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Qualitative research in health care: Assessing quality in qualitative research
Open accessAbstract
This is the first in a series of three articles In the past decade, qualitative methods have become more commonplace in areas such as health services research and health technology assessment, and there has been a corresponding rise in the reporting of qualitative research studies in medical and related journals.1 Interest in these methods and their wider exposure in health research has led to necessary scrutiny of qualitative research. Researchers from other traditions are increasingly concerned to understand qualitative methods and, most importantly, to examine the claims researchers make about the findings obtained from these methods. The status of all forms of research depends on the quality of the methods used. In qualitative research, concern about assessing quality has manifested itself recently in the proliferation of guidelines for doing and judging qualitative work.2–5 Users and funders of research have had an important role in developing these guidelines as they become increasingly familiar with qualitative methods, but require some means of assessing their quality and of distinguishing “good” and “poor” quality research. However, the issue of “quality” in qualitative research is part of a much larger and contested debate about the nature of the knowledge produced by qualitative research, whether its quality can legitimately be judged, and, if so, how. This paper cannot do full justice to this wider epistemological debate. Rather it outlines two views of how qualitative methods might be judged and argues that qualitative research can be assessed according to two broad criteria: validity and relevance. #### Summary points Qualitative methods are now widely used and increasingly accepted in health research, but quality in qualitative research is a mystery to many health services researchers There is considerable debate over the nature of the knowledge produced by such methods and how such research should be judged Antirealists argue …
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“The use of multiple sources of data (data triangulation) has been advocated as a way of increasing the internal validity of a study (i.e. the extent to which the method is appropriate to answer the research question)[8,18-21].”
From The case study approach (2011) · cites this paper as [20]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“There are several ways to address these concerns, including: the use of theoretical sampling (i.e. drawing on a particular conceptual framework); respondent validation (i.e. participants checking emerging findings and the researcher's interpretation, and providing an opinion as to whether they feel these are accurate); and transparency throughout the research process (see Table 8)[8,18-21,23,26].”
From The case study approach (2011) · cites this paper as [20]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“There are several ways to address these concerns, including: the use of theoretical sampling (i.e. drawing on a particular conceptual framework); respondent validation (i.e. participants checking emerging findings and the researcher's interpretation, and providing an opinion as to whether they feel these are accurate); and transparency throughout the research process (see Table 8)[8,18-21,23,26].”
From The case study approach (2011) · cites this paper as [20]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Evidence shows that researchers can influence their participants and that good qualitative research happens when the researcher is reflexive and truly understands their impact on the study and analysis [64–66].”
From Barriers to voluntary participation in sport for children: a systematic review (2018) · cites this paper as [66]
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In the citing paper
“In addition, the results from the qualitative analysis were compared with the quantitative measures from the questionnaire; this validation strategy is also referred to as triangulation (61).”
From Acceptance, experiences, and needs of hospitalized pregnant women toward an electronic mindfulness-based intervention: A pilot mixed-methods study (2022) · cites this paper as [61]
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In the citing paper
“Reflexive thematic analysis [16, 17], framed by a subtle realist approach [18], was used to inductively code and develop subthemes.”
From Facilitators and barriers to social distancing for young people during the COVID-19 pandemic (2022) · cites this paper as [18]
The cited source says what the claim attributes to it.
In the citing paper
“There are several ways to address these concerns, including: the use of theoretical sampling (i.e. drawing on a particular conceptual framework); respondent validation (i.e. participants checking emerging findings and the researcher's interpretation, and providing an opinion as to whether they feel these are accurate); and transparency throughout the research process (see Table 8)[8,18-21,23,26].”
From The case study approach (2011) · cites this paper as [20]
In the citing paper
“Respondents' reactions to emerging findings can certainly help refine explanations—as can key informants'—but several commentators have questioned whether it is always appropriate.20,21”
From Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? (2001) · cites this paper as [20]
In the citing paper
“As Mays and Pope point out, researchers seek to provide an overview whereas respondents have individual concerns, and this can result in apparently discrepant accounts.20”
From Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? (2001) · cites this paper as [20]
In the citing paper
“Respondents' reactions to emerging findings can certainly help refine explanations—as can key informants'—but several commentators have questioned whether it is always appropriate.20,21”
From Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? (2001) · cites this paper as [20]
In the citing paper
“As Mays and Pope conclude, comprehensiveness may be a more realistic goal for qualitative research than is internal validity.20”
From Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? (2001) · cites this paper as [20]
In the citing paper
“Attention was paid to credibility, transferability, dependability and confirmability [33,57].”
From Staying at work with chronic nonspecific musculoskeletal pain: a qualitative study of workers' experiences (2011) · cites this paper as [57]
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Cites
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Metadata
- Authors
- Mays, N.
- Affiliations
- Treasury (NZ)
- Corresponding author
- Mays, N.
- ORCID
- Mays, N.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2000-01-01
- Volume
- 320
- Issue
- 7226
- Pages
- 50-52
- ISSN
- 0959-8138 (ISSN-L)
- PMC
- PMC1117321
- OpenAlex
- W2084085196
- Cited by
- 3,742
- References
- 12
- Citations by year
- 2026: 91 · 2025: 108 · 2024: 153 · 2023: 147 · 2022: 180 · 2021: 166 · 2020: 209 · 2019: 206 · 2018: 220 · 2017: 216 · 2016: 199 · 2015: 208 · 2014: 220 · 2013: 208 · 2012: 185
- FWCI
- 243.35
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Social Sciences › Education › Qualitative Research Methods and Applications
- Social Sciences › Sociology and Political Science › Qualitative Research Methods and Ethics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- qualitative research quality, quality standards, validity, relevance, epistemology of qualitative research, anti-realism, health services research, health technology assessment, reporting guidelines
- MeSH terms
- Data Collection, Evaluation Studies as Topic, Quality Assurance, Health Care, Research, Guidelines as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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