google scholar qualitative research title

• Privacy Policy

Buy Me a Coffee

Home » 500+ Qualitative Research Titles and Topics

500+ Qualitative Research Titles and Topics

Table of Contents

Qualitative research is a methodological approach that involves gathering and analyzing non-numerical data to understand and interpret social phenomena. Unlike quantitative research , which emphasizes the collection of numerical data through surveys and experiments, qualitative research is concerned with exploring the subjective experiences, perspectives, and meanings of individuals and groups. As such, qualitative research topics can be diverse and encompass a wide range of social issues and phenomena. From exploring the impact of culture on identity formation to examining the experiences of marginalized communities, qualitative research offers a rich and nuanced perspective on complex social issues. In this post, we will explore some of the most compelling qualitative research topics and provide some tips on how to conduct effective qualitative research.

Qualitative Research Titles

Qualitative research titles often reflect the study’s focus on understanding the depth and complexity of human behavior, experiences, or social phenomena. Here are some examples across various fields:

• “Understanding the Impact of Project-Based Learning on Student Engagement in High School Classrooms: A Qualitative Study”
• “Navigating the Transition: Experiences of International Students in American Universities”
• “The Role of Parental Involvement in Early Childhood Education: Perspectives from Teachers and Parents”
• “Exploring the Effects of Teacher Feedback on Student Motivation and Self-Efficacy in Middle Schools”
• “Digital Literacy in the Classroom: Teacher Strategies for Integrating Technology in Elementary Education”
• “Culturally Responsive Teaching Practices: A Case Study in Diverse Urban Schools”
• “The Influence of Extracurricular Activities on Academic Achievement: Student Perspectives”
• “Barriers to Implementing Inclusive Education in Public Schools: A Qualitative Inquiry”
• “Teacher Professional Development and Its Impact on Classroom Practice: A Qualitative Exploration”
• “Student-Centered Learning Environments: A Qualitative Study of Classroom Dynamics and Outcomes”
• “The Experience of First-Year Teachers: Challenges, Support Systems, and Professional Growth”
• “Exploring the Role of School Leadership in Fostering a Positive School Culture”
• “Peer Relationships and Learning Outcomes in Cooperative Learning Settings: A Qualitative Analysis”
• “The Impact of Social Media on Student Learning and Engagement: Teacher and Student Perspectives”
• “Understanding Special Education Needs: Parent and Teacher Perceptions of Support Services in Schools

Health Science

• “Living with Chronic Pain: Patient Narratives and Coping Strategies in Managing Daily Life”
• “Healthcare Professionals’ Perspectives on the Challenges of Rural Healthcare Delivery”
• “Exploring the Mental Health Impacts of COVID-19 on Frontline Healthcare Workers: A Qualitative Study”
• “Patient and Family Experiences of Palliative Care: Understanding Needs and Preferences”
• “The Role of Community Health Workers in Improving Access to Maternal Healthcare in Rural Areas”
• “Barriers to Mental Health Services Among Ethnic Minorities: A Qualitative Exploration”
• “Understanding Patient Satisfaction in Telemedicine Services: A Qualitative Study of User Experiences”
• “The Impact of Cultural Competence Training on Healthcare Provider-Patient Communication”
• “Navigating the Transition to Adult Healthcare Services: Experiences of Adolescents with Chronic Conditions”
• “Exploring the Use of Alternative Medicine Among Patients with Chronic Diseases: A Qualitative Inquiry”
• “The Role of Social Support in the Rehabilitation Process of Stroke Survivors”
• “Healthcare Decision-Making Among Elderly Patients: A Qualitative Study of Preferences and Influences”
• “Nurse Perceptions of Patient Safety Culture in Hospital Settings: A Qualitative Analysis”
• “Experiences of Women with Postpartum Depression: Barriers to Seeking Help”
• “The Impact of Nutrition Education on Eating Behaviors Among College Students: A Qualitative Approach”
• “Understanding Resilience in Survivors of Childhood Trauma: A Narrative Inquiry”
• “The Role of Mindfulness in Managing Work-Related Stress Among Corporate Employees: A Qualitative Study”
• “Coping Mechanisms Among Parents of Children with Autism Spectrum Disorder”
• “Exploring the Psychological Impact of Social Isolation in the Elderly: A Phenomenological Study”
• “Identity Formation in Adolescence: The Influence of Social Media and Peer Groups”
• “The Experience of Forgiveness in Interpersonal Relationships: A Qualitative Exploration”
• “Perceptions of Happiness and Well-Being Among University Students: A Cultural Perspective”
• “The Impact of Art Therapy on Anxiety and Depression in Adult Cancer Patients”
• “Narratives of Recovery: A Qualitative Study on the Journey Through Addiction Rehabilitation”
• “Exploring the Psychological Effects of Long-Term Unemployment: A Grounded Theory Approach”
• “Attachment Styles and Their Influence on Adult Romantic Relationships: A Qualitative Analysis”
• “The Role of Personal Values in Career Decision-Making Among Young Adults”
• “Understanding the Stigma of Mental Illness in Rural Communities: A Qualitative Inquiry”
• “Exploring the Use of Digital Mental Health Interventions Among Adolescents: A Qualitative Study”
• “The Psychological Impact of Climate Change on Young Adults: An Exploration of Anxiety and Action”
• “Navigating Identity: The Role of Social Media in Shaping Youth Culture and Self-Perception”
• “Community Resilience in the Face of Urban Gentrification: A Case Study of Neighborhood Change”
• “The Dynamics of Intergenerational Relationships in Immigrant Families: A Qualitative Analysis”
• “Social Capital and Economic Mobility in Low-Income Neighborhoods: An Ethnographic Approach”
• “Gender Roles and Career Aspirations Among Young Adults in Conservative Societies”
• “The Stigma of Mental Health in the Workplace: Employee Narratives and Organizational Culture”
• “Exploring the Intersection of Race, Class, and Education in Urban School Systems”
• “The Impact of Digital Divide on Access to Healthcare Information in Rural Communities”
• “Social Movements and Political Engagement Among Millennials: A Qualitative Study”
• “Cultural Adaptation and Identity Among Second-Generation Immigrants: A Phenomenological Inquiry”
• “The Role of Religious Institutions in Providing Community Support and Social Services”
• “Negotiating Public Space: Experiences of LGBTQ+ Individuals in Urban Environments”
• “The Sociology of Food: Exploring Eating Habits and Food Practices Across Cultures”
• “Work-Life Balance Challenges Among Dual-Career Couples: A Qualitative Exploration”
• “The Influence of Peer Networks on Substance Use Among Adolescents: A Community Study”

Business and Management

• “Navigating Organizational Change: Employee Perceptions and Adaptation Strategies in Mergers and Acquisitions”
• “Corporate Social Responsibility: Consumer Perceptions and Brand Loyalty in the Retail Sector”
• “Leadership Styles and Organizational Culture: A Comparative Study of Tech Startups”
• “Workplace Diversity and Inclusion: Best Practices and Challenges in Multinational Corporations”
• “Consumer Trust in E-commerce: A Qualitative Study of Online Shopping Behaviors”
• “The Gig Economy and Worker Satisfaction: Exploring the Experiences of Freelance Professionals”
• “Entrepreneurial Resilience: Success Stories and Lessons Learned from Failed Startups”
• “Employee Engagement and Productivity in Remote Work Settings: A Post-Pandemic Analysis”
• “Brand Storytelling: How Narrative Strategies Influence Consumer Engagement”
• “Sustainable Business Practices: Stakeholder Perspectives in the Fashion Industry”
• “Cross-Cultural Communication Challenges in Global Teams: Strategies for Effective Collaboration”
• “Innovative Workspaces: The Impact of Office Design on Creativity and Collaboration”
• “Consumer Perceptions of Artificial Intelligence in Customer Service: A Qualitative Exploration”
• “The Role of Mentoring in Career Development: Insights from Women in Leadership Positions”
• “Agile Management Practices: Adoption and Impact in Traditional Industries”

Environmental Studies

• “Community-Based Conservation Efforts in Tropical Rainforests: A Qualitative Study of Local Perspectives and Practices”
• “Urban Sustainability Initiatives: Exploring Resident Participation and Impact in Green City Projects”
• “Perceptions of Climate Change Among Indigenous Populations: Insights from Traditional Ecological Knowledge”
• “Environmental Justice and Industrial Pollution: A Case Study of Community Advocacy and Response”
• “The Role of Eco-Tourism in Promoting Conservation Awareness: Perspectives from Tour Operators and Visitors”
• “Sustainable Agriculture Practices Among Smallholder Farmers: Challenges and Opportunities”
• “Youth Engagement in Climate Action Movements: Motivations, Perceptions, and Outcomes”
• “Corporate Environmental Responsibility: A Qualitative Analysis of Stakeholder Expectations and Company Practices”
• “The Impact of Plastic Pollution on Marine Ecosystems: Community Awareness and Behavioral Change”
• “Renewable Energy Adoption in Rural Communities: Barriers, Facilitators, and Social Implications”
• “Water Scarcity and Community Adaptation Strategies in Arid Regions: A Grounded Theory Approach”
• “Urban Green Spaces: Public Perceptions and Use Patterns in Megacities”
• “Environmental Education in Schools: Teachers’ Perspectives on Integrating Sustainability into Curricula”
• “The Influence of Environmental Activism on Policy Change: Case Studies of Grassroots Campaigns”
• “Cultural Practices and Natural Resource Management: A Qualitative Study of Indigenous Stewardship Models”

Anthropology

• “Kinship and Social Organization in Matrilineal Societies: An Ethnographic Study”
• “Rituals and Beliefs Surrounding Death and Mourning in Diverse Cultures: A Comparative Analysis”
• “The Impact of Globalization on Indigenous Languages and Cultural Identity”
• “Food Sovereignty and Traditional Agricultural Practices Among Indigenous Communities”
• “Navigating Modernity: The Integration of Traditional Healing Practices in Contemporary Healthcare Systems”
• “Gender Roles and Equality in Hunter-Gatherer Societies: An Anthropological Perspective”
• “Sacred Spaces and Religious Practices: An Ethnographic Study of Pilgrimage Sites”
• “Youth Subcultures and Resistance: An Exploration of Identity and Expression in Urban Environments”
• “Cultural Constructions of Disability and Inclusion: A Cross-Cultural Analysis”
• “Interethnic Marriages and Cultural Syncretism: Case Studies from Multicultural Societies”
• “The Role of Folklore and Storytelling in Preserving Cultural Heritage”
• “Economic Anthropology of Gift-Giving and Reciprocity in Tribal Communities”
• “Digital Anthropology: The Role of Social Media in Shaping Political Movements”
• “Migration and Diaspora: Maintaining Cultural Identity in Transnational Communities”
• “Cultural Adaptations to Climate Change Among Coastal Fishing Communities”

Communication Studies

• “The Dynamics of Family Communication in the Digital Age: A Qualitative Inquiry”
• “Narratives of Identity and Belonging in Diaspora Communities Through Social Media”
• “Organizational Communication and Employee Engagement: A Case Study in the Non-Profit Sector”
• “Cultural Influences on Communication Styles in Multinational Teams: An Ethnographic Approach”
• “Media Representation of Women in Politics: A Content Analysis and Audience Perception Study”
• “The Role of Communication in Building Sustainable Community Development Projects”
• “Interpersonal Communication in Online Dating: Strategies, Challenges, and Outcomes”
• “Public Health Messaging During Pandemics: A Qualitative Study of Community Responses”
• “The Impact of Mobile Technology on Parent-Child Communication in the Digital Era”
• “Crisis Communication Strategies in the Hospitality Industry: A Case Study of Reputation Management”
• “Narrative Analysis of Personal Stories Shared on Mental Health Blogs”
• “The Influence of Podcasts on Political Engagement Among Young Adults”
• “Visual Communication and Brand Identity: A Qualitative Study of Consumer Interpretations”
• “Communication Barriers in Cross-Cultural Healthcare Settings: Patient and Provider Perspectives”
• “The Role of Internal Communication in Managing Organizational Change: Employee Experiences”

Information Technology

• “User Experience Design in Augmented Reality Applications: A Qualitative Study of Best Practices”
• “The Human Factor in Cybersecurity: Understanding Employee Behaviors and Attitudes Towards Phishing”
• “Adoption of Cloud Computing in Small and Medium Enterprises: Challenges and Success Factors”
• “Blockchain Technology in Supply Chain Management: A Qualitative Exploration of Potential Impacts”
• “The Role of Artificial Intelligence in Personalizing User Experiences on E-commerce Platforms”
• “Digital Transformation in Traditional Industries: A Case Study of Technology Adoption Challenges”
• “Ethical Considerations in the Development of Smart Home Technologies: A Stakeholder Analysis”
• “The Impact of Social Media Algorithms on News Consumption and Public Opinion”
• “Collaborative Software Development: Practices and Challenges in Open Source Projects”
• “Understanding the Digital Divide: Access to Information Technology in Rural Communities”
• “Data Privacy Concerns and User Trust in Internet of Things (IoT) Devices”
• “The Effectiveness of Gamification in Educational Software: A Qualitative Study of Engagement and Motivation”
• “Virtual Teams and Remote Work: Communication Strategies and Tools for Effectiveness”
• “User-Centered Design in Mobile Health Applications: Evaluating Usability and Accessibility”
• “The Influence of Technology on Work-Life Balance: Perspectives from IT Professionals”

Tourism and Hospitality

• “Exploring the Authenticity of Cultural Heritage Tourism in Indigenous Communities”
• “Sustainable Tourism Practices: Perceptions and Implementations in Small Island Destinations”
• “The Impact of Social Media Influencers on Destination Choice Among Millennials”
• “Gastronomy Tourism: Exploring the Culinary Experiences of International Visitors in Rural Regions”
• “Eco-Tourism and Conservation: Stakeholder Perspectives on Balancing Tourism and Environmental Protection”
• “The Role of Hospitality in Enhancing the Cultural Exchange Experience of Exchange Students”
• “Dark Tourism: Visitor Motivations and Experiences at Historical Conflict Sites”
• “Customer Satisfaction in Luxury Hotels: A Qualitative Study of Service Excellence and Personalization”
• “Adventure Tourism: Understanding the Risk Perception and Safety Measures Among Thrill-Seekers”
• “The Influence of Local Communities on Tourist Experiences in Ecotourism Sites”
• “Event Tourism: Economic Impacts and Community Perspectives on Large-Scale Music Festivals”
• “Heritage Tourism and Identity: Exploring the Connections Between Historic Sites and National Identity”
• “Tourist Perceptions of Sustainable Accommodation Practices: A Study of Green Hotels”
• “The Role of Language in Shaping the Tourist Experience in Multilingual Destinations”
• “Health and Wellness Tourism: Motivations and Experiences of Visitors to Spa and Retreat Centers”

Qualitative Research Topics

Qualitative Research Topics are as follows:

• Understanding the lived experiences of first-generation college students
• Exploring the impact of social media on self-esteem among adolescents
• Investigating the effects of mindfulness meditation on stress reduction
• Analyzing the perceptions of employees regarding organizational culture
• Examining the impact of parental involvement on academic achievement of elementary school students
• Investigating the role of music therapy in managing symptoms of depression
• Understanding the experience of women in male-dominated industries
• Exploring the factors that contribute to successful leadership in non-profit organizations
• Analyzing the effects of peer pressure on substance abuse among adolescents
• Investigating the experiences of individuals with disabilities in the workplace
• Understanding the factors that contribute to burnout among healthcare professionals
• Examining the impact of social support on mental health outcomes
• Analyzing the perceptions of parents regarding sex education in schools
• Investigating the experiences of immigrant families in the education system
• Understanding the impact of trauma on mental health outcomes
• Exploring the effectiveness of animal-assisted therapy for individuals with anxiety
• Analyzing the factors that contribute to successful intergenerational relationships
• Investigating the experiences of LGBTQ+ individuals in the workplace
• Understanding the impact of online gaming on social skills development among adolescents
• Examining the perceptions of teachers regarding technology integration in the classroom
• Analyzing the experiences of women in leadership positions
• Investigating the factors that contribute to successful marriage and long-term relationships
• Understanding the impact of social media on political participation
• Exploring the experiences of individuals with mental health disorders in the criminal justice system
• Analyzing the factors that contribute to successful community-based programs for youth development
• Investigating the experiences of veterans in accessing mental health services
• Understanding the impact of the COVID-19 pandemic on mental health outcomes
• Examining the perceptions of parents regarding childhood obesity prevention
• Analyzing the factors that contribute to successful multicultural education programs
• Investigating the experiences of individuals with chronic illnesses in the workplace
• Understanding the impact of poverty on academic achievement
• Exploring the experiences of individuals with autism spectrum disorder in the workplace
• Analyzing the factors that contribute to successful employee retention strategies
• Investigating the experiences of caregivers of individuals with Alzheimer’s disease
• Understanding the impact of parent-child communication on adolescent sexual behavior
• Examining the perceptions of college students regarding mental health services on campus
• Analyzing the factors that contribute to successful team building in the workplace
• Investigating the experiences of individuals with eating disorders in treatment programs
• Understanding the impact of mentorship on career success
• Exploring the experiences of individuals with physical disabilities in the workplace
• Analyzing the factors that contribute to successful community-based programs for mental health
• Investigating the experiences of individuals with substance use disorders in treatment programs
• Understanding the impact of social media on romantic relationships
• Examining the perceptions of parents regarding child discipline strategies
• Analyzing the factors that contribute to successful cross-cultural communication in the workplace
• Investigating the experiences of individuals with anxiety disorders in treatment programs
• Understanding the impact of cultural differences on healthcare delivery
• Exploring the experiences of individuals with hearing loss in the workplace
• Analyzing the factors that contribute to successful parent-teacher communication
• Investigating the experiences of individuals with depression in treatment programs
• Understanding the impact of childhood trauma on adult mental health outcomes
• Examining the perceptions of college students regarding alcohol and drug use on campus
• Analyzing the factors that contribute to successful mentor-mentee relationships
• Investigating the experiences of individuals with intellectual disabilities in the workplace
• Understanding the impact of work-family balance on employee satisfaction and well-being
• Exploring the experiences of individuals with autism spectrum disorder in vocational rehabilitation programs
• Analyzing the factors that contribute to successful project management in the construction industry
• Investigating the experiences of individuals with substance use disorders in peer support groups
• Understanding the impact of mindfulness meditation on stress reduction and mental health
• Examining the perceptions of parents regarding childhood nutrition
• Analyzing the factors that contribute to successful environmental sustainability initiatives in organizations
• Investigating the experiences of individuals with bipolar disorder in treatment programs
• Understanding the impact of job stress on employee burnout and turnover
• Exploring the experiences of individuals with physical disabilities in recreational activities
• Analyzing the factors that contribute to successful strategic planning in nonprofit organizations
• Investigating the experiences of individuals with hoarding disorder in treatment programs
• Understanding the impact of culture on leadership styles and effectiveness
• Examining the perceptions of college students regarding sexual health education on campus
• Analyzing the factors that contribute to successful supply chain management in the retail industry
• Investigating the experiences of individuals with personality disorders in treatment programs
• Understanding the impact of multiculturalism on group dynamics in the workplace
• Exploring the experiences of individuals with chronic pain in mindfulness-based pain management programs
• Analyzing the factors that contribute to successful employee engagement strategies in organizations
• Investigating the experiences of individuals with internet addiction disorder in treatment programs
• Understanding the impact of social comparison on body dissatisfaction and self-esteem
• Examining the perceptions of parents regarding childhood sleep habits
• Analyzing the factors that contribute to successful diversity and inclusion initiatives in organizations
• Investigating the experiences of individuals with schizophrenia in treatment programs
• Understanding the impact of job crafting on employee motivation and job satisfaction
• Exploring the experiences of individuals with vision impairments in navigating public spaces
• Analyzing the factors that contribute to successful customer relationship management strategies in the service industry
• Investigating the experiences of individuals with dissociative amnesia in treatment programs
• Understanding the impact of cultural intelligence on intercultural communication and collaboration
• Examining the perceptions of college students regarding campus diversity and inclusion efforts
• Analyzing the factors that contribute to successful supply chain sustainability initiatives in organizations
• Investigating the experiences of individuals with obsessive-compulsive disorder in treatment programs
• Understanding the impact of transformational leadership on organizational performance and employee well-being
• Exploring the experiences of individuals with mobility impairments in public transportation
• Analyzing the factors that contribute to successful talent management strategies in organizations
• Investigating the experiences of individuals with substance use disorders in harm reduction programs
• Understanding the impact of gratitude practices on well-being and resilience
• Examining the perceptions of parents regarding childhood mental health and well-being
• Analyzing the factors that contribute to successful corporate social responsibility initiatives in organizations
• Investigating the experiences of individuals with borderline personality disorder in treatment programs
• Understanding the impact of emotional labor on job stress and burnout
• Exploring the experiences of individuals with hearing impairments in healthcare settings
• Analyzing the factors that contribute to successful customer experience strategies in the hospitality industry
• Investigating the experiences of individuals with gender dysphoria in gender-affirming healthcare
• Understanding the impact of cultural differences on cross-cultural negotiation in the global marketplace
• Examining the perceptions of college students regarding academic stress and mental health
• Analyzing the factors that contribute to successful supply chain agility in organizations
• Understanding the impact of music therapy on mental health and well-being
• Exploring the experiences of individuals with dyslexia in educational settings
• Analyzing the factors that contribute to successful leadership in nonprofit organizations
• Investigating the experiences of individuals with chronic illnesses in online support groups
• Understanding the impact of exercise on mental health and well-being
• Examining the perceptions of parents regarding childhood screen time
• Analyzing the factors that contribute to successful change management strategies in organizations
• Understanding the impact of cultural differences on international business negotiations
• Exploring the experiences of individuals with hearing impairments in the workplace
• Analyzing the factors that contribute to successful team building in corporate settings
• Understanding the impact of technology on communication in romantic relationships
• Analyzing the factors that contribute to successful community engagement strategies for local governments
• Investigating the experiences of individuals with attention deficit hyperactivity disorder (ADHD) in treatment programs
• Understanding the impact of financial stress on mental health and well-being
• Analyzing the factors that contribute to successful mentorship programs in organizations
• Investigating the experiences of individuals with gambling addictions in treatment programs
• Understanding the impact of social media on body image and self-esteem
• Examining the perceptions of parents regarding childhood education
• Analyzing the factors that contribute to successful virtual team management strategies
• Investigating the experiences of individuals with dissociative identity disorder in treatment programs
• Understanding the impact of cultural differences on cross-cultural communication in healthcare settings
• Exploring the experiences of individuals with chronic pain in cognitive-behavioral therapy programs
• Analyzing the factors that contribute to successful community-building strategies in urban neighborhoods
• Investigating the experiences of individuals with alcohol use disorders in treatment programs
• Understanding the impact of personality traits on romantic relationships
• Examining the perceptions of college students regarding mental health stigma on campus
• Analyzing the factors that contribute to successful fundraising strategies for political campaigns
• Investigating the experiences of individuals with traumatic brain injuries in rehabilitation programs
• Understanding the impact of social support on mental health and well-being among the elderly
• Exploring the experiences of individuals with chronic illnesses in medical treatment decision-making processes
• Analyzing the factors that contribute to successful innovation strategies in organizations
• Investigating the experiences of individuals with dissociative disorders in treatment programs
• Understanding the impact of cultural differences on cross-cultural communication in education settings
• Examining the perceptions of parents regarding childhood physical activity
• Analyzing the factors that contribute to successful conflict resolution in family relationships
• Investigating the experiences of individuals with opioid use disorders in treatment programs
• Understanding the impact of emotional intelligence on leadership effectiveness
• Exploring the experiences of individuals with learning disabilities in the workplace
• Analyzing the factors that contribute to successful change management in educational institutions
• Investigating the experiences of individuals with eating disorders in recovery support groups
• Understanding the impact of self-compassion on mental health and well-being
• Examining the perceptions of college students regarding campus safety and security measures
• Analyzing the factors that contribute to successful marketing strategies for nonprofit organizations
• Investigating the experiences of individuals with postpartum depression in treatment programs
• Understanding the impact of ageism in the workplace
• Exploring the experiences of individuals with dyslexia in the education system
• Investigating the experiences of individuals with anxiety disorders in cognitive-behavioral therapy programs
• Understanding the impact of socioeconomic status on access to healthcare
• Examining the perceptions of parents regarding childhood screen time usage
• Analyzing the factors that contribute to successful supply chain management strategies
• Understanding the impact of parenting styles on child development
• Exploring the experiences of individuals with addiction in harm reduction programs
• Analyzing the factors that contribute to successful crisis management strategies in organizations
• Investigating the experiences of individuals with trauma in trauma-focused therapy programs
• Examining the perceptions of healthcare providers regarding patient-centered care
• Analyzing the factors that contribute to successful product development strategies
• Investigating the experiences of individuals with autism spectrum disorder in employment programs
• Understanding the impact of cultural competence on healthcare outcomes
• Exploring the experiences of individuals with chronic illnesses in healthcare navigation
• Analyzing the factors that contribute to successful community engagement strategies for non-profit organizations
• Investigating the experiences of individuals with physical disabilities in the workplace
• Understanding the impact of childhood trauma on adult mental health
• Analyzing the factors that contribute to successful supply chain sustainability strategies
• Investigating the experiences of individuals with personality disorders in dialectical behavior therapy programs
• Understanding the impact of gender identity on mental health treatment seeking behaviors
• Exploring the experiences of individuals with schizophrenia in community-based treatment programs
• Analyzing the factors that contribute to successful project team management strategies
• Investigating the experiences of individuals with obsessive-compulsive disorder in exposure and response prevention therapy programs
• Understanding the impact of cultural competence on academic achievement and success
• Examining the perceptions of college students regarding academic integrity
• Analyzing the factors that contribute to successful social media marketing strategies
• Investigating the experiences of individuals with bipolar disorder in community-based treatment programs
• Understanding the impact of mindfulness on academic achievement and success
• Exploring the experiences of individuals with substance use disorders in medication-assisted treatment programs
• Investigating the experiences of individuals with anxiety disorders in exposure therapy programs
• Understanding the impact of healthcare disparities on health outcomes
• Analyzing the factors that contribute to successful supply chain optimization strategies
• Investigating the experiences of individuals with borderline personality disorder in schema therapy programs
• Understanding the impact of culture on perceptions of mental health stigma
• Exploring the experiences of individuals with trauma in art therapy programs
• Analyzing the factors that contribute to successful digital marketing strategies
• Investigating the experiences of individuals with eating disorders in online support groups
• Understanding the impact of workplace bullying on job satisfaction and performance
• Examining the perceptions of college students regarding mental health resources on campus
• Analyzing the factors that contribute to successful supply chain risk management strategies
• Investigating the experiences of individuals with chronic pain in mindfulness-based pain management programs
• Understanding the impact of cognitive-behavioral therapy on social anxiety disorder
• Understanding the impact of COVID-19 on mental health and well-being
• Exploring the experiences of individuals with eating disorders in treatment programs
• Analyzing the factors that contribute to successful leadership in business organizations
• Investigating the experiences of individuals with chronic pain in cognitive-behavioral therapy programs
• Understanding the impact of cultural differences on intercultural communication
• Examining the perceptions of teachers regarding inclusive education for students with disabilities
• Investigating the experiences of individuals with depression in therapy programs
• Understanding the impact of workplace culture on employee retention and turnover
• Exploring the experiences of individuals with traumatic brain injuries in rehabilitation programs
• Analyzing the factors that contribute to successful crisis communication strategies in organizations
• Investigating the experiences of individuals with anxiety disorders in mindfulness-based interventions
• Investigating the experiences of individuals with chronic illnesses in healthcare settings
• Understanding the impact of technology on work-life balance
• Exploring the experiences of individuals with learning disabilities in academic settings
• Analyzing the factors that contribute to successful entrepreneurship in small businesses
• Understanding the impact of gender identity on mental health and well-being
• Examining the perceptions of individuals with disabilities regarding accessibility in public spaces
• Understanding the impact of religion on coping strategies for stress and anxiety
• Exploring the experiences of individuals with chronic illnesses in complementary and alternative medicine treatments
• Analyzing the factors that contribute to successful customer retention strategies in business organizations
• Investigating the experiences of individuals with postpartum depression in therapy programs
• Understanding the impact of ageism on older adults in healthcare settings
• Examining the perceptions of students regarding online learning during the COVID-19 pandemic
• Analyzing the factors that contribute to successful team building in virtual work environments
• Investigating the experiences of individuals with gambling disorders in treatment programs
• Exploring the experiences of individuals with chronic illnesses in peer support groups
• Analyzing the factors that contribute to successful social media marketing strategies for businesses
• Investigating the experiences of individuals with ADHD in treatment programs
• Understanding the impact of sleep on cognitive and emotional functioning
• Examining the perceptions of individuals with chronic illnesses regarding healthcare access and affordability
• Investigating the experiences of individuals with borderline personality disorder in dialectical behavior therapy programs
• Understanding the impact of social support on caregiver well-being
• Exploring the experiences of individuals with chronic illnesses in disability activism
• Analyzing the factors that contribute to successful cultural competency training programs in healthcare settings
• Understanding the impact of personality disorders on interpersonal relationships
• Examining the perceptions of healthcare providers regarding the use of telehealth services
• Investigating the experiences of individuals with dissociative disorders in therapy programs
• Understanding the impact of gender bias in hiring practices
• Exploring the experiences of individuals with visual impairments in the workplace
• Analyzing the factors that contribute to successful diversity and inclusion programs in the workplace
• Understanding the impact of online dating on romantic relationships
• Examining the perceptions of parents regarding childhood vaccination
• Analyzing the factors that contribute to successful communication in healthcare settings
• Understanding the impact of cultural stereotypes on academic achievement
• Exploring the experiences of individuals with substance use disorders in sober living programs
• Analyzing the factors that contribute to successful classroom management strategies
• Understanding the impact of social support on addiction recovery
• Examining the perceptions of college students regarding mental health stigma
• Analyzing the factors that contribute to successful conflict resolution in the workplace
• Understanding the impact of race and ethnicity on healthcare access and outcomes
• Exploring the experiences of individuals with post-traumatic stress disorder in treatment programs
• Analyzing the factors that contribute to successful project management strategies
• Understanding the impact of teacher-student relationships on academic achievement
• Analyzing the factors that contribute to successful customer service strategies
• Investigating the experiences of individuals with social anxiety disorder in treatment programs
• Understanding the impact of workplace stress on job satisfaction and performance
• Exploring the experiences of individuals with disabilities in sports and recreation
• Analyzing the factors that contribute to successful marketing strategies for small businesses
• Investigating the experiences of individuals with phobias in treatment programs
• Understanding the impact of culture on attitudes towards mental health and illness
• Examining the perceptions of college students regarding sexual assault prevention
• Analyzing the factors that contribute to successful time management strategies
• Investigating the experiences of individuals with addiction in recovery support groups
• Understanding the impact of mindfulness on emotional regulation and well-being
• Exploring the experiences of individuals with chronic pain in treatment programs
• Analyzing the factors that contribute to successful conflict resolution in romantic relationships
• Investigating the experiences of individuals with autism spectrum disorder in social skills training programs
• Understanding the impact of parent-child communication on adolescent substance use
• Examining the perceptions of parents regarding childhood mental health services
• Analyzing the factors that contribute to successful fundraising strategies for non-profit organizations
• Investigating the experiences of individuals with chronic illnesses in support groups
• Understanding the impact of personality traits on career success and satisfaction
• Exploring the experiences of individuals with disabilities in accessing public transportation
• Analyzing the factors that contribute to successful team building in sports teams
• Investigating the experiences of individuals with chronic pain in alternative medicine treatments
• Understanding the impact of stigma on mental health treatment seeking behaviors
• Examining the perceptions of college students regarding diversity and inclusion on campus.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

You may also like

500+ Criminal Justice Research Topics

500+ Google Scholar Research Topics

300+ AP Research Topic Ideas

300+ American History Research Paper Topics

1000+ Sociology Research Topics

300+ Communication Research Topics

• Open access
• Published: 27 May 2020

How to use and assess qualitative research methods

• Loraine Busetto   ORCID: orcid.org/0000-0002-9228-7875 1 ,
• Wolfgang Wick 1 , 2 &
• Christoph Gumbinger 1  

Neurological Research and Practice volume  2 , Article number:  14 ( 2020 ) Cite this article

675k Accesses

262 Citations

88 Altmetric

Metrics details

This paper aims to provide an overview of the use and assessment of qualitative research methods in the health sciences. Qualitative research can be defined as the study of the nature of phenomena and is especially appropriate for answering questions of why something is (not) observed, assessing complex multi-component interventions, and focussing on intervention improvement. The most common methods of data collection are document study, (non-) participant observations, semi-structured interviews and focus groups. For data analysis, field-notes and audio-recordings are transcribed into protocols and transcripts, and coded using qualitative data management software. Criteria such as checklists, reflexivity, sampling strategies, piloting, co-coding, member-checking and stakeholder involvement can be used to enhance and assess the quality of the research conducted. Using qualitative in addition to quantitative designs will equip us with better tools to address a greater range of research problems, and to fill in blind spots in current neurological research and practice.

The aim of this paper is to provide an overview of qualitative research methods, including hands-on information on how they can be used, reported and assessed. This article is intended for beginning qualitative researchers in the health sciences as well as experienced quantitative researchers who wish to broaden their understanding of qualitative research.

What is qualitative research?

Qualitative research is defined as “the study of the nature of phenomena”, including “their quality, different manifestations, the context in which they appear or the perspectives from which they can be perceived” , but excluding “their range, frequency and place in an objectively determined chain of cause and effect” [ 1 ]. This formal definition can be complemented with a more pragmatic rule of thumb: qualitative research generally includes data in form of words rather than numbers [ 2 ].

Why conduct qualitative research?

Because some research questions cannot be answered using (only) quantitative methods. For example, one Australian study addressed the issue of why patients from Aboriginal communities often present late or not at all to specialist services offered by tertiary care hospitals. Using qualitative interviews with patients and staff, it found one of the most significant access barriers to be transportation problems, including some towns and communities simply not having a bus service to the hospital [ 3 ]. A quantitative study could have measured the number of patients over time or even looked at possible explanatory factors – but only those previously known or suspected to be of relevance. To discover reasons for observed patterns, especially the invisible or surprising ones, qualitative designs are needed.

While qualitative research is common in other fields, it is still relatively underrepresented in health services research. The latter field is more traditionally rooted in the evidence-based-medicine paradigm, as seen in " research that involves testing the effectiveness of various strategies to achieve changes in clinical practice, preferably applying randomised controlled trial study designs (...) " [ 4 ]. This focus on quantitative research and specifically randomised controlled trials (RCT) is visible in the idea of a hierarchy of research evidence which assumes that some research designs are objectively better than others, and that choosing a "lesser" design is only acceptable when the better ones are not practically or ethically feasible [ 5 , 6 ]. Others, however, argue that an objective hierarchy does not exist, and that, instead, the research design and methods should be chosen to fit the specific research question at hand – "questions before methods" [ 2 , 7 , 8 , 9 ]. This means that even when an RCT is possible, some research problems require a different design that is better suited to addressing them. Arguing in JAMA, Berwick uses the example of rapid response teams in hospitals, which he describes as " a complex, multicomponent intervention – essentially a process of social change" susceptible to a range of different context factors including leadership or organisation history. According to him, "[in] such complex terrain, the RCT is an impoverished way to learn. Critics who use it as a truth standard in this context are incorrect" [ 8 ] . Instead of limiting oneself to RCTs, Berwick recommends embracing a wider range of methods , including qualitative ones, which for "these specific applications, (...) are not compromises in learning how to improve; they are superior" [ 8 ].

Research problems that can be approached particularly well using qualitative methods include assessing complex multi-component interventions or systems (of change), addressing questions beyond “what works”, towards “what works for whom when, how and why”, and focussing on intervention improvement rather than accreditation [ 7 , 9 , 10 , 11 , 12 ]. Using qualitative methods can also help shed light on the “softer” side of medical treatment. For example, while quantitative trials can measure the costs and benefits of neuro-oncological treatment in terms of survival rates or adverse effects, qualitative research can help provide a better understanding of patient or caregiver stress, visibility of illness or out-of-pocket expenses.

How to conduct qualitative research?

Given that qualitative research is characterised by flexibility, openness and responsivity to context, the steps of data collection and analysis are not as separate and consecutive as they tend to be in quantitative research [ 13 , 14 ]. As Fossey puts it : “sampling, data collection, analysis and interpretation are related to each other in a cyclical (iterative) manner, rather than following one after another in a stepwise approach” [ 15 ]. The researcher can make educated decisions with regard to the choice of method, how they are implemented, and to which and how many units they are applied [ 13 ]. As shown in Fig.  1 , this can involve several back-and-forth steps between data collection and analysis where new insights and experiences can lead to adaption and expansion of the original plan. Some insights may also necessitate a revision of the research question and/or the research design as a whole. The process ends when saturation is achieved, i.e. when no relevant new information can be found (see also below: sampling and saturation). For reasons of transparency, it is essential for all decisions as well as the underlying reasoning to be well-documented.

Iterative research process

While it is not always explicitly addressed, qualitative methods reflect a different underlying research paradigm than quantitative research (e.g. constructivism or interpretivism as opposed to positivism). The choice of methods can be based on the respective underlying substantive theory or theoretical framework used by the researcher [ 2 ].

Data collection

The methods of qualitative data collection most commonly used in health research are document study, observations, semi-structured interviews and focus groups [ 1 , 14 , 16 , 17 ].

Document study

Document study (also called document analysis) refers to the review by the researcher of written materials [ 14 ]. These can include personal and non-personal documents such as archives, annual reports, guidelines, policy documents, diaries or letters.

Observations

Observations are particularly useful to gain insights into a certain setting and actual behaviour – as opposed to reported behaviour or opinions [ 13 ]. Qualitative observations can be either participant or non-participant in nature. In participant observations, the observer is part of the observed setting, for example a nurse working in an intensive care unit [ 18 ]. In non-participant observations, the observer is “on the outside looking in”, i.e. present in but not part of the situation, trying not to influence the setting by their presence. Observations can be planned (e.g. for 3 h during the day or night shift) or ad hoc (e.g. as soon as a stroke patient arrives at the emergency room). During the observation, the observer takes notes on everything or certain pre-determined parts of what is happening around them, for example focusing on physician-patient interactions or communication between different professional groups. Written notes can be taken during or after the observations, depending on feasibility (which is usually lower during participant observations) and acceptability (e.g. when the observer is perceived to be judging the observed). Afterwards, these field notes are transcribed into observation protocols. If more than one observer was involved, field notes are taken independently, but notes can be consolidated into one protocol after discussions. Advantages of conducting observations include minimising the distance between the researcher and the researched, the potential discovery of topics that the researcher did not realise were relevant and gaining deeper insights into the real-world dimensions of the research problem at hand [ 18 ].

Semi-structured interviews

Hijmans & Kuyper describe qualitative interviews as “an exchange with an informal character, a conversation with a goal” [ 19 ]. Interviews are used to gain insights into a person’s subjective experiences, opinions and motivations – as opposed to facts or behaviours [ 13 ]. Interviews can be distinguished by the degree to which they are structured (i.e. a questionnaire), open (e.g. free conversation or autobiographical interviews) or semi-structured [ 2 , 13 ]. Semi-structured interviews are characterized by open-ended questions and the use of an interview guide (or topic guide/list) in which the broad areas of interest, sometimes including sub-questions, are defined [ 19 ]. The pre-defined topics in the interview guide can be derived from the literature, previous research or a preliminary method of data collection, e.g. document study or observations. The topic list is usually adapted and improved at the start of the data collection process as the interviewer learns more about the field [ 20 ]. Across interviews the focus on the different (blocks of) questions may differ and some questions may be skipped altogether (e.g. if the interviewee is not able or willing to answer the questions or for concerns about the total length of the interview) [ 20 ]. Qualitative interviews are usually not conducted in written format as it impedes on the interactive component of the method [ 20 ]. In comparison to written surveys, qualitative interviews have the advantage of being interactive and allowing for unexpected topics to emerge and to be taken up by the researcher. This can also help overcome a provider or researcher-centred bias often found in written surveys, which by nature, can only measure what is already known or expected to be of relevance to the researcher. Interviews can be audio- or video-taped; but sometimes it is only feasible or acceptable for the interviewer to take written notes [ 14 , 16 , 20 ].

Focus groups

Focus groups are group interviews to explore participants’ expertise and experiences, including explorations of how and why people behave in certain ways [ 1 ]. Focus groups usually consist of 6–8 people and are led by an experienced moderator following a topic guide or “script” [ 21 ]. They can involve an observer who takes note of the non-verbal aspects of the situation, possibly using an observation guide [ 21 ]. Depending on researchers’ and participants’ preferences, the discussions can be audio- or video-taped and transcribed afterwards [ 21 ]. Focus groups are useful for bringing together homogeneous (to a lesser extent heterogeneous) groups of participants with relevant expertise and experience on a given topic on which they can share detailed information [ 21 ]. Focus groups are a relatively easy, fast and inexpensive method to gain access to information on interactions in a given group, i.e. “the sharing and comparing” among participants [ 21 ]. Disadvantages include less control over the process and a lesser extent to which each individual may participate. Moreover, focus group moderators need experience, as do those tasked with the analysis of the resulting data. Focus groups can be less appropriate for discussing sensitive topics that participants might be reluctant to disclose in a group setting [ 13 ]. Moreover, attention must be paid to the emergence of “groupthink” as well as possible power dynamics within the group, e.g. when patients are awed or intimidated by health professionals.

Choosing the “right” method

As explained above, the school of thought underlying qualitative research assumes no objective hierarchy of evidence and methods. This means that each choice of single or combined methods has to be based on the research question that needs to be answered and a critical assessment with regard to whether or to what extent the chosen method can accomplish this – i.e. the “fit” between question and method [ 14 ]. It is necessary for these decisions to be documented when they are being made, and to be critically discussed when reporting methods and results.

Let us assume that our research aim is to examine the (clinical) processes around acute endovascular treatment (EVT), from the patient’s arrival at the emergency room to recanalization, with the aim to identify possible causes for delay and/or other causes for sub-optimal treatment outcome. As a first step, we could conduct a document study of the relevant standard operating procedures (SOPs) for this phase of care – are they up-to-date and in line with current guidelines? Do they contain any mistakes, irregularities or uncertainties that could cause delays or other problems? Regardless of the answers to these questions, the results have to be interpreted based on what they are: a written outline of what care processes in this hospital should look like. If we want to know what they actually look like in practice, we can conduct observations of the processes described in the SOPs. These results can (and should) be analysed in themselves, but also in comparison to the results of the document analysis, especially as regards relevant discrepancies. Do the SOPs outline specific tests for which no equipment can be observed or tasks to be performed by specialized nurses who are not present during the observation? It might also be possible that the written SOP is outdated, but the actual care provided is in line with current best practice. In order to find out why these discrepancies exist, it can be useful to conduct interviews. Are the physicians simply not aware of the SOPs (because their existence is limited to the hospital’s intranet) or do they actively disagree with them or does the infrastructure make it impossible to provide the care as described? Another rationale for adding interviews is that some situations (or all of their possible variations for different patient groups or the day, night or weekend shift) cannot practically or ethically be observed. In this case, it is possible to ask those involved to report on their actions – being aware that this is not the same as the actual observation. A senior physician’s or hospital manager’s description of certain situations might differ from a nurse’s or junior physician’s one, maybe because they intentionally misrepresent facts or maybe because different aspects of the process are visible or important to them. In some cases, it can also be relevant to consider to whom the interviewee is disclosing this information – someone they trust, someone they are otherwise not connected to, or someone they suspect or are aware of being in a potentially “dangerous” power relationship to them. Lastly, a focus group could be conducted with representatives of the relevant professional groups to explore how and why exactly they provide care around EVT. The discussion might reveal discrepancies (between SOPs and actual care or between different physicians) and motivations to the researchers as well as to the focus group members that they might not have been aware of themselves. For the focus group to deliver relevant information, attention has to be paid to its composition and conduct, for example, to make sure that all participants feel safe to disclose sensitive or potentially problematic information or that the discussion is not dominated by (senior) physicians only. The resulting combination of data collection methods is shown in Fig.  2 .

Possible combination of data collection methods

Attributions for icons: “Book” by Serhii Smirnov, “Interview” by Adrien Coquet, FR, “Magnifying Glass” by anggun, ID, “Business communication” by Vectors Market; all from the Noun Project

The combination of multiple data source as described for this example can be referred to as “triangulation”, in which multiple measurements are carried out from different angles to achieve a more comprehensive understanding of the phenomenon under study [ 22 , 23 ].

Data analysis

To analyse the data collected through observations, interviews and focus groups these need to be transcribed into protocols and transcripts (see Fig.  3 ). Interviews and focus groups can be transcribed verbatim , with or without annotations for behaviour (e.g. laughing, crying, pausing) and with or without phonetic transcription of dialects and filler words, depending on what is expected or known to be relevant for the analysis. In the next step, the protocols and transcripts are coded , that is, marked (or tagged, labelled) with one or more short descriptors of the content of a sentence or paragraph [ 2 , 15 , 23 ]. Jansen describes coding as “connecting the raw data with “theoretical” terms” [ 20 ]. In a more practical sense, coding makes raw data sortable. This makes it possible to extract and examine all segments describing, say, a tele-neurology consultation from multiple data sources (e.g. SOPs, emergency room observations, staff and patient interview). In a process of synthesis and abstraction, the codes are then grouped, summarised and/or categorised [ 15 , 20 ]. The end product of the coding or analysis process is a descriptive theory of the behavioural pattern under investigation [ 20 ]. The coding process is performed using qualitative data management software, the most common ones being InVivo, MaxQDA and Atlas.ti. It should be noted that these are data management tools which support the analysis performed by the researcher(s) [ 14 ].

From data collection to data analysis

Attributions for icons: see Fig. 2 , also “Speech to text” by Trevor Dsouza, “Field Notes” by Mike O’Brien, US, “Voice Record” by ProSymbols, US, “Inspection” by Made, AU, and “Cloud” by Graphic Tigers; all from the Noun Project

How to report qualitative research?

Protocols of qualitative research can be published separately and in advance of the study results. However, the aim is not the same as in RCT protocols, i.e. to pre-define and set in stone the research questions and primary or secondary endpoints. Rather, it is a way to describe the research methods in detail, which might not be possible in the results paper given journals’ word limits. Qualitative research papers are usually longer than their quantitative counterparts to allow for deep understanding and so-called “thick description”. In the methods section, the focus is on transparency of the methods used, including why, how and by whom they were implemented in the specific study setting, so as to enable a discussion of whether and how this may have influenced data collection, analysis and interpretation. The results section usually starts with a paragraph outlining the main findings, followed by more detailed descriptions of, for example, the commonalities, discrepancies or exceptions per category [ 20 ]. Here it is important to support main findings by relevant quotations, which may add information, context, emphasis or real-life examples [ 20 , 23 ]. It is subject to debate in the field whether it is relevant to state the exact number or percentage of respondents supporting a certain statement (e.g. “Five interviewees expressed negative feelings towards XYZ”) [ 21 ].

How to combine qualitative with quantitative research?

Qualitative methods can be combined with other methods in multi- or mixed methods designs, which “[employ] two or more different methods [ …] within the same study or research program rather than confining the research to one single method” [ 24 ]. Reasons for combining methods can be diverse, including triangulation for corroboration of findings, complementarity for illustration and clarification of results, expansion to extend the breadth and range of the study, explanation of (unexpected) results generated with one method with the help of another, or offsetting the weakness of one method with the strength of another [ 1 , 17 , 24 , 25 , 26 ]. The resulting designs can be classified according to when, why and how the different quantitative and/or qualitative data strands are combined. The three most common types of mixed method designs are the convergent parallel design , the explanatory sequential design and the exploratory sequential design. The designs with examples are shown in Fig.  4 .

Three common mixed methods designs

In the convergent parallel design, a qualitative study is conducted in parallel to and independently of a quantitative study, and the results of both studies are compared and combined at the stage of interpretation of results. Using the above example of EVT provision, this could entail setting up a quantitative EVT registry to measure process times and patient outcomes in parallel to conducting the qualitative research outlined above, and then comparing results. Amongst other things, this would make it possible to assess whether interview respondents’ subjective impressions of patients receiving good care match modified Rankin Scores at follow-up, or whether observed delays in care provision are exceptions or the rule when compared to door-to-needle times as documented in the registry. In the explanatory sequential design, a quantitative study is carried out first, followed by a qualitative study to help explain the results from the quantitative study. This would be an appropriate design if the registry alone had revealed relevant delays in door-to-needle times and the qualitative study would be used to understand where and why these occurred, and how they could be improved. In the exploratory design, the qualitative study is carried out first and its results help informing and building the quantitative study in the next step [ 26 ]. If the qualitative study around EVT provision had shown a high level of dissatisfaction among the staff members involved, a quantitative questionnaire investigating staff satisfaction could be set up in the next step, informed by the qualitative study on which topics dissatisfaction had been expressed. Amongst other things, the questionnaire design would make it possible to widen the reach of the research to more respondents from different (types of) hospitals, regions, countries or settings, and to conduct sub-group analyses for different professional groups.

How to assess qualitative research?

A variety of assessment criteria and lists have been developed for qualitative research, ranging in their focus and comprehensiveness [ 14 , 17 , 27 ]. However, none of these has been elevated to the “gold standard” in the field. In the following, we therefore focus on a set of commonly used assessment criteria that, from a practical standpoint, a researcher can look for when assessing a qualitative research report or paper.

Assessors should check the authors’ use of and adherence to the relevant reporting checklists (e.g. Standards for Reporting Qualitative Research (SRQR)) to make sure all items that are relevant for this type of research are addressed [ 23 , 28 ]. Discussions of quantitative measures in addition to or instead of these qualitative measures can be a sign of lower quality of the research (paper). Providing and adhering to a checklist for qualitative research contributes to an important quality criterion for qualitative research, namely transparency [ 15 , 17 , 23 ].

Reflexivity

While methodological transparency and complete reporting is relevant for all types of research, some additional criteria must be taken into account for qualitative research. This includes what is called reflexivity, i.e. sensitivity to the relationship between the researcher and the researched, including how contact was established and maintained, or the background and experience of the researcher(s) involved in data collection and analysis. Depending on the research question and population to be researched this can be limited to professional experience, but it may also include gender, age or ethnicity [ 17 , 27 ]. These details are relevant because in qualitative research, as opposed to quantitative research, the researcher as a person cannot be isolated from the research process [ 23 ]. It may influence the conversation when an interviewed patient speaks to an interviewer who is a physician, or when an interviewee is asked to discuss a gynaecological procedure with a male interviewer, and therefore the reader must be made aware of these details [ 19 ].

Sampling and saturation

The aim of qualitative sampling is for all variants of the objects of observation that are deemed relevant for the study to be present in the sample “ to see the issue and its meanings from as many angles as possible” [ 1 , 16 , 19 , 20 , 27 ] , and to ensure “information-richness [ 15 ]. An iterative sampling approach is advised, in which data collection (e.g. five interviews) is followed by data analysis, followed by more data collection to find variants that are lacking in the current sample. This process continues until no new (relevant) information can be found and further sampling becomes redundant – which is called saturation [ 1 , 15 ] . In other words: qualitative data collection finds its end point not a priori , but when the research team determines that saturation has been reached [ 29 , 30 ].

This is also the reason why most qualitative studies use deliberate instead of random sampling strategies. This is generally referred to as “ purposive sampling” , in which researchers pre-define which types of participants or cases they need to include so as to cover all variations that are expected to be of relevance, based on the literature, previous experience or theory (i.e. theoretical sampling) [ 14 , 20 ]. Other types of purposive sampling include (but are not limited to) maximum variation sampling, critical case sampling or extreme or deviant case sampling [ 2 ]. In the above EVT example, a purposive sample could include all relevant professional groups and/or all relevant stakeholders (patients, relatives) and/or all relevant times of observation (day, night and weekend shift).

Assessors of qualitative research should check whether the considerations underlying the sampling strategy were sound and whether or how researchers tried to adapt and improve their strategies in stepwise or cyclical approaches between data collection and analysis to achieve saturation [ 14 ].

Good qualitative research is iterative in nature, i.e. it goes back and forth between data collection and analysis, revising and improving the approach where necessary. One example of this are pilot interviews, where different aspects of the interview (especially the interview guide, but also, for example, the site of the interview or whether the interview can be audio-recorded) are tested with a small number of respondents, evaluated and revised [ 19 ]. In doing so, the interviewer learns which wording or types of questions work best, or which is the best length of an interview with patients who have trouble concentrating for an extended time. Of course, the same reasoning applies to observations or focus groups which can also be piloted.

Ideally, coding should be performed by at least two researchers, especially at the beginning of the coding process when a common approach must be defined, including the establishment of a useful coding list (or tree), and when a common meaning of individual codes must be established [ 23 ]. An initial sub-set or all transcripts can be coded independently by the coders and then compared and consolidated after regular discussions in the research team. This is to make sure that codes are applied consistently to the research data.

Member checking

Member checking, also called respondent validation , refers to the practice of checking back with study respondents to see if the research is in line with their views [ 14 , 27 ]. This can happen after data collection or analysis or when first results are available [ 23 ]. For example, interviewees can be provided with (summaries of) their transcripts and asked whether they believe this to be a complete representation of their views or whether they would like to clarify or elaborate on their responses [ 17 ]. Respondents’ feedback on these issues then becomes part of the data collection and analysis [ 27 ].

Stakeholder involvement

In those niches where qualitative approaches have been able to evolve and grow, a new trend has seen the inclusion of patients and their representatives not only as study participants (i.e. “members”, see above) but as consultants to and active participants in the broader research process [ 31 , 32 , 33 ]. The underlying assumption is that patients and other stakeholders hold unique perspectives and experiences that add value beyond their own single story, making the research more relevant and beneficial to researchers, study participants and (future) patients alike [ 34 , 35 ]. Using the example of patients on or nearing dialysis, a recent scoping review found that 80% of clinical research did not address the top 10 research priorities identified by patients and caregivers [ 32 , 36 ]. In this sense, the involvement of the relevant stakeholders, especially patients and relatives, is increasingly being seen as a quality indicator in and of itself.

How not to assess qualitative research

The above overview does not include certain items that are routine in assessments of quantitative research. What follows is a non-exhaustive, non-representative, experience-based list of the quantitative criteria often applied to the assessment of qualitative research, as well as an explanation of the limited usefulness of these endeavours.

Protocol adherence

Given the openness and flexibility of qualitative research, it should not be assessed by how well it adheres to pre-determined and fixed strategies – in other words: its rigidity. Instead, the assessor should look for signs of adaptation and refinement based on lessons learned from earlier steps in the research process.

Sample size

For the reasons explained above, qualitative research does not require specific sample sizes, nor does it require that the sample size be determined a priori [ 1 , 14 , 27 , 37 , 38 , 39 ]. Sample size can only be a useful quality indicator when related to the research purpose, the chosen methodology and the composition of the sample, i.e. who was included and why.

Randomisation

While some authors argue that randomisation can be used in qualitative research, this is not commonly the case, as neither its feasibility nor its necessity or usefulness has been convincingly established for qualitative research [ 13 , 27 ]. Relevant disadvantages include the negative impact of a too large sample size as well as the possibility (or probability) of selecting “ quiet, uncooperative or inarticulate individuals ” [ 17 ]. Qualitative studies do not use control groups, either.

Interrater reliability, variability and other “objectivity checks”

The concept of “interrater reliability” is sometimes used in qualitative research to assess to which extent the coding approach overlaps between the two co-coders. However, it is not clear what this measure tells us about the quality of the analysis [ 23 ]. This means that these scores can be included in qualitative research reports, preferably with some additional information on what the score means for the analysis, but it is not a requirement. Relatedly, it is not relevant for the quality or “objectivity” of qualitative research to separate those who recruited the study participants and collected and analysed the data. Experiences even show that it might be better to have the same person or team perform all of these tasks [ 20 ]. First, when researchers introduce themselves during recruitment this can enhance trust when the interview takes place days or weeks later with the same researcher. Second, when the audio-recording is transcribed for analysis, the researcher conducting the interviews will usually remember the interviewee and the specific interview situation during data analysis. This might be helpful in providing additional context information for interpretation of data, e.g. on whether something might have been meant as a joke [ 18 ].

Not being quantitative research

Being qualitative research instead of quantitative research should not be used as an assessment criterion if it is used irrespectively of the research problem at hand. Similarly, qualitative research should not be required to be combined with quantitative research per se – unless mixed methods research is judged as inherently better than single-method research. In this case, the same criterion should be applied for quantitative studies without a qualitative component.

The main take-away points of this paper are summarised in Table 1 . We aimed to show that, if conducted well, qualitative research can answer specific research questions that cannot to be adequately answered using (only) quantitative designs. Seeing qualitative and quantitative methods as equal will help us become more aware and critical of the “fit” between the research problem and our chosen methods: I can conduct an RCT to determine the reasons for transportation delays of acute stroke patients – but should I? It also provides us with a greater range of tools to tackle a greater range of research problems more appropriately and successfully, filling in the blind spots on one half of the methodological spectrum to better address the whole complexity of neurological research and practice.

Availability of data and materials

Not applicable.

Abbreviations

Endovascular treatment

Randomised Controlled Trial

Standard Operating Procedure

Standards for Reporting Qualitative Research

Philipsen, H., & Vernooij-Dassen, M. (2007). Kwalitatief onderzoek: nuttig, onmisbaar en uitdagend. In L. PLBJ & H. TCo (Eds.), Kwalitatief onderzoek: Praktische methoden voor de medische praktijk . [Qualitative research: useful, indispensable and challenging. In: Qualitative research: Practical methods for medical practice (pp. 5–12). Houten: Bohn Stafleu van Loghum.

Chapter   Google Scholar  

Punch, K. F. (2013). Introduction to social research: Quantitative and qualitative approaches . London: Sage.

Kelly, J., Dwyer, J., Willis, E., & Pekarsky, B. (2014). Travelling to the city for hospital care: Access factors in country aboriginal patient journeys. Australian Journal of Rural Health, 22 (3), 109–113.

Article   Google Scholar  

Nilsen, P., Ståhl, C., Roback, K., & Cairney, P. (2013). Never the twain shall meet? - a comparison of implementation science and policy implementation research. Implementation Science, 8 (1), 1–12.

Howick J, Chalmers I, Glasziou, P., Greenhalgh, T., Heneghan, C., Liberati, A., Moschetti, I., Phillips, B., & Thornton, H. (2011). The 2011 Oxford CEBM evidence levels of evidence (introductory document) . Oxford Center for Evidence Based Medicine. https://www.cebm.net/2011/06/2011-oxford-cebm-levels-evidence-introductory-document/ .

Eakin, J. M. (2016). Educating critical qualitative health researchers in the land of the randomized controlled trial. Qualitative Inquiry, 22 (2), 107–118.

May, A., & Mathijssen, J. (2015). Alternatieven voor RCT bij de evaluatie van effectiviteit van interventies!? Eindrapportage. In Alternatives for RCTs in the evaluation of effectiveness of interventions!? Final report .

Google Scholar  

Berwick, D. M. (2008). The science of improvement. Journal of the American Medical Association, 299 (10), 1182–1184.

Article   CAS   Google Scholar  

Christ, T. W. (2014). Scientific-based research and randomized controlled trials, the “gold” standard? Alternative paradigms and mixed methodologies. Qualitative Inquiry, 20 (1), 72–80.

Lamont, T., Barber, N., Jd, P., Fulop, N., Garfield-Birkbeck, S., Lilford, R., Mear, L., Raine, R., & Fitzpatrick, R. (2016). New approaches to evaluating complex health and care systems. BMJ, 352:i154.

Drabble, S. J., & O’Cathain, A. (2015). Moving from Randomized Controlled Trials to Mixed Methods Intervention Evaluation. In S. Hesse-Biber & R. B. Johnson (Eds.), The Oxford Handbook of Multimethod and Mixed Methods Research Inquiry (pp. 406–425). London: Oxford University Press.

Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013). The dynamic sustainability framework: Addressing the paradox of sustainment amid ongoing change. Implementation Science : IS, 8 , 117.

Hak, T. (2007). Waarnemingsmethoden in kwalitatief onderzoek. In L. PLBJ & H. TCo (Eds.), Kwalitatief onderzoek: Praktische methoden voor de medische praktijk . [Observation methods in qualitative research] (pp. 13–25). Houten: Bohn Stafleu van Loghum.

Russell, C. K., & Gregory, D. M. (2003). Evaluation of qualitative research studies. Evidence Based Nursing, 6 (2), 36–40.

Fossey, E., Harvey, C., McDermott, F., & Davidson, L. (2002). Understanding and evaluating qualitative research. Australian and New Zealand Journal of Psychiatry, 36 , 717–732.

Yanow, D. (2000). Conducting interpretive policy analysis (Vol. 47). Thousand Oaks: Sage University Papers Series on Qualitative Research Methods.

Shenton, A. K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22 , 63–75.

van der Geest, S. (2006). Participeren in ziekte en zorg: meer over kwalitatief onderzoek. Huisarts en Wetenschap, 49 (4), 283–287.

Hijmans, E., & Kuyper, M. (2007). Het halfopen interview als onderzoeksmethode. In L. PLBJ & H. TCo (Eds.), Kwalitatief onderzoek: Praktische methoden voor de medische praktijk . [The half-open interview as research method (pp. 43–51). Houten: Bohn Stafleu van Loghum.

Jansen, H. (2007). Systematiek en toepassing van de kwalitatieve survey. In L. PLBJ & H. TCo (Eds.), Kwalitatief onderzoek: Praktische methoden voor de medische praktijk . [Systematics and implementation of the qualitative survey (pp. 27–41). Houten: Bohn Stafleu van Loghum.

Pv, R., & Peremans, L. (2007). Exploreren met focusgroepgesprekken: de ‘stem’ van de groep onder de loep. In L. PLBJ & H. TCo (Eds.), Kwalitatief onderzoek: Praktische methoden voor de medische praktijk . [Exploring with focus group conversations: the “voice” of the group under the magnifying glass (pp. 53–64). Houten: Bohn Stafleu van Loghum.

Carter, N., Bryant-Lukosius, D., DiCenso, A., Blythe, J., & Neville, A. J. (2014). The use of triangulation in qualitative research. Oncology Nursing Forum, 41 (5), 545–547.

Boeije H: Analyseren in kwalitatief onderzoek: Denken en doen, [Analysis in qualitative research: Thinking and doing] vol. Den Haag Boom Lemma uitgevers; 2012.

Hunter, A., & Brewer, J. (2015). Designing Multimethod Research. In S. Hesse-Biber & R. B. Johnson (Eds.), The Oxford Handbook of Multimethod and Mixed Methods Research Inquiry (pp. 185–205). London: Oxford University Press.

Archibald, M. M., Radil, A. I., Zhang, X., & Hanson, W. E. (2015). Current mixed methods practices in qualitative research: A content analysis of leading journals. International Journal of Qualitative Methods, 14 (2), 5–33.

Creswell, J. W., & Plano Clark, V. L. (2011). Choosing a Mixed Methods Design. In Designing and Conducting Mixed Methods Research . Thousand Oaks: SAGE Publications.

Mays, N., & Pope, C. (2000). Assessing quality in qualitative research. BMJ, 320 (7226), 50–52.

O'Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine : Journal of the Association of American Medical Colleges, 89 (9), 1245–1251.

Saunders, B., Sim, J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B., Burroughs, H., & Jinks, C. (2018). Saturation in qualitative research: Exploring its conceptualization and operationalization. Quality and Quantity, 52 (4), 1893–1907.

Moser, A., & Korstjens, I. (2018). Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. European Journal of General Practice, 24 (1), 9–18.

Marlett, N., Shklarov, S., Marshall, D., Santana, M. J., & Wasylak, T. (2015). Building new roles and relationships in research: A model of patient engagement research. Quality of Life Research : an international journal of quality of life aspects of treatment, care and rehabilitation, 24 (5), 1057–1067.

Demian, M. N., Lam, N. N., Mac-Way, F., Sapir-Pichhadze, R., & Fernandez, N. (2017). Opportunities for engaging patients in kidney research. Canadian Journal of Kidney Health and Disease, 4 , 2054358117703070–2054358117703070.

Noyes, J., McLaughlin, L., Morgan, K., Roberts, A., Stephens, M., Bourne, J., Houlston, M., Houlston, J., Thomas, S., Rhys, R. G., et al. (2019). Designing a co-productive study to overcome known methodological challenges in organ donation research with bereaved family members. Health Expectations . 22(4):824–35.

Piil, K., Jarden, M., & Pii, K. H. (2019). Research agenda for life-threatening cancer. European Journal Cancer Care (Engl), 28 (1), e12935.

Hofmann, D., Ibrahim, F., Rose, D., Scott, D. L., Cope, A., Wykes, T., & Lempp, H. (2015). Expectations of new treatment in rheumatoid arthritis: Developing a patient-generated questionnaire. Health Expectations : an international journal of public participation in health care and health policy, 18 (5), 995–1008.

Jun, M., Manns, B., Laupacis, A., Manns, L., Rehal, B., Crowe, S., & Hemmelgarn, B. R. (2015). Assessing the extent to which current clinical research is consistent with patient priorities: A scoping review using a case study in patients on or nearing dialysis. Canadian Journal of Kidney Health and Disease, 2 , 35.

Elsie Baker, S., & Edwards, R. (2012). How many qualitative interviews is enough? In National Centre for Research Methods Review Paper . National Centre for Research Methods. http://eprints.ncrm.ac.uk/2273/4/how_many_interviews.pdf .

Sandelowski, M. (1995). Sample size in qualitative research. Research in Nursing & Health, 18 (2), 179–183.

Sim, J., Saunders, B., Waterfield, J., & Kingstone, T. (2018). Can sample size in qualitative research be determined a priori? International Journal of Social Research Methodology, 21 (5), 619–634.

Download references

Acknowledgements

no external funding.

Author information

Authors and affiliations.

Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

Loraine Busetto, Wolfgang Wick & Christoph Gumbinger

Clinical Cooperation Unit Neuro-Oncology, German Cancer Research Center, Heidelberg, Germany

Wolfgang Wick

You can also search for this author in PubMed   Google Scholar

Contributions

LB drafted the manuscript; WW and CG revised the manuscript; all authors approved the final versions.

Corresponding author

Correspondence to Loraine Busetto .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Busetto, L., Wick, W. & Gumbinger, C. How to use and assess qualitative research methods. Neurol. Res. Pract. 2 , 14 (2020). https://doi.org/10.1186/s42466-020-00059-z

Download citation

Received : 30 January 2020

Accepted : 22 April 2020

Published : 27 May 2020

DOI : https://doi.org/10.1186/s42466-020-00059-z

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Qualitative research
• Mixed methods
• Quality assessment

Neurological Research and Practice

ISSN: 2524-3489

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

What is Qualitative in Research

• Review Essay
• Open access
• Published: 28 October 2021
• Volume 44 , pages 599–608, ( 2021 )

Cite this article

You have full access to this open access article

• Patrik Aspers 1 &
• Ugo Corte 2  

26k Accesses

5 Citations

Explore all metrics

In this text we respond and elaborate on the four comments addressing our original article. In that piece we define qualitative research as an “iterative process in which improved understanding to the scientific community is achieved by making new significant distinctions resulting from getting closer to the phenomenon studied.” In light of the comments, we identify three positions in relation to our contribution: (1) to not define qualitative research; (2) to work with one definition for each study or approach of “qualitative research” which is predominantly left implicit; (3) to systematically define qualitative research. This article elaborates on these positions and argues that a definition is a point of departure for researchers, including those reflecting on, or researching, the fields of qualitative and quantitative research. The proposed definition can be used both as a standard of evaluation as well as a catalyst for discussions on how to evaluate and innovate different styles of work.

Similar content being viewed by others

What is Qualitative in Qualitative Research

Patrik Aspers & Ugo Corte

What is “Qualitative” in Qualitative Research? Why the Answer Does not Matter but the Question is Important

Mario L. Small

Unsettling Definitions of Qualitative Research

Japonica Brown-Saracino

Avoid common mistakes on your manuscript.

The editors of Qualitative Sociology have given us the opportunity not only to receive comments by a group of particularly qualified scholars who engage with our text in a constructive fashion, but also to reply, and thereby to clarify our position. We have read the four essays that comment on our article What is qualitative in qualitative research (Aspers and Corte 2019 ) with great interest. Japonica Brown-Saracino, Paul Lichterman, Jennifer Reich, and Mario Luis Small agree that what we do is new. We are grateful for the engagement that the four commenters show with our text.

Our article is based on a standard approach: we pose a question drawing on our personal experiences and knowledge of the field, make systematic selections from existing literature, identify, collect and analyze data, read key texts closely, make interpretations, move between theory and evidence to connect them, and ultimately present a definition: “ qualitative research as an iterative process in which improved understanding to the scientific community is achieved by making new significant distinctions resulting from getting closer to the phenomenon studied” (Aspers and Corte 2019 , 139) . We acknowledge that there are different qualitative characteristics of research, meaning that we do not merely operate with a binary code of qualitative versus non-qualitative research. Our definition is an attempt to make a new distinction that clarifies what is qualitative in qualitative research and which is useful to the scientific community. Consequently, our work is in line with the definition that we have proposed.

Given the interest that our contribution has already generated, it is reasonable to argue that the new distinction we put forth is also significant . As researchers we make claims about significance, but it is always the audience—other scientists—who decide whether the contribution is significant or not. Iteration means that one goes back and forth between theory and evidence, and improved understanding refers to the epistemic gains of a study. To achieve this improved understanding by pursuing qualitative research, it is necessary that one gets close to the empirical material. When these four components are combined, we speak of qualitative research.

The four commentators welcome our text, which does not imply that they agree with all of the arguments we advance. In what follows, we single out some of the most important critiques we received and provide a reply aiming to push the conversation about qualitative research forward.

Why a Definition?

We appreciate that all critics have engaged closely with our definition. One main point of convergence between them is that one should not try to define qualitative research. Small ( Forthcoming ) asks rhetorically: “Is producing a single definition a good idea?” He justifies his concern by pointing out that the term is used to describe both different practices (different kinds of studies) and three elements (types of data; data collection, and analysis). Similarly, both Brown-Saracino ( Forthcoming ) and Lichterman, ( Forthcoming ) argue that not only there is no single entity called qualitative research—a view that we share, but instead, that definitions change over time. For Small, producing a single definition for a field as diverse as sociology, or the social sciences for that matter, is restrictive, a point which is also, albeit differently, shared by Brown-Saracino. Brown-Saracino asserts that our endeavor “might calcify boundaries, stifle innovation, and prevent recognition of areas of common ground across areas that many of us have long assumed to be disparate.” Hence, one should not define what is qualitative, because definitions may harm development. Both Small and Brown-Saracino say that we are drawing boundaries between qualitative and quantitative approaches and overstate differences between them. Yet, part of our intent was the opposite: to build bridges between different approaches by arguing that the ‘qualitative’ feature of research pertains both quantitative and qualitative methodologies, which may use and even combine different methods.

In light of these comments we need to elaborate our argument. Moreover, it is important not to maintain hard lines that may lead to scientific tribalism. Nonetheless, the critique of our—or any other definition of qualitative research—typically implies that there is something “there,” but that we have not captured it correctly with our definition. Thus, the critique that we should not define qualitative research comes with an implicit contradiction. If all agree that there is something called “qualitative research,” even if it is only something that is not quantitative, this still presumes that there is something called “qualitative.” Had we done research on any other topic it would probably have been requested by reviewers to define what we are talking about. The same criteria should apply also when we turn the researcher’s gaze on to our own practice.

Moreover, it is doubtful that our commentators would claim that qualitative research can be “anything,” as the more Dadaistic interpretation by Paul Feyerabend ( 1976 ) would have it. But without referring to the realist view of Karl Popper ( 1963 , 232–3) and his ideas of verisimilitude (i.e., that we get close to the truth) we have tried to spell out what we see as an account of the phenomenology of “qualitative.” We identify three positions in relation to the issue of definition of qualitative research:

We should not define qualitative research.

We can work with one definition for each study or approach of “qualitative research,” which is predominantly left implicit.

We can try to systematically define qualitative research.

Obviously, we have embraced and practiced position 3 in reaction to the current state of the field which is largely dominated by position 2--namely that what is qualitative research is open to a large variety of “definitions.” The critical points of our commentators explicitly or implicitly argue in favor of position 1, or perhaps position 2. Our claim that a definition can help researchers sort good from less good research has triggered criticism. Below, we elaborate on this issue.

We maintain that a definition is a valid starting point useful for junior scholars to learn more about what is qualitative and what is quantitative, and for more advanced researchers it may feature as a point of departure to make improvements, for instance, in clarifying their epistemological positions and goals. But we could have done a better job in clarifying our position. Nonetheless, we contend that change and improvement at this late stage of development in social sciences is partially related to and dependent upon pushing against or building upon clear benchmarks, such as the definition that we have formulated. We acknowledge that “definitions might evolve or diversify over time,” as Brown-Saracino suggests. Still, surely social scientists can keep two things in mind at the same time: an existing definition may be useful, but new research may change it. This becomes evident if one applies our definition to the definition itself: our definition is not immune to work that leads to new qualitative distinctions! Having said this, we are happy to see that all four comments profit from getting in close contact with the definition. This means that our definition and the article offer the reader an opportunity to think with (Fine and Corte 2022 ) or, as Small writes, “forces the reader to think.” We believe that both in principle and in practice, we all agree that clarity and definitions are scientific virtues.

What can a Definition Enable?

While we agree with several points in Small’s essay, we disagree on others. Our underlying assumption is that we can build on existing knowledge, albeit not in the way positivism envisioned it. It follows that work which is primarily descriptive, evocative, political, or generally aimed at social change may entail new knowledge, but it does not fit well within the frame within which we operate in this piece. The existence of different kinds of work, each of which relies on different standards of evaluation—which are often unclear and consequential, especially to graduate students and junior scholars (see Corte and Irwin 2017 )—brings us to another point highlighted by both Small and Lichterman: can the definition be used to differentiate good from lesser good kinds of work?

Small argues that while our article promises to develop a standard of evaluation, it fails to do so. We agree: our definition does not specify the exact criteria of what is good and what is poor research. Our definition demarcates qualitative research from non-qualitative by spelling out the qualitative elements of research, which advances a criterion of evaluation. In addition, there is definitely research that meets the characteristics of being qualitative, but that is uninteresting, irrelevant, or essentially useless (see Alvesson et al. 2017 on “gap spotting,” for instance). What is good or not good research  is to be decided in an ongoing scientific discussion led by those who actively contribute to the development of a field. A definition, nonetheless, can serve as a point of reference to evaluate scholarly work, and it can also serve as a guideline to demarcate what is qualitative from what it is not.

A Good Definition?

Even if one accepts that there should be a definition of qualitative research, and thinks that such a definition could be useful, it does not follow that one must accept our definition. Small identifies what he sees a paradox in our text, namely that we both speak of qualitative research in general and of qualitative elements in different research activities. The term qualitative, as we note and as Small specifies, is used to describe different things: from small n studies to studies of organizations, states, or other units conceptualized as case studies and analyzed quantitatively as well as qualitatively. We are grateful for this observation, which is correct. We failed to properly address this issue in the original text.

As we discuss in the article, the elements used in our definitions (distinctions, process, closeness, and improved understanding) are present in all kinds of research, even quantitative. Perhaps the title of our article should have been: “What is Qualitative in Research?” Our position is that only when all the elements of the definition are applied can one speak of qualitative research. Hence, the first order constructs (i.e., the constructs the actors in the field have made) (Aspers 2009 ) of, for example, “qualitative observations,” may indeed refer to observations that make qualitative distinction in the Aristotelian sense on which we rely. Still, if these qualitative observations are commensurated with a ratio-scale (i.e., get reduced to numbers) this research can no longer be called “qualitative.” It is for this reason that we say that, to refer to first order constructs, “quantitative” research processes entail “qualitative” elements. This research is, as it were, partially qualitative, but it is not, taken together, qualitative research. Brown-Saracino raises a similar point in relation to her own and others works that combine “qualitative” and “quantitative” research. We do not think that one is inherently better, yet we agree with the general idea that qualitative research is particularly useful in identifying research questions and formulating theories (distinctions) that, at a later point should, when possible, be tested quantitatively on larger samples (cf. Small 2005 ). It is our hope that, with our clarification above, it will be easier for researchers to understand what one is and what one is not doing. We also hope that our study will stimulate further dialogue and collaboration between researchers who primarily work within different traditions.

Small wonders if a researcher who tries to replicate a “qualitative” study (according to our definition) is doing qualitative research. The person is certainly doing research, and some elements are likely conducted in a qualitative fashion according to our definition, for example if the method of in-depth fieldwork is employed. But regardless of the method used, and regardless of whether the person finds new things, if the result is binary coded as either confirming or disconfirming existing research, qualitative research is not being conducted because no new distinction is offered. Imagine the same study being replicated for the 20 th time. Surely the researcher must use the same “qualitative” methods (to use the first order construct). It may even excite a large academic audience, but it would not count as qualitative research according to our definition. Our definition requires both that the research process has made use of all its elements, but it also requires the acceptance by the audience. Having said this, in practice, it is more likely that such a study would also report new distinctions that are acknowledged by an audience. If such a study is reviewed and published, these are additional indicators that the new distinctions are considered significant, at least to some extent: how much research space it opens up, and how much it helps other researchers continue the discussion by formulating their own questions and making their own claims (Collins 1998 , 31), whether by agreeing with it by applying it, by refining it (Snow et al. 2003 ), or by disagreeing and identifying new ways forward. There are two key characteristics that make a contribution relevant: newness and usefulness (Csikszentmihalyi 1996 ), both of which are related to the established state of knowledge within a field. Relatedly, Small asks: “Is newness enough? What does a new distinction that does not improve understanding look like?” There are also other indicators that demarcate whether a contribution is significant and to what extent. Some of these indicators include the number of citations a piece of work generates, the reputation of the journal or press where the work is published, and how widely the contribution is used—for instance, across specializations within the same discipline, or across different fields (i.e., different ways of valuation and evaluation) (Aspers and Beckert 2011 ) of scientific output. In principle, if a contribution ends up being used in an area where it would have unlikely been used, then one may further argue for its significance.

As it is implicit in our work when we talk about distinctions, we refer to theory building, albeit appreciating different conceptualizations and uses of the term theory (Abend 2008 ) and ways to achieve it (e.g., Zerubavel 2020 ). Brown-Saracino writes that our project may hold “the unintended consequence of limiting exploratory research designs and methodological innovations.” While we cannot predict the impact of our research, we are certainly in favor of experimentation and different styles of work. In line with David Snow, Calvin Morrill and Leon Anderson ( 2003 , 184), we argue that many qualitative researchers start their projects being underprepared in theory and theory development, oftentimes with the goal of describing, and leaving alone the black box of theory, or postponing it to later phases of the project. Our definition, along with the work by those authors and others on theory development, can be one way to heighten the chances researchers can make distinctions and develop theory.

Lichterman argues that we are not giving enough weight to interpretation and that we should relate more strongly to the larger project of the Geistenwissenschaften . We agree that interpretation is a key element in qualitative research, and we draw on Hans-Georg Gadamer ( 1988 ) who refined the idea of the hermeneutic circle.

Another critique, raised by Reich ( Forthcoming ), is that positionality is a key element of qualitative research. That in working towards a definition, we have “overlooked much of the methodological writings and contributions of women, scholars of color, and queer scholars” that could have enriched our definition, especially regarding “getting closer to the phenomenon studied.” Surely, the way we have searched for and included references means that we have ‘excluded’ the vast majority of research and researchers who do qualitative work. However, we have not included texts by some authors in our sample based on any specific characteristics or according to any specific position. This critique is valid only if Reich shows more explicitly what this inclusion would add to our definition.

Though we agree with much of what Reich says, for example about the role of bodies and reflexivity in ethnographic work, the idea of positionality as a normative notion is problematic. At least since Gadamer wrote in the early 1960s (1988), it is clear that there are no interpretations ‘from nowhere.’ Who one is cannot be bracketed in an interpretation of what has occurred. The scientific value of this more identity- and positionality-oriented research that accounts also of the positionality of the interpreter, is essentially already well acknowledged. Reflection is not just something that qualitative researcher do; it is a general aspect of research. Ethnographic researchers may need certain skills to get close and understand the phenomenon they study, yet they also need to maintain distance. As Fine and Hallett write: “The ethnographic stranger is uniquely positioned to be a broker in connecting the field with the academy, bringing the site into theory and, perhaps, permitting the academy to consider joint action with previously distant actors” (Fine and Hallett 2014 , 195). Moreover, Brown-Saracino illustrates well what it means to get close, and we too see that ethnography, in various forms and ways, is useful as other qualitative activities. Though ethnographic research cannot be quantitative, qualitative work is broader than solely ethnographic research. Furthermore, reflexivity is not something that one has to do when doing qualitative research, but something one does as a researcher.

Reich’s second point is more important. The claim is that if the standpoint-oriented argument is completely accepted, it will most likely violate what we see as the essence of research. We warned in our article that qualitative research may be treated as less scientific than quantitative within academia, but also in the general public, if too many in academia claim to be doing “qualitative research” while they are in fact telling stories, engaging in activism, or writing like journalists. Such approaches are extra problematic if only some people with certain characteristics are viewed as the only legitimate producers of certain types of knowledge. If these tendencies are fueled, it is not merely the definition of “qualitative” that is at stake, but what the great majority see as research in general. Science cannot reach “The Truth,” but if one gives up the idea communal and universal nature of scientific knowledge production and even a pragmatic notion of truth, much of its value and rationale of science as an independent sphere in society is lost (Merton 1973 ; Weber 1985 ). Ralf Dahrendorf framed this form of publicness by writing that: “Science is always a concert, a contrapuntal chorus of the many who are engaged in it. Insofar as truth exists at all, it exists not as a possession of the individual scholar, but as the net result of scientific interchange” (1968, 242–3). The issue of knowledge is a serious matter, but it is also another debate which relates to social sciences being low consensus fields (Collins 1994 ; Fuchs 1992 ; Parker and Corte 2017 , 276) in which the proliferation of journals and lack of agreement about common definitions, research methods, and interpretations of data contributes to knowledge fragmentation. To abandon the idea of community may also cause confusion, and piecemeal contributions while affording academics a means to communicate with a restricted in-group who speak their own small language and share their views among others of the same tribe, but without neither the risk nor possibility of gaining general public recognition. In contrast, we see knowledge as something public, that, ideal-typically, “can be seen and heard by everybody” (Arendt 1988 , 50), reflecting a pragmatic consensual approach to knowledge, but with this argument we are way beyond the theme of our article.

Our concern with qualitative research was triggered by the external critique of what is qualitative research and current debates in social science. Our definition, which deliberately tries to avoid making the use of a specific method or technique the essence of qualitative, can be used as a point of reference. In all the replies by Brown-Saracino, Lichterman, Reich, and Small, several examples of practices that are in line with our definition are given. Thus, the definition can be used to understand the practice of research, but it would also allow researchers to deliberately deviate from it and develop it. We are happy to see that all commentators have used our definition to move further, and in this pragmatic way the definition has already proved its value.

New research should be devoted to delineating standards and measures of evaluation for different kinds of work such as the those we have identified above: theoretical, descriptive, evocative, political, or aimed at social change (see Brady and Collier 2004; Ragin et al. 2004 ; Van Maanen 2011 ). And those standards could respectively be based upon scientific or stylistic advancement and social and societal impact. Footnote 1 Different work should be evaluated in relation to their respective canons, goals, and audiences, and there is certainly much to gain from learning from other perspectives. Relatedly, being fully aware of the research logics of both qualitative and quantitative traditions (Small 2005 ) is also an advantage for improving both of them and to spur further collaboration. Bringing further clarity on these points will ultimately improve different traditions, foster creativity potentially leading to innovative projects, and be useful both to younger researchers and established scholars.

The last two terms refer to whether the impacts are more micro as related to agency, or macro, as related to structural changes. An example of the latter kind is Matthew Desmond’s Eviction (2016) having substantial societal impact on public policy discussions, raising and researching a broader range of housing issues in the US. A case of the former is Arlie Hochchild’s studies on emotional labor of women in the workplace (1983) and her more recent book on the alienation of white, working-class Americans (2016).

Abend, Gabriel. 2008. The meaning of “theory” . Sociological Theory 26 (2): 173–199.

Article   Google Scholar  

Alvesson, Mats, Yannis Gabriel, and Roland Paulsen. 2017. Return to meaning . Oxford: Oxford University Press.

Book   Google Scholar  

Arendt, Hannah. 1988. The human condition . Chicago: Chicago University Press.

Google Scholar  

Aspers, Patrik. 2009. Empirical phenomenology: A qualitative research approach (the Cologne Seminars). Indo-Pacific Journal of Phenomenology 9 (2): 1–12.

Aspers, Patrik, and Ugo Corte. 2019. What is qualitative in qualitative research. Qualitative Sociology 42 (2): 139–160.

Aspers, Patrik, and Jens Beckert. 2011. Introduction. In The worth of goods , eds. Jens Beckert and Patrik Aspers, 3–38. Oxford: Oxford University Press.

Brady, Henry E., and David Collier, eds. 2004. Rethinking social inquiry: Diverse tools, shared standards . Berkeley: Rowman & Littlefield and Berkeley Public Policy Press.

Brown-Saracino, Japonica. Forthcoming. Unsettling definitions of qualitative research. Qualitative Sociology.

Collins, Randall. 1994. Why the social sciences won’t become high-consensus, rapid-discovery science. Sociological Forum 9 (2): 155–177.

Collins, Randall. 1998. The sociology of philosophies: A global theory of intellectual change . Cambridge, MA: Harvard University Press.

Corte, Ugo, and Katherine Irwin. 2017. The form and flow of teaching ethnographic knowledge: Hands-on approaches for learning epistemology. Teaching Sociology 45 (3): 209–219.

Csikszentmihalyi, Mihaly. 1996. Creativity: Flow and the psychology of discovery and iinvention . New York: Harper/Collins.

Dahrendorf, Ralf. 1968. Essays in the theory of society . Stanford: Stanford University Press.

Desmond, Matthew. 2016. Evicted: Poverty and profit in the American City . New York: Crown Publishers.

Feyerabend, Paul. 1976. Against method . London: NLB.

Fine, Gary Alan and Ugo Corte. 2022. Dark fun: The cruelties of hedonic communities. Sociological Forum 37 (1).

Fine, Gary Alan, and Tim Hallett. 2014. Stranger and stranger: Creating theory through thnographic Distance and Authority. Journal of Organizational Ethnography 3 (2): 188–203.

Fuchs, Stephan. 1992. The professional quest for truth . New York: SUNY Press.

Gadamer, Hans Georg. 1988. On the circle of understanding. In Hermenutics versus science, three German views: Wolfgang Stegmüller, Hans Georg Gadamer, Ernst Konrad Specht , eds. John Connolly and Thomas Keutner, 68–78. Notre Dame: University of Notre Dame.

Hochschild, Arlie. 1983. The managed heart: Comercialization of human feeling . Berkeley: University of California Press.

Hochschild, Arlie. 2016. Strangers in their own land: Anger and mourning on the American right . New York: The New Press.

Lichterman, Paul. Forthcoming. “Qualitative research” is a moving target. Qualitative Sociology.

Merton, Robert K. 1973. Structure of science. In The sociology of science: Theoretical and empirical investigations , ed. Robert K. Merton, 267–278. Chicago: University of Chicago Press.

Parker, John N., and Ugo Corte. 2017. Placing collaborative circles in strategic action fields: Explaining differences between highly creative groups. Sociological Theory 35 (4): 261–287.

Popper, Karl. 1963. Conjectures and refutations: The growth of scientific knowledge . London: Routledge and Kegan Paul.

Ragin, Charles, Joane Nagel, and Patricia White. 2004. Workshop on scientific foundations of qualitative research. National Research Foundation. https://www.nsf.gov/pubs/2004/nsf04219/nsf04219.pdf . Acessed 29 September 2021.

Reich, Jennifer. Forthcoming. Power, positionality, and the ethic of care in qualitative research. Qualitative Sociology.

Small, Mario Luis 2005. Lost in translation: How not to make qualitative research more scientific. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.497.4161&rep=rep1&type=pdf . Accessed 23 September 2021.

Small, Mario Luis. Forthcoming. What is “qualitative” in qualitative research? Why the answer does not matter but the question is important. Qualitative Sociology.

Snow, David A., Calvin Morrill, and Leon Anderson. 2003. Elaborating analytic ethnography: Linking fieldwork and theory. Ethnography 4 (2): 181–200.

Van Maanen, John. 2011. Tales of the field: On writing ethnography . Chicago: Chicago University Press.

Weber, Max. 1985. Gesammelte aufsätze zur wissenschaftslehre. Edited by J. Winckelmann. Tübingen: J.C.B.Mohr.

Zerubavel, Eviatar. 2020. Generally speaking: An invitation to concept-driven sociology . Oxford: Oxford University Press.

Download references

Acknowledgements

The authors are grateful for comments by Gary Alan Fine, Jukka Gronow, and John Parker.

Open access funding provided by University of St. Gallen. The research reported here is funded by University of St. Gallen, Switzerland and University of Stavanger, Norway.

Author information

Authors and affiliations.

University of St., Gallen, St. Gallen, Switzerland

Patrik Aspers

University of Stavanger, Stavanger, Norway

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Patrik Aspers .

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Aspers, P., Corte, U. What is Qualitative in Research. Qual Sociol 44 , 599–608 (2021). https://doi.org/10.1007/s11133-021-09497-w

Download citation

Accepted : 12 October 2021

Published : 28 October 2021

Issue Date : December 2021

DOI : https://doi.org/10.1007/s11133-021-09497-w

Healthcare practitioners’ perspectives of providing palliative care to patients from culturally diverse backgrounds: a qualitative systematic review

• Colette Burke 1 ,
• Owen Doody 2 &
• Barbara Lloyd 2  

BMC Palliative Care volume  22 , Article number:  182 ( 2023 ) Cite this article

1420 Accesses

1 Citations

5 Altmetric

Metrics details

Palliative care practitioners are increasingly caring for patients and families from diverse cultural backgrounds. There is growing awareness of the influence of culture on many aspects of care in the palliative phase of an illness. However, disparities have been noted in the provision of palliative care to patients from culturally diverse backgrounds and challenges have been reported in meeting their needs and those of their families.

A qualitative systematic review of research papers identified through searching four databases. Papers were screened against inclusion criteria within the timeframe of January 2012 to March 2022. Data was extraction from all included studies and methodological quality assessed utilising the Critical Appraisal Skills Programme Tool. Thematic analysis followed Braun and Clarke’s framework and the review is reported in line with PRISMA guidelines.

The search yielded 1954 results of which 26 were included for appraisal and review. Four themes were identified: communication and connection, the role of the family in death and dying, the role of education in addressing uncertainty, and institutional and societal factors. The findings highlighted challenges of communication and a fear of acting in a culturally insensitive way, the pivotal role of the family, the need for an individualised approach to care, the universality of needs when approaching end of life and the need for education of practitioners.

These findings suggest that healthcare practitioners draw on their existing skills to adapt their practice to meet the needs of patients from culturally diverse backgrounds. However, results also indicate a need for further education and identification of educational approaches best suited to supporting healthcare professionals in practice.

Peer Review reports

Introduction

The care provided to the dying should reflect the kind of society we have created and live in [ 1 ] and the philosophy of Cecily Saunders (1918–2005), that care and treatment of the ‘whole person’ is best facilitated by a team, is a cornerstone of modern palliative care throughout the world [ 2 ]. Culture is an integrated pattern of human behaviour that includes language, thoughts, actions, customs, beliefs, and institutions of racial, ethnic, and social or religious groups [ 3 ]. Culture incorporates learned, shared knowledge of values, beliefs, and lifeways, and has rules that influence attitudes and behaviours that can be overt or covert [ 4 ]. Thus, culture is multifaceted, fluid and complex creating the potential to impact significantly on both health and illness [ 5 ].

The number of persons currently residing outside their country of origin has never been greater and numbers of migrants have increased progressively over the past thirty years [ 6 ]. According to the International Organization for Migration in 2019, Europe hosted 82 million international migrants, North America 59 million and Northern Africa and Western Asia (combined) 49 million [ 7 ]. Migration patterns are a constantly evolving phenomenon and occur for a variety of reasons such as work opportunities, education, lifestyle factors and conflict/war. The World Health Organization (WHO) highlights that healthcare for migrant and refugee populations should be provided in a gender-sensitive, culturally, and linguistically appropriate manner without stigma [ 8 ]. Disparities in the care experiences of culturally diverse patients exist [ 9 ] identifying a lack of knowledge of services [ 10 ], inadequate exchanges of information [ 11 , 12 ], difficulties with the use of interpreters [ 9 ], difficulties explaining feelings and emotions [ 13 ], issues around disclosure of serious illness [ 14 ] and a focus on cultural background rather than the individuals experience [ 15 ].

If culture is the lens through which we view the world [ 16 ], then it must be acknowledged that the culture of healthcare practitioners, healthcare organisations and wider society will also impact interactions with culturally diverse patients and their families. Providing healthcare to patients from culturally diverse backgrounds has become a more frequent occurrence in developed countries [ 17 ] and a layer of complexity can be encountered when culturally diverse patients interact with healthcare in general and that this is particularly noteworthy in countries where cultural diversity is a more recent development [ 9 ]. Difficulties forming therapeutic relationships and the stress that this caused healthcare practitioners [ 18 ] and the need for practitioners to be aware of their own cultural frame of reference and to be able to recognize their own bias is evident [ 19 ]. Cultural competence in healthcare practitioners has been offered as a means of tackling the disparities in care provided to culturally diverse patients and to addressing the concerns identified by healthcare practitioners [ 20 ]. Within palliative care, it is acknowledged that the role of culture is significant [ 21 ] as it shapes how serious illness is understood, how suffering is articulated and how grief manifests in patients and their families and in the healthcare practitioners whom they encounter [ 22 ].

Culturally diverse patients are underrepresented amongst service users [ 23 ] and do not represent a homogenous group [ 24 ]. It is recognised that within the palliative phase of illness the vulnerabilities of patients and families are particularly evident [ 25 ]. All healthcare professionals governing bodies highlight that patients’ cultural background and ethnicity have an important effect on their health outcomes and healthcare professionals should try to understand culture and respond to individual needs. Therefore, the requirement for practitioners to provide care that is sensitive to the cultural background of patients is identified, reinforced, and heightened in palliative care as failure to address such needs cannot often be redressed later [ 26 ]. Thus, examining the experiences of healthcare practitioners providing palliative care to persons from culturally diverse backgrounds is important and this paper explores these experiences through a qualitative systematic review. While van Eechoud et al. [ 27 ] examined the experiences of oncology healthcare workers caring for ethnic minority patients the authors are unaware of any review from a palliative care context.

This qualitative systematic review aimed to explore the perspectives of healthcare practitioners providing palliative care to patients from culturally diverse backgrounds. Wakefield’s guide to searching and reviewing literature [ 28 ] guided and supported and the review is reported as per the PRISMA checklist (Supplementary file 1 ) and PRISMA flowchart [ 29 ] (Fig.  1 ).

PRISMA 2020 flow diagram

Search sources and strategies

Searches were conducted within five electronic databases: PsycINFO, CINAHL, Academic Search Complete, Medline and Cochrane Library. The search strategy was based on the PICo framework (Population [healthcare practitioners], Phenomenon of Interest [perspectives] and Context [patients from culturally diverse background receiving palliative care]). The following terms were included in the search string strategy; first, for population ‘healthcare practitioners’, for phenomenon of interest ‘perspectives’ and for context ‘palliative care’ ‘culturally diverse’. All terms were joined utilizing the Boolean operators (“OR” within each search string and “AND” to combine - Table  1 ).

Criteria for considering studies in this review were set as follows:

Inclusion criteria

Primary research published in peer-reviewed journals.

Papers written in English or translation available.

Papers published between 01 January 2012 and 01 March 2022.

Papers referring to the adult population over the age of 18 years.

Studies which contain each of three elements: palliative intent to care, healthcare practitioners’ views or experiences and patients with culturally diverse background.

Qualitative research design.

Exclusion criteria

Secondary research – e.g., discussions, editorials, opinion papers, conference proceedings.

Literature reviews - e.g., systematic, scoping, rapid, narrative, expert, integrative.

Studies which focus primarily on advance directives and enrolment or access to hospice programmes.

Non-qualitative methodologies.

Studies where it is not possible to extract the views of the healthcare practitioner.

Study selection and data extraction

All search results were exported to Rayyan intelligent systematic review software and duplicates deleted. The remaining titles and abstracts were screened against the inclusion criteria led by the first author (CB) during which the team met to discuss the screening criteria and 20% were doubled screening by the author and the team. All studies remaining were retrieved for full text screening where the authors worked in pairs to reach a final verdict. Reasons for exclusion were noted and reported (Fig.  1 ). A total of 1954 papers were identified with 411 duplicates leaving 1543 for screening. Title and abstract screening resulted in 1506 been excluded, leaving 37 studies for full-text screening where full-text were read and 17 excluded. Resulting in 20 papers meeting the inclusion criteria for this review. 6 additional papers were found through backward chaining from reference lists of included papers. Data extracted was performed on all 26 papers by the first author (CB) and reviewed by the other authors (BL/OD). The data extraction table (Table  2 ) developed reports: authors, year, title, country, primary aim, methodology, data collection, sample size, key findings and quality appraisal score [ 30 ].

Quality assessment of the included studies

The Critical Appraisal Skills Programme (CASP) and its supporting user guide were utilized to assess the quality of the 26 included papers. CASP allowed the authors undertake a systematic and rigorous approach through a series of ten questions, prompting the authors to consider three areas when appraising qualitative studies, the validity of the results, the nature of the results and the contribution of the results [ 30 ]. The methodological quality of the papers assessed was generally good with CASP scores ranging from 50 to 100% (Supplementary file 2 ).

Data analysis

Braun and Clarke’s six-step thematic analysis inductive approach [ 31 ] guided the data analysis process. At first, each paper was thoroughly read to highlight relevant quotes and paragraphs, with open notes made of initial ideas and concepts. Following this quotes and paragraphs with their notes were collated into an entire data set and preliminary open coding conducted to help streamline and converge the data. Here a color-coding system assisted in highlighting patterns across the data and immersion assisted with familiarisation of the data and patterns were noted, reflected upon and discussed. This process enabled the development of broader, more conceptualized themes and the reflection and discussion process allowed for the merging and/or refining and discarding some preliminary themes. Themes were then defined and labelled followed by critically reviewing each theme and coding to assess the accuracy of the coding process leading to verification of theme.

Through data analysis four key themes emerged from the literature (communication and connection, the role of the family in death and dying, the role of education in addressing uncertainty and institutional and societal factors) and these are presented. In addition, the characteristics of the studies include in this review are presented in Table  3 .

Communication and connection

Managing care when the patient does not speak the primary language of the country featured in the majority of studies [ 3 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 48 , 49 , 51 , 52 , 53 , 55 , 56 , 57 ] and was commonly identified as a barrier to the provision of comprehensive care. Practitioners voiced concern that usual methods of providing support or comfort were impaired [ 34 , 36 , 48 ]. Participants in two studies noted that the snatches of conversations [ 38 ] and all of those small things that you say all the time [ 48 ] that help to build relationships, were missing in the absence of a common language. de Voogd et al. [ 36 ] highlights the risk of misinterpretation when statements of wishes are taken literally and viewed through the care providers’ own standpoint without exploration or clarification.

Interpreters were seen as key to addressing communication issues however, difficulties accessing the services of interpreter and variability in quality are noted [ 33 , 37 , 38 , 45 , 46 , 48 , 49 , 50 , 52 , 53 , 54 , 55 , 56 , 56 , 57 , 57 ]. Green et al. [ 38 ] noted that interpreters tend only to be requested for more formal discussions around issues such as consent. Difficulties also existed when using telephone interpreter services with inadequacies of a relay conversation [ 37 ],  difficulty with hearing [ 49 ] and the missing of non-verbal cues [ 45 , 46 ] evident. Practitioners reported using interpreters infrequently, citing the need for advance planning and reported that in general, families preferred to interpret for themselves [ 34 , 37 , 38 , 45 ]. The use of family interpreters raised concerns regarding the burden it may place on family members and the extent of the information conveyed [ 34 , 35 , 36 , 37 , 38 , 45 , 48 , 53 , 55 , 57 ]. A number of studies note that practitioners at times felt that families may modify the information they were trying to convey in an attempt to shield the patient [ 34 , 35 , 36 , 38 , 45 , 53 , 56 ]. The utilisation of staff members as interpreters raises some concerns due to the perceived burden [ 53 ]. There was evidence of positive efforts made by practitioners to ensure patients could be understood and this was seen as a way of establishing trust [ 38 , 40 , 42 , 43 ]. To support understanding, practitioners sometimes used unorthodox methods such as drawing up word lists [ 36 ], drawing pictures [ 49 ], using sign language [ 34 , 55 ] and using an app on practitioners’ personal phones [ 49 ]. Communication triads involving healthcare practitioners, family members and the patient were utilised with support strategies such as additional time spent establishing relationships with the family [ 34 ]. While practitioners rated communication to be either moderate or good [ 34 , 35 ] concerns existed regarding the content of translated information relayed to the patient as patients sometimes did not understand a particular issue but are reluctant to seek clarification [ 49 ]. Communicating in the patients’ preferred language is both an ethical and licencing responsibility [ 37 , 38 ].

The importance of making connections with patients and families to forge relationships is documented in all studies. A specific emphasis on presence is discussed in a number of studies [ 36 , 39 , 40 , 41 , 42 , 49 , 52 ] expressed as having a presence at the bedside, constantly checking yet giving space [ 40 , 41 ]. Value is placed on building and maintaining trust [ 38 , 41 , 42 , 43 ] and demonstrating acceptance and concern by asking about preference and ascertaining usual ways of operating while respecting difference [ 34 , 36 , 38 , 40 , 41 , 42 , 43 , 49 , 51 , 52 , 53 , 56 ].  Seeking and building on similarities is also thought to facilitate connection [ 34 , 38 , 43 , 53 ]. Intense expressions of distress and grief by family members were noted in a number of studies [ 39 , 48 , 53 , 54 , 57 ]. Practitioners emphasised the importance of providing physical space to facilitate such expression [ 54 , 57 ] and emotional support for families at such times [ 52 ]. The importance of not labelling families also features [ 42 ].

The role of family in death and dying

All studies revealed the central role played by the families of culturally diverse patients in receipt of palliative care as perceived by practitioners. The large number of visitors was commented by practitioners working in in-patient settings [ 30 , 38 , 39 , 45 , 48 , 49 , 52 , 53 , 55 ]. Practitioners sought to support and educate families to fulfil patient and family wishes for participation in care and endeavoured to work around  the family so that they would feel included [ 30 ]. Strategies to develop relationships with family members such as actively involving family members…asking the family…listening to family  suggest that family involvement is largely significant in achieving a good death [ 40 , 42 ]. However, ambivalence to family involvement is expressed by some practitioners, suggesting that they could not care for the patient because the family want to care for their loved ones in a completely different way [ 55 ]. Preparation of the family for death was important and involved explanations of what was happening and what might broadly be expected [ 38 , 40 , 41 , 42 , 50 , 52 , 56 ]. The pressure that care provision places on family members themselves was acknowledged by practitioners reporting a sense of duty in addition to family and community expectations [ 35 , 36 , 38 , 54 , 57 ]. However, a general reluctance to discuss psychological distress by family members themselves may exist and this can hinder practitioners fulfilling their caregiving role [ 57 ].

Tensions between practitioner values and family wishes occurred in many of the studies where issues arose concerning different models of decision making, non-disclosure and differing attitudes to patient autonomy [ 30 , 33 , 34 , 35 , 36 , 37 , 38 , 45 , 46 , 48 , 51 , 52 , 53 , 54 , 55 , 56 ]. Devolved or collective decision-making was discomfiting for many practitioners and was frequently thought to result in withholding information from the patient [ 30 , 34 , 35 , 36 , 37 , 38 , 45 , 47 , 52 , 53 ]. Difficulties also arose in identifying the family spokesperson/decision-maker [ 34 , 35 , 45 , 46 ] and such decision-making was sometimes thought to impede female autonomy [ 53 ]. While acknowledging on-going professional concerns about decision-making and autonomy, care providers used a variety of approaches to address these concerns including adapting word choices, allowing additional time to hear families views and striving for an approach that is acceptable to patient, family and practitioner [ 34 , 35 , 36 , 37 , 38 , 42 , 43 , 45 , 53 ]. A further tension involved family preferences around the administration of medications, particularly opioids and practitioners perceived that patients suffered because of family members opposition to medication use [ 36 , 38 , 39 , 49 ]. Furthermore, when a trusting relationship had not been established, families and patients were more likely to reject medications [ 43 ] and fear of addiction, side -effects, stoicism and lack of understanding arising from attitudes to analgesia in country of origin were also identified [ 44 ].

There was a perception that speaking about death was disliked by patients and families from culturally diverse backgrounds [ 32 , 33 , 35 , 38 , 43 , 45 , 51 , 52 , 53 , 54 , 55 , 56 ]. Practitioners often held a view that death is a taboo topic that people did not want to talk about [ 33 , 51 , 54 ] and that patients were reluctant to die at home due to cultural influences [ 51 ]. However, practitioners also noted, within the same studies, that some families were very open to discussing impending death [ 51 , 54 ] and that reluctance to die at home was possibly due to lack of knowledge of available supports and fear of burdening family members [ 51 , 52 ]. A particular difficulty arose for practitioners when the parents of young children were involved and were reluctant to talk about death, here practitioners reported feeling complicit in concealing the truth  and had considerable concern for the families post bereavement [ 33 , 34 ]. The significance of rituals and practices around death and the resultant implications for practice were evident [ 38 , 39 , 40 , 45 , 47 , 49 , 52 , 53 , 54 , 57 ] with efforts made to facilitate families they have very strong rituals and beliefs [ 49 ]. Practitioners expressed this willingness as doing the right thing [ 40 ] and expressed satisfaction with been able to support cultural practices where they were walking alongside  patients and families [ 38 ]. Support varied from family to family highlighting an individualised approach [ 32 , 38 , 39 , 47 , 54 ] and there was a readiness to be flexible to accommodate family wishes and rituals which often required bending the rules [ 49 , 52 , 53 ]. Practitioners observed that although culture had a bearing on care, certain aspects of the approach of end of life were common to all people irrespective of culture, ethnicity or religion [ 32 , 38 , 43 , 51 ] and cultural considerations were integrated into culturally responsive individualised patient care [ 32 , 34 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 49 , 51 , 52 , 53 , 56 ].

The role of education in addressing uncertainty

All the studies documented challenges encountered by practitioners when providing palliative care to culturally diverse patients and their families, with uncertainty a common thread. Feelings of inexperience, unease, and helplessness [ 39 , 40 ],  overwhelmed and underprepared [ 40 , 41 ],  anxiety, helplessness, self-insufficiency and uncertainty [ 53 , 54 ], and uncertainty, stress, frustration [ 48 , 49 ] were expressed. Practitioners noted that they were more familiar with practices, communication cues and family dynamics in native born patients and families [ 33 , 34 , 38 , 39 , 48 , 55 ] and were concerned about causing offence or upset by contravening unfamiliar customs [ 33 , 34 , 39 , 40 , 40 , 41 , 48 , 48 , 49 , 50 , 50 ]. These concerns resulted in practitioners questioning the quality of care they provided [ 33 , 34 , 36 , 45 , 46 , 48 , 54 , 55 ] as family members views about care were sometimes at variance with their own professional ideals and values [ 33 , 45 , 46 , 48 , 55 ]. On occasions, practitioners stepped back from patients due to discomfort at the unfamiliarity of certain situations [ 48 , 49 ]. Practitioners attempted to overcome uncertainties by a constant adjustment to reconcile differences in approaches [ 51 ], proceeding slowly and with care in partnership with the patient and family [ 38 , 39 , 40 , 41 , 42 , 43 ] .Other practitioners sought understanding and joint solutions while acknowledging conflicting opinions and on occasions, resolution did not occur [ 34 , 35 ]. Where practitioners provided culturally appropriate care they reported satisfaction [ 38 , 53 ] and found support and learning from colleague’s experiences [ 40 ].

A lack of knowledge or a need for further education was voiced by practitioners [ 33 , 39 , 40 , 48 , 49 , 54 , 55 , 56 ]. Some nurses had requested training and education [ 33 , 56 ] due to the changing landscape of care we are coming across more people from abroad, different culture, it’s time we knew, we need to know. [ 39 ] Healthcare practitioners felt that the lack of knowledge could hamper their ability to care for culturally diverse patients but that more knowledge about that which was less familiar would make cross-cultural encounters feel less unusual [ 33 , 48 , 55 ]. Few studies document previous education in cultural diversity. In one, there is evidence of a yearly class on cultural competence [ 37 ] and in another, only seven out of twenty participants had formal education in the area [ 40 ]. Practitioners in this study [ 40 ], acknowledged a lack of knowledge and understanding I was ignorant  and purposefully sought to increase their knowledge informally through questioning and observing more experienced colleagues and engaging with family members. In addition, attending seminars and learning from interdisciplinary discussions were deemed helpful [ 47 , 53 ].

Institutional and societal factors

The influence of factors rooted in the wider context of palliative care provision to culturally diverse patients occur in all the studies reviewed. There is a perception of low levels of awareness of and engagement with palliative care services amongst patients and families [ 32 , 37 , 46 , 48 , 49 , 51 , 53 , 54 ]. Reasons for this are manifold, including late referrals to palliative care services [ 54 ],a perception of hospice as white and middle class [ 32 ], unfamiliarity with the concept of palliative care [ 34 , 36 , 37 , 42 , 44 , 46 , 51 , 54 ] and a lack of familiarity with health and palliative care services [ 35 , 37 , 44 , 46 , 48 , 49 , 53 , 54 , 55 ]. Influences on care such as social isolation, economic disadvantage, experience of discrimination due to religion or other factors, having endured war or trauma, level of education, and length of time in host country were also perceived to influence interaction [ 35 , 38 , 46 , 54 ]. Specific support, such as financial information, spiritual or bereavement support provided by the community from which the patient originates can play an important role in supporting engagement with palliative care services [ 36 , 37 , 39 , 44 , 46 , 57 ].

Several factors pertaining to healthcare institutions, specifically related to resources occur throughout the studies. The provision of adequate pastoral care services was seen as particularly helpful [ 38 , 39 , 47 , 53 , 57 ]. For indigenous patients and families, remote geographical location had a significant impact on the provision of palliative care with limited infrastructure and personnel available [ 54 , 56 ]. Environmental factors such as the importance of the physical environment to accommodate large family groups and facilitating gender preferences were seen as important aspects of care [ 32 , 36 , 45 , 49 , 52 , 54 , 55 , 57 ]. However, it was not always possible to facilitate and while attempts were made to adjust rosters to try and meet patient preferences for carers of a particular gender, it could not be always facilitated/accommodated as we don’t have a list, sometimes there are only men on the night shift. [ 36 ]

The experience of a culturally diverse workforce is an important factor but assigning nurses to patients of a similar cultural background did not always result in language congruence and could result in stereotyping [ 51 ] and even with a shared migrant background, issues of unfamiliarity were still encountered [ 40 ]. In addition, practitioners reported challenges when dealing with patients and families from a similar cultural background, where increased workload [ 51 ] and unease when conflicts occurred were noted [ 45 , 46 , 53 ]. Practitioners reported sense of satisfaction at being able to assist those of a similar background [ 40 , 43 , 53 ] and diversity in personnel was viewed as a positive means of meeting patients’ needs [ 36 , 40 ]. The management of issues which arise when caring for culturally diverse patients and families at ward level should be discussed as a team and efforts made to come to a consensus on approaches used [ 47 , 53 ]. It is suggested that endeavours to accommodate patient preferences, such as extending visiting times etc., can be a source of disagreement within a team so ongoing dialogue, discussion and team support are warranted [ 53 , 54 ].

This systematic review explored the perspectives of healthcare practitioners on providing palliative care to patients with culturally diverse backgrounds in a variety of settings. Findings concur in some respects with van Eechoud et al’s. [ 27 ] systematic review of oncology health workers caring for ethnic minority patients. Of similarity is the principal challenges of communication and a fear of acting in a culturally insensitive way but extending on this the findings from this review highlights the pivotal role of the family, the need for an individualised approach to care, the universality of needs when approaching end of life and the need for education as voiced by practitioners. Challenges posed to healthcare practitioners by lack of a common language with patients were found in this review [ 32 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 45 , 46 , 47 , 48 , 49 , 51 , 52 , 53 , 55 , 56 , 57 ] and this is reflected in the wider literature concerning interactions between culturally diverse patients and healthcare practitioners in palliative care contexts [ 15 , 58 , 59 ]. Difficulty accessing professional interpreters, a reluctance to use them by staff, by family or patient or dissatisfaction with the service provided, suggests a myriad of factors influencing their use [ 34 , 38 , 45 , 48 , 49 , 52 , 53 , 55 , 56 , 56 , 57 ]. Nonetheless engagement with professional interpreters has been shown to aid in reducing healthcare disparities by reducing errors and through improved communication, leading to greater patient satisfaction [ 18 ] and demonstrates clinicians’ respect for patients [ 60 ]. Research identifies that interpreters are frequently not utilized even when practitioners are aware that their use is advisable with family and bilingual staff utilized instead [ 61 , 62 ]. However, such an ad hoc means of translation is inadvisable and indicates that defaulting to use of family without exploration of alternatives or family and patient opinions does not best serve the interests of healthcare practitioners, families, or patients [ 63 , 64 ].

A clear finding of the review is the means by which practitioners built relationships with patients and families [ 32 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 49 , 52 , 53 ]. and it is recognised that intentional presence can convey compassion in intercultural encounters [ 65 ]. Culturally diverse patients report feelings of respect and support when practitioners spent time with them and try to communicate even in the absence of a common language [ 66 ] with a sense of exclusion reported in the absence of such efforts [ 60 ]. The need for time as an aid to communication and relationship building is acknowledged elsewhere [ 67 ]. Consistent with existing research this review also highlights the importance of family in the care of culturally diverse patients in receipt of palliative care [ 68 , 69 ]. The importance of a physical environment which supports large families was noted in several studies [ 32 , 52 , 57 ] and is also seen in the literature as an important asset to inpatient care and helpful to both patients, families, and practitioners [ 70 , 71 ]. While healthcare practitioners perceived that culturally diverse patients generally enjoyed good support from immediate and extended families, concerns are evident in one study regarding the difficulties family members have accepting responsibility for care of a patient at home [ 54 ]. Practitioners demonstrated awareness that particular aspects of patients and families migration history may have a bearing on care provision [ 34 , 35 , 37 , 38 , 42 , 44 , 45 , 46 , 49 , 53 , 57 ] and recognised the demand placed on female family carers [ 35 , 38 ]. This burden is recognized in the wider research [ 72 , 73 ] which also notes that a sense of responsibility for older family members in people with culturally diverse backgrounds does not automatically mean close emotional bonds [ 74 , 75 ]. This is an important factor as support for family members is an integral part of palliative care [ 75 ] and that the presence family does not negate the pressures that the caring role may place on some family members of migrant and indigenous families [ 71 , 72 , 73 ].

An expected finding from the review which occurred within all studies, is the complexity involved for practitioners in negotiating with the patient and family around such matters as perceived cultural taboos. The review reveals that widely held views about death as a taboo subject in certain cultural groups is not consistently realised [ 42 , 50 , 51 , 54 ]. This variability is echoed in the wider literature [ 76 , 77 , 78 ] further illustrating the need for individualized assessment and the need for practitioners to be aware that cultural taboos are a reality for some but that subscription to them is not uniform and individual consideration is necessary as other influences such as relationships, fear, lack of awareness of services may be relevant. A notable finding from the review is concern for patients’ autonomy where family play a greater role in decision making and disclosure [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 45 , 46 , 48 , 49 , 52 , 53 , 55 , 57 ] and this resonates with research in oncology and palliative care where devolved decision making and a preference for non-disclosure are noted [ 79 , 80 ]. Language barriers and the difficulties ascertaining patient preferences are found to make information sharing a complex matter [ 27 , 81 ]. Thus practitioners adjust communication as each situation is assessed [ 36 , 37 , 38 , 40 , 41 , 42 , 43 , 45 , 46 , 49 , 51 , 52 , 53 ] and particularly when home visiting is involved [ 34 , 35 , 39 , 54 , 57 ]. The desirability of ascertaining early from both patient and family, what their preferences are regarding information sharing and documenting their preferences is essential for working together [ 60 ].

Ascertaining the role of culture in the lives of patients, families, and clinicians themselves and negotiating and adapting care necessitates a nuanced and informed approach. Practitioners demonstrated an awareness of culture as a dynamic, evolving process i.e. that patients and families may embrace aspects of culture to varying degrees and specifically spoke of the need to avoid generalizations [ 32 , 38 , 40 , 43 , 47 , 51 ]. Reliance on a patients’ cultural background and beliefs alone can result in cultural stereotyping [ 21 ] and individualised approaches were frequently utilised as a means to overcome this risk [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 51 , 52 , 53 , 54 ] an approach supported by the wider literature [ 26 , 63 ]. However, individualised care must be delivered with awareness of the myriad of potential influences on the intercultural encounter i.e. cultural, socioeconomic, educational and family relationships and where culture is seen as part of a patients’ complex personhood  rather than a separate entity [ 82 ]. The findings of this review demonstrate that the ways care is adapted to try to meet the varying needs of patients and families are similar with all people irrespective of cultural background [ 32 , 34 , 35 , 38 , 39 , 40 , 41 , 42 , 43 , 45 , 49 , 51 , 52 ], indicating that practitioners draw on skills such as sensitive communication, individualised care and family support which are integral to the practice of palliative care [ 83 ] and therefore familiar to practitioners. This suggests that the patient-centred practice of palliative care can provide a basis for incorporating cultural considerations into every encounter by acknowledging the universality of differing communication styles, need for information, family involvement and health beliefs and negotiating these with an awareness of of how culture interconnects with these [ 84 , 85 ].

Generally, practitioners experienced uncertainty when encountering patients with an unfamiliar cultural background and this is reflected in the wider literature [ 18 , 58 , 59 ]. Within a systematic review of barriers to care of ethnic minority patients, nurses report communication difficulties, lack of culturally appropriate resources and insufficient education were primary concerns [ 86 ]. Practitioner reported knowledge deficits and requests for further education are evident in this review [ 33 , 39 , 40 , 48 , 49 , 54 , 55 , 56 ] and acknowledged within the wider literature [ 19 , 58 , 87 ]. Although further education is seen as a means to improve the care offered and to help allay uncertainties [ 33 , 39 , 48 , 57 ] culture specific knowledge is recognised as potentially contributing to stereotyping and encouraging generalisations [ 26 , 84 ] and the literature does not offer a simple solution. Studies examining cultural competence education, report that there is little assessment of outcome [ 88 ] and are seldom evidence based [ 89 ]. Instead,it is suggested that enhancing communication skills and expanding awareness of the many factors, clinician, patient and family related, which influence communication may prove beneficial. [ 89 ]. A systematic review assessing the effectiveness of cultural competence on patient satisfaction found that while training improved patient satisfaction, concerns existed regarding the quality and methodological rigor of the reviewed studies, so caution was advised on interpretation of results [ 90 ]. Nonetheless, perceived gaps in knowledge contribute to a sense of uncertainty about aspects of care provision, thus within educational settings, teaching students to approach situations which are unfamiliar, with interest rather than unease is pivotal [ 91 ]. Education in intercultural communication and an ability to question how care is provided are required to equip future clinicians to provide appropriate care for all [ 91 ]. Within training programmes there needs to be an integration and assessment of culturally sensitive care throughout curricula [ 92 , 93 ] and a combination of approaches is required to prepare nursing students to provide care to culturally diverse patients, including knowledge, simulation of cross-cultural encounters, reflection, and appropriate role models [ 94 ]. For existing practitioners, the training of staff members to become ethnic coordinators had a beneficial influence on patient related interactions and on the culture of care towards culturally diverse patients [ 95 ]. A combination of a broad knowledge of culture relating to health and to death and dying, enhanced communication skills development and self-reflection can offer practitioners a framework from which to approach clinical encounters [ 96 ]. It is also recognised that educating practitioners to use moral reasoning could help promote ethical and just decision making when exploring care for patients with culturally diverse backgrounds [ 97 , 98 ].

While there is awareness amongst practitioners in all studies of the institutional and societal factors which may influence the delivery of care, the wider literatures evidences low levels of engagement with palliative care services among some culturally diverse patients [ 22 , 25 ]. Palliative care is unfamiliar to some culturally diverse patients as the term does not translate directly in many languages [ 82 ]. A systematic review of referrals to palliative care from oncology/haematology services identified a lack of knowledge of palliative care amongst healthcare practitioners and low levels of awareness of palliative care amongst patients and families in the general population, is a significant and widespread obstacle to palliative care referrals [ 99 ]. It has been highlighted that gatekeeping by referrers who perceive that culturally diverse patients do not utilise palliative care services can occur [ 100 ] but it has also been shown that palliative care referrals were proportionally higher in hospital settings for culturally diverse patients and posited that more opportunity and time to explore understanding may have been a contributing factor [ 101 ]. The provision of time is of critical importance in the provision of patient-centred care during the palliative phase of illness and the ability to spend time with patients and families is vital to building trusting relationships [ 83 , 102 ]. Limited time resources are recognised as a barrier to care for culturally diverse patients [ 103 ]. This highlights the role of organisational support in facilitating practitioners to have time as a resource [ 33 , 47 , 52 , 54 ]. Furthermore, the existence of a culturally diverse workforce in healthcare settings is viewed as a facilitator of good care [ 14 , 22 , 104 ] but may place additional demands on culturally diverse practitioners which may impact the practitioners themselves [ 105 ].

Strengths and limitations

A strength of this review is the insight gained into the perspectives of healthcare practitioners providing palliative care to patients with a culturally diverse background. However, it is recognised that the time frame may have eliminated papers that were relevant and could have added to the current body of literature. This review included papers that were published in English, however given the subject topic of culturally diverse backgrounds the review may have eliminated papers of importance as there were not written in English. This review highlights the difficulties for healthcare practitioners caring for patients and their families from diverse cultural background and suggested strategies that could help meet the needs of their patients. Research into this topic is limited and so encompassed all multidisciplinary members and it is possible that had the review been restricted to a single professional group, the findings may be more transferable. However, given the review explored healthcare practitioner’s perspectives of providing palliative care to patients from a culturally diverse backgrounds all practitioners were included, and findings may be transferable.

In this review, it is apparent that healthcare practitioners face challenges providing palliative care to patients from a culturally diverse background. Language barriers, divergent views on autonomy, uncertainty about aspects of culture and a perception of a need for further education are all issues practitioners dealt with in practice. However, practitioners draw on their existing skills to adapt their practice to unfamiliar situations and utilise palliative care’s patient centred approach to ascertain needs and involve the family. This approach allows them to be aware of the influences that belonging to an indigenous or migrant community may bring but greater integration of culture needs to be incorporated within undergraduate and post graduate education. Ethnicity is not currently recorded in some countries for example on the Cancer Registry in Ireland therefore to help inform and develop services on a national level ethnicity should be included.

Availability of data and materials

Data used for analysis in this review are all extracted from the original published reviews and are presented in Table  2 (Data extraction table).

Ellershaw J. Care of the dying, a pathway to Excellence. 2nd ed. Oxford: Oxford University Press; 2011.

Google Scholar  

Connor SR. Hospice and Palliative Care: the essential guide. 3rd ed. New York: Routledge; 2018.

Ring JM. Psychology and medical education: collaborations for culturally responsive care. J Clin Psychol Med Settings. 2009;16(1):120–6. https://doi.org/10.1007/s10880-008-9141-8 .

Article   PubMed   Google Scholar  

Hong Y. A dynamic constructivist approach to culture: moving from describing culture to explaining culture. In: Wyer RS, Chiu C, Hong Y, editors. Understanding culture: theory, research, and application. New York: Psychology Press; 2009. pp. 3–23.

Yancu CN, Farmer DF. Product or process: cultural competence or cultural humility? Palliat Med Hosp Care Open J. 2017;3(1):e1–4. https://doi.org/10.17140/PMHCOJ-3-e005 .

Article   Google Scholar  

McAuliffe M, Khadria B. Report overview: providing perspective on migration and mobility in increasingly uncertain times. World Migration Report 2020. International Organisation for Migration, Geneva. 2020. https://publications.iom.int/system/files/pdf/wmr_2020.pdf (Accessed August 18th 2022).

2019, United Nations Department of Economic and Social Affairs (UN DESA) International Migrant Stock, Division UNDESAP. New York. https://www.un.org/en/development/desa/population/migration/publications/migrationreport/docs/MigrationStock2019_TenKeyFindings.pdf (Accessed August 18th, 2022).

World Health Organisation. Strategy and action plan for refugee and migrant health in the WHO European Region. Copenhagen, WHO Regional office for Europe., 2016. Strategy and Action Plan for Refugee and Migrant Health in the WHO European Region 2016–2022 (Accessed August 20th 2022).

Sze M, Butow P, Bell M, Vaccaro L, Dong S, Eisenbruch M, Jefford M, Girgis A, King M, McGrane J, Ng W, Asghari R, Parente P, Liauw W, Goldstein D. Migrant health in cancer: outcome disparities and the determinant role of migrant-specific variables. Oncologist. 2015;20(5):523–31. https://doi.org/10.1634/theoncologist.2014-0274 .

Article   PubMed   PubMed Central   Google Scholar  

Berlin J, Smith D, Newton P. It’s because it’s cancer, not because you’re a Traveller-exploring lay understanding of cancer in English Romany Gypsy and Irish Traveller communities. Eur J Oncol Nurs. 2018;34:49–54. https://doi.org/10.1016/j.ejon.2018.02.010 .

Mehus G, Bongo B, Engnes J, Moffitt P. Exploring why and how encounters with the Norwegian health-care system can be considered culturally unsafe by North Sami-speaking patients and relatives: a qualitative study based on 11 interviews. Int J Circumpolar Health. 2019;78(1):1612703. https://doi.org/10.1080/22423982.2019.1612703 .

Periyakoil VS, Neri E, Kraemer H. Patient-reported barriers to high-quality, end-of-life care: a multiethnic, multilingual, mixed-methods study. J Palliat Med. 2016;19(4):373–9. https://doi.org/10.1089/jpm.2015.0403 .

Alpers LM. Distrust and patients in intercultural healthcare: a qualitative interview study. Nurs Ethics. 2018;25(3):313–23. https://doi.org/10.1177/0969733016652449 .

McCleskey SG, Cain CL. Improving end-of-life care for diverse populations: communication, competency, and system supports. Am J Hosp Palliat Med. 2019;36(6):453–9. https://doi.org/10.1177/1049909119827933 .

Evans N, Meñaca A, Andrew EV, Koffman J, Harding R, Higginson IJ, Pool R, Gysels M. Appraisal of literature reviews on end-of-life care for minority ethnic groups in the UK and a critical comparison with policy recommendations from the UK end-of-life care strategy. BMC Health Serv Res. 2011;11:141. https://doi.org/10.1186/1472-6963-11-141 .

Bourque Bearskin RL. A critical lens on culture in nursing practice. Nurs Ethics. 2011;18(4):548–59. https://doi.org/10.1177/0969733011408048 .

Grandpierre V, Milloy V, Sikora L, Fitzpatrick E, Thomas R, Potter B. Barriers and facilitators to cultural competence in rehabilitation services: a scoping review. BMC Health Serv Res. 2018;18(1):1–4. https://doi.org/10.1186/s12913-017-2811-1 .

Gerchow L, Burka L, Miner S, Squires A. Language barriers between nurses and patients: a scoping review. Patient Educ Counsel. 2021;104(3):534–53. https://doi.org/10.1016/j.pec.2020.09.017 .

Weber O, Sulstarova B, Singy P. Cross-cultural communication in Oncology: challenges and training interests. Oncol Nurs Forum. 2016;43(1):534–53. https://doi.org/10.1188/16.ONF.E24-E33 .

Cai DY. A concept analysis of cultural competence. Nurs Int J Sci. 2016;3(3):268–. https://doi.org/10.1016/j.ijnss.2016.08.002 . 73.

Bosma H, Apland L, Kazanjian A. Cultural conceptualizations of hospice palliative care: more similarities than differences. Palliat Med. 2010;24(5):510–22. https://doi.org/10.1177/0269216309351380 .

Cain CL, Surbone A, Elk R, Kagawa-Singer M. Culture and palliative care: preferences, communication, meaning, and mutual decision making. J Pain Symptom Manag. 2018;55(5):1408–19. https://doi.org/10.1016/j.jpainsymman.2018.01.007 .

Gustafson C, Lazenby M. Assessing the unique experiences and needs of Muslim oncology patients receiving palliative and end-of-life care: an integrative review. J Palliat Care. 2019;34(1):52–61. https://doi.org/10.1177/0825859718800496 .

Butow PN, Sze M, Dugal-Beri P, Mikhail M, Eisenbruch M, Jefford M, Schofield P, Girgis A, King M, Goldstein D. From inside the bubble: migrants’ perceptions of communication with the cancer team. Support Care Cancer. 2011;19(2):281–90. https://doi.org/10.1007/s00520-010-0817-x .

Davidson PM, Phillips JL, Dennison-Himmelfarb C, Thompson SC, Luckett T, Currow DC. Providing palliative care for Cardiovascular Disease from a perspective of sociocultural diversity: a global view. Curr Opin Support Palliat Care. 2016;10(1):11–7. https://doi.org/10.1097/SPC.0000000000000188 .

Koffman J. Servicing multi-cultural needs at the end of life. J Ren Care. 2014;40(Suppl 1):6–15. https://doi.org/10.1111/jorc.12087 .

van Eechoud IJ, Grypdonck M, Beekman D, Van Lancker A, Van Hecke A, Veraeghe S. Oncology health workers’ views and experiences on caring for ethnic minority patients: a mixed method systematic review. Int J Nurs Studies. 2016;53:379–98. https://doi.org/10.1016/j.ijnurstu.2015.09.007 .

Wakefield A. Searching and critiquing the research literature. Nurs Standard. 2014;28(39):49–57. https://doi.org/10.7748/ns.28.39.49.e8867 .

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372. https://doi.org/10.1136/bmj.n71 .

CASP UK. CASP systematic review checklist [Internet]. Oxford: CASP UK. ; 2018 p.4. https://casp-uk.net/wp-content/uploads/2018/01/CASP-Systematic-Review-Checklist_2018.pdf (accessed March 20th 2022).

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–10. https://doi.org/10.1191/1478088706qp063oa .

Bellamy G, Gott M. What are the priorities for developing culturally appropriate palliative and end-of-life care for older people? The views of healthcare staff working in New Zealand. Health Soc Care Comm. 2013;21(1):26–34. https://doi.org/10.1111/j.1365-2524.2012.01083.x .

Debesay J, Harsløf I, Rechel B, Vike H. Facing diversity under institutional constraints: challenging situations for community nurses when providing care to ethnic minority patients. J Adv Nurs. 2014;70(9):2107–16. https://doi.org/10.1111/jan.12369 .

de Graaff FM, Francke AL, Van den Muijsenbergh METC, van der Geest. S. Talking in triads: communication with Turkish and Moroccan immigrants in the palliative phase of cancer. J Clin Nurs 2012a Nov; 21(21–22):3143–52. https://doi.org/10.1111/j.1365-2702.2012.04289.x .

de Graaff FM, Francke AL, van den Muijsenbergh M, der Geest S. Understanding and improving communication and decision-making in palliative care for Turkish and Moroccan immigrants; a multiperspective study. Ethn Health 2012b Aug1;17(4):363–84. https://doi.org/10.1080/13557858.2011.645152 .

de Voogd X, Willems DL, Onwuteaka-Philipsen B, Torensma M, Suurmond JL. Health care staff’s strategies to preserve dignity of migrant patients in the palliative phase and their families: a qualitative study. J Adv Nurs. 2021;77(6):2819–30. https://doi.org/10.1111/jan.14829 .

Eckemoff E, Sudha S, Wang D. End of life care for older Russian immigrants - perspectives of Russian immigrants and hospice staff. J Cross-Cultural Gerontol. 2018;33(3):229–45. https://doi.org/10.1007/s10823-018-9353-9 .

Green A, Jerzmanowska N, Green M, Lobb EA. Death is difficult in any language, a qualitative study of palliative care professionals’ experiences when providing end-of-life care to patients from culturally and linguistically diverse backgrounds. Palliat Med. 2018;32(8):1419–27. https://doi.org/10.1177/0269216318776850 .

Henry A, Timmins F. An exploration of specialist palliative care nurses’ experiences of providing care to hospice inpatients from minority ethnic groups–implication for religious and spiritual care. Religions. 2016;7(2):18. https://doi.org/10.3390/rel7020018 .

Johnstone MJ, Hutchinson AM, Redley B, Rawson H. Nursing roles and strategies in end-of-life decision making concerning elderly immigrants admitted to acute care hospitals. J Transcult Nurs 2016a Sep;27(5): 471–9. https://doi.org/10.1177/1043659615582088 .

Johnstone MJ, Hutchinson AM, Rawson H, Redley B. Assuaging death anxiety in older overseas-born australians of culturally and linguistically diverse backgrounds hospitalised for end-of-life care, Contemp Nurs 2016b May 6;52(2–3):269–85. https://doi.org/10.1080/10376178.2016.1192953 .

Johnstone M-J, Hutchinson MA, Rawson H, Redley B. Nursing strategies for engaging families of older immigrants hospitalized for end-of-life care: An Australian study, J Patient Exp. 2016c Sep;3(3):57–63. https://doi.org/10.1177/2374373516667004 .

Johnstone MJ, Rawson H, Hutchinson AM, Redley B. Fostering trusting relationships with older immigrants hospitalised for end-of-life care. Nurs Ethics. 2018;25(6):760–72. https://doi.org/10.1177/0969733016664978 .

Khosla N, Washington KT, Regunath H. Perspectives of health care providers on US South asians’ attitudes toward pain management at end of life. Am J Hosp Palliat Care. 2016;33(9):849–57. https://doi.org/10.1177/1049909115593063 .

Khosla N, Washington KT, Shaunfield S, Aslakson R. Communication challenges and strategies of U.S. health professionals caring for seriously ill south Asian patients and their families. J Palliat Med. 2017;20(6):611–7. https://doi.org/10.1089/jpm.2016.0167 .

Khosla N, Washington KT, Mukherjea PH, Aslakson R. Health-care providers’ perspectives on decision-making among seriously ill patients on south Asian origin in the United States. J Palliat Care. 2019;34(3):181–8. https://doi.org/10.1177/0825859719829480 .

Mahilall R, Swartz L. Spiritual care practices in hospices in the western cape, South Africa: the challenge of diversity. BMC Palliat Care. 2021;20(1):1–8. https://doi.org/10.1186/s12904-020-00704-z .

Milberg A, Torres S, Ågård P. Health care professionals’ understandings of cross-cultural interaction in end-of-life care: a focus group study. PloS ONE 2016 Nov 11(11):e0165452. https://doi.org/10.1371/journal.pone.0165452 .

Neiman T. Nurses’ perceptions of basic palliative care in the Hmong population. J Transcult Nurs. 2019;30(6):576–86. https://doi.org/10.1177/1043659619828054 .

Nielsen LS, Angus JE, Gastaldo D, Howell D, Husain A. Maintaining distance from a necessary intrusion: a postcolonial perspective on dying at home for Chinese immigrants in Toronto, Canada. Eur J Oncol Nurs. 2013;17(5):649–56. https://doi.org/10.1177/1049909114527338 .

Nielsen LS, Angus J, Howell D, Husain A, Gastaldo D. Patient-centered care or cultural competence: negotiating palliative care at home for Chinese Canadian immigrants. Am J Hosp Palliat Med. 2015;32(4):372–9. https://doi.org/10.1177/1049909114527338 .

Roider-Schur S, Rumpold T, Kirchheiner K, Masel EK, Nemecek R, Amering M, Watzke H, Schrank B. Migrate your mind: the role of palliative care in transcultural cancer treatment: a qualitative analysis. Wiener Klinische Wochenschrift. 2019;131(9):191–9. https://doi.org/10.1007/s00508-019-1474-9 .

Schrank B, Rumpold T, Amering M, Masel E, Watzke H, Schur S. Pushing boundaries—culture-sensitive care in oncology and palliative care: a qualitative study. Psycho-Oncol. 2017;26(6):763–9. https://doi.org/10.1002/pon.4217 .

Shahid S, Bessarab D, van Schailk KD, Aoun SM, Thompson SC. Improving palliative care outcomes for Aboriginal australians: service providers’ perspectives. BMC Palliat Care. 2013;12(1):26–35. https://doi.org/10.1186/1472-684X-12-26 .

Torres S, Ågård P, Milberg A. The other in end-of-life care: providers’ understandings of patients with migrant backgrounds. J Intercult Studies. 2016;37(2):103–17. https://doi.org/10.1080/07256868.2016.1141756 .

Vincent D, Rice J, Chan J, Grasseau P. Provision of comprehensive, culturally competent palliative care in the Qikiqtaaluk region of Nunavut: Health care providers’ perspectives. Canadian family physician Medecin de famille canadien. 2019;65(4): e163–e9. https://www.cfp.ca/content/cfp/65/4/e163.full.pdf (accessed: 10th March 2022).

Washington K, Khosla N, Lero C. U.S. providers’ perceptions of the psychosocial needs of seriously ill patients of south Asian origin: implications for health social work. Health Soc Work. 2019;44(3):177–84. https://doi.org/10.1093/hsw/hlz015 .

Bloomer M, Botti M, Runacres F, Poon P, Barnfield J, Hutchinson A. Cultural considerations at end of life in a geriatric inpatient rehabilitation setting. Collegian. 2019;26(1):165–70. https://doi.org/10.1016/j.colegn.2018.07.004 .

Brighi N, Colazzo AL, Bolognesi D, Surbone A, Biasco G. Cross-cultural differences in hospices: a retrospective study in Italy. Eur J Oncol. 2014;19(1):34–42. https://mattioli1885journals.com/index.php/EJOEH/article/view/3786/3025 .

Jansky M, Owusu-Boakye S, Nauck F. An odyssey without receiving proper care – experts’ views on palliative care provision for patients with migration background in Germany. BMC Palliat Care. 2019;18(1):1–0. https://doi.org/10.1186/s12904-019-0392-y .

Boyle PJ. An assessment of cultural competence of community public health nursing in Liffeyside Health Service Area, Dublin: unpublished thesis (D.Prof.), Middlesex University; 2014. http://eprints.mdx.ac.uk/13464/ (Accessed August 20th 2022).

Green A, Jerzmanowska N, Thristiawati S, Green M, Lobb E. Culturally and linguistically diverse palliative care patients’ journeys at the end-of-life. Palliat Support Care. 2019;17(2):227–33. https://doi.org/10.1017/S1478951518000147 .

Watts K, Meiser B, Zilliacus E, Kaur R, Taouk M, Girgis A, Butow P, Kissane D, Hale S, Perry A, Aranda S, Goldstein D. Perspectives of oncology nurses and oncologists regarding barriers to working with patients from a minority background: systemic issues and working with interpreters. Eur J Cancer Care. 2018;27(2):e12758. https://doi.org/10.1111/ecc.12758 .

Article   CAS   Google Scholar  

McCarthy J, Cassidy I, Graham MM, Tuohy D. Conversations through barriers of language and interpretation. Br J Nurs. 2013;22(6):335–39. https://doi.org/10.12968/bjon.2013.22.6.335 .

Papadopoulos I, Taylor G, Ali S, Aagard M, Akman O, Alpers LM, Apostolara P, Biglete-Pangilinan S, Biles J, García ÁM, González-Gil T. Exploring nurses’ meaning and experiences of compassion: an international online survey involving 15 countries. J Transcult Nurs. 2017;28(3):286–95. https://doi.org/10.1177/1043659615624740 .

Degrie L, Gastmans C, Mahieu L, de Casterle BD, Denier Y, Dierckx de Casterle B. How do ethnic minority patients experience the intercultural care encounter in hospitals? A systematic review of qualitative research. BMC Med Ethics. 2017;18(1):1–17. https://doi.org/10.1186/s12910-016-0163-8 .

Bramley L, Matiti M. How does it really feel to be in my shoes? Patients’ experiences of compassion within nursing care and their perceptions of developing compassionate nurses. J Clin Nurs. 2014;23(19–20):27. https://doi.org/10.1111/jocn.12537 .

Cruz-Oliver DM, Sanchez-Reilly S. Barriers to quality end-of-life care for latinos: Hospice health care professionals’ perspective. J Hosp Palliat Nurs. 2016;18(6):505–11. https://doi.org/10.1016/j.jpainsymman.2012.10.149 .

Weerasinghe S, Maddalena V. Negotiation, mediation and communication between cultures: end-of-life care for south Asian immigrants in Canada from the perspective of family caregivers. Soc Work Public Health. 2016;31(7):665–77. https://doi.org/10.1080/19371918.2015.1137521 .

Slater T, Matgeson A, Davies C, Earp R, Gellatly K, Holdaway M, Ellison-Loschmann L. Exploring Māori cancer patients’, their families’, community and hospice views of hospice care. Int J Palliat Nurs. 2015 Sept 2;21(9):439–45. https://doi.org/10.12968/ijpn.2015.21.9.439 .

Markham S, Islam Z, Faull C. I never knew that! Why do people from Black and Asian Minority ethnic groups in Leicester access hospice services less than other groups? A discussion with community groups. Divers Equality Health Care. 2014;11(3). https://doi.org/10.21767/2049-5471.100016 .

Nielsen DS, Minet L, Zeraig L, Rasmussen D, Sodemann M. Caught in a generation gap: a generation perspective on refugees getting old in Denmark—a qualitative study. J Transcult Nurs. 2018;29(3):265–73. https://doi.org/10.1177/1043659617718064 .

Fang M, Malcoe L, Sixsmith J, Wong, Callender M. Exploring traditional end-of-life beliefs, values, expectations, and practices among Chinese women living in England: informing culturally safe care. Palliat Support Care. 2015;13(5):1261–74. https://doi.org/10.1017/S1478951514001126 .

Wang Y, Faas D. The economic and family experiences of Hong Kong Chinese in Ireland’. Ethnic Racial Studies. 2021;44(1):115–33. https://doi.org/10.1080/01419870.2020.1723670 .

Ryan K, Connolly M, Charnley K, Ainscough A, Crinion J, Hayden C, Keegan O, Larkin P, Lynch M, McEvoy D, McQuillan R, O’Donoghue L, O’Hanlon M, Reaper-Reynolds S, Regan J, Rowe D, Wynne M. (2014) Palliative Care Competence Framework, Dublin: Health Service Executive. 2014. Competence Framework - HSE.ie. http://hdl.handle.net/10147/322310 (accessed August 18th 2022).

Zhang W. Is death taboo for older Chinese immigrants? OMEGA-J Death Dying. 2022;84(4):1061–80. https://doi.org/10.1177/0030222820927883 .

Colclough YY, Brown GM. Moving towards openness: Blackfeet Indians’ perceptions changes regarding talking about end of life. Am J Hosp Palliat Med. 2019;36(4):282–9.

Chi H, Cataldo J, Ho E, Rehm R. Please Ask Gently: Using Culturally Targeted Communication Strategies to Initiate End-of-Life Care Discussions With Older Chinese Americans. Am J Hosp Palliat Care. 2018;35(10):1265–72. https://doi.org/10.1177/1049909118760310 .

Watts KJ, Meiser B, Zilliacus E, Kaur R, Taouk M, Girgis A, Butow P, Goldstein D, Hale S, Perry A, Aranda SK, Kissane DW. Communicating with patients from minority backgrounds: individual challenges experienced by oncology health professionals. Eur J Oncol Nurs. 2017;1(26):83–90. https://doi.org/10.1016/j.ejon.2016.12.001 .

Krystallidou D, Devisch I, Van de Velde D, Pype P. Understanding patient needs without understanding the patient: the need for complementary use of professional interpreters in end-of-life care. Med Health Care Philos. 2017;20(4):477–81. https://doi.org/10.1007/s11019-017-9769-y .

Kirby Kirby, Lwin Z, Kenny K, Broom A, Birman H, Good P. “It doesn’t exist”: negotiating palliative care from a culturally and linguistically diverse patient and caregiver perspective. BMC Palliat Care. 2018;17(1). https://doi.org/10.1186/s12904-018-0343-z https://rdcu.be/cT19v .

Broom A, Parker RB, Kirby E, Kokanović R, Woodland L, Lwin Z, Koh ES. A qualitative study of cancer care professionals’ experiences of working with migrant patients from diverse cultural backgrounds. BMJ open. 2019;9(3):e025956. https://doi.org/10.1136/bmjopen-2018-025956 .

Merlane H, Cauwood L. Core principles of end-of-life care. Br J Nurs. 2020;29(5):290–2. https://doi.org/10.12968/bjon.2020.29.5.280 .

Epner DE, Baile WF. Patient-centered care: the key to cultural competence. Annals Oncol. 2012;23:iii33-42. https://doi.org/10.1093/annonc/mds086 .

Ammann E, Rauber G, Salis Gross C. Doing death” the Mediterranean way: end-of-life in a segregated nursing home. Mortality. 2019;24(3):271–89. https://doi.org/10.1080/13576275.2018.1483906 .

Joo JY, Liu MF. Nurses’ barriers to care of ethnic minorities: A qualitative systematic review. West J Nurs Res. 2020;42(9):760–71. https://doi.org/10.1177/0193945919883395 .

Shepherd SM, Willis-Esqueda C, Newton D, Sivasubramaniam D, Paradies Y. The challenge of cultural competence in the workplace: perspectives of healthcare providers. BMC Health Services Research. 2019;19(1):1–1. https://doi.org/10.1186/s12913-019-3959-7 .

Boucher N, Johnson K. Cultivating cultural competence: how are hospice staff being educated to engage racially and ethnically diverse patients? Am J Hosp Palliat Med. 2021;38(2):169–74. https://doi.org/10.1177/1049909120946729 .

Shepherd SM. Cultural awareness workshops: limitations and practical consequences. BMC Med Educ. 2019;19(1):1–0. https://doi.org/10.1186/s12909-018-1450 .

Govere L, Govere E. How effective is cultural competence training of healthcare providers on improving patient satisfaction of minority groups? A systematic review of literature. Worldviews Evid-Based Nurs. 2016;13(6):402–10. https://doi.org/10.1111/wvn.12176 .

Markey K, Okantey C. Nurturing cultural competence in nurse education through a values-based learning approach. Nurs Educ Pract. 2019;1(38):153–6. https://doi.org/10.1016/j.nepr.2019.06.011 .

Suurmond J, Lantinga K, de Voogd X, Oueslati R, Boland G, van den Muijsenbergh M. Twelve tips to teach culturally sensitive palliative care. Med Teach. 202AD;43(7):845–50. https://doi.org/10.1080/0142159X.2020.1832650 .

Zanting A, Meershoek A, Frambach JM, Krumeich A. The ‘exotic other’in medical curricula: Rethinking cultural diversity in course manuals. Medical teacher. 2020;42(7):791–8. https://doi.org/10.1080/0142159X.2020.1736534 .

O’Brien E, O’ Donnell C, Murphy J, O’ Brien B, Markey K. Intercultural readiness of nursing students: an integrative review of evidence examining cultural competence educational interventions. Nurs Educ Pract. 2021;1(50):102966. https://doi.org/10.1016/j.nepr.2021.102966 .

Nielsen DS, Korsholm K.M, Mottelson I, Sodemann M. Cultural competences gained through an education program as ethnic patient coordinator: a qualitative study. J Transcult Nurs. 2019;30(4):394–402. https://doi.org/10.1177/1043659618823923 .

Semlali I, Tamches E, Singy P, Weber O. Introducing cross-cultural education in palliative care: focus groups with experts on practical strategies. BMC Palliat Care. 2020;19(1):1–0. https://doi.org/10.1186/s12904-020-00678-y .

Markey K. Moral reasoning as a catalyst for cultural competence and culturally responsive care. Nurs Philos. 2021;22(1) https://doi.org/10.1111/hsc.12556 .

Henderson S, Horne M, Hills R, Kendall E. (2018) ‘Cultural competence in healthcare in the community: a concept analysis.’ Health Soc Care Community. 2018;26(4):590–603. https://doi.org/10.1111/hsc.12556 .

Bennardi M, Diviani N, Gamondi C, Stüssi G, Saletti P, Cinesi I, Rubinelli S. Palliative care utilization in oncology and hemato-oncology: a systematic review of cognitive barriers and facilitators from the perspective of healthcare professionals, adult patients, and their families. BMC Palliat Care. 2020;19(1):1–7. https://doi.org/10.1186/s12904-020-00556-7 .

Frey R, Gott M, Raphael D, Black S, Teleo-Hope L, Lee H, Wang Z. “Where do I go from here”? A cultural perspective on challenges to the use of hospice services. Health Soc Care Community. 2013;21(5):519–29. https://doi.org/10.1111/hsc.12038 .

Sharma RK, Cameron KA, Chmiel JS, Von Roenn JH, Szmuilowicz E, Prigerson HG, Penedo FJ. Racial/ethnic differences in inpatient palliative care consultation for patients with advanced cancer. J Clin Oncol. 2015;33(32):3802–8. https://doi.org/10.1200/JCO.2015.61.6458 .

Carvajal A, Haraldsdottir E, Kroll T, McCormack B, Errasti-Ibarrondo B, Larkin P. Barriers and facilitators perceived by registered nurses to providing person-centred care at the end of life. A scoping review. Int Pract Dev J. 2019;9(2):1–22. https://doi.org/10.19043/ipdj.92.008 .

Ogbolu Y, Scrandis D, Fitzpatrick G. Barriers and facilitators of care for diverse patients: nurse leader perspectives and nurse manager implications. J Nurs Manag. 2018;26(1):3–10. https://doi.org/10.1111/jonm.12498 .

Betancourt JR, Renfrew MR. Unequal treatment in the US: lessons and recommendations for cancer care internationally. J Paedi Haemat Oncol. 2011;1(33):S149-53. https://doi.org/10.1097/MPH.0b013e318230dfea .

Hadziabdic E, Lundin C, Hjelm K. Boundaries and conditions of interpretation in multilingual and multicultural elderly healthcare. BMC health services research. 2015;15(1):1–3. https://doi.org/10.1186/s12913-015-1124-5 .

Download references

Acknowledgements

Not applicable.

No funding was obtained for this study.

Author information

Authors and affiliations.

Milford Care Centre, Castletroy, Limerick, V94 H795, Ireland

Colette Burke

Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, V94 T9PX, Ireland

Owen Doody & Barbara Lloyd

You can also search for this author in PubMed   Google Scholar

Contributions

Study conception and design: CB, BL. Literature search, screening, and data extraction: CB, BL, and OD. Data synthesis and interpretation: CB. Checking, data synthesis and interpretation: BL and OD. Contribution in the discussion and final write-up all authors. Manuscript drafting and revision and approval of final manuscript, all authors.

Corresponding author

Correspondence to Barbara Lloyd .

Ethics declarations

Ethics approval and consent to participate.

This was a retrospective record review without any direct patient interaction by the study team. The research was performed in accordance with the Declaration of Helsinki and approved by two ethics committees. The ethics boards of the University of the Witwatersrand and Boston University reviewed and approved the study protocols and provided a waiver of informed consent.

Consent for publication

Competing interests.

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1: supplementary file 1..

PRISMA CHECKLIST.  Supplementary file 2. Quality appraisal - CASP Appraisal scores

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Burke, C., Doody, O. & Lloyd, B. Healthcare practitioners’ perspectives of providing palliative care to patients from culturally diverse backgrounds: a qualitative systematic review. BMC Palliat Care 22 , 182 (2023). https://doi.org/10.1186/s12904-023-01285-3

Download citation

Received : 10 October 2022

Accepted : 13 October 2023

Published : 17 November 2023

DOI : https://doi.org/10.1186/s12904-023-01285-3

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Palliative care
• Systematic review
• Cultural diversity

BMC Palliative Care

ISSN: 1472-684X

• Submission enquiries: [email protected]
• General enquiries: [email protected]

Writing the title and abstract for a research paper: Being concise, precise, and meticulous is the key

Milind s. tullu.

Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India

This article deals with formulating a suitable title and an appropriate abstract for an original research paper. The “title” and the “abstract” are the “initial impressions” of a research article, and hence they need to be drafted correctly, accurately, carefully, and meticulously. Often both of these are drafted after the full manuscript is ready. Most readers read only the title and the abstract of a research paper and very few will go on to read the full paper. The title and the abstract are the most important parts of a research paper and should be pleasant to read. The “title” should be descriptive, direct, accurate, appropriate, interesting, concise, precise, unique, and should not be misleading. The “abstract” needs to be simple, specific, clear, unbiased, honest, concise, precise, stand-alone, complete, scholarly, (preferably) structured, and should not be misrepresentative. The abstract should be consistent with the main text of the paper, especially after a revision is made to the paper and should include the key message prominently. It is very important to include the most important words and terms (the “keywords”) in the title and the abstract for appropriate indexing purpose and for retrieval from the search engines and scientific databases. Such keywords should be listed after the abstract. One must adhere to the instructions laid down by the target journal with regard to the style and number of words permitted for the title and the abstract.

Introduction

This article deals with drafting a suitable “title” and an appropriate “abstract” for an original research paper. Because the “title” and the “abstract” are the “initial impressions” or the “face” of a research article, they need to be drafted correctly, accurately, carefully, meticulously, and consume time and energy.[ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ] Often, these are drafted after the complete manuscript draft is ready.[ 2 , 3 , 4 , 5 , 9 , 10 , 11 ] Most readers will read only the title and the abstract of a published research paper, and very few “interested ones” (especially, if the paper is of use to them) will go on to read the full paper.[ 1 , 2 ] One must remember to adhere to the instructions laid down by the “target journal” (the journal for which the author is writing) regarding the style and number of words permitted for the title and the abstract.[ 2 , 4 , 5 , 7 , 8 , 9 , 12 ] Both the title and the abstract are the most important parts of a research paper – for editors (to decide whether to process the paper for further review), for reviewers (to get an initial impression of the paper), and for the readers (as these may be the only parts of the paper available freely and hence, read widely).[ 4 , 8 , 12 ] It may be worth for the novice author to browse through titles and abstracts of several prominent journals (and their target journal as well) to learn more about the wording and styles of the titles and abstracts, as well as the aims and scope of the particular journal.[ 5 , 7 , 9 , 13 ]

The details of the title are discussed under the subheadings of importance, types, drafting, and checklist.

Importance of the title

When a reader browses through the table of contents of a journal issue (hard copy or on website), the title is the “ first detail” or “face” of the paper that is read.[ 2 , 3 , 4 , 5 , 6 , 13 ] Hence, it needs to be simple, direct, accurate, appropriate, specific, functional, interesting, attractive/appealing, concise/brief, precise/focused, unambiguous, memorable, captivating, informative (enough to encourage the reader to read further), unique, catchy, and it should not be misleading.[ 1 , 2 , 3 , 4 , 5 , 6 , 9 , 12 ] It should have “just enough details” to arouse the interest and curiosity of the reader so that the reader then goes ahead with studying the abstract and then (if still interested) the full paper.[ 1 , 2 , 4 , 13 ] Journal websites, electronic databases, and search engines use the words in the title and abstract (the “keywords”) to retrieve a particular paper during a search; hence, the importance of these words in accessing the paper by the readers has been emphasized.[ 3 , 4 , 5 , 6 , 12 , 14 ] Such important words (or keywords) should be arranged in appropriate order of importance as per the context of the paper and should be placed at the beginning of the title (rather than the later part of the title, as some search engines like Google may just display only the first six to seven words of the title).[ 3 , 5 , 12 ] Whimsical, amusing, or clever titles, though initially appealing, may be missed or misread by the busy reader and very short titles may miss the essential scientific words (the “keywords”) used by the indexing agencies to catch and categorize the paper.[ 1 , 3 , 4 , 9 ] Also, amusing or hilarious titles may be taken less seriously by the readers and may be cited less often.[ 4 , 15 ] An excessively long or complicated title may put off the readers.[ 3 , 9 ] It may be a good idea to draft the title after the main body of the text and the abstract are drafted.[ 2 , 3 , 4 , 5 ]

Types of titles

Titles can be descriptive, declarative, or interrogative. They can also be classified as nominal, compound, or full-sentence titles.

Descriptive or neutral title

This has the essential elements of the research theme, that is, the patients/subjects, design, interventions, comparisons/control, and outcome, but does not reveal the main result or the conclusion.[ 3 , 4 , 12 , 16 ] Such a title allows the reader to interpret the findings of the research paper in an impartial manner and with an open mind.[ 3 ] These titles also give complete information about the contents of the article, have several keywords (thus increasing the visibility of the article in search engines), and have increased chances of being read and (then) being cited as well.[ 4 ] Hence, such descriptive titles giving a glimpse of the paper are generally preferred.[ 4 , 16 ]

Declarative title

This title states the main finding of the study in the title itself; it reduces the curiosity of the reader, may point toward a bias on the part of the author, and hence is best avoided.[ 3 , 4 , 12 , 16 ]

Interrogative title

This is the one which has a query or the research question in the title.[ 3 , 4 , 16 ] Though a query in the title has the ability to sensationalize the topic, and has more downloads (but less citations), it can be distracting to the reader and is again best avoided for a research article (but can, at times, be used for a review article).[ 3 , 6 , 16 , 17 ]

From a sentence construct point of view, titles may be nominal (capturing only the main theme of the study), compound (with subtitles to provide additional relevant information such as context, design, location/country, temporal aspect, sample size, importance, and a provocative or a literary; for example, see the title of this review), or full-sentence titles (which are longer and indicate an added degree of certainty of the results).[ 4 , 6 , 9 , 16 ] Any of these constructs may be used depending on the type of article, the key message, and the author's preference or judgement.[ 4 ]

Drafting a suitable title

A stepwise process can be followed to draft the appropriate title. The author should describe the paper in about three sentences, avoiding the results and ensuring that these sentences contain important scientific words/keywords that describe the main contents and subject of the paper.[ 1 , 4 , 6 , 12 ] Then the author should join the sentences to form a single sentence, shorten the length (by removing redundant words or adjectives or phrases), and finally edit the title (thus drafted) to make it more accurate, concise (about 10–15 words), and precise.[ 1 , 3 , 4 , 5 , 9 ] Some journals require that the study design be included in the title, and this may be placed (using a colon) after the primary title.[ 2 , 3 , 4 , 14 ] The title should try to incorporate the Patients, Interventions, Comparisons and Outcome (PICO).[ 3 ] The place of the study may be included in the title (if absolutely necessary), that is, if the patient characteristics (such as study population, socioeconomic conditions, or cultural practices) are expected to vary as per the country (or the place of the study) and have a bearing on the possible outcomes.[ 3 , 6 ] Lengthy titles can be boring and appear unfocused, whereas very short titles may not be representative of the contents of the article; hence, optimum length is required to ensure that the title explains the main theme and content of the manuscript.[ 4 , 5 , 9 ] Abbreviations (except the standard or commonly interpreted ones such as HIV, AIDS, DNA, RNA, CDC, FDA, ECG, and EEG) or acronyms should be avoided in the title, as a reader not familiar with them may skip such an article and nonstandard abbreviations may create problems in indexing the article.[ 3 , 4 , 5 , 6 , 9 , 12 ] Also, too much of technical jargon or chemical formulas in the title may confuse the readers and the article may be skipped by them.[ 4 , 9 ] Numerical values of various parameters (stating study period or sample size) should also be avoided in the titles (unless deemed extremely essential).[ 4 ] It may be worthwhile to take an opinion from a impartial colleague before finalizing the title.[ 4 , 5 , 6 ] Thus, multiple factors (which are, at times, a bit conflicting or contrasting) need to be considered while formulating a title, and hence this should not be done in a hurry.[ 4 , 6 ] Many journals ask the authors to draft a “short title” or “running head” or “running title” for printing in the header or footer of the printed paper.[ 3 , 12 ] This is an abridged version of the main title of up to 40–50 characters, may have standard abbreviations, and helps the reader to navigate through the paper.[ 3 , 12 , 14 ]

Checklist for a good title

Table 1 gives a checklist/useful tips for drafting a good title for a research paper.[ 1 , 2 , 3 , 4 , 5 , 6 , 12 ] Table 2 presents some of the titles used by the author of this article in his earlier research papers, and the appropriateness of the titles has been commented upon. As an individual exercise, the reader may try to improvise upon the titles (further) after reading the corresponding abstract and full paper.

Checklist/useful tips for drafting a good title for a research paper

Some titles used by author of this article in his earlier publications and remark/comment on their appropriateness

The Abstract

The details of the abstract are discussed under the subheadings of importance, types, drafting, and checklist.

Importance of the abstract

The abstract is a summary or synopsis of the full research paper and also needs to have similar characteristics like the title. It needs to be simple, direct, specific, functional, clear, unbiased, honest, concise, precise, self-sufficient, complete, comprehensive, scholarly, balanced, and should not be misleading.[ 1 , 2 , 3 , 7 , 8 , 9 , 10 , 11 , 13 , 17 ] Writing an abstract is to extract and summarize (AB – absolutely, STR – straightforward, ACT – actual data presentation and interpretation).[ 17 ] The title and abstracts are the only sections of the research paper that are often freely available to the readers on the journal websites, search engines, and in many abstracting agencies/databases, whereas the full paper may attract a payment per view or a fee for downloading the pdf copy.[ 1 , 2 , 3 , 7 , 8 , 10 , 11 , 13 , 14 ] The abstract is an independent and stand-alone (that is, well understood without reading the full paper) section of the manuscript and is used by the editor to decide the fate of the article and to choose appropriate reviewers.[ 2 , 7 , 10 , 12 , 13 ] Even the reviewers are initially supplied only with the title and the abstract before they agree to review the full manuscript.[ 7 , 13 ] This is the second most commonly read part of the manuscript, and therefore it should reflect the contents of the main text of the paper accurately and thus act as a “real trailer” of the full article.[ 2 , 7 , 11 ] The readers will go through the full paper only if they find the abstract interesting and relevant to their practice; else they may skip the paper if the abstract is unimpressive.[ 7 , 8 , 9 , 10 , 13 ] The abstract needs to highlight the selling point of the manuscript and succeed in luring the reader to read the complete paper.[ 3 , 7 ] The title and the abstract should be constructed using keywords (key terms/important words) from all the sections of the main text.[ 12 ] Abstracts are also used for submitting research papers to a conference for consideration for presentation (as oral paper or poster).[ 9 , 13 , 17 ] Grammatical and typographic errors reflect poorly on the quality of the abstract, may indicate carelessness/casual attitude on part of the author, and hence should be avoided at all times.[ 9 ]

Types of abstracts

The abstracts can be structured or unstructured. They can also be classified as descriptive or informative abstracts.

Structured and unstructured abstracts

Structured abstracts are followed by most journals, are more informative, and include specific subheadings/subsections under which the abstract needs to be composed.[ 1 , 7 , 8 , 9 , 10 , 11 , 13 , 17 , 18 ] These subheadings usually include context/background, objectives, design, setting, participants, interventions, main outcome measures, results, and conclusions.[ 1 ] Some journals stick to the standard IMRAD format for the structure of the abstracts, and the subheadings would include Introduction/Background, Methods, Results, And (instead of Discussion) the Conclusion/s.[ 1 , 2 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 17 , 18 ] Structured abstracts are more elaborate, informative, easy to read, recall, and peer-review, and hence are preferred; however, they consume more space and can have same limitations as an unstructured abstract.[ 7 , 9 , 18 ] The structured abstracts are (possibly) better understood by the reviewers and readers. Anyway, the choice of the type of the abstract and the subheadings of a structured abstract depend on the particular journal style and is not left to the author's wish.[ 7 , 10 , 12 ] Separate subheadings may be necessary for reporting meta-analysis, educational research, quality improvement work, review, or case study.[ 1 ] Clinical trial abstracts need to include the essential items mentioned in the CONSORT (Consolidated Standards Of Reporting Trials) guidelines.[ 7 , 9 , 14 , 19 ] Similar guidelines exist for various other types of studies, including observational studies and for studies of diagnostic accuracy.[ 20 , 21 ] A useful resource for the above guidelines is available at www.equator-network.org (Enhancing the QUAlity and Transparency Of health Research). Unstructured (or non-structured) abstracts are free-flowing, do not have predefined subheadings, and are commonly used for papers that (usually) do not describe original research.[ 1 , 7 , 9 , 10 ]

The four-point structured abstract: This has the following elements which need to be properly balanced with regard to the content/matter under each subheading:[ 9 ]

Background and/or Objectives: This states why the work was undertaken and is usually written in just a couple of sentences.[ 3 , 7 , 8 , 9 , 10 , 12 , 13 ] The hypothesis/study question and the major objectives are also stated under this subheading.[ 3 , 7 , 8 , 9 , 10 , 12 , 13 ]

Methods: This subsection is the longest, states what was done, and gives essential details of the study design, setting, participants, blinding, sample size, sampling method, intervention/s, duration and follow-up, research instruments, main outcome measures, parameters evaluated, and how the outcomes were assessed or analyzed.[ 3 , 7 , 8 , 9 , 10 , 12 , 13 , 14 , 17 ]

Results/Observations/Findings: This subheading states what was found, is longer, is difficult to draft, and needs to mention important details including the number of study participants, results of analysis (of primary and secondary objectives), and include actual data (numbers, mean, median, standard deviation, “P” values, 95% confidence intervals, effect sizes, relative risks, odds ratio, etc.).[ 3 , 7 , 8 , 9 , 10 , 12 , 13 , 14 , 17 ]

Conclusions: The take-home message (the “so what” of the paper) and other significant/important findings should be stated here, considering the interpretation of the research question/hypothesis and results put together (without overinterpreting the findings) and may also include the author's views on the implications of the study.[ 3 , 7 , 8 , 9 , 10 , 12 , 13 , 14 , 17 ]

The eight-point structured abstract: This has the following eight subheadings – Objectives, Study Design, Study Setting, Participants/Patients, Methods/Intervention, Outcome Measures, Results, and Conclusions.[ 3 , 9 , 18 ] The instructions to authors given by the particular journal state whether they use the four- or eight-point abstract or variants thereof.[ 3 , 14 ]

Descriptive and Informative abstracts

Descriptive abstracts are short (75–150 words), only portray what the paper contains without providing any more details; the reader has to read the full paper to know about its contents and are rarely used for original research papers.[ 7 , 10 ] These are used for case reports, reviews, opinions, and so on.[ 7 , 10 ] Informative abstracts (which may be structured or unstructured as described above) give a complete detailed summary of the article contents and truly reflect the actual research done.[ 7 , 10 ]

Drafting a suitable abstract

It is important to religiously stick to the instructions to authors (format, word limit, font size/style, and subheadings) provided by the journal for which the abstract and the paper are being written.[ 7 , 8 , 9 , 10 , 13 ] Most journals allow 200–300 words for formulating the abstract and it is wise to restrict oneself to this word limit.[ 1 , 2 , 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 22 ] Though some authors prefer to draft the abstract initially, followed by the main text of the paper, it is recommended to draft the abstract in the end to maintain accuracy and conformity with the main text of the paper (thus maintaining an easy linkage/alignment with title, on one hand, and the introduction section of the main text, on the other hand).[ 2 , 7 , 9 , 10 , 11 ] The authors should check the subheadings (of the structured abstract) permitted by the target journal, use phrases rather than sentences to draft the content of the abstract, and avoid passive voice.[ 1 , 7 , 9 , 12 ] Next, the authors need to get rid of redundant words and edit the abstract (extensively) to the correct word count permitted (every word in the abstract “counts”!).[ 7 , 8 , 9 , 10 , 13 ] It is important to ensure that the key message, focus, and novelty of the paper are not compromised; the rationale of the study and the basis of the conclusions are clear; and that the abstract is consistent with the main text of the paper.[ 1 , 2 , 3 , 7 , 9 , 11 , 12 , 13 , 14 , 17 , 22 ] This is especially important while submitting a revision of the paper (modified after addressing the reviewer's comments), as the changes made in the main (revised) text of the paper need to be reflected in the (revised) abstract as well.[ 2 , 10 , 12 , 14 , 22 ] Abbreviations should be avoided in an abstract, unless they are conventionally accepted or standard; references, tables, or figures should not be cited in the abstract.[ 7 , 9 , 10 , 11 , 13 ] It may be worthwhile not to rush with the abstract and to get an opinion by an impartial colleague on the content of the abstract; and if possible, the full paper (an “informal” peer-review).[ 1 , 7 , 8 , 9 , 11 , 17 ] Appropriate “Keywords” (three to ten words or phrases) should follow the abstract and should be preferably chosen from the Medical Subject Headings (MeSH) list of the U.S. National Library of Medicine ( https://meshb.nlm.nih.gov/search ) and are used for indexing purposes.[ 2 , 3 , 11 , 12 ] These keywords need to be different from the words in the main title (the title words are automatically used for indexing the article) and can be variants of the terms/phrases used in the title, or words from the abstract and the main text.[ 3 , 12 ] The ICMJE (International Committee of Medical Journal Editors; http://www.icmje.org/ ) also recommends publishing the clinical trial registration number at the end of the abstract.[ 7 , 14 ]

Checklist for a good abstract

Table 3 gives a checklist/useful tips for formulating a good abstract for a research paper.[ 1 , 2 , 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 17 , 22 ]

Checklist/useful tips for formulating a good abstract for a research paper

Concluding Remarks

This review article has given a detailed account of the importance and types of titles and abstracts. It has also attempted to give useful hints for drafting an appropriate title and a complete abstract for a research paper. It is hoped that this review will help the authors in their career in medical writing.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Acknowledgement

The author thanks Dr. Hemant Deshmukh - Dean, Seth G.S. Medical College & KEM Hospital, for granting permission to publish this manuscript.