swot analysis qualitative research

SWOT Analysis

All business students are assigned to conduct SWOT analysis, usually at the earlier stages of their studies. This page focuses on the application of SWOT analysis in a business context as a part of academic assignments . This is a comprehensive SWOT resource and it contains an explanation of SWOT theory, an illustration of how to do a SWOT analysis and links to examples of SWOT analysis of major multinational brands. Moreover, SWOT analysis template further below can be used to generate SWOT tables of top multinational companies along a range of industries.

SWOT Analysis: Theory

SWOT is a strategic analytical tool for assessing strengths and weaknesses of a business, analyzing opportunities available to the business, as well as, threats faced by the business. SWOT analysis can be used at organizational and personal levels.

As it is illustrated below, strengths and weaknesses are internal, i.e. businesses are able to influence and to manipulate with their strengths and weaknesses. Opportunities and threats, on the other hand, are external. It means businesses can only react to opportunities and threats and they do not have any means to influence opportunities and threats.

SWOT analysis has important practical implications. Specifically, with findings of SWOT analysis in their hands, the senior level management identify and built upon their strengths, discover new opportunities and work upon eliminating or minimising threats to the business. Accordingly, SWOT can be a powerful aid for senior level management to develop appropriate strategy for the business.

As a strategic analytical tool, SWOT analysis has some weaknesses as well. Specifically, the application of this tool may encourage users to focus on quantity of factors, instead of focusing on a few, but the most powerful factors having the biggest impact on the business. In other words, SWOT analysis lacks guidance and provision in terms of differences in importance between factors. As a result weak strengths may appear to balance strong weaknesses.

The majority of sources explaining SWOT analysis assume that their audience is businesses aiming to improve their operational efficiency. This SWOT analysis resource is different. It explains SWOT analysis assuming that you a business student and you have been assigned to conduct SWOT analysis as a part of your assignment.

How to do SWOT Analysis

You can conduct a SWOT analysis with the following four steps:

Step 1: Selecting a company

If your assignment requires conducting a SWOT analysis, you are either given a case study company by your educational institution or you are free to analyze a company of your own choice. In the first scenario, you have no option but to conduct a SWOT analysis of the company named in your assignment instructions. However, the majority of educational institutions provide students the flexibility to conduct SWOT analysis of a company of their own choice.

Students are often tempted to conduct SWOT analysis of their employer. Choosing your employer as a case study can be a good strategy if you have an access to detailed relevant information. Please note that only descriptive information would not suffice and you will have to justify your arguments by referring to relevant quantitative data. Therefore, if you are not able to find relevant quantitative data about your employer, your best choice could be to conduct SWOT analysis of a multinational enterprise. This is due to the availability of data about the majority multinational enterprises. This portal offers up-to-date sample SWOT analyses of the most famous multinational enterprises as part of company reports .

Step 2: Finding information

If you are conducting a SWOT analysis of a small or medium sized organization such as your employer, family business or a company you are related to in some ways, approaching the company directly may prove to be an efficient strategy to obtain required information. You may try to secure a meeting with a senior level manager and explain practical implications of your SWOT analysis for the business. In other words, you may be able to convince a senior manager that results of your SWOT analysis may provide an important insight into the business and managers can act upon this knowledge to increase the efficiency of the business at various fronts.

Alternatively, if you are conducting SWOT analysis of a multinational enterprise, company annual report is usually the most comprehensive source of the relevant information. Note that annual reports highlight information about strengths of the business within the first few pages and you cannot find information about weaknesses of a company in its annual report for obvious reasons.

Information about Strengths in SWOT Analysis

Information about strengths of the company is easiest to find in your SWOT analysis. Strengths are competitive advantages of the business that made it successful in the first place. In case of small or medium sized organizations, the manager you are interviewing will be happy to discuss the strengths of the business.

In case of multinational companies, on the other hand, the first few pages of annual reports boast about competitive advantages of the business by referring to specific figures and charts. Using some of these charts in your assignment and properly referencing the source is going to increase the quality of your work.

You can determine strengths of businesses in answers to the following questions:

What advantages does the company have?
What does the company better than its competitors?
What unique or low-cost resources are available to the company that are not available to its rivals?
What Unique Selling Propositions (UPS) are associated with the company?

The following table illustrates the major strengths possessed by businesses and tips about how to discuss these strengths in your swot analysis:

Information about Weaknesses in SWOT Analysis

It may not be easy to find information about weaknesses of small and medium sized businesses. The manager you are interviewing may not want to discuss weaknesses of their business either intentionally, or they may not be aware of weaknesses. It is important for you to motivate your interviewee to discuss weaknesses of their company by asking relevant questions in a polite way.

It is easier with multinational organizations. An extensive online research can reveal relevant information about weaknesses associated with the company you are analyzing.The majority of big corporations have been involved in some kind of scandals during the past two years and you can discuss the damage of these scandals to the brand image as noteworthy weakness of the company.

For example, suppose you have chosen Coca Cola Company for your SWOT analysis assignment. If you google the term ‘Coca Cola scandal’, search results on the top relate to a scandal where the company funded obesity research that downplayed the negative health implications of Coca Cola products. Negative implications of this incident on Coca Cola brand image is brand’s weakness you can discuss in you SWOT analysis.

All arguments and numbers need to be referenced using referencing style required by your educational institution in an appropriate manner. Preference has to be given to online journals and magazines over online discussion forums and personal blogs.

Answers to the following questions can help to identify weaknesses of your case study company:

What aspects of the business could the company improve?
What should the company avoid?
What factors are causing the company to lose sales?
What aspects of products/services are customers are likely to see as weaknesses?

Major weaknesses of businesses and brief tips about discussing them in your assignment are illustrated in the following table:

Information about Opportunities in SWOT Analysis

Information about opportunities available to the business can be derived from its weaknesses in a way that businesses often have an opportunity to turn their weaknesses into strengths. At the same time, it is important that your SWOT analysis also identifies a set of opportunities that are not related to weaknesses. If you can’t think of any company-specific opportunities, you can discuss business opportunities that can be explored by any business in general, such as new product development, international market expansion and increasing the level of effectiveness of social media marketing. Interesting trends in the industry can also be opportunities for the business.

Opportunities can be identified through answering the following questions:

What are interesting trends in the market that can be profitably explored by the company?
What are the demographic and social changes that present new opportunities in the industry?
Are there any government policies and regulations that can help the industry?
Are there any opportunities for the company related to technological developments?

The following table illustrates the major opportunities available for businesses and tips about how to discuss these opportunities in your SWOT analysis:

Information about Threats in SWOT Analysis

Threats faced by the business can be classified into two categories. Firstly, there are company-specific threats that stem from company-specific factors such as the threat of losing market share due to ineffective cost structure or the threat of negative media coverage and damage to the brand image due to neglecting the importance of corporate social responsibility. Secondly, there are threats to the industry or to the economy on the whole, such as a threat of introducing tariffs to a certain range of products or the threat of a global economic and financial crisis. You will need to find information about threats belonging to both categories with more emphasis on the threats from the first category, i.e. company-specific threats.

You can identify the main threats to the business through answering the following questions:

What are the main obstacles faced by the company?
What are the latest developments in competitor Unique Selling Propositions?
Does the company have substantial amount of bad debts or cash-flow problems?
Was the company involved in any scandal recently?

Main threat facing the majority of businesses and brief tips about discussing them in your SWOT analysis are illustrated in the following table:

Step 3: Writing

You can structure your writing of SWOT analysis in the following way:

Firstly, you will need to discuss the company profile, its strategy and the most recent changes that have taken place in the company prior to presenting your SWOT analysis. The length of such a discussion depends on your assignment instructions and the total word count for your assignment.

Secondly, develop a SWOT Analysis Matrix for your chosen company. You can develop a table containing four sections headed strengths, weaknesses, opportunities and threats. Major strengths, weaknesses, opportunities and threats of your chosen company can be presented in bullet points under respective boxes. These should be precise and verifiable statements.

Using steps 1 and 2 above, you should have long list of factors related to strengths, weaknesses, opportunities and threats for the business. Now it is time to prioritize factors to be included in your SWOT analysis by focusing on the most significant factors. The numbers of factors that should be discussed under each category depends on the total word-count for your assignment.

Thirdly, you have to discuss bullet points in your SWOT table. Your analysis needs to contain statistical data and ideally graphs and tables as well. Do not forget to reference sources, using referencing system required by your university. Moreover, you can discuss how to address weaknesses and threats identified as a result of your SWOT analysis and get additional marks for your work.

SWOT Analysis Example

This portal contains example SWOT analysis of the following companies:

SWOT is an acronym for strengths, weaknesses, opportunities and threats related to organizations. The following table illustrates SWOT analysis:

SWOT Analysis Template

Please choose an industry and a company below to generate a SWOT table containing bullet points of strengths, weaknesses, opportunities and threats of your chosen company. In order to complete the SWOT analysis you will need to expand the bullet points into a couple of paragraphs with discussions and references from reliable sources to support your arguments.

What Is a SWOT Analysis?

A SWOT (strengths, weaknesses, opportunities, threats) analysis is a visual framework used for strategic planning across all types of businesses and organizations. SWOT analyses are made up of four components that will help you determine the output of your team’s analysis.

What Does SWOT Analysis Stand For?

Opportunities, how do i do a swot analysis.

A SWOT analysis is a qualitative assessment of a company’s SWOT components. Individuals responsible for the assessment fill out a visual template similar to the figure above, which is usually laid out in a two-by-two matrix. This template helps visualize all the SWOT elements together in their entirety.

To understand in more detail the elements of this template, let’s dive into each component individually.

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What Are the 4 Components of a SWOT Analysis?

Your strengths are organizational features that provide a competitive and strategic advantage relative to the market and competition.

Weaknesses

Your weaknesses include organizational features that are lacking relative to market competition, or that hinder the organization’s overall effectiveness to compete, grow, and strive for optimal business performance.

These are favorable market conditions or external developments that represent an opportunity for unlocking or improving the organization’s competitive positioning and business performance. Opportunities can be related to present market conditions, but can also be forward-looking.

These are unfavorable market conditions or external developments that pose a risk to the organization’s performance or the entire viability of the current market. Threats can be related to present market conditions, but can also be forward-looking. (e.g. near-term competitive threats or geopolitical risks would be good examples to feature in this bucket)

Strengths and weaknesses are factors that are owned (and thus controlled) by the organization. As a result, the organization and its team can directly influence strengths and weaknesses.
Opportunities and threats are factors that cannot be controlled by the organization. For example, a near-term innovation trend or advantageous legal ruling that may come into play are considered opportunities, whereas near-term competitive innovation or geopolitical risks fall within the threats bucket. In either instance, your organization may prepare for these events, but it cannot control them.

During the process of filling in this template, you’ll consider all four elements individually. Once you complete the template, through brainstorming sessions and workshops, you can start putting together an actionable plan to capitalize on your strengths and opportunities while countering your weaknesses and threats.

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SWOT Analysis Example

Let’s take, for example, a smartphone-producing company in the technology industry. Your example SWOT table may include the following.

Strengths :

Strong brand positioning
Loyal customer base
High barriers to entry for the competition due to recent patent filings

Weaknesses:

Recently departed CEO who led the company for the previous 15 years
Production bottlenecks in key geographical regions
Leaked PR documents

Opportunities:

Customer trends indicating a shift towards higher-end smartphones in emerging markets
Weakened competition due to a key competitor recently filing for bankruptcy
Increased regulatory scrutiny
Global chip shortage

As a result and potential plan of action, the company in question may decide to focus on mitigating the risks caused by its weaknesses (for example by increasing production in key regions close to the ones suffering bottlenecks in addition to selecting an experienced interim CEO as soon as possible) while seizing market opportunities that may not come about again (i.e. gaining market share in the short term by exploiting the competitor’s bankruptcy).

Overall, resource allocation should flow to:

Seizing market opportunities
Developing mitigation plans for market threats and investing in limiting potential damage or performance slowdowns caused by internal weaknesses

Why Use a SWOT Analysis?

The results of a SWOT analysis inform your company’s strategic plan and help you make decisions about how to allocate future resources. As a result of a SWOT analysis your team might decide on the following:

investment/divestments related to a given product line
international market entry or market expansions
changes to the company’s position relative to its competition (based on factors such as price, target customers and barriers to entry among others)
adjustments to external macroeconomic trends (raise in interest rates) or market-related dynamics (global supply chain constraints)

SWOT Analysis Advantages and Disadvantages

The SWOT analysis as a framework for strategic planning has received its fair share of critique and scrutiny. Let’s review some of the pros and cons.

SWOT Analysis Advantages

10,000-Foot View : A SWOT allows you to consider multiple factors that you might not normally associate together all at once (departing CEO and macro-trends, for example). This process can invite management to identify creative solutions to company issues that may have previously been hard to identify; having this combination of different sources of data, from internal balance-sheet metrics to market data points to press releases may enable your organization to find more comprehensive and representative patterns.
Cross-Team Collaboration : SWOT analyses create space for the representation of multiple viewpoints within the organization. The exercise invites people from different departments of the organization to contribute and collaborate across departments, thereby enriching the overall quality of the SWOT analysis and enabling better communication across company silos.
Simplicity: A SWOT is a simple framework that allows you to consider and break down complex problems that are usually considered and tackled separately but without a link to the bigger picture offered by a SWOT exercise.
Simultaneous Consideration of Internal and External Factors : A SWOT allows us to relate internal factors with external factors, which is important since these two sides are usually considered separately from one another and only more broadly considered at the executive level. For this reason, conducting a SWOT exercise at the department level allows internal teams to understand how external forces influence and relate to their day-to-day operations.

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SWOT Analysis Disadvantages

Groupthink and Bias: The generation of a SWOT chart is heavily influenced by the individuals tasked with the exercise. If the group isn’t diverse or made up of representatives from around the organization, the analysis will result in biased outcomes and lopsided strategies.
Short Shelf Life : A SWOT analysis is a spot exercise, which means we typically perform them as a one-off planning effort. In fast-changing markets, its results (and, thus, its overall relevance) can go out of date quickly.
Research shows a weak link between the SWOT exercise and actual strategic decision-making and organization follow-through. As a result, we’ve seen alternative frameworks emerge, most notably Porter's five forces analysis .

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Situational Analysis/SWOT

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Karl Raimund Popper (1902–1994), the Austrian-British philosopher and professor, first developed the method of Situational Analysis and included it in his book, “The Poverty of Historicism,” in 1938. Later, he explained the concept in more detail in Chap. 14 of his work entitled “The Open Society and Its Enemies” in 1945.

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Boundless. M. (2014). Conduct a situational analysis Marketing Hub. http://www.boundless.com/marketing/textbooks/boundless-marketing-textbook/marketing-strategies-planning-2/steps-to-creating-a-marketing-plan-28/conduct-a-situational-analysis-151-7221

Bunge, M. (1996). The seven pillars of Popper’s social philosophy. Philosophy of the Social Sciences., 26 , 528–556. https://doi.org/10.1177/004839319602600405

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Additional Readings

Perera, R. (2020). Conducting a SWOT analysis . Independently Published.

Sarsby, A. (2016). SWOT analysis . Spectaris Ltd.

Sustrisno, A., Kwon, H. M., Gunawan, I., Eldridge, S., & Lee, T. R. (2016). Integrating SWOT analysis into the FMEA methodology to improve corrective action decision-making. International Journal of Productivity and Quality Management, 17 (1), 1–23. https://doi.org/10.1504/IJPQM.2016.073283

Villegas, R. (2017). SWOT analysis supercharged . Createspace Independent Publishing Platform.

Online Resources

How to perform a SWOT analysis . https://www.youtube.com/watch?v=I_6AVRGLXGA

How to do a SWOT analysis presentation, PESTLE & Porter 5 forces in 2020 . https://www.youtube.com/watch?v=dswljdE9B8Y

Situation analysis . https://www.youtube.com/watch?v=gkBtCmwSlVI

SWOT analysis—What is SWOT? https://www.youtube.com/watch?v=JXXHqM6RzZQ

What and how of situation analysis . https://www.youtube.com/watch?v=xlln-Cst23E

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Ndame, T. (2023). Situational Analysis/SWOT. In: Okoko, J.M., Tunison, S., Walker, K.D. (eds) Varieties of Qualitative Research Methods. Springer Texts in Education. Springer, Cham. https://doi.org/10.1007/978-3-031-04394-9_68

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SWOT Analysis Example: Definition and Template

SWOT analysis provides a comprehensive framework with a SWOT analysis example for evaluating internal and external factors impacting a company’s performance and competitiveness. By identifying a company’s strengths and weaknesses within the organization and analyzing opportunities and threats of different perspectives in the external environment, a SWOT analysis enables businesses to develop strategies for a new project that leverage their strengths, mitigate weaknesses, capitalize on opportunities, and overcome threats and negative factors

A SWOT analysis example can be valuable for understanding how this analytical strategic planning technique can be applied in practical scenarios. Whether you are a business professional, an entrepreneur, or a student studying strategic management, this SWOT analysis example will provide valuable insights and a deeper appreciation of the power of this analytical tool. So let’s dive into SWOT analysis examples and unlock the potential for strategic success with intellectual property!

SWOT Analysis: Definition

SWOT analysis is defined as an acronym for Strengths, Weakness, Opportunities, and Threats which is an effective market research analysis technique. Usually, SWOT analysis is used to evaluate an organization’s performance in the market and is used for developing effective business strategies.

LEARN ABOUT: Market research industry

This SWOT analysis framework, which is now a trusted assessment source that organizations rely on to understand the scope of opportunities, value proposition, and threats by analyzing the strengths and weaknesses.

SWOT Analysis with Internal and External Factors

Strengths and weaknesses are primarily for internal analysis of an organization (in terms of market reputation, manufacturing line location, patents, etc.). To improve these good SWOT analysis factors, constant work needs to be put in over a course of time. But, opportunities and threats are external (in terms of competition, prices, associated partners, etc.) to an organization and they have no control over the changes that might occur to these external factors.

LEARN ABOUT: Market Evaluation

SWOT analysis is also used in micro situations such as –

When an organization’s strength is the product quality and there are chances of conversion of a particular deal, it will be advisable for the organization to assign a capable workforce for the closure of this deal. It is a SWOT analysis example of internal factors.
Identifying weaknesses and their corresponding hindrances, the organization can strategize on how to overcome the weaknesses. For instance, if the sales results are a definite weakness for a company, they can try to minimize or eliminate it by regular training for the sales employees, providing access to multiple tools so that they can work off their skills, implementation of an efficient Customer Relationship Management software and other such corrective measures can be taken through this SWOT analysis. It is a good SWOT analysis example.
A competitor losing its customers and going bankrupt can be a huge business opportunity for an organization intending to expand operations. Proactive research on how to operate, demographic segmentation and taking advantages of the identified strengths to ensure the competitor’s market is explored.
Taking into consideration, organizational strengths and weaknesses, factors which may cause harm to the organization’s reputation can be identified. Considering swot analysis example, if the market forecast suggests a downfall in the economy, an organization can be prepared for it by reducing unwanted expenditures, appointing existing star-performers for sales conversions, etc.

Organizations conduct SWOT analysis extensively to make internal (strengths and weaknesses evaluation) and external (opportunities and threat evaluation) improvements as it can access an excessive pool of information with SWOT analysis examples. Already-existent companies should execute this strategic competitive analysis method at least once or twice a year to make sure they proactively analyze their market to keep making enhancements in various aspects of their organization.

Learn more: Market Research Survey

Importance of SWOT Analysis

The importance of SWOT analysis lies in its ability to provide organizations with a structured framework to assess their current situation and make informed decisions with a SWOT analysis example. Here are some key reasons why SWOT analysis is essential:

Strategic Planning:

SWOT analysis is a fundamental tool in business strategy. It helps organizations identify their internal weaknesses and strengths, and also external opportunities and threats. This information is crucial for formulating effective strategies that leverage strengths, address weaknesses, capitalize on opportunities, and mitigate threats.

Competitive Advantage:

SWOT analysis helps organizations identify and leverage their unique strengths to gain a competitive advantage in the market. By understanding market gaps, trends, and consumer preferences, organizations can align their strategies to exploit opportunities and differentiate themselves from competitors.

Alignment of Resources:

SWOT analysis helps organizations align their resources, such as financial, human, and technological, with their strategic objectives. By identifying internal strengths, organizations can allocate resources to areas where they are most effective. It ensures optimal resource allocation and maximizes organizational efficiency.

Risk Assessment:

SWOT analysis enables organizations to evaluate external threats and opportunities that may impact their operations. Organizations can develop contingency plans and proactively respond to challenges by identifying potential risks. Additionally, recognizing opportunities allows organizations to capitalize on market trends and gain competitive advantages.

Decision Making:

SWOT analysis provides a systematic approach to decision-making. It offers a comprehensive overview of various factors influencing an organization’s success. By weighing the internal and external factors, decision-makers can make informed choices that align with the organization’s goals and objectives.

Enhanced Communication and Collaboration:

SWOT analysis encourages collaboration and communication among organizational stakeholders. It brings diverse perspectives and insights, fostering a shared understanding of the organization’s strengths, weaknesses, opportunities, and threats. This collaborative approach promotes a more comprehensive and holistic decision-making process.

SWOT analysis is a necessary tool for organizations of all sizes and industries. It enables them to assess their current market position, identify key factors influencing their success, and make strategic decisions to achieve their goals.

Free SWOT Analysis Template in Market Research

A free SWOT analysis template can be a valuable resource in market research to assess an organization’s factors. The free SWOT Analysis template is a walk-through of how to conduct SWOT analysis using the 4 models: Strength, Weaknesses, Opportunities and Threat analysis. Here are the 4 SWOT Analysis templates in details:

What is the organization good at doing? What are the key differentiators they offer? What are the primary resources they have?

Strengths depict the positive factors of an organization which they can control. They can be analyzed by dividing the organization into sales, finance, marketing plan, market share, research and development, and other structural elements. Strengths involve the positive contribution of key stakeholders in terms of experience, knowledge, educational background and such skills that contribute towards the performance of an organization. This SWOT analysis factor also includes tangible assets such as distribution channel, existing customers, generated finance, accessories etc.

Factors that add value to an organization’s operation by internal factors of a SWOT analysis and in turn build a competitive advantage called Strengths.

Learn more: Quantitative Market Research

Weaknesses:

Where do you think there is a scope for improvement?

Weaknesses are those elements of the business which still need a lot of enhancement and are bringing the organization down in more than one way. There are certain areas of business which might not be shaping up according to expectation and this is leading to friction in achieving the desired goals.

Segments such as subject matter expertise, lack of financial support, unavailability of appropriate technological tools for training, an inappropriate location of the organization, etc. can fall under the category of “weakness”. These segments are under a company’s control but are contributing to significant losses.

Weaknesses are negative aspects which are contributing to an organization’s competitive disadvantage in a marketing campaign. An accurate understanding of negative characteristics will help an organization to improve and compete with the best in the business.

Opportunities:

What are the opportunities in the market, the ones from which an organization can prosper?

Opportunities gauge attractive elements of a market which can contribute towards more profits for an organization. These are external factors to an organization’s environment. There are always new avenues that crop up after executing marketing strategies. So, opportunities are generally the outcome of revenue/market growth, changes in market perception, a solution to difficulties faced by the market currently, the ability of an organization to add value to the market that in turn increases brand value. Associate a timeline for the identified opportunity after understanding whether it fits the current marketing strategy and also, whether the opportunity can be seized in the pre-decided timeline.

Which aspects of the market are a threat to a business?

Threats indicate those factors which may cause harm to the organization’s existing marketing strategies and also eventually lead to business losses. An organization can profit from inculcating the possibility of these risks into their marketing plans. Threats are those uncontrollable factors which will create business losses. Competitors, change in government policies, bad press coverage for products/services/events, a shift in customer behavior, change in market dynamics which might make certain products outdated and other similar angles are considered to be threats.

Learn more: Qualitative Market Research

Using this swot analysis template, you can conduct a comprehensive SWOT analysis by gathering relevant information and insights through market research methods, such as surveys, interviews, and data analysis. The swot template guides you to consider all factors that can impact your organization’s performance and competitiveness in the market.

Customize the free template based on your specific industry, market, and organization. The goal is to accurately assess your company’s strengths, weaknesses, opportunities, and threats, leading to actionable insights for strategic decision-making in your market research efforts

How to do a SWOT Analysis for a Business Plan?

There are two types of factors in a business model: internal factors and external factors. The factors which would exist irrespective of the existence of a specific organization are considered to be external and those that exist within an organization are of course, internal factors.

Implement the below mentioned 8 steps for SWOT analysis to develop a strategic plan:

1. Have a clear SWOT analysis objective:

The marketing team can discuss which topic needs immediate attention and this objective can be put to paper. This way, SWOT analysis can be conducted in an organized and effective manner. For example, if an organization intends to know whether or not to launch a new product line – this becomes the primary objective of SWOT analysis.

2. Conduct research to understand the target market:

For successful implementation of SWOT analysis, there should be a thorough understanding of what the market has to offer. Insights obtained from research about technology, customer service, competitors, etc, can be used to conduct an exhaustive SWOT analysis.

3. Identify business’s strengths:

An organization should understand what their strengths are, what are those features of their functioning which are better than the others in the market. Answers to these questions must be noted down. Workforce, location of the organization, product quality, etc. are some SWOT analysis examples of an organization’s strengths.

4. Identify the business’s weaknesses:

There are certain elements of the organization which need improvement. Marketers should create a list of these elements which they believe are harming their reputation in the market. Acknowledging these company’s weaknesses and working to eliminate them should be the intention of the SWOT analysis. This list can include aspects such as the reduction in product clients, constant downsizing of market share, lack of proper staff members et al.

5. Identify potential opportunities:

Evaluate external factors which can be lucrative for business growth. These are not internal processes and there are chances of the same factor being a threat to the business as well. While listing opportunities, one should keep in mind that opportunities should not be a threat to the business. As a swot analysis example, launching a new feature after opportunity SWOT analysis might cause damage to business in case there are competitors who offer the same feature at lower costs.

6. Identify threats to the organization:

Note down factors that are not a part of an organization’s ecosystem but are threats to business growth or personal growth. Unstable markets, the increasing competition in the market etc. are some threats to a small business.

7. Allot importance to various factors from SWOT analysis:

After completing step 3 to step 6, four different lists will be formed. The ideal way of amalgamating these lists is creating a side-by-side matrix . A matrix helps in generating a comprehensive picture for SWOT analysis.

Once the lists are put into a SWOT matrix, the degree of importance corresponding to each of the points so that marketing strategies for immediate implementation can be put into action.

Ask the following SWOT analysis questions to understand the priority:

Can the organization implement their strengths to benefit from existing opportunities?
Can the organization implement their strengths to get a grip on identified threats?
What are the steps to be taken in order to make sure the organization’s weaknesses do not hinder taking advantage of the opportunities?
What can be done to reduce weaknesses to get a grip on threats?

8. Create a strategy to solve identified problems:

After creating the SWOT matrix and answering all these questions, the marketing team can work to create marketing strategies to attain organizational aims.

Personal SWOT Analysis Examples

Strong communication skills
Analytical thinking and problem-solving abilities
Leadership and teamwork skills
Adaptability and flexibility
Excellent time management skills
Lack of experience in a specific area
Difficulty in delegating tasks
Limited technical skills in particular areas
Difficulty in managing stress and pressure
Lack of assertiveness in certain situations
Emerging markets and industries
Technological advancements in the field
Expansion or growth of existing industries
Changing demographics or consumer needs
Increasing demand for specific skills or expertise

LEARN ABOUT: Test Market Demand

Intense competition in the industry
Economic downturns or recessions
Potential job automation or outsourcing
Lack of job security or instability in the market
Limited access to resources or funding

A personal SWOT analysis provides valuable insights into one’s strengths, weaknesses, opportunities, and threats. Individuals can develop personal and professional growth strategies by leveraging strengths, addressing weaknesses, capitalizing on opportunities, and mitigating threats.

SWOT Analysis Example with Questions

In this SWOT analysis example, we will consider a fictional company, ABC Electronics, and explore the questions that can be asked in each category of the SWOT framework: Strengths, Weaknesses, Opportunities, and Threats.

Purpose: Launching a new mobile variant

What are your strongest assets?
How are your products/services better than competitors?
What is your unique selling point?
How efficient is your workforce?
What do your existing customers have to say about their experience with your organization?
Which sections of your organization need improvement?
Which aspects of your business can the competitors benefit from?
Do you lack subject matter technical expertise?
Do you think your business has made enough money?
How progressive are your competitors in terms of coping with market trends?
Which trends do you think can bring you new opportunities?
Will these trends benefit the market?
Where does the current market lack?
Are your competitors not successful in meeting customer demands?
If yes, can you target those customers?
Are there competitors in the market who can cut down your business?
What are the roadblocks you are currently facing?
Do your products/services comply with every existing law?
Do you foresee a change in government laws in the near future?
Do you believe your target audience might evolve in their product preferences?

By asking these questions and thoroughly analyzing each category of the SWOT analysis example, ABC Electronics can gain valuable insights for strategic decision-making. It is important to remember that the questions and factors considered will vary depending on the analyzed organization’s industry, market, and specific circumstances

SWOT analysis is a powerful tool that empowers organizations to assess their internal swot analysis strengths and weaknesses, as well as external opportunities and threats. SWOT analysis plays a vital role in the strategic planning process, enabling organizations to align their resources, identify areas for improvement, and capitalize on market opportunities.

However, it is essential to remember that each organization is unique, and customization of the SWOT analysis template to suit specific needs and contexts is vital. Utilizing the QuestionPro SWOT template for conducting a SWOT analysis offers organizations a powerful toolset to gather, analyze, and communicate data effectively. By leveraging these features, organizations can better understand their internal strengths and weaknesses, identify market opportunities, and mitigate potential threats. A comprehensive SWOT analysis using QuestionPro empowers organizations to make informed decisions, develop effective strategies, and drive overall success.

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Youwei Zhu 1 ,
Na Zhong 1 ,
Hang Su 1 ,
Xiaolu Ruan 1 ,
Jiayi Bao 1 ,
Lei Zhang 1 ,
Jiang Du 1 ,
Ding Xu 2 ,
Rongjie Ding 3 ,
Ke Xiao 3 and
1 Shanghai Mental Health Center , Shanghai Jiao Tong University School of Medicine , Shanghai , China
2 Shanghai Bureau of Drug Administration , Shanghai , China
3 Shanghai Gaojing Compulsory Drug Dependence Treatment Center , Shanghai , China
4 Shanghai Key Laboratory of Psychotic Disorders , Shanghai , China
Correspondence to Dr Min Zhao; drminzhao{at}gmail.com

Background Despite high relapse rate among methamphetamine (MA) abusers, there still have been little empirical data to date detecting the risk factors related to craving and relapse from the perspective of MA abusers. Therefore, the aim of this study was to use qualitative research methods exploring the strengths, weaknesses, opportunities and threat factors that could facilitate or impede individuals’ abstinence in a real-life context from the perspectives of MA abusers.

Aim To use qualitative research methods exploring the strengths, weaknesses, opportunities and threat factors relating to individuals’ abstinence in a real-life context.

Method Semistructured interviews were conducted with 32 MA abusers recruited in Shanghai guided by open-ended questions on narrating the real-life catalysts and inhibitors related to craving, initiation, relapse and abstinence. All data were transcribed verbatim and analysed using a strengths, weaknesses, opportunities and threats (SWOT) analysis.

Results The results of the SWOT analysis revealed that contextual factors including peer influence, prevalence and availability of MA, familiar venue of MA use, discrimination, sexual behaviours, alcohol, emotional states and their attitudes towards smoking MA were important factors that contribute to reinitiation and relapse. Surveillance systems, antidrug social workers, vocational skills trainings, moving to another city and family responsibility might serve as counter measures targeting those mentioned weaknesses and threats above.

Conclusion This SWOT analysis highlights the complex nature of relapse. Comprehensive interventions strengthening coping skills such as virtual reality techniques are desperately needed to facilitate individuals’ sustained abstinence.

methamphetamine
qualitative research
SWOT analysis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/gpsych-2019-100062

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Introduction

Methamphetamine (MA) has long been one of the most abused drugs worldwide. 1 While in China, it has become the most popular illicit drug since 2015. 2 MA use is associated with individuals’ poor physiological and psychological well-being, increased HIV/AIDS infection and increased crime rates, 3 and currently is a major public health issue both in mainland China and worldwide. Previous follow-up studies have shown that approximately 50% of patients relapsed within 6 months of treatment and developed the addiction again. 4 In addition, nearly 80% of patients would enter into a vicious cycle of ‘treatment-abstinence-relapse-addiction’, 5 thereby seriously affect their health and quality of life. As for MA, it was estimated that nearly 36% of abusers failed to remain abstinent during the first 6 months after treatment. 6 In mainland China, generally more than 90% of patients relapsed within 1 year after discharge from treatment. 7 According to the United Nations Office on Drugs and Crime, China has become one of the main markets and principal flows of MA worldwide. 8 With its severe addictive effect and neurotoxicity, MA has brought serious effects and economic burden to the whole society in China and presents a great challenge to public health. Unfortunately, until now, there is no effective medical treatment for MA addiction, and finding new treatment approaches for MA addicts is still an urgent matter. 9

Qualitative and quantitative studies have indicated that a great number of internal and external risk factors, such as positive and negative life events, social contexts, socioeconomic conditions, craving, peer pressure and lack of social support, 10 were related to individuals’ attrition from treatment and relapse. Additionally, craving reflects a strong desire to take drugs and terminate withdrawal symptoms or unpleasant feelings immediately, 11 and is one of the most important predicting factors and highly correlated with continuous drug abuse and relapse. 12 Moreover, craving is a subjective experience and therefore better understanding of the causes of craving from the patients’ viewpoint may have potential value to the development of new therapeutic approaches.

Many current intervention studies on addiction mainly focus on reducing and helping patients better manage their craving 13 and show promising results. These studies have already indicated that multiple promising treatment approaches such as pharmacotherapy, cognitive–behavioural therapy, cognitive remediation therapy, cognitive bias modification, mindfulness-based treatment and repetitive transcranial magnetic stimulation can help patients better reduce their self-reported craving, enhance their impaired impulse control abilities and contribute to a much longer period of abstinence. 14 Unfortunately, despite these efforts, attrition and relapse rates are still high among patients, and none of these mentioned medication treatments have been officially approved to treat MA addiction. 15 As such, it would be both highly important and urgent to develop better relapse prevention and management strategies for these patients.

Thus far, most of these studies were quantitative. However, studies focusing on patients’ experience and response to these risk factors contributing to individual’s craving in real-life circumstances are still insufficient, especially studies using a thematic analysis strategy to systematically analyse factors covering both internal and external aspects related to strengths, weaknesses, opportunities and threat factors contributing to abstinence or relapse. This makes it difficult to understand exactly how these factors facilitate or prevent craving and relapse based on one’s living experiences. What’s more, patients’ opinions and experiences of craving and smoking MA are critical in tailoring treatment systems and facilitating the best practices. Thus, qualitative studies using in-depth interviews with these patients would provide researchers important information about how these high-risk factors in a certain natural context may contribute or prevent individuals’ craving and relapse.

Thus, we conducted a qualitative study using the strengths, weaknesses, opportunities and threats (SWOT) approach to examine the personal experiences about factors that may facilitate or impede abstinence in a real-life context from the perspectives of MA abusers. SWOT analysis is one of the world’s most widely used methods for strategic planning. It was designed to assess strengths (S) and weaknesses (W) as internal capabilities, while opportunities (O) and threats (T) are posed by the external environment. 16 Through SWOT analysis, covering both internal and external environments, our focus was mainly on illuminating MA addicts’ experiences during abstinence and relapse periods, as this would help us understand the real-life catalysts and inhibitors contributing to one’s sustained abstinence, and hoping to inform future interventions for MA-related problems.

Participants

According to the Chinese antidrug law, compulsory isolated rehabilitation, community-based rehabilitation and voluntary detoxification treatment are three major drug rehabilitation modalities in China. If individuals were found abusing illicit drugs and diagnosed with drug addiction for the first and second time, they were required to receive either community-based rehabilitation or voluntary detoxification treatment. However, if they were found using drugs for more than three times or refuse to receive community-based rehabilitation, they are going to receive a two-year-long compulsory isolated rehabilitation. Furthermore, before the end of the compulsory isolated rehabilitation, participants were assigned with an antidrug social worker to ensure the continuous rehabilitation treatment in the community. Based on this situation, in this qualitative study, participants were also recruited from compulsory isolated rehabilitation centres, communities or hospitals. Eligibility criteria were: (1) meeting diagnostic criteria for MA dependence in accordance with the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; 17 (2) had a history of abstinence after MA addiction treatments and then relapsed at least once; (3) patients mainly used MA before receiving the latest detoxification rehabilitation treatment; (4) no language difficulties; and (5) no severe mental health problems. The exclusion criteria included: (1) current medical diseases that required hospitalisation or regular monitoring; (2) serious physical or neurological illness that required pharmacological treatment affecting cognitive function; and (3) IQ ＜70 ( figure 1 ).

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Flow chart of the study

A total of six semistructured in-depth interviews were performed. Participants were interviewed using a semistructured discussion guide developed from issues identified in previous literature related to abstinence and relapse, themes emerging from antidrug social worker interviews and in consultation with some senior professors of psychiatry at the Shanghai Mental Health Center. The interview guide was piloted with four MA addicts in another area, with minor amendments made before the interviews were formally conducted. The final topic guide covered five domains, as follows:

Histories of MA initiation.

Histories of treatment attempts and relapse.

Experiences on each abstinence attempt.

Important catalysts and inhibitors related to craving and relapse in the social environment.

Important factors facilitating or deteriorating abstinence.

For the purpose of privacy protection, participants were asked to use the given code names instead of their real names during the interview. They were encouraged to share their own stories related to MA smoking, especially the significant milestones when they relapsed or successfully overcame withdrawal and craving symptoms in accordance but not limited to the core topics. Sharing other interesting stories related to MA was also welcome. However, during the interview, participants could refuse to answer any topics or questions they were not interested in or felt uncomfortable with and they could also quit the interview at any time. One leading author together with three trained notetakers carried out all interviews and group discussions. Participants also signed a consent form before the interview. This qualitative research was carried out from April to November 2016 in Shanghai, China. Every interview and focus group discussion lasted about 1 hour and were conducted in private rooms at the Shanghai Mental Health Center.

Data analysis

Interviews were audio recorded with the permission of all the participants. Digital audio records were fully transcribed verbatim in Mandarin Chinese by two researchers independently before SWOT analysis. The SWOT analysis strategy aimed to summarise and develop themes and subthemes by generation of keywords, phrases, opinions, thoughts and attitudes of the participant towards external and internal factors in the social environment affecting abstinence. Because the transcribed data were in Mandarin Chinese, an inductive hand coding process was employed to help researchers derive potential themes. First, through an open coding procedure, transcribed data were first decomposed into many data units. These data units were then summarised and assigned a concept by the researchers, and appropriate codes were given according to the data unit concepts. 7 Second, based on the principles of system analysis, all possible key influencing factors are closely related to those achieving abstinence or restarting to abuse MA. Third, these key factors were further synthesised and organised into themes as internal and external factors. Subsequently, through a discussion meeting, identified factors were organised, synthesised and classified together into categories referring to strengths and weaknesses as internal capabilities, opportunities and threats posed by the external environment according to the SWOT analysis strategy by all authors.

Participant characteristics

A total of 32 participants were recruited and completed the interview ( figure 1 ). The mean (sd) age was 34.16 (7.13) years, average length of MA use was 4.22 (2.71) years, average years of education received was 8.84 (2.17) years, average abstinence/admission before the interview was 9.88 (8.77) months; 14 participants were unemployed before admission, 13 participants were married and 19 participants were unmarried (9 single and 10 divorced). Detailed demographic characteristics of the sample are displayed in table 1 .

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Characteristics of participants

Themes related to SWOT analysis

Themes and subthemes were identified as strengths, weaknesses, opportunities and threats based on the SWOT analysis model. The subthemes derived from the collected data were arranged under the themes found in figure 2 .

SWOT analysis matrix

External factors: strengths

Antidrug social workers.

Patients receiving community-based detoxification treatment, were assigned a social worker right before the end of compulsory isolation detoxification treatment. In Shanghai, there are a number of well-established rehabilitation social worker organisations helping patients sustain abstinence after drug addiction treatment. Participants agreed that these well-trained staff can provide good psychological counselling services, persuade them to do urine tests regularly and assist them in finding new jobs by arranging vocational skills training for them.

Vocational skills training

Some participants expressed that vocational skills training during detoxification treatments was crucial for them. These respondents described that with the skills they have learnt, they have successfully found a new job and been able to maintain abstinence longer.

I learned hairdressing skills, and with the help of my social worker and these skills, I finally found a new job and got a steady income. I have learned embroidery during compulsory isolation detoxification, and now am selling my hand-embroidered works through my own online store.

External factors: weaknesses

Peer influence.

Participants’ stories highlighting peer influence were still an important external driving force for relapse. More seriously, some participants even admitted that these ‘friends’ were their only remaining social relationships after chronic MA abuse and detoxification treatment, and they admitted that it was very difficult to refuse their friends, for fear of losing their remaining friends. Some participants also claimed that, after they finished their rehabilitation treatment, some of their ‘friends’ would ‘visit’ and persuade them to retry these drugs for celebration, and they did not know how to refuse them. More seriously, family and social supports were affected during treatments and their relationships were limited to other drug abusers that further worsen the effects of peer influence.

Prevalence and availability

Participants explained that they could get MA from their ‘friends’ and could even get MA in the communities where they were living. In addition, these patients admitted that, when facing real MA, they could hardly control the strong desires and craving for MA even if they have remained abstinent for a long time.

I initially tried MA in the community where I was living, and I could still purchase MA in the community even after two years of compulsory isolation detoxification treatments.

Familiar venue of MA smoking

Some participants complained that MA-related craving and memory could be evoked when participants went back to the place where they used to smoke and enjoy MA. These familiar places include the same hotel room, chamber in their home, offices and nightclubs.

After detoxification and rehabilitation treatments in a compulsory isolation center, I had to tell my family to rearrange the decoration of my bedroom where I used to smoke MA, because the moment I came into that room, I recalled the memory of a fun experience of using methamphetamine and the craving was aroused and became uncontrollable.

Discrimination

Participants complained that despite being abstinent for a long time, they were still judged by the people around them. They could still feel being looked down on by the residents in the community where they were living and even by their relatives, or when they were looking for a job.

My neighbors and relatives often looked down on me, and they would never believe I had quit smoking MA. Discrimination even exists during the job interview. Once the interviewers know I had a drug abuse history, they would hardly consider hiring me, and regard me as having low self-control, and could never stop taking MA.

Commodities in everyday life

Several participants claimed there were a number of commodities that can trigger craving in their daily lives. They described that rock candies, especially the brown crystal sugar in pieces, which they called ‘huang bing tang’ (in Chinese), produce more craving, and could lead to a powerful craving for MA. Second, auxiliary equipment used to smoke MA, such as tinfoil, lighters and colourful drinking straws, when put together, could also trigger their craving for MA. Third, participants also agreed that food and beverages that have excitation effects, such as coffee, maltobiose and tea, could also lead to a desire for MA, and should never be touched again.

Internal factors: opportunities

Moving to another city.

Some of these participants suggested that moving to a new place can also facilitate a longer abstinence.

After I finished the compulsory isolation detoxification treatments the second time, my parents decided to move to another city, the neighbors did not know I used to be a MA abuser, none of my friends were MA abusers, and I’ve kept sustained abstinence till now. Moving to a new city means I can better say goodbye to what I had been and live a normal life. My ‘friends’ can never affect me, and no one would discriminate against me because I used to be a drug abuser.

Family responsibility

Some participants mentioned that greater awareness of their family responsibility was a strong internal factor for staying abstinent.

The main reason I quit smoking MA was that my father was badly ill, and needed me to look after him, I finally realised that if I continued to use MA, I could lose my beloved father. When I was receiving the compulsory isolation detoxification treatment, the responsibilities of looking after my child and parents were all put on my wife, I felt regret for them.

Surveillance systems

In mainland China, surveillance systems mainly include ID card registration, police enforcement and antidrug social workers. If people were found smoking MA through urine test by police and diagnosed with MUD (methamphetamine use disorder) by psychiatrists, they were registered into the surveillance system and assigned with an antidrug social worker. They were required to take community-based detoxification treatments or voluntary detoxification treatments, and urged to receive urine tests regularly as well as spot checks through the help of an assigned social worker. However, when they were found smoking MA for the third time, they received compulsory isolation drug rehabilitation therapies. Some participants complained about how the surveillance system disrupted their everyday lives, resulted in their loss of job opportunities, made their MA abuse history more public and led to being judged by others. However, they admitted that the surveillance system works as a reminder for them to stay away from restarting smoking MA. Some participants found surveillance systems to be burdensome on their lives; however, participants also agreed that it can serve as a strong external driving force for participants to maintain abstinence.

Shortly after I had checked into a hotel, the local police came to my room and asked me to do a urine test. This reminded me that if I was found smoking MA again, I would be forced to receive two years of compulsory isolation detoxification.

Internal factors: threats

Sexual behaviours.

Sexual-related behaviours were important catalysts for craving among many male abusers. Whoring, making love with sex partners, sex parties and online video chat rooms were the most frequently mentioned occasions. Interestingly, according to these participants, sexual behaviours were more common among male abusers. For male participants, they also regarded MA as an aphrodisiac. Moreover, an uncontrollable craving was often induced when they were having sex with their partners.

Sexual desires and related behaviours were very common among male abusers, and MA may also be used as an aphrodisiac to help them when making love with their partners. We would much prefer enjoying methamphetamine with female friends, while males were not welcomed. This is because most of them would often demand sex after smoking MA.

Emotional states

Participants also described that their emotional states were related to relapse and could be intensified by stressful events, stigma and discrimination, and considered that smoking MA could help them cope with these feelings.

When I felt stressed or anxious, the first thought that would come to my mind was to enjoy MA to help release these negative feelings. The joy of a party often makes me think of enjoying MA to celebrate it.

Some participants reported that alcohol could exacerbate their craving to smoke MA. Apart from using MA, some participants also reported a high incidence of alcohol use. Alcohol was treated as ‘a good friend’ when using MA. They said they often felt the craving for MA when they were drinking alcohol during a party or dinner. However, participants revealed that they did not prefer smoking any cigarettes when enjoying MA.

When I saw alcohol or after drinking alcohol, I often thought about using methamphetamine and the feeling was always very strong. However, there were few people who chose to smoke cigarettes before or after using methamphetamine. We did not smoke after using methamphetamine, because smoking would give us a headache and it would be impossible to tolerate the foul atmosphere of the room. We do not smoke cigarettes after enjoying methamphetamine, because cigarettes were ‘hot things’ and smoking could affect the floaty euphoria of methamphetamine.

Attitudes towards smoking MA

Many patients did not think smoking MA and MUD were serious problems or mental health disorders. On the contrary, they thought that using MA was fashionable, entertaining and recreational in their everyday lives. ‘Playing with MA’ and ‘enjoying MA’ were the most used phrases when describing using MA. It seems that MA has already become one of their common daily entertainments, just like playing video games or mahjong, gambling, smoking, drinking, and so forth.

Main findings

Craving reflects the individual’s strong desire for smoking drugs in order to alleviate the withdrawal symptoms, and is one of the most important factors that leads to relapse after treatment. 12 Even after a long period of treatment, a variety of intrinsic and extrinsic drug-related cues in daily life can still induce patients’ craving and cause relapse. Better understanding of the causes of craving from the patients’ viewpoint would have potential value to the development of new therapeutic approaches. In this qualitative research, we used SWOT analysis to analyse the internal factors (opportunities and threats) and external factors (strengths and weaknesses) that are closely related to one’s craving and relapse. Overall, our findings are consistent with previous qualitative studies of drug abusers’ experiences about real-life catalysts and barriers contributing to drug-related behaviours during abstinence periods. Regarding barriers to MA abstinence, the main weaknesses and threats identified by participants were peer influence, prevalence and availability of MA, familiar venue of MA use, discrimination, sexual intercourse, alcohol and emotional states, which were in accordance with the studies in New Zealand 18 and USA 19 However, patients’ feedback on the main strengths and opportunities for maintaining abstinence were the surveillance system, antidrug social workers, vocational skills training, moving to another city and family responsibility. These could serve as count measures targeting those mentioned weaknesses and threats above.

Training patients to better cope with high-risk situations might be of great value. As this SWOT analysis has revealed, patients reported a variety of social and contextual reinitiation-related triggers. These high-risk situations, both internal and external, were very common and almost inevitable in patients’ everyday lives, which also means craving was unavoidable. Considering that many treatments now involve focusing on reducing individuals’ cravings, newly developed interventions targeting improvement of individuals’ coping skills in their social context might be a possible way out. 7 However, epidemiological and experimental studies are needed to confirm this hypothesis.

Furthermore, timely follow-up after treatment during the first few months was important, as the participants regarded most of their friends had relapsed during the first 3 months. Similar studies using an electroencephalography technique with cocaine dependent patients also highlighted the first month and sixth month of abstinence as the most vulnerable period. 20 Moreover, counting on the highly addictive nature and widespread availability of MA, following up and intensive care via surveillance systems and antidrug social workers might be effective methods to prevent reinitiation of MA.

Even unreal drug stimulus, such as drug-related pictures, can induce patients’ addition bias and craving for drugs. 21 To our knowledge, this study was the first to report that patients’ craving could be induced through re-encountering a familiar venue of MA smoking, commodities in everyday life, such as rock candy (‘huang bing tang’ in Chinese), auxiliary equipment used to smoke MA, such as tinfoil, lighters, colourful drinking straws and sexual-related behaviours, by using the SWOT analysis technology. These important findings could provide useful information when screening drug-related cues to optimise craving and MA-related bias assessment and new exposure treatment approaches, such as virtual reality (VR) therapy programmes. VR therapy often uses computer video techniques to simulate the high-risk substance abuse scenes to better induce the desires and cravings, 22 before combining psychotherapy and biofeedback treatments 23 24 to better help patients cope with the high-risk situations. These key findings could provide useful information when simulating high-risk situations through VR techniques. Moreover, avoiding going back to one’ s most familiar situation of MA smoking, such as the bedroom, hotels or KTVs, is also important for patients when keeping sustained abstinence. Re-encountering these scenes can lead to craving and deterioration of individuals’ abstinence.

Alcohol abstinence treatment is also important, especially for those with comorbidity with alcohol use disorder. Because simultaneous alcohol consumption was common among amphetamine-type stimulant abuse behaviours, 25 studies have suggested that alcohol and MA combinations may lead to greater harm, and may even link to aggression. 26

MA may affect men and women differently. An interesting finding lies in sexual behaviours. MA abuse and its association with heightened sexual desire, arousal, pleasure, loss of inhibitory control of sexual behaviour and increased sexual behaviours have long been a concern. 27 In this pilot study, male abusers turned out to have a much stronger sexual desire as well as sexual fantasies, and are more inclined to have sexual behaviours after smoking MA. Animal experiments have revealed that MA treatment in male rats causes maladaptive sex behaviours. 28 However, studies investigating sex difference on sexual motivation have lagged behind. 29 Studies investigating the nexus of sex and drug addiction in female and male patients are needed and will help to better advance our understanding of how amphetamine-type stimulants, such as MA, affect males and females differently. 30

Limitations

Findings of this study need to be interpreted in light of certain limitations. First, data were self-reported and retrospective, and accuracy of the information may be affected. Second, the study was limited to Shanghai, where socioeconomic status may be different from other parts of mainland China, and thus may not be representative of the patients in other areas. Third, most of the participants were recruited from compulsory isolation detoxification centres; however, according to Chinese antidrug law and their own experiences, they have all received community-based detoxification treatment or voluntary inpatient treatment before receiving compulsory detoxification treatments, which means they have already relapsed at least twice. Therefore, their experience could still effectively compensate for the insufficiency of the other two types of patients.

Implications

This study provides further understanding of why people continue using MA after treatment from the perspectives of abusers. Our study indicated that the first few moments confronting cue-related situations and the first 3 months after therapies have the highest risk for relapse, highlighting the role of self-control abilities and follow-up treatments in helping patients keep sustained abstinence. Moreover, peer influence, widespread availability of drugs, psychological states and combination with alcohol are among the most related factors, and may provide useful insights for preventative and rehabilitative interventions. Specifically, our findings suggest that some articles for daily use such as brown sugar candy, tinfoil paper and appliances used for smoking MA can be applied for harm reduction therapies such as visual reality and cognitive remediation therapy.

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Contributors YZ and NZ are responsible for the statistical analysis and the writing of the paper. HS and JD are responsible for English language editing. XR, JB and LZ are in charge of transcription interview data. DX, RD and KX help organise the interviews. MZ is responsible for the scientific design of the study. JD and MZ are responsible for the data checking and literature evaluation of the paper.

Funding The study was funded by the National Key R&D Program of China (2017YFC1310400), National Nature Science Foundation of China (U1502228, 81501148), Shanghai Municipal Health and Family Planning Commission (2014ZYJB0002), Shanghai Health and Family Planning Commission Clinical Research Project (20184Y0134), Program of Shanghai Academic Research Leader (17XD1403300), Shanghai Key Laboratory of Psychotic Disorders (13DZ2260500) and Qihang Project of Shanghai Mental Health Center (2018-QH-02).

Disclaimer The funders have no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Competing interests None declared.

Patient consent for publication Obtained.

Ethics approval All protocols and materials were approved by the Institutional Review Board of Shanghai Mental Health Center.

Provenance and peer review Not commissioned; externally peer reviewed.

Data availability statement Data are available upon reasonable request.

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Strengths, weaknesses, opportunities, and threats analysis of integrating the World Health Organization patient safety curriculum into undergraduate medical education in Pakistan: a qualitative case study

Samreen misbah.

1 Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan

Usman Mahboob

2 Institute of Health Professions Education and Research, Khyber Medical University, Peshawar, Pakistan

Associated Data

The purpose of this study was to conduct a strengths, weaknesses, opportunities, and threats (SWOT) analysis of integrating the World Health Organization (WHO) patient safety curriculum into undergraduate medical education in Pakistan.

A qualitative interpretive case study was conducted at Riphah International University, Islamabad, from October 2016 to June 2017. The study included 9 faculty members and 1 expert on patient safety. The interviews were audiotaped, and a thematic analysis of the transcripts was performed using NVivo software.

Four themes were derived based on the need analysis model. The sub-themes derived from the collected data were arranged under the themes of strengths, weaknesses, opportunities, and threats, in accordance with the principles of SWOT analysis. The strengths identified were the need for a formal patient safety curriculum and its early integration into the undergraduate program. The weaknesses were faculty awareness and participation in development programs. The opportunities were an ongoing effort to develop an appropriate curriculum, to improve the current culture of healthcare, and to use the WHO curricular resource guide. The threats were attitudes towards patient safety in Pakistani culture, resistance to implementation from different levels, and the role of regulatory authorities.

The theme of patient safety needs to be incorporated early into the formal medical education curriculum, with the main goals of striving to do no harm and seeing mistakes as opportunities to learn. Faculty development activities need to be organized, and faculty members should to be encouraged to participate in them. The lack of a patient safety culture was identified as the primary reason for resistance to this initiative at many levels. The WHO curriculum, amended according to local institutional culture, can be implemented appropriately with support from the corresponding regulatory bodies.

Introduction

Despite remarkable improvements in health care outcomes due to scientific innovations in modern medicine, studies from numerous countries have shown that hospitalized patients are at risk of adverse outcomes [ 1 ]. Medical errors in health care were not considered to be a preventable cause of morbidity and mortality until a foundational report on the topic was issued in 1999, followed by subsequent reports that highlighted the need for a safer system of care and the provision of quality health care as a universal concern [ 2 ]. Harm to patients is foreseeable, and to acknowledge it, health care workers and organizations need to learn from past errors to bypass imminent errors. To compete as part of an increasingly complex health care system, our future health care leaders require the competencies of patient safety knowledge, fundamental skills, and behaviors necessary to reduce patient harm. Health care professionals receive comparatively little education regarding harm reduction, and the limited patient safety knowledge among medical trainees that has been revealed by several studies means that effective educational interventions are needed to target this deficiency. Short patient safety pilot programs have shown that the continued implementation of a patient safety curriculum prepares medical students to better practice [ 3 ]. The World Health Organization (WHO) developed patient safety as a specialized discipline, and in 2009 a comprehensive guide was introduced for worldwide patient safety education implementation in medical schools [ 1 , 4 ]. This comprehensive guide focuses on 10 topics derived from patient safety education in Australia, and an additional topic selected by the WHO was to support learning in infection control. Still, few medical schools have implemented undergraduate patient safety curricula, as many factors have hampered patient safety education [ 5 ]. A study conducted in Pakistan found important reasons for violence against health care professionals to be unreasonable expectations, unexpected outcomes, communication failure, and human errors, in a context where medical graduates reliably lack the necessary knowledge, attitudes, and practical skills to provide safe care [ 6 ]. Being unfamiliar with the new literature on systems thinking and quality improvement methods, medical educators did not recognize that patient safety skills can be taught and were uncertain about how to integrate patient safety into the existing curriculum [ 5 ]. In Pakistan, patient safety is a relatively new concept and medical universities are therefore unsure of how to incorporate patient safety into their existing curricula. Thus, we planned a needs analysis study using the strengths, weaknesses, opportunities, and threats (SWOT) approach to ask faculty about their views on integrating the WHO patient safety curriculum into undergraduate medical education in Pakistan.

A qualitative interpretive case study was conducted at Riphah International University in Islamabad, Pakistan from October 2016 to June 2017. It was described according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) 32-item checklist for qualitative studies [ 7 ].

Research team and reflexivity

All interviews were conducted by the corresponding author, Samreen Misbah masters of health professions education [MHPE] trainee, (masters of public health [MPH] and a bachelor of medicine and bachelor of surgery [MBBS]). Samreen Misbah MHPE trainee at the time of study, has MPH in community medicine, and MBBS in medicine. Usman Mahboob is a Doctor of philosophy in Health Professions Education with an MPH in community medicine and an MBBS in medicine. Both authors were assistant professors at the time of the study. Samreen Misbah is female and Usman Mahboob is male. They were both trained in health professions education. Their credibility was ensured by spending the maximum possible time at the inquiry site, and the researchers allocated time for the participants to identify the salient features of the context and problem, and explained the purpose of the interviews. One to two meet ings were conducted prior to the interviews, and specific interview times were booked. Participants were given details about the researcher and the reasons why they were selected for an interview about their perceptions regarding the need analysis of integration of the WHO patient safety curriculum. Detailed information about the research project, which was conducted for the partial fulfillment of MHPE training, was also provided to them.

Study design

The case study methodology and grounded theory analysis under interpretative assumptions were combined to construct a suitable research methodology [ 8 ]. A total of 10 participants were included in the study. Information-rich cases through purposeful sampling were selected from a wide variety of sources. An introduction to the study, along with the curriculum, was sent via email to all participants explaining the purpose of the research project that was conducted for partial fulfillment of MHPE training, with the goal of conducting a need analysis of integration of the WHO patient curriculum. The first author booked time for face-to-face interviews. Nine senior faculty members from the basic and clinical sciences with at least 5 years of teaching experience, experience with teaching an integrated curriculum, and a background in health professional education were selected. These participants were working as full, associate, or assistant professors in their respective departments. A professor of medicine working as the principal and director of the Riphah Institute of Healthcare Improvement and Safety was also included, as this had been recently launched at the university. Faculty who did not fulfill the criteria or were not willing to participate were excluded ( Table 1 ). All participants who were approached co-operated with the interviews, and none dropped out. Interviews were arranged in participants’ workplaces. Only the participant was present, and each interview was conducted in a single session. The theoretical sampling was based on analyses of collected data from previous interviews that guided the researcher regarding future data collection, and the sample size was not fixed. The details of the participants and the date and time of the interviews are shown in Table 1 .

Respondents’ demographics

MBBS, bachelor of medicine and bachelor of surgery; FCPS, fellow of the College of Physicians and Surgeons; JHPE, joint Human performance enhancement; PGT, post graduate trainee; MHPE, masters of health professions education; MPH, master of public health; M. Phil, master of philosophy; PhD, doctor of philosophy; MCPS, member of College of Physicians and Surgeons (Canada); DTCD, diploma in tuberculosis and chest diseases; DIMS, Doctors’ Institute of Medical Sciences; CPQP, Certified Pharma Quality Professional; CPHQ, Certified Professional in Healthcare Quality.

The Pakistan Medical and Dental Council (PMDC) curriculum for the MBBS degree currently followed in medical schools was analyzed to identify learning outcomes related to patient safety topics. Questions for the interviews were based on a literature review and were sent to 5 experts in medical education with at least 3–5 years of experience, and to a Korean researcher with expertise in the patient safety curriculum. A pilot interview was done with a faculty member at the same university, and finally, 8 open-ended questions were selected. The interview guide with the final questions was e-mailed to the participants prior to the interviews. The interviews were completed in a single session and were not repeated. Two sources were used to audiotape the interviews; few measures were taken to avoid background sounds and interruptions, and field notes were taken during the sessions. The time for each interview was estimated to be approximately 50 minutes.

The process of data collection was stopped when the theoretical base was saturated [ 9 ]. All raw data, audiotaped interviews, and interview transcripts were sent to the participants to confirm their accuracy and to ensure credibility.

Analysis and findings

The transcripts were also scrutinized by the second author, who had expertise in medical education, and the data were coded by both authors, who reviewed and discussed the results. As a key process of grounded theory, coding began early after the first interview and open coding was done by categorizing data. Axial coding was done to relate the 4 categories of strengths, weaknesses, opportunities, and threats to the subcategories. Finally, by selective coding, core categories were identified for the SWOT analysis of integration of the WHO patient safety curriculum. Individual transcripts were read line by line; salient features related to research objectives and research questions were identified, chunks of the text were labeled with codes, and hierarchies of nodes were organized. Long lists of codes from the data were collected and merged to make a total of 27 codes. Categories were created by combining several codes. Four themes for the SWOT analysis of integration of the WHO patient safety curriculum into undergraduate medical education in Pakistan were derived based on the need analysis model. The sub-themes derived from the collected data were arranged under the themes ( Fig. 1 ). Data analysis was done in NVivo software ver. 11.0 (QSR International, Doncaster, Vic, Australia), for which the corresponding (first) author received training. The transcribed interviews were imported into the software and manual data analysis was also done as needed. Attribute codes were given to the participants to maintain anonymity. Additional information suggested by the participants after they checked the transcript was incorporated in the final report.

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Themes and sub-themes identified for integration of the World Health Organization patient safety curriculum. SWOT, strengths, weaknesses, opportunities, and threats.

Quality assurance

This research was described according to the COREQ guidelines. Data triangulation from 2 sources of evidence (audiotaped interviews and field notes) was performed. Raw material was saved for future reference and as an audit trail. All participants were asked to review the interview transcripts and any additional information, if suggested, was incorporated into the final report. A case study database was created and stored in a manner that can be retrieved in several raw and process stages. Participants from different clinical and basic sciences were selected through purposeful sampling to maximize the collected information and to enhance transferability to other similar contexts [ 8 ].

Ethical approval

Ethical clearance for the study was granted by the Institutional Review Committee of Riphah International University (IRB no. Riphah/ERC/17/0211) after receiving informed consent from the participants.

A total of 10 participants were interviewed, which took more than 100 hours of transcription time, and the total word count of all interviews was 40,096. Individual transcripts were read line by line; salient features related to research objectives and research questions were identified, and chunks of the text were labeled by making codes and saved in the storage area of nodes. Quotations from the participants to illustrate the themes were identified by attribute codes and are presented in Tables 2 – 5 . The collected data show consistent findings and interpretations of both major and minor themes. The major theme of “strengths” showed the positive internal attributes of the system identified by the participants that were under the participants’ control and in a suitable condition for implementing the curriculum ( Table 2 ). The theme of “weaknesses” represented internal areas of the system that lacked competencies as acknowledged by the participants, could destabilize implementation of the curriculum, were considered completely under control, and could be improved ( Table 3 ). The third major theme, “opportunities,” described positive external factors that were beyond our control but could open up possibilities for implementing the curriculum if taken advantage of ( Table 4 ). Finally, the main theme of “threats” depicted threats identified by the participants as external factors that were also beyond our control and for which a plausible plan to combat the accompanying risk was possible ( Table 5 ).

Summary of the major theme of strengths and the sub-themes that emerged from the analysis of faculty interviews, along with representative quotations from interview transcripts

Summary of the major theme of weaknesses and sub-themes that emerged from the analysis of faculty interviews, along with representative quotations from interview transcripts

Summary of the major theme of opportunities and sub-themes that emerged from the analysis of faculty interviews, along with representative quotations from interview transcripts

WHO, World Health Organization.

Summary of the major theme of threats and sub-themes that emerged from the analysis of faculty interviews, along with representative quotations from interview transcripts

Sub-themes under each major theme are described in detail in Fig. 1 . The strengths identified included the need for a formal patient safety curriculum and its early integration into the undergraduate program. The weaknesses were faculty awareness and participation in development programs. The opportunities were an ongoing effort to develop an appropriate curriculum, to improve the current culture of health care, and to use the WHO curricular resource guide. The threats were attitudes towards patient safety in Pakistani culture, resistance to implementation from different levels, and the role of regulatory authorities.

The purpose of this qualitative research was to highlight patient safety as a neglected component of the appropriate education and training of health care professionals that has recently become an area of concern. However, curriculum developers are uncertain about the teaching and integration of the topic. In the present study, we conducted a needs analysis to understand the insights of faculty members at a university in Pakistan. Different aspects of the internal and external factors for integration of the WHO patient safety curriculum into medical education were emphasized using the SWOT approach.

The current study suggested that patient safety education needs to be disseminated as a formal curriculum that may be introduced gradually and progressively. Presently, individual topics are communicated to students in a piecemeal fashion, with the consequence that the recipients are not sensitized to the importance of the topic. A brief lecture-based program may be sufficient to bring short-term positive changes, but for a smooth introduction of patient safety teaching into the undergraduate curriculum, a formal explicit curriculum must be used [ 10 ].

The WHO curricular guide was considered quite flexible and easy to implement by the study participants. They recommended it as a guideline that can be used according to national health care facilities and the culture on the ground. An evaluation study of the WHO patient safety curricular guide that was conducted to investigate the categorical implementation of explicit patient safety education reported that the curriculum guide was a helpful resource. However, the successful implementation of a curriculum requires the faculty to be familiar with the material, for the necessary time to be invested into developing the curriculum in the local context, for sufficient leadership and commitment to be present, and for the trainers to be trained [ 11 ].

The main weaknesses identified by participants were the awareness of the patient safety curriculum among faculty members, who must be trained first, and faculty development activities to raise their competencies in this area. Teaching the topics in a modular fashion was considered promising for implementation because integration of the entire curricular guide may result in several problems and place resource constraints on an institution. Participants were in favor of focusing on the effective implementation of the curriculum at a single institution as a pilot study that can be implemented at other institutions after seeing the results and requirements. These considerations suggest that the curricular guide should be tailored according to the culture of each institution, and that a wide range of teaching methods should be used to teach patient safety topics, ranging from whole-group lectures to small-group discussions and simulation- or clinical-based activities, as described in other studies [ 12 ]. All the teaching strategies that are used in present-day teaching need to be incorporated to support this part of the curriculum as well. Even exposure to field work and community problems can be an excellent source of lessons about safety hazards and the management thereof.

The faculty members surveyed in the present study believed that awareness sessions need to be conducted for students to understand the benefits of practicing patient safety culture for their own safety and health. Students are considered to be an excellent source for recognizing errors, and they can be trained accordingly. Despite their limited baseline knowledge of this topic, evaluation studies have found students to have a positive attitude towards the curriculum and that they have reported increases in their knowledge after teaching sessions [ 13 ]. Most medical errors cannot be attributed to individual negligence. The current study revealed patient safety issues at many levels of health care personnel, including doctors, nurses, paramedical staff, as well as at shift changes of nurses and due to lack of counseling by doctors. Miscommunication between health care personnel or with patients may be responsible for errors. A safer environment for patients also produces a safer environment for health care providers. The participants of the study stated the opinion that the current culture of health care is quite resistant to patient safety culture because everyone is not used to it, but that once patient safety culture is implemented, the resistance will decrease [ 14 ]. In response to the high rate of adverse events, the Patient Safety Friendly Hospital Initiative was launched in 7 developing countries of the Eastern Mediterranean region, and highlighted the convincing suggestion that the implementation of patient safety standards in these hospitals increased the level of awareness of participating hospitals and patients [ 15 ].

The main reason in this study for teaching patient safety education was encouraging students to avoid errors and to consider mistakes to be opportunities to learn how to provide quality medical care. Although physicians have been considered reluctant partners in reporting errors, they have shown willingness to share near misses with their institutions to avoid future errors. Participants suggested that there must be an assessment of this part of the curriculum that differentiates between learners and non-learners. However, in routine clinical settings in hospital wards, facilitators may observe and give feedback to the students in an informal way, thereby inculcating these principles as a part of ethical behavior. Assessment facilitates learning; however, a distinction can be made between assessments for learning and assessments of learning.

Some of the conclusions of the study were limited by time constraints. Although the PMDC is the main governing body for decisions about the medical education curriculum, representatives from it were not approached. Further research into implementing the curriculum in this context may help to complete the picture. The participants in this study considered patient safety to be the most neglected area of education and training, and a complex topic, for which a formal curriculum starting early in the medical education process is required. The main reason for teaching patient safety was the goal to do no harm. The faculty members were not fully aware of the need to train and participate in faculty development programs; patient safety issues occur at many levels and resistance to this curriculum was identified as being due to the lack of a patient safety culture. Once the true intentions of implementation are known, resistance will decrease. In quality medical care, a mistake is an opportunity to learn. The necessary amendments in the curriculum should be made according to our culture on the ground and level of literacy regarding these issues. This study emphasized that as patients are becoming aware of their rights, students must learn about patients’ rights and the necessity thereof. The WHO patient safety curriculum can be implemented if the PMDC makes it mandatory for medical schools and hospitals to receive assistance in developing patient safety curricula.

Acknowledgments

I am thankful to Prof. Dr. Rahila Yasmeen, the Director of the MHPE program, for facilitating this study, and to all the faculty members of basic and clinical sciences of Riphah International University who took time out of their busy schedules for the interviews (for the respondents’ demographic information, see Table 1). The informed consent forms are attached as supplementary materials.

Authors’ contributions

Conceptualization: SM, UM. Data curation: SM. Formal analysis: SM, UM. Methodology: SM, UM. Project administration: SM, UM. Visualization: SM, UM. Writing–original draft: SM, UM. Writing–review & editing: SM, UM.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

No financial support was received by the authors for the present study.

Supplementary material

Supplement 1. Audio recording of the abstract.

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Introduction

Participants

Data analysis

Participant characteristics

Themes related to SWOT analysis

External factors: strengths

Vocational skills training

External factors: weaknesses

Prevalence and availability

Familiar venue of MA smoking

Discrimination

Commodities in everyday life

Internal factors: opportunities

Family responsibility

Surveillance systems