750127

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QHRXXX10.1177/1049732317750127Qualitative Health ResearchMorgan

Commentary
Qualitative Health Research

Themes, Theories, and Models

2018, Vol. 28(3) 339­–345
© The Author(s) 2017
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DOI: 10.1177/1049732317750127
https://doi.org/10.1177/1049732317750127
journals.sagepub.com/home/qhr

David L. Morgan1

Abstract
Although theory building is often described as the ultimate goal of qualitative research, an examination of articles in
Qualitative Health Research (QHR) shows that themes are actually the typical format for reporting results. In addition,
articles that rely on themes often present low-level theories in the form of models that connect these themes. Because
models have received less attention than either themes or theories, this article concentrates on summarizing four
different kinds of models: hierarchies, timelines, processes, and cycles. In each of these cases, it presents both a general
illustration of such a model and a realistic example from a published article in QHR. It concludes with a call for greater
recognition of the role that models play in capturing the results of qualitative research.

Keywords
reflexivity; theory development; methodology; qualitative analysis

Over the past several years, I have been performing an

informal content analysis of the research articles in
Qualitative Health Research (QHR), which has led me to
two conclusions. First, themes are the most common format
for reporting results. Second, models that connect themes
are the most common form of theory building. As themes
and theme-based models are how we report our results, I
will argue that we should pay more attention to both of
them—especially in comparison with “theory building”
which is an often stated goal for qualitative research.
Figure 1 shows a chain of analytic activities that
reaches from the purely descriptive work in coding up
through the interpretive work done in creating themes,
models, and theories. Of course, some analyses produce
literally dozens of codes, which require further aggrega-
tion into categories. Following Morse (2008), I treat cate-
gorizing as a more descriptive process than interpretation,
which begins with themes and proceeds through the higher
levels of abstraction in modeling and theorizing. Hence,
this article concentrates on the top three levels in Figure 1.
Figure 1.  From codes to theories.

Defining Themes, Theories, and
Models
Themes
Themes or the equivalent (e.g., “core concepts”) made up
the basic building blocks for reporting results in well over
half of the articles that I examined in QHR. Although the
role of themes in presenting qualitative research has not
received prominent attention, it has not been ignored,
either. In particular, DeSantis and Ugarriza (2000) review
the use of themes in the nursing literature and produce the
following composite definition: “A theme is an abstract
entity that brings meaning and identity to a recurrent
experience and its variant manifestations. As such, a
1
Portland State University, Portland, Oregon, USA
Corresponding Author:
David L. Morgan, Department of Sociology, Portland State University,
USA.
Email: morgand@pdx.edu
340 Qualitative Health Research 28(3)
theme captures and unifies the nature or basis of the expe-
rience into a meaningful whole” (p. 363). Other, less for-
mal definitions include the following:
Something important about data in relation to the research
question, and represents some level of patterned response or
meaning within the data set. (Braun & Clarke, 2006, p. 82)
Recurring patterns . . . or “gestalts” which pull together many
separate pieces of data. (Miles & Huberman, 1994, p. 246)
An underlying or more latent pattern or repetition discerned
in the data. (Sandelowski & Barroso, 2003, p. 912)
My own definition is as follows: Themes are meaning-
ful patterns in the data, which researchers use to interpret
that data for an audience. This definition has two parts:
first, the same reliance on patterns that is common ele-
ment in other definitions, and second, an emphasis on
communicating with audiences. More specifically,
authors construct themes to present the core patterns they
use to interpret the data. My definitions, thus, treat themes
as tools that authors use to help their readers understand
the most important aspects of the data.
Of course, no one definition can capture the wide range of
uses that authors have made of themes. Sandelowski and
Barroso (2003) provide a useful distinction between present-
ing qualitative research through thematic surveys versus con-
ceptual/thematic interpretations, in which the former offer
interpretive summaries that are closer to the data whereas the
later move toward a more integrated reframing of the data.
This points to a tension between the extent to which themes
describe the data or to interpret it. Thorne (2016) has
addressed this issue through an approach that she describes
as “interpretive description,” where mere description of the
data is not enough, but abstract interpretation can lead to
results that are too removed from the data. As my own defini-
tion indicates, I prefer an approach based on interpretation,
but I also would argue against an overly abstract approach to
creating and using themes. Instead, I would reserve abstrac-
tion for the level of theory rather than themes.
Theories
One thing that is clear across the range of uses for themes
is that they fall short of theories. I will follow a classic
definition, where a theory specifies the links between a
set of key concepts. Collections of connected concepts
amount to low-level theories. More powerful theories go
two steps further: They explain why those particular con-
cepts are the key elements that make up the theory, and
they explain why those concepts are related to each other
in the ways that they are.
In the articles I examined, it is fair to think of the
themes they reported as representing concepts that
Figure 2.  An illustration of a model based on hierarchies.
could be built into theories. Even so, there was little
full-scale theorizing in these articles. This was obvious
from the consistent failure to describe why a given set
of themes was the most useful or powerful way of
interpreting the data. Instead, the “Results” sections of
these articles almost always began by announcing that
there was some number of themes (typically three–
five) in the data, and then worked through this list of
themes, one by one.
Of course, creating a high-level, abstract theory is an
almost impossibly large goal for an article-length presen-
tation, but this is not to say that these articles did not do
any theorizing. Instead, they worked with connections
between themes to create what I will call models.
Models
I define models as systematic depictions of the relation-
ships among a set of concepts. As such, they amount to
low-level theories, with a minimum level of abstraction.
For qualitative research, these models simply accept a list
of themes as the elements that go into a model, without
attempting to explain why those themes are the basis for
the model. Models, thus, stand between themes and more
abstract theories.
My rough estimate is that about a fourth of the QHR
articles that used themes made the next step of connecting
those themes into an explicit model. At present, these
models are most likely to appear at the beginning of the
“Discussion” section, but one can make a strong case that
they should be treated as part of the “Results” section,
because they represent the end point of the analysis and
interpretation of the data.
Interestingly, nearly all these models involved some
kind of graphic. In all likelihood, this reflects the fact that
complex sets of relations are easier to show than to
describe with words, so the point of using a graphic was
indeed to replace a thousand words.
Morgan 341
Figure 3.  An example of a model based on hierarchies (Germeni & Sarris, 2015).
Making Models
The last phase in my informal content analysis of the
articles was to sort through the models they contained to
create a basic typology. This produced four categories of
models: hierarchies, timelines, overtime processes, and
cycles. This section looks at these options, showing both
an idealized version of each and a realistic example
drawn from QHR.
However, note that organizing the coverage of models
around these four types should not be interpreted as
restricting more innovative options. For example (again,
drawing from QHR), Anderson, Foster, Freeman,
Luetsch, and Scott (2017) use a teeter-totter to show a
question involving balance; Dayal, Weaver, and Domene
(2015) use a spiderweb to show a central problem with
multiple additional layers; and Tornblom, Werbart, and
Rydelius (2015) use cogwheels to show a set of interlock-
ing issues. Thus, the four categories of models I cover
here represent only the most common formats I encoun-
tered, and future efforts may well produce a richer range
of possibilities.
Hierarchies
Models based on hierarchies, such as Figure 2, lay out a
relationship between upper level and lower level themes.
As the figure indicates, this category of models almost
always uses a top-to-bottom flow to show how the themes
are organized. The most common use for this kind of
model is to show a relatively complex combination of
themes and subthemes.
Typically, these models are quite basic—to point that
they may not require a graphic when all they do is restate
a simple pattern that could easily be summarized in the
text. Instead, the goal of diagrams such as Figure 2 should
be to provide a visualization that makes it easier to follow
what would otherwise be an overly complex description.
In addition, as the real-world example in Figure 3
shows (Germeni & Sarris, 2015), it is possible for links to
connect themes either within a single level or across lev-
els. I would argue, however, that it is best to limit the use
of such complex paths unless it is important to describe a
complicated pattern of flows, such as the centrality of
“being left high and dry” in Figure 3.
Timelines
As shown in Figure 4, models based on timelines connect
a series of themes, where one precedes another in a
sequence. In Western cultures, timelines are usually rep-
resented as moving from left to right, so the starting point
is on the far left and the terminating point is on the far
right. These steps may be treated as “causal” so that ear-
lier themes produce later ones as consequences, or they
may simply capture a flow through time.
Various forms of diagrams such as Figure 4 were com-
mon in QHR, but many of these were merely descriptive
342 Qualitative Health Research 28(3)
Figure 4.  An illustration of a model based on timelines.
Figure 5.  An example of a model based on timelines (Vann-
Ward, Morse, & Charmaz, 2017).
because, rather than connecting themes, they linked
events during the course of illnesses or treatments. When
thematic timeline models did appear, they were typically
straightforward, but could become more complicated
when they involved either a large number of steps or mul-
tiple branching options. Figure 5 (Vann-Ward, Morse, &
Charmaz, 2017) shows an example of an actual timeline,
which in this case runs from top to bottom—presumably
to save space. In addition, it includes information about
what happens between each of the steps.
Overtime Processes
Models based on overtime processes show how a series
of themes affect each other. Like timelines, they flow
from left to right, starting with initial influences and
Figure 6.  An illustration of a model based on complex
processes.
ending with ultimate outcomes. As such, they follow
many of the conventions of “path models” in quantitative
research. Figure 6 shows one potential configuration for
such a model, but numerous other arrangements are pos-
sible. One key feature of any such model is one or more
intermediate themes that intervene between the earlier
and later portions of the overall process.
As models of overtime processes become more com-
plex, there are several possible pitfalls. One thing to
avoid is putting a theme in a dead-end position, where
things flow in but not out, because only items on the far
right-hand side of the model serve as end points. Another
potential problem is a model in which everything affects
everything else, because this represents a very weak
degree of theorizing. Finally, avoid backward flows such
that a theme has an effect on something that comes before
it in the diagram, because this creates cycles that are a
special kind of models in their own right. The realistic
example from QHR in Figure 7 (Edge, Goodwin, Isba, &
Keegan, 2017) meets all these criteria—although this is
not as easy to see as it might be, given that this version
flows from bottom to top.
Cycles
Models based on cycles provide another way to represent
complex processes. In this case, things that happen later
in a process feed back into earlier aspects of the overall
process. Figure 8 shows a simple cycle, although these
models can easily become quite complex. For example, a
cycle between two major themes might contain separate
subprocesses within each theme.
Although cyclical models can be an attractive way to
represent complex processes over time, they have a
unique potential problem in the form of “unbalanced”
flows. This problem has two related versions, which are
shown in Figure 9, using diagrams that are simplified
Morgan 343
Figure 7.  An example of a model based on complex processes (Edge et al., 2017).
Figure 8.  An illustration of a model based on cycles.
even further. On the left, there is the case where each
theme has positive effect on the other, such that increases
in Theme 1 lead to increases in Theme 2, which lead to
further increases in Theme 1, and so on. The obvious
problem here is that the feedback in this model leads to
uncontrolled growth. The model on the right replaces an
escalating feedback cycle with a diminishing one, which
would drive both themes to the vanishing point.
The logical conclusion is that cyclical models can only
be balanced when increases between one theme and the
other are matched by decreases on the other side of the
cycle. Of course, the key elements of the model can also be
concepts that may grow or decrease without raising con-
cerns about whether they drive the process outside some
Figure 9.  Balance problems in cycles.
natural boundary. Figure 10 (Hayles, Harvey, Plummer, &
Jones, 2015) illustrates this through its emphasis on con-
cepts such as learning, evolving, and so on.
Conclusion: Next Steps
Clearly, we need more reflection on our processes for
reporting the results of qualitative research, regardless of
whether those results take the form of themes, models, or
theories. First, for themes, instead of treating themes as
the implicit, unquestioned format for reporting results,
we need to be more explicit in recognizing their key role
in summarizing our qualitative results. If themes are the
way we make meaning of our data, then we should pay
more attention to how we build and report themes. In par-
ticular, we need to ask the more theoretical question of
why a given set of themes are the best way to interpret the
current data.
With regard to models, we need to treat them as more
than just diagrams. Instead, they should be a self-conscious
effort to explain the connections among themes. One step
344 Qualitative Health Research 28(3)
Figure 10.  An example of a model based on cycles (Hayles et al., 2015).
toward accomplishing this goal is to recognize that, just
like themes, models can be either more descriptive or more
interpretive. Descriptive models simply summarized the
connections between themes, whereas interpretive models
actively organize themes according to explicit principles.
Finally, we should be more realistic about how we pur-
sue the goal of creating theory. For years, most textbook
writers have treated theory building as the default goal of
qualitative research. Yet, as Thorne (2016) emphasizes,
much of what we actually do is aimed at more applied
goals, which do not require abstract theory, and the same
is true for research with exploratory goals. When we do
wish to contribute to theory, we need to improve the rela-
tively low-level theories that we currently generate.
Given the state of the art, the most reasonable next step is
to create interpretive models that explain how sets of
themes are related to each other. By constructing models,
we can move beyond merely presenting themes to reach a
next level of theorizing.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author received no financial support for the research,
authorship, and/or publication of this article.
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Author Biography
David L. Morgan is an emeritus professor of sociology whose
interests include both focus groups and mixed methods research.