept on the right:

• Internal validity: Credibility
• External validity: Transferability
• Reliability: Dependability
• Objectivity: Confirmability

In conducting qualitative research, ensuring these concepts are satisfied and well thought out can mitigate potential issues from arising. For example, just as a researcher will ensure that their quantitative study is internally valid, qualitative researchers should ensure that their work has credibility. 

Indicators such as triangulation and peer examination can help evaluate the credibility of qualitative work.

• Triangulation: Triangulation involves using multiple data collection methods to increase the likelihood of getting a reliable and accurate result. In our above magic example, the result would be more reliable if we interviewed the magician, backstage hand, and the person who "vanished." In qualitative research, triangulation can include telephone surveys, in-person surveys, focus groups, and interviews and surveying an adequate cross-section of the target demographic.
• Peer examination: A peer can review results to ensure the data is consistent with the findings.

A "thick" or "rich" description can be used to evaluate the transferability of qualitative research, whereas an indicator such as an audit trail might help evaluate the dependability and confirmability.

• Thick or rich description:  This is a detailed and thorough description of details, the setting, and quotes from participants in the research. [5] Thick descriptions will include a detailed explanation of how the study was conducted. Thick descriptions are detailed enough to allow readers to draw conclusions and interpret the data, which can help with transferability and replicability.
• Audit trail: An audit trail provides a documented set of steps of how the participants were selected and the data was collected. The original information records should also be kept (eg, surveys, notes, recordings).

One issue of concern that qualitative researchers should consider is observation bias. Here are a few examples:

• Hawthorne effect: The effect is the change in participant behavior when they know they are being observed. Suppose a researcher wanted to identify factors that contribute to employee theft and tell the employees they will watch them to see what factors affect employee theft. In that case, one would suspect employee behavior would change when they know they are being protected.
• Observer-expectancy effect: Some participants change their behavior or responses to satisfy the researcher's desired effect. This happens unconsciously for the participant, so it is essential to eliminate or limit the transmission of the researcher's views.
• Artificial scenario effect: Some qualitative research occurs in contrived scenarios with preset goals. In such situations, the information may not be accurate because of the artificial nature of the scenario. The preset goals may limit the qualitative information obtained.
• Clinical Significance

Qualitative or quantitative research helps healthcare providers understand patients and the impact and challenges of the care they deliver. Qualitative research provides an opportunity to generate and refine hypotheses and delve deeper into the data generated by quantitative research. Qualitative research is not an island apart from quantitative research but an integral part of research methods to understand the world around us. [17]

• Enhancing Healthcare Team Outcomes

Qualitative research is essential for all healthcare team members as all are affected by qualitative research. Qualitative research may help develop a theory or a model for health research that can be further explored by quantitative research. Much of the qualitative research data acquisition is completed by numerous team members, including social workers, scientists, nurses, etc. Within each area of the medical field, there is copious ongoing qualitative research, including physician-patient interactions, nursing-patient interactions, patient-environment interactions, healthcare team function, patient information delivery, etc. 

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Disclosure: Steven Tenny declares no relevant financial relationships with ineligible companies.

Disclosure: Janelle Brannan declares no relevant financial relationships with ineligible companies.

Disclosure: Grace Brannan declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Tenny S, Brannan JM, Brannan GD. Qualitative Study. [Updated 2022 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Home » Qualitative Research – Methods, Analysis Types and Guide

Qualitative Research – Methods, Analysis Types and Guide

Table of Contents

Qualitative Research

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

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

Qualitative Research Methods

Qualitative Research Methods are as follows:

One-to-One Interview

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

Focus Groups

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

Ethnographic Studies

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

Text Analysis

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

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

Process of Observation

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

Record Keeping

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

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

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

Qualitative Research Analysis Methods

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

Thematic Analysis

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

Content Analysis

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

Discourse Analysis

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

Grounded Theory Analysis

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

Narrative Analysis

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

Phenomenological Analysis

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

Comparative Analysis

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

Applications of Qualitative Research

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

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

How to Conduct Qualitative Research

Here are some general steps for conducting qualitative research:

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

Examples of Qualitative Research

Here are some real-time examples of qualitative research:

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

Purpose of Qualitative Research

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

Qualitative research can serve multiple purposes, including:

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

When to use Qualitative Research

Here are some situations where qualitative research may be appropriate:

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

Characteristics of Qualitative Research

Qualitative research is characterized by several key features, including:

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

Advantages of Qualitative Research

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

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

Limitations of Qualitative Research

Qualitative research also has some limitations, including:

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

Also see Research Methods

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• Published: 15 May 2024

Sacred space: a qualitative interpretive meta-synthesis of women’s experiences of supportive birthing environments

• December Maxwell 1 ,
• Sarah R. Leat 2 ,
• Toni Gallegos 3 &
• Regina T. Praetorius 3  

BMC Pregnancy and Childbirth volume  24 , Article number:  372 ( 2024 ) Cite this article

113 Accesses

Metrics details

In the United States there are roughly three million births a year, ranging from cesarean to natural births. A major aspect of the birthing process is related to the healing environment, and how that helps or harms healing for the mother and child. Using the theoretical framework, Theory of Supportive Care Settings (TSCS), this study aimed to explore what is necessary to have a safe and sacred healing environment for mothers.

This study utilized an updated Qualitative Interpretive Meta-synthesis (QIMS) design called QIMS-DTT [deductive theory testing] to answer the research question, What are mother’s experiences of environmental factors contributing to a supportive birthing environment within healthcare settings?

Key terms were run through multiple databases, which resulted in 5,688 articles. After title and abstract screening, 43 were left for full-text, 12 were excluded, leaving 31 to be included in the final QIMS. Five main themes emerged from analysis: 1) Service in the environment, 2) Recognizing oneself within the birthing space, 3) Creating connections with support systems, 4) Being welcomed into the birthing space, and 5) Feeling safe within the birthing environment.

Conclusions

Providing a warm and welcoming birth space is crucial for people who give birth to have positive experiences. Providing spaces where the person can feel safe and supported allows them to find empowerment in the situation where they have limited control.

Peer Review reports

Introduction

In 2021, there were 3,664,292 births in the United States. Of those birth, 98.3% took place in hospitals [ 1 ]. In hospital settings, medical interventions such as induction of labor, cesarean sections, and the use of instruments like forceps or vacuum extractors may be more common [ 2 ]. These interventions can carry risks such as increased likelihood of complications for both the birthing person and the baby [ 2 , 3 ]. Some women may feel stressed or anxious in a hospital setting, which could potentially slow down labor or lead to other complications. This stress can be due to various factors such as unfamiliar surroundings, medical procedures, or concerns about interventions [ 2 ]. In a hospital setting, decisions about the birth process may be influenced by hospital policies, medical protocols, and the preferences of healthcare providers, potentially leading to a loss of autonomy for the birthing person in decision-making about their own birth experience [ 4 ]. The experience of giving birth in a hospital, especially if it involves unexpected interventions or complications, can contribute to postpartum depression or anxiety in some women [ 5 ]. Hospital routines and policies may not always be conducive to establishing breastfeeding immediately after birth, which can lead to challenges in breastfeeding initiation and continuation [ 6 ].

Birthing requires healing and a supportive environment at every stage of the birthing process, consisting of holistic support and agency [ 7 ]. This involves “constant emotional, physical, spiritual, and psychosocial” support [ 8 ]. Experiencing birthing trauma has shown to result in postpartum post-traumatic stress disorder (P-PTSD) and postpartum depression (PPD) [ 9 , 10 , 11 ]. Likewise, disempowering births can have long term impacts of maternal self-esteem [ 12 , 13 ]. Maternal mental health issues have resulted in numerous public health concerns, specifically regarding the decreased safety and negative health outcomes that the infant faces [ 14 , 15 ]. Postpartum mental health disorders can also have lasting impacts on family outcomes [ 16 , 17 ]. As such, understanding how to improve the birth experience has the potential to reduce postpartum mental health issues, as well as reduce maternal morbidities, which can improve outcomes for both mother and child.

Of note is the influence of the built environment on healing. Given that thoughtfully designed healthcare facilities can influence the amount of privacy and control a patient perceives [ 18 ], the built environment plays an integral part in healing. Ample daylight, thermal comfort, color, and noise control all contribute to environmental healing within a hospital [ 19 ]. Furthermore, patient health outcomes have been linked to the built environment of hospitals in multiple studies [ 13 , 20 , 21 ]. More specific to birthing, women have indicated that perceived hominess and control in the environment relate to their birthing experience [ 20 , 22 , 23 ].

Control over the birthing environment, including comfort and perceived healing also have mental health impacts for birthing mothers, and the birth environment can have an impact on the mother’s perception of the birth which in turn can influence maternal mental health outcomes [ 24 , 25 ]. Given that approximately 1 in 7 mothers will experience postpartum depression (PPD) in the United States [ 26 , 27 ] and 0.05%-60% of mothers will experience PPD globally [ 28 , 29 ], understanding the impact of birthing environment on maternal morbidities and mental health can create holistic approaches to birthing environment design.

Given the impacts of the birthing environment on maternal mental health, learning what is necessary to have a safe and sacred healing environment for mothers is an important endeavor and the purpose of this qualitative interpretive meta-synthesis (QIMS). A QIMS is a method that is specific to the social work field. It was created to review and analyze qualitative data to identify and synthesize themes surrounding different phenomena found in existing qualitative research [ 30 ]. QIMS has previously been used to synthesize existing data regarding social justice concerns around minority police encounters [ 31 ] and children’s exposure to intimate partner violence [ 32 ]. Concerning the topic of birthing and motherhood, one QIMS explored marginalized women’s experiences of postpartum depression [ 33 ] and another explored the experience of suicidality postpartum [ 34 ]. To date, no QIMS has considered the experiences of the birth environment for birthing mothers and the impact on maternal mental health. A synthesis of the literature qualitatively evaluating women’s perspectives on what is necessary to have a safe and sacred healing environment for mothers could bolster understanding of how hospitals could better support birthing mothers. As such, this study uses QIMS to answer the following research question: what is necessary to have a safe and sacred healing environment for mothers?

Theoretical framework

This study sought to understand how birthing mothers experienced the birthing environment and which environmental factors contributed to a safe and sacred healing environment for mothers. As such, the Theory of Supportive Care Settings (TSCS) was used to frame this synthesis [ 35 ].

Theory of supportive care settings

Theory of Supportive Care Settings (TSCS) was created through research to have a theoretical understanding of which “processes supported a supportive care setting” [ 35 ]. TSCS was developed using three different care settings–a hospice, geriatric, and acute care ward, through qualitative interviews with patients, significant others, and care staff’s experiences. Although TSCS was not developed within the birthing environment, given the raise of childbirth induced P-PTSD, it is appropriate to apply the concepts to the birthing environment. One aspect of this synthesis is to assess the utility of the application of TSCS to the birthing environment using it as the main theoretical approach. There are five main processes the theory addresses as creating a supportive care environment: experiencing welcoming in the environment, recognizing oneself in the environment, creating and maintaining social relations in the environment, experiencing a willingness to serve in the environment, and experiencing safety in the environment. An applied theoretical framework was created (Fig.  1 ).

Framework of theory of supportive birth settings

Experiencing welcoming in the environment

Experiencing welcoming in the environment has three properties which are intensely experienced when the patient first enters the healthcare setting [ 35 ]. Being expected is the first property that involves the care setting knowing the patient is coming. This happens by having the patient’s name displayed and knowing pertinent information about the person before the beginning of care [ 35 ]. Being seen entails a warm welcome upon entering the care setting, having personal introductions, and care staff showing an interest [ 35 ]. Lastly, being invited consists of being shown around the care setting for the patient to become familiar with the environment and the people within [ 35 ].

Certainly, experiencing welcoming in a care setting, such as a hospital, heightens mood among patients and increases their satisfaction with their experience of the care setting [ 36 ]. Within a birthing environment, there is also evidence that being believed and welcomed upon arrival to the hospital increases the satisfaction of mothers as well as enhances their birthing experience [ 37 ].

Recognizing oneself in the environment

Within TSCS, recognizing oneself in the environment encapsulates the intensity of which patients recognize themselves within the care environment [ 35 ]. For example, environments that are perceived as too sterile do not allow the patient to recognize themselves in the environment. Being able to recognize oneself in the care setting includes being in a familiar and calm environment [ 35 ]. A familiar environment includes objects that are familiar to the patients, as well as beauty in the environment that includes windows and warm colors [ 35 ]. Further, a calm environment has minimal loud noises from machines, phones, and patients are allowed to move freely [ 35 ]. Features of familiarity in the birthing environment can reduce the length of labor and reduce pain intensity [ 38 ].

Creating and maintaining social relations in the environment

Creating and maintaining social relations in the environment within TSCS describes the social relations a patient develops that create ease within the environment [ 35 ]. Within this concept, there are two processes: staying in contact with social relations and creating new social relations. Staying in contact entails the patient’s ability to stay in contact with those in their social circles while undergoing care and can include environmental factors that facilitate this such as access to a personal phone and privacy to visit with social relations while in care. Creating new social relations explains the way patients can create new social relationships through positive interactions such as those that include laughter and support from care staff or others in the care setting. The process further includes the structural environment and facilitation of such connections, including openness of concept, support places, and comfortable furniture in private and common areas of the care setting [ 35 ].

This process of TSCS is again supported in literature regarding birthing environments. Availability of social support is integral to the birthing experience and increased access to social support creates better birthing outcomes and perceptions of birth [ 39 ]. Similarly, those supporting the birth need to feel welcomed and included in the birth environment, and there are specific aspects of the built environment that facilitate increased support during birth such as familial alcoves in birthing rooms and increased attempts at including the supporter by care setting providers [ 40 ].

Experiencing a willingness to serve in the environment

The willingness to serve in the environment from TCSC involves both care staff and patients. In TSCS doing a little extra and receiving a little extra are the processes that promote a willingness to serve. To the patients, seeing the care staff demonstrate thoughtful actions shows the staff’s willingness to serve. These actions can include things like remembering a patient’s preferences for their pillow or water temperature or arranging food in an appealing way. The willingness to serve can also come from patients though; some patients reaching out to other patients to give support or even just showing caring attitudes towards either nurses or other patients. For patients, an environment which demonstrates the willingness to serve is one when care staff do things without being asked, are intuitive in their approaches, and do not make the patient feel like a burden [ 35 ].

Within the birthing environment, willingness to serve can look like staff providing welcome distractions from the birthing process through music or aromatherapy, dimming lights, changing ambient temperature, and ensuring loud sounds are minimal. Further, care staff can exhibit willingness to serve by advocating for the birthing mother to have less people in the room, creating a familiar space, and providing comfort [ 38 ].

Experiencing safety in the environment

TSCA defines safety in the birthing environment as the safe feelings that arise from knowing what is happening, feeling informed, being comforted, and feeling trustful of care providers. Understanding what is happening includes, knowing what is happening, having information in an accessible language, and being aware of the course of events. For the patient, being is safe hands means having trust in the providers through honest conversations, knowing that their needs and requests are honored, and that the physical environment is clean, organized, and aesthetically pleasing rather than chaotic and messy [ 35 ].

The safety in the birthing environment often ties honest conversations and knowing needs and requests will be met to feel in control over the birth and the experience. Feeling in control of the birth environment can also include creating a familiar, homey space by being allowed to personalize the space with music, design elements like personal photos, pillows, or plants, and controlling the temperature and lighting [ 40 ]. In addition, knowing that healthcare providers are respecting the birth plan as much as possible and supporting freedom to move and move through the birth process in their own way [ 38 ]. Furthermore, machinery that ties the mother down, inhibiting freedom to move, can be distracting and reduce the time midwives or nurses spend in the birthing room, diminishing the birthing mother’s trust in care providers [ 41 ].

Despite the lack of use of TCSC in birthing environment literature, all five concepts from TCSC are found within the existing literature to be recommended for use in birthing environments. That said, there is not a synthesis to date utilizing the framework to evaluate qualitative perspectives of the birthing environment. This review aims to organize the existing qualitative literature within TCSC to provide a roadmap for birthing space design that aligns with a supportive care environment, with the hopes of creating more functional birthing spaces which may reduce the rates of maternal mental health challenges following the birth of a child.

Ethics, consent for publication, availability of data and materials

The data used in this study are derived from publicly available, published research articles and thus, in the public domain. Similarly, Institutional Review Board approval was not required since all data used were in the public domain in publicly available, published research articles. Informed consent was not required as no participants were recruited to participate in this study. There is no identifiable information of participants used in this method nor do we as consumers of previously published qualitative research have access to the original data.

QIMS is a method that lets researchers find a deeper understanding of a phenomenon or shared experience using qualitative journal articles as secondary data. QIMS is focused on researchers synthesizing previously published qualitative findings on a topic across the literature to reveal insights of participants’ experiences with a phenomenon [ 30 ]. This process includes creating a research question, conducting a systematic search of existing literature, and finally analyzing identified articles through theme extraction, synthesis, and triangulation [ 30 ].

QIMS has a set analysis process that involves reviewing the original authors’ published themes, as well as the participant's quotations in the manuscript. Themes and quotations are extracted and compiled into a new dataset to capture participants’ experiences of shared phenomenon across literature, providing a larger, more diverse sample size.

Sometimes, the analysis ends with a methodological reduction as well. Methodological reduction is an accepted method within phenomenological inquiry that permits researchers to understand the phenomena being observed through a new contextual lens allowing for further abstraction [ 42 ]. That said, due to the paucity of research evaluating what is necessary to have a safe and sacred healing environment for mothers, this study utilized a rare approach to QIMS wherein the theoretical framework was provided at the outset of the study to guide the entirety of the synthesis. This deviates from the more inductive approach of traditional QIMS, but this deductive approach allows for a more pointed answer to a specific research question that seeks to operationalize a construct within a distinctive context or population and has been used previously [ 30 ]. Essentially, this analysis approach used a combination of both QIMS and theory-testing deductive analysis methods. The theory guides each step of the QIMS process, and specific steps have been applied (see Fig.  2 ). This combined approach is formalized here and is called QIMS-DTT [deductive theory testing].

Associations of birthing environment to Theory of Supportive Care Settings 

First, in line with theory-testing deductive analysis [ 43 ], a qualitative question was posed with a specific theoretical lens in mind, in this case, Edvardsson’s Theory of Supportive Care Setting. Then, following QIMS, a systematic search of the literature was conducted using PRISMA guidelines [ 44 ]. The keywords for the initial search included “birth or childbirth or labour or labor or delivery or birthing” as subject terms. The key terms “experiences or experience” and “qualitative” were added to “in abstract” as well as “birthing experiences” and “birthing perceptions.” Key terms were searched within the following databases: ERIC, Academic Search Complete, APA PsycInfo, CINAHL Complete, Family Studies Abstracts, MedicLatina, MEDLINE, Psychology and Behavioral Sciences Collection, Alt HealthWatch. This initial search yielded 5,688 articles. After duplicates were removed 5,167 articles remained. The title and abstract screened for content relating to the desired topic, and inclusion and exclusion criteria were applied.

Inclusion criteria were that the studies were U.S. based only, included pregnant women’s experiences of hospital or birthing center birth, and were qualitative research with quotations presented in the article. Inclusion was limited to U.S. based studies given that birthing practices differ vastly across the world; focusing on the U.S. provides homogeneity of context for understanding the birthing environment impact. Furthermore, even though the U.S. is a high resource country, the perinatal care system is considered unique as requires private pay insurance and not every woman has access to Medicaid or Medicare federal and state funded health insurance programs [ 45 ]. Furthermore, among 11 high resourced countries, the U.S. has the highest maternal mortality rate, which some scholars attribute to how the U.S. has the lowest supply of obstetricians and heavily lacks midwives and insurance coverage for midwifery care [ 46 ]. Theory was incorporated here as well as an inclusion criterion, and the results were filtered through the operationalization of Edvardsson’s Theory of Supportive Care Setting used for this study. Using the five constructs of the theory that were operationalized for this study, the articles were included if authors discussed at least one construct from the theory (the constructs that articles discussed can be found in Table  1 ). Articles not discussing at least one of the five constructs of the theory were excluded. In addition, other exclusion criteria included articles discussing future births or expectations about future births, choice of location for birth, mode of delivery, labor pain, healthcare providers’ perspectives, existing reviews or syntheses, and articles discussing techniques of or towards birthing [e.g., acupuncture, Lamaze, education]. After title and abstract screening, 3,178 articles were excluded, leaving 43 articles to be screened full text. During the full-text screen, 12 articles were excluded, leaving 31 total articles to be included in the QIMS.

Following this approach (inclusive of both QIMS and theory-testing deductive analysis) we have formalized within this study, the original themes (Table  2 ) from the articles were organized by one researcher into appropriate theoretical assumptions that most aligned with the constructs of TSCS (See Table  1 –providing theoretical triangulation). Then, the quotations from each article were extracted and uploaded to qualitative software, atlas.ti (v.8.1). The quotations were coded deductively by the first two authors using the theoretical framework as a guide for thematic development. The themes were then aligned with each of the five theoretical constructs by unanimous rating. This process provided a layer of analyst triangulation additional to the triangulation inherent in QIMS design resulting from triangulation in the individual studies prior to the QIMS.

Instrumentation

In addition to the analysis process, it is also important for researchers to bracket, or disclose, their experiences with a phenomenon to increase the trustworthiness of the synthesis. The authors are the main instruments of this study, as is frequently the case in qualitative research. To further lend credibility and transparency to the QIMS process, brief descriptions of the authors can be found in Table  3 . The authors purposefully include two mothers–one who experienced Postpartum Mood and Anxiety Disorders (PMADs) and one who did not, and two women who were not mothers at the time of this writing. This intentionally focused toward balancing any biases the two mothers might have brought to the analyses given their experiences further explained in Table  3 .

The final sample included 30 qualitative studies giving ear to the voices of 1,802 postpartum mothers. These mothers ranged in age from 12 to 71 and represented a wide range of races and ethnicities. For more demographic information including data collection methods and settings, see Table  4 .

Using a theory-testing deductive analysis process in conjunction with QIMS, the analysis results in five themes with various subthemes. The supporting quotations can be found in Table  5 . In addition, thematic constructs of TSCS were found across the included articles and the theoretical deduction was sound. Evidence of theoretical constructs can be found in Table  1 .

Theme 1: service in the environment

The first theme consists of ways that participants experienced service within the birthing environment. This service can be either from the healthcare team or the woman themselves and can be expressed in ways more encompassing than just direct labor. Participants described providers who exhibited exceptional care as a memorable part of their birthing experience. This aspect of service within the environment contributed to warm feelings towards their providers and allowed them to feel important and cared for. Many described how taking time out of their busy schedules to focus on the woman one-on-one, accommodating disabilities or medical conditions without being asked, and going out of their way to encourage and empower women was how a provider demonstrated “above and beyond” care.

Theme 2: recognizing oneself within the birthing space

The second theme described how birthing persons saw themselves within the birthing space. This included their personhood being acknowledged and their maternal role being validated by providers.

Subtheme 2A: acknowledging personhood

Recognizing oneself within the environment should be facilitated by feeling acknowledged as persons with dignity. For participants in these studies, this was expressed in their experiences of not having their personhood acknowledged and valued during the birthing process. One participant was not allowed to walk to the bathroom and was also not clearly told why. Her dignity was wounded, and the situation introduced emotional trauma into her birth story. Other women had a similarly emotionally traumatic experience that compromised their dignity and devalued their personhood.

Subtheme 2B: validating maternal role

Validation in becoming a mother is an important step in a woman’s transition into motherhood. The birth is an experience that will forever impact how the person views their maternal role. Many participants felt that their role as mother was overlooked by providers or not validated in a way that made them feel unequipped to mother their children. Often, participants described how providers made decisions for their newborns for them without consulting or trusting them to make such decisions.

Theme 3: creating connections with support systems

The third theme describes the ability of participants to forge or maintain social connection while experiencing birth. This could be availability of social support through communication from providers or through inclusion of support persons. Furthermore, disrespect hampered the formation of social connections.

Subtheme 3A: communication is key

This subtheme revolved around the necessity of communication to forge a strong, trusting social connection between provider and women. This communication included informing the women of medically necessary interventions and allowing them to understand the necessity of them before consenting when medically possible. Communication also included introducing themselves and accepting a patient introduction genuinely through learning womens’ names and making eye contact and gathering consent before touching the client. When providers communicated in this fashion, the participants indicated that they felt a stronger social bond to the providers and their trust and satisfaction with them was increased.

Subtheme 3B: team effort among providers

Relationships required a team effort, which meant that multiple providers needed to be on the same page and operating in good communication with one another to support mothers. Participants in the included studies described how both providers and the birthing person, as well as their support people could work together to ensure the birthing process was a positive one. Others explained that when providers did not work together or communicate among each other the birthing process felt chaotic and disjointed, leaving them feeling unsatisfied and unsafe.

Subtheme 3C: respect forges social connection

This sub theme describes how care providers can forge social connection with their patients through respecting the wishes of the birthing person. Examples included respecting their birthing plan even when it was not medically necessary, allowing the birthing person to make choices about pain interventions, and not respecting the minimal birthing requests that were not related to medical interventions. Conversely, not hearing or respecting the birthing person created a negative experience which was detrimental to social connection in the birthing space.

Theme 4: being welcomed into the birthing space

The fourth theme that emerged encompassed participants’ desires to be welcomed into the birthing space. This involved experiences of being admitted into the maternity ward or birthing suite upon arrival at the hospital and being made to feel comfortable in the space.

Subtheme 4A: being believed and admitted

Participants within the included articles discussed the importance of being believe when they presented to the hospital in what they perceived as active labor. Participants described being unsure if the sensations they were feeling were in labor and expressed anxiety as to whether they would be admitted into the maternity ward. Participants worried that if they arrived at the hospital too early, they would be treated poorly for “over-reacting” and be sent home, even though they were in pain. Participants also described the feeling of being rejected as failure. Being admitted into the birthing space was crucial for participants in the included articles to feel supported and validated.

Subtheme 4B: comfortable birthing space

In addition to being admitted, having the birthing space be comfortable was also necessary for participants to feel welcomed. Participants described spaces that had enough room for all their family members, single-occupancy rooms that allowed the birthing mother to have the whole room to herself, and rooms that had calming items present to be the most comfortable. In addition, participants in the included articles described experiences of uncomfortable spaces. Several participants expressed discomfort at having to be moved to multiple locations within the hospital. Participants also found hospitals challenging to navigate which caused stress on the family and the laboring mothering. Some participants described how the temperature of the space affected them as well, with the ability to control the temperature helping them to feel comfortable, both themselves and their families.

Theme 5: feeling safe within the birthing environment

The fifth theme encompasses various ways birthing persons felt or did not feel safety in the birthing environment. Either through consent in procedures, being able to follow birth plans, having freedom to move, and having trust and confidence in the healthcare team, there were many ways participants expressed their perceptions of safety in the birthing environment.

Subtheme 5A: interpersonal safety

This theme described how interpersonal relationships contributed to feeling safety in the birthing environment. Participants in the original studies talked about how they took action to ensure they had interpersonal safety through choosing obstetricians that felt safe to them, either due to gender or validation tactics. Others described how having continuity of care when possible created safe feeling interpersonal relationships, such as having the same nurse throughout or when they did change shifts- the outgoing nurse took extra steps to introduce the new nurse and supported the forging of an interpersonal relationship between birthing person and new nurse. Having a familiar face consistently throughout the birthing process was comforting. In addition, many quotations described how a provider could focus on the woman in a way that was comforting and forged and interpersonal connection by ensuring they knew they were being heard and supported.

Subtheme 5B: Confidence in the healthcare team

Feeling safe in the birthing environment was also influenced by how much confidence the women had in their healthcare team. Some participants in the original study described how they trust doctors because they know better through education, while others felt like their care providers were not listening to their concerns, eroding their trust and making them feel unsafe. Others explained actions the healthcare team took to ruin the trust between them, either by not sharing the full truth of the current process or by giving false information. When the providers were not honest with their patients, the birthing person was less likely to feel safe and therefore it tainted their birthing experience with anxious feelings.

Subtheme 5C: Feeling in control of the birth

Participants also described feeling in control of the space allowed them to feel safe within the birthing space. Participants who were given the ability to make decisions about positions, movements, and even presented with a way to watch the birth felt in control and supported by staff. Conversely, participants who were restricted in their movement felt trapped.

The findings of this QIMS-DTT highlight what is necessary to have a safe and sacred healing environment for mothers. Filtered through the adapted Theory of Supportive Care Settings, the findings of this deductive theory-testing study found multiple overlaps with the theoretical approach and as such, propose the importance of utilizing a Theory of Supportive Birthing Environments when evaluating birthing care environments. The five main components of Edvardsson’s theory can be found across all included articles and in the findings of this QIMS-DTT, making the findings unique in the application of the theory as a framework to approach environmental birth design.

For instance, a novel finding was the participant-described need for a welcoming birthing environment, including their initial admission to the hospital, being believed, and validated about their labor process, and the birthing environment itself being welcoming to them and their support persons. The initial moments upon arrival at the birthing facility or the presence of the healthcare team can significantly impact the birthing person's emotional well-being, comfort, and sense of security. Indeed, research does indicate that a warm welcome can help alleviate these feelings by making the birthing person feel valued, respected, and cared for from the moment they arrive. A positive and supportive atmosphere can contribute to a more relaxed state of mind [ 47 ]. Although the findings illuminate that a warm welcome into the birthing environment is critically important as it sets the tone for the entire childbirth experience, there is scant literature on this phenomenon as an attribute of the birth environment experience. A warm welcome also fosters trust and rapport between the birthing person and the healthcare team [ 46 ] which is essential for effective communication and cooperation throughout labor and childbirth. When trust is established early on, it can lead to a more collaborative and positive birthing experience. Beyond alleviating stress, feeling welcomed and respected empowers the birthing person to actively engage in their care and decision-making [ 47 ]. When they are treated with kindness and dignity, they are more likely to voice their preferences, concerns, and questions, leading to informed decision-making [ 47 , 77 ]. As many participants shared, the birthing environment itself was responsible for the welcoming feeling and contributed to a positive and comfortable birthing environment. In this study, this included friendly greetings, a clean and inviting room, soft lighting, and soothing sounds. Such an environment can promote relaxation and facilitate a smoother labor and birth [ 77 ].

The findings also illuminate the importance of social connection within the birthing space, through feeling respected and heard, clear communication, and acknowledgment and validation. Social relationships, including those with partners, family members, friends, and healthcare providers, offer emotional support during a time that can be physically and emotionally challenging. Previous literature has supported these findings, indicating that when there are people who care about the birthing person's well-being and provide comfort and encouragement, it can reduce stress and anxiety for the birthing person [ 40 ]. Trust is a critical component of any healthcare relationship, especially during childbirth [ 52 ]. Unique within these findings, however, is the importance of social connection between the women and providers on the recounting of birth stories and satisfaction with the birth environment. Furthermore, although support by providers is well documented, the findings here offer a unique approach as establishing these relationships as a facet of the birth environment. Establishing trust with healthcare providers and support staff is essential for effective communication, which, in turn, leads to better decision-making and a more positive birthing experience.

Safety in the environment was a salient finding of this study, and with good reason. Participants expressed that having interpersonal safety, seeing a good team effort among healthcare providers, and confidence in that healthcare team all contributed to their perceptions of safety in the birthing environment. Creating feelings of safety in the birthing environment is of paramount importance for several reasons. A safe and supportive birthing environment not only ensures the physical well-being of the birthing person and baby but also has a profound impact on the overall childbirth experience. Feelings of safety help reduce stress and anxiety during labor and childbirth [ 78 ]. Perceived safety benefits medical providers as well- when the birthing environment is perceived as safe, it can facilitate the release of endorphins, the body's natural pain relief hormones, and contribute to a smoother labor and birth process without unnecessary medical interventions [ 79 ].

Another important, but already substantiated, finding within safety in the environment was the element of control and agency within the birthing environment that was necessary to have positive birth experiences. Participants engaged in self-advocacy and described the importance of feeling in control over the birthing process to their well-being. Agency and control in the birthing environment are documented crucial aspects of the childbirth experience, as they can significantly impact the physical and emotional well-being of the birthing person and their overall satisfaction with the process [ 45 ]. When birthing people have a sense of agency and control over their birth experience, they report higher levels of satisfaction with the process, regardless of whether their birth unfolds as planned or not [ 45 ]. Agency and control also empower the birthing person to make informed decisions about their birth plan and medical interventions and endorse their maternal role. Informed decision-making allows individuals to choose the options that align with their values, preferences, and health needs. Notably, the findings in this study indicate that when birthing persons do not feel in control of their birth, they had poor retrospective memories about their birth and sometimes felt shame or anger about it. Indeed, a lack of agency and control during childbirth can sometimes lead to feelings of trauma or dissatisfaction [ 80 ]. Although this phenomenon is well documented, the findings from this review contextualize the need for agency and control within the theoretical approach and creates a more comprehensive look at birth environment attributes.

Implications for providers and research

The findings of this study illuminate numerous implications for providers and researchers. For providers, the knowledge that a warm welcome extends beyond them to the entire birthing team, including nurses, midwives, doulas, and support persons. A cohesive and supportive team that welcomes the birthing person with open arms can enhance the overall birthing experience. Furthermore, welcoming includes initial contact and the way a birthing person is received and treated upon arrival can significantly influence their overall perception of their birth experience. A warm welcome contributes to positive birth memories and can have long-lasting emotional and psychological benefits [ 47 ].

Empowering birthing people to have control over their experience can help reduce the risk of trauma. Establishing trust and effective communication between the birthing person, their support team, and healthcare providers is essential for maintaining agency and control. When there is open dialogue and mutual respect, the birthing person is more likely to feel comfortable expressing their preferences and concerns. In some cases, having control over the birthing environment can lead to better physical outcomes. For example, a birthing person who can move freely, choose their birthing position, and have access to comfort measures may experience shorter labor and fewer complications [ 77 ]. In addition, providers should recognize that every birthing experience is unique and respecting cultural and individual differences is essential for promoting agency and control. What one person values or finds empowering in their birthing experience may differ from another, and healthcare providers should strive to accommodate these variations. More research may be needed to understand the prevalence of agency and control better quantitatively in the birthing environment and its relationship to maternal mental health outcomes using measurements surveying the birth environment that combine the attributes of the framework presented in the findings.

Building social relationships in the birthing environment can create a supportive and celebratory atmosphere. The birthing person, their partner, and their support network can share in the joy and excitement of welcoming a new life into the world, enhancing the overall experience.

Social relationships formed during childbirth can extend into the postpartum period, providing ongoing emotional support, advice, and assistance as the birthing person navigates the challenges of early parenthood. Social relationships in the birthing environment can also be a source of valuable information and education. Healthcare providers and support persons can share knowledge about the birthing process, available options, and potential interventions, empowering the birthing person to make informed decisions.

Another implication for providers is building a culture of safety within the environment. When the birthing environment feels unsafe or traumatic, it can have long-lasting negative effects on the birthing person's mental and emotional well-being. Feelings of trauma during childbirth can lead to post-traumatic stress disorder [PTSD] and have a significant impact on future pregnancies [ 80 , 81 ]. Safety also includes trust. Trust is a cornerstone of the birthing experience and when the birthing person trusts their healthcare providers and the birthing environment, they are more likely to follow recommendations, cooperate with care plans, and have a positive overall experience. More research is needed to better understand how women experience trust in the birthing environment specifically, including better understanding of the frequencies of agency, consent, and control over their environments. In addition, research surveying the use of interdisciplinary communication and communication mechanisms with women regarding birth plans might illuminate fragmented communication in the birth environment.

Limitations

Within this study there were some primary limitations related to sampling of studies. When identifying studies through databases and services such as GoogleScholar, embargoes and artificial intelligence interference [e.g., search algorithms] create challenges in replicating and updating searches. For this study, the search was initially conducted then redone to ensure all studies were identified since sufficient time had passed since the initial search. Although exact keywords and procedures were followed from search one to search two, algorithms and embargoes may have led to some key studies not emerging in the search. A second limitation is that given the breadth of birthing environments and cultural orientations to birthing, despite the number of studies analyzed, it is likely that some experiences are not represented in this study.

While the experiences of the participants appeared to range, the scope of the search did not include birthing person experiences outside of the US. Consequently, this leaves the results of this study to only be applicable to what is needed in the small context of the US. Problems that are faced by participants in this study may not be seen as harmful to others. Likewise, since QIMS-DTT is a social work focused method, it can limit how the researchers approached the material from the participants. This can be related to the complex nature of constraints that are often faced in the health-care field. Furthermore, there is a limitation related to the relevancy of applying the TSCS to the birthing space. A key difference between the concept of service in birthing space is that mothers only spend an average of 24 to 48 h in the birthing space, whereas those in nursing care, the environmental in which TSCS originated, could spend an extended period of time in the environment.

In conclusion, a new framework using the Theory of Supportive Care Settings can be applied to evaluate a sacred and healing birthing experience. This new framework includes a balance of already documented phenomenon such as agency and control during birth, as well as integrates new findings, such as the necessity of a warm welcome into the birthing environment to promote trust, comfort, and empowerment. Indeed, the importance of a welcoming environment cannot be overstated. It sets the initial tone for the birthing experience, influencing the individual's stress levels and emotional state, which, in turn, can affect the physiological aspects of childbirth. This study supports the hypothesis from applying TSCS to the birth environment that when individuals feel welcomed, they are more likely to experience a sense of calm and readiness for birth, which can lead to more positive outcomes.

Our study contributes to the growing body of literature that underscores the significance of the birth environment in shaping birth experiences. It calls for a reevaluation of current practices and environments in which childbirth takes place, advocating for a more holistic approach that encompasses emotional, psychological, and physical well-being. The implications of our findings extend beyond the individual, suggesting that by improving birth experiences, we can foster better early bonding experiences, potentially leading to long-term benefits for both the mother and child.

Authors’contributions

Authors DM and SL contributed to the initial design and concept. DM, SL, RT, and TG all performed data collection, data analysis, interpretation of results, and drafting of the article. All authors made substantial contributions to the initial and revised manuscript. All authors have read and approved the final version and are accountable for all aspects of the work.

Availability of data and materials

The data used in this study are from publicly available existing literature, therefore the data is available within this article from the data tables.

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Maxwell, D., Leat, S.R., Gallegos, T. et al. Sacred space: a qualitative interpretive meta-synthesis of women’s experiences of supportive birthing environments. BMC Pregnancy Childbirth 24 , 372 (2024). https://doi.org/10.1186/s12884-024-06544-6

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