Article Methods

A health researcher’s guide to

qualitative methodologies

Kevin Dew Abstract

Department of Public Health, University of Otago, New Zealand Objective: To provide an overview of
qualitative methodologies for health
researchers in order to inform better

T
here are many excellent articles in
the medical literature on particular
elements of social research methods
applied to health. Most of these focus on
methods of data collection and aspects of
rigour in qualitative research.1-4 Implicit in
many of these articles are methodological
by our methodological position. Having an
informed grasp of methodology is important
if we are to interpret data sensibly and with
insight, and not simply interpret data in the
light of preconceptions and prejudice – and
so potentially perpetrate unsatisfactory
or inappropriate under-standings of the
research practices.
Approach: Different possible goals in
health research are outlined: quantifying
relationships between variables, identifying
associations, exploring experience,
understanding process, distinguishing
representations, comprehending social

issues, but these are rarely developed or
systematised in a way that is accessible to
researchers who do not have a background
in the social sciences. It is important
for qualitative researchers to consider
methodological issues and to understand
the assumptions they are using or the
theory that they are implicitly or explicitly
drawing upon. This is particularly salient
as different methodologies will provide
different research outputs. How we do social
research shapes, or even determines, the
information we get and how we interpret that
information. What is being attempted here
is an accessible introduction to qualitative
methodologies for health researchers. The
objective is to provide some signposts
phenomenon of interest.
Any particular methodology is related to
particular ontologies and epistemologies.
That is, the principles or assumptions of
our approach to research (our methodology)
is an outcome of our understanding of
what the world is (our ontology) and our
understanding of how we can know that
world (our epistemology). This paper focuses
on methodologies. Excellent overviews of
ontological and epistemological positions
in relation to different methodologies can be
found in The foundations of social research5
and Lincoln and Guba’s chapter in Handbook
of Qualitative Research.6
This article is organised as follows.
A brief discussion of the broad goals of
practices and achieving change. Three
important issues in understanding
qualitative approaches to research are
discussed: the partiality of our view
of the world, deductive and inductive
approaches to research, and the role of
the researcher in the research process.
The methodologies of phenomenology,
grounded theory, discourse analysis,
ethnography, ethnomethodology and action
research are illustrated.
Conclusion: In order to undertake high-
quality qualitative research, it is important
for researchers to consider their analytic
focus and methodological position.
Key words: Qualitative research;
health services research.
(Aust N Z J Public Health. 2007; 31:433-7)

that will help novice researchers orient to research will be followed by the introduction doi:10.1111/j.1753-6405.2007.00114.x

different research traditions and so be in of some important concepts required to

a better position to determine what sort of
approach is appropriate to their particular
research interests, theoretical assumptions
or values.
To start with, some terms need to be defined.
‘Methodology’ refers to the principles
underlying particular research approaches,
as distinct from ‘methods’, which are ways
of collecting data. The two are intimately
related in the sense that what methods we
choose and what we think we are getting
out of those methods is strongly shaped
understand the differences in methodological
positions – namely the partiality of our
understanding of the social world, the
differences between inductive and deductive
approaches to research, and the different
roles of the researcher in quantitative and
qualitative research. This is then followed
by a diagrammatic representation of some
of the major methodological positions within
qualitative research. These positions are very
briefly outlined in order to provide points of
reference for researchers attempting to place

Submitted: May 2007 Revision requested: August 2007 Accepted: August 2007
Correspondence to:
Associate Professor Kevin Dew, Department of Public Health, University of Otago, Wellington,
PO Box 7343, Wellington South, New Zealand. Fax: +64 4 389 5319;
e-mail: kevin.dew@otago.ac.nz

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Dew
their particular research projects within methodological traditions.
The outlines of the different methodologies do not provide the
reader with an in-depth understanding, but are hopefully enough
to allow researchers to follow up on methodologies that appear
to be most appealing to them.
Goals of research
We can have different goals in health research and what our
goal is will determine the methodological approach we take and
the form of data collection and analysis we deploy. To measure
the frequency or intensity of a phenomena and the relationship
between variables, quantitative research is required – where data
is converted into numbers that are then subjected to statistical
analysis. However, researchers may have other goals besides
these, and an umbrella term that covers these goals would be to
establish in-depth understanding of some aspect of the social
world. Researchers might want to understand how something is
experienced (such as an illness or a treatment), how something
is done (such as how wards are organised or how good care is
achieved), how something is represented by people (such as mental
illness or relationships between doctors and nurses) or how to bring
about change. When researchers have these different goals they
are usually involved in collecting data that is then turned to text,
and the text is analysed. That is, instead of numbers, words are
analysed. The main sources of data are one-on-one interviews or
group interviews, observation and documents. It is common for
more than one source of data to be used.
It can be noted here that qualitative health research is research
with a focus on the social world, not the world of nature.7 Some
theorists argue that researching social life is fundamentally
different from researching natural phenomena. When researching
the natural world the phenomena can be treated as objects or things
and, from careful observation, natural laws may be generated. But
in the social world we are dealing with subjective experiences, and
understandings of reality can change over time and in different
social contexts.
Important issues
There are some important issues that need to be considered in
order to get a better understanding of what qualitative research
can do. Three issues discussed here are the partiality of our view
of the world, deductive and inductive approaches to research, and
the role of the researcher in the research process.
To paraphrase Coffey and Atkinson, all forms of data collection
enshrine a distinctive version of reality.8 This can mean two things
– the way we collect data creates or constructs a particular version
of reality, or any form of data collection provides us with only
a partial view of reality. To illustrate this, we can think of the
difference between collecting data from a structured questionnaire
and collecting data from semi-structured interviews. In a structured
questionnaire, the researcher determines what categories a
participant can choose from. In the delivery of the questionnaire,
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Article
the researcher does everything possible to avoid influencing
the choices that are made. In other words, the way in which the
questions are asked are standardised for all participants. It can
be seen that there is a particular ‘bias’ inherent in this process,
as the categories provided to the participant are the ones that
the researchers (or other researchers before them) have deemed
important. In semi-structured interviews, researchers may have
lists of themes or issues to be covered, but allow participants to
discuss those in a way that suits them. Participants may discuss
themes or issues not initially identified by the researcher. Even
though the same phenomenon may be explored by the two methods
of data collection, they are likely to give very different results.7
Further, individual interviews and group interviews will differ to
some extent in the information that is provided by participants.
In addition, what people say may be different in important ways
from what they do, so observation may give different insights
not obtained in interviews.9 In quantitative research, the issue of
partiality is discussed in relation to concerns about confounding
and generalisability of the research. There is often an implicit
assumption here that we can obtain a full and comprehensive
view of the world. Many qualitative researchers assume that we
can only, ever, get a partial view of the world.6
The example of questionnaires versus semi-structured interviews
can also be used to illustrate the differences between a primarily
deductive approach to research and a primarily inductive approach
to research. A deductive approach draws on prior understandings
of an aspect of the world, and from that understanding a hypothesis
is developed that is tested. If the hypothesis is supported the
prior theoretical understanding is supported, and if not then the
understanding is modified. An inductive approach sets aside prior
theories and attempts to build up an understanding of the world
from the data. This approach is particularly important in grounded
theory and phenomenological approaches discussed in the next
section. So with a deductive approach questionnaires might be
appropriate, but they would not be appropriate in an inductive
Figure 1: Qualitative methodologies and their orientation
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Methods
approach. Semi-structured interviews, where perceptions and
understandings may be revealed that have not been documented
before, would be a preferred approach.
Finally, the different roles of the researcher can be seen when
comparing research based on questionnaire design with research
based in semi-structured interviews. In the former attempts are made,
once the questionnaire has been designed, to remove the influence
of the researcher on the participant. This can be done, for example,
by using postal questionnaires or standardising the researcher’s
response to any questions raised by participants. In semi-structured
interviews it is impossible to remove the researcher’s influence on
the process. There are a whole range of issues that will have some
impact on how the data collection goes, including similarities and
differences by age, gender, ethnicity and social status, and also
the particular understandings, experiences and capabilities of the
researcher in terms of how he or she responds to the talk of the
participant. In qualitative research, the effect of the researcher is
assumed and often reflected upon by the researchers.
Qualitative methodologies
Figure 1 provides a representation of the major methodological
approaches used in the attempt to obtain an in-depth understanding
of the social world. These methodologies are commonly used in
health research, and in this section a very brief description of the
disciplinary position of the methodology is provided and the main
focus of the methodology and why and where it may be used is
outlined. It is to be noted that each of these methodologies relates
to different disciplines and this is part of the richness and difficulty
of coming to terms with methodological issues in qualitative health
research. However, these approaches are not necessarily mutually
exclusive and should be seen as having particular emphases.
1. Phenomenology and lived experience
Phenomenology was traditionally a movement in philosophy,
seeking to apprehend phenomena in ways untainted by prior
theorising but as immediately experienced.5 In health research,
phenomenology has primarily been concerned with apprehending
experiences of illness, often in relation to the health system. The
goal in health research is often to gain insights into the lived
experience of having a particular condition. The role of the health
researcher is to provide a window into others’ experiences.
Madjar explored the phenomena of clinically inflicted pain.
Interviews and observations were undertaken over a five-month
period with 14 patients who had experienced burn injuries.10
Among other findings, Madjar argued that clinically inflicted
pain was not experienced in the same way as other pain. Patients
were required to hand over their bodies to health practitioners
to wound and hurt but at the same timed needed to restrain their
bodies and voices.
2. Grounded theory and process
Grounded theory was a development within the discipline of
sociology. Grounded theory is often used to describe research
that does not start from some prior theoretical understanding of
what is going on, but works inductively, or from the ground up,
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A guide to qualitative methodologies
to build a theory of what is going on.7 As such, grounded theory
is explicitly theory building, as opposed to theory testing. The
researcher will often start with a very simple question – what
is going on here? From there, the researcher will determine
what data need to be gathered, and as data are gathered and
analysed theoretical understandings develop. These theoretical
understandings can then be assessed through the collection of
further data, and the research process stops (ideally) when no
new understandings emerge. Grounded theory, then, does not start
with a pre-determined research process, but the process evolves
and develops as the research is undertaken through a process
of systematic data analysis. The roles of the researcher include
avoiding as far as possible using prior theoretical understandings
and to translate data into a theory or model.
Ungar and colleagues used a grounded theory methodology to
develop an interview guide to help assess quality of life for children
with asthma.11 They did this through collecting data on 16 dyad
interactions between a parent and child during the administration
of a number of previously used assessment tools. Through this
process they were able to add to previous understandings of
how to enhance children’s discussion of complex issues that are
usually left to parents to answer – in particular how to enhance
the role of the parent as an enabler and an extension of the child’s
cognitive skills.
3. Discourse analysis and language
There are a variety of strands of discourse analysis, some
developing from psychology, some from sociology and some from
linguistics. In general, discourse analysis focuses on features of
language, styles of argumentation and the way language is used
to represent a particular phenomenon or issue.7 Once we identify
these features of language we can consider what sort of effects or
impacts such language has. The role of the researcher is to identify
features of language that provide insight into how participants
represent the world and to provide an explanation for why those
aspects of language are used.
Dew used discourse analysis to explore the ways in which
the chiropractic and medical professions positioned themselves
before a commission of inquiry.12 One feature of the chiropractors’
discourse was the way in which the profession was positioned
as different, but not too radically different, from the medical
profession. It achieved this by establishing a distinction based on
philosophical understandings of the body that were not the same as
medicine’s understandings. This discursive work was accepted by
the commission of inquiry, which recommended that chiropractors
oversee training in spinal manipulation in New Zealand.
4. Ethnography and culture
Ethnographic approaches are derived from anthropology
and traditionally focused on cultural beliefs and practices.1
Ethnography typically involves close observation and often
participation in the social life of the group being researched, which
is usually referred to as fieldwork. During fieldwork other sources
of data may be gathered, such as documents and interviews.
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Fitzgerald undertook an ethnography within one hospital group
during a period of health reforms in New Zealand.13 She collected
data over a two-year period of participant observation as a radiation
therapist and involvement in a clinical management program. The
research explored the concept of care and Fitzgerald argues that
managers and workers are concerned with the expression of two
types of care, the abstract and the relational. Abstract expressions
of care relate to quantifiable understandings and are the province
of management, whereas relational aspects relate to the embodied
aspects of care work and are the province of clinical experts.
Fitzgerald concludes that there is a need to discover a common
language between these styles of care to overcome the mutual
antipathy of the different workers and the ethical problems to
which this antipathy gives rise.
5. Ethnomethodology and social practice
Ethnomethodology approaches derive from sociology and focus
on social practices. The primary question for ethnomethodology is
how is the organisation of society achieved?14 Ethnomethodology
has a number of tools and techniques to explore social organisation,
and to illustrate the example of conversation analysis will be used.
Conversation analysis focuses on the sequence and unfolding of
talk in social interaction. Research using this technique of analysis
allows rules of interaction to be identified, which in turn enhances
our understanding of outcomes of social interaction. The role of
the researcher is to pay close attention to the details of social
interaction in order to generate an understanding of the ordered
nature of the interaction.
Díaz describes the sequential organisation of encounters
between patients undertaking chemotherapy and their doctors.15
From this description, routines can be identified, and Díaz argues
that these routines make doctors’ work feasible within the time-
limits of the encounter. A consequence of the routine is that it is
difficult for patients to participate in the consultation, and to deal
with this difficulty Díaz suggests that special attention should be
paid to those slots in the routine where patient participation is
possible so that the encounter can be managed appropriately.
6. Action research and change
Action research sits between research and intervention. The
goals of action researchers are to understand something about the
social world and change it.16 The goal of change may arise from a
desire to resist or overcome forms of oppression, or to bring about
better forms of service delivery. Often action researchers work with
participants to identify issues that are important to participants
and interventions that could bring about some improvement. Once
the intervention is agreed upon the researcher and participants
continue to reflect on the impact of the intervention and any
further changes that might be made. The role of the researcher is
to facilitate processes of reflection and decision making and to
analyse the results of any change.
Schneider and co-researchers undertook a form of action
research called participatory research with a group of people with
schizophrenia.17 The people with schizophrenia participated in all
stages of the research, including data collection (they interviewed
each other), analysis and dissemination. One outcome of this
research was a theatre presentation that was made to health
professionals based on the experiences of the group members.
This process was seen as transformative for both the academic
researcher and the people with schizophrenia.
Table 1 suggests readings that provide more depth to the
methodological approaches noted here.
Concluding comments
Note that in these cases of ‘in-depth’ qualitative research,
attempts are made to go beyond simply the ‘content’ of what is
said or documented in order to come to a different understanding
about the data and the phenomenon of interest. That is, the goal
is not simply to identify common or dominant themes. Analysing
for content is the first step of a process, the start of a journey to
gain different insights.
This brief presentation of methodological positions has
inevitably had to be simplified. Each approach has a range of
concepts and tools that help the researchers to reflect on their
research goals, how they view the data and what their analytic
focus is. There is no ‘right’ way of doing qualitative research,
but some approaches are more appropriate to certain research
goals than others. Once researchers have identified an approach
that aligns with their research goals it is beholden on them to
explore the methodology in some depth in order to consider the
assumptions and values they bring to their research and conduct
analyses that go beyond common sense.
Once a researcher starts to become familiar with a particular
approach it becomes easier to consider combining approaches.
Not all approaches are easily compatible. For example, if you
take the position that interview data can be taken at face value
as representing the authentic experience of participants, then you

Table 1: Relevant readings on methodologies.

Methodology Reading
Phenomenology Jo Ann Walton and Irene Madjar (1999): Nursing and the experience of illness: Phenomenology in Practice
Grounded theory Anselm Strauss and Juliet Corbin (1998): Basics of Qualitative Research: Techniques and Procedures for
Developing Grounded Theory
Discourse analysis Robin Wooffitt (2005): Conversation analysis and discourse analysis: A comparative and critical introduction
Ethnography Martin Hammersley and Paul Atkinson (1995): Ethnography: Principles and practice
Ethnomethodology Paul ten Have (2004): Understanding qualitative research and ethnomethodology
Action research Ernie Stringer and William Genat (2004): Action research in health

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will not undertake a discourse analysis looking at how dominant
discourses shape what is talked about and how it is talked about. But
we need to understand these sorts of methodological differences in
order to make insightful interpretations of qualitative data.
Acknowledgements
I would like to thank Drs Avril Bell, Sarah Hill, Lesley Patterson,
Allanah Ryan and also the two anonymous referees for their very
helpful comments.
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