literature review qualitative

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Qualitative research: literature review .

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Exploring the literature review 

Literature review model: 6 steps.

Adapted from The Literature Review , Machi & McEvoy (2009, p. 13).

Your Literature Review

Step 2: search, boolean search strategies, search limiters, ★ ebsco & google drive.

1. Select a Topic

"All research begins with curiosity" (Machi & McEvoy, 2009, p. 14)

Selection of a topic, and fully defined research interest and question, is supervised (and approved) by your professor. Tips for crafting your topic include:

• Be specific. Take time to define your interest.
• Topic Focus. Fully describe and sufficiently narrow the focus for research.
• Academic Discipline. Learn more about your area of research & refine the scope.
• Avoid Bias. Be aware of bias that you (as a researcher) may have.
• Document your research. Use Google Docs to track your research process.
• Research apps. Consider using Evernote or Zotero to track your research.

Consider Purpose

What will your topic and research address?

In The Literature Review: A Step-by-Step Guide for Students , Ridley presents that literature reviews serve several purposes (2008, p. 16-17).  Included are the following points:

• Historical background for the research;
• Overview of current field provided by "contemporary debates, issues, and questions;"
• Theories and concepts related to your research;
• Introduce "relevant terminology" - or academic language - being used it the field;
• Connect to existing research - does your work "extend or challenge [this] or address a gap;" 
• Provide "supporting evidence for a practical problem or issue" that your research addresses.

★ Schedule a research appointment

At this point in your literature review, take time to meet with a librarian. Why? Understanding the subject terminology used in databases can be challenging. Archer Librarians can help you structure a search, preparing you for step two. How? Contact a librarian directly or use the online form to schedule an appointment. Details are provided in the adjacent Schedule an Appointment box.

2. Search the Literature

Collect & Select Data: Preview, select, and organize

AU Library is your go-to resource for this step in your literature review process. The literature search will include books and ebooks, scholarly and practitioner journals, theses and dissertations, and indexes. You may also choose to include web sites, blogs, open access resources, and newspapers. This library guide provides access to resources needed to complete a literature review.

Books & eBooks: Archer Library & OhioLINK

Databases: Scholarly & Practitioner Journals

Review the Library Databases tab on this library guide, it provides links to recommended databases for Education & Psychology, Business, and General & Social Sciences.

Expand your journal search; a complete listing of available AU Library and OhioLINK databases is available on the Databases  A to Z list . Search the database by subject, type, name, or do use the search box for a general title search. The A to Z list also includes open access resources and select internet sites.

Databases: Theses & Dissertations

Review the Library Databases tab on this guide, it includes Theses & Dissertation resources. AU library also has AU student authored theses and dissertations available in print, search the library catalog for these titles.

Did you know? If you are looking for particular chapters within a dissertation that is not fully available online, it is possible to submit an ILL article request . Do this instead of requesting the entire dissertation.

Newspapers:  Databases & Internet

Consider current literature in your academic field. AU Library's database collection includes The Chronicle of Higher Education and The Wall Street Journal .  The Internet Resources tab in this guide provides links to newspapers and online journals such as Inside Higher Ed , COABE Journal , and Education Week .

The Chronicle of Higher Education has the nation’s largest newsroom dedicated to covering colleges and universities.  Source of news, information, and jobs for college and university faculty members and administrators

The Chronicle features complete contents of the latest print issue; daily news and advice columns; current job listings; archive of previously published content; discussion forums; and career-building tools such as online CV management and salary databases. Dates covered: 1970-present.

Search Strategies & Boolean Operators

There are three basic boolean operators:  AND, OR, and NOT.

Used with your search terms, boolean operators will either expand or limit results. What purpose do they serve? They help to define the relationship between your search terms. For example, using the operator AND will combine the terms expanding the search. When searching some databases, and Google, the operator AND may be implied.

Overview of boolean terms

About the example: Boolean searches were conducted on November 4, 2019; result numbers may vary at a later date. No additional database limiters were set to further narrow search returns.

Database Search Limiters

Database strategies for targeted search results.

Most databases include limiters, or additional parameters, you may use to strategically focus search results.  EBSCO databases, such as Education Research Complete & Academic Search Complete provide options to:

• Limit results to full text;
• Limit results to scholarly journals, and reference available;
• Select results source type to journals, magazines, conference papers, reviews, and newspapers
• Publication date

Keep in mind that these tools are defined as limiters for a reason; adding them to a search will limit the number of results returned.  This can be a double-edged sword.  How? 

• If limiting results to full-text only, you may miss an important piece of research that could change the direction of your research. Interlibrary loan is available to students, free of charge. Request articles that are not available in full-text; they will be sent to you via email.
• If narrowing publication date, you may eliminate significant historical - or recent - research conducted on your topic.
• Limiting resource type to a specific type of material may cause bias in the research results.

Use limiters with care. When starting a search, consider opting out of limiters until the initial literature screening is complete. The second or third time through your research may be the ideal time to focus on specific time periods or material (scholarly vs newspaper).

★ Truncating Search Terms

Expanding your search term at the root.

Truncating is often referred to as 'wildcard' searching. Databases may have their own specific wildcard elements however, the most commonly used are the asterisk (*) or question mark (?).  When used within your search. they will expand returned results.

Asterisk (*) Wildcard

Using the asterisk wildcard will return varied spellings of the truncated word. In the following example, the search term education was truncated after the letter "t."

Explore these database help pages for additional information on crafting search terms.

• EBSCO Connect: Searching with Wildcards and Truncation Symbols
• EBSCO Connect: Searching with Boolean Operators
• EBSCO Connect: EBSCOhost Search Tips
• EBSCO Connect: Basic Searching with EBSCO
• ProQuest Help: Search Tips
• ERIC: How does ERIC search work?

★ EBSCO Databases & Google Drive

Tips for saving research directly to Google drive.

Researching in an EBSCO database?

It is possible to save articles (PDF and HTML) and abstracts in EBSCOhost databases directly to Google drive. Select the Google Drive icon, authenticate using a Google account, and an EBSCO folder will be created in your account. This is a great option for managing your research. If documenting your research in a Google Doc, consider linking the information to actual articles saved in drive.

EBSCO Databases & Google Drive

EBSCOHost Databases & Google Drive: Managing your Research

This video features an overview of how to use Google Drive with EBSCO databases to help manage your research. It presents information for connecting an active Google account to EBSCO and steps needed to provide permission for EBSCO to manage a folder in Drive.

About the Video:  Closed captioning is available, select CC from the video menu.  If you need to review a specific area on the video, view on YouTube and expand the video description for access to topic time stamps.  A video transcript is provided below.

• EBSCOhost Databases & Google Scholar

Defining Literature Review

What is a literature review.

A definition from the Online Dictionary for Library and Information Sciences .

A literature review is "a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works" (Reitz, 2014). 

A systemic review is "a literature review focused on a specific research question, which uses explicit methods to minimize bias in the identification, appraisal, selection, and synthesis of all the high-quality evidence pertinent to the question" (Reitz, 2014).

Recommended Reading

About this page

EBSCO Connect [Discovery and Search]. (2022). Searching with boolean operators. Retrieved May, 3, 2022 from https://connect.ebsco.com/s/?language=en_US

EBSCO Connect [Discover and Search]. (2022). Searching with wildcards and truncation symbols. Retrieved May 3, 2022; https://connect.ebsco.com/s/?language=en_US

Machi, L.A. & McEvoy, B.T. (2009). The literature review . Thousand Oaks, CA: Corwin Press: 

Reitz, J.M. (2014). Online dictionary for library and information science. ABC-CLIO, Libraries Unlimited . Retrieved from https://www.abc-clio.com/ODLIS/odlis_A.aspx

Ridley, D. (2008). The literature review: A step-by-step guide for students . Thousand Oaks, CA: Sage Publications, Inc.

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• Knowledge Base

Methodology

• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

Prevent plagiarism. Run a free check.

To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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Writing a Literature Review

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

Chapter 9. Reviewing the Literature

What is a “literature review”.

No researcher ever comes up with a research question that is wholly novel. Someone, somewhere, has asked the same thing. Academic research is part of a larger community of researchers, and it is your responsibility, as a member of this community, to acknowledge others who have asked similar questions and to put your particular research into this greater context. It is not simply a convention or custom to begin your study with a review of previous literature (the “ lit review ”) but an important responsibility you owe the scholarly community.

Too often, new researchers pursue a topic to study and then write something like, “No one has ever studied this before” or “This area is underresearched.” It may be that no one has studied this particular group or setting, but it is highly unlikely no one has studied the foundational phenomenon of interest. And that comment about an area being underresearched? Be careful. The statement may simply signal to others that you haven’t done your homework. Rubin ( 2021 ) refers to this as “free soloing,” and it is not appreciated in academic work:

The truth of the matter is, academics don’t really like when people free solo. It’s really bad form to omit talking about the other people who are doing or have done research in your area. Partly, I mean we need to cite their work, but I also mean we need to respond to it—agree or disagree, clarify for extend. It’s also really bad form to talk about your research in a way that does not make it understandable to other academics.…You have to explain to your readers what your story is really about in terms they care about . This means using certain terminology, referencing debates in the literature, and citing relevant works—that is, in connecting your work to something else. ( 51–52 )

A literature review is a comprehensive summary of previous research on a topic. It includes both articles and books—and in some cases reports—relevant to a particular area of research. Ideally, one’s research question follows from the reading of what has already been produced. For example, you are interested in studying sports injuries related to female gymnasts. You read everything you can find on sports injuries related to female gymnasts, and you begin to get a sense of what questions remain open. You find that there is a lot of research on how coaches manage sports injuries and much about cultures of silence around treating injuries, but you don’t know what the gymnasts themselves are thinking about these issues. You look specifically for studies about this and find several, which then pushes you to narrow the question further. Your literature review then provides the road map of how you came to your very specific question, and it puts your study in the context of studies of sports injuries. What you eventually find can “speak to” all the related questions as well as your particular one.

In practice, the process is often a bit messier. Many researchers, and not simply those starting out, begin with a particular question and have a clear idea of who they want to study and where they want to conduct their study but don’t really know much about other studies at all. Although backward, we need to recognize this is pretty common. Telling students to “find literature” after the fact can seem like a purposeless task or just another hurdle for completing a thesis or dissertation. It is not! Even if you were not motivated by the literature in the first place, acknowledging similar studies and connecting your own research to those studies are important parts of building knowledge. Acknowledgment of past research is a responsibility you owe the discipline to which you belong.

Literature reviews can also signal theoretical approaches and particular concepts that you will incorporate into your own study. For example, let us say you are doing a study of how people find their first jobs after college, and you want to use the concept of social capital . There are competing definitions of social capital out there (e.g., Bourdieu vs. Burt vs. Putnam). Bourdieu’s notion is of one form of capital, or durable asset, of a “network of more or less institutionalized relationships of mutual acquaintance or recognition” ( 1984:248 ). Burt emphasizes the “brokerage opportunities” in a social network as social capital ( 1997:355 ). Putnam’s social capital is all about “facilitating coordination and cooperation for mutual benefit” ( 2001:67 ). Your literature review can adjudicate among these three approaches, or it can simply refer to the one that is animating your own research. If you include Bourdieu in your literature review, readers will know “what kind” of social capital you are talking about as well as what kind of social scientist you yourself are. They will likely understand that you are interested more in how some people are advantaged by their social capital relative to others rather than being interested in the mechanics of how social networks operate.

The literature review thus does two important things for you: firstly, it allows you to acknowledge previous research in your area of interest, thereby situating you within a discipline or body of scholars, and, secondly, it demonstrates that you know what you are talking about. If you present the findings of your research study without including a literature review, it can be like singing into the wind. It sounds nice, but no one really hears it, or if they do catch snippets, they don’t know where it is coming from.

Examples of Literature Reviews

To help you get a grasp of what a good literature review looks like and how it can advance your study, let’s take a look at a few examples.

Reader-Friendly Example: The Power of Peers

The first is by Janice McCabe ( 2016 ) and is from an article on peer networks in the journal Contexts . Contexts presents articles in a relatively reader-friendly format, with the goal of reaching a large audience for interesting sociological research. Read this example carefully and note how easily McCabe is able to convey the relevance of her own work by situating it in the context of previous studies:

Scholars who study education have long acknowledged the importance of peers for students’ well-being and academic achievement. For example, in 1961, James Coleman argued that peer culture within high schools shapes students’ social and academic aspirations and successes. More recently, Judith Rich Harris has drawn on research in a range of areas—from sociological studies of preschool children to primatologists’ studies of chimpanzees and criminologists’ studies of neighborhoods—to argue that peers matter much more than parents in how children “turn out.” Researchers have explored students’ social lives in rich detail, as in Murray Milner’s book about high school students, Freaks, Geeks, and Cool Kids , and Elizabeth Armstrong and Laura Hamilton’s look at college students, Paying for the Party . These works consistently show that peers play a very important role in most students’ lives. They tend, however, to prioritize social over academic influence and to use a fuzzy conception of peers rather than focusing directly on friends—the relationships that should matter most for student success. Social scientists have also studied the power of peers through network analysis, which is based on uncovering the web of connections between people. Network analysis involves visually mapping networks and mathematically comparing their structures (such as the density of ties) and the positions of individuals within them (such as how central a given person is within the network). As Nicholas Christakis and James Fowler point out in their book Connected , network structure influences a range of outcomes, including health, happiness, wealth, weight, and emotions. Given that sociologists have long considered network explanations for social phenomena, it’s surprising that we know little about how college students’ friends impact their experiences. In line with this network tradition, I focus on the structure of friendship networks, constructing network maps so that the differences we see across participants are due to the underlying structure, including each participant’s centrality in their friendship group and the density of ties among their friends. ( 23 )

What did you notice? In her very second sentence, McCabe uses “for example” to introduce a study by Coleman, thereby indicating that she is not going to tell you every single study in this area but is going to tell you that (1) there is a lot of research in this area, (2) it has been going on since at least 1961, and (3) it is still relevant (i.e., recent studies are still being done now). She ends her first paragraph by summarizing the body of literature in this area (after giving you a few examples) and then telling you what may have been (so far) left out of this research. In the second paragraph, she shifts to a separate interesting focus that is related to the first but is also quite distinct. Lit reviews very often include two (or three) distinct strands of literature, the combination of which nicely backgrounds this particular study . In the case of our female gymnast study (above), those two strands might be (1) cultures of silence around sports injuries and (2) the importance of coaches. McCabe concludes her short and sweet literature review with one sentence explaining how she is drawing from both strands of the literature she has succinctly presented for her particular study. This example should show you that literature reviews can be readable, helpful, and powerful additions to your final presentation.

Authoritative Academic Journal Example: Working Class Students’ College Expectations

The second example is more typical of academic journal writing. It is an article published in the British Journal of Sociology of Education by Wolfgang Lehmann ( 2009 ):

Although this increase in post-secondary enrolment and the push for university is evident across gender, race, ethnicity, and social class categories, access to university in Canada continues to be significantly constrained for those from lower socio-economic backgrounds (Finnie, Lascelles, and Sweetman 2005). Rising tuition fees coupled with an overestimation of the cost and an underestimation of the benefits of higher education has put university out of reach for many young people from low-income families (Usher 2005). Financial constraints aside, empirical studies in Canada have shown that the most important predictor of university access is parental educational attainment. Having at least one parent with a university degree significantly increases the likelihood of a young person to attend academic-track courses in high school, have high educational and career aspirations, and ultimately attend university (Andres et al. 1999, 2000; Lehmann 2007a). Drawing on Bourdieu’s various writing on habitus and class-based dispositions (see, for example, Bourdieu 1977, 1990), Hodkinson and Sparkes (1997) explain career decisions as neither determined nor completely rational. Instead, they are based on personal experiences (e.g., through employment or other exposure to occupations) and advice from others. Furthermore, they argue that we have to understand these decisions as pragmatic, rather than rational. They are pragmatic in that they are based on incomplete and filtered information, because of the social context in which the information is obtained and processed. New experiences and information can, however, also be allowed into one’s world, where they gradually or radically transform habitus, which in turn creates the possibility for the formation of new and different dispositions. Encountering a supportive teacher in elementary or secondary school, having ambitious friends, or chance encounters can spark such transformations. Transformations can be confirming or contradictory, they can be evolutionary or dislocating. Working-class students who enter university most certainly encounter such potentially transformative situations. Granfield (1991) has shown how initially dislocating feelings of inadequacy and inferiority of working-class students at an elite US law school were eventually replaced by an evolutionary transformation, in which the students came to dress, speak and act more like their middle-class and upper-class peers. In contrast, Lehmann (2007b) showed how persistent habitus dislocation led working-class university students to drop out of university. Foskett and Hemsley-Brown (1999) argue that young people’s perceptions of careers are a complex mix of their own experiences, images conveyed through adults, and derived images conveyed by the media. Media images of careers, perhaps, are even more important for working-class youth with high ambitions as they offer (generally distorted) windows into a world of professional employment to which they have few other sources of access. It has also been argued that working-class youth who do continue to university still face unique, class-specific challenges, evident in higher levels of uncertainty (Baxter and Britton 2001; Lehmann 2004, 2007a; Quinn 2004), their higher education choices (Ball et al. 2002; Brooks 2003; Reay et al. 2001) and fears of inadequacy because of their cultural outsider status (Aries and Seider 2005; Granfield 1991). Although the number of working-class university students in Canada has slowly increased, that of middle-class students at university has risen far more steeply (Knighton and Mizra 2002). These different enrolment trajectories have actually widened the participation gap, which in tum explains our continued concerns with the potential outsider status Indeed, in a study comparing first-generation working-class and traditional students who left university without graduating, Lehmann (2007b) found that first-generation working-class students were more likely to leave university very early in some cases within the first two months of enrollment. They were also more likely to leave university despite solid academic performance. Not “fitting in,” not “feeling university,” and not being able to “relate to these people” were key reasons for eventually withdrawing from university. From the preceding review of the literature, a number of key research questions arise: How do working-class university students frame their decision to attend university? How do they defy the considerable odds documented in the literature to attend university? What are the sources of information and various images that create dispositions to study at university? What role does their social-class background- or habitus play in their transition dispositions and how does this translate into expectations for university? ( 139 )

What did you notice here? How is this different from (and similar to) the first example? Note that rather than provide you with one or two illustrative examples of similar types of research, Lehmann provides abundant source citations throughout. He includes theory and concepts too. Like McCabe, Lehmann is weaving through multiple literature strands: the class gap in higher education participation in Canada, class-based dispositions, and obstacles facing working-class college students. Note how he concludes the literature review by placing his research questions in context.

Find other articles of interest and read their literature reviews carefully. I’ve included two more for you at the end of this chapter . As you learned how to diagram a sentence in elementary school (hopefully!), try diagramming the literature reviews. What are the “different strands” of research being discussed? How does the author connect these strands to their own research questions? Where is theory in the lit review, and how is it incorporated (e.g., Is it a separate strand of its own or is it inextricably linked with previous research in this area)?

One model of how to structure your literature review can be found in table 9.1. More tips, hints, and practices will be discussed later in the chapter.

Table 9.1. Model of Literature Review, Adopted from Calarco (2020:166)

Embracing Theory

A good research study will, in some form or another, use theory. Depending on your particular study (and possibly the preferences of the members of your committee), theory may be built into your literature review. Or it may form its own section in your research proposal/design (e.g., “literature review” followed by “theoretical framework”). In my own experience, I see a lot of graduate students grappling with the requirement to “include theory” in their research proposals. Things get a little squiggly here because there are different ways of incorporating theory into a study (Are you testing a theory? Are you generating a theory?), and based on these differences, your literature review proper may include works that describe, explain, and otherwise set forth theories, concepts, or frameworks you are interested in, or it may not do this at all. Sometimes a literature review sets forth what we know about a particular group or culture totally independent of what kinds of theoretical framework or particular concepts you want to explore. Indeed, the big point of your study might be to bring together a body of work with a theory that has never been applied to it previously. All this is to say that there is no one correct way to approach the use of theory and the writing about theory in your research proposal.

Students are often scared of embracing theory because they do not exactly understand what it is. Sometimes, it seems like an arbitrary requirement. You’re interested in a topic; maybe you’ve even done some research in the area and you have findings you want to report. And then a committee member reads over what you have and asks, “So what?” This question is a good clue that you are missing theory, the part that connects what you have done to what other researchers have done and are doing. You might stumble upon this rather accidentally and not know you are embracing theory, as in a case where you seek to replicate a prior study under new circumstances and end up finding that a particular correlation between behaviors only happens when mediated by something else. There’s theory in there, if you can pull it out and articulate it. Or it might be that you are motivated to do more research on racial microaggressions because you want to document their frequency in a particular setting, taking for granted the kind of critical race theoretical framework that has done the hard work of defining and conceptualizing “microaggressions” in the first place. In that case, your literature review could be a review of Critical Race Theory, specifically related to this one important concept. That’s the way to bring your study into a broader conversation while also acknowledging (and honoring) the hard work that has preceded you.

Rubin ( 2021 ) classifies ways of incorporating theory into case study research into four categories, each of which might be discussed somewhat differently in a literature review or theoretical framework section. The first, the least theoretical, is where you set out to study a “configurative idiographic case” ( 70 ) This is where you set out to describe a particular case, leaving yourself pretty much open to whatever you find. You are not expecting anything based on previous literature. This is actually pretty weak as far as research design goes, but it is probably the default for novice researchers. Your committee members should probably help you situate this in previous literature in some way or another. If they cannot, and it really does appear you are looking at something fairly new that no one else has bothered to research before, and you really are completely open to discovery, you might try using a Grounded Theory approach, which is a methodological approach that foregrounds the generation of theory. In that case, your “theory” section can be a discussion of “Grounded Theory” methodology (confusing, yes, but if you take some time to ponder, you will see how this works). You will still need a literature review, though. Ideally one that describes other studies that have ever looked at anything remotely like what you are looking at—parallel cases that have been researched.

The second approach is the “disciplined configurative case,” in which theory is applied to explain a particular case or topic. You are not trying to test the theory but rather assuming the theory is correct, as in the case of exploring microaggressions in a particular setting. In this case, you really do need to have a separate theory section in addition to the literature review, one in which you clearly define the theoretical framework, including any of its important concepts. You can use this section to discuss how other researchers have used the concepts and note any discrepancies in definitions or operationalization of those concepts. This way you will be sure to design your study so that it speaks to and with other researchers. If everyone who is writing about microaggressions has a different definition of them, it is hard for others to compare findings or make any judgments about their prevalence (or any number of other important characteristics). Your literature review section may then stand alone and describe previous research in the particular area or setting, irrespective of the kinds of theory underlying those studies.

The third approach is “heuristic,” one in which you seek to identify new variables, hypotheses, mechanisms, or paths not yet explained by a theory or theoretical framework. In a way, you are generating new theory, but it is probably more accurate to say that you are extending or deepening preexisting theory. In this case, having a single literature review that is focused on the theory and the ways the theory has been applied and understood (with all its various mechanisms and pathways) is probably your best option. The focus of the literature reviewed is less on the case and more on the theory you are seeking to extend.

The final approach is “theory testing,” which is much rarer in qualitative studies than in quantitative, where this is the default approach. Theory-testing cases are those where a particular case is used to see if an existing theory is accurate or accurate under particular circumstances. As with the heuristic approach, your literature review will probably draw heavily on previous uses of the theory, but you may end up having a special section specifically about cases very close to your own . In other words, the more your study approaches theory testing, the more likely there is to be a set of similar studies to draw on or even one important key study that you are setting your own study up in parallel to in order to find out if the theory generated there operates here.

If we wanted to get very technical, it might be useful to distinguish theoretical frameworks properly from conceptual frameworks. The latter are a bit looser and, given the nature of qualitative research, often fit exploratory studies. Theoretical frameworks rely on specific theories and are essential for theory-testing studies. Conceptual frameworks can pull in specific concepts or ideas that may or may not be linked to particular theories. Think about it this way: A theory is a story of how the world works. Concepts don’t presume to explain the whole world but instead are ways to approach phenomena to help make sense of them. Microaggressions are concepts that are linked to Critical Race Theory. One could contextualize one’s study within Critical Race Theory and then draw various concepts, such as that of microaggressions from the overall theoretical framework. Or one could bracket out the master theory or framework and employ the concept of microaggression more opportunistically as a phenomenon of interest. If you are unsure of what theory you are using, you might want to frame a more practical conceptual framework in your review of the literature.

Helpful Tips

How to maintain good notes for what your read.

Over the years, I have developed various ways of organizing notes on what I read. At first, I used a single sheet of full-size paper with a preprinted list of questions and points clearly addressed on the front side, leaving the second side for more reflective comments and free-form musings about what I read, why it mattered, and how it might be useful for my research. Later, I developed a system in which I use a single 4″ × 6″ note card for each book I read. I try only to use the front side (and write very small), leaving the back for comments that are about not just this reading but things to do or examine or consider based on the reading. These notes often mean nothing to anyone else picking up the card, but they make sense to me. I encourage you to find an organizing system that works for you. Then when you set out to compose a literature review, instead of staring at five to ten books or a dozen articles, you will have ten neatly printed pages or notecards or files that have distilled what is important to know about your reading.

It is also a good idea to store this data digitally, perhaps through a reference manager. I use RefWorks, but I also recommend EndNote or any other system that allows you to search institutional databases. Your campus library will probably provide access to one of these or another system. Most systems will allow you to export references from another manager if and when you decide to move to another system. Reference managers allow you to sort through all your literature by descriptor, author, year, and so on. Even so, I personally like to have the ability to manually sort through my index cards, recategorizing things I have read as I go. I use RefWorks to keep a record of what I have read, with proper citations, so I can create bibliographies more easily, and I do add in a few “notes” there, but the bulk of my notes are kept in longhand.

What kinds of information should you include from your reading? Here are some bulleted suggestions from Calarco ( 2020:113–114 ), with my own emendations:

• Citation . If you are using a reference manager, you can import the citation and then, when you are ready to create a bibliography, you can use a provided menu of citation styles, which saves a lot of time. If you’ve originally formatted in Chicago Style but the journal you are writing for wants APA style, you can change your entire bibliography in less than a minute. When using a notecard for a book, I include author, title, date as well as the library call number (since most of what I read I pull from the library). This is something RefWorks is not able to do, and it helps when I categorize.

I begin each notecard with an “intro” section, where I record the aims, goals, and general point of the book/article as explained in the introductory sections (which might be the preface, the acknowledgments, or the first two chapters). I then draw a bold line underneath this part of the notecard. Everything after that should be chapter specific. Included in this intro section are things such as the following, recommended by Calarco ( 2020 ):

• Key background . “Two to three short bullet points identifying the theory/prior research on which the authors are building and defining key terms.”
• Data/methods . “One or two short bullet points with information about the source of the data and the method of analysis, with a note if this is a novel or particularly effective example of that method.” I use [M] to signal methodology on my notecard, which might read, “[M] Int[erview]s (n-35), B[lack]/W[hite] voters” (I need shorthand to fit on my notecard!).
• Research question . “Stated as briefly as possible.” I always provide page numbers so I can go back and see exactly how this was stated (sometimes, in qualitative research, there are multiple research questions, and they cannot be stated simply).
• Argument/contributions . “Two to three short bullet points briefly describing the authors’ answer to the central research question and its implication for research, theory, and practice.” I use [ARG] for argument to signify the argument, and I make sure this is prominently visible on my notecard. I also provide page numbers here.

For me, all of this fits in the “intro” section, which, if this is a theoretically rich, methodologically sound book, might take up a third or even half of the front page of my notecard. Beneath the bold underline, I report specific findings or particulars of the book as they emerge chapter by chapter. Calarco’s ( 2020 ) next step is the following:

• Key findings . “Three to four short bullet points identifying key patterns in the data that support the authors’ argument.”

All that remains is writing down thoughts that occur upon finishing the article/book. I use the back of the notecard for these kinds of notes. Often, they reach out to other things I have read (e.g., “Robinson reminds me of Crusoe here in that both are looking at the effects of social isolation, but I think Robinson makes a stronger argument”). Calarco ( 2020 ) concludes similarly with the following:

• Unanswered questions . “Two to three short bullet points that identify key limitations of the research and/or questions the research did not answer that could be answered in future research.”

As I mentioned, when I first began taking notes like this, I preprinted pages with prompts for “research question,” “argument,” and so on. This was a great way to remind myself to look for these things in particular. You can do the same, adding whatever preprinted sections make sense to you, given what you are studying and the important aspects of your discipline. The other nice thing about the preprinted forms is that it keeps your writing to a minimum—you cannot write more than the allotted space, even if you might want to, preventing your notes from spiraling out of control. This can be helpful when we are new to a subject and everything seems worth recording!

After years of discipline, I have finally settled on my notecard approach. I have thousands of notecards, organized in several index card filing boxes stacked in my office. On the top right of each card is a note of the month/day I finished reading the item. I can remind myself what I read in the summer of 2010 if the need or desire ever arose to do so…those invaluable notecards are like a memento of what my brain has been up to!

Where to Start Looking for Literature

Your university library should provide access to one of several searchable databases for academic books and articles. My own preference is JSTOR, a service of ITHAKA, a not-for-profit organization that works to advance and preserve knowledge and to improve teaching and learning through the use of digital technologies. JSTOR allows you to search by several keywords and to narrow your search by type of material (articles or books). For many disciplines, the “literature” of the literature review is expected to be peer-reviewed “articles,” but some disciplines will also value books and book chapters. JSTOR is particularly useful for article searching. You can submit several keywords and see what is returned, and you can also narrow your search by a particular journal or discipline. If your discipline has one or two key journals (e.g., the American Journal of Sociology and the American Sociological Review are key for sociology), you might want to go directly to those journals’ websites and search for your topic area. There is an art to when to cast your net widely and when to refine your search, and you may have to tack back and forth to ensure that you are getting all that is relevant but not getting bogged down in all studies that might have some marginal relevance.

Some articles will carry more weight than others, and you can use applications like Google Scholar to see which articles have made and are continuing to make larger impacts on your discipline. Find these articles and read them carefully; use their literature review and the sources cited in those articles to make sure you are capturing what is relevant. This is actually a really good way of finding relevant books—only the most impactful will make it into the citations of journals. Over time, you will notice that a handful of articles (or books) are cited so often that when you see, say, Armstrong and Hamilton ( 2015 ), you know exactly what book this is without looking at the full cite. This is when you know you are in the conversation.

You might also approach a professor whose work is broadly in the area of your interest and ask them to recommend one or two “important” foundational articles or books. You can then use the references cited in those recommendations to build up your literature. Just be careful: some older professors’ knowledge of the literature (and I reluctantly add myself here) may be a bit outdated! It is best that the article or book whose references and sources you use to build your body of literature be relatively current.

Keep a List of Your Keywords

When using searchable databases, it is a good idea to keep a list of all the keywords you use as you go along so that (1) you do not needlessly duplicate your efforts and (2) you can more easily adjust your search as you get a better sense of what you are looking for. I suggest you keep a separate file or even a small notebook for this and you date your search efforts.

Here’s an example:

Table 9.2. Keep a List of Your Keywords

Think Laterally

How to find the various strands of literature to combine? Don’t get stuck on finding the exact same research topic you think you are interested in. In the female gymnast example, I recommended that my student consider looking for studies of ballerinas, who also suffer sports injuries and around whom there is a similar culture of silence. It turned out that there was in fact research about my student’s particular questions, just not about the subjects she was interested in. You might do something similar. Don’t get stuck looking for too direct literature but think about the broader phenomenon of interest or analogous cases.

Read Outside the Canon

Some scholars’ work gets cited by everyone all the time. To some extent, this is a very good thing, as it helps establish the discipline. For example, there are a lot of “Bourdieu scholars” out there (myself included) who draw ideas, concepts, and quoted passages from Bourdieu. This makes us recognizable to one another and is a way of sharing a common language (e.g., where “cultural capital” has a particular meaning to those versed in Bourdieusian theory). There are empirical studies that get cited over and over again because they are excellent studies but also because there is an “echo chamber effect” going on, where knowing to cite this study marks you as part of the club, in the know, and so on. But here’s the problem with this: there are hundreds if not thousands of excellent studies out there that fail to get appreciated because they are crowded out by the canon. Sometimes this happens because they are published in “lower-ranked” journals and are never read by a lot of scholars who don’t have time to read anything other than the “big three” in their field. Other times this happens because the author falls outside of the dominant social networks in the field and thus is unmentored and fails to get noticed by those who publish a lot in those highly ranked and visible spaces. Scholars who fall outside the dominant social networks and who publish outside of the top-ranked journals are in no way less insightful than their peers, and their studies may be just as rigorous and relevant to your work, so it is important for you to take some time to read outside the canon. Due to how a person’s race, gender, and class operate in the academy, there is also a matter of social justice and ethical responsibility involved here: “When you focus on the most-cited research, you’re more likely to miss relevant research by women and especially women of color, whose research tends to be under-cited in most fields. You’re also more likely to miss new research, research by junior scholars, and research in other disciplines that could inform your work. Essentially, it is important to read and cite responsibly, which means checking that you’re not just reading and citing the same white men and the same old studies that everyone has cited before you” ( Calarco 2020:112 ).

Consider Multiple Uses for Literature

Throughout this chapter, I’ve referred to the literature of interest in a rather abstract way, as what is relevant to your study. But there are many different ways previous research can be relevant to your study. The most basic use of the literature is the “findings”—for example, “So-and-so found that Canadian working-class students were concerned about ‘fitting in’ to the culture of college, and I am going to look at a similar question here in the US.” But the literature may be of interest not for its findings but theoretically—for example, employing concepts that you want to employ in your own study. Bourdieu’s definition of social capital may have emerged in a study of French professors, but it can still be relevant in a study of, say, how parents make choices about what preschools to send their kids to (also a good example of lateral thinking!).

If you are engaged in some novel methodological form of data collection or analysis, you might look for previous literature that has attempted that. I would not recommend this for undergraduate research projects, but for graduate students who are considering “breaking the mold,” find out if anyone has been there before you. Even if their study has absolutely nothing else in common with yours, it is important to acknowledge that previous work.

Describing Gaps in the Literature

First, be careful! Although it is common to explain how your research adds to, builds upon, and fills in gaps in the previous research (see all four literature review examples in this chapter for this), there is a fine line between describing the gaps and misrepresenting previous literature by failing to conduct a thorough review of the literature. A little humility can make a big difference in your presentation. Instead of “This is the first study that has looked at how firefighters juggle childcare during forest fire season,” say, “I use the previous literature on how working parents juggling childcare and the previous ethnographic studies of firefighters to explore how firefighters juggle childcare during forest fire season.” You can even add, “To my knowledge, no one has conducted an ethnographic study in this specific area, although what we have learned from X about childcare and from Y about firefighters would lead us to expect Z here.” Read more literature review sections to see how others have described the “gaps” they are filling.

Use Concept Mapping

Concept mapping is a helpful tool for getting your thoughts in order and is particularly helpful when thinking about the “literature” foundational to your particular study. Concept maps are also known as mind maps, which is a delightful way to think about them. Your brain is probably abuzz with competing ideas in the early stages of your research design. Write/draw them on paper, and then try to categorize and move the pieces around into “clusters” that make sense to you. Going back to the gymnasts example, my student might have begun by jotting down random words of interest: gymnasts * sports * coaches * female gymnasts * stress * injury * don’t complain * women in sports * bad coaching * anxiety/stress * careers in sports * pain. She could then have begun clustering these into relational categories (bad coaching, don’t complain culture) and simple “event” categories (injury, stress). This might have led her to think about reviewing literature in these two separate aspects and then literature that put them together. There is no correct way to draw a concept map, as they are wonderfully specific to your mind. There are many examples you can find online.

Ask Yourself, “How Is This Sociology (or Political Science or Public Policy, Etc.)?”

Rubin ( 2021:82 ) offers this suggestion instead of asking yourself the “So what?” question to get you thinking about what bridges there are between your study and the body of research in your particular discipline. This is particularly helpful for thinking about theory. Rubin further suggests that if you are really stumped, ask yourself, “What is the really big question that all [fill in your discipline here] care about?” For sociology, it might be “inequality,” which would then help you think about theories of inequality that might be helpful in framing your study on whatever it is you are studying—OnlyFans? Childcare during COVID? Aging in America? I can think of some interesting ways to frame questions about inequality for any of those topics. You can further narrow it by focusing on particular aspects of inequality (Gender oppression? Racial exclusion? Heteronormativity?). If your discipline is public policy, the big questions there might be, How does policy get enacted, and what makes a policy effective? You can then take whatever your particular policy interest is—tax reform, student debt relief, cap-and-trade regulations—and apply those big questions. Doing so would give you a handle on what is otherwise an intolerably vague subject (e.g., What about student debt relief?).

Sometimes finding you are in new territory means you’ve hit the jackpot, and sometimes it means you’ve traveled out of bounds for your discipline. The jackpot scenario is wonderful. You are doing truly innovative research that is combining multiple literatures or is addressing a new or under-examined phenomenon of interest, and your research has the potential to be groundbreaking. Congrats! But that’s really hard to do, and it might be more likely that you’ve traveled out of bounds, by which I mean, you are no longer in your discipline . It might be that no one has written about this thing—at least within your field— because no one in your field actually cares about this topic . ( Rubin 2021:83 ; emphases added)

Don’t Treat This as a Chore

Don’t treat the literature review as a chore that has to be completed, but see it for what it really is—you are building connections to other researchers out there. You want to represent your discipline or area of study fairly and adequately. Demonstrate humility and your knowledge of previous research. Be part of the conversation.

Supplement: Two More Literature Review Examples

Elites by harvey ( 2011 ).

In the last two decades, there has been a small but growing literature on elites. In part, this has been a result of the resurgence of ethnographic research such as interviews, focus groups, case studies, and participant observation but also because scholars have become increasingly interested in understanding the perspectives and behaviors of leaders in business, politics, and society as a whole. Yet until recently, our understanding of some of the methodological challenges of researching elites has lagged behind our rush to interview them.

There is no clear-cut definition of the term elite, and given its broad understanding across the social sciences, scholars have tended to adopt different approaches. Zuckerman (1972) uses the term ultraelites to describe individuals who hold a significant amount of power within a group that is already considered elite. She argues, for example, that US senators constitute part of the country’s political elite but that among them are the ultraelites: a “subset of particularly powerful or prestigious influentials” (160). She suggests that there is a hierarchy of status within elite groups. McDowell (1998) analyses a broader group of “professional elites” who are employees working at different levels for merchant and investment banks in London. She classifies this group as elite because they are “highly skilled, professionally competent, and class-specific” (2135). Parry (1998:2148) uses the term hybrid elites in the context of the international trade of genetic material because she argues that critical knowledge exists not in traditional institutions “but rather as increasingly informal, hybridised, spatially fragmented, and hence largely ‘invisible,’ networks of elite actors.” Given the undertheorization of the term elite, Smith (2006) recognizes why scholars have shaped their definitions to match their respondents . However, she is rightly critical of the underlying assumption that those who hold professional positions necessarily exert as much influence as initially perceived. Indeed, job titles can entirely misrepresent the role of workers and therefore are by no means an indicator of elite status (Harvey 2010).

Many scholars have used the term elite in a relational sense, defining them either in terms of their social position compared to the researcher or compared to the average person in society (Stephens 2007). The problem with this definition is there is no guarantee that an elite subject will necessarily translate this power and authority in an interview setting. Indeed, Smith (2006) found that on the few occasions she experienced respondents wanting to exert their authority over her, it was not from elites but from relatively less senior workers. Furthermore, although business and political elites often receive extensive media training, they are often scrutinized by television and radio journalists and therefore can also feel threatened in an interview, particularly in contexts that are less straightforward to prepare for such as academic interviews. On several occasions, for instance, I have been asked by elite respondents or their personal assistants what they need to prepare for before the interview, which suggests that they consider the interview as some form of challenge or justification for what they do.

In many cases, it is not necessarily the figureheads or leaders of organizations and institutions who have the greatest claim to elite status but those who hold important social networks, social capital, and strategic positions within social structures because they are better able to exert influence (Burt 1992; Parry 1998; Smith 2005; Woods 1998). An elite status can also change, with people both gaining and losing theirs over time. In addition, it is geographically specific, with people holding elite status in some but not all locations. In short, it is clear that the term elite can mean many things in different contexts, which explains the range of definitions. The purpose here is not to critique these other definitions but rather to highlight the variety of perspectives.

When referring to my research, I define elites as those who occupy senior-management- and board-level positions within organizations. This is a similar scope of definition to Zuckerman’s (1972) but focuses on a level immediately below her ultraelite subjects. My definition is narrower than McDowell’s (1998) because it is clear in the context of my research that these people have significant decision-making influence within and outside of the firm and therefore present a unique challenge to interview. I deliberately use the term elite more broadly when drawing on examples from the theoretical literature in order to compare my experiences with those who have researched similar groups.

”Changing Dispositions among the Upwardly Mobile” by Curl, Lareau, and Wu ( 2018 )

There is growing interest in the role of cultural practices in undergirding the social stratification system. For example, Lamont et al. (2014) critically assess the preoccupation with economic dimensions of social stratification and call for more developed cultural models of the transmission of inequality. The importance of cultural factors in the maintenance of social inequality has also received empirical attention from some younger scholars, including Calarco (2011, 2014) and Streib (2015). Yet questions remain regarding the degree to which economic position is tied to cultural sensibilities and the ways in which these cultural sensibilities are imprinted on the self or are subject to change. Although habitus is a core concept in Bourdieu’s theory of social reproduction, there is limited empirical attention to the precise areas of the habitus that can be subject to change during upward mobility as well as the ramifications of these changes for family life.

In Bourdieu’s (1984) highly influential work on the importance of class-based cultural dispositions, habitus is defined as a “durable system of dispositions” created in childhood. The habitus provides a “matrix of perceptions” that seems natural while also structuring future actions and pathways. In many of his writings, Bourdieu emphasized the durability of cultural tastes and dispositions and did not consider empirically whether these dispositions might be changed or altered throughout one’s life (Swartz 1997). His theoretical work does permit the possibility of upward mobility and transformation, however, through the ability of the habitus to “improvise” or “change” due to “new experiences” (Friedman 2016:131). Researchers have differed in opinion on the durability of the habitus and its ability to change (King 2000). Based on marital conflict in cross-class marriages, for instance, Streib (2015) argues that cultural dispositions of individuals raised in working-class families are deeply embedded and largely unchanging. In a somewhat different vein, Horvat and Davis (2011:152) argue that young adults enrolled in an alternative educational program undergo important shifts in their self-perception, such as “self-esteem” and their “ability to accomplish something of value.” Others argue there is variability in the degree to which habitus changes dependent on life experience and personality (Christodoulou and Spyridakis 2016). Recently, additional studies have investigated the habitus as it intersects with lifestyle through the lens of meaning making (Ambrasat et al. 2016). There is, therefore, ample discussion of class-based cultural practices in self-perception (Horvat and Davis 2011), lifestyle (Ambrasat et al. 2016), and other forms of taste (Andrews 2012; Bourdieu 1984), yet researchers have not sufficiently delineated which aspects of the habitus might change through upward mobility or which specific dimensions of life prompt moments of class-based conflict.

Bourdieu (1999:511; 2004) acknowledged simmering tensions between the durable aspects of habitus and those aspects that have been transformed—that is, a “fractured” or “cleft” habitus. Others have explored these tensions as a “divided” or “fragmented” habitus (Baxter and Britton 2001; Lee and Kramer 2013). Each of these conceptions of the habitus implies that changes in cultural dispositions are possible but come with costs. Exploration of the specific aspects of one’s habitus that can change and generate conflict contributes to this literature.

Scholars have also studied the costs associated with academic success for working-class undergraduates (Hurst 2010; Lee and Kramer 2013; London 1989; Reay 2017; Rondini 2016; Stuber 2011), but we know little about the lasting effects on adults. For instance, Lee and Kramer (2013) point to cross-class tensions as family and friends criticize upwardly mobile individuals for their newly acquired cultural dispositions. Documenting the tension many working-class students experience with their friends and families of origin, they find that the source of their pain or struggle is “shaped not only by their interactions with non-mobile family and friends but also within their own minds, by their own assessments of their social positions, and by how those positions are interpreted by others” (Lee and Kramer 2013:29). Hurst (2010) also explores the experiences of undergraduates who have been academically successful and the costs associated with that success. She finds that decisions about “class allegiance and identity” are required aspects of what it means to “becom[e] educated” (4) and that working-class students deal with these cultural changes differently. Jack (2014, 2016) also argues that there is diversity among lower-income students, which yields varied college experiences. Naming two groups, the “doubly disadvantaged” and the “privileged poor,” he argues that previous experience with “elite environments” (2014:456) prior to college informs students’ ability to take on dominant cultural practices, particularly around engagement, such as help seeking or meeting with professors (2016). These studies shed light on the role college might play as a “lever for mobility” (2016:15) and discuss the pain and difficulty associated with upward mobility among undergraduates, but the studies do not illuminate how these tensions unfold in adulthood. Neither have they sufficiently addressed potential enduring tensions with extended family members as well as the specific nature of the difficulties.

Some scholars point to the positive outcomes upwardly mobile youth (Lehmann 2009) and adults (Stuber 2005) experience when they maintain a different habitus than their newly acquired class position, although, as Jack (2014, 2016) shows, those experiences may vary depending on one’s experience with elite environments in their youth. Researchers have not sufficiently explored the specific aspects of the habitus that upwardly mobile adults change or the conflicts that emerge with family and childhood friends as they reach adulthood and experience colliding social worlds. We contribute to this scholarship with clear examples of self-reported changes to one’s cultural dispositions in three specific areas: “horizons,” food and health, and communication. We link these changes to enduring tension with family members, friends, and colleagues and explore varied responses to this tension based on race.

Further Readings

Bloomberg, Linda Dale, and Marie F. Volpe. 2012. Completing Your Qualitative Dissertation: A Road Map from Beginning to End . 2nd ed. Thousand Oaks, CA: SAGE. In keeping with its general approach to qualitative research, includes a “road map” for conducting a literature review.

Hart, Chris. 1998. Doing a Literature Review: Releasing the Social Science Research Imagination . London: SAGE. A how-to book dedicated entirely to conducting a literature review from a British perspective. Useful for both undergraduate and graduate students.

Machi, Lawrence A., and Brenda T. McEvoy. 2022. The Literature Review: Six Steps to Success . 4th ed. Newbury Park, CA: Corwin. A well-organized guidebook complete with reflection sections to prompt successful thinking about your literature review.

Ridley, Diana. 2008. The Literature Review: A Step-by-Step Guide for Students . London: SAGE. A highly recommended companion to conducting a literature review for doctoral-level students.

The process of systematically searching through pre-existing studies (“literature”) on the subject of research; also, the section of a presentation in which the pre-existing literature is discussed.

Follow-up questions used in a semi-structured interview  to elicit further elaboration.  Suggested prompts can be included in the interview guide  to be used/deployed depending on how the initial question was answered or if the topic of the prompt does not emerge spontaneously.

A tool for identifying relationships among ideas by visually representing them on paper.  Most concept maps depict ideas as boxes or circles (also called nodes), which are structured hierarchically and connected with lines or arrows (also called arcs). These lines are labeled with linking words and phrases to help explain the connections between concepts.  Also known as mind mapping.

The people who are the subjects of an interview-based qualitative study. In general, they are also known as the participants, and for purposes of IRBs they are often referred to as the human subjects of the research.

Introduction to Qualitative Research Methods Copyright © 2023 by Allison Hurst is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

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A Guide to Writing a Qualitative Systematic Review Protocol to Enhance Evidence-Based Practice in Nursing and Health Care

Affiliations.

• 1 PhD candidate, School of Nursing and Midwifey, Monash University, and Clinical Nurse Specialist, Adult and Pediatric Intensive Care Unit, Monash Health, Melbourne, Victoria, Australia.
• 2 Lecturer, School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia.
• 3 Senior Lecturer, School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia.
• PMID: 26790142
• DOI: 10.1111/wvn.12134

Background: The qualitative systematic review is a rapidly developing area of nursing research. In order to present trustworthy, high-quality recommendations, such reviews should be based on a review protocol to minimize bias and enhance transparency and reproducibility. Although there are a number of resources available to guide researchers in developing a quantitative review protocol, very few resources exist for qualitative reviews.

Aims: To guide researchers through the process of developing a qualitative systematic review protocol, using an example review question.

Methodology: The key elements required in a systematic review protocol are discussed, with a focus on application to qualitative reviews: Development of a research question; formulation of key search terms and strategies; designing a multistage review process; critical appraisal of qualitative literature; development of data extraction techniques; and data synthesis. The paper highlights important considerations during the protocol development process, and uses a previously developed review question as a working example.

Implications for research: This paper will assist novice researchers in developing a qualitative systematic review protocol. By providing a worked example of a protocol, the paper encourages the development of review protocols, enhancing the trustworthiness and value of the completed qualitative systematic review findings.

Linking evidence to action: Qualitative systematic reviews should be based on well planned, peer reviewed protocols to enhance the trustworthiness of results and thus their usefulness in clinical practice. Protocols should outline, in detail, the processes which will be used to undertake the review, including key search terms, inclusion and exclusion criteria, and the methods used for critical appraisal, data extraction and data analysis to facilitate transparency of the review process. Additionally, journals should encourage and support the publication of review protocols, and should require reference to a protocol prior to publication of the review results.

Keywords: guidelines; meta synthesis; qualitative; systematic review protocol.

© 2016 Sigma Theta Tau International.

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Article Contents

Introduction, challenging some common methodological assumptions about online qualitative surveys, ten practical tips for designing, implementing and analysing online qualitative surveys, acknowledgements, conflict of interest statement, data availability, ethical approval.

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Methodological and practical guidance for designing and conducting online qualitative surveys in public health

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Samantha L Thomas, Hannah Pitt, Simone McCarthy, Grace Arnot, Marita Hennessy, Methodological and practical guidance for designing and conducting online qualitative surveys in public health, Health Promotion International , Volume 39, Issue 3, June 2024, daae061, https://doi.org/10.1093/heapro/daae061

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Online qualitative surveys—those surveys that prioritise qualitative questions and interpretivist values—have rich potential for researchers, particularly in new or emerging areas of public health. However, there is limited discussion about the practical development and methodological implications of such surveys, particularly for public health researchers. This poses challenges for researchers, funders, ethics committees, and peer reviewers in assessing the rigour and robustness of such research, and in deciding the appropriateness of the method for answering different research questions. Drawing and extending on the work of other researchers, as well as our own experiences of conducting online qualitative surveys with young people and adults, we describe the processes associated with developing and implementing online qualitative surveys and writing up online qualitative survey data. We provide practical examples and lessons learned about question development, the importance of rigorous piloting strategies, use of novel techniques to prompt detailed responses from participants, and decisions that are made about data preparation and interpretation. We consider reviewer comments, and some ethical considerations of this type of qualitative research for both participants and researchers. We provide a range of practical strategies to improve trustworthiness in decision-making and data interpretation—including the importance of using theory. Rigorous online qualitative surveys that are grounded in qualitative interpretivist values offer a range of unique benefits for public health researchers, knowledge users, and research participants.

Public health researchers are increasingly using online qualitative surveys.

There is still limited practical and methodological information about the design and implementation of these studies.

Building on Braun and Clarke (2013) , Terry and Braun (2017) and Braun et al . (2021) , we reflect on the methodological and practical lessons we have learnt from our own experience with conducting online qualitative surveys.

We provide guidance and practical examples about the design, implementation and analysis processes.

We argue that online qualitative surveys have rich potential for public health researchers and can be an empowering and engaging way to include diverse populations in qualitative research.

Public health researchers mostly engage in experiential (interpretive) qualitative approaches ( Braun and Clarke, 2013 ). These approaches are ‘centred on the exploration of participants’ subjective experiences and sense-making’ [( Braun and Clarke, 2021c ), p. 39]. Given the strong focus in public health on social justice, power and inequality, researchers proactively use the findings from these qualitative studies—often in collaboration with lived experience experts and others who are impacted by key decisions ( Reed et al ., 2024 )—to advocate for changes to public health policy and practice. There is also an important level of theoretical, methodological and empirical reflection that is part of the public health researcher’s role. For example, as qualitative researchers actively construct and interpret meaning from data, they constantly challenge their assumptions, their way of knowing and their way of ‘doing’ research ( Braun and Clarke, 2024 ). This reflexive practice also includes considering how to develop more inclusive opportunities for people to participate in research and to share their opinions and experiences about the issues that matter to them.

While in-depth interviews and focus groups provide rich and detailed narratives that are central to understanding people’s lives, these forms of data collection may sometimes create practical barriers for both researchers and participants. For example, they can be time consuming, and the power dynamics associated with face-to-face interviews (even in online settings) may make them less accessible for groups that are marginalized or stigmatized ( Edwards and Holland, 2020 ). While some population subgroups (and contexts) may suit (or require) face-to-face qualitative data collection approaches, others may lend themselves to different forms of data collection. Young people, for example, may be keen to be civically involved in research about the issues that matter to them, such as the climate crisis, but they may find it more convenient and comfortable using anonymized digital technologies to do so ( Arnot et al ., 2024b ). As such, part of our reflexive practice as public health researchers must be to explore, and be open to, a range of qualitative methodological approaches that could be more convenient, less intimidating and more engaging for a diverse range of population subgroups. This includes thinking about pragmatic ways of operationalizing qualitative data collection methods. How can we develop methods and engagement strategies that enable us to gain insights from a diverse range of participants about new issues or phenomenon that may pose threats to public health, or look at existing issues in new ways?

Advancements in online data collection methods have also created new options for researchers and participants about how they can be involved in qualitative studies ( Hensen et al ., 2021 ; Chen, 2023 ; Fan et al ., 2024 ). Online qualitative surveys—those surveys that prioritize qualitative values and questions—have rich potential for qualitative researchers. Braun and Clarke (2013 , p. 135) state that qualitative surveys:

…consist of a series of open-ended questions about a topic, and participants type or hand-write their responses to each question. They are self-administered; a researcher-administered qualitative survey would basically be an interview.

While these types of studies are increasingly utilized in public health, researchers have highlighted that there is still relatively limited discussion about the methodological and practical implications of these surveys ( Braun and Clarke, 2013 ; Terry and Braun, 2017 ; Braun et al ., 2021 ). This poses challenges for qualitative public health researchers, funders, ethics committees and peer reviewers in assessing the purpose, rigour and contribution of such research, and in deciding the appropriateness of the method for answering different research questions.

Using examples from online qualitative surveys that we have been involved in, this article discusses a range of methodological and practical lessons learnt from developing, implementing and analysing data from these types of surveys. While we do not claim to have all the answers, we aim to develop and extend on the methodological and practical guidance from Braun and Clarke (2013) , Terry and Braun (2017) and Braun et al . (2021) about the potential for online qualitative surveys. This includes how they can provide a rigorous ‘wide-angle picture’ [( Toerien and Wilkinson, 2004 ), p. 70] from a diverse range of participants about contemporary public health phenomena.

Figure 1 aims to develop and extend on the key points made by Braun and Clarke (2013) , Terry and Braun (2017) and Braun et al . (2021) , which provide the methodological and empirical foundation for our article.

: Methodological considerations in conducting online qualitative surveys.

Harnessing interpretivist approaches and qualitative values in online qualitative surveys

Online qualitative surveys take many forms. They may be fully qualitative or qualitative dominant—mostly qualitative with some quantitative questions ( Terry and Braun, 2017 ). There are also many different ways of conducting these studies—from using a smaller number of questions that engage specific population groups or knowledge users in understanding detailed experiences  ( Hennessy and O’Donoghue, 2024 ), to a larger number of questions (which may use market research panel providers to recruit participants), that seek broader opinions and attitudes about public health issues ( Marko et al ., 2022a ; McCarthy et al ., 2023 ; Arnot et al ., 2024a ). However, based on our experiences of applying for grant funding and conducting, publishing and presenting these studies, there are still clear misconceptions and uncertainties about these types of  surveys.

One of the concerns raised about online qualitative surveys is how they are situated within broader qualitative values and approaches. This includes whether they can provide empirically innovative, rigorous, rich and theoretically grounded qualitative contributions to knowledge. Our experience is that online qualitative surveys have the most potential when they harness the values of interpretivist ‘Big Q’ approaches to collect information from a diverse range of participants about their experiences, opinions and practices ( Braun et al ., 2021 ). The distinction between positivist (small q) and interpretivist (Big Q) approaches to online qualitative surveys is an important one that requires some initial methodological reflection, particularly in considering the (largely unhelpful) critiques that are made about the rigour and usefulness of these surveys. These critiques often overlook the theoretical underpinnings and qualitative values inherent in such surveys. For example, while there may be a tendency to think of surveys and survey data as atheoretical and descriptive, the use of theory is central in informing online qualitative surveys. For example, Varpio and Ellaway (2021 , p. 343) explain that theory can ‘offer explanations and detailed premises that we can wrestle with, agree with, disagree with, reject and/or accept’. This includes the research design, the approach to data collection and analysis, the interpretation of findings and the conclusions that are drawn. Theory is also important in helping researchers to engage in reflexive practice. The use of theory is essential in progressing online qualitative surveys beyond description and towards in-depth interpretation and explanations—thus facilitating a deeper understanding of the studied phenomenon ( Collins and Stockton, 2018 ; Jamie and Rathbone, 2022 ).

Considering the assumptions that online qualitative surveys can only collect ‘thin’ data

The main assumptions about online qualitative surveys are that they can only collect ‘thin’ textual data, and that they are not flexible enough as a data collection tool for researchers to prompt or ask follow-up questions or to co-create detailed and rich data with participants ( Braun and Clarke, 2013 ; Terry and Clarke, 2017 ; Braun et al ., 2021 ). While we acknowledge that the type of data that is collected in these types of studies is different from those in in-depth interview studies, these surveys may be a more accessible and engaging way to collect rich insights from a diverse range of participants who may otherwise not participate in qualitative research ( Braun and Clarke, 2013 ; Terry and Braun, 2017 ; Braun et al ., 2021 ). Despite this, peer reviewers can question the depth of information that may be collected in these studies. Assumptions about large but ‘thin’ datasets may also mean that researchers, funders and reviewers take (and perhaps expect) a more positivist approach to the design and analytical processes associated with these surveys. For example, the multiple topics and questions, larger sample sizes, and the generally smaller textual responses that online qualitative surveys generate may lead researchers to approach these surveys using more descriptive and atheoretical paradigms. This approach may focus on ‘measuring’ phenomena, using variables, developing thinner analytical description and adding numerical values to the number of responses for different categories or themes.

We have found that assumptions can also impact the review processes associated with these types of studies, receiving critiques from those with both positivist and interpretivist positions. Positivist critiques focus on matters associated with whether the samples are ‘representative’, and the flaws associated with ‘self-selecting convenience’ samples. Critiques from interpretivist colleagues question why such large sample sizes are needed for qualitative studies, seeing surveys as a less rigorous method for gaining rich and meaningful data. For example, we have had reviewers query the scope and depth of the analysis of the data that we present from these studies because they are concerned that the type of data collected lacks depth and does not fully contextualize and explain how participants think about issues. We have also had reviewers request that we should return to the study to collect quantitative data to supplement the qualitative findings of the survey. They also question how ‘representative’ the samples are of population groups. These comments, of course, are not unique to online qualitative surveys but do highlight the difficulty that reviewers may have in placing and situating these types of studies in broader qualitative approaches. With this in mind, we have also found that some reviewers can ask for additional information to justify both the use of online qualitative surveys and why we have chosen these over other qualitative approaches. For example, reviewers have asked us to justify why we have chosen an online qualitative survey and also to explain what we may have missed out on by not conducting in-depth interviews or quantitative or mixed methods surveys instead.

Requests for ‘numbers’ and ‘strategies to minimize bias’

While there is now a general understanding that attributing ‘numbers’ to qualitative data is largely unhelpful and inappropriate ( Chowdhury, 2015 ), there may be expectations that the larger sample sizes associated with online qualitative surveys enable researchers to provide numerical indicators of data. Rather than focusing on the ‘artfully interpretive’ techniques used to analyse and construct themes from the data ( Finlay, 2021 ), we have found that reviewers often ask us to provide numerical information about how many people provided different responses to different questions (or constructed themes), and the number at which ‘saturation’ was determined. Reviewer feedback that we have received about analytical processes has asked for detailed explanations about why attempts to ‘minimize bias’ (including calculations of inter-rater reliability and replicability of data quality) were not used. This demonstrates that peer reviewers may misinterpret the interpretivist values that guide online qualitative surveys, asking for information that is essentially ‘meaningless’ in qualitative paradigms in which researchers’ subjectivity ‘sculpts’ the knowledge that is produced ( Braun and Clarke, 2021a ).

The benefits and limitations of online qualitative surveys for participants, researchers and knowledge users

As well as a ‘wide-angle picture’ [( Toerien and Wilkinson, 2004 ), p. 70] on phenomenon, online qualitative surveys can also: (i) generate both rich and focused data about perceptions and practices, and (ii) have multiple participatory and practical advantages—including helping to overcome barriers to research participation ( Braun and Clarke, 2013 ; Terry and Braun, 2017 ; Braun et al ., 2021 ). For researchers , online qualitative surveys can be a more cost-effective alternative ( Braun and Clarke, 2013 ; Terry and Braun, 2017 )—they are generally more time-efficient and less labour-intensive (particularly if working with market research companies to recruit panels). They are also able to reach a broad range of participants—such as those who are geographically dispersed ( Braun and Clarke, 2013 ; Terry and Braun, 2017 ), and those who may not have internet connectivity that is reliable enough to complete online interviews (a common issue for individuals living in regional or rural settings) ( de Villiers et al ., 2022 ). We are also more able to engage young people in qualitative research through online surveys, perhaps partly due to extensive panel company databases but also because they may be a more accessible and familiar way for young people to participate in research. The ability to quickly investigate new public health threats from the perspective of lived experience can also provide important information for researchers, providing justification for new areas of research focus, including setting agendas and advocating for the need for funding (or policy attention). Collecting data from a diverse range of participants—including from those who hold views that we may see as less ‘politically acceptable’, or inconsistent with our own public health reasoning about health and equity—is important in situating and contextualizing community attitudes towards particular issues.

For participants , benefits include having a degree of autonomy and control over their participation, including completing the survey at a time and place that suits them, and the anonymous nature of participation (that may be helpful for people from highly stigmatized groups). Participants can take time to reflect on their responses or complete the survey, and may feel more able to ‘talk back’ to the researcher about the framing of questions or the purpose of the research ( Braun et al ., 2021 ). We would also add that a benefit of these types of studies is that participants can also drop out of the study easily if the survey does not interest them or meet their expectations—something that we think might be more onerous or uncomfortable for participants in an interview or focus group.

For knowledge users, including advocates, service providers and decision-makers, qualitative research provides an important form of evidence, and the ‘wide-angle picture' [( Toerien and Wilkinson, 2004 ), p. 70] on issues from a diverse range of individuals in a community or population can be a powerful advocacy tool. Online qualitative surveys can also provide rapid insights into how changes to policy and practice may impact population subgroups in different ways.

There are, of course, some limitations associated with online qualitative surveys ( Braun et al ., 2021 ; Marko et al ., 2022b ). For example, there is no ability to engage individuals in a ‘traditional’ conversation or to prompt or probe meaning in the interactive ways that we are familiar with in interview studies. There is less ability to refine the questions that we ask participants in an iterative way throughout a study based on participant responses (particularly when working with market research panel companies). There may also be barriers associated with written literacy, access to digital technologies and stable internet connections ( Braun et al ., 2021 ). They may also not be the most suitable for individuals who have different ways of ‘knowing, being and doing’ qualitative research—including Indigenous populations [( Kennedy et al ., 2022 ), p. 1]. All of these factors should be taken into consideration when deciding whether online qualitative surveys are an appropriate way of collecting data. Finally, while these types of surveys can collect data quickly ( Marko et al ., 2022b ), there can also be additional decision-making processes related to data preparation and inclusion that can be time-consuming.

There are a range of practical considerations that can improve the rigour, trustworthiness and quality of online qualitative survey data. Again, developing and expanding on ( Braun and Clarke, 2013 ; Terry and Braun, 2017 ; Braun et al ., 2021 ), Figure 2 gives an overview of some key practical considerations associated with the design, implementation and analysis of these surveys. We would also note that before starting your survey design, you should be aware that people may use different types of technology to complete the survey, and in different spaces. For example, we cannot assume that people will be sitting in front of a computer or laptop at home or in the office, with people more likely to complete surveys on a mobile phone, perhaps on a train or bus on the way to work or school.

: Top ten practical tips for conducting online qualitative surveys.

Survey design

Creating an appropriate and accessible structure

The first step in designing an online qualitative survey is to plan the structure of your survey. This step is important because the structure influences the way that participants interact with and participate through the survey. The survey structure helps to create an ‘environment’ that helps participants to share their perspectives, prompt their views and develop their ideas ( Braun and Clarke, 2013 ; Terry and Braun, 2017 ). Similar to an interview study, the structure of the survey guides participants from one set of questions (and topics) to the next. It is important to consider the ordering of topics to enable participants to complete a survey that has a logical flow, introduces participants to concepts and allows them to develop their depth of responses.

Before participants start the survey, we provide a clear and simple lay language summary of the survey. Because many individuals will be familiar with completing quantitative surveys, we include a welcoming statement and reiterate the qualitative nature of the survey, stating that their answers can be about their own experiences:

Thank you for agreeing to take part in this survey about [topic] . This survey involves writing responses to questions rather than checking boxes.

We then clearly reiterate the purpose of the survey, providing a short description of the topic that we are investigating. We state that we do not seek to collect any data that is identifiable, that we are interested in participants perspectives, that there are no right or wrong answers, and that participants can withdraw from the survey at any time without giving a reason.

Similar to Braun et al . (2021) , we start our surveys with questions about demographic and related characteristics (which we often call ‘ participant/general characteristics ’). These can be discrete choice questions, but can also utilize open text—for example, in relation to gender identity. We have found that there is always a temptation with surveys to ask many questions about the demographic characteristics of participants. However, we caution that too many questions can be intrusive for participants and can take away valuable time from open-text questions, which are the core focus of the survey. We recommend asking participant characteristic and demographic questions that situate and contextualize the sample ( Elliott et al ., 1999 ).

We generally start the open-text sections of these surveys by asking broad introductory questions about the topic. This might include questions such as: ‘Please describe the main reasons you drink alcohol ’, and ‘W hat do you think are the main impacts of climate change on the world? ’ We have found that these types of questions get participants used to responding to open-text questions relevant to the study’s research questions and aims. For each new topic of investigation (which are based on our theoretical concepts and overall study aims and research questions), we provide a short explanation about what we will ask participants. We also use tools and text to signpost participant progress through the survey. This can be a valuable way to avoid high attrition rates where participants exit the survey because they are getting fatigued and are unclear when the survey will end:

Great! We are just over half-way through the survey.

We ask more detailed questions that are more aligned with our theoretical concepts in the middle of the survey. For example, we may start with broad questions about a harmful industry and their products (such as gambling, vaping or alcohol) and then in the middle of the survey ask more detailed questions about the commercial determinants of health and the specific tactics that these industries use (for example, about product design, political tactics, public relations strategies or how these practices may influence health and equity). In relation to these more complex questions, it is particularly important that we reiterate that there are no wrong answers and try to include encouraging text throughout the survey:

There are no right or wrong answers—we are curious to hear your opinions .

We always try to end the survey on a positive. While these types of questions depend on the study, we try to ask questions which enable participants to reflect on what could be done to address or improve an issue. This might include their attitudes about policy, or what they would say to those in positions of power:

What do you think should be done to protect young people from sports betting advertising on social media? If there was one thing that could be done to prevent young people from being exposed to the risks associated with alcohol, cigarettes, vaping, or gambling, what would it be? If you could say one thing to politicians about climate change, what would it be?

Finally, we ask participants if there is anything we have missed or if they have anything else to add, sometimes referred to as a ‘clean-up’ question ( Braun and Clarke, 2013 ). The following provides a few examples of how we have framed these questions in some of our studies:

Is there anything you would like to say about alcohol, cigarettes, vaping, and gambling products that we have not covered? Is there anything we haven’t asked you about the advertising of alcohol to women that you would like us to know?

Considering the impact of the length of the survey on responses

The length of the survey (both the number of questions and the time it takes an individual to complete the survey) is guided by a range of methodological and practical considerations and will vary between studies ( Braun and Clarke, 2013 ). Many factors will influence completion times. We try to give individuals a guide at the start of the survey about how long we think it will take to complete the survey (for example, between 20 and 30 minutes). We highlight that it may take people a little longer or shorter and that people are able to leave their browser open or save the survey and come back to finish it later. For our first few online qualitative surveys, we found that we asked lots of questions because we felt less in control of being able to prompt or ask follow-up questions from participants. However, we have learned that less is more! Asking too many questions may lead to more survey dropouts, and may significantly reduce the textual quality of the information that you receive from participants ( Braun and Clarke, 2013 ; Terry and Clarke, 2017 ). This includes considering how the survey questions might lead to repetition, which may be annoying for participants, leading to responses such as ‘like I’ve already said’ , ‘I’ve already answered that’ or ‘see above’ .

Providing clear and simple guidance

When designing an online qualitative survey, we try to think of ways to make participation in the survey engaging. We do not want individuals to feel that we are ‘mining’ them for data. Rather we want to demonstrate that we are genuinely interested in their perspectives and views. We use a range of mechanisms to do this. Because there is no opportunity to verbally explain or clarify concepts to participants, there is a particular need to ensure that the language used is clear and accessible ( Braun and Clarke, 2013 ; Terry and Clarke, 2017 ). If language or concepts are complex, you are more likely to receive ‘I don’t know’ responses to your questions. We need to remember that participants have a range of written and comprehension skills, and inclusive and accessible language is important. We also never try to assume a level of knowledge about an issue (unless we have specifically asked for participants who are aware and engaged in an issue—such as women who drink alcohol) ( Pitt et al ., 2023 ). This includes avoiding highly technical or academic language and not making assumptions that the individuals completing the survey will understand concepts in the same way that researchers do ( Braun and Clarke, 2013 ). Clearly explaining concepts or using text or images to prompt memories can help to overcome this:

Some big corporations (such as the tobacco, vaping, alcohol, junk food, or gambling industries) sponsor women's sporting teams or clubs, or other events. You might see sponsor logos on sporting uniforms, or at sporting grounds, or sponsoring a concert or arts event.

At all times, we try to centre the language that we use with the population from which we are seeking responses. Advisory groups can be particularly helpful in framing language for different population subgroups. We often use colloquial language, even if it might not be seen as the ‘correct’ academic language or terminology. Where possible, we also try to define theoretical concepts in a clear and easy to understand way. For example, in our study investigating parent perceptions of the impact of harmful products on young people, we tried to clearly define ‘normalization’:

In this section we ask you about some of the perceived health impacts of the above products on young people. We also ask you about the normalisation of these products for young people. When we talk about normalisation, we are thinking about the range of factors that might make these products more acceptable for young people to use. These factors might include individual factors, such as young people being attracted to risk, the influence of family or peers, the accessibility and availability of these products, or the way the industry advertises and promotes these products.

Using innovative approaches to improve accessibility and prompt responses

Online qualitative surveys can include features beyond traditional question-and-answer formats ( Braun and Clarke, 2013 ; Terry and Braun, 2017 ). For example, we often use a range of photo elicitation techniques (using images or videos) to make surveys more accessible to participate in, address different levels of literacy, and overcome the assumption that we are not able to ‘prompt’ responses. These types of visual methodologies enable a collaborative and creative research experience by asking the participant to reflect on aspects of the visual materials, such as symbolic representations, and discuss these in relation to the research objectives ( Glaw et al ., 2017 ). The combination of visual images and clear descriptions helps to provide a focus for responses about different issues, as well as prompting nuanced information such as participant memories and emotions ( Glaw et al ., 2017 ). We use different types of visuals in our studies, such as photographs (including of the public health issues we’re investigating); screenshots from websites and social media posts (including newspaper headlines) and videos (including short videos from social media sites such as TikTok) ( Arnot et al ., 2024b ). For example, when talking about government responses to the climate crisis, we used a photograph of former Australian Prime Minister Scott Morrison holding a piece of coal in the Australian parliament to prompt participants’ thinking about the government’s relationship with fossil fuels and to provide a focal point for their answer. However, we would caution against using any images that may be confronting for participants or deliberately provocative. The purpose of using visuals must always be in the interests of the participants—to clarify, prompt and reflect on concepts. Ethics committees should carefully review the images used in surveys to ensure that they have a clear purpose and are unlikely to cause any discomfort.

Survey implementation

Thinking carefully about your criteria for recruitment

Determining the sample size of online qualitative studies is not an exact science. The sample sizes for recent studies have ranged from n = 46 in a study about pregnancy loss ( Hennessy and O’Donoghue, 2024 ), to n = 511 in a study with young people about the climate crisis ( Arnot et al ., 2023b ). We follow ‘rules of thumb’ [( Braun and Clarke, 2021b ), p. 211] which try to balance the needs of the research and data richness with key practical considerations (such as funding and time constraints), funder expectations, discipline-specific norms and our knowledge and experience of designing and implementing online qualitative surveys. However, we have found that peer reviewers expect much more justification of sample sizes than they do for other types of qualitative research. Robust justification of sample sizes are often needed to prevent any ‘concerns’ that reviewers may raise. Our response to these reviews often reiterates that our focus (as with all qualitative research) is not to produce a ‘generalisable’ or ‘representative’ sample but to recruit participants who will help to provide ‘rich, complex and textured data’ [( Terry and Braun, 2017 ), p. 15] about an issue. Instead of focusing on data saturation, a contested concept which is incongruent with reflexive thematic analysis in particular ( Braun and Clarke, 2021b ), we find it useful to consider information power to determine the sample size for these surveys ( Malterud et al ., 2016 ). Information power prioritizes the adequacy, quality and variability of the data collected over the number of participants.

Recruitment for online qualitative surveys can be influenced by a range of factors. Monetary and time constraints will impact the size and, if using market research company panels, the specificity of participant quotas. Recruitment strategies must be developed to ensure that the data provides enough information to answer the research questions of the study. For our research purposes, we often try to ensure that participants with a range of socio-demographic characteristics are invited to participate in the sample. We set soft quotas for age, gender and geographic location to ensure some diversity. We have found that some population subgroups may also be recruited more easily than others—although this may depend on the topic of the survey. For example, we have found that quotas for women and those living in metropolitan areas may fill more quickly. In these scenarios, the research team must weigh up the timelines associated with recruitment and data collection (e.g. How long do we want to run data collection for? How much of our budget can be spent on achieving a more equally split sample? Are quotas necessary?) versus the purpose and goals of the research (i.e. to generate ideas rather than data representativeness), and the study-specific aims and research questions.

There are, of course, concerns about not being able to ‘see’ the people that are completing these surveys. There is an increasing focus in the academic literature on ‘false’ respondents, particularly in quantitative online surveys ( Levi et al ., 2021 ; Wang et al ., 2023 ). This will be an important ongoing discussion for qualitative researchers, and we do not claim to have the answers for how to overcome these issues. For example, some individuals may say that they meet the inclusion criteria to access the survey, while others may not understand or misinterpret the inclusion criteria. There is also a level of discomfort about who and how we judge who may be a ‘legitimate’ participant or not. However, we can talk practically about some of the strategies that we use to ensure the rigour of data. For example, we find that screening questions can provide a ‘double-check’ in relation to inclusion criteria and can also help with ensuring that there is consistency between the information an individual provides about how they meet the inclusion criteria and subsequent responses. For example, in a recent survey of parents of young people, a participant stated that they were 18 years old and were a parent to a 16-year-old and 15-year-old. Their overall responses were inconsistent with being a parent of children these ages. Similarly, in our gambling studies, people may tick that they have gambled in the last year but then in subsequent questions say they have not gambled at all. This highlights the importance of checking data across all questions, although it should be noted that time and cost constraints associated with comprehensively scanning the data for such responses are not always feasible and can result in overlooking these participants.

Ensuring that there are strategies to create agency and engage participants in the research

One of the benefits of online qualitative surveys compared to traditional quantitative surveys is the scope for participants to explain their answers and to disagree with the research team’s position. An indication that participants are feeling able to do this is when they are asked for any additional comments at the end of the survey. For example, in a survey about women’s attitudes towards alcohol marketing, the following participant concluded the survey by writing: ‘I think you have covered everything. I think that you need to stop shaming women for having fun’. Other participants demonstrate their engagement and interest in the survey by reaffirming the perspectives they have shared throughout the survey. For example, in a study with young people on climate, participants responded at the end that ‘it’s one of the few things I actually care about’ , while another commented on the quality of the survey questions, stating, ‘I think this survey did a great job with probing questions to prompt all the thoughts I have on it’ .

We also think that online qualitative surveys may lead to less social desirability in participants’ responses. Participants seem less wary about communicating less politically correct opinions than they may do in a face-to-face interview. For example, at times, participants communicate attitudes that may not align with public health values (e.g. supporting personal responsibility, anti-nanny state, and neoliberal ideologies of health and wellbeing), that we rarely see communicated to us in in-depth interview or focus group studies. We would argue that these perspectives are valuable for public health researchers because they capture a different community voice that may not otherwise be represented in research. This may show where there is a lack of support for health interventions and policy reforms and may indicate where further awareness-raising needs to occur. These types of responses also contribute to reflexive practice by challenging our assumptions and positions about how we think people should think or feel about responses to particular public health issues. Examples of such responses from our surveys include:

"Like I have already said, if you try to hide it you will only make it more attractive. This nanny-state attitude of the elite drives me crazy. People must be allowed to decide for themselves."

Ethical issues for participants and researchers

Researchers should also be aware that some of the ethical issues associated with online qualitative surveys may be different from those in in-depth interviews—and it is important that these are explained in any ethical consideration of the study. Providing a clear and simply worded Plain Language Statement (in written or video form) is important in establishing informed consent and willingness to participate. While participants are given information about who to contact if they have further questions about the study, this may be an extra step for participants, and they may not feel as able to ask for clarification about the study. Because of this, we try to provide multiple examples of the types of questions that we will ask, as well as providing downloadable support details (for example, for mental health support lines). A positive aspect of surveys is that participants are able to easily ignore recruitment notices to participate in the study. They are also able to stop the survey at any time by exiting out of the browser if they feel discomfort without having to give a reason in person to a researcher.

While the anonymous nature of the survey may be empowering for some participants ( Braun and Clarke, 2013 ; Terry and Braun, 2017 ; Braun et al. , 2021 ), it can also make it difficult for researchers to ascertain if people need any further support after completing the survey. Participants may also fill in surveys with someone else and may be influenced about how they should respond to questions (with the exception of some studies in which people may require assistance from someone to type their responses). Because of the above, some researchers, ethics committees and funders may be more cautious about using these studies for highly sensitive subjects. However, we would argue that the important point is that the studies follow ethical principles and take the lack of direct contact with participants into the ethical considerations of the study. It is also important to ensure that platforms used to collect survey data are trusted and secure. Here, we would argue that universities have an obligation to investigate and, where possible, approve survey providers to ensure that researchers are using platforms that meet rigorous standards for data and privacy.

It is also important to note that there may be responses from participants that may be challenging ( Terry and Braun, 2017 ; Braun and Clarke, 2021 ). Online spaces are rife with trolling due to their anonymous nature, and online surveys are not immune to this behaviour. Naturally, this leads to some silly responses—‘ Deakin University is responsible for all of this ’, but researchers should also be aware that the anonymity of surveys can (although in our experience not often) lead to responses that may cause discomfort for the researchers. For example, when asked if participants had anything else to add to a climate survey ( Arnot et al ., 2024c ), one responded ‘ nope, but you sure asked a lot of dumbass questions’ . Just as with interview-based studies, there must be processes built into the research for debriefing—particularly for students and early career researchers—as well as clear decisions about whether to include or exclude these types of responses when preparing the dataset for analysis and in writing up the results from the survey.

The importance of piloting the survey

Because of the lack of ability to explain and clarify concepts, piloting is particularly important ( Braun and Clarke, 2013 ; Terry and Braun, 2017 ; Braun et al. , 2021 ) to ensure that: (i) the technical aspects of the survey work as intended; (ii) the survey is eliciting quality responses (with limited ‘nonsensical’ responses such as random characters); (iii) the survey responses indicate comprehension of the survey questions; and (vi) there is not a substantial number of people who ‘drop-out’ of the study. Typically, we pilot our survey with 10% of the intended sample size. After piloting, we often change question wording, particularly to address questions that elicit very small text responses, the length of the survey and sometimes refine definitions or language to ensure increased comprehension. Researchers should remember that changes to the survey questions may need to be reviewed by ethics committees before launching the full survey. It is important to build in time for piloting and the revision of the survey to ensure you get this right as once you launch the full survey, there is no going back!

Survey analysis and write-up

Preparing the dataset

Once launching the full survey, the quality of data and types of responses you receive in these types of surveys can vary. There is very limited transparency around how the dataset was prepared (more familiar to some as ‘data cleaning’) in published papers, including the decisions about which (if any) participants (or indeed responses) were excluded from the dataset and why. Nonsensical responses can be common—and can take a range of forms ( Figure 3 ). These can include random numbers or letters, a chunk of text that has been copied and pasted from elsewhere, predictive text or even repeat emojis. In one study, we had a participant quote the script of The Bee Movie in response to questions.

: Visual examples of nonsensical responses in online qualitative surveys.

Part of our familiarization with the dataset [Phase One in Braun and Clarke’s reflexive approach to thematic analysis ( Braun and Clarke, 2013 ; Braun et al ., 2021 )] includes preparing the dataset for analysis. We use this phase to help make decisions about what to include and exclude from the final dataset. While a row of emojis in the data file can easily be spotted and removed from the dataset, sometimes responses can look robust until you read, become familiar and engage with the data. For example, when asked about what they thought about collective climate action ( Arnot et al ., 2023a , 2024c ), some participants entered random yet related terms such as ‘ plastic ’, or repeated similar phrases across multiple questions:

“ why do we need paper straws ”, “ paper straws are terrible ”, “ papers straws are bad for you ”, “ paper straws are gross .”

Participants can also provide comprehensive answers for the first few questions and then nonsensical responses for the rest, which may also be due to question fatigue [( Braun and Clarke, 2013 ), p. 138]. Therefore, it is important to closely go through each participant’s response to ensure they have attempted to provide bone-fide responses. For example, in one of our young people and climate surveys ( Arnot et al ., 2023a , 2024c ), one participant responded genuinely to the first half of the survey before their quality dropped dramatically:

“I can’t even be bothered to read that question ”, “ why so many questions ”, “ bro too many sections. ”

Some market research panel providers may complete an initial quality screen of data. However, this does not replace the need for the research teams’ own data preparation processes. Researchers should ensure they are checking that responses are coherent—for example, not giving information that contradicts or is not credible. In our more recent studies, we have increasingly seen responses cut and pasted from ChatGPT and other AI tools—providing a new challenge in assessing the quality of responses. If you are seeing these types of responses, it might be an opportunity to think about the style and suitability of the questions being asked. For example, the use of AI tools might suggest that people are finding it difficult to answer questions or may feel that they have to present a ‘correct’ answer. We would also note that because of the volume of data in these surveys, the preparation of data involves multiple members of the team. In many cases, decisions need to be made about participants who may not have provided authentic responses across the survey. The research team should make clear in any paper their decisions about their choices to include or exclude participants from the study. There is a careful balancing act that can require assessing the quality of the participants’ responses across the whole dataset to determine if the overall quality of responses contributes to the research.

Navigating the volume of data and writing up results

Finally, discussions about how to navigate the volume of data that these types of studies produce could be a standalone paper. In general, principles of reflexive practices apply to the analysis of data from these studies. However, as a starting point, here are a few considerations when approaching these datasets.

We would argue that online qualitative surveys lend themselves to some types of analytical approaches over others—for example, reflexive thematic analysis, as compared to grounded theory or interpretive phenomenological analysis (though it can be used with these) ( Braun and Clarke, 2013 ; Terry and Braun, 2017 ).

While initial familiarization, coding and analysis can focus on specific questions and associated responses, it is important to analyse the dataset as a whole (or as clusters associated with particular topics) as participants may provide relevant data to a topic under multiple questions ( Terry and Braun, 2017 ). We initially focus our coding on specific questions or a group of survey questions under a topic of investigation. Once we have developed and constructed preliminary themes from the data associated with these clusters of questions, we then move to looking at responses across the dataset as we review themes further.

Researchers should think carefully about how to manage the data—which may not be available as ‘individual participant transcripts’ but rather as a ‘whole’ dataset in an Excel spreadsheet. Some may prefer qualitative data analysis software (QDAS) to manage and navigate data. However, many of us find that Excel (and particularly the use of labelled Tabs) is useful in grouping data and moving from codes to constructing themes.

As with all rigorous qualitative research, coding and theme development should be guided by the research questions. A clear record of decision-making about analytical choices (and being reflexive about these) should be kept. In any write-up, we would recommend that researchers are clear about which survey questions they used in the analysis [researchers could consider providing a supplementary file of some or all of the survey questions—see, for example Hennessy and O’Donoghue (2024) ].

In writing up the results, researchers should still seek to present a rich description of the data, as demonstrated in the presentation of results in the following papers ( Marko et al ., 2022a , 2022b ; McCarthy et al ., 2023 ; Pitt et al ., 2023 ; Hennessy and O’Donoghue, 2024 ). We have found the use of tables with additional examples of quotes as they relate to themes and subthemes can be a practical way of providing the reader with further examples of the data, particularly when constrained by journal word count limits [see, for example, Table 2 in Arnot et al ., (2024c) ]. However, these tables do not replace a full and complete presentation of the interpretation of the data.

This article offers methodological reflections and practical guidance around online qualitative survey design, implementation and analysis. While online qualitative surveys engage participants in a different type of conversation, they have design features that enable the collection of rich data. We recognize that we have much to learn and that while no survey of ours has been perfect, each new experience with developing and conducting online qualitative surveys has brought new understandings and lessons for future studies. In recognizing that we are learning, we also feel that our experience to date could be valuable for progressing the conversation about the rigour of online qualitative surveys and maximizing this method for public health gains.

H.P. is funded through a VicHealth Postdoctoral Research Fellowship. S.M. is funded through a Deakin University Faculty of Health Deans Postdoctoral Fellowship. G.A. is funded by an Australian Government Research Training Program Scholarship. M.H. is funded through an Irish Research Council Government of Ireland Postdoctoral Fellowship Award [GOIPD/2023/1168].

The pregnancy loss study was funded by the Irish Research Council through its New Foundations Awards and in partnership with the Irish Hospice Foundation as civil society partner [NF/2021/27123063].

S.T. is Editor in Chief of Health Promotion International, H.P. is a member of the Editorial Board of Health Promotion International, S.M. and G.A. are Social Media Coordinators for Health Promotion International, M.H. is an Associate Editor for Health Promotion International. They were not involved in the review process or in any decision-making on the manuscript.

The data used in this study are not available.

Ethical approval for studies conducted by Deakin University include the climate crisis (HEAG-H 55_2020, HEAG-H 162_2021); parents perceptions of harmful industries on young people (HEAG-H 158_2022); women and alcohol marketing (HEAG-H 123_2022) and gambling (HEAG 227_2020).

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Qualitative researchers TEND to:

Researchers using qualitative methods tend to:

• t hink that social sciences cannot be well-studied with the same methods as natural or physical sciences
• feel that human behavior is context-specific; therefore, behavior must be studied holistically, in situ, rather than being manipulated
• employ an 'insider's' perspective; research tends to be personal and thereby more subjective.
• do interviews, focus groups, field research, case studies, and conversational or content analysis.

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Qualitative Research (an operational definition)

Qualitative Research: an operational description

Purpose : explain; gain insight and understanding of phenomena through intensive collection and study of narrative data

Approach: inductive; value-laden/subjective; holistic, process-oriented

Hypotheses: tentative, evolving; based on the particular study

Lit. Review: limited; may not be exhaustive

Setting: naturalistic, when and as much as possible

Sampling : for the purpose; not necessarily representative; for in-depth understanding

Measurement: narrative; ongoing

Design and Method: flexible, specified only generally; based on non-intervention, minimal disturbance, such as historical, ethnographic, or case studies

Data Collection: document collection, participant observation, informal interviews, field notes

Data Analysis: raw data is words/ ongoing; involves synthesis

Data Interpretation: tentative, reviewed on ongoing basis, speculative

• Qualitative research with more structure and less subjectivity
• Increased application of both strategies to the same study ("mixed methods")
• Evidence-based practice emphasized in more fields (nursing, social work, education, and others).

Some Other Guidelines

• Guide for formatting Graphs and Tables
• Critical Appraisal Checklist for an Article On Qualitative Research

Quantitative researchers TEND to:

Researchers using quantitative methods tend to:

• think that both natural and social sciences strive to explain phenomena with confirmable theories derived from testable assumptions
• attempt to reduce social reality to variables, in the same way as with physical reality
• try to tightly control the variable(s) in question to see how the others are influenced.
• Do experiments, have control groups, use blind or double-blind studies; use measures or instruments.

Quantitative Research (an operational definition)

Quantitative research: an operational description

Purpose: explain, predict or control phenomena through focused collection and analysis of numberical data

Approach: deductive; tries to be value-free/has objectives/ is outcome-oriented

Hypotheses : Specific, testable, and stated prior to study

Lit. Review: extensive; may significantly influence a particular study

Setting: controlled to the degree possible

Sampling: uses largest manageable random/randomized sample, to allow generalization of results to larger populations

Measurement: standardized, numberical; "at the end"

Design and Method: Strongly structured, specified in detail in advance; involves intervention, manipulation and control groups; descriptive, correlational, experimental

Data Collection: via instruments, surveys, experiments, semi-structured formal interviews, tests or questionnaires

Data Analysis: raw data is numbers; at end of study, usually statistical

Data Interpretation: formulated at end of study; stated as a degree of certainty

This page on qualitative and quantitative research has been adapted and expanded from a handout by Suzy Westenkirchner. Used with permission.

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Are Systematic Reviews Qualitative or Quantitative?

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A systematic review is designed to be transparent and replicable. Therefore, systematic reviews are considered reliable tools in scientific research and clinical practice. They synthesize the results using multiple primary studies by using strategies that minimize bias and random errors. Depending on the research question and the objectives of the research, the reviews can either be qualitative or quantitative. Qualitative reviews deal with understanding concepts, thoughts, or experiences. Quantitative reviews are employed when researchers want to test or confirm a hypothesis or theory. Let’s look at some of the differences between these two types of reviews.

To learn more about how long it takes to do a systematic review , you can check out the link to our full article on the topic.

Differences between Qualitative and Quantitative Reviews

The differences lie in the scope of the research, the methodology followed, and the type of questions they attempt to answer. Some of these differences include:

Research Questions

As mentioned earlier qualitative reviews attempt to answer open-ended research questions to understand or formulate hypotheses. This type of research is used to gather in-depth insights into new topics. Quantitative reviews, on the other hand, test or confirm existing hypotheses. This type of research is used to establish generalizable facts about a topic.

Type of Sample Data

The data collected for both types of research differ significantly. For qualitative research, data is collected as words using observations, interviews, and interactions with study subjects or from literature reviews. Quantitative studies collect data as numbers, usually from a larger sample size.

Data Collection Methods

To collect data as words for a qualitative study, researchers can employ tools such as interviews, recorded observations, focused groups, videos, or by collecting literature reviews on the same subject. For quantitative studies, data from primary sources is collected as numbers using rating scales and counting frequencies. The data for these studies can also be collected as measurements of variables from a well-designed experiment carried out under pre-defined, monitored conditions.

Data Analysis Methods

Data by itself cannot prove or demonstrate anything unless it is analyzed. Qualitative data is more challenging to analyze than quantitative data. A few different approaches to analyzing qualitative data include content analysis, thematic analysis, and discourse analysis. The goal of all of these approaches is to carefully analyze textual data to identify patterns, themes, and the meaning of words or phrases.

Quantitative data, since it is in the form of numbers, is analyzed using simple math or statistical methods. There are several software programs that can be used for mathematical and statistical analysis of numerical data.

Presentation of Results

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Final Takeaway – Qualitative or Quantitative?

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A literature review is an integrated analysis -- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.  That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

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A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
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1. Choose a topic. Define your research question.

Your literature review should be guided by your central research question.  The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

• Make sure your research question is not too broad or too narrow.  Is it manageable?
• Begin writing down terms that are related to your question. These will be useful for searches later.
• If you have the opportunity, discuss your topic with your professor and your class mates.

2. Decide on the scope of your review

How many studies do you need to look at? How comprehensive should it be? How many years should it cover? 

• This may depend on your assignment.  How many sources does the assignment require?

3. Select the databases you will use to conduct your searches.

Make a list of the databases you will search. 

Where to find databases:

• use the tabs on this guide
• Find other databases in the Nursing Information Resources web page
• More on the Medical Library web page
• ... and more on the Yale University Library web page

4. Conduct your searches to find the evidence. Keep track of your searches.

• Use the key words in your question, as well as synonyms for those words, as terms in your search. Use the database tutorials for help.
• Save the searches in the databases. This saves time when you want to redo, or modify, the searches. It is also helpful to use as a guide is the searches are not finding any useful results.
• Review the abstracts of research studies carefully. This will save you time.
• Use the bibliographies and references of research studies you find to locate others.
• Check with your professor, or a subject expert in the field, if you are missing any key works in the field.
• Ask your librarian for help at any time.
• Use a citation manager, such as EndNote as the repository for your citations. See the EndNote tutorials for help.

Review the literature

Some questions to help you analyze the research:

• What was the research question of the study you are reviewing? What were the authors trying to discover?
• Was the research funded by a source that could influence the findings?
• What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.
• Does the research seem to be complete? Could it have been conducted more soundly? What further questions does it raise?
• If there are conflicting studies, why do you think that is?
• How are the authors viewed in the field? Has this study been cited? If so, how has it been analyzed?

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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• Perceptions of families and healthcare providers about feeding preterm infants in the neonatal intensive care unit: protocol for a qualitative systematic review
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• http://orcid.org/0009-0008-5313-9272 Willow R Schanz 1 ,
• Aunum Akhter 2 ,
• Georgette Richardson 3 ,
• http://orcid.org/0000-0003-0229-966X William T Story 4 ,
• Riley Samuelson 5 ,
• http://orcid.org/0000-0002-7026-0006 Aamer Imdad 6
• 1 The University of Iowa Roy J and Lucille A Carver College of Medicine , Iowa City , Iowa , USA
• 2 Division of Neonatology , The University of Iowa Health Care, Stead Family Department of Pediatrics, Roy J and Lucille A Carver College of Medicine , Iowa City , Iowa , USA
• 3 Division of Pediatric Psychology , The University of Iowa Health Care, Stead Family Department of Pediatrics , Iowa City , Iowa , USA
• 4 Department of Community and Behavioral Health , The University of Iowa College of Public Health , Iowa City , Iowa , USA
• 5 University of Iowa Hardin Library for the Health Sciences , Iowa City , Iowa , USA
• 6 Division of Gastroenterology, Hepatology, Pancreatology and Nutrition , University of Iowa Health Care, Stead Family Department of Pediatrics, Roy J and Lucille A Carver College of Medicine , Iowa City , Iowa , USA
• Correspondence to Dr Aamer Imdad; aamer-imdad{at}uiowa.edu

Introduction The underdevelopment of preterm infants can lead to delayed progression through key early milestones. Demonstration of safe oral feeding skills, constituting proper suck-swallow reflex are requirements for discharge from the neonatal intensive care unit (NICU) to ensure adequate nutrition acquisition. Helping an infant develop these skills can be draining and emotional for both families and healthcare staff involved in the care of preterm infants with feeding difficulties. Currently, there are no systematic reviews evaluating both family and healthcare team perspectives on aspects of oral feeding. Thus, we first aim to evaluate the current knowledge surrounding the perceptions, experiences and needs of families with preterm babies in the context of oral feeding in the NICU. Second, we aim to evaluate the current knowledge surrounding the perceptions, experiences and needs of healthcare providers (physicians, advanced practice providers, nurses, dietitians, speech-language pathologists and occupational therapists) in the context of oral feeding in the NICU.

Methods and analysis A literature search will be conducted in multiple electronic databases from their inception, including PubMed, CINHAL, Embase, the Cochrane Central Register for Controlled Trials and PsycINFO. No restrictions will be applied based on language or data of publication. Two authors will screen the titles and abstracts and then review the full text for the studies’ inclusion in the review. The data will be extracted into a pilot-tested data collection sheet by three independent authors. To evaluate the quality, reliability and relevance of the included studies, the Critical Appraisal Skills Programme checklist will be used. The overall evidence will be assessed using the Grading of Recommendation Assessment, Development and Evaluation criteria. We will report the results of the systematic review by following the Enhancing Transparency in Reporting the synthesis of Qualitative research checklist.

Ethics and dissemination Ethical approval of this project is not required as this is a systematic review using published and publicly available data and will not involve contact with human subjects. Findings will be published in a peer-reviewed journal.

PROSPERO registration number CRD42023479288.

• Paediatric gastroenterology
• Systematic Review
• Percieved Social Support
• NEONATOLOGY

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/bmjopen-2024-084884

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STRENGTHS AND LIMITATIONS OF THIS STUDY

This will be a systematic review evaluating both the perspectives of families and neonatal healthcare professionals on feeding practices of preterm infants in the neonatal intensive care unit (NICU).

Evaluating the perspectives of both family members and neonatal healthcare professionals involved in the care of preterm babies with feeding difficulties may uncover shared grievances and mutually beneficial opportunities for quality improvement in the NICU.

Included studies might be conducted in diverse settings, so generalisability to clinical practice may be affected by cultural, language and healthcare systems context.

Introduction

An estimated 13.4 million babies were born preterm (<37 weeks gestation) in 2020, which represented about 10% of all live births worldwide. 1 Preterm birth is a serious health event that contributes to significant morbidity, mortality and increased healthcare cost in neonates. Over 40% of premature infants will experience feeding difficulties, such as struggling to develop typical feeding reflexes (sucking, swallowing, appropriate breathing) and coordinated oesophageal bolus transport. 2 Consequently, feeding difficulties are associated with elevated healthcare costs due to increased length of stay in the neonatal intensive care unit (NICU) and invasive measures, such as a central line or other parenteral support, to supply the infant with adequate nutrients. 3 4 Poor feeding skills are associated with increased morbidity through malnutrition and growth restriction as well as increased mortality through oropharyngeal aspiration. 5 6

Despite the global prevalence, expense and severity of feeding difficulties, no universal guidelines function as the gold standard of care for feeding preterm infants. 7 The resulting high variability in approach may lead to dissatisfaction among NICU families and healthcare professionals. Families of preterm infants have been shown to express concerns about the technicality of feeding interventions, communication with providers regarding their child and feeling isolated from the feeding approaches in the NICU. 8 Tube feeding, a common feeding intervention for preterm infants, has been associated with increased cost, rehospitalisation, stress and anxiety for families. Due to the emotional nature of feeding a newborn, family members may struggle with learning to feed their infant in this manner. 8 Additionally, nurse perceptions of oral feeding in the NICU have emphasised the impactful role they hold in teaching feeding techniques and relieving emotional distress for the family, which has highlighted a need for greater collaboration between the family and care providers. 9 Family integrated care has been perceived to be helpful in the reduction of maternal stress by parents of preterm infants as well as a necessary and feasible care model by neonatologists and NICU nurses that has the potential to lower length of hospitalisation, decrease healthcare costs and improve breastfeeding rates in preterm infants. 10–12 The approach to feeding preterm infants requires a multidisciplinary effort, including the family, nurses, dietitians, occupational therapists, speech-language pathologists, social workers, advanced practice providers and physicians. Despite these experiences being reported, there is still limited understanding regarding the perceptions of families and caregivers on feeding preterm infants in the NICU. 13 14 This qualitative systematic review aims to analyse the current global knowledge of the perceptions, experiences and needs of families and healthcare staff (nurses, physicians, advanced practice providers, dietitians, occupational therapists, social workers and speech-language pathologists) involved in the feeding process of preterm infants in the NICU, as well as possible improvements to decrease barriers to high-quality care.

Methods and analysis

This systematic review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. 15

Literature search

Systematic electronic queries, available in online supplemental appendix A , will be conducted in major databases, including PubMed, CINHAL, Embase, the Cochrane Central Register for Controlled Trials and PsycINFO from their inception to date of inquiry. Key terms used in the search are those related to population, context and phenomena of interest (perspectives, views, needs, experiences, perceptions, barriers, challenges). Studies will not be excluded based on the publication year, publication status, geographical location or language. Thus, this analysis will include studies from all countries. Studies evaluating specific racial, gender, geographic, age (of family or provider) differences will be included in this review as long as they evaluate qualitative aspects of our phenomena of interest. Bibliographic software (EndNote) will be used to combine database search results, and duplicates will be removed.

Supplemental material

Eligibility criteria.

The populations of interest include families of preterm infants (parents, mother, father, grandmother, grandfather and guardians) and neonatal healthcare professionals (nurses, physicians, advanced practice providers, caregivers, dietitians, speech-language pathologists, social workers and occupational therapists) involved in the feeding care of preterm infants. For this review, preterm birth will be defined as gestational age <37 weeks at birth. If relevant, additional definitions such as late preterm: 34–36 weeks, moderately preterm: 32–34 weeks, very preterm: 28–32 weeks, extremely preterm: <28 weeks gestational age at birth, will be used and clearly reported.

We are interested in the global state of enteral and oral feeding in preterm infants while in NICUs from the perspective of both families and healthcare providers.

Phenomena of interest

The main phenomena of interest are the experiences and perceptions of families with preterm infants and healthcare providers of preterm infants as outlined below:

Family experiences regarding NICU feeding practices.

Family perceptions of NICU feeding practices.

Family needs regarding care of infants with feeding difficulties.

Family barriers regarding care of infants with feeding difficulties.

Healthcare staff perceptions of the NICU feeding practices.

Healthcare staff needs regarding care of infants with feeding difficulties.

Healthcare staff barriers regarding care of infants with feeding difficulties.

Screening and selection of studies

Screening of studies will be conducted through systematic review software Covidence by three authors (WRS, GR and AI). The initial review will consist of title and abstract filtering for relevance to systematic review objective by three authors (WRS, GR and AI). For studies to progress to future screening, they must evaluate the perceptions regarding feeding practices of preterm infants in the NICU in one of our two populations of interest: (1) families and (2) healthcare providers. Studies deemed irrelevant or out of context will be excluded, such as those evaluating children in the paediatric intensive care unit and those evaluating NICU graduates following up in outpatient clinics. The second stage of study selection will include a complete text review of each potential article by three authors (WRS, GR and AI). Conflicts at all stages will be resolved by discussion and contacting a senior author. Additionally, the references of relevant reviews will be evaluated for inclusion in the review. In the case that only an abstract is available for a given study, authors will be contacted to obtain information on and evaluate methods and results. If we are unable to obtain additional information, the abstract will be evaluated exclusively by inclusion criteria. If a paper is published in a language other than English, we will attempt to translate the article for use in this review. If we are unable to translate the article, we will exclude it from this review.

Data extraction

Data extraction will occur independently by three authors (WRS, GR and AI) and subsequent comparison will occur. Conflicts will be resolved through discussion. To standardise data acquisition, a custom data extraction template will be piloted and used in Covidence. Information to be collected from each study will include:

Study design, study duration, study setting, setting country/region, study year and interventions.

Participants

Recruitment methods, including inclusion and exclusion criteria; group differences; sample size; sample size calculation; relevant baseline characteristics (family participants: maternal age, infant gestational age at birth, infant weight at birth, race/ethnicity, etc.; healthcare professional participants: role, experience, race/ethnicity, etc.); intervention groups.

Qualitative: Phenomena of interest (perceptions, experiences, change in satisfaction, change in feeding rate, etc); definitions of phenomena of interest.

Quantitative (if regarding phenomena of interest): variable type (continuous, dichotomous, qualitative); reporting measure (continuous variable: CIs, SD, SE, etc; dichotomous variable: the number of participants, percentage of participants, OR, etc; qualitative); statistical significance of outcome (p value).

Major themes addressed

Stress, anxiety, fear, needs, barriers, satisfaction, etc.

Other relevant constructs

First-order constructs (participant quotes); second-order constructs (author interpretations).

This data extraction protocol is modelled from thematic analysis principles of qualitative evidence synthesis and recommendations by the Cochrane Qualitative and Implementation Methods Group guidance for data extraction and data synthesis. 16 17 After data extraction, these data will be exported to Excel for synthesis and organised by relevant population.

Data synthesis

Data will be synthesised for each relevant population and outcome combination by three authors (WRS, GR and AI). Major themes will be described in a narrative fashion and simple descriptive statistics may be utilised for clarity. In the case of studies having quantitative measures of our qualitative interests, we will report the data as follows: If relevant, dichotomous data will be reported with OR, 95% CIs, and risk ratios, and continuous data will be reported as confidence intervals. Significant construct findings will be reported as quotes, percentages or other descriptive reports. Any inconsistencies or discrepancies between studies will be considered and reported. Data will be reported in narratives and tables for presentation.

Reporting results

Once the study analysis is complete, we will provide a narrative synthesis of all included studies and analysis between comparable studies. We will compare knowledge, beliefs, attitudes and perceptions of families with infants in the NICU within this population as well as compare these findings to the knowledge, beliefs, attitudes and perceptions knowledge of neonatal healthcare professionals. We will include all findings listed in the ‘Phenomena of interest’ section. Reporting of results will be in accordance with PRISMA and Enhancing Transparency in Reporting the synthesis of Qualitative research guidelines. 15 18

Critical appraisal of the studies

To evaluate the quality, reliability and relevance of the included studies, we plan to follow the Critical Appraisal Skills Programme checklist. 19 This tool is often used to appraise qualitative research and is adaptable to emphasise particular areas of interest within our research question. It is recommended by Cochrane and complements the use of the Grading of Recommendations Assessment, Development and Evaluation—Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQ) approach through evaluating the strengths and weaknesses of each study rather than on the basis of exclusion. This tool will be used by three members of the review team (WRS, GR and AI), and disagreements will be mediated through conversation.

Certainty of review findings

The GRADE-CERQ approach will be used to evaluate the overall certainty of evidence. 20 This approach is a comprehensive framework used to assess the overall certainty of the evidence for an outcome using study characteristics such as study design, inconsistency, indirectness of evidence, risk of bias, publication bias and imprecision estimates. We will include the GRADE-CERQ assessment results in an evidence profile that contains certainty ratings, including very low, low, moderate or high, based on the evidence across studies for primary outcomes. We will follow the GRADE-CERQ guidelines for assessing confidence in our qualitative evidence findings, which are based on four components: methodological limitations, relevance, adequacy and coherence. Based on analysis in each of these categories, the study will be given a score of either strong or weak. Concerns with any of the components may reduce our confidence in a review finding.

Patient and public involvement

Ethics and dissemination.

This is a qualitative systematic review that evaluates data present in the public domain through published studies and does not involve contact with human subjects. As a study of published literature, this study was not subject to formal IRB (Institutional Reviw Board) approval. We anticipate that the systematic review will be complete by fall of 2024 and will be submitted for publication in a peer-reviewed journal.

Ethics statements

Patient consent for publication.

Not applicable.

Acknowledgments

The authors would like to acknowledge Paul Casella for his help in editing the manuscript

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

Contributors Conceptualisation: WRS, AA, GR and AI; Methodology: WRS, AA, GR, WTS, RS and AI; Writing–original draft preparation: WRS and AI; Writing–review and editing: WRS, AA, GR, WTS, RS and AI. All authors have read and agreed to the published version of the manuscript.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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• Published: 26 June 2024

Understanding the contexts in which female sex workers sell sex in Kampala, Uganda: a qualitative study

• Kenneth Roger Katumba 1 , 2 ,
• Mercy Haumba 1 ,
• Yunia Mayanja 1 , 2 ,
• Yvonne Wangui Machira 3 ,
• Mitzy Gafos 2 ,
• Matthew Quaife 2 ,
• Janet Seeley 2 &
• Giulia Greco 2  

BMC Women's Health volume  24 , Article number:  371 ( 2024 ) Cite this article

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Structural, interpersonal and individual level factors can present barriers for HIV prevention behaviour among people at high risk of HIV acquisition, including women who sell sex. In this paper we document the contexts in which women selling sex in Kampala meet and provide services to their clients.

We collected qualitative data using semi-structured interviews. Women were eligible to participate if they were 18 years or older, self-identified as sex workers or offered sex for money and spoke Luganda or English. Ten women who met clients in venues and outdoor locations were selected randomly from a clinic for women at high risk of HIV acquisition. Ten other women who met clients online were recruited using snowball sampling. Interviews included demographic data, and themes included reasons for joining and leaving sex work, work locations, nature of relationships with clients and peers, interaction with authorities, regulations on sex work, and reported stigma. We conducted interviews over three months. Data were analysed thematically using a framework analysis approach. The coding framework was based on structural factors identified from literature, but also modified inductively with themes arising from the interviews.

Women met clients in physical and virtual spaces. Physical spaces included venues and outdoor locations, and virtual spaces were online platforms like social media applications and websites. Of the 20 women included, 12 used online platforms to meet clients. Generally, women from the clinic sample were less educated and predominantly unmarried, while those from the snowball sample had more education, had professional jobs, or were university students. Women from both samples reported experiences of stigma, violence from clients and authorities, and challenges accessing health care services due to the illegality of sex work. Even though all participants worked in settings where sex work was illegal and consequently endured harsh treatment, those from the snowball sample faced additional threats of cybersecurity attacks, extortion from clients, and high levels of violence from clients.

Conclusions

To reduce risk of HIV acquisition among women who sell sex, researchers and implementers should consider these differences in contexts, challenges, and risks to design innovative interventions and programs that reach and include all women.

Peer Review reports

Introduction

Globally women who sell sex face a disproportionately large risk of HIV acquisition compared to the general population [ 1 , 2 , 3 ]. Among those at greatest risk are female sex workers (FSWs) in low- and middle-income countries (LMICs) who are 13.5 times more likely to acquire HIV relative to the general population [ 3 , 4 ]. Research indicates that structural, interpersonal, and individual factors influence HIV prevention behaviour [ 4 , 5 , 6 , 7 , 8 , 9 ]. Structural factors are defined as the economic, social, political, organizational or other aspects of the environment in which women sell sex, and which might act as barriers to or facilitators of women’s HIV prevention behaviour [ 7 , 10 , 11 , 12 , 13 , 14 ]. Interpersonal factors are those which relate to risks or protective factors between women and their clients, or intimate partners [ 2 , 15 ]. Individual factors are those which relate to a woman’s individual attributes such as age of initiation into sex work, alcohol and other substance use, knowledge of HIV prevention, physical, and psychological attributes [ 6 , 15 ]. Together, the structural and interpersonal factors influence the contexts in which women who sell sex work. Several structural and interpersonal factors that influence condom use among sex workers have been identified, including zoning restrictions and regulation of sex work, how women join sex work, the location where sex workers meet and provide services to clients, experiences of violent relationships with clients, and harassment by authorities and police [ 7 ]. Stigma has also been identified as an important influence on the way sex workers work and as a contributor to their risk environment. Stigma increases the risk of HIV acquisition to sex workers, yet it is experienced in several forms at the individual, interpersonal and structural levels [ 14 , 16 , 17 , 18 , 19 ].

In Uganda, sex work is illegal and criminalised. Research that investigated the contexts in which women in Kampala sell sex has however shown that women join commercial sex work because of their disadvantaged backgrounds and restricted access to economic resources [ 11 , 20 , 21 , 22 ]. Mbonye et al. [ 11 ] showed that women providing services in outdoor locations like streets, alleys and parking lots faced more challenges than women providing services in indoor locations like nightclubs, bars, and lodges. These challenges included exposure to violence, stigma from the public, and visibility to police [ 11 , 23 ]. Kawuma et al. [ 20 ]reported in a more recent study that the places in which women sell sex in Kampala are fluid in that they move from one type of venue to another. All these studies also showed that women selling sex in Kampala faced violent relationships with both the police/authorities and with their clients [ 11 , 20 , 21 ].

It is however noteworthy that women included in these studies were participants from large epidemiological cohorts that recruited participants from low socio-economic settings, with little or no education, and who typically recruited their clients in physical locations, indoor or outdoor [ 11 , 23 ]. Women outside of these cohort settings, who have higher education, belong to higher socioeconomic status, and meet clients in spaces other than those identified in these studies have not been included in important HIV research, programming, and prevention efforts in Uganda to date. Research in the United Kingdom, USA, Australia, Japan, and India has reported the experiences of women who sell sex using internet websites and social media platforms [ 24 , 25 , 26 ]. These women also face risks, violence, and crime just like their peers who meet clients in physical locations like venues and streets [ 24 , 27 ]. Understanding the contexts in which women sell sex and the strategies that they use to advertise, meet, and provide services to their clients will help us to understand HIV risk among women by highlighting how structural, interpersonal, and individual factors interact to influence HIV transmission. In Kampala, earlier studies have reported on the contexts in which women recruiting and providing services in physical locations work, but there is still a gap in knowledge about the prevalence of client recruitment using online platforms, how women who recruit this way are organised, and how this strategy affects their risk of HIV acquisition. Understanding these gaps will improve our understanding of the structural determinants framework for HIV prevention among women selling sex in Kampala. This paper presents a more comprehensive understanding of the contexts in which women sell sex in Kampala by including women who have not been included in prior research studies and emphasizes the need to reach them and target intervention efforts to them. This aligns with the UNAIDS strategy of leaving no one behind and reaching the populations at the greatest need of care [ 28 ].

Study design, participants, and process

Twenty women from Kampala and surrounding suburbs were included in the study, using two sampling strategies. The first sample – the clinic sample – included 10 women sampled from a cohort of 4500 women who had been attending a clinic dedicated to women at risk of HIV acquisition including FSWs run by the Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit in Kampala [ 23 ]. Women who met clients in physical spaces like venues and outdoor locations had prior been recruited into the clinic through peers. The second sample – the snowball sample – included 10 women who met clients using online platforms including social media and websites such as Instagram. We identified one key informant who started the snowball recruitment as described by Heckathorn [ 29 ] and Rao et al. [ 30 ]. Women were eligible to participate if they were 18 years or older, self-identified as sex workers or offered sex for money and spoke Luganda or English. In our study, “women who meet clients” includes women actively recruiting clients, women searched out by clients, and women who are introduced to clients by peers, but meet using online spaces.

Data collection and management

An experienced female graduate social scientist (MH) made first contact with all women, planned interview appointments, administered the study information and consent process, and carried out in-depth interviews with them. For the clinic sample, we selected women from the cohort using a random number generator in Microsoft Excel to generate 10 random numbers within the range of 1 and 4,500 inclusive, which matched the women’s unique cohort identifiers. We invited women with the corresponding numbers to participate. To identify the seed for the snowball sample, the female social scientist (MH) used the Instagram search function to search through posts of women who offered mobile (in-house) massage services or sex for money. She used the keyword “massage” and the location filter set to “Kampala”. The results included both personal accounts and accounts for massage parlors. We considered the first personal account that appeared on the search results as the potential seed for our sample. The female social scientist (MH) contacted the first personal account via the Instagram chat function, providing information about the opportunity to participate in a research study. The owner of the personal account agreed to take part in the study. After her interview, the seed identified through Instagram identified other women and provided their contacts. The female social scientist (MH) then invited the potential participants to the study, and the snowball continued until 10 interviews were completed. We allocated participant numbers from A01 to A10 for those in the snowball sample, and B01 to B10 for those in the clinic sample. Interviews were carried out between September and October 2022.

We developed the interview guide from a literature review of the structural factors that influence HIV prevention for women who sell sex, and a review by Shannon et al. [ 6 ], which presented a framework for the structural drivers of HIV and the pathways through which they interact with interpersonal and individual behavioural factors. This framework expanded structural factors to include macro-structural factors such as legal, socio-political, cultural, economic, and geographic contexts in which women sell sex, sex work organisation which includes the organisational structure, community empowerment and collectivisation of sex work, and the work environment which includes the physical, social, economic and political features of the environments in which sex workers operate, such as violence, access to condoms and anti-retroviral therapy (ART), and venue policies [ 6 ]. Using this framework, we developed this guide specifically for this study, and included questions on how women joined and why they would leave sex work, how their work was organised including recruitment and where they provided services to clients, their relationships with clients and authorities, the illegality of sex work, and the stigma they experienced. A copy of this interview guide is included as an additional file (see Additional file 1). We collected basic demographics at the beginning of the interview, asking women about their age, number of children, level of education, if sex work was the main occupation, and if they used social media to meet men for sex work. These were summarised in MS Excel, and the corresponding frequencies presented as descriptive statistics. Recruitment logs with personal information were stored in a secure access-controlled cabinet separate from where interview notes, recorders and computers were kept. After obtaining informed consent from the participants, we audio-recorded interviews, then transcribed and translated them into English. The social scientist (MH) took notes to back up the recordings. We imported the transcripts, translations, and interviewer notes into NVivo 12 for data organisation and management.

Data analysis

We used framework analysis as outlined by Gale et al. [ 31 ] to analyse the qualitative data. This analytical approach involves developing a thematic structure for interpretation, under which individual codes can be grouped and compared [ 31 ].

A study team member checked five random transcripts in English for transcription accuracy, and all the 10 Luganda transcripts for translation accuracy. In the first step of the coding, both the first author and the social scientist (MH) coded four interviews independently using initial frameworks constructed both deductively using the review by Shannon et al. (2015) and inductively using themes arising from the interviews [ 3 ]. The two coders then met and consolidated their coding frameworks into a revised version, which the first author used to finalise coding of all the interviews. From the consolidated coding framework, we developed a framework matrix with the themes and subthemes as the columns, and the participants as the rows. We populated the cells of the matrix with both summaries and representative quotes from the data. We then analysed the data from each of the columns to generate analytical memos on prominent themes arising from the data. All the steps of the analysis were reviewed by two other co-authors.

Ethical considerations

This study was approved by the Uganda Virus Research Institute Research and Ethics Committee (GC/127/912), the Uganda National Council for Science and Technology (HS2386ES), and the ethics committee of the London School of Hygiene and Tropical Medicine (28,175). We obtained written informed consent from all the respondents before data collection. We compensated the participants 20,000 Uganda shillings (UGX), (USD 5.5) for their time, and 20,000 UGX (USD 5.5) for their transport. We did not offer current participants any incentive to refer seeds and informed them that they would not face any penalties whatsoever if they did not refer any seeds. To contact new participants for the snowball sample, the qualitative researcher was provided with a partial name and a contact number, or with the new participant’s Instagram handle. The identity of the referring participant was not disclosed to new participants. The referring participant was not told which of the potential participants suggested by her eventually participated in the study. A copy of the script we used is included as an additional file (see Additional file 2).

Women in our study

Twenty women participated in the study, 10 in each of the clinic and snowball samples. Of the 20 included women, 12 met clients using online platforms. Of these 12, nine were from the snowball sample and three were from the clinic sample. We reached out to 26 women for inclusion in the snowball sample, eight of whom opted not to participate, six did not come for their appointments, and two did not respond. In the clinic sample, only one of the 10 women was not reachable and was replaced. While women from the clinic sample generally had less schooling and were predominantly unmarried, women from the snowball sample generally had high levels of education, had professional jobs or were students in training for professional jobs, were able to negotiate better prices for sex, and were able to avoid outdoor confrontation with police, authorities, and the public. Table  1 below gives details of women’s individual characteristics.

The contexts in which women sold sex

The prominent themes we identified in our study included: how the women organised their work, why and how they joined or would leave sex work, the relationships that they had with clients, authorities, family, and their peers, and the stigma they experienced. We present them in Table  2 below and explain them in detail in the sections that follow.

Reasons women joined sex work, and why they would leave

Women mentioned economic need as the main reason for joining sex work, and this was driven by the loss of parents, abandonment by partners, economic hardships due to the COVID-19 pandemic, inability to continue school due to lack of school fees, and costs like rent and food.

I joined sex work because of the hardship I was going through after my husband abandoned me and the children, he was not paying their school dues, and they had nothing to eat. So, I decided to devise means of survival. (Clinic sample, 23–25 years, B04).

Women remained in sex work because of economic responsibilities and no alternative sources of comparable income. For women who met clients in public spaces, these responsibilities included costs such as rent, school fees and food for themselves and their families. For women who met clients using online spaces, responsibilities included special costs such as maintaining their lifestyle and good aesthetics both on online platforms and the social scene. They included rent for expensive apartments, hairstyles, makeup, expensive clothing and phones, trips outside Kampala and Uganda, and keeping up appearances on the Kampala party scene.

At this point as much as the money you get from sex work is little if I decide to leave, I won’t be able to sustain myself or even be able to start another business since I will not have money. The situation is bad these days, so if I leave sex work, which other job am I going to do? (Clinic sample, 23–25 years, B04). The money that it comes with is not little money. This is like salaries that people get for months, and I am doing it for just one day. So, it becomes addictive, and you must keep up with the lifestyle that you have started so you must keep going back until you are somewhere that you want to be. (Snowball sample, 25–30 years, A04).

While all participants mentioned economic need as reason for joining or staying in sex work, some women joined sex work because of trauma from being abused as children. The pain that they harboured from this trauma kept them in sex work, even if they were not proud of their work. Regardless of how they joined sex work or where they met their clients, most women would leave sex work if they had major changes in their social or financial status, for example if they got married, achieved financial stability through stable alternative and comparable sources of income, or having a home that they own.

Oh well yeah one day I want to have a family settle down and have a husband and have kids so definitely there is no way I can be married to someone when I am still doing this kind of work. (Snowball sample, 25–30 years, A04).

How female sex work in Kampala was organised

Where women met clients and provided services.

Women discussed recruiting clients in public physical spaces, in private virtual online spaces, and through go-betweens. The public spaces were both outdoor and indoor. Outdoor public spaces included streets, alleys, and markets, while indoor public spaces included venues such as bars, pubs, cafés, offices, churches, malls, casinos, hotels, restaurants, massage parlours and lodges. Women also discussed the lack of privacy and the higher risks of police prosecution and arrests, attacks by thugs, robbery, and exposure to judgement by the society, in addition to meteorological challenges like cold, windy, and rainy weather.

The person who took me on the streets [a female friend], one time we were on the street and her [the friend’s] uncle was the one haggling with her. (Laughs). Those are the things that make us leave the streets. At least you go to [the clients’] places or at our [the woman’s] place it has no problem. (Clinic sample, > 30 years, B02).

Women discussed benefiting from security offered by the management of indoor public spaces, even if in some cases they were charged a fee to be allowed to work at these places.

The street is not good but at the bar they first check clients before entering, they do not allow them to enter with keys, knives and other things which is not done on streets. That is why you see that many people who work from streets die a lot, that is why the street near [a pub nearby] many people die from there…For the places, I told you like [a specific pub], it is safe, even if a client becomes chaotic, we are protected by the guards at the bars. (Clinic sample, > 30 years, B03.

The private virtual spaces mentioned by women were online platforms that can be accessed from their homes, or other private and protected places. They included social media applications (apps) and sites such as Snapchat, Instagram, Badoo, and dating websites. Women who met clients using these spaces were able to reach many clients, had more time between the first contact with a client and accepting to offer services to the client. This time allowed them to make decisions both about their perceived safety with clients and avoid potential violent clients, but also about HIV prevention. They earned more than their peers who met clients in public spaces, and they provided services mostly in hotels, in the clients’ homes, and sometimes in their homes.

The advantage of hotels is that you can easily get help in case of any problems, which you can’t get when you are in someone’s home because its already night and some people’s homes are fenced even if you shout no one can help. (Snowball sample, 25–30 years, A07). Well, the truth is there is a lot going on, on social media. When you get offers, it is up to you to take them or not. Social media things are so easy now. You can meet people; you can easily associate with people from different parts of the world. (Snowball sample, 25–30 years, A02).

Women who met clients in virtual spaces faced some challenges particular to their strategy of recruiting clients, for example cyber threats and their online accounts being hacked into, new clients who did not want to pay being extorting money from them, and old clients who traded women’s confidentiality for money.

Because I had so many people writing to me. They wanted to meet me. So, I felt like Instagram wasn’t a safe place for me. And by then people used to hack into accounts. (Snowball sample, 25–30 years, A01).

Some women relied on pimps or peers who acted as go-betweens procuring clients for them. These women were assured of a reliable flow of clients from middle and high socio-economic status; and of more security since the go-between knew which woman was with which client, and at what location. However, they were prone to exploitation since the go-between usually took a commission off the women’s pay, while some protected violent clients.

Well, first there are what they call pimps who usually have contacts of men. Some are like delegates who come to Uganda, or who want to take girls outside for meetings outside of Uganda. These pimps are always looking for sex workers you don’t even have to look for them. (Snowball sample, 25–30 years, A04).

As much as some women used only private online spaces, others had a primary space where they usually met clients, and one ‘filler’ space they would resort to in case they didn’t have enough clients from their primary space. For example, women from the clinic sample mostly relied on online spaces during day, but used go-between or went out to clubs and bars in the night. On the other hand, women from the clinic sample relied heavily on physical spaces to recruit their clients.

During the day you can be on your phone, but you must go to clubs at night. If you are in another country, you can’t just stay in the house and chat on phone, you must go outside and look for clients if you need money. (Snowball sample, 25–30 years, A07).

Women who met clients using online platforms provided services in indoor spaces like their own and clients’ homes, and in hotels, but never mentioned offering services in public outdoor spaces. On the other hand, women who met clients in public outdoor spaces like streets provided services in indoor spaces, but also in the outdoor spaces where they met the clients.

How women competed for clients

Women who met their clients in public spaces viewed their counterparts who met clients using online platforms to be in a higher income and of a higher socio-economic status. The latter women discussed that the former operated a more versatile, more mobile, and less exposing form of sex work which was able to attract a clientele of higher socio-economic status and higher paying. Among women who met clients in physical spaces, women who met clients using online platforms were referred to as bikapu (plural for kikapu ) sex workers. A kikapu is a large travel or shopping basket that can be carried anywhere at any time, and whose contents are known only to the owner.

There are sex workers whom you will never see seated in corridors waiting for clients or even see clients entering her house. But she is also at her home doing sex work. If a client calls her, she goes, services the client, and returns to her house. They are always called ‘bikapu’ sex workers. (Clinic sample, 25–30 years, B05).

The prices women charged, and how they negotiated with clients

It was clear from the interviews that women who met clients using online spaces charged more than women who met clients in public spaces. Among women who met clients in public spaces, the highest amount received for a sexual act was 100,000 UGX (USD 27), compared to 40,000,000 UGX (USD 10,767) for those who met clients using online spaces. The latter had a minimum reserve price of 250,000 UGX (USD 67), compared to no payment or providing sex on credit among the former. Moreover, those recruiting online had more time to negotiate prices and compare offers from clients before meeting clients physically, compared to the former, who usually negotiated with one client at a time and when they had already met physically.

I can even get 8 million shillings. The lowest I get in a month is 5,000,000 shillings [USD 1,356] but it’s usually between 8 and 15 million shillings [USD 2,170–4,069]. When people who live abroad are around in large numbers, I can get up to 15,000,000 UGX [USD 4,069]. (Snowball sample, 25–30 years, A06). There are those sex workers who cannot come to my place where I work, but they meet their clients using the internet and somehow charge more expensively than me. I cannot compete with them; I am cheaper because I charge from 5,000 UGX [USD 1.40] but those sex workers charge from 100,000 [USD 28] or 200,000 UGX [USD 54]. (clinic sample, > 30 years, B03). You can get a customer who runs away after getting the service as agreed. That is what they call ‘bidding farewell with a zip’ (okusibuza zip). It depends, there is when we work tirelessly and you get 30,000–50,000 shillings [USD 8.20–13.60] monthly, and between two to three thousand (54–81 cents) daily. (Clinic sample, 25–30 years, B01).

Moreover, women who met clients using online spaces discussed being offered substantial non-financial incentives in addition to cash payment. In most cases, these incentives, which included gifts and trips within and outside Uganda, supplemented the cash payment clients offered and influenced women’s decision to reconsider some clients that had been rejected because the initial payment offer was deemed unattractive.

The relationships women had with authorities, clients, and peers

Women faced violence from clients in form of physical, verbal, and sexual abuse such as rape, clients removing or tearing condoms intentionally, and even death threats.

For me a man almost killed me. We went into a room, and I told him the amount of money I wanted. He said he did not have it. I told him to let me get out, but he started strangling me. Then I accepted that he had robbed me. (Clinic sample, > 30 years, B02). Ah God (covers her face with her palms and shakes her head) it was so hard for me. He slapped me, did everything you can think of. My dear, I gave up and had to act soft because some clients need you to be submissive. So, you must act like you are enjoying whatever he wanted. (Snowball sample, 25–30 years, A06).

However, some women met friendly and supportive clients who treated them well, got them business connections and supported them financially in their personal lives.

I will not lie to you; he was taking care of me just like any other man takes care of what he loves. (Snowball sample, 25–30 years, A01). Women’s relationships with peers were usually characterised by jealousy, mistrust, hatred, and threats. They fought with each other verbally, physically, and spiritually with witchcraft. That said, there was evidence of friendships among women who met clients in physical spaces. For example, they could demand their peers’ release if they witnessed their arrest. First, a massage parlour has a lot of girls. So, there is that hatred that comes along. Then there is a risk of being bewitched by those girls at the parlour. (Snowball sample, 23–25 years, A08). Yes, there are sex workers who compete against each other. I don’t know how to explain this but sometimes your fellow sex workers might notice that you are getting a lot of customers then they go and bewitch you. (Clinic sample, 23–25 years, B04).

Women who met using online spaces worked in isolation and were in many cases not able to get help in cases where clients turned violent. And because sex work is illegal in Uganda, women had no legal support or protection from authorities. Instead, they were exploited sexually and financially by the authorities, abused, and violated. All our participants faced some form of violence, abuse and exploitation from police and authorities.

We are treated badly. Police officers also come and arrest you and sometimes even rape you. Sometimes when they arrest you and you don’t have money to give, they force you to have sex. (Clinic sample, 23–25 years, B04. They all want sex (laughs). The truth is I don’t want to say everybody is bad among authorities but it’s like they all want to get something [sex]. Of course, I don’t give them, but I am sure there are people who do. (Snowball sample, 25–30 years, A02).

Authorities only offered protection when they got sexual favours from women, and when women paid regular fees to them. Women working in private indoor spaces like pubs discussed being protected from clients that turned violent, by private guards stationed at these indoor spaces.

Women who met clients in physical spaces were more affected by the illegality of sex work compared to their peers who met clients using online platforms. The former discussed restrictions on the areas or times when they could work, being exposed to arrest by authorities, and public shame and ridicule. The latter women discussed not knowing any laws against sex work, and their work not being hindered in by any regulations. However, majority of the women discussed not being able to report to authorities or disclose to friends and family in cases where they had been raped, for fear of prosecution, ridicule, and stigmatisation.

Women’s experiences of stigma

Our participants experienced internalised stigma where they felt like disappointments to their families, and unworthy of some things or levels of achievement in life, such as good loving relationships respect, and leadership positions in society. Some women thought they would only be able to fit in society if they left sex work. Otherwise, they had to live with persistent guilt, shame, and embarrassment from doing sex work, and consequently keeping their work secret from friends, family, and society.

Then there is also that persistent guilt of letting down your family and them expecting better. I don’t know but it’s embarrassing, how do you even start telling someone that you are getting money from having sex with multiple people not even one. (Snowball sample, 25–30 years, A07).

Women experienced stigma when they were shunned by their family and friends, health workers, local leaders, and the communities in which they live and work. They were pushed to operate in secrecy because they feared the stigma they would face if exposed. Women who met clients in public outdoor spaces like streets were most affected because they were more exposed to the public while working, and to arrests by authorities.

Banvuma [They insulted me]. I remember my mum told me I decided to go out and embarrass the family, yet they have degrees and masters. It was really bad. I never got invited to any family function. Ever since then I became a reject, and you know you can tell when you are rejected by how people look at and talk to you. (Snowball sample, 25–30 years, A01). Yes, from the neighbours one of them can see you or in a way find out that you do sex work. Then she comes and tells another person that you are a sex worker. Then they spend the whole day gossiping about you. (Clinic sample, 25–30 years, B05).

Women discussed not being able to get licences since their work is illegal, and not being able to report in cases where clients violated them. They were exposed to discrimination because they had no legal or structural backing for them to work or to be protected against violence, attacks, and exploitation.

We present the contexts in which women selling sex in Kampala met and provided services to their clients. Our participants met clients in physical spaces including venues and outdoor locations and using online spaces that included social media applications and websites. Earlier studies also found that women who sell sex in Kampala recruit clients in venues and outdoor locations like those we presented [ 11 , 17 ]. Our study goes a step further and highlights that some women met clients using virtual online spaces like social media platforms and websites. While this finding is new to literature on Uganda, it is consistent with studies carried out in other settings, where sex workers recruiting clients using online platforms like social media and websites were identified [ 24 , 25 , 27 ]. similarly to their peers who recruit clients from physical spaces, women who recruit clients using online platforms are also high-risk population, yet they have not been targeted in HIV prevention efforts. There is need for inclusion of women who recruit clients using online platforms in HIV prevention interventions.

We assert that women selling sex in Kampala work in settings where sex work is illegal and criminalised, and because of this they are forced to endure harsh treatment; they face violent and abusive clients; they are arrested, abused, and exploited by authorities; and they experience jealousy and violence from their peers, and stigma from society. It is known that sex work is illegal in Uganda, that women who sell sex have violent relationships with both clients and authorities, and that women selling sex get no legal protection [ 17 , 21 ]. Our findings are consistent with other studies in this respect. We go further and highlight the larger extent to which the illegality of sex work was felt by women who met clients in physical spaces compared to those who met clients using online platforms. This stresses the continued need for support to women who face violent relationships, and to create safe spaces for women selling sex.

We also show that women who met clients using online platforms had more time to engage and negotiate with the clients before meeting them physically, were able to generate a pool of potential clients and consequently had less pressure to find clients. These women also seemed to have better education and income compared to their peers who met clients in physical spaces. Despite these apparent individual level advantages, we show that in many ways women selling sex faced similar pressures at the structural and interpersonal levels and faced similar risks with regards to HIV acquisition.

All our participants faced challenges that are similar and consistent with those identified in earlier studies [ 11 , 17 , 20 , 21 , 23 ]. These challenges were sustained by gaps in structural, social, and interpersonal support with regards to HIV prevention. For example, all study participants were either unable or unwilling to obtain support from authorities in situations where they were abused, exploited, or violated by clients or authorities. Women who met clients using online platforms faced some challenges specific to them because of their client recruitment strategy. First, they had to deal with cybersecurity threats like their social media accounts being hacked into and being exposed on the online platforms where they met clients. The damage caused by such negative exposure would be amplified by information on these platforms being easily and affordably accessible to very many people simultaneously. Secondly, they were threatened with exposure and reputational harm by clients who did not want to pay for services. This further increased their already high costs of operation. In terms of risk, most women who met clients using online platforms were unable to get immediate help in case a client turned violent because they mostly provided services to clients in their homes (both the clients’ and women’s) and in hotels. These women were exposed to high levels of violence that was potentially fatal from clients, and yet they did not readily access the needed services because they were pushed to operate in secrecy due to fear of stigma, judgement, and prosecution. This was exacerbated by the fact that they were mostly university graduates with professional jobs and were therefore very secretive and protective of their involvement in selling sex. Women’s experiences of stigma were consistent with what has been found in the literature (Beattie et al., 2023; Cruz, 2015; Fitzgerald-Husek et al., 2017; Ruegsegger et al., 2021; Seeley et al., 2012). It is still interesting to note that our participants across the samples faced stigma in similar ways and that most were ashamed of their work. Even women who met clients using online platforms were unable to report clients because they feared the prosecution by authorities or judgement by society that would come with being exposed. Provision of safe structural and social environments that support and protect women who sell sex as they carry out their work is necessary. Additionally, interventions to reduce stigma for women who sell sex are still very important but should target the more secretive and protective women who recruit clients using online platforms.

While access to health care for women who sell sex has improved over the years, these improvements in access have been identified among women who sell sex and have been included in research studies. This includes women in the clinic sample of our study, who mostly meet clients in physical spaces. Access to health care and HIV prevention services for women who meet clients using online platforms has not been systematically recorded. Yet, our results show that women who meet clients using online platforms face similar and even more challenges than their peers who meet clients in physical spaces. While the common challenges that all women face, including stigma and violence are barriers to health care access [ 32 , 33 , 34 ], the additional challenges that women who meet clients using online platforms face could be additional barriers for access to health care. This calls for continued efforts to address the common challenges but also highlights the need for specific interventions to improve access to health care among women who meet clients using online platforms. Our findings on how women joined sex work or would leave are consistent with published literature. Earlier research showed that women joined due to economic need, or because of earlier traumatic experiences of sexual abuse, and they would leave if they achieved economic stability [ 16 , 21 , 35 ]. This further highlights the importance of continued efforts to empower all women, and protect them from sexual violence, regardless of their level of education, status of work, and where they recruit or provide services to their clients.

Women who met clients using online platforms were hard to reach for us as a research team, and we assume that it will be hard for other researchers, health service providers and policy to reach them effectively. In fact, most women who we contacted to be part of the snowball sample (16 of 26) did not participate in the study, and those who accepted did so with caution. The spaces in which our participants provided services were identical to those reported in the literature, i.e., in indoor venues and outdoor locations [ 11 , 17 , 20 ]. We however highlight the fact that women who met clients using online spaces always provided services in indoor spaces and never in public outdoor spaces. Intervention efforts that target women recruiting clients in venues and in outdoor spaces will therefore miss women who recruit using online platforms. To increase their access to health care, to support services, and to the HIV prevention services they need, research and policy makers need to generate innovative strategies that will reach and engage women recruiting clients using online platforms.

Strengths and limitations

We used the framework analysis method. This method can neither handle highly heterogeneous data nor pay attention to the language of the respondents and how it is used [ 31 ]. We could therefore have missed some heterogeneity in women’s individual, interpersonal, or structural factors because of our choice of data analysis method. Moreover, we based our initial interview guide and coding framework on structural factors identified in the literature. Even though we used some inductive coding to complement the initial deductive framework, results from a similar study using a fully inductive approach would make an interesting comparison. We neither used complex theories nor sought to develop theory derived from the data but used robust framework analysis techniques to generate the major themes related to the structural factors that affect the sexual and reproductive health of women selling sex in Uganda. Despite these limitations, we present important results that could be applicable to women selling sex in Uganda, and other similar settings.

Over half of women in our study met their clients using online platforms and faced additional specific challenges and risks by recruiting their clients using online platforms. Regardless of where they met their clients, our participants worked in environments that exposed them to high risk of acquiring HIV. To reduce risk of HIV acquisition among women who sell sex, researchers and implementers should consider these differences in contexts, challenges, and risks, and design innovative interventions and programs that reach and include all women selling sex in Kampala.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Female Sex Worker

Low and Middle Income Country

Human Immunodeficiency Virus

Anti-Retroviral Therapy

Uganda Shillings

United States Dollars

COrona VIrus Disease of 2019

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Acknowledgements

We are grateful to all the participants for their time and information, the entire UPTAKE consortium from which this work drew, Rachel Kawuma and Andrew Ssemata for the support on qualitative data analysis, and the MUL study site team for the invaluable support, thank you.

This work was supported by the European and Developing Countries Clinical Trials Partnership (EDCTP) [grant number CSA2018HS-2525]. This work was conducted at the MRC/UVRI and LSHTM Uganda Research Unit which is jointly funded by the UK Medical Research Council (MRC) part of UK Research and Innovation (UKRI) and the UK Foreign, Commonwealth and Development Office (FCDO) under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union.

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KRK: Conceptualization, formal analysis, investigation, methodology, project administration, writing - original draft, writing - review & editing. MH: Investigation, writing - review & editing. YM: Funding acquisition, project administration, writing - review & editing. MG: Funding acquisition, supervision, validation, writing - review & editing. YWM: Funding acquisition, writing - review & editing. MQ: Conceptualization, funding acquisition, methodology, supervision, validation, writing - review & editing. JS: Methodology, supervision, validation, writing - review & editing. GG: Conceptualization, methodology, supervision, validation, writing - review & editing. All authors read and approved the final version.

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Katumba, K.R., Haumba, M., Mayanja, Y. et al. Understanding the contexts in which female sex workers sell sex in Kampala, Uganda: a qualitative study. BMC Women's Health 24 , 371 (2024). https://doi.org/10.1186/s12905-024-03216-7

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Galdas P, Darwin Z, Fell J, et al. A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN). Southampton (UK): NIHR Journals Library; 2015 Aug. (Health Services and Delivery Research, No. 3.34.)

A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN).

Chapter 3 qualitative review methods.

The objective of the qualitative metaethnography was to systematically identify experiences of, and perceptions of, interventions or specific activities aimed at supporting or promoting self-management of LTCs among men of differing age, ethnicity and socioeconomic background.

A summary of the methods used in the metaethnography is provided in Appendix 3 , using the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) reporting standards for qualitative evidence synthesis, developed by Tong et al. 93

The evidence synthesis was conducted using a metaethnography approach originally described by Noblit and Hare. 94 This approach was chosen because of its emphasis on conceptual development and generating new insights (i.e. being interpretive rather than integrative 94 ) and because it is compatible with synthesising all types of qualitative research. 95

Metaethnography involves seven stages: getting started, deciding what is relevant, reading the studies, determining how studies are related to each other, translating studies into each other, synthesising translations and expressing the synthesis; 94 these seven, often overlapping, stages are depicted in Figure 7 .

Seven steps of metaethnography.

• Step 1: getting started

The first stage involved identifying a ‘worthy’ research question and one that could be addressed through qualitative evidence synthesis. 94 This stage took place in developing the original funding application for the current review and its justification is presented in Chapter 1 .

• Step 2: deciding what is relevant

The second stage, ‘deciding what is relevant’, was viewed as comprising the search strategy, inclusion criteria and quality appraisal, consistent with the experiences of Atkins et al. 96 These are presented next, before steps 3–7 are described in the section Data extraction strategy and data analysis .

• Search methods

Search strategy

A comprehensive electronic search strategy ( Appendix 4 ) was developed in liaison with information specialists. It sought to identify all available studies, rather than using purposive sampling to identify all available concepts. Five electronic databases were searched in July 2013 [Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO and Social Science Citation Index].

Because of challenges with methodological indexing of qualitative research, 97 the electronic search was complemented by checking reference lists, and using an adapted strategy published elsewhere 98 that includes ‘thesaurus terms’ (keywords indexed in electronic databases, e.g. ‘Qualitative Research’), ‘free text terms’ (commonly used research methodology terms searched for in the titles, abstracts and keywords) and ‘broad-based terms’ (i.e. the broad free-text terms ‘qualitative’, ‘findings’ and ‘interview$’ and the thesaurus term ‘Interviews’). Terms relating to gender were combined with other terms to narrow the search and increase the precision of the strategy (e.g. ‘men’, ‘male’, ‘masculine$’, ‘gender’, ‘sex difference$’, ‘sex factors’).

Study selection: study screening methods and inclusion criteria

Records were initially screened by one reviewer (ZD) on the basis of the title and abstract. Decisions were recorded in EndNote X7.0.2 (Thomson Reuters, CA, USA), a reference management database. All articles identified as potentially eligible for inclusion were obtained in full. Attempts were made to identify and obtain published findings for unpublished literature that was otherwise eligible, for example doctoral theses or conference proceedings.

The full-text literature was screened independently by two reviewers (ZD and PG) using the inclusion criteria listed in Table 5 . Studies that explored the experiences of men alone, or included a clear and explicit comparison between men and women, were included. Studies which focused on self-management experiences of people with LTCs more generally (i.e. did not consider experiences of, or perceptions of, a self-management support intervention or activity) were excluded. The approach to screening was inclusive; for example, studies where the qualitative findings were limited (e.g. Iredale et al. , 99 Ramachandra et al. , 100 Smith et al. 101 ) and mixed-sex studies with limited findings on gender comparisons (e.g. Barlow et al. 102 , 103 ) were retained in case they contributed to the synthesis.

Screening criteria: qualitative

• Classification of self-management interventions and support activities in the qualitative evidence synthesis

The original study protocol sought to code self-management interventions and support activities using the most up-to-date version of the taxonomy of BCT. 104 – 106 As in the quantitative review (see Chapter 2 , Coding interventions for analysis ), we found that the level of detail reported on self-management interventions or activities in the qualitative literature was limited in detail, precision and consistency, making coding with the BCT taxonomy unfeasible.

Most of the qualitative literature did not focus on behaviour change per se or seek to address men’s views and experiences of behaviour change techniques; for example, some papers were concerned with the dynamics of social support groups, or the use of other self-management support and information. The BCT taxonomy is applicable to only studies that are judged as targeting behaviour change; we were therefore limited to ‘lifestyle’ and ‘psychological’ studies. Only a minority of the studies ( n  = 13) provided sufficient information on interventions to allow even rudimentary coding with the BCT taxonomy, and these are presented in Appendix 5 . Issues around application of the BCT taxonomy are returned to in the discussion chapter (see Chapter 6 ).

The lack of detail reported in the qualitative literature also made it unfeasible to classify interventions using the system developed for the quantitative review. Whereas the quantitative review concerned trials of specific interventions, approximately half of the studies in the qualitative review 99 , 101 , 107 – 130 included more than one intervention or activity (e.g. ‘any cancer support group’).

We therefore developed a broad system for classifying interventions and support activities that offered a pragmatic way to group studies and make the analysis process more manageable. The categories are shown in Table 6 .

Categories and descriptions of self-management interventions and support activities in the qualitative evidence synthesis

• Quality assessment strategy

The purpose of quality appraisal in the review was to provide descriptive information on the quality of the included studies rather than as a basis for inclusion. We considered that studies of weaker quality either would not contribute or would contribute only minimally to the final synthesis. 94 , 131 We therefore chose not to use design-specific appraisal tools (which the original protocol stated we would) because we placed emphasis on conceptual contribution, which did not require a detailed design-specific appraisal of methodological quality. With that in mind, we used the Critical Appraisal Skills Programme (CASP) tool. 132

The CASP tool comprises 10 checklist-style questions (see Appendix 6 ) for assessing the quality of various domains (including aims, design, methods, data analysis, interpretation, findings and value of the research). Because of the checklist nature of the CASP tool, we developed some additional questions informed by other metaethnography studies 96 , 131 that enabled us to extract and record more detailed narrative summaries of the main strengths, limitations and concerns of each study (see Appendix 7 ).

The CASP tool was used in the light of the experiences reported by other researchers who recommended that, despite rather low inter-rater agreement, such an approach ‘encourag[es] the reviewers to read the papers carefully and systematically, and serves as a reminder to treat the papers as data for the synthesis’ (p. 44). 131

Its focus is on procedural aspects of the conduct of the research rather than the insights offered. 133 The quality appraisal (which focused on methodological quality) did not form part of the inclusion criteria because, as recognised by Campbell et al. , 131 it is conceptual quality that is most important for evidence synthesis and it is the process of synthesis that judges the ‘worth’ of studies, with conceptually limited studies making a limited contribution. 94 Additionally, it is acknowledged that agreement is often slight, with low reproducibility. 131 , 133 Appraisal was conducted by two reviewers independently (ZD and PG), with discrepancies resolved through discussion.

Search outcome

The electronic search strategy identified 6330 unique references. Screening based on title and abstract identified 149 papers for full-text screening. Dual screening of these full-text articles identified 34 studies (reported in 38 papers) to be included in the review. Reasons for excluding the remaining 111 articles are shown in Table 7 .

Reasons for exclusion of full-text articles

Inter-rater agreement on the decision to include was 88.6%. The majority of disagreements ( n  = 17) concerned the definition of self-management intervention or activity. Having discussed the 17 disagreements, we agreed that five studies on which there was disagreement would be included. 100 , 103 , 110 , 116 , 134

An additional four studies were identified through reference checks and efforts to locate published literature linked to unpublished work identified through the electronic search. 111 , 112 , 135 , 136 An additional two papers (women only), although individually ineligible, were located as ‘linked papers’ for two of the original 34 studies, 114 , 120 giving a total of 38 studies (reported in 44 papers), as shown in Figure 8 .

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for the qualitative review.

• Data extraction strategy and data analysis

The lead reviewer (ZD) extracted all papers using data extraction forms previously tested and refined through a pilot study of four papers. All study details (including aim, participant details, methodology, method of data collection and analysis) were extracted into Microsoft Excel ® version 14 (Microsoft Corporation, Redmond, WA, USA) and checked by a second reviewer (PG). Extraction and analysis of study findings was undertaken by a group of coreviewers within the research team (ZD, PG, LK, CB, KM, KH) and followed steps 3–7 of the metaethnography process described by Noblit and Hare. 94 Despite being numbered sequentially, these phases do not occur in a linear process. 94

Step 3: reading the studies

The metaethnography process involved three levels of constructs, as described by Schutz 137 and operationalised by Atkins et al. : 96

• first-order: participant quotes and participant observations, while recognising that in secondary analysis these represent the participants’ views as selected by the study authors in evidencing their second-order constructs
• second-order: study authors’ themes/concepts and interpretations, also described by Noblit and Hare 94 as ‘metaphors’
• third-order: our ‘interpretations of interpretations of interpretations’ (p. 35), 94 based on our analysis of the first-order and second-order constructs extracted from the studies.

Each paper was read in full and copied verbatim into NVivo version 10 (QSR International, Warrington, UK) for line-by-line coding by the lead reviewer. Coding involved repeated reading and line-by-line categorising of first-order and second-order constructs, using participants’ and authors’ words wherever possible, and reading for possible third-order constructs.

Third-order constructs were developed by building second-order constructs into broader categories and themes in a framework which was revised iteratively using the hierarchical functions of the NVivo software (i.e. using ‘parent’ and ‘child’ nodes).

Rather than simply being a synthesis of the second-order constructs, third-order-constructs were derived inductively from the extracted data; this was an interpretive process that was not limited to interpretations offered by the original authors of included studies.

Coding by coreviewers (i.e. other members of the research team) was idiosyncratic but commonly involved working with printed papers, noting key ‘metaphors’ (themes, concepts and ideas) in the margins and highlighting first-order and second-order evidence that supported the coreviewers’ interpretations. The lead reviewer, ZD, met with each coreviewer to discuss/debrief coding decisions and ensure the credibility (i.e. the congruence of coding decisions with the original author interpretations) of the overall analytical process.

Step 4: determining how the studies are related

To offer a ‘way in’ to the synthesis, we adopted a similar approach to that of Campbell et al. : 131 initially grouping studies by the broad categories of self-management intervention and support activity shown in Table 6 . Each coreviewer was allocated one or more category of studies to analyse. The lead reviewer then read each category of studies in the following order: face-to-face group support, online support, online information, information, psychological, lifestyle and ‘various’; within this, she read the studies in alphabetical order of first author rather than nominating ‘key’ papers. All included papers were analysed, rather than reading until saturation of concepts.

The lead reviewer and coreviewer independently completed matrices to report the second-order constructs and emerging third-order constructs for each paper (which for the lead reviewer were based on a more comprehensive line-by-line coding using NVivo). This facilitated the juxtaposing of metaphors and/or constructs alongside each other, leading to initial assumptions about relationships between studies.

Step 5: translating studies into one another

A defining element of metaethnography is the ‘translation’ of studies into each other, whereby metaphors, together with their inter-relationships, are compared across studies. Facilitated by discussions using the matrices of second- and third-order constructs, we translated studies firstly within types of support activity and then, secondly, across types.

The lead reviewer initially developed the constructs in relation to face-to-face support (the largest category of studies) and read other categories of studies with reference to this, using a constant comparison approach to identify and refine concepts. The ‘models’ function in NVivo was used to depict relationships between third-order constructs; this helped to develop the line-of-argument synthesis, which is discussed next.

Step 6: synthesising translations

Studies can be synthesised in three ways: 94

• reciprocal translation, where the findings are directly comparable
• refutational translation, where the findings are in opposition
• a line-of-argument synthesis, where both similarities and contradictions are found and translations are encompassed in one overarching interpretation that aims to discover a whole among the set of parts, uncovering aspects that may be hidden in individual studies.

Because we found similarities and contradictions, we developed a line-of-argument synthesis (rather than reciprocal or refutational translation) that encompassed four key concepts, each of which was based around a set of third-order constructs.

Step 7: expressing the synthesis

The output of the synthesis, that is communicating our third-order concepts and overarching line-of-argument synthesis, is described by Noblit and Hare 94 as ‘expressing the synthesis’ (p. 29). They state that ‘the worth of any synthesis is in its comprehensibility to some audience’ (p. 82), 94 emphasising the importance of communicating the synthesis effectively, being mindful of the intended audience and using concepts and language that are meaningful (and understandable). We worked to make the synthesis comprehensible by discussion with coreviewers and, critically, through involvement of the patient and public involvement (PPI) group. The synthesis is presented in Chapter 5 and will also be expressed through other dissemination activities, for example the SELF-MAN symposium ( www.self-man.com ), mini-manuals and journal publications.

We undertook several steps to enhance the rigour of our analysis. Authors’ themes and interpretations (second-order constructs) were independently extracted by two reviewers, each of whom additionally suggested their own interpretations of the study findings (third-order constructs).

We were influenced by a recent Health Technology Assessment metaethnography which found multiple reviewers offered ‘broad similarities in interpretation, but differences of detail’ (p. x). 131 We therefore treated the lead reviewer’s analyses as the ‘master copy’ and compared these with the coreviewers’ extractions and interpretations. Peer debriefing meetings were held between the lead reviewer and each coreviewer to discuss matrices of second-order and third-order constructs which facilitated the consideration of alternative interpretations.

The third-order constructs and line-of-argument synthesis were further refined at a full-day meeting (January 2014) attended by the lead qualitative reviewer and wider team of five coreviewers involved in coding, extraction, analysis and interpretation (PG, KH, LK, KM, CB).

We identified the need to be reflexive about our interpretations and recognised potential sources of influence on our interpretations; for example, two reviewers (PG, KH) identified having a ‘constructions of masculinity’ lens, and we agreed to focus the line-of-argument synthesis on interpretations offered by authors of studies being synthesised, rather than framing our interpretations around constructions of masculinity. We considered it a strength that the six reviewers involved reflected a wide range of backgrounds and perspectives. Although PPI colleagues were not involved in the coding process, the line-of-argument synthesis and four key concepts were discussed with the PPI group to ensure credibility.

• Public and patient involvement

The SELF-MAN research team worked with a specially constituted public and patient advisory group comprising men living with one or more LTCs who were involved in either running or attending a LTC support group in the north of England. Members were recruited via the research team’s existing networks. Stakeholders’ support groups were all condition-specific – arthritis ( n  = 1), diabetes ( n  = 1), heart failure ( n  = 2) and Parkinson’s disease ( n  = 1) – although some men lived with multiple LTCs. All stakeholders attended a welcome meeting prior to the commencement of the study to prepare them for the involvement in the research, and were provided with ongoing support and guidance by the chief investigator throughout the research process. Members were reimbursed for travel, expenses and time throughout the duration of the project (in line with current INVOLVE recommendations 138 ).

The overarching aims of PPI in the project were, first, to help ensure that the review findings spoke to the self-management needs and priorities of men with LTCs, and, second, to ensure the development of appropriate outputs that would have benefit and relevance for service users. A recognised limitation of our group was that stakeholder representation was drawn from face-to-face group-based support interventions.

The stakeholder group met on three half-days over the course of the 12-month project. On each occasion, the group provided positive affirmation that the project was being conducted in accordance with its stated objectives. In the first two meetings, the group offered feedback and advice to the investigative team on preliminary and emerging analysis of the qualitative data throughout the research process: specifically, the development of third-order constructs and the line-of-argument synthesis. Responding to their input, we made revisions to some of our interpretations, particularly in relation to the importance of physical aspects of environments in which interventions took place. The group’s input also highlighted the need for future research to address depression as a common and often overlooked comorbidity in men (see Chapter 7 , Recommendations for future research ), and that they welcomed recommendations for sustainability of support groups and improving communication within groups. When considering the key outcomes to be assessed in the quantitative review, stakeholders also recommended that emphasis should be placed on quality-of-life outcome measures when considering whether or not a self-management support intervention is effective.

In the final meeting, the stakeholder group provided detailed recommendations for the content of the Self-Manual: Man’s Guide to Better Self-Management of Long Term Conditions (not yet available). It advised that the guide should be rephrased from ‘how to’ self-manage to ‘how to better ’ self-manage because men may view themselves as already self-managing and therefore not identify with the former.

Six or seven stakeholders attended each meeting. The female partner of one of the men attended and contributed to discussions at each meeting. Members of the group each received reimbursement of travel expenses and a £150 honorarium for each meeting they attended. In the final meeting, the stakeholders provided feedback on their involvement in the research process overall, focusing on what was done well and what could be improved. Feedback indicated that most stakeholders had a positive experience, particularly valuing the opportunity to have their ‘voices heard’ and make a potential impact on future service delivery. Recommendations for improvements mostly centred on ensuring prompt reimbursement of expenses incurred in attending the meetings.

Included under terms of UK Non-commercial Government License .

• Cite this Page Galdas P, Darwin Z, Fell J, et al. A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN). Southampton (UK): NIHR Journals Library; 2015 Aug. (Health Services and Delivery Research, No. 3.34.) Chapter 3, Qualitative review methods.
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