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Qualitative research methodologies: ethnography

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• Peer review
• Scott Reeves , associate professor 1 ,
• Ayelet Kuper , assistant professor 2 ,
• Brian David Hodges , associate professor and vice chair (education) 3
• 1 Department of Psychiatry, Li Ka Shing Knowledge Institute, Centre for Faculty Development, and Wilson Centre for Research in Education, University of Toronto, 200 Elizabeth Street, Eaton South 1-565, Toronto, ON, Canada M5G 2C4
• 2 Department of Medicine, Sunnybrook Health Sciences Centre, and Wilson Centre for Research in Education, University of Toronto, Toronto, ON, Canada M4N 3M5
• 3 Department of Psychiatry, Wilson Centre for Research in Education, University of Toronto, Toronto, ON, Canada M5G 2C4
• Correspondence to: S Reeves scott.reeves{at}utoronto.ca

The previous articles (there were 2 before this 1) in this series discussed several methodological approaches commonly used by qualitative researchers in the health professions. This article focuses on another important qualitative methodology: ethnography. It provides background for those who will encounter this methodology in their reading rather than instructions for carrying out such research.

What is ethnography?

Ethnography is the study of social interactions, behaviours, and perceptions that occur within groups, teams, organisations, and communities. Its roots can be traced back to anthropological studies of small, rural (and often remote) societies that were undertaken in the early 1900s, when researchers such as Bronislaw Malinowski and Alfred Radcliffe-Brown participated in these societies over long periods and documented their social arrangements and belief systems. This approach was later adopted by members of the Chicago School of Sociology (for example, Everett Hughes, Robert Park, Louis Wirth) and applied to a variety of urban settings in their studies of social life.

The central aim of ethnography is to provide rich, holistic insights into people’s views and actions, as well as the nature (that is, sights, sounds) of the location they inhabit, through the collection of detailed observations and interviews. As Hammersley states, “The task [of ethnographers] is to document the culture, the perspectives and practices, of the people in these settings. The aim is to ‘get inside’ the way each group of people sees the world.” 1 Box 1 outlines the key features of ethnographic research.

Box 1 Key features of ethnographic research 2

A strong emphasis on exploring the nature of a particular social phenomenon, rather than setting out to test hypotheses about it

A tendency to work primarily with “unstructured data” —that is, data that have not been coded at the point of data collection as a closed set of analytical categories

Investigation of a small number of cases (perhaps even just …

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• What Is Ethnography? | Definition, Guide & Examples

What Is Ethnography? | Definition, Guide & Examples

Published on March 13, 2020 by Jack Caulfield . Revised on June 22, 2023.

Ethnography is a type of qualitative research that involves immersing yourself in a particular community or organization to observe their behavior and interactions up close. The word “ethnography” also refers to the written report of the research that the ethnographer produces afterwards.

Ethnography is a flexible research method that allows you to gain a deep understanding of a group’s shared culture, conventions, and social dynamics. However, it also involves some practical and ethical challenges.

Table of contents

What is ethnography used for, different approaches to ethnographic research, gaining access to a community, working with informants, observing the group and taking field notes, writing up an ethnography, other interesting articles.

Ethnographic research originated in the field of anthropology, and it often involved an anthropologist living with an isolated tribal community for an extended period of time in order to understand their culture.

This type of research could sometimes last for years. For example, Colin M. Turnbull lived with the Mbuti people for three years in order to write the classic ethnography The Forest People .

Today, ethnography is a common approach in various social science fields, not just anthropology. It is used not only to study distant or unfamiliar cultures, but also to study specific communities within the researcher’s own society.

For example, ethnographic research (sometimes called participant observation ) has been used to investigate  football fans , call center workers , and police officers .

Advantages of ethnography

The main advantage of ethnography is that it gives the researcher direct access to the culture and practices of a group. It is a useful approach for learning first-hand about the behavior and interactions of people within a particular context.

By becoming immersed in a social environment, you may have access to more authentic information and spontaneously observe dynamics that you could not have found out about simply by asking.

Ethnography is also an open and flexible method. Rather than aiming to verify a general theory or test a hypothesis , it aims to offer a rich narrative account of a specific culture, allowing you to explore many different aspects of the group and setting.

Disadvantages of ethnography

Ethnography is a time-consuming method. In order to embed yourself in the setting and gather enough observations to build up a representative picture, you can expect to spend at least a few weeks, but more likely several months. This long-term immersion can be challenging, and requires careful planning.

Ethnographic research can run the risk of observer bias . Writing an ethnography involves subjective interpretation, and it can be difficult to maintain the necessary distance to analyze a group that you are embedded in.

There are often also ethical considerations to take into account: for example, about how your role is disclosed to members of the group, or about observing and reporting sensitive information.

Should you use ethnography in your research?

If you’re a student who wants to use ethnographic research in your thesis or dissertation , it’s worth asking yourself whether it’s the right approach:

• Could the information you need be collected in another way (e.g. a survey , interviews)?
• How difficult will it be to gain access to the community you want to study?
• How exactly will you conduct your research, and over what timespan?
• What ethical issues might arise?

If you do decide to do ethnography, it’s generally best to choose a relatively small and easily accessible group, to ensure that the research is feasible within a limited timeframe.

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There are a few key distinctions in ethnography which help to inform the researcher’s approach: open vs. closed settings, overt vs. covert ethnography, and active vs. passive observation. Each approach has its own advantages and disadvantages.

Open vs. closed settings

The setting of your ethnography—the environment in which you will observe your chosen community in action—may be open or closed.

An open or public setting is one with no formal barriers to entry. For example, you might consider a community of people living in a certain neighborhood, or the fans of a particular baseball team.

• Gaining initial access to open groups is not too difficult…
• …but it may be harder to become immersed in a less clearly defined group.

A closed or private setting is harder to access. This may be for example a business, a school, or a cult.

• A closed group’s boundaries are clearly defined and the ethnographer can become fully immersed in the setting…
• …but gaining access is tougher; the ethnographer may have to negotiate their way in or acquire some role in the organization.

Overt vs. covert ethnography

Most ethnography is overt . In an overt approach, the ethnographer openly states their intentions and acknowledges their role as a researcher to the members of the group being studied.

• Overt ethnography is typically preferred for ethical reasons, as participants can provide informed consent…
• …but people may behave differently with the awareness that they are being studied.

Sometimes ethnography can be covert . This means that the researcher does not tell participants about their research, and comes up with some other pretense for being there.

• Covert ethnography allows access to environments where the group would not welcome a researcher…
• …but hiding the researcher’s role can be considered deceptive and thus unethical.

Active vs. passive observation

Different levels of immersion in the community may be appropriate in different contexts. The ethnographer may be a more active or passive participant depending on the demands of their research and the nature of the setting.

An active role involves trying to fully integrate, carrying out tasks and participating in activities like any other member of the community.

• Active participation may encourage the group to feel more comfortable with the ethnographer’s presence…
• …but runs the risk of disrupting the regular functioning of the community.

A passive role is one in which the ethnographer stands back from the activities of others, behaving as a more distant observer and not involving themselves in the community’s activities.

• Passive observation allows more space for careful observation and note-taking…
• …but group members may behave unnaturally due to feeling they are being observed by an outsider.

While ethnographers usually have a preference, they also have to be flexible about their level of participation. For example, access to the community might depend upon engaging in certain activities, or there might be certain practices in which outsiders cannot participate.

An important consideration for ethnographers is the question of access. The difficulty of gaining access to the setting of a particular ethnography varies greatly:

• To gain access to the fans of a particular sports team, you might start by simply attending the team’s games and speaking with the fans.
• To access the employees of a particular business, you might contact the management and ask for permission to perform a study there.
• Alternatively, you might perform a covert ethnography of a community or organization you are already personally involved in or employed by.

Flexibility is important here too: where it’s impossible to access the desired setting, the ethnographer must consider alternatives that could provide comparable information.

For example, if you had the idea of observing the staff within a particular finance company but could not get permission, you might look into other companies of the same kind as alternatives. Ethnography is a sensitive research method, and it may take multiple attempts to find a feasible approach.

All ethnographies involve the use of informants . These are people involved in the group in question who function as the researcher’s primary points of contact, facilitating access and assisting their understanding of the group.

This might be someone in a high position at an organization allowing you access to their employees, or a member of a community sponsoring your entry into that community and giving advice on how to fit in.

However,  i f you come to rely too much on a single informant, you may be influenced by their perspective on the community, which might be unrepresentative of the group as a whole.

In addition, an informant may not provide the kind of spontaneous information which is most useful to ethnographers, instead trying to show what they believe you want to see. For this reason, it’s good to have a variety of contacts within the group.

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The core of ethnography is observation of the group from the inside. Field notes are taken to record these observations while immersed in the setting; they form the basis of the final written ethnography. They are usually written by hand, but other solutions such as voice recordings can be useful alternatives.

Field notes record any and all important data: phenomena observed, conversations had, preliminary analysis. For example, if you’re researching how service staff interact with customers, you should write down anything you notice about these interactions—body language, phrases used repeatedly, differences and similarities between staff, customer reactions.

Don’t be afraid to also note down things you notice that fall outside the pre-formulated scope of your research; anything may prove relevant, and it’s better to have extra notes you might discard later than to end up with missing data.

Field notes should be as detailed and clear as possible. It’s important to take time to go over your notes, expand on them with further detail, and keep them organized (including information such as dates and locations).

After observations are concluded, there’s still the task of writing them up into an ethnography. This entails going through the field notes and formulating a convincing account of the behaviors and dynamics observed.

The structure of an ethnography

An ethnography can take many different forms: It may be an article, a thesis, or an entire book, for example.

Ethnographies often do not follow the standard structure of a scientific paper, though like most academic texts, they should have an introduction and conclusion. For example, this paper begins by describing the historical background of the research, then focuses on various themes in turn before concluding.

An ethnography may still use a more traditional structure, however, especially when used in combination with other research methods. For example, this paper follows the standard structure for empirical research: introduction, methods, results, discussion, and conclusion.

The content of an ethnography

The goal of a written ethnography is to provide a rich, authoritative account of the social setting in which you were embedded—to convince the reader that your observations and interpretations are representative of reality.

Ethnography tends to take a less impersonal approach than other research methods. Due to the embedded nature of the work, an ethnography often necessarily involves discussion of your personal experiences and feelings during the research.

Ethnography is not limited to making observations; it also attempts to explain the phenomena observed in a structured, narrative way. For this, you may draw on theory, but also on your direct experience and intuitions, which may well contradict the assumptions that you brought into the research.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Ecological validity

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

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Qualitative study design: Ethnography

• Qualitative study design
• Phenomenology
• Grounded theory

Ethnography

• Narrative inquiry
• Action research
• Case Studies
• Field research
• Focus groups
• Observation
• Surveys & questionnaires
• Study Designs Home

To describe the characteristics of a particular culture/ethnographic group. 

Ethnography is the study of culture (Taylor & Francis, 2013) it is in many ways similar to anthropology; this being the study of human societies and cultures. 

Exploration and data collection can occur in either an emic or etic approach. Emic meaning that the observation happens from within the culture. Etic meaning the observation is external looking in (Taylor et al., 2006) 

Used to explore questions relating to the understanding of a certain group's beliefs, values, practices and how they adapt to change. (Taylor & Francis, 2013) 

Ethnographic studies can be about identifying inequalities. For example exploring racial and cultural aspects of how a cultural group functions and the rules that guide behaviours. (Taylor & Francis, 2013) 

One form of ethnography is an auto-ethnography which involves exploration of the self as the topic being explored. 

The researcher places themselves as a ‘participant observer’ amidst the culture. 

The setting is a very important consideration within ethnographic studies as the exploration of the people and their behaviours must be within the context of that cultural situation. 

Methods used include, but are not limited to: observation, interviews, focus groups, review of documentary evidence and keeping field notes. (Taylor & Francis, 2013) 

Steps involved include:  

Identify the culture to be studied  

Identify the significant variables within the culture 

Review existing literature 

Gain entrance 

Immerse within the culture or observe the culture 

Acquire the informants 

Gather data 

Describe the culture 

Develop theories. 

(Taylor & Francis, 2013) 

Direct insight into the lives and experiences of the people and the group of interest. 

Allows for rich detailed data to be collected (Howitt, 2019). 

Provides an opportunity for researchers to uncover new unknown ways of thinking. Researchers may become aware of behaviors, trends and beliefs that are present within one culture although these may be previously unknown to other cultures. This enables new opportunities for improved ways of viewing and solving issues within other cultures.   

Limitations

Biases can be apparent because a researcher will always bring with them their own culture and own perspective which may impact their interpretations of the experiences they observe within this different culture. 

Genuine co-operation and engagement from the people of interest may not always be forthcoming and rapport might be difficult to establish. 

There can be a greater cost involved for this study type than others. Due to the need for transport, accommodation and researcher time that is spent in the field among the participants. This can be greater than what would be spent in a different research methodology where the engagement may be limited to a laboratory or shorter duration. 

Certain logistics can pose challenges for this type of research approach, such as travelling and gaining access to communities depending on their unique cultural values, for example there are many indigenous societies that only permit people of certain genders to have access. 

As the setting may be very specific to a particular group or community of people it may not be possible to generalise and apply the findings very broadly. 

Researchers need to be aware of the impact that their presence can have on the behaviours of the population they are investigating. 

The “Hawthorne effect” can be a limitation to observing genuine behaviours within a group. This is a situation founded by Dickson and Roethlisberger in 1966 when they reviewed previous experiments conducted at the Hawthorne factory. These experiments observed the ways that different influences, such as the level of lighting, impacted on the efficiency of factory workers. Their re-examination demonstrated that participants can behave differently to what they usually would when they are aware that they are being studied or recorded. As such, the methods selected need to counteract this effect for all study types, but for ethnographic studies especially, as authenticity of the cultural experience is quite important to ethnographic methodology. 

Example questions

What expectations and beliefs do people within specific communities hold about their healthcare options? 

What practices are being undertaken by healthcare professionals in specific settings and are these consistent with best practice? 

What barriers are certain communities experiencing in relation to different healthcare access? 

Are people within a specific community receiving the appropriate information and communication about aspects of their health for them to then make informed educated decisions? 

Example studies

Coughlin, C. (n.d.). An ethnographic study of main events during hospitalisation: perceptions of nurses and patients . Journal of Clinical Nursing, 22(15–16), 2327–2337.  

Molloy, L., Walker, K., Lakeman, R., & Lees, D. (2019). Mental Health Nursing Practice and Indigenous Australians: A Multi-Sited Ethnography. Issues in Mental Health Nursing, 40(1), 21–27. 

Rainsford, S., Phillips, C. B., Glasgow, N. J., MacLeod, R. D., & Wiles, R. B. (2018). The ‘safe death’: An ethnographic study exploring the perspectives of rural palliative care patients and family caregivers. Palliative Medicine, 32(10), 1575–1583. 

Newnham, E., McKellar, L., & Pincombe, J. (2017). ‘It’s your body, but…’ Mixed messages in childbirth education: Findings from a hospital ethnography. Midwifery, 55, 53–59 

King, P. (2019). The woven self: An auto-ethnography of cultural disruption and connectedness . International Perspectives in Psychology: Research, Practice, Consultation, 8(3), 107–123.  

Howitt, D. (2019). Introduction to qualitative research methods in psychology: putting theory into practice. Pearson Education.

Taylor, B. J., & Francis, K. (2013). Qualitative research in the health sciences: methodologies, methods and processes: Routledge.

Taylor, B. J., Kermode, S., & Roberts, K. L. (2006). Research in nursing and health care: creating evidence for practice (Third edition. ed.): Thomson. 

O’Connor, S. J. (2011). Context is everything: The role of auto‐ethnography, reflexivity and self‐critique in establishing the credibility of qualitative research findings. European Journal of Cancer Care, 20(4), 421–423. https://doi.org/10.1111/j.1365-2354.2011.01261.x 

Dickson, W. J & Roethlisberger, F. J., (1966) Counseling in an organization: a sequel to the Hawthorne researches. 1898-1974 & Western Electric Company (U.S.) Division of Research, Graduate School of Business Administration, Harvard University, Boston   

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Qualitative Research: Ethnography

• Data Analysis
• Ethnography
• Interviewing & Focus Groups
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• Library Help

Journals on Ethnography

• Common Ground: Archeology and Ethnography in the Public Interest
• Cultural Anthropology
• Ethnography and Education
• The Journal for Undergraduate Ethnography
• Journal of Contemporary Ethnography
• Journal of Museum Ethnography
• Journal of Organizational Ethnography

Ethnography Methodology

Topical Ethnography

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Ethnography In Qualitative Research

Saul McLeod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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On This Page:

What is Ethnography?

Ethnography is a qualitative research method that emphasizes studying what people do and say in particular contexts. Ethnographers typically spend considerable time observing and interacting with a social group to understand how the group develops cultural constructions and relations.

Ethnography is used anthropology and other social sciences to systematically study people and cultures.

The goal of ethnography is to explore cultural phenomena from the perspective of the subjects being studied.

They aim to uncover the reasons for particular behaviors and practices within a specific cultural context. For example, an ethnographic study might examine why certain communities use specific child-rearing techniques or how cultural values influence emotional expression.

This often involves immersing oneself in a community or organization to observe their behaviors and interactions up close.

Ethnographic research is often open-ended and exploratory. Researchers may enter the field with a research question in mind, but they remain open to unexpected findings and allow the social order of the community to guide their observations.

This openness to discovery helps researchers develop a deeper understanding of the cultural phenomena they study.

How does an ethnographic perspective view psychological knowledge?

Ethnography considers the social context of psychological phenomena to be critical to the field of psychology.

An ethnographic perspective argues that psychological knowledge is not complete unless it examines how communal practices, economic and political structures, shared values, histories, aspirations, and other life dimensions shape human experiences.

The interaction of identity and self-definition is dynamic and shaped by an individual’s social contexts.

Ethnography is primarily used in the following situations:

• Cultural anthropology : Ethnography is the primary research method used by cultural anthropologists to study and understand different societies and cultures around the world. Margaret Mead conducted ethnographic research among the Arapesh, Mundugumor, and Tchambuli people of New Guinea, which resulted in her book Sex and Temperament in Three Primitive Societies (1935). In this work, she explored the ways in which gender roles and personality traits varied across cultures.
• Sociology : Ethnographic methods are used in sociology to study subcultures, communities, and social groups within a larger society, such as urban neighborhoods, religious communities, or professional groups. Paul Willis conducted an ethnographic study of working-class youth culture, presented in his work Learning to Labo r. Willis sought to understand why working-class youth often ended up in working-class jobs. His research involved a series of interviews and observations, focusing on a school setting to gain insight into the connection between working-class backgrounds and career trajectories. Willis concluded that working-class children often develop a counter-school culture, characterized by opposition to academics and authority figures.
• Education : Ethnography is used in educational research to study classroom dynamics, student-teacher interactions, and the impact of cultural factors on learning.
• Healthcare : Ethnography is used in healthcare research to study patient experiences, healthcare provider practices, and the cultural factors that influence health behaviors and outcomes.
• Social work : Ethnographic research helps social workers understand the lived experiences of marginalized or vulnerable populations, informing the development of more effective interventions and support services.
• Policy and development : Ethnography is used in policy research and international development to assess the impact of policies and programs on local communities and to ensure that development initiatives are culturally appropriate and sustainable.

What distinguishes ethnography from other qualitative methods?

While ethnography shares commonalities with other qualitative methods, these distinctions highlight its unique capacity to provide rich, nuanced insights into the complexities of human behavior and culture.

• Immersive Fieldwork: Unlike other qualitative methods that might rely solely on interviews or surveys, ethnography necessitates the researcher to be directly involved in the community or group they are studying, often for extended periods. This immersive approach allows for a depth of understanding unattainable through less participatory methods.
• Unstructured Data Collection: Ethnographers typically begin their research with a more exploratory approach rather than testing predetermined hypotheses. They embrace unstructured data collection, allowing patterns and theories to emerge from their observations and interactions rather than imposing pre-existing frameworks.
• Emphasis on Observation Over Interviews: Although interviews are a common tool in ethnographic research, the core of the method lies in observing what people do rather than solely relying on what they say . This focus on action allows ethnographers to identify discrepancies between stated beliefs and actual practices, providing a richer understanding of the complexities within a social group.
• Interpretative and Reflexive Analysis: Ethnographers acknowledge the inherent subjectivity involved in interpreting social phenomena. They embrace reflexivity, acknowledging that their own backgrounds and perspectives shape how they observe and interpret data.
• Focus on Process, Meaning, and Place: Ethnography seeks to uncover the dynamic processes, shared meanings, and influence of place that shape social life. It investigates how individuals make sense of their world and how these understandings influence their actions and interactions within specific geographical and social contexts.
• Thick description : Thick description, a concept by Geertz, is an ethnographer’s in-depth and nuanced representation of social life that goes beyond simple observation, exploring the meanings and motivations behind behaviors. This nuanced understanding illustrates how ethnographers use thick description to reveal what is “at stake” in people’s lives.

Gaining Access to a Community for Ethnographic Research

Negotiating access to a community for research can be a delicate process, requiring sensitivity and understanding of local social practices.

There is no one-size-fits-all approach; instead, researchers must adapt their approach to the specific community and setting they wish to study.

• Initial Contact: Start by identifying potential participants and settings relevant to the research question. Initial contact can be made remotely through emails, calls, or social connections. Reaching out to researchers who have previously worked in the field can be beneficial. Physical visits to the field can also be helpful in the initial stages.
• Building Trust and Understanding Local Norms: Establishing trust is paramount in ethnographic research. Researchers should prioritize initiating contact in a manner that aligns with the community’s social practices. For example, directly emailing community centers in a culture that values personal introductions might be ineffective. Introducing the researcher through a trusted community member, like a friend or neighbor, can foster trust and facilitate acceptance. Researchers should remain mindful of their position in relation to the community’s cultural norms and how their presence might be perceived.
• Addressing Challenges and Maintaining Access: Unexpected challenges and setbacks are common in ethnographic research. Embracing methodological agility allows researchers to adapt their methods to the contingencies of the field site and view setbacks as opportunities for refining research design. Flexibility is key, and researchers should be open to exploring alternative settings or communities if access to the initial choice proves difficult.
• Ethical Considerations and Reciprocity: Ethnographic research involves a responsibility to the community being studied. Ethnographers must be aware of the power dynamics inherent in research and strive to minimize harm by respecting participants’ privacy and cultural norms. Researchers should consider how their work can benefit the community, for instance, by offering insights, providing resources, or advocating for positive change.

Working with Informants in Ethnography

Informants are crucial to ethnographic research, acting as primary points of contact and facilitating the researcher’s understanding of the group being studied.

Identifying the right informants is vital, and a “friend-of-a-friend” approach, leveraging existing social networks, can be advantageous.

This method can grant access to otherwise inaccessible aspects of social life and provide a unique, embedded perspective on the community’s language use and attitudes.

However, over-reliance on a single informant can skew the researcher’s perspective, potentially leading to biased or unrepresentative findings.

An informant may consciously or unconsciously shape their interactions with the researcher to align with what they believe is expected, hindering the collection of spontaneous and authentic data.

Therefore, it’s essential to cultivate relationships with a diverse range of informants within the community. This approach helps ensure a more comprehensive understanding of the group’s dynamics and mitigates the risk of individual bias influencing the research findings.

While the sources don’t provide detailed steps on managing relationships with multiple informants, they emphasize the importance of ethical considerations, open communication, and building trust throughout the research process.

Data Sources in Ethnographic Research

Ethnographers often employ a  multi-method approach , combining data from these various sources to create a rich and comprehensive understanding of the group being studied.

They may also utilize audio and video recordings to capture interactions and analyze nonverbal communication.

The choice of specific data collection methods depends on factors like the research question, available resources, and ethical considerations

• Participant observation involves the researcher immersing themselves in the daily life of a community to gain an understanding of the actions, activities, rituals, routines, and daily practices. The ethnographer might participate in activities to learn through experience or observe from the sidelines. There are varying levels of participation in this method. Some researchers fully adopt the social role they are studying, like a factory worker or police officer, to better understand the group’s worldview. Others maintain a more detached relationship, observing from the sidelines, while acknowledging that some interaction is inevitable.
• Field notes  are a primary data source, meticulously recording observations, conversations, and preliminary analyses made during immersion in the research setting3.
• Interviews  play a significant role, providing insights into individuals’ perspectives and experiences within the group. Interviews provide a source of witness accounts about settings and events in the social world that the ethnographer may or may not have been able to observe.
• Documents , both official and personal, can offer valuable contextual information and supplement observational data

When conducting ethnographic research, researchers should be mindful of their ontological and epistemological stances, their research questions, and the context of their research.

Ethnographers must also consider ethical implications, the type of data they are collecting, and how their findings will be used.

What are the limitations of solely relying on interviews in ethnographic research?

While interviews are a common element of ethnographic research, relying on them solely as a source of data has some significant limitations.

• Discrepancies Between Words and Actions : Interviews primarily capture what people say about their lives, beliefs, and practices. However, what people say and what they actually do can differ. Observing participants in their natural environment can reveal these discrepancies and provide a more complete understanding of their lived experiences.
• Influence of Interviewer and Context : The interview itself is a constructed situation that can influence participants’ responses. Participants may modify their language or opinions to align with perceived expectations or power dynamics, particularly when discussing sensitive topics.
• Limited Insight into Meaning-Making : While interviews can provide information about perspectives and beliefs, they may not fully capture the subtle ways cultural meanings are embedded in everyday practices and interactions. Ethnographic observation allows researchers to witness these meaning-making processes firsthand.
• Difficulty in Capturing Complexity : Interviews, especially structured ones, often rely on pre-determined questions and response categories. This approach can oversimplify complex cultural phenomena and miss nuances that emerge through observation of natural interactions.

Supplementing Interviews with Observation

To mitigate these limitations, sources emphasize the importance of combining interviews with other ethnographic methods, primarily participant observation .

• Observing participants in their natural environment provides a more holistic and nuanced understanding of their practices, interactions, and the cultural meanings embedded within them.
• This immersive approach allows researchers to go beyond self-reported accounts and gain insights that might not be revealed through interviews alone.

Skills Required for Ethnographic Studies

• High Degree of Interpretative Agility: Understanding the intricacies of ethnographic studies necessitates a high degree of interpretative agility to make sense of the diverse range of issues and facts gathered.
• Cultural Sensitivity: Sensitivity towards the culture, values, and norms of the social setting is paramount for conducting ethical and meaningful research. This is essential for building trust and rapport with research participants and understanding their perspectives.
• Reflexivity : Ethnographers must be self-aware and reflective about their own positionality, biases, and impact on the research process, and be transparent about these factors in their writing.

The Role of Reflexivity in Ethnography

Reflexivity in ethnographic writing involves thoughtfully examining how the researcher’s background, beliefs, and position influence their observations, interpretations, and the final ethnographic account.

It’s a crucial aspect of producing responsible and insightful ethnographic work.

• Acknowledging Subjectivity: Ethnographers who practice reflexivity understand that their accounts are not objective truths, but rather interpretations shaped by their own experiences and perspectives. They acknowledge that other researchers, with different backgrounds and positions, might interpret the same data differently.
• Positioning the Researcher: Reflexivity encourages ethnographers to explicitly consider and articulate how their personal and cultural background, as well as their social position relative to the community being studied, might influence their understanding of the observed phenomena. This includes acknowledging any preconceived notions or biases they bring to the research.
• Examining Power Dynamics: Ethnographic research often involves power imbalances between the researcher and the researched, especially when studying marginalized groups. Reflexivity encourages researchers to critically examine these power dynamics and to consider how their work might perpetuate or challenge existing inequalities. This involves being transparent about the research process and engaging in ethical practices that protect participants.
• Enhancing the Validity of Findings : Ultimately, reflexivity aims to strengthen the ethnographic account by making the researcher’s interpretive process more transparent and by providing a more nuanced and accountable representation of the community being studied. This can involve explicitly discussing the researcher’s positionality and reflecting on how their presence might have influenced the data collected.

It is important to note that while reflexivity is widely recognized as crucial in ethnography, there are different understandings of its application and implications.

Some argue for a more radical approach that emphasizes the subjective nature of ethnographic knowledge and the limitations of representation.

Others advocate for a more moderate stance that acknowledges the importance of reflexivity while still striving for rigorous and insightful accounts of social reality.

Importance of Local Context in Ethnography

Understanding the local context is crucial for ethnographic research because it allows researchers to accurately interpret the meanings behind people’s actions and perspectives within their specific social and cultural environment.

Ethnography examines the intricate relationships between human agency and the structures of society within the everyday experiences of a particular place. This method aims to understand the processes and meanings that underpin social life, recognizing that these processes and meanings vary across locations.

Here’s why local context is so important for ethnographic research:

• Connecting Macro and Micro Levels of Analysis: Ethnography aims to reveal the link between large-scale societal structures and the everyday experiences of individuals. The local context provides the specific setting where these connections are made visible and understandable. For instance, studying violence statistically cannot capture the contextual factors that lead to it, but ethnographic research can uncover the specific social dynamics and meanings within particular places that contribute to such behavior.
• Uncovering Meaning Systems: The meanings people assign to events and actions are often deeply embedded within their local culture and not always explicitly stated. Ethnographers, by immersing themselves in the local context, can gradually understand these meaning systems through prolonged observation, interaction, and analysis of daily practices.
• Context-Sensitivity of Behavior: People’s actions and accounts of their actions are highly context-dependent, meaning they can vary significantly across different settings. Ethnographic research acknowledges this by emphasizing firsthand observation and understanding of the local context to ensure accurate interpretation of behavior and perspectives.
• Avoiding Misinterpretation: Without a deep understanding of the local context, researchers risk misinterpreting observations or imposing their own cultural biases on the data. Immersing oneself in the local context allows ethnographers to develop cultural competence and sensitivity, which helps them arrive at more accurate and insightful interpretations of the group’s actions and beliefs.

In essence, understanding the local context is not just about knowing where something occurs, but about comprehending the intricate web of cultural meanings, social dynamics, and historical factors that shape people’s lives and experiences in that specific location.

This understanding is fundamental to the ethnographic approach and its ability to generate meaningful insights into human behavior and social life.

Challenges in Conducting Ethnographic Research

Ethnography, a qualitative research method focusing on the study of people and cultures, presents a unique set of challenges for researchers:

• Time Commitment : Ethnography is a time-consuming endeavor. Researchers need to spend significant time immersed in the community or organization they are studying to build relationships, observe interactions, and gain a deep understanding of the culture. This long-term immersion requires careful planning and can be personally demanding. For instance, some research may necessitate a “focused” or “mini” ethnography lasting a few weeks or months, while others require a year or more.
• Observer Bias : Ethnographers are at risk of introducing their own biases into the research. Writing an ethnography involves subjective interpretation, and it can be difficult to remain objective when analyzing a group in which the researcher is deeply involved. The researcher’s background, beliefs, and experiences can influence their observations and interpretations.
• Representing Culture : Writing about other people is inherently complicated, and ethnographers must consider how to describe people in a manner that is informative, honest, sensitive, and ethical.
• Ethical Issues : Recognize that ethnographers often hold a position of power relative to the communities they study, particularly when working with marginalized groups. Ensure participants are volunteers who understand the study’s purpose and their right to withdraw.
• Gaining Access : Getting access to a community or organization for research can be a delicate process. Researchers need to establish trust with gatekeepers and negotiate their role within the community. This can be particularly difficult in settings that are closed or suspicious of outsiders. For instance, researchers may face resistance from organizations concerned about negative publicity stemming from the study’s findings.
• Data Analysis and Interpretation : Ethnographic research often generates large amounts of data in various forms, such as field notes, interviews, and documents. Analyzing this data and developing meaningful interpretations can be challenging and time-consuming. Researchers must develop systematic ways to manage, analyze, and interpret their data while staying true to the experiences and perspectives of the participants.
• Generalizability : The findings of ethnographic research, which typically focuses on a specific case or setting, can be challenging to generalize to other populations or contexts. The in-depth, context-specific nature of ethnographic research, while a strength in understanding a particular group, poses challenges for drawing broader conclusions about human behavior and social phenomena.
• External Pressures : Ethnographers may face pressure from funding agencies or institutions to conduct research that aligns with specific agendas or produces immediate, tangible outcomes. This pressure can create ethical dilemmas and compromise the integrity of the research. For example, ethnography may be perceived as an inefficient research method due to its reliance on long-term engagement.

Strategies for Ethical Representation

Any ethnographic account of another cultural group risks engaging in what Edward Said (1978) called the “politics of othering,” potentially distorting the lives of those being studied in support of “scientific racism and projects of colonial domination and exploitation”.

The ethnographer should chronicle the community’s experiences, including their struggles, aspirations, losses, and stagnation, with compassion

Thick Description

Provide a nuanced perspective on social life, connecting observed behaviors to underlying meanings, emotions, and decision-making strategies, while avoiding simplistic or reductive accounts of complex experiences.

For example, instead of simply stating that Alzheimer’s carries a social stigma, an ethnographer might connect this observation to the community’s beliefs about family and social change.

Respect and Dignity

Represent individuals with respect and dignity, appreciating their values within the context of their lives.

The ethnographer should chronicle the community’s experiences, including their struggles, aspirations, losses, and stagnation, with compassion.

Reflexivity and Collaboration

Acknowledge the historical legacy of ethnography, including its role in colonialism and the potential for exploitative research practices.

Ethnographers should strive for a more equitable and collaborative approach by:

• Recognizing participants as “epistemic agents and interlocutors” who contribute theoretical interpretations, not merely data points2.
• Involving community members in shaping research questions, data analysis, and the dissemination of findings.
• Considering co-authorship with community members

Strengths of Ethnography

• Ethnography offers a nuanced understanding of cultural phenomena by directly observing behaviors and interactions within a specific community or organization. This immersive approach allows researchers to gain firsthand knowledge of shared culture, conventions, and social dynamics. Ethnography is particularly useful for studying complex social phenomena like football fans, call center workers, and police officers.
• Flexibility, allowing researchers to adapt their research strategy and direction based on their observations and developing understanding. Rather than aiming to confirm a hypothesis or test a general theory, ethnographic research prioritizes providing a comprehensive and detailed narrative of a specific culture. This open-ended approach enables the exploration of various aspects of the group and setting being studied.
• Ethnographers can uncover authentic information and observe spontaneous dynamics that might not surface through direct questioning. By becoming immersed in the social environment, researchers gain access to a deeper understanding of the lived experiences of the group under study. For example, ethnographers can examine discrepancies between what people say and their actual actions, providing insights that other methodologies might miss.
• Ethnography enables researchers to understand the meanings behind social actions by revealing the knowledge and meaning structures that guide them. Through prolonged engagement and observation, ethnographers gain insight into the cultural systems of meaning that shape individuals’ perceptions and actions. Unlike surveys or interviews with pre-determined questions, ethnography allows for an emergent understanding of the cultural competencies within a social setting.
• Ethnographic research relies on a comprehensive approach to data collection, incorporating observations, conversations, and preliminary analysis through detailed field notes. This rigorous documentation helps ensure the accuracy and representativeness of the findings. Moreover, ethnography goes beyond simply describing behaviors; it strives to provide a structured explanation of the observed phenomena, drawing on the researcher’s direct experiences, intuitions, and relevant theoretical frameworks.

However, it’s important to note that ethnography, while valuable, has limitations. It is a time-consuming method requiring significant planning and careful consideration of ethical issues.

Additionally, maintaining objectivity and minimizing observer bias can be a challenge due to the researcher’s immersive role.

Further Information

• Brewer, J. (2000).  Ethnography . McGraw-Hill Education (UK).
• Hammersley, M. (2006). Ethnography: problems and prospects .  Ethnography and education ,  1 (1), 3-14.
• Herbert, S. (2000). For ethnography .  Progress in human geography ,  24 (4), 550-568.
• Lew-Levy, S., Reckin, R., Lavi, N., Cristóbal-Azkarate, J., & Ellis-Davies, K. (2017). How do hunter-gatherer children learn subsistence skills? A meta-ethnographic review. Human Nature,  28 (4), 367–394.  https://doi.org/10.1007/S12110-017-9302-2
• Mead, M. (1963). Sex and temperament in three primitive societies (Vol. 370). New York: Morrow.
• Said, E. W. (2013). Orientalism reconsidered. In  Literature Politics & Theory  (pp. 230-249). Routledge.
• Willis, P. (1977). Learning to Labor: How Working-class Kids Get Working-class Jobs . New York: Colombia University Press

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Chapter 9: Ethnography

Darshini Ayton

Learning outcomes

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

• Identify the key terms and concepts used in ethnography.
• Discuss the advantages and disadvantages of ethnography.

What is ethnography?

The key concept in ethnography is culture .

Ethnography studies emerged from the discipline of anthropology. They aim to understand the meanings and behaviours associated with the membership of groups, teams, organisations and communities. 1 The focus of ethnographic research is on the lived culture of groups of people; ethnographers have studied systems of belief, religious frameworks, worldviews and structures that form the social world. There are many definitions of culture. In ethnography, culture is defined as the group norms and expectations that allow members of the group to communicate and work together. This includes attributes, beliefs, customs, behaviours, knowledge, capabilities and habits. Examples of cultural groups include people from a particular region or race, religious groups, organisational groups, workplaces and social groups (for example, friendship groups, and mothers groups). Note that culture is dynamic and socially constructed and it is normal for there to be sub-cultures within cultural groups. 2

Multiple methods can be used in ethnographic research, but participant observation is a hallmark method. 1,3 To explore culture requires a ‘triangulation’; that is,  the use of multiple methods, such as observations and interviews, to develop a comprehensive understanding of culture through observing people and listening to what they have to say about (or within) the culture.

Several approaches to data analysis lend themselves to ethnography, including the identification, study and analysis of patterns. The process of analysis follows a typically unstructured and iterative path consisting of description (describing data), analysis (examining relationships and linkages) and interpretation (explanations beyond analysis). 4

There are other key concepts in ethnographic research, which are outlined below.

Additional key concepts in ethnographic research

• Fieldwork and field notes – the time spent engaging in primary data collection, which is predominantly participant observation, and the mode of data collection. Fieldwork is the time spent immersed in the culture under study, while field notes are the written reflections, observations and ideas documented during or soon after fieldwork. 5
• Participant observation – the main method of data collection in ethnography involves the researcher participating as a member of the community or culture, to gain first-hand experience of daily life in the research setting. 5
• An emic perspective – ethnography seeks to understand the worldview of the participant; it thus follows that the researcher can have an emic perspective (insider) or an etic perspective (outsider). This is not a binary category. Rather, researchers might be considered on a continuum, from emic to etic 6 (see Chapter 28 for an overview of insider and outsider research), and therefore reflexivity (Chapter 30) and researcher positionality (Chapter 28) are important elements of the research process . Implementing ‘insider’ ethnography: lessons from the Public Conversations about HIV/AIDS  project in rural South Africa describes an ethnography project involving insider community members and outsider investigators reflecting on the advantages and challenges of this approach. 7
• Thick description – the researcher creates detailed observational field notes with references to the social actions and behaviours of participants. The field notes include anecdotes, observations about the language used and quotes to illustrate the activities of the cultural group being observed. The researcher then integrates theoretical frameworks to help create meaning for the observations. 8
• Holism – ethnography focuses on studying all aspects of a culture, including religious practices, politics, institutions, family structures and cultural traditions. Using the analogy of the structure of the human body, Bronislaw Malinowski, one of the founders of the functionalist school of anthropology, described survey research as the skeleton and ethnography as the flesh and blood. 4

How long researchers spend conducting observations in the field depends on the research question and context. For example, in research to observe and characterise the behaviours and processes of antimicrobial decision-making in two surgical units of an acute hospital setting, researchers spent 58 hours in participant observation at three points of care: pre-admission clinic, surgery and on the ward following surgery. These three points of care were chosen as key moments in the patient’s experience of surgery. The observations were conducted in an acute hospital where medical practice is process-driven and protocol-driven. Hence, it did not take extensive time to observe the typical process and protocol in this setting. Researchers used an observation audit sheet (see Chapter 15) and informed participants that the study was focused on clinical decision-making, rather than specifically antimicrobial prescribing. This was done to minimise the ‘Hawthorne effect’, whereby people are said to change their behaviour because they know they are being observed. Following participant observations, six semi-structured interviews were conducted with two surgeons and four anaesthetists to clarify and discuss the findings of the observations. Interview data were analysed thematically, using inductive and deductive coding. 9

In contrast, an ethnographic study of homecare workers supporting people living with dementia involved 100 hours of participant observations of 16 homecare workers who were supporting 17 people living with dementia. Interviews were conducted with 82 people, including people living with dementia, family carers, homecare managers and support staff, homecare workers, and health and social care professionals. 10

Advantages and challenges of ethnography

The immersive approach to ethnography enables a nuanced understanding of the cultural group under study. Unlike other research designs, the prolonged engagement with the research setting provides an opportunity to refine and iterate research questions leading to a deeper understanding of the phenomenon. Participant observation provides a first hand of the behaviours and interactions of people within a cultural group which can be triangulated with interviews and documents to increase the rigour of the research. 9

There are many challenges in conducting ethnographic research. The time required to undertake ethnographic fieldwork can range from short sessions of observations over months or years, to the researcher living in the community for a period of time. The resources and time required may be substantial. When a researcher is embedded within a community, their departure can cause anxiety and distress for both the researcher and the community members. This experience was described by Paolo Franco, who spent 18 months conducting fieldwork in a retirement village, as a volunteer technology supporter for the residents. Franco described how the participants became dependent on his technology service as well as socially and emotionally connected to him as the researcher. To mitigate problems occurring with a researcher withdraws from a research setting, the researcher should let participants know as early as possible about their estimated time in the community, and should have a plan for their exit. 11

Another key challenge in ethnography is gaining access to ‘the field’ and enlisting the support of gatekeepers. Careful planning and engagement are required to ensure communication channels are open and positive relationships are established. Managing ethical conduct is another important consideration in ethnography. Researchers need to consider how much they will disclose to participants about the purpose of the research, and whether they will be covert (undercover) or overt (open and transparent) in their approach to fieldwork. For the most part, researchers are overt about their research, hoping that participants will ‘forget’ that they are being studied and will revert to natural behaviours. 5

Table 9.1 provides two examples of ethnography from health and social care.

Table 9.1. Ethnographic examples

Ethnography focuses on understanding culture and the behaviours, experiences and meanings at the group level. The main method of data collection is participant observation, which can be combined with interviews, focus groups and field notes to inform interpretations of the research topic.

• Reeves S, Kuper A, Hodges BD. Qualitative research methodologies: ethnography. BMJ . 2008;337:a1020. doi:10.1136/bmj.a1020
• Hudelson PM. Culture and quality: an anthropological perspective. Int J Qual Health Care . 2004;16(5):345-346. doi:10.1093/intqhc/mzh076
• Strudwick RM. Ethnographic research in healthcare – patients and service users as participants. Disabil Rehabil . 2020;43(22): 3271-327. doi:10.1080/09638288.2020.1741695
• Reeves S, Peller J, Goldman J, Kitto S. Ethnography in qualitative educational research: AMEE Guide No. 80. Med Teach . 2013;35(8):e1365-e1379. doi:10.3109/0142159X.2013.804977
• O’Reilly K, Bone JH. Key Concepts in Ethnography . The SAGE Key Concepts Series. SAGE; 2009.
• Eriksson P, Kovalainen A. Qualitative Methods in Business Research . SAGE; 2008.
• Angotti N, Sennott C. Implementing ‘insider’ ethnography: lessons from the Public Conversations about HIV/AIDS project in rural South Africa. Qual Res . 2015;15(4):437-453. doi:10.1177/1468794114543402
• Clark L, Chevrette R. Thick Description. In: Matthes J, Davis CS, Potter RE, eds. The International Encyclopedia of Communication Research Methods : John Wiley & Sons; 2017.
• Jackson J. Ethnography. In: Hua Z, ed. Research Methods in Intercultural Communication . John Wiley & Sons;  2015.
• Leverton M, Burton A, Beresford-Dent J, et al. Supporting independence at home for people living with dementia: a qualitative ethnographic study of homecare. Soc Psychiatry Psychiatr Epidemiol . 2021;56(12):2323-2336. doi:10.1007/s00127-021-02084-y
• Franco P, Yang YN. Existing fieldwork ‘with grace’: reflections on the unintended consequences of participant observation and researcher-participant relationships. Qualitative Market Research . 2021;24(3):358-374. doi:10.1108/QMR-07-2020-0094
• Johnson EK. The costs of care: an ethnography of care work in residential homes for older people. Sociol Health Illn . 2023;45(1):54-69. doi:10.1111/1467-9566.13546
• Kitson C, Haines M, O’Byrne P. Understanding the perspectives of women who use intravenous drugs and are experiencing homelessness in an urban centre in Canada: an analysis of ethnographic data. Glob Qual Nurs Res . Published online March 20, 2022. doi:10.1177/23333936221080935

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

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Ethnography in qualitative educational research: AMEE Guide No. 80

Affiliation.

• 1 Center for Innovation in Interprofessional Education, University of California, 520 Parnassus Avenue, CL112 San Francisco, CA 94143, USA. [email protected]
• PMID: 23808715
• DOI: 10.3109/0142159X.2013.804977

Ethnography is a type of qualitative research that gathers observations, interviews and documentary data to produce detailed and comprehensive accounts of different social phenomena. The use of ethnographic research in medical education has produced a number of insightful accounts into its role, functions and difficulties in the preparation of medical students for clinical practice. This AMEE Guide offers an introduction to ethnography - its history, its differing forms, its role in medical education and its practical application. Specifically, the Guide initially outlines the main characteristics of ethnography: describing its origins, outlining its varying forms and discussing its use of theory. It also explores the role, contribution and limitations of ethnographic work undertaken in a medical education context. In addition, the Guide goes on to offer a range of ideas, methods, tools and techniques needed to undertake an ethnographic study. In doing so it discusses its conceptual, methodological, ethical and practice challenges (e.g. demands of recording the complexity of social action, the unpredictability of data collection activities). Finally, the Guide provides a series of final thoughts and ideas for future engagement with ethnography in medical education. This Guide is aimed for those interested in understanding ethnography to develop their evaluative skills when reading such work. It is also aimed at those interested in considering the use of ethnographic methods in their own research work.

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• Qualitative Research and Ethnography [SAGE video] Dr. Marsha Henry discusses ethnography and broader feminist qualitative research. She defines ethnography as embedded and embodied research, then explores the implications of that definition. She also touches on the differences between qualitative and quantitative approaches, and how feminism is challenging long-held assumptions about research.
• What Do You Mean by the Term “Ethnography”? [SAGE video] Dr. Sara Delamont discusses ethnography and ethnographic research. Ethnographic research is done primarily through observation, usually over a long period of time. Delamont examines ethnography through research that she has done, primarily in classrooms.
• Researching Rural Schools Using an Ethnographic Approach [SAGE video] Dr. Sam Hillyard describes her ethnographic research into the idea that schools are at the heart of village communities. She highlights unexpected findings, particularly in how and in where the village has changed. She also brings in concepts of space and agency from human geography.
• Researching Multiracial Identity Using Ethnographic Methods [SAGE video] Dr. Jennifer Jones discusses her ethnographic research into multiracial identity and whether "mixed race" is a simple category or a cohesive identity group. She explains the challenges she faced as well as the importance of theory building throughout the research process.

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• Janice Jones 1 ,
• Joanna Smith 2
• 1 Institute of Vocational Learning, School of Health and Social Care, London South Bank University , London , UK
• 2 Children’s Nursing, School of Healthcare, University of Leeds , Leeds , UK
• Correspondence to Dr Janice Jones, Institute of Vocational Learning, School of Health and Social Care, London South Bank University, London SE1 0AA, UK; jonesj33{at}lsbu.ac.uk

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Introduction

Collectively qualitative research is a group of methodologies, with each approach offering a different lens though which to explore, understand, interpret or explain phenomena in real word contexts and settings. This article will provide an overview of one of the many qualitative approaches, ethnography , and its relevance to healthcare. We will use an exemplar based on a study that used participant-as-observer observation and follow-up interviews to explore how occupational therapists embed spirituality into everyday practice, and offer insights into the future directions of ethnography in response to increased globalisation and technological advances.

What is ethnography?

What research methods do ethnographic researchers adopt.

Ethnographic methods are diverse and a range of approaches can be adopted; they are based on observation, often complemented with interviews, and detailed analysis often at a micro level. Although the methods used are not exclusive to ethnography, it is the depth of fieldwork and the continuous process of engaging with participants and their natural environments that is central and adds strength to the findings of ethnographic studies. 6 Participant observation requires immersion in the setting under investigation, and observing the language, behaviours and values of the participants. 7 Consequently, paramount to undertaking an ethnographic study is the role of the researcher in data collection.

Engaging with participants in the real world poses several challenges; first the researcher must decide whether to adopt an overt or covert approach to data collection and observation. In an overt approach the participants know they are being observed, whereas in a covert approach the participants are unaware they are being observed. The rationale for undertaking covert data collection in healthcare contexts needs careful consideration because of ethical implications, and the tensions with the principles of good research governance such as the right to choice whether to participate, information provision and gaining consent. 8 Second, the researcher must consider ‘their position’ either as an ‘insider’ (emic) or ‘outsider’ (etic). 5 Broadly, an emic approach is aligned with immersing into the culture, observing and recording participants’ way of life and activity, in contrast to the etic approach that observes and describes communities and cultures ( table 1 ). Both methods produce rich, in-depth data aiming to make sense of the context or phenomena under investigation, and require the researcher to be reflexive when undertaking fieldwork, accounting for their own assumptions and presuppositions to strengthen the findings. 5

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Approaches to participant observation 7

Ethnographic approaches to data collection produce voluminous unstructured data from a range of sources, for example fieldwork notes, diary entries, memos and, where appropriate, interview transcripts. The volume of data can be challenging to analyse and we would recommend a structured approach such as the framework approach. 9 The framework approach is rigorous, logical and transparent, and is particularly suitable to manage large amounts of textual information, while remaining close to the original data. 10 Framework approach supports the process of crystallisation, where the multiple facets of an ethnographic study are iteratively analysed, and constantly reviewed to identify patterns and associations across the data. 9 While the final stage in the framework approach aims to present the data in a way that is meaningful to the reader by grouping findings into categories and themes, the role of the researcher is to offer explanations about ‘how and why’ events, actions and interactions occur. 9 10

Table 2 outlines the methods adopted, rationale for decisions made and challenges of undertaking an ethnographical study that explored how occupational therapists incorporate spiritual care into their everyday practice. 11 Data were collected through participant-as-observer, recognising JJ’s role as an occupational therapist and knowledge of the study setting, with semistructured interviews used to explore with participants their decisions and thoughts by reflection on the observational data collected. Several key findings emerged; first spirituality is more meaningfully described than defined for occupational therapy practice. Second, central to occupational therapy practice is supporting patients during times of vulnerability; addressing the spiritual constructs of practice is essential to holistic person-centred care. Finally, organisational and contextual factors influenced how the occupational therapists framed their practice, and adopted strategies to retain their commitment to holistic, person-centred practice. 11

Methods, rationale for decision and challenges undertaking ethnographical research

How flexible is ethnography to social changes, globalisation and technological advances?

Rapidly advancing technology and increased globalisation require healthcare organisations to adapt and change; similarly approaches to undertaking qualitative research must evolve. 12 The increased use of web-based platforms as a means of sharing information, offering support networks and monitoring patients is creating opportunities for health researchers to study the naturally occurring and vast amount of data generated online. The rapid advancement of online communities has resulted in the emergence of online research methodologies such as netnography. 13 Netnography is rooted in ethnographical methods that aim to explore the social interactions of online communities, and can be adapted across the spectrum of online activities. 14

The emergence of team-based ethnography, as a departure from the traditional lone researcher working ‘ in the field’ , is in part in response to the globalisation of societies, economies and ororganisations. 15 Multisite or global ethnography is a new way of conceptualising ethnography that offers opportunities to study the interconnectedness of modern society, 15 and could be appropriate to study healthcare systems globally.

In summary, it is not surprising that qualitative research has been widely adopted as a means of understanding healthcare from the patient experience, and exploring service provision, care delivery and organisational cultures. The value of focused ethnographic studies in healthcare is essential to develop an in-depth understanding of healthcare cultures and explore complex phenomenon in real world contexts.

• Ritchie J ,
• Streubert HJ ,
• Carpenter DR
• Hammersley M ,
• Edgecombe N
• McNaughton Nichols C ,
• Angrosino M
• Hammersley M
• Costello L ,
• McDermott M ,
• Kozinets RV
• Jarzabkowski P ,
• Bednarek R ,
• Cabantous L
• Monahan T ,

Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

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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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