- Pre-registration nursing students
- No definition of master’s degree in nursing described in the publication
After the search, we collated and uploaded all the identified records into EndNote v.X8 (Clarivate Analytics, Philadelphia, Pennsylvania) and removed any duplicates. Two independent reviewers (MCS and SA) screened the titles and abstracts for assessment in line with the inclusion criteria. They retrieved and assessed the full texts of the selected studies while applying the inclusion criteria. Any disagreements about the eligibility of studies were resolved by discussion or, if no consensus could be reached, by involving experienced researchers (MZ-S and RP).
The first reviewer (MCS) extracted data from the selected publications. For this purpose, an extraction tool developed by the authors was used. This tool comprised the following criteria: author(s), year of publication, country, research question, design, case definition, data sources, and methodologic and data-analysis triangulation. First, we extracted and summarized information about the case study design. Second, we narratively summarized the way in which the data and methodological triangulation were described. Finally, we summarized the information on within-case or cross-case analysis. This process was performed using Microsoft Excel. One reviewer (MCS) extracted data, whereas another reviewer (SA) cross-checked the data extraction, making suggestions for additions or edits. Any disagreements between the reviewers were resolved through discussion.
A total of 149 records were identified in 2 databases. We removed 20 duplicates and screened 129 reports by title and abstract. A total of 46 reports were assessed for eligibility. Through hand searches, we identified 117 additional records. Of these, we excluded 98 reports after title and abstract screening. A total of 17 reports were assessed for eligibility. From the 2 databases and the hand search, 63 reports were assessed for eligibility. Ultimately, we included 8 articles for data extraction. No further articles were included after the reference list screening of the included studies. A PRISMA flow diagram of the study selection and inclusion process is presented in Figure 1 . As shown in Tables 2 and and3, 3 , the articles included in this scoping review were published between 2010 and 2022 in Canada (n = 3), the United States (n = 2), Australia (n = 2), and Scotland (n = 1).
PRISMA flow diagram.
Characteristics of Articles Included.
Author | Contandriopoulos et al | Flinter | Hogan et al | Hungerford et al | O’Rourke | Roots and MacDonald | Schadewaldt et al | Strachan et al |
---|---|---|---|---|---|---|---|---|
Country | Canada | The United States | The United States | Australia | Canada | Canada | Australia | Scotland |
How or why research question | No information on the research question | Several how or why research questions | What and how research question | No information on the research question | Several how or why research questions | No information on the research question | What research question | What and why research questions |
Design and referenced author of methodological guidance | Six qualitative case studies Robert K. Yin | Multiple-case studies design Robert K. Yin | Multiple-case studies design Robert E. Stake | Case study design Robert K. Yin | Qualitative single-case study Robert K. Yin Robert E. Stake Sharan Merriam | Single-case study design Robert K. Yin Sharan Merriam | Multiple-case studies design Robert K. Yin Robert E. Stake | Multiple-case studies design |
Case definition | Team of health professionals (Small group) | Nurse practitioners (Individuals) | Primary care practices (Organization) | Community-based NP model of practice (Organization) | NP-led practice (Organization) | Primary care practices (Organization) | No information on case definition | Health board (Organization) |
Overview of Within-Method, Between/Across-Method, and Data-Analysis Triangulation.
Author | Contandriopoulos et al | Flinter | Hogan et al | Hungerford et al | O’Rourke | Roots and MacDonald | Schadewaldt et al | Strachan et al |
---|---|---|---|---|---|---|---|---|
Within-method triangulation (using within-method triangulation use at least 2 data-collection procedures from the same design approach) | ||||||||
: | ||||||||
Interviews | X | x | x | x | x | |||
Observations | x | x | ||||||
Public documents | x | x | x | |||||
Electronic health records | x | |||||||
Between/across-method (using both qualitative and quantitative data-collection procedures in the same study) | ||||||||
: | ||||||||
: | ||||||||
Interviews | x | x | x | |||||
Observations | x | x | ||||||
Public documents | x | x | ||||||
Electronic health records | x | |||||||
: | ||||||||
Self-assessment | x | |||||||
Service records | x | |||||||
Questionnaires | x | |||||||
Data-analysis triangulation (combination of 2 or more methods of analyzing data) | ||||||||
: | ||||||||
: | ||||||||
Deductive | x | x | x | |||||
Inductive | x | x | ||||||
Thematic | x | x | ||||||
Content | ||||||||
: | ||||||||
Descriptive analysis | x | x | x | |||||
: | ||||||||
: | ||||||||
Deductive | x | x | x | x | ||||
Inductive | x | x | ||||||
Thematic | x | |||||||
Content | x |
The following sections describe the research question, case definition, and case study design. Case studies are most appropriate when asking “how” or “why” questions. 1 According to Yin, 1 how and why questions are explanatory and lead to the use of case studies, histories, and experiments as the preferred research methods. In 1 study from Canada, eg, the following research question was presented: “How and why did stakeholders participate in the system change process that led to the introduction of the first nurse practitioner-led Clinic in Ontario?” (p7) 19 Once the research question has been formulated, the case should be defined and, subsequently, the case study design chosen. 1 In typical case studies with mixed methods, the 2 types of data are gathered concurrently in a convergent design and the results merged to examine a case and/or compare multiple cases. 10
“How” or “why” questions were found in 4 studies. 16 , 17 , 19 , 22 Two studies additionally asked “what” questions. Three studies described an exploratory approach, and 1 study presented an explanatory approach. Of these 4 studies, 3 studies chose a qualitative approach 17 , 19 , 22 and 1 opted for mixed methods with a convergent design. 16
In the remaining studies, either the research questions were not clearly stated or no “how” or “why” questions were formulated. For example, “what” questions were found in 1 study. 21 No information was provided on exploratory, descriptive, and explanatory approaches. Schadewaldt et al 21 chose mixed methods with a convergent design.
A total of 5 studies defined the case as an organizational unit. 17 , 18 - 20 , 22 Of the 8 articles, 4 reported multiple-case studies. 16 , 17 , 22 , 23 Another 2 publications involved single-case studies. 19 , 20 Moreover, 2 publications did not state the case study design explicitly.
This section describes within-method triangulation, which involves employing at least 2 data-collection procedures within the same design approach. 6 , 7 This can also be called data source triangulation. 8 Next, we present the single data-collection procedures in detail. In 5 studies, information on within-method triangulation was found. 15 , 17 - 19 , 22 Studies describing a quantitative approach and the triangulation of 2 or more quantitative data-collection procedures could not be included in this scoping review.
Five studies used qualitative data-collection procedures. Two studies combined face-to-face interviews and documents. 15 , 19 One study mixed in-depth interviews with observations, 18 and 1 study combined face-to-face interviews and documentation. 22 One study contained face-to-face interviews, observations, and documentation. 17 The combination of different qualitative data-collection procedures was used to present the case context in an authentic and complex way, to elicit the perspectives of the participants, and to obtain a holistic description and explanation of the cases under study.
All 5 studies used qualitative interviews as the primary data-collection procedure. 15 , 17 - 19 , 22 Face-to-face, in-depth, and semi-structured interviews were conducted. The topics covered in the interviews included processes in the introduction of new care services and experiences of barriers and facilitators to collaborative work in general practices. Two studies did not specify the type of interviews conducted and did not report sample questions. 15 , 18
In 2 studies, qualitative observations were carried out. 17 , 18 During the observations, the physical design of the clinical patients’ rooms and office spaces was examined. 17 Hungerford et al 18 did not explain what information was collected during the observations. In both studies, the type of observation was not specified. Observations were generally recorded as field notes.
In 3 studies, various qualitative public documents were studied. 15 , 19 , 22 These documents included role description, education curriculum, governance frameworks, websites, and newspapers with information about the implementation of the role and general practice. Only 1 study failed to specify the type of document and the collected data. 15
In 1 study, qualitative documentation was investigated. 17 This included a review of dashboards (eg, provider productivity reports or provider quality dashboards in the electronic health record) and quality performance reports (eg, practice-wide or co-management team-wide performance reports).
This section describes the between/across methods, which involve employing both qualitative and quantitative data-collection procedures in the same study. 6 , 7 This procedure can also be denoted “methodologic triangulation.” 8 Subsequently, we present the individual data-collection procedures. In 3 studies, information on between/across triangulation was found. 16 , 20 , 21
Three studies used qualitative and quantitative data-collection procedures. One study combined face-to-face interviews, documentation, and self-assessments. 16 One study employed semi-structured interviews, direct observation, documents, and service records, 20 and another study combined face-to-face interviews, non-participant observation, documents, and questionnaires. 23
All 3 studies used qualitative interviews as the primary data-collection procedure. 16 , 20 , 23 Face-to-face and semi-structured interviews were conducted. In the interviews, data were collected on the introduction of new care services and experiences of barriers to and facilitators of collaborative work in general practices.
In 2 studies, direct and non-participant qualitative observations were conducted. 20 , 23 During the observations, the interaction between health professionals or the organization and the clinical context was observed. Observations were generally recorded as field notes.
In 2 studies, various qualitative public documents were examined. 20 , 23 These documents included role description, newspapers, websites, and practice documents (eg, flyers). In the documents, information on the role implementation and role description of NPs was collected.
In 1 study, qualitative individual journals were studied. 16 These included reflective journals from NPs, who performed the role in primary health care.
Only 1 study involved quantitative service records. 20 These service records were obtained from the primary care practices and the respective health authorities. They were collected before and after the implementation of an NP role to identify changes in patients’ access to health care, the volume of patients served, and patients’ use of acute care services.
In 2 studies, quantitative questionnaires were used to gather information about the teams’ satisfaction with collaboration. 16 , 21 In 1 study, 3 validated scales were used. The scales measured experience, satisfaction, and belief in the benefits of collaboration. 21 Psychometric performance indicators of these scales were provided. However, the time points of data collection were not specified; similarly, whether the questionnaires were completed online or by hand was not mentioned. A competency self-assessment tool was used in another study. 16 The assessment comprised 70 items and included topics such as health promotion, protection, disease prevention and treatment, the NP-patient relationship, the teaching-coaching function, the professional role, managing and negotiating health care delivery systems, monitoring and ensuring the quality of health care practice, and cultural competence. Psychometric performance indicators were provided. The assessment was completed online with 2 measurement time points (pre self-assessment and post self-assessment).
This section describes data-analysis triangulation, which involves the combination of 2 or more methods of analyzing data. 6 Subsequently, we present within-case analysis and cross-case analysis.
Three studies combined qualitative and quantitative methods of analysis. 16 , 20 , 21 Two studies involved deductive and inductive qualitative analysis, and qualitative data were analyzed thematically. 20 , 21 One used deductive qualitative analysis. 16 The method of analysis was not specified in the studies. Quantitative data were analyzed using descriptive statistics in 3 studies. 16 , 20 , 23 The descriptive statistics comprised the calculation of the mean, median, and frequencies.
Two studies combined deductive and inductive qualitative analysis, 19 , 22 and 2 studies only used deductive qualitative analysis. 15 , 18 Qualitative data were analyzed thematically in 1 study, 22 and data were treated with content analysis in the other. 19 The method of analysis was not specified in the 2 studies.
In 7 studies, a within-case analysis was performed. 15 - 20 , 22 Six studies used qualitative data for the within-case analysis, and 1 study employed qualitative and quantitative data. Data were analyzed separately, consecutively, or in parallel. The themes generated from qualitative data were compared and then summarized. The individual cases were presented mostly as a narrative description. Quantitative data were integrated into the qualitative description with tables and graphs. Qualitative and quantitative data were also presented as a narrative description.
Of the multiple-case studies, 5 carried out cross-case analyses. 15 - 17 , 20 , 22 Three studies described the cross-case analysis using qualitative data. Two studies reported a combination of qualitative and quantitative data for the cross-case analysis. In each multiple-case study, the individual cases were contrasted to identify the differences and similarities between the cases. One study did not specify whether a within-case or a cross-case analysis was conducted. 23
This section describes confirmation or contradiction through qualitative and quantitative data. 1 , 4 Qualitative and quantitative data were reported separately, with little connection between them. As a result, the conclusions on neither the comparisons nor the contradictions could be clearly determined.
In 3 studies, the consistency of the results of different types of qualitative data was highlighted. 16 , 19 , 21 In particular, documentation and interviews or interviews and observations were contrasted:
Both types of data showed that NPs and general practitioners wanted to have more time in common to discuss patient cases and engage in personal exchanges. 21 In addition, the qualitative and quantitative data confirmed the individual progression of NPs from less competent to more competent. 16 One study pointed out that qualitative and quantitative data obtained similar results for the cases. 20 For example, integrating NPs improved patient access by increasing appointment availability.
Although questionnaire results indicated that NPs and general practitioners experienced high levels of collaboration and satisfaction with the collaborative relationship, the qualitative results drew a more ambivalent picture of NPs’ and general practitioners’ experiences with collaboration. 21
The studies included in this scoping review evidenced various research questions. The recommended formats (ie, how or why questions) were not applied consistently. Therefore, no case study design should be applied because the research question is the major guide for determining the research design. 2 Furthermore, case definitions and designs were applied variably. The lack of standardization is reflected in differences in the reporting of these case studies. Generally, case study research is viewed as allowing much more freedom and flexibility. 5 , 24 However, this flexibility and the lack of uniform specifications lead to confusion.
Methodologic triangulation, as described in the literature, can be somewhat confusing as it can refer to either data-collection methods or research designs. 6 , 8 For example, methodologic triangulation can allude to qualitative and quantitative methods, indicating a paradigmatic connection. Methodologic triangulation can also point to qualitative and quantitative data-collection methods, analysis, and interpretation without specific philosophical stances. 6 , 8 Regarding “data-collection methods with no philosophical stances,” we would recommend using the wording “data source triangulation” instead. Thus, the demarcation between the method and the data-collection procedures will be clearer.
Yin 1 advocated the use of multiple sources of evidence so that a case or cases can be investigated more comprehensively and accurately. Most studies included multiple data-collection procedures. Five studies employed a variety of qualitative data-collection procedures, and 3 studies used qualitative and quantitative data-collection procedures (mixed methods). In contrast, no study contained 2 or more quantitative data-collection procedures. In particular, quantitative data-collection procedures—such as validated, reliable questionnaires, scales, or assessments—were not used exhaustively. The prerequisites for using multiple data-collection procedures are availability, the knowledge and skill of the researcher, and sufficient financial funds. 1 To meet these prerequisites, research teams consisting of members with different levels of training and experience are necessary. Multidisciplinary research teams need to be aware of the strengths and weaknesses of different data sources and collection procedures. 1
When using multiple data sources and analysis methods, it is necessary to present the results in a coherent manner. Although the importance of multiple data sources and analysis has been emphasized, 1 , 5 the description of triangulation has tended to be brief. Thus, traceability of the research process is not always ensured. The sparse description of the data-analysis triangulation procedure may be due to the limited number of words in publications or the complexity involved in merging the different data sources.
Only a few concrete recommendations regarding the operationalization of the data-analysis triangulation with the qualitative data process were found. 25 A total of 3 approaches have been proposed 25 : (1) the intuitive approach, in which researchers intuitively connect information from different data sources; (2) the procedural approach, in which each comparative or contrasting step in triangulation is documented to ensure transparency and replicability; and (3) the intersubjective approach, which necessitates a group of researchers agreeing on the steps in the triangulation process. For each case study, one of these 3 approaches needs to be selected, carefully carried out, and documented. Thus, in-depth examination of the data can take place. Farmer et al 25 concluded that most researchers take the intuitive approach; therefore, triangulation is not clearly articulated. This trend is also evident in our scoping review.
Few studies in this scoping review used a combination of qualitative and quantitative analysis. However, creating a comprehensive stand-alone picture of a case from both qualitative and quantitative methods is challenging. Findings derived from different data types may not automatically coalesce into a coherent whole. 4 O’Cathain et al 26 described 3 techniques for combining the results of qualitative and quantitative methods: (1) developing a triangulation protocol; (2) following a thread by selecting a theme from 1 component and following it across the other components; and (3) developing a mixed-methods matrix.
The most detailed description of the conducting of triangulation is the triangulation protocol. The triangulation protocol takes place at the interpretation stage of the research process. 26 This protocol was developed for multiple qualitative data but can also be applied to a combination of qualitative and quantitative data. 25 , 26 It is possible to determine agreement, partial agreement, “silence,” or dissonance between the results of qualitative and quantitative data. The protocol is intended to bring together the various themes from the qualitative and quantitative results and identify overarching meta-themes. 25 , 26
The “following a thread” technique is used in the analysis stage of the research process. To begin, each data source is analyzed to identify the most important themes that need further investigation. Subsequently, the research team selects 1 theme from 1 data source and follows it up in the other data source, thereby creating a thread. The individual steps of this technique are not specified. 26 , 27
A mixed-methods matrix is used at the end of the analysis. 26 All the data collected on a defined case are examined together in 1 large matrix, paying attention to cases rather than variables or themes. In a mixed-methods matrix (eg, a table), the rows represent the cases for which both qualitative and quantitative data exist. The columns show the findings for each case. This technique allows the research team to look for congruency, surprises, and paradoxes among the findings as well as patterns across multiple cases. In our review, we identified only one of these 3 approaches in the study by Roots and MacDonald. 20 These authors mentioned that a causal network analysis was performed using a matrix. However, no further details were given, and reference was made to a later publication. We could not find this publication.
Because it focused on the implementation of NPs in primary health care, the setting of this scoping review was narrow. However, triangulation is essential for research in this area. This type of research was found to provide a good basis for understanding methodologic and data-analysis triangulation. Despite the lack of traceability in the description of the data and methodological triangulation, we believe that case studies are an appropriate design for exploring new nursing roles in existing health care systems. This is evidenced by the fact that case study research is widely used in many social science disciplines as well as in professional practice. 1 To strengthen this research method and increase the traceability in the research process, we recommend using the reporting guideline and reporting checklist by Rodgers et al. 9 This reporting checklist needs to be complemented with methodologic and data-analysis triangulation. A procedural approach needs to be followed in which each comparative step of the triangulation is documented. 25 A triangulation protocol or a mixed-methods matrix can be used for this purpose. 26 If there is a word limit in a publication, the triangulation protocol or mixed-methods matrix needs to be identified. A schematic representation of methodologic and data-analysis triangulation in case studies can be found in Figure 2 .
Schematic representation of methodologic and data-analysis triangulation in case studies (own work).
This study suffered from several limitations that must be acknowledged. Given the nature of scoping reviews, we did not analyze the evidence reported in the studies. However, 2 reviewers independently reviewed all the full-text reports with respect to the inclusion criteria. The focus on the primary care setting with NPs (master’s degree) was very narrow, and only a few studies qualified. Thus, possible important methodological aspects that would have contributed to answering the questions were omitted. Studies describing the triangulation of 2 or more quantitative data-collection procedures could not be included in this scoping review due to the inclusion and exclusion criteria.
Given the various processes described for methodologic and data-analysis triangulation, we can conclude that triangulation in case studies is poorly standardized. Consequently, the traceability of the research process is not always given. Triangulation is complicated by the confusion of terminology. To advance case study research in nursing, we encourage authors to reflect critically on methodologic and data-analysis triangulation and use existing tools, such as the triangulation protocol or mixed-methods matrix and the reporting guideline checklist by Rodgers et al, 9 to ensure more transparent reporting.
Acknowledgments.
The authors thank Simona Aeschlimann for her support during the screening process.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
Supplemental Material: Supplemental material for this article is available online.
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Speaker 1: In this video, we're going to dive into the topic of qualitative coding, which you'll need to understand if you plan to undertake qualitative analysis for any dissertation, thesis, or research project. We'll explain what exactly qualitative coding is, the different coding approaches and methods, and how to go about coding your data step by step. So go ahead, grab a cup of coffee, grab a cup of tea, whatever works for you, and let's jump into it. Hey, welcome to Grad Coach TV, where we demystify and simplify the oftentimes intimidating world of academic research. My name's Emma, and today we're going to explore qualitative coding, an essential first step in qualitative analysis. If you'd like to learn more about qualitative analysis or research methodology in general, we've also got videos covering those topics, so be sure to check them out. I'll include the links below. If you're new to Grad Coach TV, hit that subscribe button for more videos covering all things research related. Also, if you're looking for hands-on help with your qualitative coding, check out our one-on-one coaching services, where we hold your hand through the coding process step by step. Alternatively, if you're looking to fast track your coding, we also offer a professional coding service, where our seasoned qualitative experts code your data for you, ensuring high-quality initial coding. If that sounds interesting to you, you can learn more and book a free consultation at gradcoach.com. All right, with that out of the way, let's get into it. To kick things off, let's start by understanding what a code is. At the simplest level, a code is a label that describes a piece of content. For example, in the sentence, pigeons attacked me and stole my sandwich, you could use pigeons as a code. This code would simply describe that the sentence involves pigeons. Of course, there are many ways you could code this, and this is just one approach. We'll explore the different ways in which you can code later in this video. So, qualitative coding is simply the process of creating and assigning codes to categorize data extracts. You'll then use these codes later down the road to derive themes and patterns for your actual qualitative analysis. For example, thematic analysis or content analysis. It's worth It's worth noting that coding and analysis can take place simultaneously. In fact, it's pretty much expected that you'll notice some themes emerge while you code. That said, it's important to note that coding does not necessarily involve identifying themes. Instead, it refers to the process of labeling and grouping similar types of data, which in turn will make generating themes and analyzing the data more manageable. You might be wondering then, why should I bother with coding at all? Why not just look for themes from the outset? Well, coding is a way of making sure your data is valid. In other words, it helps ensure that your analysis is undertaken systematically, and that other researchers can review it. In the world of research, we call this transparency. In other words, coding is the foundation of high quality analysis, which makes it an essential first step. Right, now that we've got a plain language definition of coding on the table, the next step is to understand what types of coding exist. Let's start with the two main approaches, deductive and inductive coding. With deductive coding, you as the researcher begin with a set of pre-established codes and apply them to your data set, for example, a set of interview transcripts. Inductive coding, on the other hand, works in reverse, as you start with a blank canvas and create your set of codes based on the data itself. In other words, the codes emerge from the data. Let's take a closer look at both of these approaches. With deductive coding, you'll make use of predetermined codes, also called a priori codes, which are developed before you interact with the present data. This usually involves drawing up a set of codes based on a research question or previous research from your literature review. You could also use an existing code set from the codebook of a previous study. For example, if you were studying the eating habits of college students, you might have a research question along the lines of, what foods do college students eat the most? As a result of this research question, you might develop a code set that includes codes such as sushi, pizza, and burgers. You'd then code your data set using only these codes, regardless of what you find in the data. On the upside, the deductive approach allows you to undertake your analysis with a very tightly focused lens and quickly identify relevant data, avoiding distractions and detours. The downside, of course, is that you could miss out on some very valuable insights as a result of this tight predetermined focus. Now let's look at the opposite approach, inductive coding. As I mentioned earlier, this type of coding involves jumping right into the data without predetermined codes and developing the codes based on what you find within the data. For example, if you were to analyze a set of open-ended interview question responses, you wouldn't necessarily know which direction the conversation would flow. If a conversation begins with a discussion of cats, it might go on to include other animals too. And so, you'd add these codes as you progress with your analysis. Simply put, with inductive coding, you go with the flow of the data. Inductive coding is great when you're researching something that isn't yet well understood because the coding derived from the data helps you explore the subject. Therefore, this approach to coding is usually adopted when researchers want to investigate new ideas or concepts or when they want to create new theories. So, as you can see, the inductive and deductive approaches represent two ends of a spectrum, but this doesn't mean that they're mutually exclusive. You can also take a hybrid approach where you utilize a mix of both. For example, if you've got a set of codes you've derived from a literature review or a previous study, in other words, a deductive approach, but you still don't have a rich enough code set to capture the depth of your qualitative data, you can combine deductive and inductive approaches, which we call a hybrid approach. To adopt a hybrid approach, you'll begin your analysis with a set of a priori codes, in other words, a deductive approach, and then add new codes, in other words, an inductive approach, as you work your way through the data. Essentially, the hybrid coding approach provides the best of both worlds, which is why it's pretty common to see this in research. All right, now that we've covered what qualitative coding is and the overarching approaches, let's dive into the actual coding process and look at how to undertake the coding. So, let's take a look at the actual coding process step by step. Whether you adopt an inductive or deductive approach, your coding will consist of two stages, initial coding and line-by-line coding. In the initial coding stage, the objective is to get a general overview of the data by reading through and understanding it. If you're using an inductive approach, this is also where you'll develop an initial set of codes. Then in the second stage, line-by-line coding, you'll delve deeper into the data and organize it into a formalized set of codes. Let's take a look at these stages of qualitative coding in more detail. Stage one, initial coding. The first step of the coding process is to identify the essence of the text and code it accordingly. While there are many qualitative analysis software options available, you can just as easily code text-based data using Microsoft Word's comments feature. In fact, if it's your first time coding, it's oftentimes best to just stick with Word as this eliminates the additional need to learn new software. Importantly, you should avoid the temptation of any sort of automated coding software or service. No matter what promises they make, automated software simply cannot compare to human-based coding as it can't understand the subtleties of language and context. Don't waste your time with this. In all likelihood, you'll just end up having to recode everything yourself anyway. Okay, so let's take a look at a practical example of the coding process. Assume you had the following interview data from two interviewees. In the initial stage of coding, you could assign the code of pets or animals. These are just initial fairly broad codes that you can and will develop and refine later. In the initial stage, broad rough codes are fine. They're just a starting point which you will build onto later when you undertake line-by-line coding. So, at this stage, you're probably wondering how to decide what codes to use, especially when there are so many ways to read and interpret any given sentence. Well, there are a few different coding methods you can adopt and the right method will depend on your research aims and research questions. In other words, the way you code will depend on what you're trying to achieve with your research. Five common methods utilized in the initial coding stage include in vivo coding, process coding, descriptive coding, structural coding, and value coding. These are not the only methods available, but they're a useful starting point. Let's take a look at each of them to understand how and when each method could be useful. Method number one, in vivo coding. When you use in vivo coding, you make use of a participant's own words rather than your interpretation of the data. In other words, you use direct quotes from participants as your codes. By doing this, you'll avoid trying to infer meaning by staying as close to the original phrases and words as possible. In vivo coding is particularly useful when your data are derived from participants who speak different languages or come from different cultures. In cases like these, it's often difficult to accurately infer meaning thanks to linguistic and or cultural differences. For example, English speakers typically view the future as in front of them and the past as behind them. However, this isn't the same in all cultures. Speakers of Aymara view the past as in front of them and the future as behind them. Why? Because the future is unknown. It must be out of sight or behind them. They know what happened in the past so their perspective is that it's positioned in front of them where they can see it. In a scenario like this one, it's not possible to derive the reason for viewing the past as in front and the future as behind without knowing the Aymara culture's perception of time. Therefore, in vivo coding is particularly useful as it avoids interpretation errors. While this case is a unique one, it illustrates the point that different languages and cultures can view the same things very differently, which would have major impacts on your data. Method number two, process coding. Next up, there's process coding, which makes use of action-based codes. Action-based codes are codes that indicate a movement or procedure. These actions are often indicated by gerunds, that is words ending in ing. For example, running, jumping, or singing. Process coding is useful as it allows you to code parts of data that aren't necessarily spoken but that are still important to understand the meaning of the text. For example, you may have action codes such as describing a panda, singing a song, or arguing with a relative. Another example would be if a participant were to say something like, I have no idea where she is. A sentence like this could be interpreted in many different ways depending on the context and movements of the participant. The participant could, for example, shrug their shoulders, which would indicate that they genuinely don't know where the girl is. Alternatively, they could wink, suggesting that they do actually know where the girl is. Simply put, process coding is useful as it allows you to, in a concise manner, identify occurrences in a set of data that are not necessarily spoken and to provide a dynamic account of events. Method number three, descriptive coding. Descriptive coding is a popular coding method that aims to summarize extracts by using a single word that encapsulates the general idea of the data. These words will typically describe the data in a highly condensed manner, which allows you as the researcher to quickly refer to the content. For example, a descriptive code could be food, when coding a video clip that involves a group of people discussing what they ate throughout the day, or cooking, when coding an image showing the steps of a recipe. Descriptive coding is very useful when dealing with data that appear in forms other than text. For example, video clips, sound recordings, or images. It's also particularly useful when you want to organize a large data set by topic area. This makes descriptive coding a popular choice for many research projects. Method number four, structural coding. True to its name, structural coding involves labeling and describing specific structural attributes of the data. Generally, it includes coding according to answers of the questions of who, what, where, and how, rather than the actual topics expressed in the data. For example, if you were coding a collection of dissertations, which would be quite a large data set, structural coding might be useful as you could code according to different sections within each of these documents. Coding what centric labels, such as hypotheses, literature review, and methodology, would help you to efficiently refer to sections and navigate without having to work through sections of data all over again. So, structural coding is useful when you want to access segments of data quickly, and it can help tremendously when you're dealing with large data sets. Structural coding can also be useful for data from open-ended survey questions. This data may initially be difficult to code as they lack the set structure of other forms of data, such as an interview with a strict closed set of questions to be answered. In this case, it would be useful to code sections of data that answer certain questions, such as who, what, where, and how. Method number five, values coding. Last but not least, values-based coding involves coding excerpts that relate to the participant's worldviews. Typically, this type of coding focuses on excerpts that provide insight regarding the values, attitudes, and beliefs of the participants. In practical terms, this means you'd be looking for instances where your participants say things like, I feel, I think that, I need, and it's important that, as these sorts of statements often provide insight into their values, attitudes, and beliefs. Values coding is therefore very useful when your research aims and research questions seek to explore cultural values and interpersonal experiences and actions, or when you're looking to learn about the human experience. All right, so we've looked at five popular methods that can be used in the initial coding stage. As I mentioned, this is not a comprehensive list, so if none of these sound relevant to your project, be sure to look up alternative coding methods to find the right fit for your research aims. The five methods we've discussed allow you to arrange your data so that it's easier to navigate during the next stage, line-by-line coding. While these methods can all be used individually, it's important to know that it's possible, and quite often beneficial, to combine them. For example, when conducting initial coding with interview data, you could begin by using structural coding to indicate who speaks when. Then, as a next step, you could apply descriptive coding so that you can navigate to and between conversation topics easily. As with all design choices, the right method or combination of methods depends on your research aims and research questions, so think carefully about what you're trying to achieve with your research. Then, select the method or methods that make sense in light of that. So, to recap, the aim of initial coding is to understand and familiarize yourself with your data, to develop an initial code set, if you're taking an inductive approach, and to take the first shot at coding your data. Once that's done, you can move on to the next stage, line-by-line coding. Let's do it. Line-by-line coding is pretty much exactly what it sounds like, reviewing your data line-by-line, digging deeper, refining your codes, and assigning additional codes to each line. With line-by-line coding, the objective is to pay close attention to your data, to refine and expand upon your coding, especially when it comes to adopting an inductive approach. For example, if you have a discussion of beverages and you previously just coded this as beverages, you could now go deeper and code more specifically, such as coffee, tea, and orange juice. The aim here is to scratch below the surface. This is the time to get detailed and specific so that you can capture as much richness from the data as possible. In the line-by-line coding process, it's useful to code as much data as possible, even if you don't think you're going to use it. As you go through this process, your coding will become more thorough and detailed, and you'll have a much better understanding of your data as a result of this. This will be incredibly valuable in the analysis phase, so don't cut corners here. Take your time to work through your data line-by-line and apply your mind to see how you refine your coding as much as possible. Keep in mind that coding is an iterative process, which means that you'll move back and forth between interviews or documents to apply the codes consistently throughout your data set. Be careful to clearly define each code and update previously coded excerpts if you adjust or update the definition of any code, or if you split any code into narrower codes. Line-by-line coding takes time, so don't rush it. Be patient and work through your data meticulously to ensure you develop a high-quality code set. Stage three, moving from coding to analysis. Once you've completed your initial and line-by-line coding, the next step is to start your actual qualitative analysis. Of course, the coding process itself will get you in analysis mode, and you'll probably already have some insights and ideas as a result of it, so you should always keep notes of your thoughts as you work through the coding process. When it comes to qualitative data analysis, there are many different methods you can use, including content analysis, thematic analysis, and discourse analysis. The analysis method you adopt will depend heavily on your research aims and research questions. We cover qualitative analysis methods on the Grad Coach blog, so we're not going to go down that rabbit hole here, but we'll discuss the important first steps that build the bridge from qualitative coding to qualitative analysis. So, how do you get started with your analysis? Well, each analysis will be different, but it's useful to ask yourself the following more general questions to get the wheels turning. What actions and interactions are shown in the data? What are the aims of these interactions and excerpts? How do participants interpret what is happening, and how do they speak about it? What does their language reveal? What are the assumptions made by the participants? What are the participants doing? Why do I want to learn about this? What am I trying to find out? As with initial coding and line-by-line coding, your qualitative analysis can follow certain steps. The first two steps will typically be code categorization and theme identification. Let's look at these two steps. Code categorization, which is the first step, is simply the process of reviewing everything you've coded and then creating categories that can be used to guide your future analysis. In other words, it's about bundling similar or related codes into categories to help organize your data effectively. Let's look at a practical example. If you were discussing different types of animals, your codes may include dogs, llamas, and lions. In the process of code categorization, you could label, in other words, categorize these three animals as mammals, whereas you could categorize flies, crickets, and beetles as insects. By creating these code categories, you will be making your data more organized, as well as enriching it so that you can see new connections between different groups of codes. Once you've categorized your codes, you can move on to the next step, which is to identify the themes in your data. Let's look at the theme identification step. From the coding and categorization processes, you'll naturally start noticing themes. Therefore, the next logical step is to identify and clearly articulate the themes in your data set. When you determine themes, you'll take what you've learned from the coding and categorization stages and synthesize it to develop themes. This is the part of the analysis process where you'll begin to draw meaning from your data and produce a narrative. The nature of this narrative will, of course, depend on your research aims, your research questions, and the analysis method you've chosen. For example, content analysis or thematic analysis. So, keep these factors front of mind as you scan for themes, as they'll help you stay aligned with the big picture. All right, now that we've covered both the what and the how of qualitative coding, I want to quickly share some general tips and suggestions to help you optimize your coding process. Let's rapid fire. One, before you begin coding, plan out the steps you'll take and the coding approach and method or methods you'll follow to avoid inconsistencies. Two, when adopting a deductive approach, it's best to use a codebook with detailed descriptions of each code right from the start of the coding process. This will ensure that you apply codes consistently based on their descriptions and will help you keep your work organized. Three, whether you adopt an inductive or deductive approach, keep track of the meanings of your codes and remember to revisit these as you go along. Four, while coding, keep your research aims, research questions, coding methods, and analysis method front of mind. This will help you to avoid directional drift, which happens when coding is not kept consistent. Five, if you're working in a research team with multiple coders, make sure that everyone has been trained and clearly understands how codes need to be assigned. If multiple coders are pulling in even slightly different directions, you will end up with a mess that needs to be redone. You don't want that. So keep these five tips in mind and you'll be on the fast track to coding success. And there you have it, qualitative coding in a nutshell. Remember, as with every design choice in your dissertation, thesis, or research project, your research aims and research questions will have a major influence on how you approach the coding. So keep these two elements front of mind every step of the way and make sure your coding approach and methods align well. If you enjoyed the video, hit the like button and leave a comment if you have any questions. Also, be sure to subscribe to the channel for more research-related content. If you need a helping hand with your qualitative coding or any part of your research project, remember to check out our private coaching service where we work with you on a one-on-one basis, chapter by chapter, to help you craft a winning piece of research. If that sounds interesting to you, book a free consultation with a friendly coach at gradcoach.com. As always, I'll include a link below. That's all for this episode of Grad Coach TV. Until next time, good luck.
While the importance of physician research has been underscored, a shortage of qualified physicians engaged in research persists. Early exposure to research could potentially ignite medical students’ interest in research, thereby motivating them to pursue research-related careers.
The study aims to examine early research engagement and medical graduates’ interest in incorporating research into their future career paths.
This was a national cross-sectional survey administered in 2020, with 152,624 medical students from 119 medical schools in China completing it. We selected and resampled the graduates’ data, and the final sample included 17,451 respondents graduating from 101 medical schools.
For graduates engaged in research, 63.4% (3054) had the interest in integrating research into their future careers. Such interest in research did differ between medical graduates with and without research engagement by linear probability regression ( β , 0.50; 95%CI, 0.48 to 0.52), but did not differ in instrumental variable regression analysis ( β , 0.31; 95%CI, − 0.18 to 0.80). Furthermore, engaging in research significantly increased the top 50% of academically ranked graduates’ research interest in instrumental variable regression analysis ( β , 0.44; 95%CI, 0.01 to 0.86).
Contrary to expectations, research engagement does not necessarily enhance medical graduates’ interest in integrating research into their future careers. However, graduates with strong academic performance are more inclined to develop this research interest. In light of these findings, we propose recommendations for nurturing research interest within medical education.
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The research project was funded by the National Natural Science Foundation of China (Grant No. 72174013) and the China Scholarship Council (File No. 202208310033). The funders had no role in the design and development of the study protocol or the decision to publish.
Authors and affiliations.
School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
Guoyang Zhang
Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
School of Public Health, Peking University, Beijing, People’s Republic of China
Xuanxuan Ma
Institute of Medical Education, Peking University, Beijing, People’s Republic of China
National Centre for Health Professions Education Development, Peking University, Beijing, People’s Republic of China
Xuanxuan Ma & Hongbin Wu
School of Medicine, The Fourth Affiliated Hospital of Zhejiang University, Yiwu, Zhejiang, People’s Republic of China
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HBW made substantial contributions to the study conception and design. HBW and GYZ conducted the data analyses and drafted the manuscript. HBW interpreted the results with the support from GYZ, LL, and XXM. XXM made editing contributions. All authors reviewed the final manuscript and have approved the final version.
Correspondence to Hongbin Wu .
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Zhang, G., Li, L., Ma, X. et al. Examining the Effect of Research Engagement on the Interest in Integrating Research into Future Career Paths Among Medical Graduates in China: An Instrumental Variable Analysis. Med.Sci.Educ. (2024). https://doi.org/10.1007/s40670-024-02152-3
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Accepted : 21 August 2024
Published : 29 August 2024
DOI : https://doi.org/10.1007/s40670-024-02152-3
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