health and social work qualitative research

Qualitative Research – a practical guide for health and social care researchers and practitioners

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Darshini Ayton, Monash University

Tess Tsindos, Monash University

Danielle Berkovic, Monash University

Copyright Year: 2023

Last Update: 2024

ISBN 13: 9780645755404

Publisher: Monash University

Language: English

Formats Available

Conditions of use.

Table of Contents

• Acknowledgement of Country
• About the authors
• Accessibility statement
• Introduction to research
• Research design
• Data collection
• Data analysis
• Writing qualitative research
• Peer review statement
• Licensing and attribution information
• Version history

Ancillary Material

About the book.

This guide is designed to support health and social care researchers and practitioners to integrate qualitative research into the evidence base of health and social care research. Qualitative research designs are diverse and each design has a different focus that will inform the approach undertaken and the results that are generated. The aim is to move beyond the “what” of qualitative research to the “how”, by (1) outlining key qualitative research designs for health and social care research – descriptive, phenomenology, action research, case study, ethnography, and grounded theory; (2) a decision tool of how to select the appropriate design based on a guiding prompting question, the research question and available resources, time and expertise; (3) an overview of mixed methods research and qualitative research in evaluation studies; (4) a practical guide to data collection and analysis; (5) providing examples of qualitative research to illustrate the scope and opportunities; and (6) tips on communicating qualitative research.

About the Contributors

Associate Professor Darshini Ayton is the Deputy Head of the Health and Social Care Unit at Monash University in Melbourne, Australia. She is a transdisciplinary implementation researcher with a focus on improving health and social care for older Australians and operates at the nexus of implementation science, health and social care policies, public health and consumer engagement. She has led qualitative research studies in hospitals, aged care, not-for-profit organisations and for government and utilises a range of data collection methods.  Associate Professor Ayton established and is the director of the highly successful Qualitative Research Methods for Public Health short course which has been running since 2014.

Dr Tess Tsindos  is a Research Fellow with the Health and Social Care Unit at Monash University in Melbourne, Australia. She is a public health researcher and lecturer with strong qualitative and mixed methods research experience conducting research studies in hospital and community health settings, not-for-profit organisations and for government. Prior to working in academia, Dr Tsindos worked in community care for government and not-for-profit organisations for more than 25 years. Dr Tsindos has a strong evaluation background having conducted numerous evaluations for a range of health and social care organisations. Based on this experience she coordinated the Bachelor of Health Science/Public Health Evaluation unit and the Master of Public Health Evaluation unit and developed the Evaluating Public Health Programs short course in 2022. Dr Tsindos is the Unit Coordinator of the Master of Public Health Qualitative Research Methods Unit which was established in 2022.

Dr Danielle Berkovic  is a Research Fellow in the School of Public Health and Preventive Medicine at Monash University in Melbourne, Australia. She is a public health and consumer-led researcher with strong qualitative and mixed-methods research experience focused on improving health services and clinical guidelines for people with arthritis and other musculoskeletal conditions. She has conducted qualitative research studies in hospitals and community health settings. Dr Berkovic currently provides qualitative input into Australia’s first Living Guideline for the pharmacological management of inflammatory arthritis. Dr Berkovic is passionate about incorporating qualitative research methods into traditionally clinical and quantitative spaces and enjoys teaching clinicians and up-and-coming researchers about the benefits of qualitative research.

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Qualitative Health Research

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• Description
• Aims and Scope
• Editorial Board
• Abstracting / Indexing
• Submission Guidelines

Qualitative Health Research provides an international, interdisciplinary forum to enhance health and health care and further the development and understanding of qualitative health research. The journal is an invaluable resource for researchers and academics, administrators and others in the health and social service professions, and graduates, who seek examples of studies in which the authors used qualitative methodologies. Each issue of Qualitative Health Research provides readers with a wealth of information on conceptual, theoretical, methodological, and ethical issues pertaining to qualitative inquiry. A Variety of Perspectives We encourage submissions across all health-related areas and disciplines. Qualitative Health Research understands health in its broadest sense and values contributions from various traditions of qualitative inquiry. As a journal of SAGE Publishing, Qualitative Health Research aspires to disseminate high-quality research and engaged scholarship globally, and we are committed to diversity and inclusion in publishing. We encourage submissions from a diverse range of authors from across all countries and backgrounds. There are no fees payable to submit or publish in Qualitative Health Research .

Original, Timely, and Insightful Scholarship Qualitative Health Research aspires to publish articles addressing significant and contemporary health-related issues. Only manuscripts of sufficient originality and quality that align with the aims and scope of Qualitative Health Research will be reviewed. As part of the submission process authors are required to warrant that they are submitting original work, that they have the rights in the work, that they have obtained, and that can supply all necessary permissions for the reproduction of any copyright works not owned by them, and that they are submitting the work for first publication in the Journal and that it is not being considered for publication elsewhere and has not already been published elsewhere. Please note that Qualitative Health Research does not accept submissions of papers that have been published elsewhere. Sage requires authors to identify preprints upon submission (see https://us.sagepub.com/en-us/nam/preprintsfaq ). This Journal is a member of the Committee on Publication Ethics (COPE) .

This Journal recommends that authors follow the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals formulated by the International Committee of Medical Journal Editors (ICMJE).

Qualitative Health Research is an international, interdisciplinary, refereed journal for the enhancement of health care and to further the development and understanding of qualitative research methods in health care settings. We welcome manuscripts in the following areas: the description and analysis of the illness experience, health and health-seeking behaviors, the experiences of caregivers, the sociocultural organization of health care, health care policy, and related topics. We also seek critical reviews and commentaries addressing conceptual, theoretical, methodological, and ethical issues pertaining to qualitative enquiry.

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Manuscript submission guidelines:

Qualitative Health Research (QHR)  has specific guidelines! While  Sage Publishing has general guidelines , all manuscripts submitted to QHR must follow our specific guidelines (found below). Once you have reviewed these guidelines, please visit QHR ’s  submission site  to upload your manuscript.   Please note that manuscripts not conforming to these guidelines will be returned and/or encounter delays in peer review.   Remember you can log in to the submission site at any time to check on the progress of your manuscript throughout the peer review process.

1. Deciding whether to submit a manuscript to QHR

1.1 Aims & scope

1.2 Article types

2. Review criteria

2.1  Original research studies

2.2 Pearls, Piths, and Provocations

2.3 Common reasons for rejection

3.  Preparing your manuscript

3.1 Title page

3.2 Abstract

3.3 Manuscript

3.4 Tables, Figures, Artwork, and other graphics

3.5 Supplemental material

4. Submitting your manuscript

5. Editorial Policies

5.1 Peer review policy

5.2 Authorship

5.3 Acknowledgments

5.4 Funding

5.5 Declaration of conflicting interests

5.6 Research ethics and participant consent

6. Publishing Policies

6.1 Publication ethics

6.2 Contribtor's publishing agreement

6.3 Open access and author archiving

1. Deciding whether to submit a manuscript to QHR 

QHR  provides an international, interdisciplinary forum to enhance health and health care and further the development and understanding of qualitative health research. The journal is an invaluable resource for researchers and academics, administrators and others in the health and social service professions, and graduates, who seek examples of studies in which the authors used qualitative methodologies.  Each issue of QHR provides readers with a wealth of information on conceptual, theoretical, methodological, and ethical issues pertaining to qualitative inquiry.

Rather than send query letters to the Editor regarding article fit, QHR asks authors to make their own decision regarding the suitability of their manuscript for QHR   by  asking: Does your proposed submission make a meaningful and strong contribution to qualitative health research literature? Is it useful to readers and/or practitioners?

The following manuscript types are considered for publication.

• Original Research Studies : These are fully developed qualitative research studies. This may include mixed method studies in which the major focus/portion of the study is qualitative research. Please read  Maintaining the Integrity of Qualitatively Driven Mixed Methods: Avoiding the “ This Work is Part of a Larger Study”  Syndrome . 
• Pearls, Piths, and Provocations : These manuscripts should foster discussion and debate about significant issues, enhance communication of methodological advances, promote and discuss issues related to the teaching of qualitative approaches in health contexts, and/or encourage the discussion of new and/or provocative ideas. They should also make clear what the manuscript adds to the existing body of knowledge in the area.
• Editorials : These are generally invited articles written by editors/editorial board members associated with QHR.

Please note, QHR does NOT publish pilot studies. We do not normally publish   literature reviews unless they focus on qualitative research studies elaborating methodological issues and developments. Review articles should be submitted to the Pearls, Piths, and Provocations section. They are reviewed according to criteria in 2.2.

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2. Review criteria 

2.1 Original research

Reviewers are asked to consider the following areas and questions when making recommendations about research manuscripts:

• Importance of submission : Does the manuscript make a significant contribution to qualitative health research literature?  Is it original? Relevant? In depth? Insightful? Is it useful to the reader and/or practitioner?
• Methodological considerations : Is the overall study design clearly explained including why this design was an appropriate one? Are the methodology/methods/approaches used in keeping with that design? Are they appropriate given the research question and/or aims? Are they logically articulated? Clarity in design and presentation? Data adequacy and appropriateness? Evidence of rigor?
• Ethical Concerns : Are relevant ethical concerns discussed and acknowledged? Is enough detail given to enable the reader to understand how ethical issues were navigated? Has formal IRB approval (when needed) and consent from participants been obtained?
• Data analysis, findings, discussion : Does the analysis of data reflect depth and coherence? In-depth descriptive but also interpretive dimensions? Creative and insightful analysis? Are results linked to existing literature and theory, as appropriate? Is the contribution of the research clear including its relevance to health disciplines and their practice?
• Manuscript style and format : Is the manuscript organized in a clear and concise manner? Has sufficient attention been paid to word choice, spelling, grammar, and so forth? Did the author adhere to APA guidelines? Do diagrams/illustrations comply with guidelines? Is the overall manuscript aligned with QHR guidelines in relation to formatting?
• Scope:  Does the article fit with QHR ’s publication mandate? Has the author cited the major work in the area, including those published in QHR ? 

The purpose of papers in this section is to raise and discuss issues pertinent to the development and advancement of qualitative research in health-related arenas.  As the name Pearls, Piths, and Provocations suggests, we are looking for manuscripts that make a significant contribution to areas of dialogue, development, experience sharing and debate relevant to the scope of QHR in this section of the journal.  Reviewers are asked to consider the following questions when making recommendations about  articles in the Pearls, Piths, and Provocations section.

• Significance :   Does the paper highlight issues that have the potential to advance, develop, and/or challenge thinking in qualitative health related research?
• Clarity :   Are the arguments clearly presented and well supported? 
• Rigor :   Is there the explicit use of/interaction with methodology and/or theory and/or empirical studies (depending on the focus of the paper) that grounds the work and is coherently carried throughout the arguments and/or analysis in the manuscript? Put another way, is there evidence of a rigorously constructed argument?
• Engagement :   Does the paper have the potential to engage the reader to ‘think differently’ by raising questions, suggesting innovative directions for qualitative health research, and/or stimulating critical reflection?   Are the implications of the paper for the practice of either qualitative research and/or health clear? 
• Quality of the writing :   Is the main argument of the paper clearly articulated and presented with few grammatical or typographical issues? Are terms and concepts key to the scholarship communicated clearly and in sufficient detail? 

QHR  most commonly turns away manuscripts that fall outside the journal’s scope, do not make a novel contribution to the literature, lack substantive and/or interpretative depth, require extensive revisions, and/or do not adequately address ethical issues that are fundamental to qualitative inquiry. Submissions of the supplementary component of mixed methods studies often are rejected as the findings are difficult to interpret without the findings of the primary study. For additional information on this policy, please read  Maintaining the Integrity of Qualitatively Driven Mixed Methods: Avoiding the “ This Work is Part of a Larger Study”  Syndrome . 

3. Preparing your manuscript for submission 

We strongly encourage all authors to review previously published articles in QHR for style prior to submission.

QHR  journal practices include double anonymization. All identifying information MUST be removed completely from the Abstract, Manuscript, Acknowledgements, Tables, and Figure files prior to submission. ONLY the Title Page and Cover Letter may contain identifying information. See  Sage’s general submission guidelines  for additional guidance on making an anonymous submission.

Preferred formats for the text and tables of your manuscript are Word DOC or PDF. The text must be double-spaced throughout with standard 1-inch margins (APA formatting). Text should be standard font (i.e., Times New Roman) 12-point. 

3.1 Title page 

• The title page should be uploaded as a separate document containing the following information: Author names; Affiliations; Author contact information; Contribution list; Acknowledgements; Ethical statement; Funding Statement; Conflict of Interest Statements; and, Grant Number. Please know that the Title Page is NOT included in the materials sent out for Peer Review.
• Ethical statement: An ethical statement must include the following: the full name of the ethical board that approved your study; the approval number given by the ethical board; and, confirmation that all your participants gave informed consent. Authors are also required to state in the methods section whether participants provided informed consent, whether the consent was written or verbal, and how it was obtained and by whom. For example: “Our study was approved by The Mercy Health Research Ethics Committee (approval no. XYZ123). All participants provided written informed consent prior to enrollment in the study.” If your study did not need ethical approval (often manuscripts in the Pearls, Piths, and Provocations may not), we still need a statement that states that your study did not need approval and an explanation as to why. For example: “Ethical Statement: Our study did not require an ethical board approval because it did not directly involve humans or animals.” 

3.2 Abstract and Keywords

• The Abstract should be unstructured, written in narrative form. Maximum of 250 words. This should be on its own page, appearing as the first page of the Main Manuscript file.
• The keywords should be included beneath the abstract on the Main Manuscript file. 
• Length: 8,000 words or less excluding the abstract, list of references, and acknowledgements. Please note that text from Tables and Figures is included in the word count limits. On-line supplementary materials are not included in the word limit. 
• Structure: While many authors will choose to use headings of Background, Methods, Results, and Discussion to organize their manuscript, it is up to authors to choose the most appropriate terms and structure for their submission. It is the expectation that manuscripts contain detailed reflections on methodological considerations.
• Ethics: In studies where data collection or other methods present ethical challenges, the authors should explicate how such issues were navigated including how consent was gained and by whom. An anonymized version of the ethical statement should be included in the manuscript (in addition to appearing on the title page).
• Participant identification: Generally, demographics should be described in narrative form or otherwise reported as a group. Quotations may be linked to particular participants and/or demographic features provided measures are taken to ensure anonymity of participants (e.g., use of pseudonyms).
• Use of checklists: Authors should not include qualitative research checklists, such as COREQ (COnsolidated criteria for REporting Qualitative research).  Generally, authors should use a narrative approach to describe the processes used to enhance the rigor of their study. For additional information on this policy, please read  Why the Qualitative Health Research (QHR) Review Process Does Not Use Checklists
• References: APA format. While there is no limit to the number of references, authors are recommended to use pertinent references only, including literature previously published in QHR . References should be on a separate page.   QHR adheres to the APA 7 reference style. View the APA guidelines to ensure your manuscript conforms to this reference style. Please ensure you check carefully that both your in-text references and list of references are in the correct format.
• Authors are required to disclose the use of generative Artificial Intelligence (such as ChatGPT) and other technologies (such as NVivo, ATLAS. Ti, Quirkos, etc.), whether used to conceive ideas, develop study design, generate data, assist in analysis, present study findings, or other activities formative of qualitative research. We suggest authors provide both a description of the technology, when it was accessed, and how it was used (see  https://uk.sagepub.com/en-gb/eur/chatgpt-and-generative-ai ).
• Manuscripts that receive favorable reviews will not be accepted until any formatting and copy-editing required has been done. 
• Tables, Figures, Artwork, and other graphics should be submitted as separate files rather than incorporated into the main manuscript file. Within the manuscript, indicate where these items should appear (i.e. INSERT TABLE 1 HERE).
• TIFF, JPED, or common picture formats accepted. The preferred format for graphs and line art is EPS.
• Resolution: Rasterized based files (i.e. with .tiff or .jpeg extension) require a resolution of at least 300 dpi (dots per inch). Line art should be supplied with a minimum resolution of 800 dpi.
• Dimension: Check that the artworks supplied match or exceed the dimensions of the journal. Images cannot be scaled up after origination.
• Figures supplied in color will appear in color online regardless of whether or not these illustrations are reproduced in color in the printed version. For specifically requested color reproduction in print, you will receive information regarding the costs from Sage after receipt of your accepted article. 
• Core elements of the manuscript should not be included as supplementary material.
• QHR  is able to host additional materials online (e.g., datasets, podcasts, videos, images etc.) alongside the full-text of the article. For more information please refer to Sage’s general  guidelines on submitting supplemental files .

4. Submitting your manuscript 

QHR  is hosted on Sage Track, a web based online submission and peer review system powered by ScholarOne™ Manuscripts. Visit  https://mc.manuscriptcentral.com/QHR  to login and submit your article online. 

IMPORTANT:  Please check whether you already have an account in the system before trying to create a new one. If you have reviewed or authored for the Journal in the past year it is likely that you will have had an account created.  For further guidance on submitting your manuscript online please visit  ScholarOne Online Help . 

5. Editorial policies 

QHR  adheres to a rigorous double-anonymized reviewing policy in which the identities of both the reviewer and author are always concealed from both parties.

Sage does not permit the use of author-suggested (recommended) reviewers at any stage of the submission process, be that through the web-based submission system or other communication. Reviewers should be experts in their fields and should be able to provide an objective assessment of the manuscript. Our policy is that reviewers should not be assigned to a manuscript if:

•  The reviewer is based at the same institution as any of the co-authors

•  The reviewer is based at the funding body of the manuscript

•  The author has recommended the reviewer

•  The reviewer has provided a personal (e.g. Gmail/Yahoo/Hotmail) email account and an institutional email account cannot be found after performing a basic Google search (name, department and institution). 

Qualitative Health Research  is committed to delivering high quality, fast peer-review for your manuscript, and as such has partnered with Web of Science. Web of Science is a third-party service that seeks to track, verify and give credit for peer review. Reviewers for Qualitative Health Research can opt in to Web of Science in order to claim their reviews or have them automatically verified and added to their reviewer profile. Reviewers claiming credit for their review will be associated with the relevant journal, but the article name, reviewer’s decision, and the content of their review is not published on the site. For more information visit the  Web of Science  website.

The Editor or members of the Editorial Team or Board may occasionally submit their own manuscripts for possible publication in the Journal. In these cases, the peer review process will be managed by alternative members of the Editorial Team or Board and the submitting Editor Team/Board member will have no involvement in the decision-making process. 

Manuscripts should only be submitted for consideration once consent is given by all contributing authors. Those submitting manuscripts should carefully check that all those whose work contributed to the manuscript are acknowledged as contributing authors. The list of authors should include all those who can legitimately claim authorship. This is all those who meet all of the following criteria:

(i)   Made a substantial contribution to the design of the work or acquisition, analysis, interpretation, or presentation of data,  (ii)  Drafted the article or revised it critically for important intellectual content,  (iii) Approved the version to be published,  (iv) Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content.

Acquisition of funding, collection of data, or general supervision of the research group alone does not constitute authorship, although all contributors who do not meet the criteria for authorship should be listed in the Acknowledgments section. Please refer to the  International Committee of Medical Journal Editors (ICMJE) authorship guidelines   for more information on authorship.

Authors are required to disclose the use of generative Artificial Intelligence (such as ChatGPT) and other technologies (such as NVivo, ATLAS. Ti, Quirkos, etc.), whether used to conceive ideas, develop study design, generate data, assist in analysis, present study findings, or other activities formative of qualitative research. We suggest authors provide both a description of the technology, when it was accessed, and how it was used. This needs to be clearly identified within the text and acknowledged within your Acknowledgements section. Please note that AI bots such as ChatGPT should not be listed as an author. For more details on this policy, please visit  ChatGPT and Generative AI . 

5.3 Acknowledgements

All contributors who do not meet the criteria for authorship should be listed in an Acknowledgements section. Examples of those who might be acknowledged include a person who provided purely technical help, or a department chair who provided only general support.

Please supply any personal acknowledgements separately to the main text to facilitate anonymous peer review. 

Per  ICMJE recommendations , it is best practice to obtain consent from non-author contributors who you are acknowledging in your manuscript.

1.3.1 Writing assistance

Individuals who provided writing assistance, e.g., from a specialist communications company, do not qualify as authors and so should be included in the Acknowledgements section. Authors must disclose any writing assistance – including the individual’s name, company and level of input – and identify the entity that paid for this assistance. It is not necessary to disclose use of language polishing services. 

Qualitative Health Research   requires all authors to acknowledge their funding in a consistent fashion under a separate heading.  Please visit the  Funding Acknowledgements   page on the Sage Journal Author Gateway to confirm the format of the acknowledgment text in the event of funding, or state that: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. 

It is the policy of  Qualitative Health Research to require a declaration of conflicting interests from all authors enabling a statement to be carried within the paginated pages of all published articles.

Please ensure that a ‘Declaration of Conflicting Interests’ statement is included at the end of your manuscript, after any acknowledgements and prior to the references. If no conflict exists, please state that ‘The Author(s) declare(s) that there is no conflict of interest’. For guidance on conflict of interest statements, please see the ICMJE recommendations  here . 

Research involving participants must be conducted according to the  World Medical Association Declaration of Helsinki

Submitted manuscripts should conform to the  ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals :

All manuscripts must state that the relevant Ethics Committee or Institutional Review Board provided (or waived) approval. Please ensure that you blind the name and institution of the review committee until such time as your article has been accepted. The Editor will request authors to replace the name and add the approval number once the article review has been completed. Please note that in itself, simply stating that Ethics Committee or Institutional Review was obtained is not sufficient.  Authors are also required to state in the methods section whether participants provided informed consent, whether the consent was written or verbal, and how it was obtained and by whom.

Please do not submit the participant’s informed consent documents with your article, as this in itself breaches the participant’s confidentiality. The Journal requests that you confirm to us, in writing, that you have obtained informed consent recognizing the documentation of consent itself should be held by the authors/investigators themselves (for example, in a participant’s hospital record or an author’s institution’s archives).

Please also refer to the  ICMJE Recommendations for the Protection of Research Participants . 

6. Publishing Policies 

Sage is committed to upholding the integrity of the academic record. We encourage authors to refer to the Committee on Publication Ethics’  International Standards for Authors  and view the Publication Ethics page on the  Sage Author Gateway .

6.1.1 Plagiarism

Qualitative Health Research  and Sage take issues of copyright infringement, plagiarism or other breaches of best practice in publication very seriously. The Committee on Publication Ethics (COPE) defines plagiarism as: “When somebody presents the work of others (data, words or theories) as if they were his/her own and without proper acknowledgment.” We seek to protect the rights of our authors and we always investigate claims of plagiarism or misuse of published articles. Equally, we seek to protect the reputation of the journal against malpractice. Submitted articles may be checked with duplication-checking software. Where an article, for example, is found to have plagiarised other work or included third-party copyright material without permission or with insufficient acknowledgement, or where the authorship of the article is contested, we reserve the right to take action including, but not limited to: publishing an erratum or corrigendum (correction); retracting the article; taking up the matter with the head of department or dean of the author's institution and/or relevant academic bodies or societies; or taking appropriate legal action.

6.1.2 Prior publication

If material has been previously published it is not generally acceptable for publication in a Sage journal. However, there are certain circumstances where previously published material can be considered for publication. Please refer to the guidance on the  Sage Author Gateway  or if in doubt, contact the Editor at the address given below. 

6.2 Contributor's publishing agreement

Before publication, Sage requires the author as the rights holder to sign a Journal Contributor’s Publishing Agreement. Sage’s Journal Contributor’s Publishing Agreement is an exclusive licence agreement which means that the author retains copyright of the work but grants Sage the sole and exclusive right and licence to publish for the full legal term of copyright. Exceptions may exist where an assignment of copyright is required or preferred by a proprietor other than Sage. In this case copyright in the work will be assigned from the author to the society. For more information please visit the  Sage Author Gateway . 

Qualitative Health Research  offers optional open access publishing via the Sage Choice programme and Open Access agreements, where authors can publish open access either discounted or free of charge depending on the agreement with Sage. Find out if your institution is participating by visiting Open Access Agreements at Sage . For more information on Open Access publishing options at Sage please visit Sage Open Access . For information on funding body compliance, and depositing your article in repositories, please visit Sage’s Author Archiving and Re-Use Guidelines and Publishing Policies .

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In This Article Expand or collapse the "in this article" section Qualitative Research

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• Definitions and Descriptions
• Quasi-Statistical Approaches
• Template Analysis
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• Immersion or Crystallization Methods
• Participatory Action Research
• Qualitative Inquiry
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Qualitative Research by James Drisko LAST REVIEWED: 01 May 2017 LAST MODIFIED: 25 May 2011 DOI: 10.1093/obo/9780195389678-0047

“Qualitative research” is a term that encompasses a wide variety of research types and methods. Its great variety makes it difficult to define and describe succinctly. This bibliography will offer a general introduction but will inevitably be incomplete. Qualitative research in the social sciences has deep roots in sociology and anthropology. For example, fieldwork and ethnography continue to be pivotal methods in these and other disciplines. The professions have also drawn extensively on qualitative research, though emphasis on quantitative research in the academy after World War II and the current ideology of evidence-based approaches among academics and service funders devalue it. Qualitative research is widely found and widely taught in nursing and in education. It is quite evident, but less prominent, in social work, in medicine, in psychology, and in occupational therapy.

In social work, Jane Addams’s portrayals of the circumstances of immigrant populations in Chicago ( Addams 1895 ) are public qualitative research works that are still highly valued. Indeed, Addams is sometimes claimed as a role model by scholars outside the profession as well as within social work. Mary Richmond’s 1917 Social Diagnosis ( Richmond 1955 ) details a method for learning the psychosocial needs of clients and families in context, drawing on qualitative interviews, observations, and documents. These social work contributions emerged as sociology began to define its research methods ( Znaniecki 1934 ). The widely used traditional case study is one well-known form of qualitative research ( Gilgun 1994 ), though case study methods, purposes, and reporting vary, as does its quality. Social work education has long included both formal and informal training in qualitative data collection methods, including interviewing and participant observation, described by Zimbalist 1977 . Further, the traditional method of process recording has provided both a technique and active training in recording interview data. Beyond documentation, process recording also provided an introduction to active reflection on the participant and on the self that is a key element of professional practice as well as of qualitative research. Since 1994 qualitative research has been required content in the Council on Social Work Education’s accreditation standards for all bachelor’s and master’s level programs.

Addams, Jane, Agnes Sinclair Holbrook Florence Kelley, Alzina P. Stevens, Isabel Eaton, Charles Zeublin, Josefa Humpal Zeman, Alessandro Mastro-Valerio, Julia C. Lathrop, and Ellen Gates Starr . 1895. Hull House maps and papers . New York: Crowell.

Addams sought to document and publicize the living conditions of immigrant populations in Chicago. Her goal was to raise public awareness and to catalyze social change. Both Addams’s methods, which draw on fieldwork from sociology, and her goals, which affirm social justice, are widely evident in qualitative research across disciplines in the early 21st century. Seminal, groundbreaking work from a social work pioneer.

Gilgun, Jane F. 1994. A case for case studies in social work research. Social Work 39:371–380.

Gilgun argues for the wide applicability of the case study method to social work research and to social work practice. The article offers an overview of the case study method and takes stock of the method’s strengths and limitations. A very widely known, classic article.

Richmond, Mary Ellen. 1955. Social diagnosis . New York: Russell Sage Foundation.

First published in 1917. The originator of the psychosocial perspective, Richmond details a qualitative method of diagnosis that balances attention to macro-level social issues with micro-level family and individual concerns. Several case studies portray people-in-environments in great detail and with broad perspective. An early example of social work case studies based on planned interviews and observations—key tools in qualitative research as well.

Zimbalist, Sidney. 1977. Historic themes and landmarks in social welfare research . New York: Harper & Row.

A unique book on the history of social work research. Chronological in plan, the book shows the development of social work research models in context. Extensive use of qualitative methods is documented, and the forces that have promoted quantitative research as a dichotomous alternative to qualitative research are noted. Lacks contemporary perspective, however, given its publication date.

Znaniecki, Florian. 1934. The method of sociology . New York: Farrar & Rinehart.

In this early, classic work in sociology, Znaniecki details the method of analytic induction. Analytic indication seeks deductively to frame new concepts and preliminary theory while maintaining clear connections to its evidence base. This method is clearly the foundation of grounded theory, which followed it in the 1960s.

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Qualitative Research in Global Health Research

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• Pranee Liamputtong 5 &
• Zoe Sanipreeya Rice 6  

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This chapter discusses the contribution of qualitative research and its value in global health. Qualitative research alludes to “a broad approach” that qualitative researchers adopt as a means to examine social circumstances. The inquiry posits that people use “what they see, hear, and feel” to make sense of social experiences. There are many features that differentiate qualitative research from the quantitative approach. Fundamentally, it is interpretive. The meanings and interpretation of the participants are the essence of qualitative inquiry. Qualitative research is valuable in many ways. It offers researchers to hear silenced voices, to work with marginalized and vulnerable people, to address social justice issue, and to contribute to the person-centered healthcare and the design of clinical trials and plays an important role in evidence-based global health. Qualitative researchers are seen as constructivists who attempt to find answers in the real world. Fundamentally, qualitative researchers look for meanings that people have constructed. In this chapter, we discuss the value of qualitative research, qualitative inquiry in global health, qualitative research, and evidence-based practice in global health. The chapter also discusses in great depth some distinctiveness of the qualitative research, in particular the inductive nature of qualitative research, methodological frameworks, purposive sampling technique, saturation concept, qualitative data analysis, and the trustworthiness of a qualitative study. We also provide a concrete example of how a qualitative study was undertaken using details from the research project that we have conducted.

• Qualitative inquiry
• Interpretation
• Evidence-based practice in health
• Methodological framework
• Trustworthiness
• Qualitative researcher

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Liamputtong, P., Rice, Z.S. (2021). Qualitative Research in Global Health Research. In: Kickbusch, I., Ganten, D., Moeti, M. (eds) Handbook of Global Health. Springer, Cham. https://doi.org/10.1007/978-3-030-45009-0_10

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• Published: 26 June 2020

“I need to take care of myself”: a qualitative study on coping strategies, support and health promotion for social workers serving refugees and homeless individuals

• Janika Mette 1 ,
• Tanja Wirth 2 ,
• Albert Nienhaus 2 , 3 ,
• Volker Harth 1 &
• Stefanie Mache 1  

Journal of Occupational Medicine and Toxicology volume  15 , Article number:  19 ( 2020 ) Cite this article

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Social workers provide support for various groups of clients, such as refugees and homeless people. Refugees and homeless individuals represent particularly vulnerable groups in precarious living conditions. Therefore, social workers serving these clients are likely to be confronted with extensive job demands. The aim of this study was to investigate the coping strategies of social workers serving refugees and homeless individuals and to explore their support sources and health promotion offers at work as well as their respective needs.

26 semi-structured qualitative interviews were carried out with social workers in Berlin and Hamburg and analysed according to Mayring’s qualitative content analysis.

The respondents reported various coping strategies to deal with their job demands which involved both problem-oriented (e.g. time management, setting boundaries, seeking support in conflict situations) and emotion-focused approaches (e.g. self-care, distance from work, leisure activities). In addition, they emphasised various sources of workplace (social) support, e.g. provided by team members, supervisors, and other institutions. However, unmet needs for support were also formulated by the workers, e.g. in terms of individual supervision and regular exchange. Furthermore, several employees did not know about any health promotion offers at their workplace and expressed a desire for structural and behavioural health promotion measures.

Conclusions

In view of the diverse needs of the workers, the results can provide a basis to design needs-based health promotion interventions for staff in social work.

Social work in the refugee and homeless aid

In recent years, a persistent upward trend in the number of refugees and homeless individuals has been observed worldwide [ 1 , 2 ]. The global refugee population is constantly increasing, reaching 25.9 million by the end of 2018 [ 1 ]. In the context of the rapidly increasing migration in Europe in 2015 and 2016, a total of 745,545 people submitted asylum applications in Germany in 2016 [ 3 ]. Since then, the number of asylum applications in Germany has declined again (2019: 165,938), which was partly due to the refugee agreement between the European Union and Turkey [ 3 ].

Homelessness has also increased substantially in most countries [ 2 ]. In 2017, there were around 650,000 homeless individuals in Germany, from which the number of homeless recognised refugees was estimated at about 375,000. In fact, there is a notable overlap between the groups of refugees and homeless people; from 2007 to 2017, an increase in the number of non-German EU citizens and non-EU citizens in homeless assistance was observed [ 2 ]. The main reasons cited for the rising number of homeless people in Germany are the insufficient supply of affordable housing, the shrinking social housing stock and the consolidation of poverty [ 2 ].

Refugees and homeless individuals represent particularly vulnerable groups. They find themselves in precarious life circumstances, are often marginalised and frequently suffer from severe traumatic experiences [ 4 , 5 , 6 ]. Prejudices were revealed in recent surveys. For example, in 2017, 80% of German survey respondents feared a burden on the welfare state and 72% feared an increase in social conflicts due to refugee immigration [ 7 ]. Regarding homelessness, in a representative long-term study of the German population, homeless people were perceived as unpleasant (38%) and work-shy (30%) [ 8 ]. Both groups share certain similarities in terms of their precariousness (e.g., their material situation, income, social integration) and regarding their health impairment and strain (e.g. high rates of traumatisation, comorbidities between mental health disorders and substance misuse) [ 4 , 9 ]. In terms of traumatic experiences, the prevalence of traumatisation among refugee clients was found to be around 40–60%, corresponding to a significantly increased risk in these clients [ 4 ]. Overall, both refugees and homeless individuals represent important clients for today’s and future social work [ 1 , 2 ].

Previous research has examined the working conditions and health of various subgroups of social workers, e.g. mental health workers [ 10 ] or child welfare workers [ 11 , 12 ]. However, less attention has been paid to the situation of social workers in refugee and homeless aid. Social workers who provide counselling and care services for refugees and homeless individuals are likely to face similar demands in their daily work [ 13 ], which makes it plausible to conduct research studies that address workers for both client groups simultaneously. For example, particular stress factors for social workers serving refugees and homeless persons consist of cultural and language problems, negative attitudes from public towards their work and their clients as well as high caseloads due to the increasing number of clients [ 13 ]. Moreover, a relatively high prevalence of secondary or post-traumatic stress has been revealed in social workers serving refugees (52% [ 14 ]) and homeless clients (36% [ 15 ]).

In a recent scoping review of 25 studies, evidence on the working conditions, health and coping strategies of social workers serving refugees and homeless individuals was systematically mapped for the first time [ 9 ]. The review revealed common job demands for this staff, including high workloads, the bureaucratic system, clients’ suffering, difficulties in maintaining boundaries with clients, as well as limited success concerning the clients’ progress. Job resources of value to workers were also identified, e.g. a high personal meaning of work and social support from colleagues. Overall, there was a high prevalence of mental health problems (e.g. burnout) among social workers in these areas. At the same time, they were found to show high levels of job satisfaction. The review also demonstrated methodological issues in relation to available studies and claimed for more research to examine the effectiveness of coping strategies and workplace health promotion offers for staff in social work with refugees and homeless clients [ 9 ].

Similar results regarding these topics were obtained in our interview study in which social workers in refugee and homeless aid described high emotional demands, high word loads, a lack of personnel, and overtime work as critical job demands [ 13 ]. In contrast, the joy of working with their clients and appreciation from clients, colleagues and superiors were underlined as job resources. Strain reactions in relation to their work involved perceptions of fatigue and stress (as short-term reactions) as well as sleeping problems, depression and burnout symptoms (as long-term consequences). Moreover, some respondents stated that they felt ill more frequently and reported high levels of sickness absences within their institutions [ 13 ].

Given the recent findings on the job demands and strains experienced by social workers in the refugee and homeless aid as well as the limited evidence, it is important to address the question of how these workers deal with their job demands. Precisely, what coping strategies do they use and what sources of support and health promotion offers at work help them to maintain their health and well-being?

Coping strategies of social workers

In previous studies, social workers in refugee and homeless aid were found to use various coping strategies to deal with their job demands [ 5 , 6 , 16 , 17 , 18 ]. They consisted of accepting the boundaries of one’s sphere of influence [ 18 ] and maintaining professional boundaries with clients [ 5 , 16 , 17 ] and between work and private life [ 5 , 16 , 17 ]. Further coping strategies were to engage in hobbies (e.g. physical activity, reading, listening to music) and to have an active social life and exchange with friends, family members, and colleagues [ 5 , 6 , 16 , 17 ]. Moreover, coping behaviours employed by staff in the homeless sector included the acknowledgement of small successes [ 5 ] and the acceptance of clients’ undesirable behaviour without taking it personally [ 19 ]. In addition, in a study with social workers serving unaccompanied asylum-seeking refugee children, the workers used both emotion-focused (e.g. positive reappraisal, distancing) and problem-focused strategies (planful problem solving) [ 20 ].

In general, evidence from coping research suggests that coping may have an impact on the link between employees’ working conditions and health [ 21 ]. This buffering effect has also been proven in the area of social work [ 12 , 22 ]. For example, using active control-oriented coping behaviours which implied personal engagement (e.g. problem solving, cognitive restructuring, expressing emotions) buffered the impact of work stress on the emotional exhaustion and job satisfaction of social workers [ 12 , 23 ]. Similarly, in a study with child protection workers, the use of active and engaged coping strategies (rather than avoidant coping strategies) led to a decline in depersonalisation levels and increased employees’ sense of personal accomplishment [ 22 ].

Sources of support for social workers

Research suggests that further sources of support at work may help social workers to deal with their job demands [ 16 , 17 , 24 , 25 ]. In general, team support has been described as a relevant job resource for social workers [ 16 , 17 ]. Furthermore, several forms of supervision and training have been highlighted in their importance [ 16 , 24 ]. In a study with case managers serving homeless clients, managers were offered an occupational therapy consultant who provided client assessments and treatment recommendations [ 25 ]. The results showed that case managers who used the consultations more actively showed higher levels of job satisfaction and self-efficacy.

However, disparity was found in previous studies with regard to whether staff felt adequately supported or wished for more support at work [ 16 ]. Indeed, social workers in refugee and homeless aid expressed the need for external counselling, supervision and training (e.g. on self-protection or to better understand new policies) [ 5 , 16 , 17 , 24 , 26 ]. In a study with German refugee aid workers, the workers particularly wished for training to better recognise the mental health problems of their clients and learn about suitable intervention strategies [ 27 ]. In addition, frontline homeless workers expressed a desire for more support (e.g. in the form of manuals, additional personnel and supervision), team development activities and greater recognition of their needs [ 15 ].

Workplace health promotion for social workers

Studies in the area of social work, in particular refugee and homeless aid, have not yet focused on the topic of workplace health promotion. Therefore, it is still unclear to what extent social workers may benefit from health promotion offers. In general, meta-analyses indicate that workplace health promotion can contribute to maintaining employees’ health and well-being, e.g. with regard to their physical activity [ 28 , 29 ], dietary habits [ 30 , 31 ], and mental well-being [ 32 ]. Health promotion offers were also found to be associated with reduced job stress [ 28 ] and sickness absence [ 28 , 32 , 33 ] as well as increased work ability [ 32 ]. Moreover, they were related to economic benefits for companies in the form of a high return on investment [ 34 , 35 ]. In view of the possible positive effects of workplace health promotion, it seems worthwhile to explore the availability of such offers for the target group more closely.

Theoretical framework

To investigate the coping strategies of social workers, the concept of coping by Lazarus and Folkman was used as a theoretical framework [ 36 , 37 ]. According to this model, coping is defined as cognitive and behavioural efforts made to master, tolerate or reduce external and internal demands, as well as conflicts among them [ 36 , 37 ]. Coping is seen as a buffer between stressors and health outcomes [ 38 , 39 ]. Before coping behaviour is initiated, a cognitive-transactional process takes place which encompasses a primary cognitive appraisal (evaluation of the situation as potentially stressful) and a secondary cognitive appraisal (assessment of available coping resources) [ 36 , 37 ]. Coping strategies either aim at managing the stress-inducing problem (problem-focused) or at regulating emotions or distress caused by the problem (emotion-focused).

To examine the sources of support for the workers, we primarily referred to the concept of workplace social support [ 40 ]. Workplace social support emanates from multiple sources, such as supervisors, colleagues and the institution. A meta-analysis concluded that workplace social support includes both an individual’s belief that one is valued, appreciated and cared for, as well as the perception that one has access to helping relationships of varying quality and strength [ 40 ].

To assess the availability of health promotion offers and social workers’ respective needs, the Luxembourg Declaration on Workplace Health Promotion provided a useful framework [ 41 ]. The declaration defines workplace health promotion as “the combined efforts of employees, employers and society to improve the health and well-being of people at work”. Health promotion offers can include behavioural and structural interventions; the former aim at changing behavioural patterns of individuals or groups, while the latter refer to environmental and political interventions to influence health-related ecological, social, cultural and technical-material environments [ 42 ].

Study aims and research questions

The aim of the study was to investigate the coping strategies of social workers in homeless and refugee aid to deal with their job demands. In addition, we aimed to explore the sources of support and health promotion offers for these workers, as well as their respective needs. To address our study objectives, we proposed the following research questions:

What coping strategies do social workers in refugee and homeless aid use to deal with their job demands?

What sources of support are available to social workers in refugee and homeless aid at their workplace?

What health promotion offers are available to social workers in refugee and homeless aid, and what are their respective needs that are currently not addressed?

Materials and methods

Study design.

We conducted 26 semi-structured qualitative interviews with staff in social work in Berlin and Hamburg. Interviews were carried out from October to December 2017. The qualitative approach was chosen as it allowed us to gain first explorative insights into little researched topics. Since little was known about the topics for the specific target group, a qualitative investigation was most suitable to get a comprehensive and detailed understanding. A central advantage of the qualitative method is that it allows to describe complex social phenomena from the perspective of the people affected. Semi-structured interviews were especially suitable in order to approach the target group and study the topics within their natural environment [ 43 ]. The results of the qualitative study were subsequently used as a basis to design a quantitative online survey.

Recruitment of participants

Participants were recruited from institutions in the refugee and homeless aid sector. Purposeful sampling was applied to the selection of institutions by contacting walk-in and residential facilities from various supporting organisations. Institutions were informed about the study by telephone and sent invitation emails and leaflets which were distributed within the organisations. In total, 19 institutions were contacted from which 10 agreed to participate. Employees who were interested in participation could contact the researchers confidentially and directly to make interview appointments (convenience sample). Eligibility criteria for study participation were as follows: participants had to have direct contact with refugees and/or homeless individuals at work and at least 6 months of work experience in social work. Moreover, they had to be of full age and fluent in the German language. Volunteers and employees working in administrative services without direct contact to clients were excluded from the study.

Data collection

A semi-structured interview guideline was developed based on the empirical evidence and theoretical background. The questions of the interview guideline regarding the coping strategies, sources of support and health promotion are provided in Additional file  1 . The guideline consisted of further questions, e.g. regarding social workers’ working conditions and strains, which are presented elsewhere [ 13 ]. A pretest interview was carried out with a former social worker from refugee aid. The guideline was slightly revised based on the workers’ recommendations. The interviews were conducted by two female researchers, a health scientist and a psychologist who were experienced with qualitative research and worked as researchers in occupational health psychology during the study period. Prior to data collection, participants were informed about the study aims and data confidentiality and signed a declaration of informed consent. All interviews were carried out face-to-face and took place in the workers’ institutions during their work time. The interviews were conducted in German and recorded with an audio device. They lasted from 27 to 86 min (51 min on average). The participants were able to terminate the interviews at any time. Interviews were conducted until no new topics were identified, i.e. data saturation was reached. Field notes were made immediately after each interview. No repeat interviews were carried out.

Data analysis

The audio recordings were transcribed verbatim and subsequently anonymised. The data analysis was carried out in a deductive-inductive process according to Mayring’s qualitative content analysis [ 44 ]. Important features of this analysis include the systematic and rule-based approach and the development of a profound category system [ 44 ]. The well-validated, rule guided process applied in Mayring’s content analysis strengthens the reliability of the qualitative results. Qualitative content analysis was chosen, since this method focuses on the content (rather than on the latent meaning) of what is said [ 45 ]. Thus, we adopted a realistic position in the theory of science by focusing on the semantic content of the data [ 45 ]. The main categories were retrieved deductively on the basis of the interview guideline. Moreover, sub-categories were developed inductively in an iterative process. First, one interview was test-coded by both interviewers and compared in terms of consensus. Disagreements were thoroughly discussed until consensus was reached and the coding system was slightly revised. The other interviews were then each coded by one interviewer. Unclear coding was regularly discussed during team meetings. The software MAXQDA Analytics Pro (version 11) was used for the analysis [ 46 ]. The final coding system was summarised in a separate document in which the material was further compacted (paraphrased, generalised and reduced) in accordance with Mayring’s specifications [ 44 ]. During the analysis, the researchers’ personal involvement, preconceptions and influence on the results and interpretations were thoroughly reflected upon. In order to minimize such personal influences, special emphasis was placed on discussing results in the team and weighing up alternative paths of interpretation together to increase validity of the findings. Results were not made available to the participants before completion of the data analysis. Direct quotes from the interviewees were translated into English by a native speaker. The COREQ-Checklist was used to describe the study [ 47 ].

Participant characteristics

In total, 17 interviewees were female and 9 were male (Table  1 ). They were aged between 26 and 64 years with a mean age of 42 years. The majority had a degree in social work ( n  = 16). 14 interviewees worked in homeless aid and 12 in refugee aid. Most of the participants worked full-time ( n  = 20) and had three or less years of experience in social work ( n  = 15).

Coping strategies

The coping strategies presented in the following were named by the participants as strategies they actually applied and perceived as helpful. The strategies were classified into problem-oriented and emotion-oriented strategies.

Problem-oriented strategies

Problem-oriented strategies referred to employees’ work tasks and content, to the work organisation, social relations and personal strategies (Table  2 ).

Work tasks and content

Some employees reported that they had actively reduced their work tasks and only accepted tasks they were responsible for and able to finish on time. Moreover, acquiring knowledge in dealing with stress was described as a coping strategy and associated with an increased sense of security and the development of a professional identity. Knowledge was, for example, acquired through training and education, reading books and having discussions with experts in the field. Moreover, independent problem-solving and solution-oriented thinking were reported as a further coping strategy at work:

“There is a lot of collaborative thinking involved, and a lot of ‘Yes, okay, how can we solve this now? It’s hard, of course, but we’ll try to find a solution for this now too.’ And, yes, there is a lot of willingness too.” [#21, female, homeless aid].

Work organisation

With respect to work organisation, having good time management was an important strategy. This included scheduling enough breaks between appointments and avoiding appointments at the beginning of a working day to be able to prepare for the day. Furthermore, compliance with regular working hours, breaks and counselling times and the avoidance of overtime work were highlighted in order to recover briefly during breaks and between consultations:

“Yes, so at the beginning I did a lot more overtime. And, well, now I’m trying to curb that a bit. (…) Including when it comes to consulting time. “[#9, female, homeless aid].

Two interviewees mentioned that they had deliberately reduced their work time in order to decrease their workloads, which was perceived as a relief. In situations of high workload and time pressure, another strategy named by the interviewees was to prioritise tasks that needed to be done:

“Setting priorities. You learn that with time. What can I move, what can I let go? (…) But that simply comes with experience, which comes with time.” [#23, male, homeless aid].

Many interviewees described that setting clear boundaries between work and private life was an essential strategy to be able to switch off from work. These people explained, for example, that they did not share their private telephone numbers with clients, did not meet clients in their spare time and did not discuss work-related problems at home with their family and friends:

“Sometimes we even make it clear, and say that today we aren’t going to talk about work, or about clients, or about anything remotely to do with social work. Simply so that you can switch off for once.” [#22, female, homeless aid].

Two interviewees also described their efforts to create change at higher levels of the system, e.g. through discourse with responsible staff, committee work or work situation analyses at their workplaces in order to identify critical job demands.

Social relations

Several workers reported setting limits towards clients at work as a fundamental coping strategy. This involved showing clients the limits for aid and support, pointing out clients’ personal responsibilities and encouraging them to reflect on their (sometimes unrealistic) expectations:

“Sometimes there are these expectations: ‘You’re my support worker, you have to solve this for me or do that for me.’ And we have to tell people again and again, I can help you with this and that issue, I’m here to help you with this, but this and that you have to do yourself.” [#24, female, refugee aid].

Employees stated that it was particularly important to set clear boundaries in cases where clients showed demanding and aggressive behaviour or disrespectful conduct towards women:

“And I set really clear boundaries. If they come in acting in an aggressive manner and insult me, then I say: ‘You have to leave now and when you’ve calmed down, then you can come back and we can talk to each other calmly.” And then they might come back a couple of days later and have calmed down.” [#25, male, refugee aid].

A general coping strategy in conflict situations consisted of acting self-confidently, calmly and in a self-determined manner, while showing understanding and empathy for the clients’ needs at the same time. Moreover, actively searching for support in challenging situations was another strategy stated by many interviewees; for example, asking colleagues for help, requesting additional supervision or calling the police as a last resort in cases where clients acted in an extremely violent or aggressive manner:

“And when it’s totally unacceptable and residents won’t calm down at all, then I just call the police.” [#22, female, homeless aid].

In addition, overcoming language barriers with clients by communicating through gestures and mimicry was reported as a strategy by one worker. Another respondent described that it was important to discuss conflicts with colleagues and superiors (e.g. bullying, gossip) directly and openly with the involved team members.

Personal strategies

With respect to coping strategies at a personal level, one worker mentioned receiving medical treatment for insomnia and sleep disorders. Furthermore, three interviewees stated that they had started psychotherapy to be able to talk about their job strain and learn about mechanisms to better deal with their demands at work:

“A year ago I started psychotherapy because I was just going straight to sleep when I got home from work. And I simply wasn’t doing anything else (…). It was just work and sleep, work and sleep. So that’s why I started therapy and have learned how to deal with this strain.” [#4, female, refugee aid].

In this regard, psychotherapy sessions were described as a substitute for a lack of collegial counselling and individual supervision that was not provided by the employer:

“In the end I sorted out psychotherapy for myself (…). I just simply got to the point where I said, ‘Okay, I have to look after myself, because what I need isn’t happening here.’” [#6, female, refugee aid].

Emotion-oriented strategies

The emotion-oriented coping strategies named by the interviewees are depicted in Table  3 .

Seeking emotional support and exchange with partners, parents and friends represented an important emotion-oriented coping strategy for many participants, especially when there were acute problems at work. In addition, a lot of the interviewees highlighted the relevance of regular exchange with their colleagues, and sometimes also with executives:

“There you can also (…) talk about things that are bothering you at the moment or just vent. That really helps a lot.” [#2, female, homeless aid].

Engagement in leisure activities

Further emotion-oriented coping strategies were related to the engagement in leisure activities to seek distraction, detachment and a balance with work. Many respondents emphasised that they preferred active activities in their spare time, such as sports or physical activity (e.g. sports courses, cycling, swimming, dancing and horse riding). Spending time and pursuing activities with friends and family was often deemed helpful. Other workers reported that they preferred calm activities as a contrast to their busy working lives, e. g. yoga, qi gong, or going to the sauna:

“Well, I can already see that I really need to relax and recover a lot in my private life, so there you really have to find an absolute counterbalance, otherwise it gets really difficult.” [#11, female, refugee aid].

Spending time in nature and outdoors, for example going for walks with the dog or gardening, was described as a compensation for stressful and mainly sedentary work. According to several workers, it represented a good way to switch off from work:

“I surround myself in nature a lot. I go out with my dog and even sometimes make my journey to or from work longer and use the time to go for a walk or bike ride (…). And by doing that I definitely unwind.” [#3, female, homeless aid].

Creative hobbies were also mentioned by some respondents, e.g. making music, singing, writing, sewing or photography. Others indicated reading or using media, such as TV or the computer, to detach from work.

Acceptance and focus

Another coping strategy mentioned by many respondents consisted of withstanding negative feelings at work (e.g. caused by criticism regarding one’s way of working). As described by the interviewees, such feelings could be reduced by cognitively distancing oneself from criticism and confidently following one’s own work tasks. Moreover, accepting situations that could not be changed was described as important, for example, with regard to the fates of clients, when clients maintained their unrealistic expectations or did not accept help:

“Well, just by simply saying: ‘I accept the situation as it is.’ Being able to do that is also pretty difficult, as you actually have your own ideas of how things might go for people, but it often just doesn’t work out.” [#9, female, homeless aid].

In addition, one interviewee underlined that it was helpful to concentrate on the positive sides of work and to remind oneself and one’s clients of previous positive achievements:

“(…) that again and again you try to concentrate on the positive things and remind yourself: What went well and what have you already achieved?” [#2, female, homeless aid].

Self-care and mindfulness

Further coping strategies were related to the workers’ self-care. Some interviewees stressed the importance of reporting sick in the event of illness and of taking short breaks at work despite potentially negative comments from colleagues or postponed work. Various workers talked about not being put under stress, being mindful, knowing one’s limits and not working beyond them. Increasing awareness of one’s own needs was described as essential, as well as taking concrete actions for recovery at work, e.g. using relaxation techniques, having active breaks or following healthy eating:

“You have to watch out for that, and when you realise, you have to say: ‘Okay, good, I have to look after myself a bit too.’ So simply that you keep an eye on yourself.” [#7, female, homeless aid].

Distance to work

Creating distance from work, especially from clients’ problems and concerns, was described as a useful coping strategy to better deal with challenges and perceived failures in the work context. This meant taking a step back from clients’ problems and “getting a big tank”:

“I try maybe to not let everything get to me. So (…) that they are their problems, not my problems, basically.” [#1, female, homeless aid].

It also meant not taking failures, aggression or appointment cancellations by clients personally. Helpful mechanisms were to consciously reflect and understand that failures had nothing to do with one’s professional skills, and to recall the clients’ responsibilities:

“It’s really a question of attitude (…), that people are always independent and act independently. And, yes, that I offer support and provide guidance, but that I can’t do things for them (…).” [#21, female, homeless aid].

Sources of support

There were various sources of support mentioned by the interviewees, many of them relating to workplace social support, i.e. interpersonal relationships in the work context (Table  4 ).

Support from colleagues and supervisors

Social workers repeatedly stated that support was provided by their colleagues in the form of collegial advice in difficult situations, which was especially helpful for finding quick solutions. Good team spirit and sense of community were also underlined by most of the workers. It was stated that colleagues cared for each other and that an open question culture was promoted:

“Well, advice from colleagues, that goes really fast. We simply go from door to door or we arrange to meet, that goes pretty well and works out pretty well.” [#8, male, homeless aid].

Moreover, supervisors’ support was mentioned. For example, it was specified that they were approachable for work-related questions and particularly supportive in difficult situations at work:

“And that we also have a boss who is receptive to us and takes us seriously. That’s also worth a lot and I have had completely different experiences with that.” [#2, female, homeless aid].

Team meetings

Team meetings were also pointed out as an important source of support by several workers. In many cases, meetings in small teams were held once a week. Meetings in larger teams, e.g. cross-departmental or cross-location meetings, took place every 2 weeks, once a month or every 3 months. Team meetings were predominantly regarded as helpful for regular exchange and, in some cases, for collegial case consulting. However, some participants perceived the meetings as too superficial or too short to provide enough time for detailed discussion:

“Case assessments are sometimes too short because in team meetings we have to talk about organisational issues and things like that, and in the end case discussions are neglected a bit.” [#20, female, homeless aid].

Team meetings were sporadically used to develop concrete measures for improving the work conditions. Examples for such measures were the provision of number assignments for clients for open consultation hours, the use of stop signs indicating that there was no consultation hour, and the provision of mobile phones for communication with clients. Three workers also explained that conceptual and strategic planning took place on so-called “concept days” in the institutions:

“Well, we do concept days here where we get together and talk and think about next steps. And actually I find that pretty ideal here.” [#10, male, homeless aid].

Supervision

Supervision was another important source of support for many interviewees. It was typically provided once a month and in the form of group supervision. Some participants described larger time periods for supervision, e.g. once every 6 or 8 weeks. Two workers indicated that group supervision was not available to them. For the majority of the workers, supervision was perceived as helpful for self-reflection, knowledge exchange and for learning new tools and work methods:

“I find supervision helpful because then somebody external comes along and sometimes you’re sort of a bit out on ledge when you’re just doing things yourself. And that just gives another perspective, which is often simply a relief.” [#3, female, homeless aid].

However, dissatisfaction with supervision was also occasionally expressed, e.g. that it had to be postponed or cancelled due to understaffing, or that group supervision was not welcomed by all team members. The availability of individual supervision varied: for most of the interviewees, this form of supervision was not available. One worker stated that individual supervision was generally available, another said that it was only available for managers, and two interviewees declared that it was only available in extremely worrying situations (e.g. stalking, sexual abuse).

Training courses

The provision of training courses was another frequently mentioned source of support. Courses covered a range of topics, e.g. legal aspects, de-escalation techniques, counselling know-how and management skills. In some cases, there was a training budget available for each employee, and employees could select and request training themselves:

“I am offered [training], internally or sometimes I can even make suggestions and organise things myself. And taking part in training with other providers is also approved and financed. That’s important.” [#12, male, refugee aid].

Support from other institutions

Single interviewees described further sources of support within their institutions, e.g. support provided by experts from the human resources department or the sponsoring association. With respect to support from external sources, three workers stated that there were no other institutions to which they could turn for advice. The other workers described several sources of support in the form of network centres and counselling services (e.g. for issues like violence, drugs, debt and flight). Furthermore, sources of support also included federal associations, lawyers, doctors, psychologists, training providers, former professors and colleagues, volunteers or professionals with similar tasks who could be asked for advice. Cooperation with other institutions was generally perceived as supportive, as it allowed the interviewees to pass clients on to other parties if they were not able to provide support in all necessary aspects:

“A large part of the work is actually that we look to see where there are places where we can send our people if they need special or concrete help.” [#15, male, refugee aid].

Support in private life

Employees also described sources of support in their private lives provided by partners, families, friends and roommates. Support was particularly noticed when people in the family or circle of friends had a refugee background themselves and could assist with translation or interpreting tasks. Conversations with family members were also generally perceived as supportive:

“Well, in my family we talk about the topic of homelessness a lot (…). My partner is also very interested in what I do and asks about it, so does my family.” [#8, male, homeless aid].

• Workplace health promotion

Comments on workplace health promotion concerned the availability of health promotion offers as well as the further needs and wishes of employees.

Available health promotion offers

Overall, six respondents declared that no health promotion offers were available at their workplace, although some of them indicated the possibility of available health promotion offers that were unknown to them, e.g. due to the size of their organisations:

“Maybe it does exist. But I think I just don’t know anything about it. Around Germany, they [the institutions] have up to 14,000 workers, and (…) a lot of roles and facilities and it is sometimes not really clear and you don’t always find out about everything.” [#14, female, refugee aid].

Other workers reported several health promotion activities which consisted of individual offers rather than systematic workplace health management. With regard to behavioural measures, eleven interviewees stated that health days were organised every year or every 2 years. Two workers stated that there were massage services offered. These were either cross-departmental health days for all employees or organised individually by smaller teams. Moreover, respondents mentioned that courses and workshops were offered on different topics, ranging from stress management, mindfulness, yoga and relaxation to back training, healthy cooking and acupuncture. Quick relaxation and sports exercises were also occasionally organised, e.g. in the form of active lunch breaks. Furthermore, one respondent said that there was a volleyball group and another stated that there was an intern who had given the team Kung Fu lessons.

With respect to structural measures, four interviewees reported that companies offered medical examinations, vaccinations and funding for glasses at work. In addition, five workers reported funding for the use of gyms and two for fruit purchases at work. The implementation of a risk assessment on mental stress, regular health and safety information, funding for participation in company runs, and a service bike offer were described by one worker each.

In terms of workers’ experiences with health promotion offers, some employees stated that they had already used the offers or planned on doing so in due course. Six workers who had not used any offer so far indicated various reasons for not having done so, e.g. a lack of interest in existing offers and lacking motivation after work. In addition, the preference to take part in sport offers privately rather than in the work context was expressed by seven employees:

“I mean, doing exercise activities with my colleagues isn’t really my thing. Doing Thai Chi on the roof with people, I would find that a bit weird. Because I do my own exercise.” [#5, female, refugee aid].

Two respondents cited shift work as a major obstacle to participation in health promotion activities. Moreover, excessive workload and a resulting lack of time were described. One worker said that courses took place at unfavourable times and two commented that they took place in unfavourable locations (e.g. offers held in headquarters, but not in branch offices). Furthermore, the unclear and time-consuming registration process was noticed. Three respondents said that they would have to initiate and organise health promotion activities themselves, since this was not organised by the institutions.

Needs and wishes for health promotion offers

In terms of behavioural measures, several respondents stated their general interest in sports offers and in the organisation of company sports groups (e.g. a running group after work):

“Doing some sort of exercise activities with colleagues, some communal activities. Just that we do something to release a bit of energy and have a laugh, laughing is important.” [#7, female, homeless aid].

Requests for regular, company-wide training courses were also made. Such courses should consist of a mixture of theory and practice and deal with various topics, e.g. back therapy training, stress management, relaxation techniques, qigong, yoga, body awareness, de-escalation and self-care. Three respondents particularly wanted activities to be offered during their work hours. Moreover, easily accessible activities at different times of the day were preferred and considered necessary for coordination with shift work:

“You would really have to be able to choose when you go. (…) That you really can go in the mornings, maybe in the evenings, because, you know, we do a lot of shift work.” [#23, male, homeless aid].

Four workers reported their desire for massages at work and two wished for a massage chair. Regarding structural measures, financial support for private hobbies and discounts for nearby gyms were desired. Moreover, further supervision, contact to lawyers for legal questions and regular medical examinations were stated. In addition, one respondent introduced the idea of a social worker counsellor working in the organisation’s facilities (instead of hard-to-reach external supervision):

“If someone were to come into the facility and simply offer an open space to talk, somewhere you can simply drop in. Someone that doesn’t work here themselves, but who you could go to and simply talk about things, especially during working hours. A social worker for social workers.” [#6, female, refugee aid].

With regard to the work environment, separate rooms for exercise and relaxation activities as well as rest rooms for breaks were requested. Two workers indicated their satisfaction with the available health promotion offers and stated that they had no need for further offers.

To our knowledge, this is the first study to empirically explore the coping strategies, support sources and health promotion offers available to German social workers in the growing work areas of refugee and homeless aid. By conducting qualitative interviews with 26 social workers in these fields, we were able to gain important new insights into these topics and extend current evidence.

Some of the problem-focused coping strategies identified in this study have previously been reported for social workers, such as the strategies of setting limits and boundaries in contact with clients or with regard to work and private life [ 5 , 16 , 17 ]. Moreover, acquiring knowledge (e.g. through training activities) in order to manage work-related stress has also been stated before by German refugee aid workers [ 27 ]. In addition to this, our study uncovered further problem-oriented strategies that have received little attention so far, such as strategies related to employees’ work organisation and time management. Time management coping strategies were described as helping workers prioritise and make the best use of their time, which was particularly important in view of their multiple work tasks and restricted time resources.

Another important coping strategy revealed in our study was the search for social support. This strategy emerged both in the context of problem-oriented coping strategies (seeking instrumental support from colleagues and superiors to deal with stressful situations and concrete problems at work) and emotion-oriented coping strategies (seeking informal social support from family and friends to alleviate negative emotions). In general, the search for social support is a frequently used coping strategy, and protective links between social support and health are well documented [ 48 , 49 ]. The finding is consistent with previous research in which social support represented an essential job resource for staff in refugee and homeless aid [ 6 , 50 ].

In addition, a notable finding of our study is that some interviewees had started psychotherapy to better cope with their job demands and associated strains. The fact that psychotherapy was initiated by the interviewees themselves points to a high level of suffering among these workers, which was emphasized by the workers themselves. In accordance with this, previous studies have shown a high prevalence of long-term psychological strain reactions among social workers, including depressive moods and burnout [ 9 , 13 , 51 , 52 ]. The result is somewhat alarming, as it suggests a perceived lack of possibilities for the workers to address their problems in the workplace and receive adequate help, e.g. through individual supervision. In fact, individual supervision was unavailable to most workers in our study. Earlier research suggests that the availability of individual supervision may vary across different settings and countries. For example, in a recent study on homeless aid in the UK, 83% of the frontline workers had access to individual supervision [ 26 ].

With respect to the reported emotion-oriented coping strategies, being active (e.g. exercising, taking walks outdoors) and pursuing leisure activities were underlined by many workers as central coping behaviours. The importance of these strategies has been outlined before [ 5 , 6 , 16 , 17 ]. Moreover, actively organising their leisure time helped the workers to get away from work. Evidence suggests that social workers often find it difficult to switch off from work [ 13 , 17 ], which further explains their use of coping strategies that enable them to detach and recover from job stress.

Further emotion-focused coping strategies employed by the interviewees were the strategy of avoiding presenteeism and consciously taking self-care actions. Similarly, the use of self-care strategies (e.g. diet changes, improvement in sleep hygiene, relaxation) was found to be a functional coping strategy [ 21 ] which was also used by employees in homeless aid [ 6 ].

Notably, several emotion-oriented coping strategies used by the workers in our study involved cognitive components, e.g. gaining mental distance from work, accepting unchangeable situations and focusing on positive experiences. In earlier studies with social workers, similar cognitive coping efforts were described, e.g. with regard to the acceptance of clients’ undesirable behaviour without taking it personally [ 19 ] and of their boundaries of influence [ 18 ]. The use of cognitive coping strategies may be particularly efficacious for social workers when they encounter problems that cannot be changed directly (e.g. political laws). However, making use of such strategies is also demanding, as it firstly requires the workers’ ability to reflect problems on a meta level.

In earlier research, most of the coping strategies employed by social workers were classified as emotion-focused [ 9 ]. In comparison, employees in our study used both problem-oriented and emotion-oriented strategies, although a slight tendency towards the use of more emotion-oriented strategies was observable. Referring back to the theoretical definition of coping provided by Lazarus and Folkman [ 36 , 37 ], the variety of identified coping strategies underpins the notion that most individuals use both problem-oriented and emotion-oriented coping strategies to deal with stressful events [ 36 ].

Regarding the identified sources of support for social workers, most of them were linked to workplace social support [ 40 ], e.g. provided by team members, supervisors, external persons and institutions. This result underlines the importance of social interaction for the working group. It also suggests that the workers may already have some sources of support available in the work setting. At the same time, however, our study sheds light on potential for improvement, e.g. with regard to team meetings and supervision being postponed, too short or too superficial to provide help for complex problems. Our results are consistent with earlier research indicating that social workers (especially those with severe strain reactions) did not feel sufficiently supported by supervisors [ 13 ]. External supervision and consulting are important tools for reflecting on one’s work methods and stressors, and have shown protective effects on the health [ 53 ] and job satisfaction [ 25 ] of social workers. Conversely, a recent qualitative study suggested that inadequate supervision and a lack of supervisor support may play a critical role in the development of long-term strain among social workers [ 13 ]. Summarising the above, the need for adequate supervision for social workers in homeless and refugee aid has been raised before [ 9 , 13 ] and is strongly reinforced by our results.

With regard to workplace health promotion, a relevant finding of our study is that several employees were unaware of health promotion offers at their workplaces, although some of them indicated that such offers could possibly exist. Furthermore, several workers named individual health promotion offers, but none of them described a systematic workplace health management. On the one hand, this suggests that there may be little systematic approaches to workplace health management within the organisations so far. On the other hand, the findings may also point to a lack of information on the part of the interviewees, suggesting that health promotion offers may not be advertised properly and that communication flows within the organisations need to be improved. Many of the cited needs for behavioural and structural health promotion measures are consistent with the results from earlier research. For example, in terms of behavioural measures, the respondents wished for regular and company-wide training courses on a range of topics, which has been similarly revealed in previous studies [ 16 , 50 ]. A recent study showed that over one fifth of frontline workers in homeless services never had access to relevant training, e.g. relating to suicide, self-harm and mental health [ 26 ]. Some training options were especially scarce, e.g. training on trauma and domestic violence, which one third of the workers had never received. Needs in terms of structural measures concerned offers for supervision and counselling as well as changes in the work environment. Likewise, in a recent study, it was demanded that employees should be provided with adequate facilities to enable relaxation during their breaks [ 13 ].

Implications

From the results of our study, some implications for research can be drawn. In terms of research-related implications, quantitative studies with higher sample sizes should be carried out to generalise and quantify our findings, e.g. regarding the potentially positive effects of coping and the status quo of workplace health promotion for social workers in refugee and homeless aid. In future studies, it would be interesting to compare the support sources and health promotion offers for social workers in different work settings (e.g. organisations of different types and sizes, with independent and public sponsors, and in rural and urban structures). This could help to gain a deeper understanding of the beneficial and impeding factors for implementing health promotion offers.

Practical implications can also be derived (Table  5 ). Our findings indicate that workplace interventions should be carried out aiming at empowering social workers to further expand upon their coping strategies. In organised courses and workshops, employees could acquire relevant skills and learn about further ways of coping with job stress in a resilient manner. With respect to the development of support sources, demands for greater support and expanded supervision for social workers have previously been made [ 53 ] and are strongly reinforced by our findings. Supervision is highly valuable, as it promotes reflection, support and evidence-based expertise [ 53 ]. To support employees in dealing with their emotional demands, easy and low-threshold access to qualified supervision must be provided for all workers in the form of individual and/or group supervision. This seems particularly relevant in view of the stress factors and secondary/post-traumatic stress in social workers serving refugees and homeless clients [ 14 , 15 ]. In the same vein, it is important to inform the workers well about the usefulness of supervision, especially those who are still inexperienced and unsure about using this offer. Moreover, team support within the institutions should be nurtured and upheld. For this purpose, the provision of regular meetings with sufficient time for case consulting and enough room to spend breaks together with colleagues would be useful. Emphasis should also be placed on networking, regular exchange and cooperation with other counselling services which can provide support as neutral entities.

In view of the diverse needs for health promotion stated by the workers, our findings provide a useful starting point for planning needs-based health promotion offers. Suitable structural measures may address the work organisation (e.g. in terms of ensuring reliable work hours and a manageable workload). They should also aim at improving the work environment, e.g. by providing more rooms for rest and recovery. With respect to behavioural measures, training courses on work- and health-related topics (exercise, relaxation, de-escalation, violence, etc.) are recommended. For example, since workers in our study mentioned aggressive behaviour of clients, the availability of training courses on de-escalation and non-violent communication may be particularly helpful for those who encounter such problems at work. Our results indicate that initial health promotion offers are already available at many organisations, meaning that future interventions can be based on existing offers and can expand upon them, taking the workers’ needs into account. Employees should be given opportunities to make flexible use of health promotion offers, e.g. during work hours and at different locations in order to improve coordination with shift work, which is often a major obstacle in participation. Since health promotion offers may not always be well-promoted, this highlights the importance of systematic and target-oriented advertisement within the organisations. After all, politicians at a higher level also have a responsibility for creating a framework and providing sufficient resources to promote these crucial fields of social work, so that adequate programs can be implemented at company level.

Strengths and limitations

A particular strength of this study is that the views of social workers were assessed in a heterogeneous sample (e.g. in terms of age, work experience, etc.). Thereby, we were able to capture different perspectives and broadly map the topics of interest. Considering the explorative character of the study, a sufficient number of workers was included in order to attain data saturation [ 54 ]. Further strengths of this study are the consistent orientation towards and application of recognized field practices, e.g. the data analysis according to Mayring’s qualitative content analysis [ 44 ]. To improve the internal quality of the study, we used rich descriptions as well as numerous direct quotes to describe our results [ 55 ], and applied the international checklist “COREQ” [ 47 ]. Moreover, all results were compared to empirical references and to the theoretical framework [ 56 ].

Some limitations of the study should also be noted. As in any qualitative study, the interviewees’ responses may have been influenced by the lack of anonymity between the workers and the interviewer as well as by social desirability tendencies. Selection effects cannot be ruled out either. For example, all respondents spoke fluent German and were rather young; results could be different for older employees or employees of other nationalities. Qualitative research captures the subjective perspectives and truths of the respondents. The interview sample is not representative of the general population of social workers, and the results are not generalisable to other settings or time periods. The temporal context of the study period should also be noted: the interviews were conducted in autumn 2017, when immigration in Germany slowly subsided, leading to restructuring measures and closures of institutions. In homeless aid, employees experienced a steady increase in homelessness and changes in the clientele in terms of, for example, gender and origin [ 57 ]. Such recent developments should generally be kept in mind with regard to their potential impact on our results.

The results of the study provide novel insights into the coping strategies employed by social workers in refugee and homeless aid and into the available support sources and workplace health promotion. On the one hand, the findings show that social workers use multiple coping strategies and have access to different support sources in the workplace, helping them to deal with their job demands and regulate their emotional responses. On the other hand, the results suggest that certain needs for support among employees are not yet covered, and that systematic workplace health promotion appears to be scarce within the organisations. The identified wishes of the workers for behavioural and structural measures are particularly relevant for health promotion, as they indicate diverse areas and starting points for policy makers and organisations to design needs-based health promotion interventions for social workers in refugee and homeles aid.

Availability of data and materials

The datasets are not publicly available due to German national data protection regulations. They are available from the corresponding author upon reasonable request.

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Acknowledgements

We’d like to thank all institutions and employees who participated in the interviews. Moreover, we thank the students Gabriel David Westermann, Friederike Seemann, Jerrit Prill, and Lara Steinke for their support in the recruitment of interview participants and data transcription.

This research was funded by the Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW; non-profit organisation which is part of the German social security system), Hamburg, Germany. The funder had no role in the study design, data collection, data analysis and interpretation, preparation of the manuscript and decision to submit the paper for publication.

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JM, TW, AN, VH, and SM planned the study and study design. JM and TW carried out the qualitative study and analysed the data. JM, TW, and SM interpreted the data. JM drafted the manuscript. TW, AN, VH, and SM reviewed the manuscript and contributed substantially to its revision. All authors read and approved the final version of the manuscript.

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Correspondence to Stefanie Mache .

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The study was approved by the Medical Ethics Committee of the Hamburg Medical Association, Germany (PV5652). Prior to data collection, participants were informed about the study aims and data confidentiality and signed a declaration of informed consent.

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Additional file 1..

Relevant interview guideline questions.

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Mette, J., Wirth, T., Nienhaus, A. et al. “I need to take care of myself”: a qualitative study on coping strategies, support and health promotion for social workers serving refugees and homeless individuals. J Occup Med Toxicol 15 , 19 (2020). https://doi.org/10.1186/s12995-020-00270-3

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DOI : https://doi.org/10.1186/s12995-020-00270-3

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Emotions, Feelings, and Experiences of Social Workers While Attending to Vulnerable Groups: A Qualitative Approach

María dolores ruiz-fernández.

1 Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; se.lau@757frm (M.D.R.-F.); moc.liamg@iicor92 (R.O.-A.); [email protected] (J.M.H.-P.); se.lau@nanrefc (C.F.-S.)

Rocío Ortiz-Amo

Elena andina-díaz.

2 Department of Nursing and Physiotherapy, University of León, 24071 León, Spain

3 SALBIS Research Group, University of León, 24071 León, Spain

4 EYCC Research Group, University of Alicante, 03690 Alicante, Spain

Isabel María Fernández-Medina

José manuel hernández-padilla.

5 Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, London NW4 4BT, UK

Cayetano Fernández-Sola

6 Faculty of Health Sciences, University Autónoma of Chile, Temuco 3580000, Chile

Ángela María Ortega-Galán

7 Department of Nursing, University of Huelva, 21007 Huelva, Spain; moc.liamg@69agetroalegna

Associated Data

Not applicable.

Social workers in the community setting are in constant contact with the suffering experienced by the most vulnerable individual. Social interventions are complex and affect social workers’ emotional well-being. The aim of this study was to identify the emotions, feelings, and experiences social workers have while attending to individuals in situations of vulnerability and hardship. A qualitative methodology based on hermeneutic phenomenology was used. Six interviews and two focus group sessions were conducted with social workers from the community social services and health services of the Andalusian Public Health System in the province of Almería (Spain). Atlas.ti 8.0 software was used for discourse analysis. The professionals highlighted the vulnerability of certain groups, such as the elderly and minors, people with serious mental problems, and people with scarce or no economic resources. Daily contact with situations of suffering generates a variety of feelings and emotions (anger, sadness, fear, concern). Therefore, more attention should be paid to working with the emotions of social workers who are exposed to tense and threatening situations. Peer support, talking, and discussions of experiences are pointed out as relevant by all social workers. Receiving training and support (in formal settings) in order to learn how to deal with vulnerable groups could be positive for their work and their professional and personal quality of life.

1. Introduction

According to the World Health Organization (WHO), vulnerability is the degree to which a population, individual, or organization is unable to anticipate, cope with, resist, and recover from the impacts of disasters [ 1 ]. The concept of vulnerability refers to those sectors or groups of the population that, due to their age, sex, marital status, or ethnic origin, are in a risky condition that prevents them from accessing development and better welfare conditions [ 2 ]. These people are suffering or undergoing a painful experience [ 3 ] and turn to social services for a solution [ 4 , 5 ]. The care they receive may come from community social services [ 6 ] or, more specifically, from integrated social services in the health field [ 7 ].

Social workers are the frontline professionals of social services [ 8 ], that is, the first professionals in charge of meeting the demands of users upon arrival at care services [ 9 ]. They therefore play a fundamental role in the care trajectory of individuals in situations of need and social vulnerability [ 10 ].

The number of service users with very complex demands is quite high [ 11 ]. As a result, in daily practice, social work professionals find themselves in constant contact with individuals who are experiencing considerable social challenges [ 12 , 13 ]. Professionals are confronted with the task of promoting equality and well-being for individuals [ 14 ]. However, the interventions carried out with users are based on the traditional social intervention model of social services [ 15 ]. This strategy provides material and/or financial resources to users, which could help them to escape from that particular situation [ 16 ]. In this case, this means that the actual implementation of this model would be carried out to a greater or lesser extent, depending on the resources available to the state in question [ 17 ].

Professionals witness the suffering and despair of those most in need [ 18 , 19 ]. This situation triggers professionals’ emotions and feelings, the first being understood as the automatic and uncontrollable response to a stimulus and the feelings being the conscious evaluation of the emotion or experience suffered by the individual [ 20 ]. It is quite common that the demands made are greater than the resources available to manage them or that they need to be met faster than is possible due to the administrative procedures involved [ 21 ]. In addition, the vulnerability of some groups must be added to this context [ 22 ]. According to WHO, children, the elderly, and people who are ill are particularly vulnerable. Poverty is a major contributor to vulnerability [ 23 ]. In this sense, different studies establish that minors and the elderly are among the most vulnerable populations [ 24 ]. Thus, the occupational and professional commitment to these groups of individuals becomes even greater [ 25 ].

These repeated working conditions, alongside the contact with the person’s suffering, have repercussions on the professionals’ well-being [ 26 , 27 , 28 ], causing stress, emotional discomfort, and even vicarious trauma, defined as “those emotions and behaviours resulting from the interaction with traumatic events experienced by others” [ 29 , 30 ]. This is known as the cost of the emotional impact of caring [ 31 , 32 ], that is, the price professionals pay in the process of helping people in situations of intense suffering or trauma. According to the stress process models, some of the resources that potentially serve as a protective barrier include social support, the repertoire of confrontations, and some self-concepts such as self-esteem [ 33 , 34 , 35 ]. Other protective resources with the ability to significantly reduce the harmful consequences of existing stressors are the mastery and control of existing circumstances and mutual support among the professionals themselves [ 36 , 37 ].

According to the reviewed literature, research on social work has traditionally focused on professional performance and how this performance affects intervention subjects. However, there are fewer studies on the impact that the suffering of users has on social workers [ 38 , 39 , 40 , 41 ]. In recent years, there has been an increase in research, from a quantitative paradigm, in order to describe the working conditions of this group of professionals and their professional needs [ 42 , 43 , 44 ]. Despite this, research from a qualitative paradigm, from the perspective of social workers themselves, is still scarce. In particular, it reflects the emotional situation they experience in the development of their work, and seeks to delve into the experiences, the consequences, and what they would need, in order to continue helping in a sustainable way [ 45 , 46 , 47 ].

Bearing this in mind, the main objective of this research was to identify the social workers’ emotions, feelings, and experiences while attending to individuals in situations of vulnerability and hardship. Specifically, two secondary objectives were raised: to learn about the situations causing discomfort and suffering, as well as about the consequences of the same on the social workers themselves, and to inquire about the needs and resources of professionals so as to meet the demands of their work.

2. Materials and Methods

2.1. approach.

In the present study, a qualitative design based on a phenomenological–hermeneutic approach was used. According to Van Manen [ 48 ], this approach allows the study of non-conceptualized experiences lived by people, as well as the meaning of these experiences. Thus, it was possible to perform an in-depth analysis of the daily work experiences of social workers in community social services and health services. Their feelings and perceptions about the implementation of social interventions involving vulnerable groups of individuals were explored and interpreted.

2.2. Recruitment and Sampling

Participants in the study were the social workers at the community social services and health services of the Andalusian Public Health System in the province of Almería (Spain). Community social services in Andalusia are distributed as follows: In the capitals and cities of more than 20,000 inhabitants, the municipalities carry out the management of these services. In cities with less than 20,000 inhabitants, the provincial council carries out the management. Specifically, in Almeria city, there are 4 community social services centers managed by the city council. Regarding the Andalusian Health Service, in the capital city of Almería, there are 13 health centers (6 of these are centers with a full-time social worker). We selected social workers employed at three community social services centers in Almeria and social workers employed at the six health centers.

A total of 20 social workers participated. Of these, 11 worked in community social services centers and 9 worked in the Andalusian Health Service.

The inclusion criteria were the following: holding a stable position as a social work professional in community social services and/or the Andalusian Health Service, having a professional career or experience of no less than eight years, and regularly providing assistance to individuals in need of social services. The following professionals were excluded: professionals with temporary employment contracts or little work experience (less than eight years), professionals in managerial positions, professionals who had no contact with people in vulnerable situations, and professionals who had any psychological impairment that made it difficult for them to provide information.

Convenience sampling was the sampling method used. To recruit as many participants as possible, a snowball sampling procedure was used: a professional was contacted, who, in turn, would contact other professionals willing to participate [ 49 ]. First, the director of an urban community social services center was contacted by telephone. The study was explained to her, and a brief summary of the study, along with authorization from the Ethics and Research Commission, was sent to her via email. Subsequently, the director of the center informed her colleagues of the study and invited them to participate. Finally, the director contacted other directors of other centers, who then followed the same procedure.

The social workers at the health centers were contacted by a mental health social worker and a case manager nurse working at an urban health center. Both professionals were responsible for providing the health and social care workers with information about the study. Once they agreed to participate in the research, the participants were contacted to arrange a meeting.

When selecting participants, gender diversity was sought, although there were few male social workers among the centers’ staff. In Spain, the social work profession is predominantly female, so the sample (a larger number of women) could be considered representative. Equal representation of health and community social workers was also sought.

2.3. Data Collection

In-depth interviews and focus groups were the information-gathering techniques used. Two focus group sessions (with a total of seven people in each group) and six in-depth interviews were carried out. The two focus groups were conducted by a researcher and a collaborator, who had received specific training by specialists. The discourses were taped for transcription.

First, two focus group sessions were held in February 2019. One focus group session was held in the meeting room of an urban community social services center, and the other focus group was held in the multipurpose room of a social services center in the province of Almería (Spain). The groups comprised professionals working in both services (community and health services) to ensure that professionals from both sectors were included in each focus group. The researcher led the group, while the collaborator wrote down in a field notebook those observations that could be useful in subsequent analysis. The session began with an exercise that prompted discussion and dialogue among the members of the group: “Describe your day-to-day work experiences with individuals in vulnerable situations.” Finally, the conclusions were summarized, and the members were thanked for their participation. Each session lasted approximately 90 min.

Second, in-depth interviews were conducted by the researcher of this study in the professionals’ offices. Three interviews were undertaken with community services social workers and a further three with health and social care workers during the month of March 2019. None of them had participated before in the focus groups. In these interviews, those dimensions that had not been sufficiently explored in the focus groups were addressed. A list of interview questions was not used. Only an opening question was asked: “Tell me about your daily work. How does attending to individuals in situations of vulnerability on a daily basis affect you?” This question facilitated the participants’ discussion. The interviewer took all the necessary notes in a field notebook. The interviews lasted approximately one hour.

In the opinion of the researchers, the two focus groups and the six in-depth interviews were sufficient to achieve data saturation. The possibility of conducting one focus group session in the urban area and the other in a rural municipality was considered in order to identify the differences between community social services in the capital of the province and community social services in a rural setting. Furthermore, both focus groups included not only community social services professionals but also health services professionals in order to have discourses from both types of workers in the two settings studied. Once the focus group sessions were completed, in-depth interviews were conducted to investigate the emerging issues in the focus groups in order to obtain additional data.

2.4. Analysis

Giorgi’s method of analysis [ 50 ], which involves creating a series of categories and subcategories, was used to analyze the information from both the in-depth interviews and the focus groups. This procedure was carried out in several phases. The first one was an in-depth reading of all the discourses, which had already been transcribed verbatim. The second phase involved a second reading and the division of the data into parts. The basis of the division into parts is meaning discrimination, which presupposes the prior assumption of a disciplinary perspective (social work, in this case). These meaning discriminations constitute parts known as meaning units. The meaning units were examined, tested, and redefined so that the disciplinary value of each unit could be more explicit. These meaning units were then grouped into broader categories according to their shared characteristics and the disciplinary value. In the last phase, the contents of each of the categories were interpreted and analyzed based on the phenomenon or experience lived.

The theoretical–methodological approach was adequate to achieve the objectives of the study. The data obtained were relevant in the context and in other contexts, when compared to the literature.

As for the validity of the results of the analysis, contrast through triangulation was used to control for potential biases resulting from the heterogeneity of the data and the informants’ different points of view. To make a contrast between the differences and similarities conveyed in the discourses, the techniques of focus groups and in-depth interviews were used. In terms of triangulation between subjects, informants were selected from different settings and fields of work to diversify the information present in the discourses regarding the participants’ work experiences in these services. Two researchers began the analysis after the first interview in order to constantly verify that it was in line with the study’s objectives and in order to be prepared in case any change in the research design was needed (it was not). The main categories that researchers identified in the analysis were shared with the participants (by email) to confirm the discourses. In the participants’ discourses where contradictory information was detected, this moment was used to clarify it. The analysis was shared with the rest of the team to ratify the categories. At the same time, an external researcher (with expertise in the subject) validated the analysis.

Reflexivity and a self-critical attitude were maintained throughout the process by all the researchers. To avoid influencing data collection, sample recruitment, and location, the researchers only knew the topic in a superficial manner (as health professionals) and it was not their usual work/subject matter of research.

Atlas.ti 8.0 software (Scientific Software Development GmbH, Berlin, Germany) was used to analyze the discourses.

2.5. Ethical Aspects

This research obtained all the necessary authorization from the corresponding Research and Ethics Committee of the University of Almería, Spain (EFM-11/19). Previously, participants had been informed verbally and in writing of the purpose of the study, and their informed consent had been obtained in writing in a dedicated document. The confidentiality and anonymity of participants were preserved throughout this research, in compliance with the bioethical principles of the Declaration of Helsinki [ 51 ]. The data from the discourses were safeguarded and protected in accordance with the Spanish regulations in force regarding the official protection of personal data, i.e., the Spanish Organic Law 3/2018, of the 5th of December, on Personal Data Protection and Guarantee of Digital Rights [ 52 ].

The study population comprised 20 professionals: 11 professionals working in community social services and 9 professionals working in the Andalusian Health Service, with a mean age of 46.35 (SD = 7.36) years and with a mean work experience of 24.16 (SD = 7.87) years. Table 1 shows a summary of the sociodemographic characteristics of the sample of professionals who participated in this research.

Sociodemographic characteristics of participants.

An analysis of the discourses was performed with the information gathered from the focus groups (FGs) and from the in-depth interviews (IDIs). Three categories with nine subcategories emerged from this analysis. All categories and subcategories were encompassed by a broader category relating to the social workers’ experience ( Table 2 ).

Categories and subcategories emerging from the study.

3.1. Working with Vulnerable Groups

In day-to-day practice, health and social care workers serve users with very different demands. The characteristics of the population visited by social services are highly varied. Certain settings and realities experienced by users are perceived by social workers as generators of further personal suffering or dismay. Moreover, the traditional social intervention model adopted by social services causes chronic frustration and professional burnout. The main element identified by the informants as a generator of further suffering in the person of the social worker was the intervention work carried out with vulnerable groups.

3.1.1. Minors and the Elderly

Two of the vulnerable groups that had an impact on participants were minors and the elderly, as they are fragile and innocent groups.

You can’t avoid being touched by the toughest situations, such as those involving minors or the elderly [who are] on their own… (IDIs, P3).

…then, well, that… what I always say when there are cases and cases, when you see the despair of a daughter because her mother is ill and the resources she needs do not arrive… There are cases that have an impact, and that no matter how professional you are, you can’t help it, of course not! Because I’m also a person… (FGs1, P11).

My weak point, so to speak, is the elderly, especially those who are alone… Many needs arise, and sometimes they cannot be met, and I cannot help but take work home with me… (FGs2, P17).

There are users who inevitably impact your situation, or groups such as minors who are still fragile and innocent… And, you find cases where these minors have a rather difficult context and that touches your heart… (IDIs, P5).

3.1.2. People with Serious Mental Problems

Another group mentioned by participants was people with serious mental problems. The fact of thinking that nobody understands them, that nobody believes them, that they are in danger, that they feel threatened, generates a lot of suffering.

…above all, patients with serious mental disorders, when they’re having delusions and hallucinations… and it’s so upsetting to think that nobody understands them, that nobody believes them, that they are in danger, that they feel threatened, and that causes me a lot of suffering, and to that, we must add the social aspect, when they see that the life project they had just like everybody else, their dreams… all is shattered… (IDIs, P5).

3.1.3. People with Scarce or a Lack of Economic Resources

There are also situations of poverty that become permanent for some people and that professionals attend to repeatedly. People with scarce or a lack of economic resources find themselves in very complex situations, and figuring out a way out of these situations has become almost impossible for them, so they visit social workers in a state of desperation, seeking help.

…these are people who come to my office in great distress because they don’t have the most basic things to eat. I mean, they can’t even pay for water [bills]; they can’t afford the most basic items. Besides, these are chronic situations; they no longer know how to get out of that labyrinth (IDIs, P3).

There are families with real hardships; they do not even have a snack for their children to eat at school, and they’ve had it for a long time, and that distresses them so much that they come looking for you again and again… (FGs1, P9).

We have many users who are poor, but really poor; they do not even have the most basic needs covered… (IDIs, P4).

The fight against poverty that leads to social exclusion must be prioritized. We have seen families with children, families who have suffered evictions, people who have reached a situation of poverty without the possibility of any intervention, and who are constantly visiting you out of desperation… (FGs2, P20).

3.2. Emotions Emerging from Working with Vulnerable Groups

Daily contact with situations of suffering can generate a variety of feelings and emotions among health and social care workers. The need arising in professionals to help users who find themselves in a complex situation is evident. However, sometimes social workers encounter a different reality, and aid does not arrive as expected, thus generating various emotions in them.

The most common emotions expressed by professionals, when facing users’ serious situations or when the outcome is not as expected, included anger, sadness, fear, and concern.

3.2.1. Anger

In relation to anger, participants commented on how seeing injustice, because things are not done as they should be, for example, made them feel helpless, and that helplessness generates anger.

…and many times, you feel angry and helpless; of course you feel that [way], and whoever says they don’t is lying, because we [usually] see very tough situations… (FGs2, P14).

…sometimes I get angry; other times I get sad… It’s a constant state of alertness. That’s my natural state, [and it has been] for some time now (FGs1, P12).

When you see injustice, I feel tremendous anger; it makes me very angry that things are not done as they should… or that the response to a user is not what he needs (IDIs, P6).

There are days when you get very angry or upset about certain situations that we have to deal with… (IDIs, P2).

3.2.2. Sadness

The fact of witnessing difficult times that other people go through, or the despair they experience, generates sadness in social workers.

…I feel like… how can I put it into words?… in a pyramid of dissatisfaction, in the sense that, you know, although you do everything you can, [you see] the outcome in the very long term, and then, in the meantime, you see those people here every day… (IDIs, P2).

…other times I have feelings of sadness… (FGs2, P19).

It is inevitable to feel sad on many occasions, when users are desperate and the answers do not come… (IDIs, P1).

Sometimes there are cases, people, who are in a difficult moment of their lives, and when they share their story with you, you feel a lot of sadness, although you cannot transmit it to them, but inside, you get sad… (FSs2, P18).

3.2.3. Fear

In some cases, some participants even mentioned the word “fear,” although they did not delve into that emotion.

…powerlessness, frustration, or even fear… (FGs2, P17).

…and so, it scares me… (FGs2, P15)

There are situations where you feel fear… (IDIs, P3)

3.2.4. Concern

Social workers disclosed that there are situations they cannot possibly stop thinking about, such as people who find themselves in very serious circumstances. These are extraordinary cases that social workers keep thinking about, even after their working hours, because, according to their accounts, some issues inevitably haunt them owing to their significance or complexity. The emotion that emerged related to this was concern about the problems of the users.

…but there are times and situations, quite exceptional ones, that I can’t help remembering; you definitely remember them… There are situations that I still do take home with me, although I’ve been [working this job] for many years, and you have to learn not to take [these situations] with you. Two, three…? or more [of these situations] a year, at least (FGs1, P13).

I guess situations stop shocking you with the passage of time, or you see it differently… But that does not mean that there are no cases that do not affect me, or that I [don’t] take them home, flitting around in my head… and you mull over them, or even after some time, you would remember that nothing could be done, you see that family member on the street and you remember. There are always situations that affect you…I don’t know… (IDIs, P1).

…I take problems home with me because [first] we’re people and then we’re professionals, and you’re there [trying to] figure out how to solve that situation… (FGs 1, P12).

Social workers identify the need and the urgency of some situations for some vulnerable groups. Not being able to respond adequately, because sometimes resolving a demand takes time, generates discomfort and concern among professionals.

…although you do everything you can, [you see] the outcome in the very long term… (IDIs, P2).

…when urgent cases arise and you can’t resolve them with the same urgency…you go home thinking “[hopefully] nothing [bad] happens by tomorrow,” and, well, you don’t even know if that’ll be resolved the next day (FGs2, P20).

…and when the user leaves, I think, what if by the time it’s resolved it’s too late…? And I know it’s not my fault, but I’m the one who’s facing the music… (FGs 2, P18).

…because I have cases [i.e., users] that you attend to and you tell them, “Come back tomorrow to finish this,” or that they have to wait for such-and-such… (FGs2, P18).

3.3. Need for Spaces for Self-Care

Health and social care workers recognized that working with vulnerable groups causes them many negative emotions, as we have previously described. They said that they feel the need to express and share those feelings.

3.3.1. Mutual Support

They end up developing more informal strategies, such as mutual support. Sharing complex cases and learning from the experience of other professionals and their way of dealing with different situations are two of the most valued strategies according to the discourses. Peer support, talking, and discussions of experiences are highlighted and widely accepted by all social workers. They agree that talking to peers and team support are essential to address certain cases or avoid being affected by them in one way or another. Sharing experiences with peers who have undergone similar situations is described as an informal therapy that social workers use to cope with daily work.

…we support each other here and help each other quite a lot; the director is always there… and that makes a big difference. Maybe peer support is a useful tool to deal with the most vulnerable situations, or so that the most complex cases don’t affect you that much (IDIs, P6).

…[having a] good relationship with my peers always helps; for me that’s my therapy (FGs2, P15).

Sharing experiences with colleagues is a mechanism that comes in handy so as to manage all these situations of frustration or in order to consider what [other] alternatives may exist, in addition to the ones you already know (IDIs, P4).

…we are like a kind of group therapy, and [I have] wonderful colleagues; we support each other, really, at least in my experience (FGs 2, P13).

If there is a case that worries me, she always asks me the first one, always, and I feel very supported. Also, in this office, [which] is shared with another colleague, if you arrive from a bad day, especially tired from so many kilometers, we can share how the day has gone and we can let off steam between us (IDIs, P4).

The truth is that relationships with colleagues are very good, and you find support, and of course that matters; just talking and venting our feelings already help (IDIs, P1).

…I have colleagues who may have [many] more years of experience or who have already undergone a similar case and similar experiences. It’s always good that they give you, like, their insight (FGs1, P12).

3.3.2. Formal Spaces to Work Emotions

Professionals talk about the benefits of peer support and report that it exists and is real. However, they also emphatically express the need for training and support in formal settings to learn how to deal with certain cases or not to bring those situations to their personal lives. They recognize the need to develop other types of skills to help them manage their own suffering and dissatisfaction in structured spaces dedicated to training, and emotional support. Receiving training and support in formal spaces can be positive. Working with emotions could favor their work and their professional and personal quality of life. Informants demand that social workers be cared for so that their work, which is in contact with suffering, is sustainable, without becoming exhausted or burned out.

…from the upper management, they have to think about the professionals; we lack the tools to face the current situations we are experiencing… (FGs2, P15).

Yeah, why not? Spaces to work on emotional education or other types of therapies and teachings so as to care for professionals, [and] formal spaces to talk to peers. These can be things that greatly facilitate and favor the work of social workers and their professional and personal quality of life. Psychologists and others to be within our reach… All professionals need their own space, and I think that in the long run it may prove useful, so why not? (IDIs, P1).

I believe that emotional education and self-care must be present… emotional education must always be present, on a professional and [a] personal level. Spaces where we can formally work with our colleagues… (FGs2, P12).

…maybe it would be good to have a structured space for the self-care of professionals (FGs1, P13).

A space to take care of oneself would be great, spending time with each other while learning to work with emotions (IDIs, P5).

4. Discussion

Social workers constantly provide care to people in vulnerable situations with complex demands. This scenario causes suffering in professionals.

In the literature consulted, social workers are portrayed as resource providers [ 17 ], that is, as mere intermediaries between the group of individuals with needs and the resources that the state decides to allocate. As a result, neither deadlines nor requirements depend on social workers themselves [ 53 ]. The professionals in our study and those in previous studies [ 54 ] agree that the bureaucratic processes faced by users represent obstacles for social workers as well, who have the feeling of not stepping in on time.

Social services users are very varied. The needs of each individual are different, and not all of these needs are equally demanding [ 9 ]. Among the plethora of cases, some groups are more vulnerable than others [ 38 ]. In concordance with our research, other studies have also shown that minors and the elderly are considered to be among the most vulnerable populations [ 24 ]. In addition, health and social care workers point out that individuals with mental illnesses [ 22 ] and individuals who are in a chronic situation from which they cannot get out are groups at greater risk [ 55 , 56 ].

As shown in this research, the emotions generated in professionals who are in constant contact with situations of suffering with a high emotional impact, such as the aforementioned, originate deep frustration, anger, and dissatisfaction, as well as sadness, fear, and concern. This is in consonance with the literature consulted, which also reports the great effect that working daily with the intense suffering of users has on social workers, along with a potentially poor response [ 26 , 27 , 57 , 58 ]. In fact, some studies conceptualize emotion as both a potential resource and a risk for social workers’ professional judgment and practice [ 59 ].

The social workers in our study considered that the most complex interventions with vulnerable people inevitably make it difficult for them to switch off from work. This aspect is consistent with other studies in which social workers had difficulties when switching off from work after attending to groups with complicated needs [ 55 , 60 ]. With regard to the reported resources for self-care, mutual support is virtually the only helping tool available to these professionals. In previous studies, professionals referred to social support as a key element [ 13 , 27 , 43 ] but did not specifically mention mutual peer support. Social workers ask for training and support in the face of complex social interventions, as proposed by different research studies that underline the importance of taking care, preparing, training, and supporting social workers in this regard [ 61 , 62 ]. Therefore, more attention should be paid to working with the emotions of social workers who are exposed to tense and threatening situations [ 63 , 64 ]. In this way, for instance, reflexivity strategies in order to build and rebuild emotions in social workers could be useful [ 65 ]. Receiving training and support in formal spaces, as social workers described in this study, could be positive for their work and their professional and personal quality of life.

As for the limitations of this study, we considered the possibility that the researchers’ personal positions on the matter may have introduced bias into the results. To control for bias, reflexivity and a self-critical attitude were maintained throughout the process by all the researchers. To avoid influencing data collection, sample recruitment, and location, the researchers only knew the topic in a superficial manner (as health professionals) and it was not their usual work/subject matter of research. We relied on the ultimate motivation for our work, which is to acquire knowledge to improve, rather than to demonstrate. Nevertheless, we have set out to conduct a release exercise to clarify our own assumptions and put them into perspective when designing our research.

Regarding future lines of research, a study with the methods combined regarding the quality of professional life of social workers should be conducted in order to identify related factors and to assess the levels of compassion fatigue. In addition, research should be undertaken on the concept of compassion among social workers and its relationship to suffering. Finally, interventions should be carried out with social work professionals to develop compassion as a protective element against compassion fatigue.

5. Conclusions

Social workers experience high levels of emotional discomfort when carrying out their work, which is exacerbated when the populations they attend to are particularly vulnerable groups, such as children, the elderly, individuals with mental health problems, or people with scarce or a lack of economic resources. The traditional hegemonic intervention model that lies within the structure of social services in this context results in all social work efforts revolving around the allocation of available resources, which are generally scarce. All aspects of the individual have been eliminated from the repertoire of interventions according to the comprehensive support approach. In this new model of care, based mainly on providing support to individuals, the professionals themselves are the main tools and resources. In the future, this will further enhance the role of social workers when supporting people experiencing social exclusion, poverty, and marginalization. More attention should be paid to working with the emotions of social workers who are exposed to tense and threatening situations. Peer support, talking, and discussions of experiences are highlighted as relevant to deal with their work. Receiving training and support (in formal spaces) in order to learn how to deal with vulnerable groups could be positive for their work and their professional and personal quality of life.

Acknowledgments

The authors thank the Health Sciences Research Group CTS-451 and the Health Research Center (CEINSA) of the University of Almería (Spain) for its support.

Author Contributions

Conceptualization, M.D.R.-F., E.A.-D., Á.M.O.-G. and R.O.-A.; methodology, R.O.-A. and E.A.-D.; validation, C.F.-S., I.M.F.-M. and J.M.H.-P.; formal analysis, Á.M.O.-G.; investigation, R.O.-A.; data curation, M.D.R.-F. and R.O.-A.; writing—original draft preparation, Á.M.O.-G. and R.O.-A.; writing—review and editing, M.D.R.-F. and E.A.-D.; visualization and supervision, C.F.-S., I.M.F.-M. and J.M.H.-P.; and funding acquisition, M.D.R.-F. All authors have read and agreed to the published version of the manuscript.

This research was funded by the University of Almería (project TRFE-SI-2019/010).

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of University of Almería (protocol code EFM-11/19, 11/03/2019).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

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