what is the unit of analysis in qualitative research

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Unit of Analysis: Definition, Types & Examples

A unit of analysis is what you discuss after your research, probably what you would regard to be the primary emphasis of your research.

The unit of analysis is the people or things whose qualities will be measured. The unit of analysis is an essential part of a research project. It’s the main thing that a researcher looks at in his research.

A unit of analysis is the object about which you hope to have something to say at the end of your analysis, perhaps the major subject of your research.

In this blog post, we will explore and clarify the concept of the “unit of analysis,” including its definition, various types, and a concluding perspective on its significance.

What is a unit of analysis?

A unit of analysis is the thing you want to discuss after your research, probably what you would regard to be the primary emphasis of your research.

The researcher plans to comment on the primary topic or object in the research as a unit of analysis. The research question plays a significant role in determining it. The “who” or “what” that the researcher is interested in investigating is, to put it simply, the unit of analysis.

In his 2001 book Man, the State, and War, Waltz divides the world into three distinct spheres of study: the individual, the state, and war.

Understanding the reasoning behind the unit of analysis is vital. The likelihood of fruitful research increases if the rationale is understood. An individual, group, organization, nation, social phenomenon, etc., are a few examples.

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Types of “unit of analysis”

In business research, there are almost unlimited types of possible analytical units. Data analytics and data analysis are closely related processes that involve extracting insights from data to make informed decisions. Even though the most typical unit of analysis is the individual, many research questions can be more precisely answered by looking at other types of units. Let’s find out,

1. Individual Level

The most prevalent unit of analysis in business research is the individual. These are the primary analytical units. The researcher may be interested in looking into:

Employee actions
Perceptions
Attitudes or opinions.

Employees may come from wealthy or low-income families, as well as from rural or metropolitan areas.

A researcher might investigate if personnel from rural areas are more likely to arrive on time than those from urban areas. Additionally, he can check whether workers from rural areas who come from poorer families arrive on time compared to those from rural areas who come from wealthy families.

Each time, the individual (employee) serving as the analytical unit is discussed and explained. Employee analysis as a unit of analysis can shed light on issues in business, including customer and human resource behavior.

For example, employee work satisfaction and consumer purchasing patterns impact business, making research into these topics vital.

Psychologists typically concentrate on research on individuals. This research may significantly aid a firm’s success, as individuals’ knowledge and experiences reveal vital information. Thus, individuals are heavily utilized in business research.

2. Aggregates Level

Social science research does not usually focus on people. However, by combining individuals’ reactions, social scientists frequently describe and explain social interactions, communities, and groupings. Additionally, they research the collective of individuals, including communities, groups, and countries.

Aggregate levels can be divided into Groups (groups with an ad hoc structure) and Organizations (groups with a formal organization).

The following levels of the unit of analysis are made up of groups of people. A group is defined as two or more individuals who interact, share common traits, and feel connected to one another.

Many definitions also emphasize interdependence or objective resemblance (Turner, 1982; Platow, Grace, & Smithson, 2011) and those who identify as group members (Reicher, 1982) .

As a result, society and gangs serve as examples of groups. According to Webster’s Online Dictionary (2012), they can resemble some clubs but be far less formal.

Siblings, identical twins, family, and small group functioning are examples of studies with many units of analysis.

In such circumstances, a whole group might be compared to another. Families, gender-specific groups, pals, Facebook groups, and work departments can all be groups.

By analyzing groups, researchers can learn how they form and how age, experience, class, and gender affect them. When aggregated, an individual’s data describes the group they belong to.

Sociologists study groups like economists and businesspeople to form teams to complete projects. They continually research groups and group behavior.

Organizations

The next level of the unit of analysis is organizations, which are groups of people set up formally. Organizations could include businesses, religious groups, parts of the military, colleges, academic departments, supermarkets, business groups, and so on.

The social organization includes things like sexual composition, styles of leadership, organizational structure, systems of communication, and so on. (Susan & Wheelan, 2005; Chapais & Berman, 2004) . (Lim, Putnam, and Robert, 2010) say that well-known social organizations and religious institutions are among them.

Moody, White, and Douglas (2003) say social organizations are hierarchical. Hasmath, Hildebrandt, and Hsu (2016) say social organizations can take different forms. For example, they can be made by institutions like schools or governments.

Sociology, economics, political science, psychology, management, and organizational communication are some social science fields that study organizations (Douma & Schreuder, 2013) .

Organizations are different from groups in that they are more formal and have better organization. A researcher might want to study a company to generalize its results to the whole population of companies.

One way to look at an organization is by the number of employees, the net annual revenue, the net assets, the number of projects, and so on. He might want to know if big companies hire more or fewer women than small companies.

Organization researchers might be interested in how companies like Reliance, Amazon, and HCL affect our social and economic lives. People who work in business often study business organizations.

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3. Social Level

The social level has 2 types,

Social Artifacts Level

Things are studied alongside humans. Social artifacts are human-made objects from diverse communities. Social artifacts are items, representations, assemblages, institutions, knowledge, and conceptual frameworks used to convey, interpret, or achieve a goal (IGI Global, 2017).

Cultural artifacts are anything humans generate that reveals their culture (Watts, 1981).

Social artifacts include books, newspapers, advertising, websites, technical devices, films, photographs, paintings, clothes, poems, jokes, students’ late excuses, scientific breakthroughs, furniture, machines, structures, etc. Infinite.

Humans build social objects for social behavior. As people or groups suggest a population in business research, each social object implies a class of items.

Same-class goods include business books, magazines, articles, and case studies. A business magazine’s quantity of articles, frequency, price, content, and editor in a research study may be characterized.

Then, a linked magazine’s population might be evaluated for description and explanation. Marx W. Wartofsky (1979) defined artifacts as primary artifacts utilized in production (like a camera), secondary artifacts connected to primary artifacts (like a camera user manual), and tertiary objects related to representations of secondary artifacts (like a camera user-manual sculpture).

The scientific study of an artifact reveals its creators and users. The artifact researcher may be interested in advertising, marketing, distribution, buying, etc.

Social Interaction Level

Social artifacts include social interaction. Such as:

Eye contact with a coworker
Buying something in a store
Friendship decisions
Road accidents
Airline hijackings
Professional counseling
Whatsapp messaging

A researcher might study youthful employees’ smartphone addictions. Some addictions may involve social media, while others involve online games and movies that inhibit connection.

Smartphone addictions are examined as a societal phenomenon. Observation units are probably individuals (employees).

Anthropologists typically study social artifacts. They may be interested in the social order. A researcher who examines social interactions may be interested in how broader societal structures and factors impact daily behavior, festivals, and weddings.

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Even though there is no perfect way to do research, it is generally agreed that researchers should try to find a unit of analysis that keeps the context needed to make sense of the data.

Researchers should consider the details of their research when deciding on the unit of analysis.

They should remember that consistent use of these units throughout the analysis process (from coding to developing categories and themes to interpreting the data) is essential to gaining insight from qualitative data and protecting the reliability of the results.

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The Unit of Analysis Explained

By DiscoverPhDs
October 3, 2020

The unit of analysis refers to the main parameter that you’re investigating in your research project or study. Example of the different types of unit analysis that may be used in a project include:

Individual people
Groups of people
Objects such as photographs, newspapers and books
Geographical unit based on parameters such as cities or counties
Social parameters such as births, deaths, divorces

The unit of analysis is named as such because the unit type is determined based on the actual data analysis that you perform in your project or study.

For example, if your research is based around data on exam grades for students at two different universities, then the unit of analysis is the data for the individual student due to each student having an exam score associated with them.

Conversely if your study is based on comparing noise level data between two different lecture halls full of students, then your unit of analysis here is the collective group of students in each hall rather than any data associated with an individual student.

In the same research study involving the same students, you may perform different types of analysis and this will be reflected by having different units of analysis. In the example of student exam scores, if you’re comparing individual exam grades then the unit of analysis is the individual student.

On the other hand, if you’re comparing the average exam grade between two universities, then the unit of analysis is now the group of students as you’re comparing the average of the group rather than individual exam grades.

These different levels of hierarchies of units of analysis can become complex with multiple levels. In fact, its complexity has led to a new field of statistical analysis that’s commonly known as hierarchical modelling.

As a researcher, you need to be clear on what your specific research questio n is. Based on this, you can define each data, observation or other variable and how they make up your dataset.

A clarity of your research question will help you identify your analysis units and the appropriate sample size needed to obtain a meaningful result (and is this a random sample/sampling unit or something else).

In developing your research method, you need to consider whether you’ll need any repeated observation of each measurement. You also need to consider whether you’re working with qualitative data/qualitative research or if this is quantitative content analysis.

The unit of analysis of your study is the specifically ‘who’ or what’ it is that your analysing – for example are you analysing the individual student, the group of students or even the whole university. You may have to consider a different unit of analysis based on the concept you’re considering, even if working with the same observation data set.

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Chapter 4: Measurement and Units of Analysis

4.4 Units of Analysis and Units of Observation

Unit of Analysis

A unit of analysis is the entity that you wish to be able to say something about at the end of your study, probably what you would consider to be the main focus of your study.

Unit of Observation

A unit of observation is the item (or items) that you actually observe, measure, or collect in the course of trying to learn something about your unit of analysis. In a given study, the unit of observation might be the same as the unit of analysis, but that is not always the case. Further, units of analysis are not required to be the same as units of observation. What is required, however, is for researchers to be clear about how they define their units of analysis and observation, both to themselves and to their audiences. More specifically, your unit of analysis will be determined by your research question. Your unit of observation, on the other hand, is determined largely by the method of data collection that you use to answer that research question.

To demonstrate these differences, let us look at the topic of students’ addictions to their cell phones. We will consider first how different kinds of research questions about this topic will yield different units of analysis. Then we will think about how those questions might be answered and with what kinds of data. This leads us to a variety of units of observation.

If I were to ask, “Which students are most likely to be addicted to their cell phones?” our unit of analysis would be the individual. We might mail a survey to students on a university or college campus, with the aim to classify individuals according to their membership in certain social classes and, in turn, to see how membership in those classes correlates with addiction to cell phones. For example, we might find that students studying media, males, and students with high socioeconomic status are all more likely than other students to become addicted to their cell phones. Alternatively, we could ask, “How do students’ cell phone addictions differ and how are they similar? In this case, we could conduct observations of addicted students and record when, where, why, and how they use their cell phones. In both cases, one using a survey and the other using observations, data are collected from individual students. Thus, the unit of observation in both examples is the individual. But the units of analysis differ in the two studies. In the first one, our aim is to describe the characteristics of individuals. We may then make generalizations about the populations to which these individuals belong, but our unit of analysis is still the individual. In the second study, we will observe individuals in order to describe some social phenomenon, in this case, types of cell phone addictions. Consequently, our unit of analysis would be the social phenomenon.

Another common unit of analysis in sociological inquiry is groups. Groups, of course, vary in size, and almost no group is too small or too large to be of interest to sociologists. Families, friendship groups, and street gangs make up some of the more common micro-level groups examined by sociologists. Employees in an organization, professionals in a particular domain (e.g., chefs, lawyers, sociologists), and members of clubs (e.g., Girl Guides, Rotary, Red Hat Society) are all meso-level groups that sociologists might study. Finally, at the macro level, sociologists sometimes examine citizens of entire nations or residents of different continents or other regions.

A study of student addictions to their cell phones at the group level might consider whether certain types of social clubs have more or fewer cell phone-addicted members than other sorts of clubs. Perhaps we would find that clubs that emphasize physical fitness, such as the rugby club and the scuba club, have fewer cell phone-addicted members than clubs that emphasize cerebral activity, such as the chess club and the sociology club. Our unit of analysis in this example is groups. If we had instead asked whether people who join cerebral clubs are more likely to be cell phone-addicted than those who join social clubs, then our unit of analysis would have been individuals. In either case, however, our unit of observation would be individuals.

Organizations are yet another potential unit of analysis that social scientists might wish to say something about. Organizations include entities like corporations, colleges and universities, and even night clubs. At the organization level, a study of students’ cell phone addictions might ask, “How do different colleges address the problem of cell phone addiction?” In this case, our interest lies not in the experience of individual students but instead in the campus-to-campus differences in confronting cell phone addictions. A researcher conducting a study of this type might examine schools’ written policies and procedures, so his unit of observation would be documents. However, because he ultimately wishes to describe differences across campuses, the college would be his unit of analysis.

Social phenomena are also a potential unit of analysis. Many sociologists study a variety of social interactions and social problems that fall under this category. Examples include social problems like murder or rape; interactions such as counselling sessions, Facebook chatting, or wrestling; and other social phenomena such as voting and even cell phone use or misuse. A researcher interested in students’ cell phone addictions could ask, “What are the various types of cell phone addictions that exist among students?” Perhaps the researcher will discover that some addictions are primarily centred on social media such as chat rooms, Facebook, or texting, while other addictions centre on single-player games that discourage interaction with others. The resultant typology of cell phone addictions would tell us something about the social phenomenon (unit of analysis) being studied. As in several of the preceding examples, however, the unit of observation would likely be individual people.

Finally, a number of social scientists examine policies and principles, the last type of unit of analysis we will consider here. Studies that analyze policies and principles typically rely on documents as the unit of observation. Perhaps a researcher has been hired by a college to help it write an effective policy against cell phone use in the classroom. In this case, the researcher might gather all previously written policies from campuses all over the country, and compare policies at campuses where the use of cell phones in classroom is low to policies at campuses where the use of cell phones in the classroom is high.

In sum, there are many potential units of analysis that a sociologist might examine, but some of the most common units include the following:

Individuals
Organizations
Social phenomena.
Policies and principles.

Table 4.1 Units of analysis and units of observation: A hypothetical study of students’ addictions to cell phones.

Research Methods for the Social Sciences: An Introduction Copyright © 2020 by Valerie Sheppard is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Article contents

Qualitative data analysis.

Paul Mihas Paul Mihas University of North Carolina at Chapel Hill
https://doi.org/10.1093/acrefore/9780190264093.013.1195
Published online: 23 May 2019

Qualitative analysis—the analysis of textual, visual, or audio data—covers a spectrum from confirmation to exploration. Qualitative studies can be directed by a conceptual framework, suggesting, in part, a deductive thrust, or driven more by the data itself, suggesting an inductive process. Generic or basic qualitative research refers to an approach in which researchers are simply interested in solving a problem, effecting a change, or identifying relevant themes rather than attempting to position their work in a particular epistemological or ontological paradigm.

Other qualitative traditions include grounded theory, narrative analysis, and phenomenology. Grounded theory encompasses several approaches, including objectivist and constructivist traditions, and commonly invites researchers to theorize a process and perhaps identify its contexts and consequences. Narrative analysis is an approach that treats stories not only as representations of events but as narrative events in themselves. Researchers using this approach analyze the form and content of narrative data and examine how these elements serve the storyteller and the story. Other elements often considered include plot, genre, character, values, resolutions, and motifs. Phenomenology is an approach designed to “open up” a phenomenon and make sense of its invariant structure, its identifiable essence across all narrative accounts. In this approach, the focus is on the lived experiences of those deeply familiar with the phenomenon and how they experience the phenomenon as they are going through it, before it is categorized and conceptualized. Each tradition has its own investigative emphasis and particular tools for analysis—specific approaches to coding, memo writing, and final products, such as diagrams, matrices, and condensed reports.

qualitative analysis
basic qualitative research
generic qualitative research
grounded theory
phenomenology
narrative analysis
memo writing
qualitative approaches
qualitative design research methods

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13 Qualitative analysis

Qualitative analysis is the analysis of qualitative data such as text data from interview transcripts. Unlike quantitative analysis, which is statistics driven and largely independent of the researcher, qualitative analysis is heavily dependent on the researcher’s analytic and integrative skills and personal knowledge of the social context where the data is collected. The emphasis in qualitative analysis is ‘sense making’ or understanding a phenomenon, rather than predicting or explaining. A creative and investigative mindset is needed for qualitative analysis, based on an ethically enlightened and participant-in-context attitude, and a set of analytic strategies. This chapter provides a brief overview of some of these qualitative analysis strategies. Interested readers are referred to more authoritative and detailed references such as Miles and Huberman’s (1984) [1] seminal book on this topic.

Grounded theory

How can you analyse a vast set of qualitative data acquired through participant observation, in-depth interviews, focus groups, narratives of audio/video recordings, or secondary documents? One of these techniques for analysing text data is grounded theory —an inductive technique of interpreting recorded data about a social phenomenon to build theories about that phenomenon. The technique was developed by Glaser and Strauss (1967) [2] in their method of constant comparative analysis of grounded theory research, and further refined by Strauss and Corbin (1990) [3] to further illustrate specific coding techniques—a process of classifying and categorising text data segments into a set of codes (concepts), categories (constructs), and relationships. The interpretations are ‘grounded in’ (or based on) observed empirical data, hence the name. To ensure that the theory is based solely on observed evidence, the grounded theory approach requires that researchers suspend any pre-existing theoretical expectations or biases before data analysis, and let the data dictate the formulation of the theory.

Strauss and Corbin (1998) describe three coding techniques for analysing text data: open, axial, and selective. Open coding is a process aimed at identifying concepts or key ideas that are hidden within textual data, which are potentially related to the phenomenon of interest. The researcher examines the raw textual data line by line to identify discrete events, incidents, ideas, actions, perceptions, and interactions of relevance that are coded as concepts (hence called in vivo codes ). Each concept is linked to specific portions of the text (coding unit) for later validation. Some concepts may be simple, clear, and unambiguous, while others may be complex, ambiguous, and viewed differently by different participants. The coding unit may vary with the concepts being extracted. Simple concepts such as ‘organisational size’ may include just a few words of text, while complex ones such as ‘organizational mission’ may span several pages. Concepts can be named using the researcher’s own naming convention, or standardised labels taken from the research literature. Once a basic set of concepts are identified, these concepts can then be used to code the remainder of the data, while simultaneously looking for new concepts and refining old concepts. While coding, it is important to identify the recognisable characteristics of each concept, such as its size, colour, or level—e.g., high or low—so that similar concepts can be grouped together later . This coding technique is called ‘open’ because the researcher is open to and actively seeking new concepts relevant to the phenomenon of interest.

Next, similar concepts are grouped into higher order categories . While concepts may be context-specific, categories tend to be broad and generalisable, and ultimately evolve into constructs in a grounded theory. Categories are needed to reduce the amount of concepts the researcher must work with and to build a ‘big picture’ of the issues salient to understanding a social phenomenon. Categorisation can be done in phases, by combining concepts into subcategories, and then subcategories into higher order categories. Constructs from the existing literature can be used to name these categories, particularly if the goal of the research is to extend current theories. However, caution must be taken while using existing constructs, as such constructs may bring with them commonly held beliefs and biases. For each category, its characteristics (or properties) and the dimensions of each characteristic should be identified. The dimension represents a value of a characteristic along a continuum. For example, a ‘communication media’ category may have a characteristic called ‘speed’, which can be dimensionalised as fast, medium, or slow . Such categorisation helps differentiate between different kinds of communication media, and enables researchers to identify patterns in the data, such as which communication media is used for which types of tasks.

The second phase of grounded theory is axial coding , where the categories and subcategories are assembled into causal relationships or hypotheses that can tentatively explain the phenomenon of interest. Although distinct from open coding, axial coding can be performed simultaneously with open coding. The relationships between categories may be clearly evident in the data, or may be more subtle and implicit. In the latter instance, researchers may use a coding scheme (often called a ‘coding paradigm’, but different from the paradigms discussed in Chapter 3) to understand which categories represent conditions (the circumstances in which the phenomenon is embedded), actions/interactions (the responses of individuals to events under these conditions), and consequences (the outcomes of actions/interactions). As conditions, actions/interactions, and consequences are identified, theoretical propositions start to emerge, and researchers can start explaining why a phenomenon occurs, under what conditions, and with what consequences.

The third and final phase of grounded theory is selective coding , which involves identifying a central category or a core variable, and systematically and logically relating this central category to other categories. The central category can evolve from existing categories or can be a higher order category that subsumes previously coded categories. New data is selectively sampled to validate the central category, and its relationships to other categories—i.e., the tentative theory. Selective coding limits the range of analysis, and makes it move fast. At the same time, the coder must watch out for other categories that may emerge from the new data that could be related to the phenomenon of interest (open coding), which may lead to further refinement of the initial theory. Hence, open, axial, and selective coding may proceed simultaneously. Coding of new data and theory refinement continues until theoretical saturation is reached—i.e., when additional data does not yield any marginal change in the core categories or the relationships.

The ‘constant comparison’ process implies continuous rearrangement, aggregation, and refinement of categories, relationships, and interpretations based on increasing depth of understanding, and an iterative interplay of four stages of activities: comparing incidents/texts assigned to each category to validate the category), integrating categories and their properties, delimiting the theory by focusing on the core concepts and ignoring less relevant concepts, and writing theory using techniques like memoing, storylining, and diagramming. Having a central category does not necessarily mean that all other categories can be integrated nicely around it. In order to identify key categories that are conditions, action/interactions, and consequences of the core category, Strauss and Corbin (1990) recommend several integration techniques, such as storylining, memoing, or concept mapping, which are discussed here. In storylining , categories and relationships are used to explicate and/or refine a story of the observed phenomenon. Memos are theorised write-ups of ideas about substantive concepts and their theoretically coded relationships as they evolve during ground theory analysis, and are important tools to keep track of and refine ideas that develop during the analysis. Memoing is the process of using these memos to discover patterns and relationships between categories using two-by-two tables, diagrams, or figures, or other illustrative displays. Concept mapping is a graphical representation of concepts and relationships between those concepts—e.g., using boxes and arrows. The major concepts are typically laid out on one or more sheets of paper, blackboards, or using graphical software programs, linked to each other using arrows, and readjusted to best fit the observed data.

After a grounded theory is generated, it must be refined for internal consistency and logic. Researchers must ensure that the central construct has the stated characteristics and dimensions, and if not, the data analysis may be repeated. Researcher must then ensure that the characteristics and dimensions of all categories show variation. For example, if behaviour frequency is one such category, then the data must provide evidence of both frequent performers and infrequent performers of the focal behaviour. Finally, the theory must be validated by comparing it with raw data. If the theory contradicts with observed evidence, the coding process may need to be repeated to reconcile such contradictions or unexplained variations.

Content analysis

Content analysis is the systematic analysis of the content of a text—e.g., who says what, to whom, why, and to what extent and with what effect—in a quantitative or qualitative manner. Content analysis is typically conducted as follows. First, when there are many texts to analyse—e.g., newspaper stories, financial reports, blog postings, online reviews, etc.—the researcher begins by sampling a selected set of texts from the population of texts for analysis. This process is not random, but instead, texts that have more pertinent content should be chosen selectively. Second, the researcher identifies and applies rules to divide each text into segments or ‘chunks’ that can be treated as separate units of analysis. This process is called unitising . For example, assumptions, effects, enablers, and barriers in texts may constitute such units. Third, the researcher constructs and applies one or more concepts to each unitised text segment in a process called coding . For coding purposes, a coding scheme is used based on the themes the researcher is searching for or uncovers as they classify the text. Finally, the coded data is analysed, often both quantitatively and qualitatively, to determine which themes occur most frequently, in what contexts, and how they are related to each other.

A simple type of content analysis is sentiment analysis —a technique used to capture people’s opinion or attitude toward an object, person, or phenomenon. Reading online messages about a political candidate posted on an online forum and classifying each message as positive, negative, or neutral is an example of such an analysis. In this case, each message represents one unit of analysis. This analysis will help identify whether the sample as a whole is positively or negatively disposed, or neutral towards that candidate. Examining the content of online reviews in a similar manner is another example. Though this analysis can be done manually, for very large datasets—e.g., millions of text records—natural language processing and text analytics based software programs are available to automate the coding process, and maintain a record of how people’s sentiments fluctuate with time.

A frequent criticism of content analysis is that it lacks a set of systematic procedures that would allow the analysis to be replicated by other researchers. Schilling (2006) [4] addressed this criticism by organising different content analytic procedures into a spiral model. This model consists of five levels or phases in interpreting text: convert recorded tapes into raw text data or transcripts for content analysis, convert raw data into condensed protocols, convert condensed protocols into a preliminary category system, use the preliminary category system to generate coded protocols, and analyse coded protocols to generate interpretations about the phenomenon of interest.

Content analysis has several limitations. First, the coding process is restricted to the information available in text form. For instance, if a researcher is interested in studying people’s views on capital punishment, but no such archive of text documents is available, then the analysis cannot be done. Second, sampling must be done carefully to avoid sampling bias. For instance, if your population is the published research literature on a given topic, then you have systematically omitted unpublished research or the most recent work that is yet to be published.

Hermeneutic analysis

Hermeneutic analysis is a special type of content analysis where the researcher tries to ‘interpret’ the subjective meaning of a given text within its sociohistoric context. Unlike grounded theory or content analysis—which ignores the context and meaning of text documents during the coding process—hermeneutic analysis is a truly interpretive technique for analysing qualitative data. This method assumes that written texts narrate an author’s experience within a sociohistoric context, and should be interpreted as such within that context. Therefore, the researcher continually iterates between singular interpretation of the text (the part) and a holistic understanding of the context (the whole) to develop a fuller understanding of the phenomenon in its situated context, which German philosopher Martin Heidegger called the hermeneutic circle . The word hermeneutic (singular) refers to one particular method or strand of interpretation.

More generally, hermeneutics is the study of interpretation and the theory and practice of interpretation. Derived from religious studies and linguistics, traditional hermeneutics—such as biblical hermeneutics —refers to the interpretation of written texts, especially in the areas of literature, religion and law—such as the Bible. In the twentieth century, Heidegger suggested that a more direct, non-mediated, and authentic way of understanding social reality is to experience it, rather than simply observe it, and proposed philosophical hermeneutics , where the focus shifted from interpretation to existential understanding. Heidegger argued that texts are the means by which readers can not only read about an author’s experience, but also relive the author’s experiences. Contemporary or modern hermeneutics, developed by Heidegger’s students such as Hans-Georg Gadamer, further examined the limits of written texts for communicating social experiences, and went on to propose a framework of the interpretive process, encompassing all forms of communication, including written, verbal, and non-verbal, and exploring issues that restrict the communicative ability of written texts, such as presuppositions, language structures (e.g., grammar, syntax, etc.), and semiotics—the study of written signs such as symbolism, metaphor, analogy, and sarcasm. The term hermeneutics is sometimes used interchangeably and inaccurately with exegesis , which refers to the interpretation or critical explanation of written text only, and especially religious texts.

Finally, standard software programs, such as ATLAS.ti.5, NVivo, and QDA Miner, can be used to automate coding processes in qualitative research methods. These programs can quickly and efficiently organise, search, sort, and process large volumes of text data using user-defined rules. To guide such automated analysis, a coding schema should be created, specifying the keywords or codes to search for in the text, based on an initial manual examination of sample text data. The schema can be arranged in a hierarchical manner to organise codes into higher-order codes or constructs. The coding schema should be validated using a different sample of texts for accuracy and adequacy. However, if the coding schema is biased or incorrect, the resulting analysis of the entire population of texts may be flawed and non-interpretable. However, software programs cannot decipher the meaning behind certain words or phrases or the context within which these words or phrases are used—such sarcasm or metaphors—which may lead to significant misinterpretation in large scale qualitative analysis.

Miles, M. B., & Huberman, A. M. (1984). Qualitative data analysis: A sourcebook of new methods . Newbury Park, CA: Sage Publications. ↵
Glaser, B., & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research . New York: Aldine Pub Co. ↵
Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques , Beverly Hills: Sage Publications. ↵
Schiling, J. (2006). On the pragmatics of qualitative assessment: Designing the process for content analysis. European Journal of Psychological Assessment , 22(1), 28–37. ↵

Social Science Research: Principles, Methods and Practices (Revised edition) Copyright © 2019 by Anol Bhattacherjee is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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7.3: Unit of analysis and unit of observation

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Matthew DeCarlo
Radford University via Open Social Work Education

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Learning Objectives

Define units of analysis and units of observation, and describe the two common errors people make when they confuse the two

Another point to consider when designing a research project, and which might differ slightly in qualitative and quantitative studies, has to do with units of analysis and units of observation. These two items concern what you, the researcher, actually observe in the course of your data collection and what you hope to be able to say about those observations. A unit of analysis is the entity that you wish to be able to say something about at the end of your study, probably what you’d consider to be the main focus of your study. A unit of observation is the item (or items) that you actually observe, measure, or collect in the course of trying to learn something about your unit of analysis.

In a given study, the unit of observation might be the same as the unit of analysis, but that is not always the case. For example, a study on electronic gadget addiction may interview undergraduate students (our unit of observation) for the purpose of saying something about undergraduate students (our unit of analysis) and their gadget addiction. Perhaps, if we were investigating gadget addiction in elementary school children (our unit of analysis), we might collect observations from teachers and parents (our units of observation) because younger children may not report their behavior accurately. In this case and many others, units of analysis are not the same as units of observation. What is required, however, is for researchers to be clear about how they define their units of analysis and observation, both to themselves and to their audiences.

More specifically, your unit of analysis will be determined by your research question. Your unit of observation, on the other hand, is determined largely by the method of data collection that you use to answer that research question. We’ll take a closer look at methods of data collection later on in the textbook. For now, let’s consider again a study addressing students’ addictions to electronic gadgets. We’ll consider first how different kinds of research questions about this topic will yield different units of analysis. Then, we’ll think about how those questions might be answered and with what kinds of data. This leads us to a variety of units of observation.

If we were to explore which students are most likely to be addicted to their electronic gadgets, our unit of analysis would be individual students. We might mail a survey to students on campus, and our aim would be to classify individuals according to their membership in certain social groups in order to see how membership in those classes correlated with gadget addiction. For example, we might find that majors in new media, men, and students with high socioeconomic status are all more likely than other students to become addicted to their electronic gadgets. Another possibility would be to explore how students’ gadget addictions differ and how are they similar. In this case, we could conduct observations of addicted students and record when, where, why, and how they use their gadgets. In both cases, one using a survey and the other using observations, data are collected from individual students. Thus, the unit of observation in both examples is the individual.

Another common unit of analysis in social science inquiry is groups. Groups of course vary in size, and almost no group is too small or too large to be of interest to social scientists. Families, friendship groups, and group therapy participants are some common examples of micro-level groups examined by social scientists. Employees in an organization, professionals in a particular domain (e.g., chefs, lawyers, social workers), and members of clubs (e.g., Girl Scouts, Rotary, Red Hat Society) are all meso-level groups that social scientists might study. Finally, at the macro-level, social scientists sometimes examine citizens of entire nations or residents of different continents or other regions.

A study of student addictions to their electronic gadgets at the group level might consider whether certain types of social clubs have more or fewer gadget-addicted members than other sorts of clubs. Perhaps we would find that clubs that emphasize physical fitness, such as the rugby club and the scuba club, have fewer gadget-addicted members than clubs that emphasize cerebral activity, such as the chess club and the women’s studies club. Our unit of analysis in this example is groups because groups are what we hope to say something about. If we had instead asked whether individuals who join cerebral clubs are more likely to be gadget-addicted than those who join social clubs, then our unit of analysis would have been individuals. In either case, however, our unit of observation would be individuals.

Organizations are yet another potential unit of analysis that social scientists might wish to say something about. Organizations include entities like corporations, colleges and universities, and even nightclubs. At the organization level, a study of students’ electronic gadget addictions might explore how different colleges address the problem of electronic gadget addiction. In this case, our interest lies not in the experience of individual students but instead in the campus-to-campus differences in confronting gadget addictions. A researcher conducting a study of this type might examine schools’ written policies and procedures, so her unit of observation would be documents. However, because she ultimately wishes to describe differences across campuses, the college would be her unit of analysis.

In sum, there are many potential units of analysis that a social worker might examine, but some of the most common units include the following:

Individuals
Organizations

One common error people make when it comes to both causality and units of analysis is something called the ecological fallacy . This occurs when claims about one lower-level unit of analysis are made based on data from some higher-level unit of analysis. In many cases, this occurs when claims are made about individuals, but only group-level data have been gathered. For example, we might want to understand whether electronic gadget addictions are more common on certain campuses than on others. Perhaps different campuses around the country have provided us with their campus percentage of gadget-addicted students, and we learn from these data that electronic gadget addictions are more common on campuses that have business programs than on campuses without them. We then conclude that business students are more likely than non-business students to become addicted to their electronic gadgets. However, this would be an inappropriate conclusion to draw. Because we only have addiction rates by campus, we can only draw conclusions about campuses, not about the individual students on those campuses. Perhaps the social work majors on the business campuses are the ones that caused the addiction rates on those campuses to be so high. The point is we simply don’t know because we only have campus-level data. By drawing conclusions about students when our data are about campuses, we run the risk of committing the ecological fallacy.

On the other hand, another mistake to be aware of is reductionism. Reductionism occurs when claims about some higher-level unit of analysis are made based on data from some lower-level unit of analysis. In this case, claims about groups or macro-level phenomena are made based on individual-level data. An example of reductionism can be seen in some descriptions of the civil rights movement. On occasion, people have proclaimed that Rosa Parks started the civil rights movement in the United States by refusing to give up her seat to a white person while on a city bus in Montgomery, Alabama, in December 1955. Although it is true that Parks played an invaluable role in the movement, and that her act of civil disobedience gave others courage to stand up against racist policies, beliefs, and actions, to credit Parks with starting the movement is reductionist. Surely the confluence of many factors, from fights over legalized racial segregation to the Supreme Court’s historic decision to desegregate schools in 1954 to the creation of groups such as the Student Nonviolent Coordinating Committee (to name just a few), contributed to the rise and success of the American civil rights movement. In other words, the movement is attributable to many factors—some social, others political and others economic. Did Parks play a role? Of course she did—and a very important one at that. But did she cause the movement? To say yes would be reductionist.

It would be a mistake to conclude from the preceding discussion that researchers should avoid making any claims whatsoever about data or about relationships between levels of analysis. While it is important to be attentive to the possibility for error in causal reasoning about different levels of analysis, this warning should not prevent you from drawing well-reasoned analytic conclusions from your data. The point is to be cautious and conscientious in making conclusions between levels of analysis. Errors in analysis come from a lack of rigor and deviating from the scientific method.

Key Takeaways

A unit of analysis is the item you wish to be able to say something about at the end of your study while a unit of observation is the item that you actually observe.
When researchers confuse their units of analysis and observation, they may be prone to committing either the ecological fallacy or reductionism.
Ecological fallacy- claims about one lower-level unit of analysis are made based on data from some higher-level unit of analysis
Reductionism- when claims about some higher-level unit of analysis are made based on data at some lower-level unit of analysis
Unit of analysis- entity that a researcher wants to say something about at the end of her study
Unit of observation- the item that a researcher actually observes, measures, or collects in the course of trying to learn something about her unit of analysis

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7.3 Unit of analysis and unit of observation

Learning objectives.

Define units of analysis and units of observation, and describe the two common errors people make when they confuse the two

young boy peering through binoculars in a desert

Organizations are yet another potential unit of analysis that social scientists might wish to say something about. Organizations include entities like corporations, colleges and universities, and even nightclubs. At the organization level, a study of students’ electronic gadget addictions might explore how different colleges address the problem of electronic gadget addiction. In this case, our interest lies not in the experience of individual students but instead in the campus-to-campus differences in confronting gadget addictions. A researcher conducting a study of this type might examine schools’ written policies and procedures, so her unit of observation would be documents. However, because she ultimately wishes to describe differences across campuses, the college would be her unit of analysis.

In sum, there are many potential units of analysis that a social worker might examine, but some of the most common units include the following:

Individuals
Organizations

Key Takeaways

A unit of analysis is the item you wish to be able to say something about at the end of your study while a unit of observation is the item that you actually observe.
When researchers confuse their units of analysis and observation, they may be prone to committing either the ecological fallacy or reductionism.
Ecological fallacy- claims about one lower-level unit of analysis are made based on data from some higher-level unit of analysis
Reductionism- when claims about some higher-level unit of analysis are made based on data at some lower-level unit of analysis
Unit of analysis- entity that a researcher wants to say something about at the end of her study
Unit of observation- the item that a researcher actually observes, measures, or collects in the course of trying to learn something about her unit of analysis

Image attributions

Binoculars by nightowl CC-0

Scientific Inquiry in Social Work Copyright © 2018 by Matthew DeCarlo is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Unit of Analysis: Definition, Types & Examples

Introduction

A unit of analysis is the smallest level of analysis for a research project. It’s important to choose the right unit of analysis because it helps you make more accurate conclusions about your data.

What Is a Unit of Analysis?

A unit of analysis is the smallest element in a data set that can be used to identify and describe a phenomenon or the smallest unit that can be used to gather data about a subject. The unit of analysis will determine how you will define your variables, which are the things that you measure in your data.

If you want to understand why people buy a particular product, you should choose a unit of analysis that focuses on buying behavior. This means choosing a unit of analysis that is relevant to your research topic and question .

For example, if you want to study the needs of soldiers in a war zone, you will need to choose an appropriate unit of analysis for this study: soldiers or the war zone. In this case, choosing the right unit of analysis would be important because it could help you decide if your research design is appropriate for this particular subject and situation.

Why is Choosing the Right Unit of Analysis Important?

The unit of analysis is important because it helps you understand what you are trying to find out about your subject, and it also helps you to make decisions about how to proceed with your research.

Choosing the right unit of analysis is also important because it determines what information you’re going to use in your research. If you have a small sample, then you’ll have to choose whether or not to focus on the entire population or just a subset of it.

If you have a large sample, then you’ll be able to find out more about specific groups within your population. For example, if you want to understand why people buy certain types of products, then you should choose a unit of analysis that focuses on buying behavior.

This means choosing a unit of analysis that is relevant to your research topic and question.

Unit of Analysis vs Unit of Observation

Unit of analysis is a term used to refer to a particular part of a data set that can be analyzed. For example, in the case of a survey, the unit of analysis is an individual: the person who was selected to take part in the survey.

Unit of analysis is used in the social sciences to refer to the individuals or groups that have been studied. It can also be referred to as the unit of observation.

Unit of observation refers to a specific person or group in the study being observed by the researcher. An example would be a particular town, census tract, state, or other geographical location being studied by researchers conducting research on crime rates in that area.

Unit of analysis refers to the individual or group being studied by the researcher. An example would be an entire town being analyzed for crime rates over time.

Types of “Unit of Analysis”

The unit of analysis is a way to understand and study a phenomenon. There are four main types of unit of analysis: individuals, groups, artifacts (books, photos, newspapers), and geographical units (towns, census tracts, states).

Individuals are the smallest level of analysis. For example, an individual may be a person or an animal. A group can be composed of individuals or a collection of people who interact with each other. For example, an individual might go to college with other individuals or a family might live together as roommates.
An artifact is anything that can be studied using empirical methods—including books and photos but also any physical object like knives or phones.
A geographical unit is smaller than an entire country but larger than just one city block or neighborhood; it may be smaller than just two houses but larger than just two houses in the same street.
Social interactions include dyadic relations (such as friendships or romantic relationships) and divorces among many other things such as arrests.

Examples of Each Type of Unit of Analysis

Individuals are the smallest unit of analysis. An individual is a person, animal, or thing. For example, an individual can be a person or a building.
Artifacts are the next largest units of analysis. An artifact is something produced by human beings and is not alive. For example, a child’s toy is an artifact. Artifacts can include any material object that was produced by human activity and which has meaning to someone. Artifacts can be tangible or intangible and may be produced intentionally or accidentally.
Geographical units are large geographic areas such as states, counties, provinces, etc. Geographical units may also refer to specific locations within these areas such as cities or townships.
Social interaction refers to interactions between members of society (e.g., family members interacting with each other). Social interaction includes both formal interactions (such as attending school) and informal interactions (such as talking on the phone).

How Does a Social Scientist Choose a Unit of Analysis?

Social scientists choose a unit of analysis based on the purpose of their research, their research question, and the type of data they have. For example, if they are trying to understand the relationship between a person’s personality and their behavior, they would choose to study personality traits.

For example, if a researcher wanted to study the effects of legalizing marijuana on crime rates, they may choose to use administrative data from police departments. However, if they wanted to study how culture influences crime rates, they might use survey data from smaller groups of people who are further removed from the influence of culture (e.g., individuals living in different areas or countries).

Factors to Consider When Choosing a Unit of Analysis

The unit of analysis is the object or person that you are studying, and it determines what kind of data you are collecting and how you will analyze it.

Factors to consider when choosing a unit of analysis include:

What is your purpose for studying this topic? Is it for a research paper or an article? If so, which type of paper do you want to write?
What is the most appropriate unit for your study? If you are studying a specific event or period of time, this may be obvious. But if your focus is broader, such as all social sciences or all human development, then you need to determine how broad your scope should be before beginning any research process (see question one above) so that you know where to start in order for it to be effective (see question three below).
How do other people define their units? This can be helpful when trying to understand what other people mean when they use certain terms like “social science” or “human development” because they may define those terms differently than what you would expect them to.
The nature of the data collected. Is it quantitative or qualitative? If it’s qualitative, what kind of data is collected? How much time was spent observing each participant/examining their behavior?
The scale used to measure variables. Is every variable measured on a one-to-one scale (like measurements between people)? Or do some variables only take on discrete values (like yes/no questions)?

The unit of analysis is the smallest part of a data set that you analyze. It’s important to remember that your data is made up of more than just one unit—you have lots of different units in your dataset, and each of those units has its own characteristics that you need to think about when you’re trying to analyze it.

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4.3 Unit of analysis and unit of observation

Learning objectives.

Define units of analysis and units of observation, and describe the two common errors people make when they confuse the two

Another common unit of analysis in social science inquiry is groups. Groups of course vary in size, and almost no group is too small or too large to be of interest to social scientists. Families, friendship groups, and group therapy participants are some common examples of micro-level groups examined by social scientists. Employees in an organization, professionals in a particular domain (e.g., chefs, lawyers, social workers), and members of clubs (e.g., Girl Scouts, Rotary, Red Hat Society) are all meso-level groups that social scientists might study. Finally, at the macro-level, social scientists sometimes examine policies, citizens of entire nations, or residents of different continents or other regions.

Organizations are yet another potential unit of analysis that social scientists might wish to say something about. Organizations include entities like corporations, colleges and universities, and even nightclubs. At the organization level, a study of students’ electronic gadget addictions might explore how different colleges address the problem of electronic gadget addiction. In this case, our interest lies not in the experience of individual students but instead in the campus-to-campus differences in confronting gadget addictions. A researcher conducting a study of this type might examine schools’ written policies and procedures, so her unit of observation would be documents. However, because she ultimately wishes to describe differences across campuses, the college would be her unit of analysis.

In sum, there are many potential units of analysis that a social worker might examine, but some of the most common units include the following: i ndividuals, g roups, and o rganizations.

Key Takeaways

A unit of analysis is the item you wish to be able to say something about at the end of your study while a unit of observation is the item that you actually observe.
When researchers confuse their units of analysis and observation, they may be prone to committing either the ecological fallacy or reductionism.
Ecological fallacy- claims about one lower-level unit of analysis are made based on data from some higher-level unit of analysis
Reductionism- when claims about some higher-level unit of analysis are made based on data at some lower-level unit of analysis
Unit of analysis- entity that a researcher wants to say something about at the end of her study
Unit of observation- the item that a researcher actually observes, measures, or collects in the course of trying to learn something about her unit of analysis

Image attributions

Binoculars by nightowl CC-0

Foundations of Social Work Research Copyright © 2020 by Rebecca L. Mauldin is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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One of the most important ideas in a research project is the unit of analysis . The unit of analysis is the major entity that you are analyzing in your study. For instance, any of the following could be a unit of analysis in a study:

individuals
artifacts (books, photos, newspapers)
geographical units (town, census tract, state)
social interactions (dyadic relations, divorces, arrests)

Why is it called the ‘unit of analysis’ and not something else (like, the unit of sampling)? Because it is the analysis you do in your study that determines what the unit is . For instance, if you are comparing the children in two classrooms on achievement test scores, the unit is the individual child because you have a score for each child. On the other hand, if you are comparing the two classes on classroom climate, your unit of analysis is the group, in this case the classroom, because you only have a classroom climate score for the class as a whole and not for each individual student. For different analyses in the same study you may have different units of analysis. If you decide to base an analysis on student scores, the individual is the unit. But you might decide to compare average classroom performance. In this case, since the data that goes into the analysis is the average itself (and not the individuals’ scores) the unit of analysis is actually the group. Even though you had data at the student level, you use aggregates in the analysis. In many areas of social research these hierarchies of analysis units have become particularly important and have spawned a whole area of statistical analysis sometimes referred to as hierarchical modeling . This is true in education, for instance, where we often compare classroom performance but collected achievement data at the individual student level.

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Qualitative Methods in Health Care Research

Vishnu renjith.

School of Nursing and Midwifery, Royal College of Surgeons Ireland - Bahrain (RCSI Bahrain), Al Sayh Muharraq Governorate, Bahrain

Renjulal Yesodharan

1 Department of Mental Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Judith A. Noronha

2 Department of OBG Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Elissa Ladd

3 School of Nursing, MGH Institute of Health Professions, Boston, USA

Anice George

4 Department of Child Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Healthcare research is a systematic inquiry intended to generate robust evidence about important issues in the fields of medicine and healthcare. Qualitative research has ample possibilities within the arena of healthcare research. This article aims to inform healthcare professionals regarding qualitative research, its significance, and applicability in the field of healthcare. A wide variety of phenomena that cannot be explained using the quantitative approach can be explored and conveyed using a qualitative method. The major types of qualitative research designs are narrative research, phenomenological research, grounded theory research, ethnographic research, historical research, and case study research. The greatest strength of the qualitative research approach lies in the richness and depth of the healthcare exploration and description it makes. In health research, these methods are considered as the most humanistic and person-centered way of discovering and uncovering thoughts and actions of human beings.

Introduction

Healthcare research is a systematic inquiry intended to generate trustworthy evidence about issues in the field of medicine and healthcare. The three principal approaches to health research are the quantitative, the qualitative, and the mixed methods approach. The quantitative research method uses data, which are measures of values and counts and are often described using statistical methods which in turn aids the researcher to draw inferences. Qualitative research incorporates the recording, interpreting, and analyzing of non-numeric data with an attempt to uncover the deeper meanings of human experiences and behaviors. Mixed methods research, the third methodological approach, involves collection and analysis of both qualitative and quantitative information with an objective to solve different but related questions, or at times the same questions.[ 1 , 2 ]

In healthcare, qualitative research is widely used to understand patterns of health behaviors, describe lived experiences, develop behavioral theories, explore healthcare needs, and design interventions.[ 1 , 2 , 3 ] Because of its ample applications in healthcare, there has been a tremendous increase in the number of health research studies undertaken using qualitative methodology.[ 4 , 5 ] This article discusses qualitative research methods, their significance, and applicability in the arena of healthcare.

Qualitative Research

Diverse academic and non-academic disciplines utilize qualitative research as a method of inquiry to understand human behavior and experiences.[ 6 , 7 ] According to Munhall, “Qualitative research involves broadly stated questions about human experiences and realities, studied through sustained contact with the individual in their natural environments and producing rich, descriptive data that will help us to understand those individual's experiences.”[ 8 ]

Significance of Qualitative Research

The qualitative method of inquiry examines the 'how' and 'why' of decision making, rather than the 'when,' 'what,' and 'where.'[ 7 ] Unlike quantitative methods, the objective of qualitative inquiry is to explore, narrate, and explain the phenomena and make sense of the complex reality. Health interventions, explanatory health models, and medical-social theories could be developed as an outcome of qualitative research.[ 9 ] Understanding the richness and complexity of human behavior is the crux of qualitative research.

Differences between Quantitative and Qualitative Research

The quantitative and qualitative forms of inquiry vary based on their underlying objectives. They are in no way opposed to each other; instead, these two methods are like two sides of a coin. The critical differences between quantitative and qualitative research are summarized in Table 1 .[ 1 , 10 , 11 ]

Differences between quantitative and qualitative research

Qualitative Research Questions and Purpose Statements

Qualitative questions are exploratory and are open-ended. A well-formulated study question forms the basis for developing a protocol, guides the selection of design, and data collection methods. Qualitative research questions generally involve two parts, a central question and related subquestions. The central question is directed towards the primary phenomenon under study, whereas the subquestions explore the subareas of focus. It is advised not to have more than five to seven subquestions. A commonly used framework for designing a qualitative research question is the 'PCO framework' wherein, P stands for the population under study, C stands for the context of exploration, and O stands for the outcome/s of interest.[ 12 ] The PCO framework guides researchers in crafting a focused study question.

Example: In the question, “What are the experiences of mothers on parenting children with Thalassemia?”, the population is “mothers of children with Thalassemia,” the context is “parenting children with Thalassemia,” and the outcome of interest is “experiences.”

The purpose statement specifies the broad focus of the study, identifies the approach, and provides direction for the overall goal of the study. The major components of a purpose statement include the central phenomenon under investigation, the study design and the population of interest. Qualitative research does not require a-priori hypothesis.[ 13 , 14 , 15 ]

Example: Borimnejad et al . undertook a qualitative research on the lived experiences of women suffering from vitiligo. The purpose of this study was, “to explore lived experiences of women suffering from vitiligo using a hermeneutic phenomenological approach.” [ 16 ]

Review of the Literature

In quantitative research, the researchers do an extensive review of scientific literature prior to the commencement of the study. However, in qualitative research, only a minimal literature search is conducted at the beginning of the study. This is to ensure that the researcher is not influenced by the existing understanding of the phenomenon under the study. The minimal literature review will help the researchers to avoid the conceptual pollution of the phenomenon being studied. Nonetheless, an extensive review of the literature is conducted after data collection and analysis.[ 15 ]

Reflexivity

Reflexivity refers to critical self-appraisal about one's own biases, values, preferences, and preconceptions about the phenomenon under investigation. Maintaining a reflexive diary/journal is a widely recognized way to foster reflexivity. According to Creswell, “Reflexivity increases the credibility of the study by enhancing more neutral interpretations.”[ 7 ]

Types of Qualitative Research Designs

The qualitative research approach encompasses a wide array of research designs. The words such as types, traditions, designs, strategies of inquiry, varieties, and methods are used interchangeably. The major types of qualitative research designs are narrative research, phenomenological research, grounded theory research, ethnographic research, historical research, and case study research.[ 1 , 7 , 10 ]

Narrative research

Narrative research focuses on exploring the life of an individual and is ideally suited to tell the stories of individual experiences.[ 17 ] The purpose of narrative research is to utilize 'story telling' as a method in communicating an individual's experience to a larger audience.[ 18 ] The roots of narrative inquiry extend to humanities including anthropology, literature, psychology, education, history, and sociology. Narrative research encompasses the study of individual experiences and learning the significance of those experiences. The data collection procedures include mainly interviews, field notes, letters, photographs, diaries, and documents collected from one or more individuals. Data analysis involves the analysis of the stories or experiences through “re-storying of stories” and developing themes usually in chronological order of events. Rolls and Payne argued that narrative research is a valuable approach in health care research, to gain deeper insight into patient's experiences.[ 19 ]

Example: Karlsson et al . undertook a narrative inquiry to “explore how people with Alzheimer's disease present their life story.” Data were collected from nine participants. They were asked to describe about their life experiences from childhood to adulthood, then to current life and their views about the future life. [ 20 ]

Phenomenological research

Phenomenology is a philosophical tradition developed by German philosopher Edmond Husserl. His student Martin Heidegger did further developments in this methodology. It defines the 'essence' of individual's experiences regarding a certain phenomenon.[ 1 ] The methodology has its origin from philosophy, psychology, and education. The purpose of qualitative research is to understand the people's everyday life experiences and reduce it into the central meaning or the 'essence of the experience'.[ 21 , 22 ] The unit of analysis of phenomenology is the individuals who have had similar experiences of the phenomenon. Interviews with individuals are mainly considered for the data collection, though, documents and observations are also useful. Data analysis includes identification of significant meaning elements, textural description (what was experienced), structural description (how was it experienced), and description of 'essence' of experience.[ 1 , 7 , 21 ] The phenomenological approach is further divided into descriptive and interpretive phenomenology. Descriptive phenomenology focuses on the understanding of the essence of experiences and is best suited in situations that need to describe the lived phenomenon. Hermeneutic phenomenology or Interpretive phenomenology moves beyond the description to uncover the meanings that are not explicitly evident. The researcher tries to interpret the phenomenon, based on their judgment rather than just describing it.[ 7 , 21 , 22 , 23 , 24 ]

Example: A phenomenological study conducted by Cornelio et al . aimed at describing the lived experiences of mothers in parenting children with leukemia. Data from ten mothers were collected using in-depth semi-structured interviews and were analyzed using Husserl's method of phenomenology. Themes such as “pivotal moment in life”, “the experience of being with a seriously ill child”, “having to keep distance with the relatives”, “overcoming the financial and social commitments”, “responding to challenges”, “experience of faith as being key to survival”, “health concerns of the present and future”, and “optimism” were derived. The researchers reported the essence of the study as “chronic illness such as leukemia in children results in a negative impact on the child and on the mother.” [ 25 ]

Grounded Theory Research

Grounded theory has its base in sociology and propagated by two sociologists, Barney Glaser, and Anselm Strauss.[ 26 ] The primary purpose of grounded theory is to discover or generate theory in the context of the social process being studied. The major difference between grounded theory and other approaches lies in its emphasis on theory generation and development. The name grounded theory comes from its ability to induce a theory grounded in the reality of study participants.[ 7 , 27 ] Data collection in grounded theory research involves recording interviews from many individuals until data saturation. Constant comparative analysis, theoretical sampling, theoretical coding, and theoretical saturation are unique features of grounded theory research.[ 26 , 27 , 28 ] Data analysis includes analyzing data through 'open coding,' 'axial coding,' and 'selective coding.'[ 1 , 7 ] Open coding is the first level of abstraction, and it refers to the creation of a broad initial range of categories, axial coding is the procedure of understanding connections between the open codes, whereas selective coding relates to the process of connecting the axial codes to formulate a theory.[ 1 , 7 ] Results of the grounded theory analysis are supplemented with a visual representation of major constructs usually in the form of flow charts or framework diagrams. Quotations from the participants are used in a supportive capacity to substantiate the findings. Strauss and Corbin highlights that “the value of the grounded theory lies not only in its ability to generate a theory but also to ground that theory in the data.”[ 27 ]

Example: Williams et al . conducted a grounded theory research to explore the nature of relationship between the sense of self and the eating disorders. Data were collected form 11 women with a lifetime history of Anorexia Nervosa and were analyzed using the grounded theory methodology. Analysis led to the development of a theoretical framework on the nature of the relationship between the self and Anorexia Nervosa. [ 29 ]

Ethnographic research

Ethnography has its base in anthropology, where the anthropologists used it for understanding the culture-specific knowledge and behaviors. In health sciences research, ethnography focuses on narrating and interpreting the health behaviors of a culture-sharing group. 'Culture-sharing group' in an ethnography represents any 'group of people who share common meanings, customs or experiences.' In health research, it could be a group of physicians working in rural care, a group of medical students, or it could be a group of patients who receive home-based rehabilitation. To understand the cultural patterns, researchers primarily observe the individuals or group of individuals for a prolonged period of time.[ 1 , 7 , 30 ] The scope of ethnography can be broad or narrow depending on the aim. The study of more general cultural groups is termed as macro-ethnography, whereas micro-ethnography focuses on more narrowly defined cultures. Ethnography is usually conducted in a single setting. Ethnographers collect data using a variety of methods such as observation, interviews, audio-video records, and document reviews. A written report includes a detailed description of the culture sharing group with emic and etic perspectives. When the researcher reports the views of the participants it is called emic perspectives and when the researcher reports his or her views about the culture, the term is called etic.[ 7 ]

Example: The aim of the ethnographic study by LeBaron et al . was to explore the barriers to opioid availability and cancer pain management in India. The researchers collected data from fifty-nine participants using in-depth semi-structured interviews, participant observation, and document review. The researchers identified significant barriers by open coding and thematic analysis of the formal interview. [ 31 ]

Historical research

Historical research is the “systematic collection, critical evaluation, and interpretation of historical evidence”.[ 1 ] The purpose of historical research is to gain insights from the past and involves interpreting past events in the light of the present. The data for historical research are usually collected from primary and secondary sources. The primary source mainly includes diaries, first hand information, and writings. The secondary sources are textbooks, newspapers, second or third-hand accounts of historical events and medical/legal documents. The data gathered from these various sources are synthesized and reported as biographical narratives or developmental perspectives in chronological order. The ideas are interpreted in terms of the historical context and significance. The written report describes 'what happened', 'how it happened', 'why it happened', and its significance and implications to current clinical practice.[ 1 , 10 ]

Example: Lubold (2019) analyzed the breastfeeding trends in three countries (Sweden, Ireland, and the United States) using a historical qualitative method. Through analysis of historical data, the researcher found that strong family policies, adherence to international recommendations and adoption of baby-friendly hospital initiative could greatly enhance the breastfeeding rates. [ 32 ]

Case study research

Case study research focuses on the description and in-depth analysis of the case(s) or issues illustrated by the case(s). The design has its origin from psychology, law, and medicine. Case studies are best suited for the understanding of case(s), thus reducing the unit of analysis into studying an event, a program, an activity or an illness. Observations, one to one interviews, artifacts, and documents are used for collecting the data, and the analysis is done through the description of the case. From this, themes and cross-case themes are derived. A written case study report includes a detailed description of one or more cases.[ 7 , 10 ]

Example: Perceptions of poststroke sexuality in a woman of childbearing age was explored using a qualitative case study approach by Beal and Millenbrunch. Semi structured interview was conducted with a 36- year mother of two children with a history of Acute ischemic stroke. The data were analyzed using an inductive approach. The authors concluded that “stroke during childbearing years may affect a woman's perception of herself as a sexual being and her ability to carry out gender roles”. [ 33 ]

Sampling in Qualitative Research

Qualitative researchers widely use non-probability sampling techniques such as purposive sampling, convenience sampling, quota sampling, snowball sampling, homogeneous sampling, maximum variation sampling, extreme (deviant) case sampling, typical case sampling, and intensity sampling. The selection of a sampling technique depends on the nature and needs of the study.[ 34 , 35 , 36 , 37 , 38 , 39 , 40 ] The four widely used sampling techniques are convenience sampling, purposive sampling, snowball sampling, and intensity sampling.

Convenience sampling

It is otherwise called accidental sampling, where the researchers collect data from the subjects who are selected based on accessibility, geographical proximity, ease, speed, and or low cost.[ 34 ] Convenience sampling offers a significant benefit of convenience but often accompanies the issues of sample representation.

Purposive sampling

Purposive or purposeful sampling is a widely used sampling technique.[ 35 ] It involves identifying a population based on already established sampling criteria and then selecting subjects who fulfill that criteria to increase the credibility. However, choosing information-rich cases is the key to determine the power and logic of purposive sampling in a qualitative study.[ 1 ]

Snowball sampling

The method is also known as 'chain referral sampling' or 'network sampling.' The sampling starts by having a few initial participants, and the researcher relies on these early participants to identify additional study participants. It is best adopted when the researcher wishes to study the stigmatized group, or in cases, where findings of participants are likely to be difficult by ordinary means. Respondent ridden sampling is an improvised version of snowball sampling used to find out the participant from a hard-to-find or hard-to-study population.[ 37 , 38 ]

Intensity sampling

The process of identifying information-rich cases that manifest the phenomenon of interest is referred to as intensity sampling. It requires prior information, and considerable judgment about the phenomenon of interest and the researcher should do some preliminary investigations to determine the nature of the variation. Intensity sampling will be done once the researcher identifies the variation across the cases (extreme, average and intense) and picks the intense cases from them.[ 40 ]

Deciding the Sample Size

A-priori sample size calculation is not undertaken in the case of qualitative research. Researchers collect the data from as many participants as possible until they reach the point of data saturation. Data saturation or the point of redundancy is the stage where the researcher no longer sees or hears any new information. Data saturation gives the idea that the researcher has captured all possible information about the phenomenon of interest. Since no further information is being uncovered as redundancy is achieved, at this point the data collection can be stopped. The objective here is to get an overall picture of the chronicle of the phenomenon under the study rather than generalization.[ 1 , 7 , 41 ]

Data Collection in Qualitative Research

The various strategies used for data collection in qualitative research includes in-depth interviews (individual or group), focus group discussions (FGDs), participant observation, narrative life history, document analysis, audio materials, videos or video footage, text analysis, and simple observation. Among all these, the three popular methods are the FGDs, one to one in-depth interviews and the participant observation.

FGDs are useful in eliciting data from a group of individuals. They are normally built around a specific topic and are considered as the best approach to gather data on an entire range of responses to a topic.[ 42 Group size in an FGD ranges from 6 to 12. Depending upon the nature of participants, FGDs could be homogeneous or heterogeneous.[ 1 , 14 ] One to one in-depth interviews are best suited to obtain individuals' life histories, lived experiences, perceptions, and views, particularly while exporting topics of sensitive nature. In-depth interviews can be structured, unstructured, or semi-structured. However, semi-structured interviews are widely used in qualitative research. Participant observations are suitable for gathering data regarding naturally occurring behaviors.[ 1 ]

Data Analysis in Qualitative Research

Various strategies are employed by researchers to analyze data in qualitative research. Data analytic strategies differ according to the type of inquiry. A general content analysis approach is described herewith. Data analysis begins by transcription of the interview data. The researcher carefully reads data and gets a sense of the whole. Once the researcher is familiarized with the data, the researcher strives to identify small meaning units called the 'codes.' The codes are then grouped based on their shared concepts to form the primary categories. Based on the relationship between the primary categories, they are then clustered into secondary categories. The next step involves the identification of themes and interpretation to make meaning out of data. In the results section of the manuscript, the researcher describes the key findings/themes that emerged. The themes can be supported by participants' quotes. The analytical framework used should be explained in sufficient detail, and the analytic framework must be well referenced. The study findings are usually represented in a schematic form for better conceptualization.[ 1 , 7 ] Even though the overall analytical process remains the same across different qualitative designs, each design such as phenomenology, ethnography, and grounded theory has design specific analytical procedures, the details of which are out of the scope of this article.

Computer-Assisted Qualitative Data Analysis Software (CAQDAS)

Until recently, qualitative analysis was done either manually or with the help of a spreadsheet application. Currently, there are various software programs available which aid researchers to manage qualitative data. CAQDAS is basically data management tools and cannot analyze the qualitative data as it lacks the ability to think, reflect, and conceptualize. Nonetheless, CAQDAS helps researchers to manage, shape, and make sense of unstructured information. Open Code, MAXQDA, NVivo, Atlas.ti, and Hyper Research are some of the widely used qualitative data analysis software.[ 14 , 43 ]

Reporting Guidelines

Consolidated Criteria for Reporting Qualitative Research (COREQ) is the widely used reporting guideline for qualitative research. This 32-item checklist assists researchers in reporting all the major aspects related to the study. The three major domains of COREQ are the 'research team and reflexivity', 'study design', and 'analysis and findings'.[ 44 , 45 ]

Critical Appraisal of Qualitative Research

Various scales are available to critical appraisal of qualitative research. The widely used one is the Critical Appraisal Skills Program (CASP) Qualitative Checklist developed by CASP network, UK. This 10-item checklist evaluates the quality of the study under areas such as aims, methodology, research design, ethical considerations, data collection, data analysis, and findings.[ 46 ]

Ethical Issues in Qualitative Research

A qualitative study must be undertaken by grounding it in the principles of bioethics such as beneficence, non-maleficence, autonomy, and justice. Protecting the participants is of utmost importance, and the greatest care has to be taken while collecting data from a vulnerable research population. The researcher must respect individuals, families, and communities and must make sure that the participants are not identifiable by their quotations that the researchers include when publishing the data. Consent for audio/video recordings must be obtained. Approval to be in FGDs must be obtained from the participants. Researchers must ensure the confidentiality and anonymity of the transcripts/audio-video records/photographs/other data collected as a part of the study. The researchers must confirm their role as advocates and proceed in the best interest of all participants.[ 42 , 47 , 48 ]

Rigor in Qualitative Research

The demonstration of rigor or quality in the conduct of the study is essential for every research method. However, the criteria used to evaluate the rigor of quantitative studies are not be appropriate for qualitative methods. Lincoln and Guba (1985) first outlined the criteria for evaluating the qualitative research often referred to as “standards of trustworthiness of qualitative research”.[ 49 ] The four components of the criteria are credibility, transferability, dependability, and confirmability.

Credibility refers to confidence in the 'truth value' of the data and its interpretation. It is used to establish that the findings are true, credible and believable. Credibility is similar to the internal validity in quantitative research.[ 1 , 50 , 51 ] The second criterion to establish the trustworthiness of the qualitative research is transferability, Transferability refers to the degree to which the qualitative results are applicability to other settings, population or contexts. This is analogous to the external validity in quantitative research.[ 1 , 50 , 51 ] Lincoln and Guba recommend authors provide enough details so that the users will be able to evaluate the applicability of data in other contexts.[ 49 ] The criterion of dependability refers to the assumption of repeatability or replicability of the study findings and is similar to that of reliability in quantitative research. The dependability question is 'Whether the study findings be repeated of the study is replicated with the same (similar) cohort of participants, data coders, and context?'[ 1 , 50 , 51 ] Confirmability, the fourth criteria is analogous to the objectivity of the study and refers the degree to which the study findings could be confirmed or corroborated by others. To ensure confirmability the data should directly reflect the participants' experiences and not the bias, motivations, or imaginations of the inquirer.[ 1 , 50 , 51 ] Qualitative researchers should ensure that the study is conducted with enough rigor and should report the measures undertaken to enhance the trustworthiness of the study.

Conclusions

Qualitative research studies are being widely acknowledged and recognized in health care practice. This overview illustrates various qualitative methods and shows how these methods can be used to generate evidence that informs clinical practice. Qualitative research helps to understand the patterns of health behaviors, describe illness experiences, design health interventions, and develop healthcare theories. The ultimate strength of the qualitative research approach lies in the richness of the data and the descriptions and depth of exploration it makes. Hence, qualitative methods are considered as the most humanistic and person-centered way of discovering and uncovering thoughts and actions of human beings.

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[Explained] The Unit of Analysis in Qualitative Research

Have you ever wondered how social scientists choose what unit of analysis to use in their research? The answer may surprise you – it’s not always a simple decision! In this article, we’ll explore the different factors that social scientists must consider when choosing a unit of analysis.

What is a Unit of Analysis?

A unit of analysis is the basic element that social scientists study in their research. It can be a person, a group of people, an organization, or even a country. The unit of analysis is important because it helps determine the scope and focus of the research. When choosing a unit of analysis, social scientists must consider several factors, including the nature of the phenomenon being studied, the research question, and the data available.

Why is Choosing the Right Unit of Analysis Important?

The choice of unit of analysis can influence the results of a study in several ways. First, it can determine what type of data the researcher will be able to collect. Second, it can affect the way that data is analyzed. And finally, it can determine the conclusions that can be drawn from the research.

For example, let’s say a researcher is interested in studying how climate change affects agricultural production. One potential unit of analysis would be individual farmers. However, this unit of analysis might not be ideal because it would be difficult to collect data on every individual farmer in the world.

Alternatively, the researcher could choose to study countries as their unit of analysis. This would allow for more reliable and comprehensive data, but it would also mean that the conclusions drawn from the study might be less applicable to individual farmers.

Read also: List of MBA Scholarships in the USA to Consider

How does Social Scientist Choose a Unit of Analysis?

There is no single answer to this question – social scientists must consider a variety of factors when choosing a unit of analysis. Some of the key considerations include:

The nature of the research question: What are you trying to answer with your research? This will often dictate the most appropriate unit of analysis.
The type of data you have available: Do you have access to individual-level data, or are you limited to aggregate data?
The level of analysis you want to conduct: Are you interested in looking at individuals, groups, organizations, or something else?
The resources you have available: Do you have the time and/or money to collect and analyze data at the individual level?

Ultimately, there is no right or wrong answer when it comes to choosing a unit of analysis. It is important to carefully consider all of the above factors before making a decision.

Factors to Consider when Choosing a Unit of Analysis

When choosing a unit of analysis, social scientists must consider a variety of factors. The most important factor is usually the research question. What are you trying to answer with your research? Once you have a clear research question, you can begin to narrow down your options for units of analysis.

Furthermore, other important factors to consider include the type of data you have, the geographical area you’re studying, and the timeframe of your research. For example, if you’re studying voting patterns in the United States, your unit of analysis would likely be the individual voter. However, if you’re looking at economic growth in Europe, your unit of analysis would be countries or regions.

Read also: Guide to Study MBA in Canada Without GMAT

What are the Four Units of Analysis?

There are four main units of analysis that social scientists can use: individuals, groups, organizations, and societies. Each unit of analysis has its strengths and weaknesses and choosing the right unit of analysis is crucial to conducting successful research.

Individuals are the most common unit of analysis in social science research. Studying individuals allows researchers to analyze data at a very detailed level. However, individuals are also the most difficult unit of analysis to study, because they can be hard to track and access.

Groups are another common unit of analysis in social science research. Groups are easier to study than individuals because they are more accessible. However, groups are also less detailed than individuals, so researchers must be careful not to lose important information when studying groups.

Organizations are another unit of analysis that social scientists can use. Organizations offer a unique perspective on social phenomena because they are often at the center of social interactions. However, organizations can be difficult to study because they often have close access and require special permission from researchers.

Societies are the largest unit of analysis. Researchers who study societies look at how different groups within society interact with each other. They also examine how societies change over time.

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Text-Types and Their Analysis in Qualitative Interview Research: A Methodological Update

Judith Eckert Universität Osnabrück https://orcid.org/0000-0003-4555-1650
Malin Houben Universität Bielefeld
Carsten G. Ullrich Universität Duisburg-Essen

In his work on narrative interviews, Fritz SCHÜTZE introduced the concept of text-types, which plays an important role in various interview procedures in the German-speaking area today. It is employed by researchers in order to generate a certain methodologically preferred quality of interview responses and to identify corresponding transcript passages during data analysis. However, the continued popularity of text-types is offset by three fundamental problems: 1. the neglect of the interactive character of text-type production, 2. the limited analytical value of formal language markers and 3. ambiguities regarding the taxonomy of text-types. These problems arise from the lack of systematic work on text-types and their determination within the German methodological discourse since SCHÜTZE's (and KALLMEYER's) significant contributions in the 1970s and 1980s, as well as from the ignorance of relevant contributions from conversational linguistics. In this article, we make an empirically grounded proposal to address these problems by resorting to the conversation-analytic framework and analytical tool "globality and locality in the organization of jointly constructed units" (GLOBE), which has not yet been utilized in interview research. With this enhancement of the method, determining text-types becomes fruitful for a variety of research contexts even beyond narrative interviews.

Author Biographies

Judith eckert, universität osnabrück.

Judith ECKERT , Dr. phil., ist wissenschaftliche Mitarbeiterin mit Schwerpunkt in der qualitativen Methodenausbildung am Institut für Sozialwissenschaften der Universität Osnabrück. Zuvor forschte sie an der Universität Duisburg-Essen im Rahmen der DFG-geförderten Projekte "Fragen in qualitativen Interviews. Sekundäranalysen zur Bedeutung unterschiedlicher Frageformen in Interviews" und "Methode und Ungleichheit. Sekundäranalysen zur Bedeutung sozialer Unterschiede in qualitativen Interviews". Ihre Arbeitsschwerpunkte liegen in den Bereichen qualitative Methoden, soziale Ungleichheit, Geschlechterforschung, Beziehungs- und Familiensoziologie sowie Soziologie der (Un-)Sicherheit und Angst.

Malin Houben, Universität Bielefeld

Malin HOUBEN , M.A., ist wissenschaftliche Mitarbeiterin am Arbeitsbereich Geschlechtersoziologie an der Fakultät für Soziologie und Promovendin der Bielefeld Graduate School in History and Sociology, Universität Bielefeld. Zuvor arbeitete sie im von der DFG geförderten Methodenforschungsprojekt "Fragen in qualitativen Interviews. Sekundäranalysen zur Bedeutung unterschiedlicher Frageformen in Interviews" an der Universität Duisburg-Essen. Ihre Arbeitsschwerpunkte liegen im Bereich der qualitativen Forschungsmethoden, insbesondere Interviewmethodologie und ethnografische Interaktionsstudien, sowie in der mikrosoziologischen Geschlechter-, Medizin- und Körpersoziologie.

Carsten G. Ullrich, Universität Duisburg-Essen

Carsten G. ULLRICH , Soziologe, ist Professor für Methoden der qualitativen Sozialforschung an der Universität Duisburg-Essen. Zu seinen Arbeitsschwerpunkten zählen Allgemeine Soziologie, Soziologie der Sozialpolitik und qualitative Methoden. Aktuelle Veröffentlichung: Das Diskursive Interview. Methodische und methodologische Grundlagen. Wiesbaden: Springer VS (2. Aufl. 2020).

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Published: 16 May 2024

Integrating qualitative research within a clinical trials unit: developing strategies and understanding their implementation in contexts

Jeremy Segrott ORCID: orcid.org/0000-0001-6215-0870 1 ,
Sue Channon 2 ,
Amy Lloyd 4 ,
Eleni Glarou 2 , 3 ,
Josie Henley 5 ,
Jacqueline Hughes 2 ,
Nina Jacob 2 ,
Sarah Milosevic 2 ,
Yvonne Moriarty 2 ,
Bethan Pell 6 ,
Mike Robling 2 ,
Heather Strange 2 ,
Julia Townson 2 ,
Qualitative Research Group &
Lucy Brookes-Howell 2

Trials volume 25 , Article number: 323 ( 2024 ) Cite this article

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Background/aims

The value of using qualitative methods within clinical trials is widely recognised. How qualitative research is integrated within trials units to achieve this is less clear. This paper describes the process through which qualitative research has been integrated within Cardiff University’s Centre for Trials Research (CTR) in Wales, UK. We highlight facilitators of, and challenges to, integration.

We held group discussions on the work of the Qualitative Research Group (QRG) within CTR. The content of these discussions, materials for a presentation in CTR, and documents relating to the development of the QRG were interpreted at a workshop attended by group members. Normalisation Process Theory (NPT) was used to structure analysis. A writing group prepared a document for input from members of CTR, forming the basis of this paper.

Actions to integrate qualitative research comprised: its inclusion in Centre strategies; formation of a QRG with dedicated funding/roles; embedding of qualitative research within operating systems; capacity building/training; monitoring opportunities to include qualitative methods in studies; maximising the quality of qualitative research and developing methodological innovation. Facilitators of these actions included: the influence of the broader methodological landscape within trial/study design and its promotion of the value of qualitative research; and close physical proximity of CTR qualitative staff/students allowing sharing of methodological approaches. Introduction of innovative qualitative methods generated interest among other staff groups. Challenges included: pressure to under-resource qualitative components of research, preference for a statistical stance historically in some research areas and funding structures, and difficulties faced by qualitative researchers carving out individual academic profiles when working across trials/studies.

Conclusions

Given that CTUs are pivotal to the design and conduct of RCTs and related study types across multiple disciplines, integrating qualitative research into trials units is crucial if its contribution is to be fully realised. We have made explicit one trials unit’s experience of embedding qualitative research and present this to open dialogue on ways to operationalise and optimise qualitative research in trials. NPT provides a valuable framework with which to theorise these processes, including the importance of sense-making and legitimisation when introducing new practices within organisations.

Peer Review reports

The value of using qualitative methods within randomised control trials (RCTs) is widely recognised [ 1 , 2 , 3 ]. Qualitative research generates important evidence on factors affecting trial recruitment/retention [ 4 ] and implementation, aiding interpretation of quantitative data [ 5 ]. Though RCTs have traditionally been viewed as sitting within a positivist paradigm, recent methodological innovations have developed new trial designs that draw explicitly on both quantitative and qualitative methods. For instance, in the field of complex public health interventions, realist RCTs seek to understand the mechanisms through which interventions generate hypothesised impacts, and how interactions across different implementation contexts form part of these mechanisms. Proponents of realist RCTs—which integrate experimental and realist paradigms—highlight the importance of using quantitative and qualitative methods to fully realise these aims and to generate an understanding of intervention mechanisms and how context shapes them [ 6 ].

A need for guidance on how to conduct good quality qualitative research is being addressed, particularly in relation to feasibility studies for RCTs [ 7 ] and process evaluations embedded within trials of complex interventions [ 5 ]. There is also guidance on the conduct of qualitative research within trials at different points in the research cycle, including development, conduct and reporting [ 8 , 9 ].

A high proportion of trials are based within or involve clinical trials units (CTUs). In the UK the UKCRC Registered CTU Network describes them as:

… specialist units which have been set up with a specific remit to design, conduct, analyse and publish clinical trials and other well-designed studies. They have the capability to provide specialist expert statistical, epidemiological, and other methodological advice and coordination to undertake successful clinical trials. In addition, most CTUs will have expertise in the coordination of trials involving investigational medicinal products which must be conducted in compliance with the UK Regulations governing the conduct of clinical trials resulting from the EU Directive for Clinical Trials.

Thus, CTUs provide the specialist methodological expertise needed for the conduct of trials, and in the case of trials of investigational medicinal products, their involvement may be mandated to ensure compliance with relevant regulations. As the definition above suggests, CTUs also conduct and support other types of study apart from RCTs, providing a range of methodological and subject-based expertise.

However, despite their central role in the conduct and design of trials, (and other evaluation designs) little has been written about how CTUs have integrated qualitative work within their organisation at a time when such methods are, as stated above, now recognised as an important aspect of RCTs and evaluation studies more generally. This is a significant gap, since integration at the organisational level arguably shapes how qualitative research is integrated within individual studies, and thus it is valuable to understand how CTUs have approached the task. There are different ways of involving qualitative work in trials units, such as partnering with other departments (e.g. social science) or employing qualitative researchers directly. Qualitative research can be imagined and configured in different ways—as a method that generates data to inform future trial and intervention design, as an embedded component within an RCT or other evaluation type, or as a parallel strand of research focusing on lived experiences of illness, for instance. Understanding how trials units have integrated qualitative research is valuable, as it can shed light on which strategies show promise, and in which contexts, and how qualitative research is positioned within the field of trials research, foregrounding the value of qualitative research. However, although much has been written about its use within trials, few accounts exist of how trials units have integrated qualitative research within their systems and structures.

This paper discusses the process of embedding qualitative research within the work of one CTU—Cardiff University’s Centre for Trials Research (CTR). It highlights facilitators of this process and identifies challenges to integration. We use the Normalisation Process Theory (NPT) as a framework to structure our experience and approach. The key gap addressed by this paper is the implementation of strategies to integrate qualitative research (a relatively newly adopted set of practices and processes) within CTU systems and structures. We acknowledge from the outset that there are multiple ways of approaching this task. What follows therefore is not a set of recommendations for a preferred or best way to integrate qualitative research, as this will comprise diverse actions according to specific contexts. Rather, we examine the processes through which integration occurred in our own setting and highlight the potential value of these insights for others engaged in the work of promoting qualitative research within trials units.

Background to the integration of qualitative research within CTR

The CTR was formed in 2015 [ 10 ]. It brought together three existing trials units at Cardiff University: the South East Wales Trials Unit, the Wales Cancer Trials Unit, and the Haematology Clinical Trials Unit. From its inception, the CTR had a stated aim of developing a programme of qualitative research and integrating it within trials and other studies. In the sections below, we map these approaches onto the framework offered by Normalisation Process Theory to understand the processes through which they helped achieve embedding and integration of qualitative research.

CTR’s aims (including those relating to the development of qualitative research) were included within its strategy documents and communicated to others through infrastructure funding applications, annual reports and its website. A Qualitative Research Group (QRG), which had previously existed within the South East Wales Trials Unit, with dedicated funding for methodological specialists and group lead academics, was a key mechanism through which the development of a qualitative portfolio was put into action. Integration of qualitative research within Centre systems and processes occurred through the inclusion of qualitative research in study adoption processes and representation on committees. The CTR’s study portfolio provided a basis to track qualitative methods in new and existing studies, identify opportunities to embed qualitative methods within recently adopted studies (at the funding application stage) and to manage staff resources. Capacity building and training were an important focus of the QRG’s work, including training courses, mentoring, creation of an academic network open to university staff and practitioners working in the field of healthcare, presentations at CTR staff meetings and securing of PhD studentships. Standard operating procedures and methodological guidance on the design and conduct of qualitative research (e.g. templates for developing analysis plans) aimed to create a shared understanding of how to undertake high-quality research, and a means to monitor the implementation of rigorous approaches. As the QRG expanded its expertise it sought to develop innovative approaches, including the use of visual [ 11 ] and ethnographic methods [ 12 ].

Understanding implementation—Normalisation Process Theory (NPT)

Normalisation Process Theory (NPT) provides a model with which to understand the implementation of new sets of practices and their normalisation within organisational settings. The term ‘normalisation’ refers to how new practices become routinised (part of the everyday work of an organisation) through embedding and integration [ 13 , 14 ]. NPT defines implementation as ‘the social organisation of work’ and is concerned with the social processes that take place as new practices are introduced. Embedding involves ‘making practices routine elements of everyday life’ within an organisation. Integration takes the form of ‘sustaining embedded practices in social contexts’, and how these processes lead to the practices becoming (or not becoming) ‘normal and routine’ [ 14 ]. NPT is concerned with the factors which promote or ‘inhibit’ attempts to embed and integrate the operationalisation of new practices [ 13 , 14 , 15 ].

Embedding new practices is therefore achieved through implementation—which takes the form of interactions in specific contexts. Implementation is operationalised through four ‘generative mechanisms’— coherence , cognitive participation , collective action and reflexive monitoring [ 14 ]. Each mechanism is characterised by components comprising immediate and organisational work, with actions of individuals and organisations (or groups of individuals) interdependent. The mechanisms operate partly through forms of investment (i.e. meaning, commitment, effort, and comprehension) [ 14 ].

Coherence refers to how individuals/groups make sense of, and give meaning to, new practices. Sense-making concerns the coherence of a practice—whether it ‘holds together’, and its differentiation from existing activities [ 15 ]. Communal and individual specification involve understanding new practices and their potential benefits for oneself or an organisation. Individuals consider what new practices mean for them in terms of tasks and responsibilities ( internalisation ) [ 14 ].

NPT frames the second mechanism, cognitive participation , as the building of a ‘community of practice’. For a new practice to be initiated, individuals and groups within an organisation must commit to it [ 14 , 15 ]. Cognitive participation occurs through enrolment —how people relate to the new practice; legitimation —the belief that it is right for them to be involved; and activation —defining which actions are necessary to sustain the practice and their involvement [ 14 ]. Making the new practices work may require changes to roles (new responsibilities, altered procedures) and reconfiguring how colleagues work together (changed relationships).

Third, Collective Action refers to ‘the operational work that people do to enact a set of practices’ [ 14 ]. Individuals engage with the new practices ( interactional workability ) reshaping how members of an organisation interact with each other, through creation of new roles and expectations ( relational interaction ) [ 15 ]. Skill set workability concerns how the work of implementing a new set of practices is distributed and the necessary roles and skillsets defined [ 14 ]. Contextual integration draws attention to the incorporation of a practice within social contexts, and the potential for aspects of these contexts, such as systems and procedures, to be modified as a result [ 15 ].

Reflexive monitoring is the final implementation mechanism. Collective and individual appraisal evaluate the value of a set of practices, which depends on the collection of information—formally and informally ( systematisation ). Appraisal may lead to reconfiguration in which procedures of the practice are redefined or reshaped [ 14 , 15 ].

We sought to map the following: (1) the strategies used to embed qualitative research within the Centre, (2) key facilitators, and (3) barriers to their implementation. Through focused group discussions during the monthly meetings of the CTR QRG and in discussion with the CTR senior management team throughout 2019–2020 we identified nine types of documents (22 individual documents in total) produced within the CTR which had relevant information about the integration of qualitative research within its work (Table 1 ). The QRG had an ‘open door’ policy to membership and welcomed all staff/students with an interest in qualitative research. It included researchers who were employed specifically to undertake qualitative research and other staff with a range of study roles, including trial managers, statisticians, and data managers. There was also diversity in terms of career stage, including PhD students, mid-career researchers and members of the Centre’s Executive team. Membership was therefore largely self-selected, and comprised of individuals with a role related to, or an interest in, embedding qualitative research within trials. However, the group brought together diverse methodological perspectives and was not solely comprised of methodological ‘champions’ whose job it was to promote the development of qualitative research within the centre. Thus whilst the group (and by extension, the authors of this paper) had a shared appreciation of the value of qualitative research within a trials centre, they also brought varied methodological perspectives and ways of engaging with it.

All members of the QRG ( n = 26) were invited to take part in a face-to-face, day-long workshop in February 2019 on ‘How to optimise and operationalise qualitative research in trials: reflections on CTR structure’. The workshop was attended by 12 members of staff and PhD students, including members of the QRG and the CTR’s senior management team. Recruitment to the workshop was therefore inclusive, and to some extent opportunistic, but all members of the QRG were able to contribute to discussions during regular monthly group meetings and the drafting of the current paper.

The aim of the workshop was to bring together information from the documents in Table 1 to generate discussion around the key strategies (and their component activities) that had been adopted to integrate qualitative research into CTR, as well as barriers to, and facilitators of, their implementation. The agenda for the workshop involved four key areas: development and history of the CTR model; mapping the current model within CTR; discussing the structure of other CTUs; and exploring the advantages and disadvantages of the CTR model.

During the workshop, we discussed the use of NPT to conceptualise how qualitative research had been embedded within CTR’s systems and practices. The group produced spider diagrams to map strategies and actions on to the four key domains (or ‘generative mechanisms’ of NPT) summarised above, to aid the understanding of how they had functioned, and the utility of NPT as a framework. This is summarised in Table 2 .

Detailed notes were made during the workshop. A core writing group then used these notes and the documents in Table 1 to develop a draft of the current paper. This was circulated to all members of the CTR QRG ( n = 26) and stored within a central repository accessible to them to allow involvement and incorporate the views of those who were not able to attend the workshop. This draft was again presented for comments in the monthly CTR QRG meeting in February 2021 attended by n = 10. The Standards for QUality Improvement Reporting Excellence 2.0 (SQUIRE) guidelines were used to inform the structure and content of the paper (see supplementary material) [ 16 ].

In the following sections, we describe the strategies CTR adopted to integrate qualitative research. These are mapped against NPT’s four generative mechanisms to explore the processes through which the strategies promoted integration, and facilitators of and barriers to their implementation. A summary of the strategies and their functioning in terms of the generative mechanisms is provided in Table 2 .

Coherence—making sense of qualitative research

In CTR, many of the actions taken to build a portfolio of qualitative research were aimed at enabling colleagues, and external actors, to make sense of this set of methodologies. Centre-level strategies and grant applications for infrastructure funding highlighted the value of qualitative research, the added benefits it would bring, and positioned it as a legitimate set of practices alongside existing methods. For example, a 2014 application for renewal of trials unit infrastructure funding stated:

We are currently in the process of undertaking […] restructuring for our qualitative research team and are planning similar for trial management next year. The aim of this restructuring is to establish greater hierarchical management and opportunities for staff development and also provide a structure that can accommodate continuing growth.

Within the CTR, various forms of communication on the development of qualitative research were designed to enable staff and students to make sense of it, and to think through its potential value for them, and ways in which they might engage with it. These included presentations at staff meetings, informal meetings between project teams and the qualitative group lead, and the visibility of qualitative research on the public-facing Centre website and Centre committees and systems. For instance, qualitative methods were included (and framed as a distinct set of practices) within study adoption forms and committee agendas. Information for colleagues described how qualitative methods could be incorporated within funding applications for RCTs and other evaluation studies to generate new insights into questions research teams were already keen to answer, such as influences on intervention implementation fidelity. Where externally based chief investigators approached the Centre to be involved in new grant applications, the existence of the qualitative team and group lead enabled the inclusion of qualitative research to be actively promoted at an early stage, and such opportunities were highlighted in the Centre’s brochure for new collaborators. Monthly qualitative research network meetings—advertised across CTR and to external research collaborators, were also designed to create a shared understanding of qualitative research methods and their utility within trials and other study types (e.g. intervention development, feasibility studies, and observational studies). Training events (discussed in more detail below) also aided sense-making.

Several factors facilitated the promotion of qualitative research as a distinctive and valuable entity. Among these was the influence of the broader methodological landscape within trial design which was promoting the value of qualitative research, such as guidance on the evaluation of complex interventions by the Medical Research Council [ 17 ], and the growing emphasis placed on process evaluations within trials (with qualitative methods important in understanding participant experience and influences on implementation) [ 5 ]. The attention given to lived experience (both through process evaluations and the move to embed public involvement in trials) helped to frame qualitative research within the Centre as something that was appropriate, legitimate, and of value. Recognition by research funders of the value of qualitative research within studies was also helpful in normalising and legitimising its adoption within grant applications.

The inclusion of qualitative methods within influential methodological guidance helped CTR researchers to develop a ‘shared language’ around these methods, and a way that a common understanding of the role of qualitative research could be generated. One barrier to such sense-making work was the varying extent to which staff and teams had existing knowledge or experience of qualitative research. This varied across methodological and subject groups within the Centre and reflected the history of the individual trials units which had merged to form the Centre.

Cognitive participation—legitimising qualitative research

Senior CTR leaders promoted the value and legitimacy of qualitative research. Its inclusion in centre strategies, infrastructure funding applications, and in public-facing materials (e.g. website, investigator brochures), signalled that it was appropriate for individuals to conduct qualitative research within their roles, or to support others in doing so. Legitimisation also took place through informal channels, such as senior leadership support for qualitative research methods in staff meetings and participation in QRG seminars. Continued development of the QRG (with dedicated infrastructure funding) provided a visible identity and equivalence with other methodological groups (e.g. trial managers, statisticians).

Staff were asked to engage with qualitative research in two main ways. First, there was an expansion in the number of staff for whom qualitative research formed part of their formal role and responsibilities. One of the three trials units that merged to form CTR brought with it a qualitative team comprising methodological specialists and a group lead. CTR continued the expansion of this group with the creation of new roles and an enlarged nucleus of researchers for whom qualitative research was the sole focus of their work. In part, this was linked to the successful award of projects that included a large qualitative component, and that were coordinated by CTR (see Table 3 which describes the PUMA study).

Members of the QRG were encouraged to develop their own research ideas and to gain experience as principal investigators, and group seminars were used to explore new ideas and provide peer support. This was communicated through line management, appraisal, and informal peer interaction. Boundaries were not strictly demarcated (i.e. staff located outside the qualitative team were already using qualitative methods), but the new team became a central focus for developing a growing programme of work.

Second, individuals and studies were called upon to engage in new ways with qualitative research, and with the qualitative team. A key goal for the Centre was that groups developing new research ideas should give more consideration in general to the potential value and inclusion of qualitative research within their funding applications. Specifically, they were asked to do this by thinking about qualitative research at an early point in their application’s development (rather than ‘bolting it on’ after other elements had been designed) and to draw upon the expertise and input of the qualitative team. An example was the inclusion of questions on qualitative methods within the Centre’s study adoption form and representation from the qualitative team at the committee which reviewed new adoption requests. Where adoption requests indicated the inclusion of qualitative methods, colleagues were encouraged to liaise with the qualitative team, facilitating the integration of its expertise from an early stage. Qualitative seminars offered an informal and supportive space in which researchers could share initial ideas and refine their methodological approach. The benefits of this included the provision of sufficient time for methodological specialists to be involved in the design of the proposed qualitative component and ensuring adequate costings had been drawn up. At study adoption group meetings, scrutiny of new proposals included consideration of whether new research proposals might be strengthened through the use of qualitative methods where these had not initially been included. Meetings of the QRG—which reviewed the Centre’s portfolio of new studies and gathered intelligence on new ideas—also helped to identify, early on, opportunities to integrate qualitative methods. Communication across teams was useful in identifying new research ideas and embedding qualitative researchers within emerging study development groups.

Actions to promote greater use of qualitative methods in funding applications fed through into a growing number of studies with a qualitative component. This helped to increase the visibility and legitimacy of qualitative methods within the Centre. For example, the PUMA study [ 12 ], which brought together a large multidisciplinary team to develop and evaluate a Paediatric early warning system, drew heavily on qualitative methods, with the qualitative research located within the QRG. The project introduced an extensive network of collaborators and clinical colleagues to qualitative methods and how they could be used during intervention development and the generation of case studies. Further information about the PUMA study is provided in Table 3 .

Increasing the legitimacy of qualitative work across an extensive network of staff, students and collaborators was a complex process. Set within the continuing dominance of quantitative methods with clinical trials, there were variations in the extent to which clinicians and other collaborators embraced the value of qualitative methods. Research funding schemes, which often continued to emphasise the quantitative element of randomised controlled trials, inevitably fed through into the focus of new research proposals. Staff and external collaborators were sometimes uncertain about the added value that qualitative methods would bring to their trials. Across the CTR there were variations in the speed at which qualitative research methods gained legitimacy, partly based on disciplinary traditions and their influences. For instance, population health trials, often located within non-health settings such as schools or community settings, frequently involved collaboration with social scientists who brought with them experience in qualitative methods. Methodological guidance in this field, such as MRC guidance on process evaluations, highlighted the value of qualitative methods and alternatives to the positivist paradigm, such as the value of realist RCTs. In other, more clinical areas, positivist paradigms had greater dominance. Established practices and methodological traditions across different funders also influenced the ease of obtaining funding to include qualitative research within studies. For drugs trials (CTIMPs), the influence of regulatory frameworks on study design, data collection and the allocation of staff resources may have played a role. Over time, teams gained repeated experience of embedding qualitative research (and researchers) within their work and took this learning with them to subsequent studies. For example, the senior clinician quoted within the PUMA case study (Table 3 below) described how they had gained an appreciation of the rigour of qualitative research and an understanding of its language. Through these repeated interactions, embedding of qualitative research within studies started to become the norm rather than the exception.

Collective action—operationalising qualitative research

Collective action concerns the operationalisation of new practices within organisations—the allocation and management of the work, how individuals interact with each other, and the work itself. In CTR the formation of a Qualitative Research Group helped to allocate and organise the work of building a portfolio of studies. Researchers across the Centre were called upon to interact with qualitative research in new ways. Presentations at staff meetings and the inclusion of qualitative research methods in portfolio study adoption forms were examples of this ( interactive workability ). It was operationalised by encouraging study teams to liaise with the qualitative research lead. Development of standard operating procedures, templates for costing qualitative research and methodological guidance (e.g. on analysis plans) also helped encourage researchers to interact with these methods in new ways. For some qualitative researchers who had been trained in the social sciences, working within a trials unit meant that they needed to interact in new and sometimes unfamiliar ways with standard operating procedures, risk assessments, and other trial-based systems. Thus, training needs and capacity-building efforts were multidirectional.

Whereas there had been a tendency for qualitative research to be ‘bolted on’ to proposals for RCTs, the systems described above were designed to embed thinking about the value and design of the qualitative component from the outset. They were also intended to integrate members of the qualitative team with trial teams from an early stage to promote effective integration of qualitative methods within larger trials and build relationships over time.

Standard Operating Procedures (SOPs), formal and informal training, and interaction between the qualitative team and other researchers increased the relational workability of qualitative methods within the Centre—the confidence individuals felt in including these methods within their studies, and their accountability for doing so. For instance, study adoption forms prompted researchers to interact routinely with the qualitative team at an early stage, whilst guidance on costing grants provided clear expectations about the resources needed to deliver a proposed set of qualitative data collection.

Formation of the Qualitative Research Group—comprised of methodological specialists, created new roles and skillsets ( skill set workability ). Research teams were encouraged to draw on these when writing funding applications for projects that included a qualitative component. Capacity-building initiatives were used to increase the number of researchers with the skills needed to undertake qualitative research, and for these individuals to develop their expertise over time. This was achieved through formal training courses, academic seminars, mentoring from experienced colleagues, and informal knowledge exchange. Links with external collaborators and centres engaged in building qualitative research supported these efforts. Within the Centre, the co-location of qualitative researchers with other methodological and trial teams facilitated knowledge exchange and building of collaborative relationships, whilst grouping of the qualitative team within a dedicated office space supported a collective identity and opportunities for informal peer support.

Some aspects of the context in which qualitative research was being developed created challenges to operationalisation. Dependence on project grants to fund qualitative methodologists meant that there was a continuing need to write further grant applications whilst limiting the amount of time available to do so. Similarly, researchers within the team whose role was funded largely by specific research projects could sometimes find it hard to create sufficient time to develop their personal methodological interests. However, the cultivation of a methodologically varied portfolio of work enabled members of the team to build significant expertise in different approaches (e.g. ethnography, discourse analysis) that connected individual studies.

Reflexive monitoring—evaluating the impact of qualitative research

Inclusion of questions/fields relating to qualitative research within the Centre’s study portfolio database was a key way in which information was collected ( systematisation ). It captured numbers of funding applications and funded studies, research design, and income generation. Alongside this database, a qualitative resource planner spreadsheet was used to link individual members of the qualitative team with projects and facilitate resource planning, further reinforcing the core responsibilities and roles of qualitative researchers within CTR. As with all staff in the Centre, members of the qualitative team were placed on ongoing rather than fixed-term contracts, reflecting their core role within CTR. Planning and strategy meetings used the database and resource planner to assess the integration of qualitative research within Centre research, identify opportunities for increasing involvement, and manage staff recruitment and sustainability of researcher posts. Academic meetings and day-to-day interaction fulfilled informal appraisal of the development of the group, and its position within the Centre. Individual appraisal was also important, with members of the qualitative team given opportunities to shape their role, reflect on progress, identify training needs, and further develop their skillset, particularly through line management systems.

These forms of systematisation and appraisal were used to reconfigure the development of qualitative research and its integration within the Centre. For example, group strategies considered how to achieve long-term integration of qualitative research from its initial embedding through further promoting the belief that it formed a core part of the Centre’s business. The visibility and legitimacy of qualitative research were promoted through initiatives such as greater prominence on the Centre’s website. Ongoing review of the qualitative portfolio and discussion at academic meetings enabled the identification of areas where increased capacity would be helpful, both for qualitative staff, and more broadly within the Centre. This prompted the qualitative group to develop an introductory course to qualitative methods open to all Centre staff and PhD students, aimed at increasing understanding and awareness. As the qualitative team built its expertise and experience it also sought to develop new and innovative approaches to conducting qualitative research. This included the use of visual and diary-based methods [ 11 ] and the adoption of ethnography to evaluate system-level clinical interventions [ 12 ]. Restrictions on conventional face-to-face qualitative data collection due to the COVID-19 pandemic prompted rapid adoption of virtual/online methods for interviews, observation, and use of new internet platforms such as Padlet—a form of digital note board.

In this paper, we have described the work undertaken by one CTU to integrate qualitative research within its studies and organisational culture. The parallel efforts of many trials units to achieve these goals arguably come at an opportune time. The traditional designs of RCTs have been challenged and re-imagined by the increasing influence of realist evaluation [ 6 , 18 ] and the widespread acceptance that trials need to understand implementation and intervention theory as well as assess outcomes [ 17 ]. Hence the widespread adoption of embedded mixed methods process evaluations within RCTs. These broad shifts in methodological orthodoxies, the production of high-profile methodological guidance, and the expectations of research funders all create fertile ground for the continued expansion of qualitative methods within trials units. However, whilst much has been written about the importance of developing qualitative research and the possible approaches to integrating qualitative and quantitative methods within studies, much less has been published on how to operationalise this within trials units. Filling this lacuna is important. Our paper highlights how the integration of a new set of practices within an organisation can become embedded as part of its ‘normal’ everyday work whilst also shaping the practices being integrated. In the case of CTR, it could be argued that the integration of qualitative research helped shape how this work was done (e.g. systems to assess progress and innovation).

In our trials unit, the presence of a dedicated research group of methodological specialists was a key action that helped realise the development of a portfolio of qualitative research and was perhaps the most visible evidence of a commitment to do so. However, our experience demonstrates that to fully realise the goal of developing qualitative research, much work focuses on the interaction between this ‘new’ set of methods and the organisation into which it is introduced. Whilst the team of methodological specialists was tasked with, and ‘able’ to do the work, the ‘work’ itself needed to be integrated and embedded within the existing system. Thus, alongside the creation of a team and methodological capacity, promoting the legitimacy of qualitative research was important to communicate to others that it was both a distinctive and different entity, yet similar and equivalent to more established groups and practices (e.g. trial management, statistics, data management). The framing of qualitative research within strategies, the messages given out by senior leaders (formally and informally) and the general visibility of qualitative research within the system all helped to achieve this.

Normalisation Process Theory draws our attention to the concepts of embedding (making a new practice routine, normal within an organisation) and integration —the long-term sustaining of these processes. An important process through which embedding took place in our centre concerned the creation of messages and systems that called upon individuals and research teams to interact with qualitative research. Research teams were encouraged to think about qualitative research and consider its potential value for their studies. Critically, they were asked to do so at specific points, and in particular ways. Early consideration of qualitative methods to maximise and optimise their inclusion within studies was emphasised, with timely input from the qualitative team. Study adoption systems, centre-level processes for managing financial and human resources, creation of a qualitative resource planner, and awareness raising among staff, helped to reinforce this. These processes of embedding and integration were complex and they varied in intensity and speed across different areas of the Centre’s work. In part this depended on existing research traditions, the extent of prior experience of working with qualitative researchers and methods, and the priorities of subject areas and funders. Centre-wide systems, sometimes linked to CTR’s operation as a CTU, also helped to legitimise and embed qualitative research, lending it equivalence with other research activity. For example, like all CTUs, CTR was required to conform with the principles of Good Clinical Practice, necessitating the creation of a quality management system, operationalised through standard operating procedures for all areas of its work. Qualitative research was included, and became embedded, within these systems, with SOPs produced to guide activities such as qualitative analysis.

NPT provides a helpful way of understanding how trials units might integrate qualitative research within their work. It highlights how new practices interact with existing organisational systems and the work needed to promote effective interaction. That is, alongside the creation of a team or programme of qualitative research, much of the work concerns how members of an organisation understand it, engage with it, and create systems to sustain it. Embedding a new set of practices may be just as important as the quality or characteristics of the practices themselves. High-quality qualitative research is of little value if it is not recognised and drawn upon within new studies for instance. NPT also offers a helpful lens with which to understand how integration and embedding occur, and the mechanisms through which they operate. For example, promoting the legitimacy of a new set of practices, or creating systems that embed it, can help sustain these practices by creating an organisational ambition and encouraging (or requiring) individuals to interact with them in certain ways, redefining their roles accordingly. NPT highlights the ways in which integration of new practices involves bi-directional exchanges with the organisation’s existing practices, with each having the potential to re-shape the other as interaction takes place. For instance, in CTR, qualitative researchers needed to integrate and apply their methods within the quality management and other systems of a CTU, such as the formalisation of key processes within standard operating procedures, something less likely to occur outside trials units. Equally, project teams (including those led by externally based chief investigators) increased the integration of qualitative methods within their overall study design, providing opportunities for new insights on intervention theory, implementation and the experiences of practitioners and participants.

We note two aspects of the normalisation processes within CTR that are slightly less well conceptualised by NPT. The first concerns the emphasis within coherence on identifying the distinctiveness of new practices, and how they differ from existing activities. Whilst differentiation was an important aspect of the integration of qualitative research in CTR, such integration could be seen as operating partly through processes of de-differentiation, or at least equivalence. That is, part of the integration of qualitative research was to see it as similar in terms of rigour, coherence, and importance to other forms of research within the Centre. To be viewed as similar, or at least comparable to existing practices, was to be legitimised.

Second, whilst NPT focuses mainly on the interaction between a new set of practices and the organisational context into which it is introduced, our own experience of introducing qualitative research into a trials unit was shaped by broader organisational and methodological contexts. For example, the increasing emphasis placed upon understanding implementation processes and the experiences of research participants in the field of clinical trials (e.g. by funders), created an environment conducive to the development of qualitative research methods within our Centre. Attempts to integrate qualitative research within studies were also cross-organisational, given that many of the studies managed within the CTR drew together multi-institutional teams. This provided important opportunities to integrate qualitative research within a portfolio of studies that extended beyond CTR and build a network of collaborators who increasingly included qualitative methods within their funding proposals. The work of growing and integrating qualitative research within a trials unit is an ongoing one in which ever-shifting macro-level influences can help or hinder, and where the organisations within which we work are never static in terms of barriers and facilitators.

The importance of utilising qualitative methods within RCTs is now widely recognised. Increased emphasis on the evaluation of complex interventions, the influence of realist methods directing greater attention to complexity and the widespread adoption of mixed methods process evaluations are key drivers of this shift. The inclusion of qualitative methods within individual trials is important and previous research has explored approaches to their incorporation and some of the challenges encountered. Our paper highlights that the integration of qualitative methods at the organisational level of the CTU can shape how they are taken up by individual trials. Within CTR, it can be argued that qualitative research achieved high levels of integration, as conceptualised by Normalisation Process Theory. Thus, qualitative research became recognised as a coherent and valuable set of practices, secured legitimisation as an appropriate focus of individual and organisational activity and benefitted from forms of collective action which operationalised these organisational processes. Crucially, the routinisation of qualitative research appeared to be sustained, something which NPT suggests helps define integration (as opposed to initial embedding). However, our analysis suggested that the degree of integration varied by trial area. This variation reflected a complex mix of factors including disciplinary traditions, methodological guidance, existing (un)familiarity with qualitative research, and the influence of regulatory frameworks for certain clinical trials.

NPT provides a valuable framework with which to understand how these processes of embedding and integration occur. Our use of NPT draws attention to the importance of sense-making and legitimisation as important steps in introducing a new set of practices within the work of an organisation. Integration also depends, across each mechanism of NPT, on the building of effective relationships, which allow individuals and teams to work together in new ways. By reflecting on our experiences and the decisions taken within CTR we have made explicit one such process for embedding qualitative research within a trials unit, whilst acknowledging that approaches may differ across trials units. Mindful of this fact, and the focus of the current paper on one trials unit’s experience, we do not propose a set of recommendations for others who are working to achieve similar goals. Rather, we offer three overarching reflections (framed by NPT) which may act as a useful starting point for trials units (and other infrastructures) seeking to promote the adoption of qualitative research.

First, whilst research organisations such as trials units are highly heterogenous, processes of embedding and integration, which we have foregrounded in this paper, are likely to be important across different contexts in sustaining the use of qualitative research. Second, developing a plan for the integration of qualitative research will benefit from mapping out the characteristics of the extant system. For example, it is valuable to know how familiar staff are with qualitative research and any variations across teams within an organisation. Thirdly, NPT frames integration as a process of implementation which operates through key generative mechanisms— coherence , cognitive participation , collective action and reflexive monitoring . These mechanisms can help guide understanding of which actions help achieve embedding and integration. Importantly, they span multiple aspects of how organisations, and the individuals within them, work. The ways in which people make sense of a new set of practices ( coherence ), their commitment towards it ( cognitive participation ), how it is operationalised ( collective action ) and the evaluation of its introduction ( reflexive monitoring ) are all important. Thus, for example, qualitative research, even when well organised and operationalised within an organisation, is unlikely to be sustained if appreciation of its value is limited, or people are not committed to it.

We present our experience of engaging with the processes described above to open dialogue with other trials units on ways to operationalise and optimise qualitative research in trials. Understanding how best to integrate qualitative research within these settings may help to fully realise the significant contribution which it makes the design and conduct of trials.

Availability of data and materials

Some documents cited in this paper are either freely available from the Centre for Trials Research website or can be requested from the author for correspondence.

O’Cathain A, Thomas KJ, Drabble SJ, Rudolph A, Hewison J. What can qualitative research do for randomised controlled trials? A systematic mapping review. BMJ Open. 2013;3(6):e002889.

Article PubMed PubMed Central Google Scholar

O’Cathain A, Thomas KJ, Drabble SJ, Rudolph A, Goode J, Hewison J. Maximising the value of combining qualitative research and randomised controlled trials in health research: the QUAlitative Research in Trials (QUART) study – a mixed methods study. Health Technol Assess. 2014;18(38):1–197.

Clement C, Edwards SL, Rapport F, Russell IT, Hutchings HA. Exploring qualitative methods reported in registered trials and their yields (EQUITY): systematic review. Trials. 2018;19(1):589.

Hennessy M, Hunter A, Healy P, Galvin S, Houghton C. Improving trial recruitment processes: how qualitative methodologies can be used to address the top 10 research priorities identified within the PRioRiTy study. Trials. 2018;19:584.

Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350(mar19 6):h1258.

Bonell C, Fletcher A, Morton M, Lorenc T, Moore L. Realist randomised controlled trials: a new approach to evaluating complex public health interventions. Soc Sci Med. 2012;75(12):2299–306.

Article PubMed Google Scholar

O’Cathain A, Hoddinott P, Lewin S, Thomas KJ, Young B, Adamson J, et al. Maximising the impact of qualitative research in feasibility studies for randomised controlled trials: guidance for researchers. Pilot Feasibility Stud. 2015;1:32.

Cooper C, O’Cathain A, Hind D, Adamson J, Lawton J, Baird W. Conducting qualitative research within Clinical Trials Units: avoiding potential pitfalls. Contemp Clin Trials. 2014;38(2):338–43.

Rapport F, Storey M, Porter A, Snooks H, Jones K, Peconi J, et al. Qualitative research within trials: developing a standard operating procedure for a clinical trials unit. Trials. 2013;14:54.

Cardiff University. Centre for Trials Research. Available from: https://www.cardiff.ac.uk/centre-for-trials-research . Accessed 10 May 2024.

Pell B, Williams D, Phillips R, Sanders J, Edwards A, Choy E, et al. Using visual timelines in telephone interviews: reflections and lessons learned from the star family study. Int J Qual Methods. 2020;19:160940692091367.

Thomas-Jones E, Lloyd A, Roland D, Sefton G, Tume L, Hood K, et al. A prospective, mixed-methods, before and after study to identify the evidence base for the core components of an effective Paediatric Early Warning System and the development of an implementation package containing those core recommendations for use in th. BMC Pediatr. 2018;18:244.

May C, Finch T, Mair F, Ballini L, Dowrick C, Eccles M, et al. Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Serv Res. 2007;7:148.

May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology. 2009;43(3):535–54.

Article Google Scholar

May CR, Mair F, Finch T, Macfarlane A, Dowrick C, Treweek S, et al. Development of a theory of implementation and integration: normalization process theory. Implement Sci. 2009;4:29.

Ogrinc G, Davies L, Goodman D, Batalden PB, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality and Safety. 2016;25:986-92.

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.

Jamal F, Fletcher A, Shackleton N, Elbourne D, Viner R, Bonell C. The three stages of building and testing mid-level theories in a realist RCT: a theoretical and methodological case-example. Trials. 2015;16(1):466.

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Acknowledgements

Members of the Centre for Trials Research (CTR) Qualitative Research Group were collaborating authors: C Drew (Senior Research Fellow—Senior Trial Manager, Brain Health and Mental Wellbeing Division), D Gillespie (Director, Infection, Inflammation and Immunity Trials, Principal Research Fellow), R Hale (now Research Associate, School of Social Sciences, Cardiff University), J Latchem-Hastings (now Lecturer and Postdoctoral Fellow, School of Healthcare Sciences, Cardiff University), R Milton (Research Associate—Trial Manager), B Pell (now PhD student, DECIPHer Centre, Cardiff University), H Prout (Research Associate—Qualitative), V Shepherd (Senior Research Fellow), K Smallman (Research Associate), H Stanton (Research Associate—Senior Data Manager). Thanks are due to Kerry Hood and Aimee Grant for their involvement in developing processes and systems for qualitative research within CTR.

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JS contributed to the design of the work and interpretation of data and was responsible for leading the drafting and revision of the paper. SC contributed to the design of the work, the acquisition of data and the drafting and revision of the paper. AL contributed to the design of the work, the acquisition of data and the drafting and revision of the paper. EG contributed to a critical review of the manuscript and provided additional relevant references. JH provided feedback on initial drafts of the paper and contributed to subsequent revisions. JHu provided feedback on initial drafts of the paper and contributed to subsequent revisions. NG provided feedback on initial drafts of the paper and contributed to subsequent revisions. SM was involved in the acquisition and analysis of data and provided a critical review of the manuscript. YM was involved in the acquisition and analysis of data and provided a critical review of the manuscript. MR was involved in the interpretation of data and critical review and revision of the paper. HS contributed to the conception and design of the work, the acquisition and analysis of data, and the revision of the manuscript. JT provided feedback on initial drafts of the paper and contributed to subsequent revisions. LB-H made a substantial contribution to the design and conception of the work, led the acquisition and analysis of data, and contributed to the drafting and revision of the paper.

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Segrott, J., Channon, S., Lloyd, A. et al. Integrating qualitative research within a clinical trials unit: developing strategies and understanding their implementation in contexts. Trials 25 , 323 (2024). https://doi.org/10.1186/s13063-024-08124-7

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Parental experiences of caring for preterm infants in the neonatal intensive care unit, Limpopo Province: a descriptive qualitative study exploring the cultural determinants

Madimetja J. Nyaloko 1 ,
Welma Lubbe 1 ,
Salaminah S. Moloko-Phiri 1 &
Khumoetsile D. Shopo 1

BMC Health Services Research volume 24 , Article number: 669 ( 2024 ) Cite this article

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Parent-infant interaction is highly recommended during the preterm infant hospitalisation period in the Neonatal Intensive Care Unit (NICU). Integrating culturally sensitive healthcare during hospitalisation of preterm infants is critical for positive health outcomes. However, there is still a paucity of evidence on parental experience regarding cultural practices that can be integrated into preterm infant care in the NICU. The study explored and described the cultural determinants of parents that can be integrated into the care of preterm infants in the NICU.

A descriptive qualitative research design was followed where twenty ( n =20) parents of preterm infants were purposively selected. The study was conducted in the NICU in Limpopo using in-depth individual interviews. Taguette software and a thematic analysis framework were used to analyse the data. The COREQ guidelines and checklist were employed to ensure reporting standardisation.

Four themes emerged from the thematic analysis: 1) Lived experienced by parents of preterm infants, 2) Interactions with healthcare professionals, 3) Cultural practices concerning preterm infant care, and 4) Indigenous healthcare practices for preterm infants.

Conclusions

The study emphasised a need for healthcare professionals to understand the challenges parents of preterm infants face in NICU care. Furthermore, healthcare professionals should know indigenous healthcare practices to ensure relevant, culturally sensitive care.

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Introduction and background

Parenting is an intricate process involving the upbringing and caring for a child from infancy to adulthood through promoting and supporting the child’s physical, emotional, social, and intellectual development [ 1 ]. This process becomes challenging, particularly when it involves preterm infants admitted to the hospital [ 2 ]. The birth of a preterm infant can be an epoch-making, evocative, and occasionally devastating parental experience [ 3 ]. A preterm infant is defined as a child born before the 37 th week of pregnancy is completed [ 4 ]. Annually, approximately 15 million preterm births are documented out of 160 million live births, accounting for an 11.5% global preterm birth rate [ 5 ]. Between 2010 and 2020, more than 60% of global preterm births occurred in South Asia and Sub-Saharan Africa [ 5 ]. One in every seven infants in South Africa was born before their due date and required NICU admission [ 5 ].

The NICU is typically a foreign and intimidating environment for parents, due to the need for continuous monitoring and medical intervention for infants who are fragile and sick. Parents can experience stress, guilt, anxiety, and sadness due to the infant's uncertain health prognosis [ 6 ]. The active involvement of parents in preterm infant care activities in the NICU is crucial for infant developmental outcomes [ 7 ]. Healthcare professionals should comprehend the parental experience of caring for a preterm infant in the NICU to address parental needs and enhance parent-infant interaction and attachment [ 8 ]. This interaction may in turn increase parental satisfaction, thus promoting more appropriate parent-infant interaction, including attachment and bonding [ 9 ].

Although parent-infant interaction is beneficial, cultural variables need to be acknowledged. Parenting is deeply rooted in a culture characterized by ideologies concerning how an individual should act, feel and think as an in-group member [ 10 ]. Therefore, the parental involvement and parent-infant interaction might be disrupted if the parental cultural practice is not considered. Cultural practices influence the parents' infant care approach [ 11 , 12 ]. The values and ideals of culture are conveyed to the next generation through child-rearing practices, which implies that cultures are contextually sensitive parenting guidelines [ 13 ].

Parents of preterm infants in Limpopo Province, South Africa, come from various cultural backgrounds, which may influence how they understand and react to the care provided to their preterm infant in the NICU. Various childrearing practices associated with culture influence the health of preterm infants [ 14 ]. These practices include massaging the baby, applying oil to the eyes and ears, burping the baby, applying black carbon to the eyes, and trimming the nails. Parental involvement in preterm infant care in the NICU may also be influenced by culture [ 15 ]. The cultural views and ideas of healthcare professionals can potentially affect the standard of care offered to preterm infants and their parents in the NICU. These cultural views and ideas are health beliefs that explain the cause of illness, its prevention or treatment methods, and the appropriate individuals who should participate in the healing process [ 16 ].

Healthcare professionals who have a comprehensive understanding of the parental cultural determinants can facilitate the nurturing and promoting of adequate parental-infant care and interaction, which is the foundation for developing preterm infants [ 17 ]. Lack of support from healthcare professionals regarding the cultural aspects of parent-infant interaction may negate parents' cultural practices, and increase negative perceptions and dissatisfaction with the healthcare service provided in the NICU [ 17 ]. Consequently, this may result in a lack of parental awareness or responsiveness to the infant, associated with delayed infant cognitive development and multiple behavioural problems [ 18 ].

Despite the recognition of the importance of parental involvement in NICU care and the documented emotional challenges experienced by parents, there is a gap in the literature regarding the specific experiences and cultural practices of parents caring for preterm infants which can be integrated in NICU in settings, such as Limpopo Province in South Africa. The province has seen a significant increase in the number of newborn babies weighing under 2,500 grams in recent years [ 19 ]. The study aimed to explore and describe the cultural determinants of parents that can be integrated into the care of preterm infants admitted to the NICU in Limpopo Province to ensure culturally sensitive care. This study is unique due to its focus on South Africa, specifically Limpopo Province, which is the centre of cultural practices due to its rurality. The main research question was: 'What are the cultural determinants which influence the parental experience that can be integrated into the care of preterm infants in the NICU in Limpopo Province?

The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was followed to ensure standardisation in reporting the study type, design, execution, analysis, and results [ 20 ].

The study applied a qualitative research design following a descriptive approach [ 21 ]. In-depth individual interviews were used to explore and describe the experiences of parents of preterm infants admitted to the NICU in Limpopo Province through a cultural determinant lens.

The current study was conducted in the NICU of a tertiary hospital in Limpopo Province, South Africa. Limpopo Province was selected based on two grounds: 1) Cultural practices are more evident in rural villages than in semi-urban or urban settings [ 22 ], 84.2% of the study population live in rural areas [ 23 ]; and 2) one in every seven infants is born before its due date in South Africa [ 5 ], the Limpopo Province accounts for high preterm birth rates [ 19 ].

Participants and sample

The population comprised mothers of a preterm infant admitted to the NICU. For this study, a parent was defined as the mother of a preterm infant in the NICU. Purposive sampling was used to select twenty ( n =20) participants from the NICU in a tertiary hospital [ 24 ]. The inclusion criteria required that 1) the participant be the parent of a preterm infant; 2) the parent had a preterm infant in the NICU for a minimum of two weeks (As set out by the researcher, the contextually relevant time for an immersive experience was two weeks); 3) the parent be able to speak either Sepedi, Xitsonga, Tshivenda, or English (the common local languages). Mothers of preterm infants who were in critical condition were excluded. There were no refusals to participate. The sample size was determined based on data saturation, which was reached with n =20 participants [ 25 ].

Recruitment

The first author (Ph.D.) and an independent person recruited the participants face-to-face by distributing recruitment material such as flyers and asynchronously by displaying posters on the noticeboards in the selected hospital's NICU and a place where the mother lodge in the hospital. Recruitment was conducted after ethical approvals and permission from the hospital were granted. Participants who expressed interest in the study notified the first author through a phone call, SMS, or WhatsApp text message. The first author then contacted the potential participants to provide detailed information regarding the study aim and data collection method, including audio recordings of interviews, confidentiality agreements, written informed consent, and voluntary participation. Potential participants who showed interest were given an informed consent form and a minimum of 48 hours to consult and inform their partners or family members. The first author was accessible telephonically for any clarity-seeking questions. The first author contacted the agreed participants to schedule the hospital-based interviews on the agreed-upon dates. All consented mothers participated and there were no withdrawals.

Data collection

The interview guide was developed for this current study in English, and translated to local languages (Sepedi, Xitsonga, and Tshivenda) by assistant researchers who are fluent with these respective languages. Three bilingual speakers (Sepedi, Xitsonga, and Tshivenda) checked the translations from English to these local languages for accuracy, which was endorsed. Furthermore, the interview schedule was piloted with two participants to assess its effectiveness and suitability (See supplementary document 1). Pilot study was instrumental in refining the interview guide and ensuring that it would yield the desired data during the primary study. The in-depth interview began with an open-ended question, as shown in Table 1 below.

The data was collected between August and September 2022. In-depth individual interviews were conducted by the first author and assistant researcher using Sepedi, Xitsonga, Tshivenda, or English in a private room in the hospital to ensure confidentiality. COVID-19 precautionary measures were followed to protect the health and safety of participants and interviewers. Furniture was wiped with a 70% based-alcohol solution before and after each interview, chairs were spaced 1.5 meters apart to ensure adequate social distance and researchers and participants sanitised their hands before entering and exiting the room. Participants and the interviewer wore a surgical facial mask covering the nose and mouth throughout the interview.

The first author served as the lead interviewer, the assistant researcher functioned as a support system in case of a language barrier. The interviews were conducted in the participant's preferred language (Sepedi, Xitsonga, Tshivenda, or English). The interviewer used probing questions to encourage the participants to elaborate, and all other questions arose from the dialogue. The duration of each interview was between 45 and 65 minutes.

With the participants' permission, two audio recording devices were used to record each interview, whereby one served as a backup in case the main one defaulted. During each interview, the first author compiled field notes regarding the context, non-communication cues, and impressions to complement the recorded audio. Data collection continued until no new data emerged, whereby data saturation was declared. All the interviews were conducted at the hospital.

After data collection, the first author and assistant researchers transcribed the data verbatim, including field notes in English. The researchers' subjective experiences regarding the explored phenomenon were described to avoid influencing data analysis: a process termed bracketing [ 26 ]. Three bilingual speakers (Sepedi, Xitsonga, and Tshivenda) checked the translations to English transcriptions for accuracy against the audio recordings. Additionally, two transcripts (10% of the sample) were back translated, and accuracy was verified by an independent co-coder and two co-authors [SSM, KDS]. No substantial linguistic issues were identified during the translation process.

Data analysis

Giorgi's data analysis method [ 27 , 28 ] was applied to comprehend the essence of the experiences of parents of preterm infants in the NICU. The data analysis process constituted five steps: understanding raw data, constructing a constituent profile, forming a theme index, merging participants' theme indexes, and searching the thematic index to develop interpretive themes.

Trustworthiness

The four criteria of Lincoln and Guba [ 29 ] were applied to establish the trustworthiness of the current study. Credibility was established by member checking with 10% of the sample ( n =2) by sending the transcript and developed themes. The supervisors (experts) conducted a confirmability audit of the study project by checking and rechecking the collected raw-, coded- and interpreted data to affirm neutrality. Additionally, the study followed a rigorous descriptive qualitative method and underwent a peer review process that confirmed the consistency of the data, and the findings ensured dependability, while data saturation and a detailed description of the methodology ensured transferability.

Demographic data

Twenty ( n =20) mothers of preterm infants admitted to the NICU in a tertiary hospital participated in this study. The participants’ ages ranged from 18 to 39 years, with the majority being between 18 and 25. The majority of parents had three children. Regarding education, nine participants had a secondary-level education, and 11 had a tertiary education. Of the 20 participants, nine were unemployed, two were self-employed, one was fully employed, one was employed part-time, and seven were students (Refer to Table 2 ).

Emerging themes and sub-themes

Four main themes emerged from the data analysis. These were: lived experienced by parents of preterm infants, interactions with healthcare professionals, cultural practices concerning preterm infant care, and indigenous healthcare practices for preterm infants. These themes, supported by sub-themes, are outlined in Table 3 .

Theme 1 lived experienced by parents of preterm infants

The current study's first theme emerged as the lived experienced by parents of preterm infants. Parents experienced considerable challenges while caring for the preterm infants in the NICU. Lived difficulties experiences by parents are further explored through the sub-themes: stress and exhaustion, and longing for home.

Sub-theme 1.1 stress and exhaustion

Participants felt an overwhelming sense of exhaustion and stress, as they cared for their infants in the NICU. Participant responses revealed a pervasive fear of the unknown, coupled with emotional turmoil and physical strain. The uncertainty surrounding the health of their infants exacerbates their distress, leading to heightened anxiety and feelings of helplessness. This emotional burden is compounded by the challenges of navigating complex medical information and coping with unexpected health complications. Participants expressed shock, describing the unexpected event of preterm birth and the overwhelming emotions following the delivery of a preterm infant.

One participant reported:

We are always scared when we go to see babies because we don't know what it is, especially when you leave the baby without the tube; you think she may vomit when you are not around, and the next thing you will be receiving a call saying your baby is no more. (P1, 18-year-old)

Participant 1's expression of fear illustrates the constant apprehension experienced by mothers in the NICU, highlighting the emotional strain of anticipating potential emergencies and adverse outcomes. Another participant indicated the overwhelming uncertainty faced by the mothers upon entering the NICU, emphasizing the need for clear communication and reassurance from healthcare providers. The following quote supports the participant’s experience:

What if they tell me the situation is like this when I enter there? Honestly speaking, it frightens us. We just wish that it didn't ring so that when you get there, they tell you that they needed you so and so . (P2, 25-year-old)

Another participant highlighted the shock and fear induced by the sight of an extremely premature infant, illustrating the emotional toll of witnessing their vulnerability.

This baby, she was too small, like it was the first time seeing a small child like this. I once saw premature, but it was not like this, this one was so small, so I was scared. (P4, 24-year-old)

Another participant described her emotional response to distressing news about her baby's health which underscores the profound impact of medical uncertainties on maternal well-being, emphasizing the need for sensitive communication and support.

When they told me that my baby was like this and this, I even cried. (P10, 39-year-old)

Additionally, other participant’s narrative reflected the overwhelming fear and uncertainty experienced by mothers in the NICU, highlighting the emotional toll of constantly anticipating adverse outcomes and navigating complex medical situations. The following quotes reflect the participants’ experiences:

What I'm dealing with, because I was very broken and did not know what it is, will the baby survive, what will she do, what's going to happen. The answer is not right, as, for us, we are always afraid, we don't know what it is when you are here. (P17, 23-year-old)

Sub-theme 1.2 longing for home

The emotional strain and challenges faced by mothers while caring for their infants in the hospital setting evoke a profound yearning for the sense of security, comfort and belonging that home provides. The participants described their experience of not getting enough rest and sleep while caring for their preterm infant in the NICU which would not happen if they were home. Contributing factors include the time required to visit the NICU for the infant’s care routine, time spent walking from the mother's lodge to the NICU and back, and the separation of mother and infant.

The participant reflected on the contrast between hospital practices and what would have been done if she were at home:

Yes, here in the hospital, they want you to bathe the baby like this while at home they want you to do this and this or at home, you would do this when you see him doing that. It's things I want to know. (P5, 38-year-old)

This quote encapsulates the longing for the familiar routines and comforts of home amidst the unfamiliarity of hospital protocols. It highlights the sense of control and autonomy associated with home, where individuals adhere to their own customs and practices, as opposed to the regulated environment of the hospital. Another participant reminisces about cultural practices that would have been observed in her home environment:

Yeah, like mostly, like back at home, in our culture, we believe that a baby less than a month old must be bathed by the mother or grandmother... If I was at home, I will be feeding her with soft porridge without giving her any medications because this medication makes her defecate twice a day or so and this makes her lose weight. (P7, 32-year-old)

This excerpt emphasises the role of cultural traditions and familial support in shaping caregiving practices. It underlines the interconnectedness between home and cultural identity, where adherence to traditional customs provides a sense of security and belonging, particularly in the context of new-born care. Furthermore, another participant described the traditional approach to newborn care back home:

No, after birth when I come home, we don’t bathe the baby right away, we dampen the cloth in lukewarm water and just wipe the baby where he is dirty. We wash the head because the hair traps a lot of dirty things (blood and birth secretions), we avoid the full bath so that we don’t expose the baby to flu. (P18, 20-year-old)

Other participants compared hospital feeding methods with traditional practices at home. The participants reported that:

Here we feed the baby with breast milk using pipes (NG tubes and syringes) but at home, we do a light and very soft porridge. (P16, 38-year-old)

This comparison highlights the adaptation to different environments and the longing for familiar routines. It shows how home serves as a sanctuary where individuals adhere to their preferred methods of infant care, reinforcing the notion of home as a place of comfort and familiarity. Other participants expressed a longing for the comforts of home and the familiar routines:

So, the first challenge is that we wake up. We only sleep two hours. Most of the time we spend on the way, we do not have time to rest. Like when you are going that way, you may find that you are going for a long time in the baby’s room. When you are coming here, and you try to sleep, time is gone, you must go back. (P14, 39-year-old)

This statement reflects the desire for a sense of normalcy and routine amidst the challenges of hospitalisation. It highlights the idea that home represents a heaven of rest and recuperation, where individuals can adhere to their preferred practices and routines, particularly during significant life events such as childrearing.

Theme 2 interactions with healthcare professionals

In this study, interaction is perceived as communication and involvement in preterm infant care among healthcare professionals and parents of preterm infants in the NICU. The sub-themes included NICU care, communication, and healthcare professional attitudes.

Sub-theme 2.1 care in NICU

This sub-theme concerns how healthcare professionals cared for preterm infants and their parents in the NICU. Some indicated that they received adequate care from nurses and doctors in the NICU.

One participant indicated that:

The doctors are mostly here; they used to come only to check and update [us] about the baby's condition. The people who take part mostly are the nurses. Okay, looking at the ICU there is no problems, all is right. (P02, 25-year-old)

A similar view was echoed by another participant who stated:

Yes, they help me take care of the baby, and the doctors are nearby if there is something the doctor and nurses can help with. (P13, 22-year-old)

Another participant shared that she had only seen good things and is at peace with the care that she is receiving in the NICU:

In [N]ICU I have not seen any bad things; I only noticed the good things. My baby was in troubles, but she is not well, nurses are checking her every time so does the doctors. So up to so far, I never had any problems with nurses and doctors. I am at peace. (P18, 20-year-old)

However, one participant expressed dissatisfaction with the care she received in the NICU. The following quote confirms this:

They end up swearing at us and to be treated this way, been shouted, it ends up affecting our minds since I already have a problem with my baby’s condition. (P12, 28-year-old)

The participants’ responses highlight that they experienced positive and negative care while looking after their preterm infants in NICU; it appears that they appreciated the care, although some were unhappy.

Sub-theme 2.2 communication in NICU

Nearly all parents mentioned the importance of healthcare professionals practising effective communication as clinicians. In this context, communication is the exchange of information between parents of preterm infants and healthcare professionals in the NICU. The parents indicated that they had experienced satisfactory communication with healthcare professionals while caring for their preterm infant in the NICU. This includes comprehensive explanations; for instance, the doctor offered information regarding the baby's weight decrease in terms that parents could comprehend, giving them relief. The following quotes support the experience:

Yes, is not it that when we come here, we are under stress? So, if we want to say sister (nurse), may I ask, how is my baby doing? She can answer me; if she does not know, she must go and ask or tell me that I do not know about this one. I can ask someone who knows, like have good communication. (P17, 23-year-old)

Yes, the same doctor that I ask him regarding the baby’s weight loss. He explained to me well and now I understand, am free because the weight is no longer 0.8 kg, it is now around 1.0 kg. The support is good because when you ask something they quickly actioned it, so there is support. (P18, 20-year-old)

The above participants highlighted the importance of efficient communication in interactions between parents and healthcare professionals in the NICU and its positive effects on parents’ experiences and well-being. Nevertheless, other participants expressed dissatisfaction with the communication they received from the healthcare professionals in the NICU. One of the cited reasons for their dissatisfaction was that healthcare professionals discussed the infant's condition in a language the parents did not understand.

One participant mentioned that:

They asked me if I knew why my baby went to the theatre? What is the reason he came here? I said yes; I just heard them saying it is the authority which I do not know what they meant. (P06, 23-year-old)

Similarly, other participants expressed disappointment that healthcare professionals were not informing them about the interventions/procedures before implementation. The following quotes support the parental disappointment:

We do want to know because when we arrive in the ward, we just see that intravenous lines were inserted, and blood sample were collected, and we also see that the infant was pricked several times on the extremities hence do not even know where the samples are taken to. (P16, 38-year-old)

It is the same as when he was in high care because after labour, my baby was sent to high care, and the next morning he was in ICU without informing me. (P19, 23-year-old)

Moreover, another participant mentioned feeling confused because of the conflicting communication from healthcare professionals. The following quote supports this confusion:

The other one enters tells you the baby should change sides and give you reasons. When you tell them one said I should not change sides, they end up swearing at us end up confusing us. (P12, 28-year-old)

Participants highlighted the negative impact that poor communication could have on their experience in the NICU, as well as the significance of simple and consistent communication with healthcare professionals. They expressed a desire for precise, reliable information to understand what was happening to their preterm infants and to feel more involved in the care of their infants.

Sub-theme 2.3 attitude of healthcare professionals in NICU

The participants in the study expressed dissatisfaction with the attitudes of healthcare professionals in the NICU, as illustrated by the two quotes below:

When you go to the nurse and tell her that the tube is disconnected from the baby and the secretions are coming out through the nose, so the response will be like, what do you want me to do because your baby did that (mother rolling the eyes)? (P01, 18-year-old)

Okay there was this nurse who was on a night shift yesterday and she was busy with files, and when we wanted to ask her to collect some of the things for us, and she would say to us that we must go collect those things for ourselves because she is busy. So, when we got there to collect for ourselves, we found another nurse who asked us as to where our nurse is because we should not be doing this for ourselves. So, when we called her, she showed to me that she does not like her job. (P08, 31-year-old)

Another participant further mentioned that:

There is a nurse that seemed to have an advanced age, whenever we ask her to assist our babies, or asking some supplies to help our babies she is rude. She once told me that [my] babies are ugly such like me. (P20, 19-year-old)

More so, some mothers lamented the lack of communication from the nurses. For example

Their communication is not good because they hide things from us, sometimes you will find that they had taken your baby’s blood and not tell you about the results or what the results implies, and even when you ask the nurses, they would tell you that they are doing what they have been instructed to do. Sometimes you also find your baby inserted with drip, and when you ask, they do not say or explain the reason for all of these. (P08, 31-year-old)

Even though other participants expressed their dissatisfaction regarding the attitude of the healthcare professionals, other participants felt the opposite. One participant mentioned that she had a satisfactory relationship with the healthcare professionals expressed in the quote:

I am pleased with how the hospital is providing her with milk, yes, I am happy they help. (P12, 28-year-old)

Similarly, another participant added that she has only observed good things concerning the level of service provided to her infant:

In [N]ICU I haven’t seen any bad things; I only noticed the good things. (P18, 20-year-old)

Most parents expressed satisfaction with the level of support provided by the healthcare professionals in the NICU. The participants describe the support as encouraging and helping them to understand that challenges are a normal part of the process, as indicated by the below quotes:

Yes, their support is good. It is the kind of support that encourages you to understand that things like this are there and there are these kinds of challenges. (P07, 32-year-old)

Additionally, another participant alluded that:

The support from the nurses is very good, each one of them know me because I have been here for a long time. When they arrive, they call and ask how is the baby [doing]? Initially it was scary because my baby was the smallest one in the unit, and I was new but now am used to the nurses and the unit. (P18, 20-year-old)

Theme 3 cultural practice concerning preterm infant care

The third main theme was the cultural practices concerning preterm infant care. This study's concepts associated with this theme include practices and behaviours conducted after childbirth. This includes the infant naming practice, infant access restrictions, family involvement, and religious practice observance.

Sub-theme 3.1 infant naming by senior family members

Participants indicated that they adhere to the cultural practices of naming the preterm infant after birth. These cultural practices include understanding who is responsible for naming the infant, introducing the infant to the ancestors, and the meaning associated with the name given. The quotes show that senior family members, particularly grandmothers, are responsible for naming the infant and performing ancestral veneration to introduce the infant to the ancestors after birth.

One participant shared that:

If the granny [was] still alive, she [would be] the right [person] to appoint my parent to name the infant. (P02, 25-year-old)

Another participant supported the preceding statement by stating:

Well, when I call them at home regarding the name, my grandmother would want her name to be passed down to the child. (P08, 31-year-old)

The above data highlight that the grandmothers are responsible for naming the infants. This is because naming a preterm infant in Limpopo Province is culturally associated with the practice of ancestral communication, which grandmothers perform. Furthermore, one participant indicated that the infants are named based on various events in life. The following quotation illustrates this:

Because they used a dead person's name, so they are informing the owner of the name that there is someone who will use it. (P02, 25-year-old)

The above quote highlights the belief that a preterm infant is given the name of a deceased person to keep their memory alive and to ensure the continuation of a family legacy. Also, ancestral communication rituals should be performed to inform the name's owner. In addition, another participant indicated that infant naming is culturally essential and that a misnamed infant will continuously cry. The following quotation evidences this belief:

They do that; for example, they can call a baby by name like Sara, and if the baby stops crying, it means that is the name she wanted. And these things happen because they can call her by her name; the baby then stops crying and is healed instantly. (P01, 18-year-old)

The above data suggest that naming a preterm infant may positively affect the infant’s health and well-being when culturally informed. The beliefs and practices related to naming a preterm infant reflect the cultural values and traditions of the parents, which are essential considerations in providing culturally sensitive care in the NICU.

Sub-theme 3.2 infant access restrictions

Participants indicated that everyone is not permitted access to the room where the preterm infant is kept. Access restrictions include funeral attendees, pregnant women and individuals who recently engaged in sexual activities. The following section further explores how participants perceived these restricted individuals as harmful to the infant through a cultural lens based on their experiences during preterm infant care. A common experience for many participants was that individuals who participated in funeral services should perform cultural rituals with ashes and some aloes when entering, as illustrated in the following quotes.

They [those attended the funeral] enter the baby's room, they bath the baby with aloe and ashes a little bit and even on the joints so that she must never get sick. (P01, 18-year-old)

Usually, when they are from a funeral, they take ashes, apply them to the baby and make her swallow a bit of it so that they do not suppress her. (P02, 25-year-old)

An additional participant concurred with the preceding participants and elaborated that:

According to culture all babies from newborn to a child aged 6 to 7, when one person at home goes to the funeral, when that person comes back home takes ashes and rub it on the tummies of all these age group so that none of them can get suppressed or have negative auras. (P20, 19-year-old)

The data highlight the cultural belief that there are diseases and negative auras that can be acquired from funeral services and that precautionary measures must be taken to prevent the spread of these harmful elements to the preterm infant. In addition to the precautionary measures highlighted above, other participants explained that people who attend funerals should be isolated from the infant for some period before regaining access to the infant's room, as illustrated by the two quotes below:

I am staying with my grandmother, but if they are from the funeral, it means only I will nurse the baby. They will take seven days without entering the baby's room. (P04, 24-year-old)

She [person attended the funeral] must stay there for seven days before she returns, and after that, she can come back and help me with the baby. (P11, 27-year-old)

The above quotes indicate that isolating individuals who attended the funeral service for seven days will allow the acquired diseases and negative auras from the funeral to clear up and minimize the chances of transmission to the infant. Pregnant women were the second restriction. The following quotes illustrate beliefs and practices surrounding the presence and interactions of preterm infants and pregnant women:

Traditionally, we think she will suppress the baby. If a pregnant person carries the baby, she will delay the baby's growth. You find that at around six months, the baby is still unable to sit, so they believe it is because a pregnant person carried the baby. She is not supposed to enter the baby's room until the baby gets out. (P02, 25-year-old)

Another participant said:

If someone is pregnant, she is not supposed to hold a baby in such a way that the legs of the baby are on [her-pregnant woman] abdomen because we believe that if the baby's legs are stepping on top of the pregnant person's abdomen, the baby won't walk until the pregnant woman give birth, she will wait for the unborn baby to be born before she can walk. (P01, 18-year-old)

The first quote highlights the complete restriction of pregnant women from gaining access to the infant due to the negative impact (slow growth) that she can have on the infant. However, the second quote indicated that a pregnant woman can be granted access to the infant’s room and can even carry the infant, although with precautions not to allow the infant’s leg to come in contact with the abdomen. Through this analysis, it becomes clear that cultural beliefs and practices play a substantial role in shaping the experiences of pregnant women and their interaction with preterm infants. The final restriction was holding the infant after sexual intercourse. Most participants revealed a common belief that sexual intercourse could lead to the transfer of a negative aura to the infant. The following quote exemplifies this belief:

When the cord has not yet fallen, my grandmother is the only person who is allowed to enter because she has passed that stage of sexual intercourse. The rest of them are not allowed because we are trying to avoid negative aura to be passed on to the child, and if that happen, he will cry a lot. So, no one is allowed except my grandmother. (P08, 31-year-old)

Other participants stated, in support of the preceding statement:

They [siblings] might be coming from their partners and you would find that they were intimate in a way, so their energies will affect the baby negatively. (P09, 30-year-old)

Because they [grandmothers] do not have sexual intercourse anymore and they have experience. Culturally, it is believed that people who had sexual intercourse had negative aura. (P16, 38-year-old)

The data suggest that the role of grandmothers in caring for preterm infants is essential and safe as they are free of negative energies due to their age, experience, and abstinence from sexual intercourse. Furthermore, the data highlights that individuals who engage in sexual intercourse bring negative auras to the baby and are, therefore, not allowed to be in close proximity to the newborn. This cultural practice aims to ensure the well-being and health of the preterm infant by avoiding contact with individuals who have recently engaged in sexual intercourse.

Sub-theme 3.3 family involvement

Cultural practices concerning preterm infant care restrict infant access and allow family members to assist in caring for the infant. The following quotations illustrate participants' experience regarding family involvement while caring for the infant.

One participant stated that:

When I am here, the nurses help me, which is the same when you are at home. There is no difference. (P11, 27-year-old)

Another participant expressed a similar view:

It is very important because when you get help as a new mom you also get time to rest, in my family they would bathe the infant and massage you. (P12, 28-year-old)

In support of the above participants, another participant added that:

At home it is better because we have people who are assisting us, and we have time to rest (P16, 38-year-old)

The conclusion that can be drawn from these findings is that the involvement of family members in caring for the infant enabled the mothers to rest rather than continuously caring for the infant alone, which may be exhausting.

Sub-theme 3.4 religious practices observance/beliefs

In context of this study, most parents were religious and observed religious practices in terms of prayer and using ditaelo (church prescriptions - the church practices believed to be effective in curing the patient and preventing misfortune). This is connected to the belief that their infants would be protected from illness and be healthy, parents would be strengthened, and healthcare professionals would be granted wisdom to care for the infants. Most parents prayed to God for their preterm infant to get better and be healed. The following quotes illustrate this:

I just thought my baby is going to die but because God is present, I prayed I got baby boy. Now I thank God because of my faith and even the doctors had confidence that the baby will be okay. (P18, 20-year-old)

I pray every time I go to the ward for God to give her life and when I leave, I do not know what they will do to her, to not be affected when a lot of activities are done to her body. (P02, 25-year-old) Furthermore, parents also prayed for themselves and drew strength from their spiritual anchor to overcome the challenges they experienced while caring for their preterm infant in the NICU.

I have a way of overcoming my fears and sadness through prayer so that I can be able to receive strength . (P11, 27-year-old)

Other participants also highlighted this. For example, one participant indicated that:

When I am down, I pray for 2 minutes and ask God for strength. Then after, I feel okay. (P02, 25-year-old)

Moreover, participants did not only pray for themselves and their infants but also for healthcare professionals to have wisdom while caring for their infants. The following quotes demonstrate this intercession:

I believe that is the reason I prayed, because evil spirits can block the doctors view for them not see anything. (P12, 28-year-old)

Until now I just pray to God to give wisdom to doctors so that they treat my baby well then, I can go home. (P18, 20-year-old)

Lastly, one participant believed that prayer is more effective when performed in person, in the presence of others, rather than done alone. The participant stated that:

I prefer that when I pray, I must be there with two or more people because the prayer becomes more powerful when you are many. (P11, 27-year-old)

These findings highlights that the communal aspect of religious practices is vital for some individuals and that they believe that the power of prayer is amplified when performed with others. The quotes in this analysis indicate that the participants view prayer as connecting with a higher power, seeking strength, wisdom, and healing for themselves and the preterm infant in their care. Another aspect of religious practice, observance/practice called ditaelo , was also used to protect their infants from evil spirits and heal them.

Theme 4 indigenous healthcare practices for preterm infants

The final theme from the data analysis was “indigenous healthcare practices for preterm infants,” which parents described as the beliefs, knowledge, and habits about health passed down from generation to generation in a specific community. This theme is further explored through the following four subthemes.

Sub-theme 4.1 cultural practices used for cleaning the umbilical cord

Most participants believed that the indigenous care method for the umbilical cord is a vital cultural practice related to preterm infant care. Although the participants used surgical spirit in the NICU, they expressed the practices of using various herbal formulations that they would like to incorporate in the NICU during umbilical cord care. The following quotes reflect this.

I take table salt with that powdered wood soot and apply it [umbilical cord] on the cord every time you bathe the baby until it dries. (P10, 39-year-old)

We took soil from termite mound, chickens’ manure and placed them there for it to fall. (P12, 28-year-old)

Additionally, the same view was echoed by other participants, explaining that:

The herbs will shrink the cord, which will eventually fall off. After that, they will give you herbs to spread over the cord area, which will help the cord to close from inside. I was using the ashes to mix with Vaseline, then spread the mixture over the cord. (P15, 32-year-old)

We clean the cord with surgical spirit. Then we also use the head from the ‘matches’ stick and mix with the mouse poo and crush it down until is a fine powder. Then we apply the fine powder on the cord area. (P20, 19-year-old)

In addition to the various preferred herbal formulations, other participants mentioned that they apply breastmilk on the umbilical cord to increase the rate at which it dries. This is evident in the following quotes:

We do a full bath after two days with warm water, then clean the cord with the spirit, and apply breast milk so that the cord can dry and fall fast. (P18, 20-year-old)

They say we pour breast milk on the cord, like basically the newborn baby we need to apply the breast milk when I wake up in the morning, on the belly button. (P17, 23-year-old)

Furthermore, despite using surgical spirit in the NICU, participants were dissatisfied with its effectiveness. Most mothers felt that the delayed umbilical cord drying, and detachment were caused using surgical spirits.

One participant mentioned:

The way of taking care of children here is different; for instance, the surgical spirit is not so effective in cleaning and making the cord dry. The cord would have fallen by now if I was home. (P05, 38-year-old)

Another participant expressed that:

With home remedies it takes up to three days but with the surgical spirit, it takes seven days. It is fast if you do it traditionally. (P13, 22-year-old)

In support of the above participant, another participant further explained that:

We are staying with elderly people at our homes, so immediately after the baby is born, we start by treating her umbilical cord, which, culturally or religion-wise, is much faster than what we use here at the hospital, because even here at the hospital, they treat the cord by spreading spirit on the cord, but it takes time. (P14, 39-year-old)

Sub-theme 4.2 treatment of dehydration “ phogwana or lebalana ”

Some illnesses experienced by newborns are deemed to be not-for-hospital treatment but require indigenous healthcare practices or treatment. For example, dehydration is an indigenous childhood illness called phogwana, which traditionalists treat through herbal formulations. Other participants were concerned that their infant might suffer from phogwana while admitted to the NICU.

Maybe if I do things the way I am used to doing on the baby, he might recover, or maybe the baby has phogwana, and the doctor thinks it is something they can treat. (P06, 23-year-old)

The following participant echoed a similar notion in support:

When the baby is sick with lebalana, you do not take the baby to the hospital because they do not know how to treat that. You take her to someone. In Tshivenda, we say when the baby has lebalana, they must cut, burn things that came out of it, and then come to the baby… then the baby heals at the same time. (P17, 23-year-old)

Furthermore, participants shared that phogwana needs to be treated by a traditional healer or with traditional medicine. This is evident in the following quote.

If the phogwana is not beating well, there is a traditional medicine that we apply to make sure that it does not affect the baby. (P16, 38-year-old)

Sub-theme 4.3 care of eyes, ears, and nose

The subtheme of "care of eyes, ears, and nose " within the major theme of indigenous healthcare practices for preterm infants is represented by traditional methods of addressing issues related to the eyes, ears, and nose. Most participants reported using breast milk to clean and treat minor ailments of the eyes, ears, and nose.

Most of the time we use breast milk to take care of their eyes, and that even allows them to sleep peacefully, we take few drops of our breast milk and pour them inside his eyes. (P08, 31-year-old)

Another participant added that:

If the eyes are having discharge, we express breast milk inside the eyes and wipes it using the tongue to remove the discharges. (P16, 38-year-old)

In addition to using breast milk for eyes, it was reported to treat blocked nostrils and common flu and clean the umbilical cord, as reflected in the following quotes.

Breast milk works especially when the eyes are white or having the discharges. Same as the nose, when the baby is having a flu, we put few drops of breast milk that is our culture. (P18, 20-year-old)

Participants believe that the non-nutritional use of breast milk as a remedy or treatment for minor ailments of the eyes, sinuses, and ears is effective. This traditional belief may be because breast milk contains antibacterial and anti-inflammatory properties.

Sub-theme 4.4 infant bathing practices

The current study further revealed that preterm infant bathing was not only done for hygiene-related reasons but was also seen as serving to stimulate weight, for physical strengthening, and to protect the infant against evil spirits. These reasons are reflected in the following quotes.

Traditionally we bathe her with sehlapišo (traditional medicine) used to bathe infants to stimulate weight gain. (P13, 22-year-old)

Another participant also shared that:

We use leaves from the Baobab tree to bathe the baby; it is a medication. It is responsible for making the baby strong. (P10, 39-year-old)

In addition to herbal medicines that stimulate infant weight, other participants reported using herbal formulations to protect the infant against evil spirits and negative auras. The usage of herbal formulations is evident in the following quotes:

They use mogato (a traditional form of medicine to protect the baby from being suppressed) for bathing her. They put mogato inside the water and then just bath her, more especially if there is someone from the extended family coming to visit. (P02, 25-year-old)

I use the mixture, add it to the water, and bathe the baby to remove the negative spirits and aura, and some is for weight-gaining stimulation because young babies are difficult to hold due to their size. (P14, 39-year-old)

Lastly, other participants also shared the same notion; however, they indicated that this kind of herbal formulation called sehlapišo should not be used on the infant’s head during bathing as it is believed that the infant’s head will grow at an expedited rate should it come in contact with sehlapišo . The following quotes demonstrate this point:

When we use ‘sehlapišo’ for two days, we keep the water and then the next day we dilute it with hot water so that it becomes warm, and then after bathing we rinse him. we only bath his arms and legs because if we bath his head and neck they will grow too as this is used for growing or gaining weight. (P08, 31-year-old)

You do not touch the baby’s head when using ‘sehlapišo’ you only bath him from the neck to his toes, because they say if it happens that you touch the baby’s head while bathing him, [otherwise] the head and face becomes swollen and changes size. (P09, 30-year-old)

This study highlights parents' experiences caring for their preterm infants and the cultural determinants that can be integrated into preterm care to ensure culturally sensitive care. Four major themes and related sub-themes emphasise the importance of healthcare professionals respecting and acknowledging cultural practices, beliefs, and customs relevant to parents of preterm infants admitted to their facilities.

Participants in the current study experienced a range of negative feelings, including shock, fear, and anxiety, concerning the unexpected event of preterm birth, consistent with the literature. For instance, studies conducted in Sweden [ 30 ] and Denmark [ 31 ] reported that the abruptness of preterm birth, combined with the physical environment of the NICU, evokes feelings of shock and overwhelm in parents. Furthermore, the fear and anxiety experienced by the participants in this study while caring for their preterm infant in the NICU corroborate the findings in existing literature [ 32 , 33 ]. Both studies reported that parents often oscillate between hope and fear, particularly regarding their infant's survival and the possible long-term health complications associated with preterm birth. This correlation could be explained by the fact that preterm birth is traumatic and a potential stressor because it occurs mostly under emergency conditions, often threatening both the parents and the infant's well-being.

The current study's findings revealed that most participants acknowledged receiving satisfactory care from the nurses and doctors, as they were regularly present and helpful in tending to the infants' needs. This finding mirrors those of a study which noted that parents appreciate the quality of care provided by healthcare professionals in the NICU [ 34 ]. However, some participants felt that the nurses were often not friendly and mistreated them in the NICU. The findings are similar to the study which reported that some parents were dissatisfied with the care they received, which often stemmed from perceived rude behavior or negligence [ 35 ]. While technical, medical treatment and care are vital, the current data highlight how such care significantly influences parents' experiences in the NICU.

Communication, both in content and manner, is essential in the NICU setting, as it profoundly impacts parental experiences [ 36 ]. In addition, communication was also identified as a critical component in providing quality care to a diverse population concerning incorporating culturally competent care [ 37 ]. The current findings showed that many parents were satisfied with the communication they received from healthcare professionals, particularly when they were given clear explanations about their infants' condition. However, specific communication issues, including using incomprehensible medical jargon, insufficient intervention information, and conflicting advice from different professionals, were pointed out. These issues align with previous research, highlighting the need for improved communication strategies in the NICU to better inform and support parents [ 38 ].

Regarding the attitude of healthcare professionals, our findings revealed a mixed perception among parents. Some parents expressed dissatisfaction with the perceived negative attitudes of healthcare professionals, echoing similar findings by Shields et al. [ 39 ]. Negative attitudes from healthcare professionals can lead to mistrust and increased stress among parents [ 40 ]. Conversely, other parents in our study reported positive attitudes and felt well-supported and valued by the NICU staff. This positive perception aligns with the previous study which suggested that positive interactions with healthcare professionals can improve parental satisfaction [ 41 ]. While the current findings corroborate existing literature, the heightened perception of both positive and negative aspects of care, communication, and attitude might be attributed to cultural diversity in Limpopo Province.

The current study found that naming preterm infants is the domain of senior family members, particularly grandmothers. This finding aligns with previous work which asserted that grandmothers play a crucial role in naming infants and performing associated rituals in African cultures [ 42 ]. This role could be because the naming process is closely related to ancestral communication, which grandmothers frequently facilitate. Furthermore, the study indicates that infants' names often carry important cultural meanings or memorials, reflecting events or individuals in the family's history. The belief in the power of naming to affect an infant's well-being corroborates with the previous study’s assertion that names in most African cultures bear profound significance, carrying the family's hopes, aspirations, and legacies [ 43 ]. Additionally, names help individuals understand who they are and the community to which they belong. Such findings underscore the importance of cultural considerations concerning naming preterm infants in the NICU to promote culturally sensitive care and enhance parents' experiences.

In this study, three cultural restrictions on infant access aimed at safeguarding preterm infants' health were revealed. These restrictions primarily concern those who attended funerals, pregnant women, and people who recently engaged in sexual intercourse. First, funeral attendants: participants believed they could introduce diseases or negative auras to preterm infants, so precautionary measures needed to be taken before access could be granted again. The precautionary measure, which includes isolating funeral attendants for several days and having them wash their hands with aloe and ashes before touching the infant, aligns with a study by McAdoo [ 44 ], which reported similar customs among various African cultures. The use of aloe and ashes might stem from the fact that they contain some antibacterial properties, which may kill or lessen bacteria.

Second, according to our findings, pregnant women were also viewed as potentially harmful to preterm infants. This finding is unique as no other similar study could be located regarding the harm that could be brought by pregnant women. Third, individuals who recently engaged in sexual intercourse were deemed to have negative auras that could harm infants, particularly from parents' perspectives. This restriction echoes findings of previous study which revealed that newborns are isolated from young girls who engage in sexual activities as they can delay umbilical cord falling off [ 45 ]. This finding highlights the need for open dialogue and understanding regarding sexual practices in NICU care.

This study's findings underline the key role of family members in caring for preterm infants, which aligns with previous research in the field. Particularly, participant responses corroborated the evidence of family involvement as crucial to maternal well-being and infant care, as shown in a study conducted in the United States [ 46 ]. The responses reflect an appreciation for the support offered by extended family, primarily in providing mothers with rest and recovery time, mirroring previous findings [ 47 ]. The significance of family engagement in this study can be linked to cultural norms and values in the Limpopo Province and South Africa.

Most South African tribes, particularly indigenous ones, strongly believe in communal assistance and interdependence, particularly at significant life events such as childbirth. This is frequently characterised by extended family members stepping in to aid and support the new mother, allowing her time to relax and heal while contributing to the infant's care. Additionally, the similarity in support between NICU nurses and family members emphasized by participants resonates with the notion of family-centred care advocated by other scholars [ 48 ]. This approach, which suggests that healthcare providers can emulate a sense of familial support, highlights the importance of aligning clinical practices with the socio-cultural context of care.

Most participants expressed a reliance on prayer for the health of their infants, personal strength, and wisdom for healthcare professionals, which aligns with other studies that demonstrated the importance of spiritual beliefs in health outcomes and coping mechanisms [ 49 , 50 , 51 ]. Moreover, the idea of communal prayer being more potent than individual prayer, as pointed out by one participant, echoes classic sociological theory on the collective effervescence and emotional energy generated in communal religious rituals [ 52 ]. This finding accentuates the importance of understanding and integrating spiritual needs and beliefs in the NICU environment.

Interestingly, participants in the current study also invoked ' ditaelo ', or church prescriptions, in protecting and healing their infants. This practice, not extensively documented in the existing literature, appears to be a distinct element of religious observance in this cultural context. It may relate to African traditional healing practices, as discussed in the previous studies which indicated a unique fusion of Christianity and indigenous beliefs [ 53 , 54 ]. This practice underscores the cultural and spiritual complexity surrounding NICU care in the Limpopo Province and calls for further research to better comprehend these practices and their implications for infant care.

The participants’ experiences in the current study regarding umbilical cord care revealed that most parents reported using and believing in traditional cord care practices. These participants further described using ashes, powdered wood soot, breast milk, and soil from termite mounds topically to dry off and heal the umbilical cord. The use of herbs to treat and care for the umbilical cord was not unique to the participants in this study. In Sub-Saharan countries including South Africa [ 45 ], Zambia [ 55 ], Nigeria [ 56 ], Pakistan [ 57 ], and Uganda [ 58 ], the topical application of substances to the umbilical cord to hasten its detachment has been reported. It is important to acknowledge that while these traditional practices hold cultural significance and have been used for generations, their efficacy and safety may differ. In some cases, such practices may carry risks, such as infection or irritation. Healthcare providers should be aware of these cultural practices and engage in open and respectful conversation with families to understand their beliefs and preferences while also providing safe evidence-based care.

Moreover, participants also expressed dissatisfaction with modern procedures, such as surgical spirits, which they perceived as less effective than traditional practices because it makes the cord detach after seven days. This perception echoes the findings of study which revealed that some cultures believe traditional practices provide superior results compared to modern medical care, particularly for infants [ 59 ]. Although the herbal formulation was preferred over modern medical care, it has not been scientifically evaluated and studied; therefore, there is a potential risk of infection and other complications. Further research is needed to understand the scientific functionality of herbal formulations used to treat and dry off the umbilical cord.

This study showed that there are perceptions that certain medical conditions affecting newborns do not necessitate hospital care but rather require indigenous healthcare practices or treatment. For instance, phogwana was mentioned as a condition that needs out-of-hospital treatment by traditionalists. Similarly, this finding supports the previous literature which documented that the treatment of phogwana requires a traditional healer [ 44 , 60 ]. In addition, the literature indicated that the characteristics, prevention, and treatment of phogwana correspond to specific cultural contexts [ 61 ]. Providing medical care for premature infants outside of the hospital, under the guidance of traditionalists, may pose result risks, such as adverse responses to herbal therapy and metabolic poisoning. The immature organs of preterm newborns may have limited ability to efficiently remove metabolites of herbal medicines, which could potentially cause more health complications and death [ 62 ].

Furthermore, regarding the care of eyes, ears, and nose, participants reported using breast milk as a treatment for minor ailments. The belief in the antibacterial effects and healing properties of breast milk in traditional medicine is further substantiated by this finding, aligning with existing literature. These studies reinforce the multifunctional uses of breast milk beyond nutrition, including its application in treating eye infections [ 63 ] and alleviating nasal congestion, among others [ 64 ]. Although the benefits of breast milk are recognised, it is crucial to follow proper hygiene protocols when dealing with it. This includes washing your hands before handling breast milk and using sterile containers and applicators. Neglecting to maintain good hygiene can potentially introduce infections to the ears, nose, and eyes.

The participants in the current study reported that infant bathing was performed with different herbs for several purposes, such as stimulation of weight, warding off the evil spirit, and strengthening and protecting the infant. Herbal formulations used for bathing included sehlapišo , mogato , and baobab tree leaves. This study's findings agree with several studies on the African continent. In Uganda, infants were bathed with kyogero to attract fortunes [ 65 ], and in South Africa [ 44 ], India [ 66 ] and Nigeria [ 67 ], herbal medicine was also used during infant bathing for strengthening and spiritual protection purposes. One possible reason for the similarity could be that all studies reporting indigenous infant bathing were conducted on the African continent, which has overlapping cultural practices. It is clear from this finding that bathing practices are not merely physiologically functional but are often symbolic, serving various socio-cultural purposes and highlighting the intersection of cultural belief and healthcare. Preterm infants are vulnerable to health risks such as hypothermia, skin irritation, and infection due to their underdeveloped thermoregulatory system, delicate skin, and immature immune system [ 68 ]. Ritual bathing, particularly if not performed carefully, has the potential to worsen these health risks. It is recommended that healthcare professionals should ensures measures to guarantee that the ritual bathing environment for preterm newborns is secure, hygienic, and at a suitable temperature to reduce these dangers.

Limitations and strengths of the study

This study explored the cultural determinants of parents that can be incorporated into preterm infant care to ensure culturally sensitive care as part of maternal and childcare routine in the NICU in Limpopo Province. Although the qualitative design was the most appropriate to explore the phenomenon in this study, it limited the study's findings as it was not generalizable. Additionally, the primary investigator’s unconscious biases and perceptions could have influenced data analysis, however bracketing was applied to limit bias. Furthermore, to limit biases, the experts conducted a confirmability audit of the study project by checking and rechecking the collected raw-, coded- and interpreted data. The current study was conducted in a public hospital in Limpopo Province to explore the experiences of parents of preterm infants in the NICU, which may differ substantially from those in private hospitals and other provinces. Therefore, future research is recommended to explore this phenomenon in private hospitals and other provinces in South Africa.

The current study provides an understanding of parents' experiences caring for preterm infants in the NICU. The study offered meaningful insights into indigenous healthcare practices, emphasizing their crucial role in preterm infant care in specific cultural contexts. The cultural determinants included various topics, such as caring for the umbilical cord, treating phogwana , caring for the eyes, ears, and nose, and infant bathing customs. These practices showed a deeply ingrained belief system and a rich cultural heritage that have a meaningful impact on healthcare behaviours. However, these cultural determinants might have both positive and negative implications.

The findings demonstrated a strong reliance on traditional methods and herbal formulations in caring for preterm infants. Parents emphasised the advantages of these practices over current medical procedures, notably in treating disorders not frequently recognised by modern medicine and the care of the umbilical cord. This discontent with contemporary practices, highlights the need for culturally sensitive healthcare which can be conducted by conducting cultural assessments to understand the beliefs, values, and practices of the families in the NICU.

Overall, the findings of this study highlight the profound role of indigenous healthcare practices for preterm infants, reinforcing the need for a culturally sensitive approach in healthcare.

Availability of data and materials

The dataset materials generated and analysed during this study are accessible upon justified request from the corresponding author [MN].

Abbreviations

Neonatal Intensive Care Unit

North-West University

Brooks JB. The process of parenting. 9th ed. McGraw-Hill Higher Education; 2012.

Muller-Nix C, Ansermet F. Prematurity, risk factors, and protective factors. In: Zeanah CH, editor. Handbook of infant mental health. New York: The Guilford Press; 2009. p. 180–96.

Google Scholar

Shaw RJ, St John N, Lilo EA, Jo B, Benitz W, Stevenson DK, Horwitz SM. Prevention of traumatic stress in mothers with preterm infants: a randomized controlled trial. Pediatrics. 2013;132(Suppl 4):e886-94.

Article PubMed PubMed Central Google Scholar

CDC (Centers for Disease Control and Prevention). Reproductive health. Preterm birth. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm#:~:text=Preterm%20birth%0is%20when%20a,of%20pregnancy%20have%20been%20completed Accessed 02 December 2022.

WHO (World Health Organization). Preterm birth. 2017; https://www.who.int/news-room/fact-sheets/detail/preterm-birth Accessed 18 Feb 2022.

Malakouti J, Jabraeeli M, Valizadeh S, Babapour J. Mother’s experience of having a preterm infant in the neonatal intensive care unit: a phenomenological study. Iran J Crit Care Nurs. 2013;5:172–81.

Pineda R, Bender J, Hall B, Shabosky L, Annecca A, Smith J. Parent participation in the neonatal intensive care unit: predictors and relationships to neuro behavior and developmental outcomes. Early Hum Dev. 2018;117:32–8. https://doi.org/10.1016/j.earlhumdev.2017.12.008 .

Article PubMed Google Scholar

Rihan SH, Mohamadeen LM, Zayadneh SA, Hilal FM, Rashid HA, Azzam NM, Khalaf DJ, Badran EF, Safadi R.R. Parents’ experience of having an infant in the neonatal intensive care unit: a qualitative study. Cureus. 2021;13 Suppl 7:e16747. https://doi.org/10.7759/cureus.16747 .

Ghadery-Sefat A, Abdeyazdan Z, Badiee Z, Zargham-Boroujeni A. Relationship between parent-infant attachment and parental satisfaction with supportive nursing care. Iran J Nurs Midwifery Res. 2016;21(Suppl 1):71–6. https://doi.org/10.4103/1735-9066.174756 .

Bornstein MH. Cultural approaches to parenting. Parenting. 2012;12(Suppl 2–3):212–21. https://doi.org/10.1080/15295192.2012.683359 .

Sarapat P, Fongkaew W, Jintrawet U, Mesukko J, Ray, L. Perceptions and practices of parents in caring for their hospitalized preterm infants. Pac Rim Int J Nurs Res. 2017;21 Suppl 3: 220–233. Available online: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/78177 Accessed 20 April 2021.

Brooks JL, Holdtich-Davis D, Docherty SL, Theodorou CS. Birthing and parenting a premature infant in a cultural context. Qual Health Res. 2016;26(Suppl 3):387–98. https://doi.org/10.1177/1049732315573205 .

Harkness S, Super CM, Moscardino U, Rha JH, Blom MJ, Huitrón B, Johnston C, Sutherland M, Hyun OK, Axia G, Palacios J. Cultural models and developmental agendas: implications for arousal and self-regulation in early infancy. J Dev Processes. 2007;1(Suppl 2):5–39.

Joseph N, Unnikrishnan B, Naik V, Mahantshetti N, Mallapur M, Kotian S, Nelliyanil M. Infant rearing practices in South India: a longitudinal study. J Family Med Prim Care. 2013;2(Suppl 1):37–47. https://doi.org/10.4103/2249-4863.109942 .

Owoo NS, Lambon-Quayefio MP. National health insurance, social influence and antenatal care use in Ghana. Health Econ Rev. 2013;3(Suppl 19):1–12. https://doi.org/10.1186/2191-1991-3-19 .

Article Google Scholar

Arabiat D, Whitehead L, Al Jabery M, Hamdan-Mansour A, Shaheen A, Abu Sabbah E. Beliefs about illness and treatment decision modelling during ill-health in Arabic families. J Multidiscip Healthc. 2021;14:1755–68. https://doi.org/10.2147/JMDH.S311900 .

Steyn E, Poggenpoel M, Myburgh C. Lived experiences of parents of premature babies in the intensive care unit in a private hospital in Johannesburg, South Africa. Curationis. 2017;40(Suppl 1):8. https://doi.org/10.4102/curationis.v40i1.1698 .

Pinderhughes EE, Dodge KA, Bates JE, Pettit GS, Zelli A. Discipline responses: Influences of parents’ socioeconomic status, ethnicity, beliefs about parenting, stress, and cognitive-emotional processes. J Fam Psychol. 2000;14(Suppl 3):380–400. https://doi.org/10.1037//0893-3200.14.3.380 .

Article CAS PubMed PubMed Central Google Scholar

Malwela T, Maputle MS. The preterm birth rate in a resource-stricken rural area of the Limpopo Province South Africa. NRR. 2022;12:67–75. https://doi.org/10.2147/NRR.S33816 .

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(Suppl 6):349–57. https://doi.org/10.1093/intqhc/mzm042 .

Aggarwal R, Ranganathan P. Study designs: part 2 - descriptive studies. Perspect Clin Res. 2019;10(1):34–6. https://doi.org/10.4103/picr.PICR_154_18 .

Tani Y, Hashimoto S, Ochiai M. What makes rural, traditional, cultures more sustainable? Implications from conservation efforts in mountainous rural communities of Japan. Landsc Res. 2016;41(Suppl 8):892–905. https://doi.org/10.1080/01426397.2016.1184631 .

Stats SA (Statistics South Africa). General Household Survey 2019: statistical release P0318. 2020; http://www.statssa.gov.za/publications/P0318/P03182019.pdf Accessed 1 June 2021.

Edmonds WA, Kennedy TD. An applied guide to research designs: quantitative, qualitative, and mixed methods. 2nd ed. Los Angeles: Sage Publications; 2017.

Book Google Scholar

Boddy CR. Sample size for qualitative research. Qual Market Res. 2016;19 Suppl 4:426–32. https://doi.org/10.1108/qmr-06-2016-0053 .

Vagle MD. Crafting phenomenological research. 3rd ed. Walnut Creek: Left Coast Press Inc; 2014.

Giorgi A. A phenomenological perspective on certain qualitative research methods. J Phenomenol Psychol. 1994;25(Suppl 2):190–220. https://doi.org/10.1163/156916294X00034 .

Schweitzer RPD. Phenomenological research methodology: a guide paper presented at phenomenology seminar for Edith Cowan University. Bunbury: Bunbury; 1998.

Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills: Sage Publications; 1985.

Lindberg B, Öhrling K. Experiences of having a prematurely born infant from the perspective of others in Northern Sweden. Int J Circumpolar Health. 2008;67(Suppl 5):461–71. https://doi.org/10.3402/ijch.v67i5.18353 .

Moseholm E, Fetters MD. Early parental coping and children’s behavioural and emotional problems at 6 and 18 months: a Danish cohort study. BMJ Open. 2016;6(Suppl 5):e010347.

Cleveland LM. Parenting in the neonatal intensive care unit. J Obstet Gynecol Neonatal Nurs. 2008;37(Suppl 6):666–91. https://doi.org/10.1111/j.1552-6909.2008.00288.x .

Holditch-Davis D, Bartlett TR, Blickman AL, Miles MS, Poston DJ. Parental distress and adjustment over time in neonatal intensive care unit. J Dev Behav. 2003;24(Suppl 5):314–22.

Wigert H, Berg M, Hellström AL. Parental presence when their child is in neonatal intensive care. Scand J Caring Sci. 2010;24(Suppl 1):139–46. https://doi.org/10.1111/j.1471-6712.2009.00697.x .

Franck LS, Cox S, Allen A, Winter I. Parental concern and distress about infant pain. Arch Dis Child Fetal Neonatal Ed. 2004;89(Suppl 1):71F – 75. https://doi.org/10.1136/fn.89.1.F71 .

De Rouck S, Leys M. Information needs of parents of children admitted to a neonatal intensive care unit: a review of the literature (1990–2008). Patient Educ Couns. 2009;76(Suppl 2):159–73.

Shopo KD, Rabie T, Du Preez A, Bester P. Experiences of midwives regarding provision of culturally competent care to women receiving maternal care in South Africa. Midwifery. 2023;116:103527. https://doi.org/10.1016/j.midw.2022.103527 .

O’Hagan S, Manias E, Elder C, Pill J, Woodward-Kron R, McNamara T, Webb G, McColl G. What counts as effective communication in nursing? Evidence from nurse educators’ and clinicians’ feedback on nurse interactions with simulated patients. J Adv Nurs. 2014;70(Suppl 6):1344–55. https://doi.org/10.1111/jan.12296 .

Shields L, Zhou H, Pratt J, Taylor M. Family-centered care for hospitalized children aged 0–12 years. Cochrane Database Syst Rev. 2012;10:CD004811.

PubMed Google Scholar

Lindberg B, Axelsson K, Öhrling K. The birth of premature infants: experiences from the fathers’ perspective. J Neonatal Nurs. 2007;13(Suppl 4):142–9. https://doi.org/10.1016/j.jnn.2007.05.004 .

Labrie NH, van Veenendaal NR, Ludolph RA, Ket JC, van der Schoor SR, van Kempen AA. Effects of parent-provider communication during infant hospitalization in the NICU on parents: a systematic review with meta-synthesis and narrative synthesis. Patient Educ Counsel. 2021;104(Suppl 7):1526–52.

Mkhize N. African traditions and the social, economic and moral dimensions of fatherhood. In: Richter L.M, Morrell R, editors. Baba: men and fatherhood in South Africa. HSRC Press, California, United States; 2006. 183–198.

McAdoo JL. The roles of African American fathers: an ecological perspective. Fam Soc. 1993;74(Suppl 1):28–35. https://doi.org/10.1177/104438949307400103 .

Clouse K, Malope-Kgokong B, Bor J, Nattey C, Mudau M, Maskew M. The South African National HIV pregnancy cohort: evaluating continuity of care among women living with HIV. BMC Public Health. 2020;20:1662. https://doi.org/10.1186/s12889-020-09679-1 .

Shopo KD, Rabie T, Du Preez A, Bester P. Experiences of women receiving maternal care regarding cultural practices in selected public hospitals in the North West Province, South Africa. Int J Afr Nursing Sci. 2024;20:100680. https://doi.org/10.1016/j.ijans.2024.100680 .

Craig JW, Glick C, Phillips R, Hall SL, Smith J, Browne J. Recommendations for involving the family in developmental care of the NICU baby. J Perinatol. 2015;35 Suppl S1:S5–8. https://doi.org/10.1038/jp.2015.142 .

Mabaso MHL, Ndaba T, Mkhize-Kwitshana ZL. Overview of maternal, neonatal and child deaths in South Africa: challenges, opportunities, progress and future prospects. Int J MCH AIDS. 2014;2(Suppl 2):182–9.

PubMed PubMed Central Google Scholar

Kuo DZ, Houtrow AJ, Arango P, Kuhlthau KA, Simmons JM, Neff JM. Family-centered care: current applications and future directions in pediatric health care. Matern Child Health J. 2012;16(Suppl 2):297–305. https://doi.org/10.1007/s10995-011-0751-7 .

Willemse S, Smeets W, Van Leeuwen E, Nielen-Rosier T, Janssen L, Foudraine N. Spiritual care in the intensive care unit: an integrative literature research. J Crit Care. 2020;57:55–78. https://doi.org/10.1016/j.jcrc.2020.01.026 .

Koenig HG. Religion, spirituality, and health: the research and clinical implications. ISRN Psychiatry. 2012;2012:1–33. https://doi.org/10.5402/2012/278730 .

Pargament KI. The psychology of religion and coping: theory, research, practice. New York: The Guilford Press; 1997.

Durkheim E, Fields KE. The elementary forms of religious life. New York: Free Press; 1995.

Mbiti JS. African religions & philosophy. 2nd rev. and enl. Edition. Heinemann: Oxford: Portsmouth, N.H., United Kingdom; 1990.

Ngubane H. Body and mind in Zulu medicine: an ethnography of health and disease in Nyuswa-Zulu thought and practice. London, New York: Academic Press; 1977.

Herlihy JM, Shaikh A, Mazimba A, Gagne N, Grogan C, Mpamba C, et al. Local perceptions, cultural beliefs and practices that shape umbilical cord care: a qualitative study in Southern Province, Zambia. PLoS ONE. 2013;8(Suppl 11):e79191. https://doi.org/10.1371/journal.pone.0079191 .

Abhulimhen-Iyoha B, Ibadin M. Determinants of cord care practices among mothers in Benin city, Edo State Nigeria. Niger J Clin Pract. 2012;15(Suppl 2):210–3. https://doi.org/10.4103/1119-3077.97320 .

Article CAS PubMed Google Scholar

Khan GN, Memon ZA, Bhutta ZA. A cross sectional study of newborn care practices in Gilgit Pakistan. J Neonatal Perinatal Med. 2013;6(Suppl 1):69–76. https://doi.org/10.3233/NPM-1364712 .

Byaruhanga RN, Nsungwa-Sabiiti J, Kiguli J, Balyeku A, Nsabagasani X, Peterson S. Hurdles and opportunities for newborn care in rural Uganda. Midwifery. 2011;27(Suppl 6):775–80. https://doi.org/10.1016/j.midw.2010.02.005 .

Ozioma EOJ, Chinwe OAN. Herbal medicines in African traditional medicine. Herb Med. 2019;10:191–214. https://doi.org/10.5772/intechopen.80348 .

Shai-Mahoko SN. The Role of indigenous healers in disease prevention and health promotion among black South Africans: a case study of the North West Province. Thesis, doctor of philosophy, University of South Africa, South Africa. 1997; https://uir.unisa.ac.za/handle/10500/17721 Accessed 20 June 2023.

Kay MA. Fallen fontanelle: culture-bound or cross-cultural? Med Anthropol. 1993;15(Suppl 2):137–56. https://doi.org/10.1080/01459740.1993.9966086 .

Adama EA, Sundin D, Bayes S. Sociocultural practices affecting the care of preterm infants in the Ghanaian community. J Transcult Nurs. 2021;32(Suppl 5):458–65.

Baynham JT, Moorman MA, Donnellan C, Cevallos V, Keenan JD. Antibacterial effect of human milk for common causes of paediatric conjunctivitis. Br J Ophthalmol. 2013;97:377–439. https://doi.org/10.1136/bjophthalmol-2012-302833 .

Karcz K, Walkowiak M, Makuch J, Olejnik I, Królak-Olejnik B. Non-nutritional use of human milk part 1: a survey of the use of breast milk as a therapy for mucosal infections of various types in Poland. Int J Environ Res Public Health. 2019;16(Suppl 10):1715. https://doi.org/10.3390/ijerph16101715 .

Kayom VO, Kakuru A, Kiguli S. Newborn care practices among mother-infant dyads in urban Uganda. Int J Pediatr. 2015;2015:1–8. https://doi.org/10.1155/2015/815938 .

Owns AM, Mengue Eyi S, Van Andel T. Traditional medicine, and childcare in Western Africa: mothers’ knowledge, folk illnesses, and patterns of healthcare-seeking behaviour. PLoS One. 2014;9(Suppl 8):e105972. https://doi.org/10.1371/journal.pone.0105972 .

Article CAS Google Scholar

John ME, Nsemo AD, John EE, Opiah MM, Robinson-Bassey GC, Yagba J. Indigenous child care beliefs and practices in the Niger Delta Region of Nigeria: implications for health care. Int J Health Res. 2015;5(Suppl 11):235–47.

Oranges T, Dini V, Romanelli M. Skin physiology of the neonate and infant: clinical implications. Adv Wound Care (New Rochelle). 2015;4 Suppl 10:587–95. https://doi.org/10.1089/wound.2015.0642 .

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Acknowledgements

The authors would like to extend their gratitude to all the parents of preterm infants who participated in this study and the assistant researchers who assisted in collecting the data.

Open access funding provided by North-West University. This manuscript was extracted from a funded research project by the NWU postgraduate bursary and Faculty of Health Sciences bursary (Funding code/number: not applicable).

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Madimetja J. Nyaloko, Welma Lubbe, Salaminah S. Moloko-Phiri & Khumoetsile D. Shopo

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M.N. conceptualised and developed the research protocol, conducted research (gathered, analysed, interpreted, and managed the data), and wrote the initial draft. W.L., S.S.M., and K.D.S. supervised the research and provided inputs and guidance for the research protocol development, data collection, analysis, and interpretations. All authors have read and approved the manuscript.

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Correspondence to Madimetja J. Nyaloko .

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The current study was executed in accordance with the Declaration of Helsinki and approved by North-West University Health Research Ethical committee [NWU-00267-21-S1]. Limpopo Province [LP-2021-08-027] granted permission to conduct the study through the National Health Research Database website. The management of the tertiary hospital granted goodwill permission for the study to be undertaken in their NICU. All the parents of preterm infants who participated in the study provided written informed consent. Participants were informed that participation in the study was voluntary and that they could withdraw anytime without penalty.

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Nyaloko, M.J., Lubbe, W., Moloko-Phiri, S.S. et al. Parental experiences of caring for preterm infants in the neonatal intensive care unit, Limpopo Province: a descriptive qualitative study exploring the cultural determinants. BMC Health Serv Res 24 , 669 (2024). https://doi.org/10.1186/s12913-024-11117-6

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7.3: Unit of analysis and unit of observation

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7.3 Unit of analysis and unit of observation

Key Takeaways

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Introduction

What Is a Unit of Analysis?

Why is Choosing the Right Unit of Analysis Important?

Unit of Analysis vs Unit of Observation

Types of “Unit of Analysis”

Examples of Each Type of Unit of Analysis

How Does a Social Scientist Choose a Unit of Analysis?

Factors to Consider When Choosing a Unit of Analysis

Projective Techniques In Surveys: Definition, Types & Pros & Cons

The McNamara Fallacy: How Researchers Can Detect and to Avoid it.

Research Summary: What Is It & How To Write One

What is Field Research: Meaning, Examples, Pros & Cons

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4.3 Unit of analysis and unit of observation

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Unit of Analysis

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Qualitative Methods in Health Care Research

Renjulal Yesodharan

Judith A. Noronha

Elissa Ladd

Anice George

Introduction

Qualitative Research

Significance of Qualitative Research

Differences between Quantitative and Qualitative Research

Qualitative Research Questions and Purpose Statements

Review of the Literature

Reflexivity

Types of Qualitative Research Designs

Narrative research

Phenomenological research

Grounded Theory Research

Ethnographic research

Historical research

Case study research