chapter 4 of research qualitative

Chapter 4. Finding a Research Question and Approaches to Qualitative Research

We’ve discussed the research design process in general and ways of knowing favored by qualitative researchers. In chapter 2, I asked you to think about what interests you in terms of a focus of study, including your motivations and research purpose. It might be helpful to start this chapter with those short paragraphs you wrote about motivations and purpose in front of you. We are now going to try to develop those interests into actual research questions (first part of this chapter) and then choose among various “traditions of inquiry” that will be best suited to answering those questions. You’ve already been introduced to some of this (in chapter 1), but we will go further here.

Developing a Research Question

Research questions are different from general questions people have about the social world. They are narrowly tailored to fit a very specific issue, complete with context and time boundaries. Because we are engaged in empirical science and thus use “data” to answer our questions, the questions we ask must be answerable by data. A question is not the same as stating a problem. The point of the entire research project is to answer a particular question or set of questions. The question(s) should be interesting, relevant, practical, and ethical. Let’s say I am generally interested in the problem of student loan debt. That’s a good place to start, but we can’t simply ask,

General question: Is student loan debt really a problem today?

How could we possibly answer that question? What data could we use? Isn’t this really an axiological (values-based) question? There are no clues in the question as to what data would be appropriate here to help us get started. Students often begin with these large unanswerable questions. They are not research questions. Instead, we could ask,

Poor research question: How many people have debt?

This is still not a very good research question. Why not? It is answerable, although we would probably want to clarify the context. We could add some context to improve it so that the question now reads,

Mediocre research question: How many people in the US have debt today? And does this amount vary by age and location?

Now we have added some context, so we have a better idea of where to look and who to look at. But this is still a pretty poor or mediocre research question. Why is that? Let’s say we did answer it. What would we really know? Maybe we would find out that student loan debt has increased over time and that young people today have more of it. We probably already know this. We don’t really want to go through a lot of trouble answering a question whose answer we already have. In fact, part of the reason we are even asking this question is that we know (or think) it is a problem. Instead of asking what you already know, ask a question to which you really do not know the answer. I can’t stress this enough, so I will say it again: Ask a question to which you do not already know the answer . The point of research is not to prove or make a point but to find out something unknown. What about student loan debt is still a mystery to you? Reviewing the literature could help (see chapter 9). By reviewing the literature, you can get a good sense of what is still mysterious or unknown about student loan debt, and you won’t be reinventing the wheel when you conduct your research. Let’s say you review the literature, and you are struck by the fact that we still don’t understand the true impact of debt on how people are living their lives. A possible research question might be,

Fair research question: What impact does student debt have on the lives of debtors?

Good start, but we still need some context to help guide the project. It is not nearly specific enough.

Better research question: What impact does student debt have on young adults (ages twenty-five to thirty-five) living in the US today?

Now we’ve added context, but we can still do a little bit better in narrowing our research question so that it is both clear and doable; in other words, we want to frame it in a way that provides a very clear research program:

Optimal research question: How do young adults (ages twenty-five to thirty-five) living in the US today who have taken on $30,000 or more in student debt describe the impact of their debt on their lives in terms of finding/choosing a job, buying a house, getting married, and other major life events?

Now you have a research question that can be answered and a clear plan of how to answer it. You will talk to young adults living in the US today who have high debt loads and ask them to describe the impacts of debt on their lives. That is all now in the research question. Note how different this very specific question is from where we started with the “problem” of student debt.

Take some time practicing turning the following general questions into research questions:

What can be done about the excessive use of force by police officers?
Why haven’t societies taken firmer steps to address climate change?
How do communities react to / deal with the opioid epidemic?
Who has been the most adversely affected by COVID?
When did political polarization get so bad?

Hint: Step back from each of the questions and try to articulate a possible underlying motivation, then formulate a research question that is specific and answerable.

It is important to take the time to come up with a research question, even if this research question changes a bit as you conduct your research (yes, research questions can change!). If you don’t have a clear question to start your research, you are likely to get very confused when designing your study because you will not be able to make coherent decisions about things like samples, sites, methods of data collection, and so on. Your research question is your anchor: “If we don’t have a question, we risk the possibility of going out into the field thinking we know what we’ll find and looking only for proof of what we expect to be there. That’s not empirical research (it’s not systematic)” ( Rubin 2021:37 ).

Researcher Note

How do you come up with ideas for what to study?

I study what surprises me. Usually, I come across a statistic that suggests something is common that I thought was rare. I tend to think it’s rare because the theories I read suggest it should be, and there’s not a lot of work in that area that helps me understand how the statistic came to be. So, for example, I learned that it’s common for Americans to marry partners who grew up in a different class than them and that about half of White kids born into the upper-middle class are downwardly mobile. I was so shocked by these facts that they naturally led to research questions. How do people come to marry someone who grew up in a different class? How do White kids born near the top of the class structure fall?

—Jessi Streib, author of The Power of the Past and Privilege Lost

What if you have literally no idea what the research question should be? How do you find a research question? Even if you have an interest in a topic before you get started, you see the problem now: topics and issues are not research questions! A research question doesn’t easily emerge; it takes a lot of time to hone one, as the practice above should demonstrate. In some research designs, the research question doesn’t even get clearly articulated until the end of data collection . More on that later. But you must start somewhere, of course. Start with your chosen discipline. This might seem obvious, but it is often overlooked. There is a reason it is called a discipline. We tend to think of “sociology,” “public health,” and “physics” as so many clusters of courses that are linked together by subject matter, but they are also disciplines in the sense that the study of each focuses the mind in a particular way and for particular ends. For example, in my own field, sociology, there is a loosely shared commitment to social justice and a general “sociological imagination” that enables its practitioners to connect personal experiences to society at large and to historical forces. It is helpful to think of issues and questions that are germane to your discipline. Within that overall field, there may be a particular course or unit of study you found most interesting. Within that course or unit of study, there may be an issue that intrigued you. And finally, within that issue, there may be an aspect or topic that you want to know more about.

When I was pursuing my dissertation research, I was asked often, “Why did you choose to study intimate partner violence among Native American women?” This question is necessary, and each time I answered, it helped shape me into a better researcher. I was interested in intimate partner violence because I am a survivor. I didn’t have intentions to work with a particular population or demographic—that came from my own deep introspection on my role as a researcher. I always questioned my positionality: What privileges do I hold as an academic? How has public health extracted information from institutionally marginalized populations? How can I build bridges between communities using my position, knowledge, and power? Public health as a field would not exist without the contributions of Indigenous people. So I started hanging out with them at community events, making friends, and engaging in self-education. Through these organic relationships built with Native women in the community, I saw that intimate partner violence was a huge issue. This led me to partner with Indigenous organizations to pursue a better understanding of how Native survivors of intimate partner violence seek support.

—Susanna Y. Park, PhD, mixed-methods researcher in public health and author of “How Native Women Seek Support as Survivors of Intimate Partner Violence: A Mixed-Methods Study”

One of the most exciting and satisfying things about doing academic research is that whatever you end up researching can become part of the body of knowledge that we have collectively created. Don’t make the mistake of thinking that you are doing this all on your own from scratch. Without even being aware of it, no matter if you are a first-year undergraduate student or a fourth-year graduate student, you have been trained to think certain questions are interesting. The very fact that you are majoring in a particular field or have signed up for years of graduate study in a program testifies to some level of commitment to a discipline. What we are looking for, ideally, is that your research builds on in some way (as extension, as critique, as lateral move) previous research and so adds to what we, collectively, understand about the social world. It is helpful to keep this in mind, as it may inspire you and also help guide you through the process. The point is, you are not meant to be doing something no one has ever thought of before, even if you are trying to find something that does not exactly duplicate previous research: “You may be trying to be too clever—aiming to come up with a topic unique in the history of the universe, something that will have people swooning with admiration at your originality and intellectual precociousness. Don’t do it. It’s safer…to settle on an ordinary, middle-of-the-road topic that will lend itself to a nicely organized process of project management. That’s the clever way of proceeding.… You can always let your cleverness shine through during the stages of design, analysis, and write-up. Don’t make things more difficult for yourself than you need to do” ( Davies 2007:20 ).

Rubin ( 2021 ) suggests four possible ways to develop a research question (there are many more, of course, but this can get you started). One way is to start with a theory that interests you and then select a topic where you can apply that theory. For example, you took a class on gender and society and learned about the “glass ceiling.” You could develop a study that tests that theory in a setting that has not yet been explored—maybe leadership at the Oregon Country Fair. The second way is to start with a topic that interests you and then go back to the books to find a theory that might explain it. This is arguably more difficult but often much more satisfying. Ask your professors for help—they might have ideas of theories or concepts that could be relevant or at least give you an idea of what books to read. The third way is to be very clever and select a question that already combines the topic and the theory. Rubin gives as one example sentencing disparities in criminology—this is both a topic and a theory or set of theories. You then just have to figure out particulars like setting and sample. I don’t know if I find this third way terribly helpful, but it might help you think through the possibilities. The fourth way involves identifying a puzzle or a problem, which can be either theoretical (something in the literature just doesn’t seem to make sense and you want to tackle addressing it) or empirical (something happened or is happening, and no one really understands why—think, for example, of mass school shootings).

Once you think you have an issue or topic that is worth exploring, you will need to (eventually) turn that into a good research question. A good research question is specific, clear, and feasible .

Specific . How specific a research question needs to be is somewhat related to the disciplinary conventions and whether the study is conceived inductively or deductively. In deductive research, one begins with a specific research question developed from the literature. You then collect data to test the theory or hypotheses accompanying your research question. In inductive research, however, one begins with data collection and analysis and builds theory from there. So naturally, the research question is a bit vaguer. In general, the more closely aligned to the natural sciences (and thus the deductive approach), the more a very tight and specific research question (along with specific, focused hypotheses) is required. This includes disciplines like psychology, geography, public health, environmental science, and marine resources management. The more one moves toward the humanities pole (and the inductive approach), the more looseness is permitted, as there is a general belief that we go into the field to find what is there, not necessarily what we imagine we are looking for (see figure 4.2). Disciplines such as sociology, anthropology, and gender and sexuality studies and some subdisciplines of public policy/public administration are closer to the humanities pole in this sense.

Natural Sciences are more likely to use the scientific method and be on the Quantitative side of the continuum. Humanities are more likely to use Interpretive methods and are on the Qualitative side of the continuum.

Regardless of discipline and approach, however, it is a good idea for beginning researchers to create a research question as specific as possible, as this will serve as your guide throughout the process. You can tweak it later if needed, but start with something specific enough that you know what it is you are doing and why. It is more difficult to deal with ambiguity when you are starting out than later in your career, when you have a better handle on what you are doing. Being under a time constraint means the more specific the question, the better. Questions should always specify contexts, geographical locations, and time frames. Go back to your practice research questions and make sure that these are included.

Clear . A clear research question doesn’t only need to be intelligible to any reader (which, of course, it should); it needs to clarify any meanings of particular words or concepts (e.g., What is excessive force?). Check all your concepts to see if there are ways you can clarify them further—for example, note that we shifted from impact of debt to impact of high debt load and specified this as beginning at $30,000. Ideally, we would use the literature to help us clarify what a high debt load is or how to define “excessive” force.

Feasible . In order to know if your question is feasible, you are going to have to think a little bit about your entire research design. For example, a question that asks about the real-time impact of COVID restrictions on learning outcomes would require a time machine. You could tweak the question to ask instead about the long-term impacts of COVID restrictions, as measured two years after their end. Or let’s say you are interested in assessing the damage of opioid abuse on small-town communities across the United States. Is it feasible to cover the entire US? You might need a team of researchers to do this if you are planning on on-the-ground observations. Perhaps a case study of one particular community might be best. Then your research question needs to be changed accordingly.

Here are some things to consider in terms of feasibility:

Is the question too general for what you actually intend to do or examine? (Are you specifying the world when you only have time to explore a sliver of that world?)
Is the question suitable for the time you have available? (You will need different research questions for a study that can be completed in a term than one where you have one to two years, as in a master’s program, or even three to eight years, as in a doctoral program.)
Is the focus specific enough that you know where and how to begin?
What are the costs involved in doing this study, including time? Will you need to travel somewhere, and if so, how will you pay for it?
Will there be problems with “access”? (More on this in later chapters, but for now, consider how you might actually find people to interview or places to observe and whether gatekeepers exist who might keep you out.)
Will you need to submit an application proposal for your university’s IRB (institutional review board)? If you are doing any research with live human subjects, you probably need to factor in the time and potential hassle of an IRB review (see chapter 8). If you are under severe time constraints, you might need to consider developing a research question that can be addressed with secondary sources, online content, or historical archives (see chapters 16 and 17).

In addition to these practicalities, you will also want to consider the research question in terms of what is best for you now. Are you engaged in research because you are required to be—jumping a hurdle for a course or for your degree? If so, you really do want to think about your project as training and develop a question that will allow you to practice whatever data collection and analysis techniques you want to develop. For example, if you are a grad student in a public health program who is interested in eventually doing work that requires conducting interviews with patients, develop a research question and research design that is interview based. Focus on the practicality (and practice) of the study more than the theoretical impact or academic contribution, in other words. On the other hand, if you are a PhD candidate who is seeking an academic position in the future, your research question should be pitched in a way to build theoretical knowledge as well (the phrasing is typically “original contribution to scholarship”).

The more time you have to devote to the study and the larger the project, the more important it is to reflect on your own motivations and goals when crafting a research question (remember chapter 2?). By “your own motivations and goals,” I mean what interests you about the social world and what impact you want your research to have, both academically and practically speaking. Many students have secret (or not-so-secret) plans to make the world a better place by helping address climate change, pointing out pressure points to fight inequities, or bringing awareness to an overlooked area of concern. My own work in graduate school was motivated by the last of these three—the not-so-secret goal of my research was to raise awareness about obstacles to success for first-generation and working-class college students. This underlying goal motivated me to complete my dissertation in a timely manner and then to further continue work in this area and see my research get published. I cared enough about the topic that I was not ready to put it away. I am still not ready to put it away. I encourage you to find topics that you can’t put away, ever. That will keep you going whenever things get difficult in the research process, as they inevitably will.

On the other hand, if you are an undergraduate and you really have very little time, some of the best advice I have heard is to find a study you really like and adapt it to a new context. Perhaps you read a study about how students select majors and how this differs by class ( Hurst 2019 ). You can try to replicate the study on a small scale among your classmates. Use the same research question, but revise for your context. You can probably even find the exact questions I used and ask them in the new sample. Then when you get to the analysis and write-up, you have a comparison study to guide you, and you can say interesting things about the new context and whether the original findings were confirmed (similar) or not. You can even propose reasons why you might have found differences between one and the other.

Another way of thinking about research questions is to explicitly tie them to the type of purpose of your study. Of course, this means being very clear about what your ultimate purpose is! Marshall and Rossman ( 2016 ) break down the purpose of a study into four categories: exploratory, explanatory, descriptive, and emancipatory ( 78 ). Exploratory purpose types include wanting to investigate little-understood phenomena, or identifying or discovering important new categories of meaning, or generating hypotheses for further research. For these, research questions might be fairly loose: What is going on here? How are people interacting on this site? What do people talk about when you ask them about the state of the world? You are almost (but never entirely) starting from scratch. Be careful though—just because a topic is new to you does not mean it is really new. Someone else (or many other someones) may already have done this exploratory research. Part of your job is to find this out (more on this in “What Is a ‘Literature Review’?” in chapter 9). Descriptive purposes (documenting and describing a phenomenon) are similar to exploratory purposes but with a much clearer goal (description). A good research question for a descriptive study would specify the actions, events, beliefs, attitudes, structures, and/or processes that will be described.

Most researchers find that their topic has already been explored and described, so they move to trying to explain a relationship or phenomenon. For these, you will want research questions that capture the relationships of interest. For example, how does gender influence one’s understanding of police brutality (because we already know from the literature that it does, so now we are interested in understanding how and why)? Or what is the relationship between education and climate change denialism? If you find that prior research has already provided a lot of evidence about those relationships as well as explanations for how they work, and you want to move the needle past explanation into action, you might find yourself trying to conduct an emancipatory study. You want to be even more clear in acknowledging past research if you find yourself here. Then create a research question that will allow you to “create opportunities and the will to engage in social action” ( Marshall and Rossman 2016:78 ). Research questions might ask, “How do participants problematize their circumstances and take positive social action?” If we know that some students have come together to fight against student debt, how are they doing this, and with what success? Your purpose would be to help evaluate possibilities for social change and to use your research to make recommendations for more successful emancipatory actions.

Recap: Be specific. Be clear. Be practical. And do what you love.

Choosing an Approach or Tradition

Qualitative researchers may be defined as those who are working with data that is not in numerical form, but there are actually multiple traditions or approaches that fall under this broad category. I find it useful to know a little bit about the history and development of qualitative research to better understand the differences in these approaches. The following chart provides an overview of the six phases of development identified by Denzin and Lincoln ( 2005 ):

Table 4.1. Six Phases of Development

There are other ways one could present the history as well. Feminist theory and methodologies came to the fore in the 1970s and 1980s and had a lot to do with the internal critique of more positivist approaches. Feminists were quite aware that standpoint matters—that the identity of the researcher plays a role in the research, and they were ardent supporters of dismantling unjust power systems and using qualitative methods to help advance this mission. You might note, too, that many of the internal disputes were basically epistemological disputes about how we know what we know and whether one’s social location/position delimits that knowledge. Today, we are in a bountiful world of qualitative research, one that embraces multiple forms of knowing and knowledge. This is good, but it means that you, the student, have more choice when it comes to situating your study and framing your research question, and some will expect you to signal the choices you have made in any research protocols you write or publications and presentations.

Creswell’s ( 1998 ) definition of qualitative research includes the notion of distinct traditions of inquiry: “Qualitative research is an inquiry process of understanding based on distinct methodological traditions of inquiry that explore a social or human problem. The research builds complex, holistic pictures, analyzes words, reports detailed views of informants , and conducted the study in a natural setting” (15; emphases added). I usually caution my students against taking shelter under one of these approaches, as, practically speaking, there is a lot of mixing of traditions among researchers. And yet it is useful to know something about the various histories and approaches, particularly as you are first starting out. Each tradition tends to favor a particular epistemological perspective (see chapter 3), a way of reasoning (see “ Advanced: Inductive versus Deductive Reasoning ”), and a data-collection technique.

There are anywhere from ten to twenty “traditions of inquiry,” depending on how one draws the boundaries. In my accounting, there are twelve, but three approaches tend to dominate the field.

Ethnography

Ethnography was developed from the discipline of anthropology, as the study of (other) culture(s). From a relatively positivist/objective approach to writing down the “truth” of what is observed during the colonial era (where this “truth” was then often used to help colonial administrators maintain order and exploit people and extract resources more effectively), ethnography was adopted by all kinds of social science researchers to get a better understanding of how groups of people (various subcultures and cultures) live their lives. Today, ethnographers are more likely to be seeking to dismantle power relations than to support them. They often study groups of people that are overlooked and marginalized, and sometimes they do the obverse by demonstrating how truly strange the familiar practices of the dominant group are. Ethnography is also central to organizational studies (e.g., How does this institution actually work?) and studies of education (e.g., What is it like to be a student during the COVID era?).

Ethnographers use methods of participant observation and intensive fieldwork in their studies, often living or working among the group under study for months at a time (and, in some cases, years). I’ve called this “deep ethnography,” and it is the subject of chapter 14. The data ethnographers analyze are copious “field notes” written while in the field, often supplemented by in-depth interviews and many more casual conversations. The final product of ethnographers is a “thick” description of the culture. This makes reading ethnographies enjoyable, as the goal is to write in such a way that the reader feels immersed in the culture.

There are variations on the ethnography, such as the autoethnography , where the researcher uses a systematic and rigorous study of themselves to better understand the culture in which they find themselves. Autoethnography is a relatively new approach, even though it is derived from one of the oldest approaches. One can say that it takes to heart the feminist directive to “make the personal political,” to underscore the connections between personal experiences and larger social and political structures. Introspection becomes the primary data source.

Grounded Theory

Grounded Theory holds a special place in qualitative research for a few reasons, not least of which is that nonqualitative researchers often mistakenly believe that Grounded Theory is the only qualitative research methodology . Sometimes, it is easier for students to explain what they are doing as “Grounded Theory” because it sounds “more scientific” than the alternative descriptions of qualitative research. This is definitely part of its appeal. Grounded Theory is the name given to the systematic inductive approach first developed by Glaser and Strauss in 1967, The Discovery of Grounded Theory: Strategies for Qualitative Research . Too few people actually read Glaser and Strauss’s book. It is both groundbreaking and fairly unremarkable at the same time. As a historical intervention into research methods generally, it is both a sharp critique of positivist methods in the social sciences (theory testing) and a rejection of purely descriptive accounts-building qualitative research. Glaser and Strauss argued for an approach whose goal was to construct (middle-level) theories from recursive data analysis of nonnumerical data (interviews and observations). They advocated a “constant comparative method” in which coding and analysis take place simultaneously and recursively. The demands are fairly strenuous. If done correctly, the result is the development of a new theory about the social world.

So why do I call this “fairly unremarkable”? To some extent, all qualitative research already does what Glaser and Strauss ( 1967 ) recommend, albeit without denoting the processes quite so specifically. As will be seen throughout the rest of this textbook, all qualitative research employs some “constant comparisons” through recursive data analyses. Where Grounded Theory sets itself apart from a significant number of qualitative research projects, however, is in its dedication to inductively building theory. Personally, I think it is important to understand that Glaser and Strauss were rejecting deductive theory testing in sociology when they first wrote their book. They were part of a rising cohort who rejected the positivist mathematical approaches that were taking over sociology journals in the 1950s and 1960s. Here are some of the comments and points they make against this kind of work:

Accurate description and verification are not so crucial when one’s purpose is to generate theory. ( 28 ; further arguing that sampling strategies are different when one is not trying to test a theory or generalize results)

Illuminating perspectives are too often suppressed when the main emphasis is verifying theory. ( 40 )

Testing for statistical significance can obscure from theoretical relevance. ( 201 )

Instead, they argued, sociologists should be building theories about the social world. They are not physicists who spend time testing and refining theories. And they are not journalists who report descriptions. What makes sociologists better than journalists and other professionals is that they develop theory from their work “In their driving efforts to get the facts [research sociologists] tend to forget that the distinctive offering of sociology to our society is sociological theory, not research description” ( 30–31 ).

Grounded Theory’s inductive approach can be off-putting to students who have a general research question in mind and a working hypothesis. The true Grounded Theory approach is often used in exploratory studies where there are no extant theories. After all, the promise of this approach is theory generation, not theory testing. Flying totally free at the start can be terrifying. It can also be a little disingenuous, as there are very few things under the sun that have not been considered before. Barbour ( 2008:197 ) laments that this approach is sometimes used because the researcher is too lazy to read the relevant literature.

To summarize, Glaser and Strauss justified the qualitative research project in a way that gave it standing among the social sciences, especially vis-à-vis quantitative researchers. By distinguishing the constant comparative method from journalism, Glaser and Strauss enabled qualitative research to gain legitimacy.

So what is it exactly, and how does one do it? The following stages provide a succinct and basic overview, differentiating the portions that are similar to/in accordance with qualitative research methods generally and those that are distinct from the Grounded Theory approach:

Step 1. Select a case, sample, and setting (similar—unless you begin with a theory to test!).

Step 2. Begin data collection (similar).

Step 3. Engage data analysis (similar in general but specificity of details somewhat unique to Grounded Theory): (1) emergent coding (initial followed by focused), (2) axial (a priori) coding , (3) theoretical coding , (4) creation of theoretical categories; analysis ends when “theoretical saturation ” has been achieved.

Grounded Theory’s prescriptive (i.e., it has a set of rules) framework can appeal to beginning students, but it is unnecessary to adopt the entire approach in order to make use of some of its suggestions. And if one does not exactly follow the Grounded Theory rulebook, it can mislead others if you tend to call what you are doing Grounded Theory when you are not:

Grounded theory continues to be a misunderstood method, although many researchers purport to use it. Qualitative researchers often claim to conduct grounded theory studies without fully understanding or adopting its distinctive guidelines. They may employ one or two of the strategies or mistake qualitative analysis for grounded theory. Conversely, other researchers employ grounded theory methods in reductionist, mechanistic ways. Neither approach embodies the flexible yet systematic mode of inquiry, directed but open-ended analysis, and imaginative theorizing from empirical data that grounded theory methods can foster. Subsequently, the potential of grounded theory methods for generating middle-range theory has not been fully realized ( Charmaz 2014 ).

Phenomenology

Where Grounded Theory sets itself apart for its inductive systematic approach to data analysis, phenomenologies are distinct for their focus on what is studied—in this case, the meanings of “lived experiences” of a group of persons sharing a particular event or circumstance. There are phenomenologies of being working class ( Charlesworth 2000 ), of the tourist experience ( Cohen 1979 ), of Whiteness ( Ahmed 2007 ). The phenomenon of interest may also be an emotion or circumstance. One can study the phenomenon of “White rage,” for example, or the phenomenon of arranged marriage.

The roots of phenomenology lie in philosophy (Husserl, Heidegger, Merleau-Ponty, Sartre) but have been adapted by sociologists in particular. Phenomenologists explore “how human beings make sense of experience and transform experience into consciousness, both individually and as shared meaning” ( Patton 2002:104 ).

One of the most important aspects of conducting a good phenomenological study is getting the sample exactly right so that each person can speak to the phenomenon in question. Because the researcher is interested in the meanings of an experience, in-depth interviews are the preferred method of data collection. Observations are not nearly as helpful here because people may do a great number of things without meaning to or without being conscious of their implications. This is important to note because phenomenologists are studying not “the reality” of what happens at all but an articulated understanding of a lived experience. When reading a phenomenological study, it is important to keep this straight—too often I have heard students critique a study because the interviewer didn’t actually see how people’s behavior might conflict with what they say (which is, at heart, an epistemological issue!).

In addition to the “big three,” there are many other approaches; some are variations, and some are distinct approaches in their own right. Case studies focus explicitly on context and dynamic interactions over time and can be accomplished with quantitative or qualitative methods or a mixture of both (for this reason, I am not considering it as one of the big three qualitative methods, even though it is a very common approach). Whatever methods are used, a contextualized deep understanding of the case (or cases) is central.

Critical inquiry is a loose collection of techniques held together by a core argument that understanding issues of power should be the focus of much social science research or, to put this another way, that it is impossible to understand society (its people and institutions) without paying attention to the ways that power relations and power dynamics inform and deform those people and institutions. This attention to power dynamics includes how research is conducted too. All research fundamentally involves issues of power. For this reason, many critical inquiry traditions include a place for collaboration between researcher and researched. Examples include (1) critical narrative analysis, which seeks to describe the meaning of experience for marginalized or oppressed persons or groups through storytelling; (2) participatory action research, which requires collaboration between the researcher and the research subjects or community of interest; and (3) critical race analysis, a methodological application of Critical Race Theory (CRT), which posits that racial oppression is endemic (if not always throughout time and place, at least now and here).

Do you follow a particular tradition of inquiry? Why?

Shawn Wilson’s book, Research Is Ceremony: Indigenous Research Methods , is my holy grail. It really flipped my understanding of research and relationships. Rather than thinking linearly and approaching research in a more canonical sense, Wilson shook my world view by drawing me into a pattern of inquiry that emphasized transparency and relational accountability. The Indigenous research paradigm is applicable in all research settings, and I follow it because it pushes me to constantly evaluate my position as a knowledge seeker and knowledge sharer.

Autoethnography takes the researcher as the subject. This is one approach that is difficult to explain to more quantitatively minded researchers, as it seems to violate many of the norms of “scientific research” as understood by them. First, the sample size is quite small—the n is 1, the researcher. Two, the researcher is not a neutral observer—indeed, the subjectivity of the researcher is the main strength of this approach. Autoethnographies can be extremely powerful for their depth of understanding and reflexivity, but they need to be conducted in their own version of rigor to stand up to scrutiny by skeptics. If you are skeptical, read one of the excellent published examples out there—I bet you will be impressed with what you take away. As they say, the proof is in the pudding on this approach.

Advanced: Inductive versus Deductive Reasoning

There has been a great deal of ink shed in the discussion of inductive versus deductive approaches, not all of it very instructive. Although there is a huge conceptual difference between them, in practical terms, most researchers cycle between the two, even within the same research project. The simplest way to explain the difference between the two is that we are using deductive reasoning when we test an existing theory (move from general to particular), and we are using inductive reasoning when we are generating theory (move from particular to general). Figure 4.2 provides a schematic of the deductive approach. From the literature, we select a theory about the impact of student loan debt: student loan debt will delay homeownership among young adults. We then formulate a hypothesis based on this theory: adults in their thirties with high debt loads will be less likely to own homes than their peers who do not have high debt loads. We then collect data to test the hypothesis and analyze the results. We find that homeownership is substantially lower among persons of color and those who were the first in their families to graduate from college. Notably, high debt loads did not affect homeownership among White adults whose parents held college degrees. We thus refine the theory to match the new findings: student debt loads delay homeownership among some young adults, thereby increasing inequalities in this generation. We have now contributed new knowledge to our collective corpus.

The inductive approach is contrasted in figure 4.3. Here, we did not begin with a preexisting theory or previous literature but instead began with an observation. Perhaps we were conducting interviews with young adults who held high amounts of debt and stumbled across this observation, struck by how many were renting apartments or small houses. We then noted a pattern—not all the young adults we were talking to were renting; race and class seemed to play a role here. We would then probably expand our study in a way to be able to further test this developing theory, ensuring that we were not seeing anomalous patterns. Once we were confident about our observations and analyses, we would then develop a theory, coming to the same place as our deductive approach, but in reverse.

A third form of reasoning, abductive (sometimes referred to as probabilistic reasoning) was developed in the late nineteenth century by American philosopher Charles Sanders Peirce. I have included some articles for further reading for those interested.

Among social scientists, the deductive approach is often relaxed so that a research question is set based on the existing literature rather than creating a hypothesis or set of hypotheses to test. Some journals still require researchers to articulate hypotheses, however. If you have in mind a publication, it is probably a good idea to take a look at how most articles are organized and whether specific hypotheses statements are included.

Table 4.2. Twelve Approaches. Adapted from Patton 2002:132-133.

Inductive, Deductive, and Abductive Reasoning and Nomothetic Science in General

Aliseda, Atocha. 2003. “Mathematical Reasoning vs. Abductive Reasoning: A Structural Approach.” Synthese 134(1/2):25–44.

Bonk, Thomas. 1997. “Newtonian Gravity, Quantum Discontinuity and the Determination of Theory by Evidence.” Synthese 112(1):53–73. A (natural) scientific discussion of inductive reasoning.

Bonnell, Victoria E. 1980. “The Uses of Theory, Concepts and Comparison in Historical Sociology.” C omparative Studies in Society and History 22(2):156–173.

Crane, Mark, and Michael C. Newman. 1996. “Scientific Method in Environmental Toxicology.” Environmental Reviews 4(2):112–122.

Huang, Philip C. C., and Yuan Gao. 2015. “Should Social Science and Jurisprudence Imitate Natural Science?” Modern China 41(2):131–167.

Mingers, J. 2012. “Abduction: The Missing Link between Deduction and Induction. A Comment on Ormerod’s ‘Rational Inference: Deductive, Inductive and Probabilistic Thinking.’” Journal of the Operational Research Society 63(6):860–861.

Ormerod, Richard J. 2010. “Rational Inference: Deductive, Inductive and Probabilistic Thinking.” Journal of the Operational Research Society 61(8):1207–1223.

Perry, Charner P. 1927. “Inductive vs. Deductive Method in Social Science Research.” Southwestern Political and Social Science Quarterly 8(1):66–74.

Plutynski, Anya. 2011. “Four Problems of Abduction: A Brief History.” HOPOS: The Journal of the International Society for the History of Philosophy of Science 1(2):227–248.

Thompson, Bruce, and Gloria M. Borrello. 1992. “Different Views of Love: Deductive and Inductive Lines of Inquiry.” Current Directions in Psychological Science 1(5):154–156.

Tracy, Sarah J. 2012. “The Toxic and Mythical Combination of a Deductive Writing Logic for Inductive Qualitative Research.” Qualitative Communication Research 1(1):109–141.

A place or collection containing records, documents, or other materials of historical interest; most universities have an archive of material related to the university’s history, as well as other “special collections” that may be of interest to members of the community.

A person who introduces the researcher to a field site’s culture and population. Also referred to as guides. Used in ethnography .

A form of research and a methodological tradition of inquiry in which the researcher uses self-reflection and writing to explore personal experiences and connect this autobiographical story to wider cultural, political, and social meanings and understandings. “Autoethnography is a research method that uses a researcher's personal experience to describe and critique cultural beliefs, practices, and experiences” ( Adams, Jones, and Ellis 2015 ).

The philosophical framework in which research is conducted; the approach to “research” (what practices this entails, etc.). Inevitably, one’s epistemological perspective will also guide one’s methodological choices, as in the case of a constructivist who employs a Grounded Theory approach to observations and interviews, or an objectivist who surveys key figures in an organization to find out how that organization is run. One of the key methodological distinctions in social science research is that between quantitative and qualitative research.

The process of labeling and organizing qualitative data to identify different themes and the relationships between them; a way of simplifying data to allow better management and retrieval of key themes and illustrative passages. See coding frame and codebook.

A later stage coding process used in Grounded Theory in which data is reassembled around a category, or axis.

A later stage-coding process used in Grounded Theory in which key words or key phrases capture the emergent theory.

The point at which you can conclude data collection because every person you are interviewing, the interaction you are observing, or content you are analyzing merely confirms what you have already noted. Achieving saturation is often used as the justification for the final sample size.

A methodological tradition of inquiry that focuses on the meanings held by individuals and/or groups about a particular phenomenon (e.g., a “phenomenology of whiteness” or a “phenomenology of first-generation college students”). Sometimes this is referred to as understanding “the lived experience” of a particular group or culture. Interviews form the primary tool of data collection for phenomenological studies. Derived from the German philosophy of phenomenology (Husserl 1913; 2017).

The number of individuals (or units) included in your sample

A form of reasoning which employs a “top-down” approach to drawing conclusions: it begins with a premise or hypothesis and seeks to verify it (or disconfirm it) with newly collected data. Inferences are made based on widely accepted facts or premises. Deduction is idea-first, followed by observations and a conclusion. This form of reasoning is often used in quantitative research and less often in qualitative research. Compare to inductive reasoning . See also abductive reasoning .

A form of reasoning that employs a “bottom-up” approach to drawing conclusions: it begins with the collection of data relevant to a particular question and then seeks to build an argument or theory based on an analysis of that data. Induction is observation first, followed by an idea that could explain what has been observed. This form of reasoning is often used in qualitative research and seldom used in qualitative research. Compare to deductive reasoning . See also abductive reasoning .

An “interpretivist” form of reasoning in which “most likely” conclusions are drawn, based on inference. This approach is often used by qualitative researchers who stress the recursive nature of qualitative data analysis. Compare with deductive reasoning and inductive reasoning .

A form of social science research that generally follows the scientific method as established in the natural sciences. In contrast to idiographic research , the nomothetic researcher looks for general patterns and “laws” of human behavior and social relationships. Once discovered, these patterns and laws will be expected to be widely applicable. Quantitative social science research is nomothetic because it seeks to generalize findings from samples to larger populations. Most qualitative social science research is also nomothetic, although generalizability is here understood to be theoretical in nature rather than statistical . Some qualitative researchers, however, espouse the idiographic research paradigm instead.

Chapter 4: Home
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Analysis and Coding Example: Qualitative Data

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The following is an example of how to engage in a three step analytic process of coding, categorizing, and identifying themes within the data presented. Note that different researchers would come up with different results based on their specific research questions, literature review findings, and theoretical perspective.

There are many ways cited in the literature to analyze qualitative data. The specific analytic plan in this exercise involved a constant comparative (Glaser & Strauss, 1967) approach that included a three-step process of open coding, categorizing, and synthesizing themes. The constant comparative process involved thinking about how these comments were interrelated. Intertwined within this three step process, this example engages in content analysis techniques as described by Patton (1987) through which coherent and salient themes and patterns are identified throughout the data. This is reflected in the congruencies and incongruencies reflected in the memos and relational matrix.

Step 1: Open Coding

Codes for the qualitative data are created through a line by line analysis of the comments. Codes would be based on the research questions, literature review, and theoretical perspective articulated. Numbering the lines is helpful so that the researcher can make notes regarding which comments they might like to quote in their report.

It is also useful to include memos to remind yourself of what you were thinking and allow you to reflect on the initial interpretations as you engage in the next two analytic steps. In addition, memos will be a reminder of issues that need to be addressed if there is an opportunity for follow up data collection. This technique allows the researcher time to reflect on how his/her biases might affect the analysis. Using different colored text for memos makes it easy to differentiate thoughts from the data.

Many novice researchers forgo this step. Rather, they move right into arranging the entire statements into the various categories that have been pre-identified. There are two problems with the process. First, since the categories have been listed open coding, it is unclear from where the categories have been derived. Rather, when a researcher uses the open coding process, he/she look at each line of text individually and without consideration for the others. This process of breaking the pieces down and then putting them back together through analysis ensures that the researcher consider all for the data equally and limits the bias that might introduced. In addition, if a researcher is coding interviews or other significant amounts of qualitative data it will likely become overwhelming as the researcher tries to organize and remember from which context each piece of data came.

Step 2: Categorizing

To categorize the codes developed in Step 1 , list the codes and group them by similarity. Then, identify an appropriate label for each group. The following table reflects the result of this activity.

Step 3: Identification of Themes

In this step, review the categories as well as the memos to determine the themes that emerge. In the discussion below, three themes emerged from the synthesis of the categories. Relevant quotes from the data are included that exemplify the essence of the themes.These can be used in the discussion of findings. The relational matrix demonstrates the pattern of thinking of the researcher as they engaged in this step in the analysis. This is similar to an axial coding strategy.

Note that this set of data is limited and leaves some questions in mind. In a well-developed study, this would just be a part of the data collected and there would be other data sets and/or opportunities to clarify/verify some of the interpretations made below. In addition, since there is no literature review or theoretical statement, there are no reference points from which to draw interferences in the data. Some assumptions were made for the purposes of this demonstration in these areas.

T h eme 1: Professional Standing

Individual participants have articulated issues related to their own professional position. They are concerned about what and when they will teach, their performance, and the respect/prestige that they have within the school. For example, they are concerned about both their physical environment and the steps that they have to take to ensure that they have the up to date tools that they need. They are also concerned that their efforts are being acknowledged, sometimes in relation to their peers and their beliefs that they are more effective.

Selected quotes:

Some teachers are carrying the weight for other teachers. (demonstrates that they think that some of their peers are not qualified.)
We need objective observations and feedback from the principal (demonstrates that they are looking for acknowledgement for their efforts. Or this could be interpreted as a belief that their peers who are less qualified should be acknowledged).
There is a lack of support for individual teachers

Theme 2: Group Dynamics and Collegiality

Rationale: There are groups or clicks that have formed. This seems to be the basis for some of the conflict. This conflict is closely related to the status and professional standing themes. This theme however, has more to do with the group issues while the first theme is an individual perspective. Some teachers and/or subjects are seen as more prestigious than others. Some of this is related to longevity. This creates jealously and inhibits collegiality. This affects peer-interaction, instruction, and communication.

Grade level teams work against each other rather than together.
Each team of teachers has stereotypes about the other teams.
There is a division between the old and new teachers

Theme 3: Leadership Issues

Rationale: There seems to be a lack of leadership and shared understanding of the general direction in which the school will go. This is also reflected in a lack of two way communications. There doesn’t seem to be information being offered by the leadership of the school, nor does there seem to be an opportunity for individuals to share their thoughts, let alone decision making. There seems to be a lack of intervention in the conflict from leadership.

Decisions are made on inaccurate information.
We need consistent decisions about school rules

Coding Example - Category - Relationships - Themes

Glaser, B.G., & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research . Chicago, IL: Aldine.

Patton, M. Q. (1987). How to use qualitative methods in evaluation . Newbury Park, CA: Sage Publications.

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An Introduction to Qualitative Research

Student resources, chapter 4: methods and data in qualitative research.

Flick, U. (2015). Qualitative inquiry—2.0 at 20?: Developments, trends, and challenges for the politics of research

The overview in this article complements this chapter with a focus on trends such as re-using qualitative data and the problems of archiving them.

Flick, U. (2015). Qualitative inquiry—2.0 at 20?: Developments, trends, and challenges for the politics of research. Qualitative Inquiry , 21 (7), 599–608.

Drawson, A. S., Toombs, E., & Mushquash, C. J. (2017). Indigenous research methods: A systematic review.

This (open access) systematic review informs about methods discussed and used in Indigenous research.

Drawson, A. S., Toombs, E., & Mushquash, C. J. (2017). Indigenous research methods: A systematic review. The International Indigenous Policy Journal , 8 (2). doi:10.18584/ iipj.2017.8.2.5

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

Unit 11: Interpretive.

50 Characteristics of Qualitative Research

Qualitative research is like diving into the real world to see how people actually live and interact. It’s all about hanging out in natural settings and getting the scoop on how folks make sense of their experiences. Think of it as a way to capture the juicy details and unique stories that numbers just can’t tell. Researchers get up close and personal, listening to people’s stories and interpreting the rich, complex web of human life. It’s messy, it’s subjective, and it’s all about understanding the world from the inside out.

After this unit you should be able to:

Characteristics of Qualitative Research:

Interpretive in orientation; subject to inference, impressions, and an inductive form of reasoning .

Study on Multiethnic Identity Development : Researchers used in-depth interviews to explore how individuals with multiethnic backgrounds construct their identities. The study relied on inductive reasoning to identify patterns and themes from participants’ narratives, highlighting the interpretive nature of qualitative research

Naturalistic: Research that is conducted in the field or where participants live, work, and play.

Naturalistic Setting: Emphasizes the importance of studying individuals in their natural environment to gain authentic insights into their experiences and behaviors.

Qualitative research often involves studying communication in real-world settings, emphasizing the importance of context in shaping interactions. This approach allows researchers to observe communication as it naturally occurs, capturing the nuances and complexities that might be missed in controlled laboratory environments or other artificial environments.

Another key term is in vivo : Research that takes place in a natural setting.

Research on Workplace Communication : A study conducted in various office environments observed how employees communicate during their daily tasks. By being present in the natural setting of the workplace, researchers were able to capture authentic interactions and understand the context of communication

Socially Constructed Reality: Acknowledgement that reality is subjective and interpreted differently by individuals based on their social contexts.

Qualitative research recognizes that meaning is not inherent but is created through communication and social interactions. Researchers acknowledge that individuals interpret and construct their realities based on their social and cultural contexts.

Study on Social Media Use : Researchers examined how teenagers use social media to construct their social identities. Through focus groups and online observations, the study revealed how social interactions on these platforms shape participants’ perceptions of reality

Primacy of Subject Matter: Focus on understanding the individual perspectives and experiences of those who have encountered the phenomenon being studied.

Qualitative research is deeply interested in individual perspectives and experiences, particularly those of individuals who have encountered the phenomenon under study. Qualitative research seeks to understand the meaning individuals create around their experiences, recognizing that reality is socially constructed and understanding that there is no single objective reality. Qualitative research, therefore, aims to illuminate the richness and depth of these individual interpretations of the world.

Emic Perspective: Emphasizes understanding the phenomenon from the participant’s point of view, capturing their interpretations and meanings.

Qualitative research prioritizes the participant’s viewpoint, seeking to understand communication phenomena from the perspective of those involved. Researchers strive to capture the lived experiences and interpretations of participants, allowing their voices and perspectives to guide the research process.

Study on Cultural Communication Practices : Researchers immersed themselves in a community to study traditional communication practices. By adopting an emic perspective, they were able to capture the meanings and interpretations that community members attach to their communication rituals

Complex and Interwoven Variables: Recognition that human experiences and behaviors are complex and influenced by multiple interconnected factors that cannot be easily isolated and measured quantitatively.

Qualitative research recognizes the inherent complexity of human experiences and behaviors. Unlike quantitative research, which often seeks to isolate and measure specific variables, qualitative research embraces the idea that numerous interconnected factors shape how people experience the world. It acknowledges that these factors are often difficult, if not impossible, to disentangle and quantify.

Research on Family Communication : A qualitative study on family communication patterns explored how various factors such as cultural background, family dynamics, and individual personalities influence communication. The study acknowledged the complexity and interrelatedness of these variables

Interpretive Analysis: Highlights the role of the researcher in interpreting the data to identify themes, patterns, and meanings, acknowledging the subjective nature of qualitative analysis.

In qualitative research, data analysis involves interpreting the meanings and patterns present in the data. Researchers analyze data like interview transcripts, field notes, and documents to identify themes, relationships, and underlying meanings, acknowledging the subjective nature of qualitative analysis.

Study on Organizational Communication : Researchers analyzed interview transcripts and meeting notes to identify themes related to organizational culture and communication practices. The interpretive analysis highlighted the subjective nature of understanding organizational communication

Thus, we must also remember:

Reflexivity : How one’s own thoughts, feelings, and behaviors interact with their research site and their research itself.

Research on Ethnographic Fieldwork : In an ethnographic study of a community organization, the researcher reflected on how their own background and interactions with participants influenced the research process. This reflexivity helped in understanding the impact of the researcher’s presence on the data collected

Cambridge Scholars Publishing. (n.d.). Exploring communication through qualitative research . Retrieved from https://www.cambridgescholars.com/resources/pdfs/978-1-4438-9589-7-sample.pdf

Research that takes place in a natural setting

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Analysing qualitative data

Catherine pope, sue ziebland, nicholas mays.

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Correspondence to: C Pope [email protected]

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Qualitative research in health care

Contrary to popular perception, qualitative research can produce vast amounts of data. These may include verbatim notes or transcribed recordings of interviews or focus groups, jotted notes and more detailed “fieldnotes” of observational research, a diary or chronological account, and the researcher's reflective notes made during the research. These data are not necessarily small scale: transcribing a typical single interview takes several hours and can generate 20-40 pages of single spaced text. Transcripts and notes are the raw data of the research. They provide a descriptive record of the research, but they cannot provide explanations. The researcher has to make sense of the data by sifting and interpreting them.

Summary points

Qualitative research produces large amounts of textual data in the form of transcripts and observational fieldnotes

The systematic and rigorous preparation and analysis of these data is time consuming and labour intensive

Data analysis often takes place alongside data collection to allow questions to be refined and new avenues of inquiry to develop

Textual data are typically explored inductively using content analysis to generate categories and explanations; software packages can help with analysis but should not be viewed as short cuts to rigorous and systematic analysis

High quality analysis of qualitative data depends on the skill, vision, and integrity of the researcher; it should not be left to the novice

Relation between analysis and qualitative data

In much qualitative research the analytical process begins during data collection as the data already gathered are analysed and shape the ongoing data collection. This sequential analysis 1 or interim analysis 2 has the advantage of allowing the researcher to go back and refine questions, develop hypotheses, and pursue emerging avenues of inquiry in further depth. Crucially, it also enables the researcher to look for deviant or negative cases; that is, examples of talk or events that run counter to the emerging propositions or hypotheses and can be used to refine them. Such continuous analysis is almost inevitable in qualitative research: because the researcher is “in the field” collecting the data, it is impossible not to start thinking about what is being heard and seen.

The analysis

None the less there is still much analytical work to do once the researcher has left the field. Textual data (in the form of fieldnotes or transcripts) are explored using some variant of content analysis. In general, qualitative research does not seek to quantify data. Qualitative sampling strategies do not aim to identify a statistically representative set of respondents, so expressing results in relative frequencies may be misleading. Simple counts are sometimes used and may provide a useful summary of some aspects of the analysis. In most qualitative analyses the data are preserved in their textual form and “indexed” to generate or develop analytical categories and theoretical explanations.

Qualitative research uses analytical categories to describe and explain social phenomena. These categories may be derived inductively—that is, obtained gradually from the data—or used deductively, either at the beginning or part way through the analysis as a way of approaching the data. Deductive analysis is less common in qualitative research but is increasingly being used, for example in the “framework approach” described below. The term grounded theory is used to describe the inductive process of identifying analytical categories as they emerge from the data (developing hypotheses from the ground or research field upwards rather defining them a priori). 3 Initially the data are read and reread to identify and index themes and categories: these may centre on particular phrases, incidents, or types of behaviour. Sometimes interesting or unfamiliar terms used by the group studied can form the basis of analytical categories. Becker and Geer's classic study of medical training uncovered the specialist use of the term “crock” to denote patients who were seen as less worthwhile to treat by medical staff and students. 4

All the data relevant to each category are identified and examined using a process called constant comparison, in which each item is checked or compared with the rest of the data to establish analytical categories. This requires a coherent and systematic approach. The key point about this process is that it is inclusive; categories are added to reflect as many of the nuances in the data as possible, rather than reducing the data to a few numerical codes. Sections of the data—such as discrete incidents—will typically include multiple themes, so it is important to have some system of cross indexing to deal with this. A number of computer software packages have been developed to assist with this process (see below).

Indexing the data creates a large number of “fuzzy categories” or units. 5 Informed by the analytical and theoretical ideas developed during the research, these categories are further refined and reduced in number by grouping them together. It is then possible to select key themes or categories for further investigation— typically by “cutting and pasting”—that is, selecting sections of data on like or related themes and putting them together. Paper systems for this (using multiple photocopies, cardex systems, matrices, or spreadsheets), although considered somewhat old fashioned and laborious, can help the researcher to develop an intimate knowledge of the data. Word processors can also facilitate data searching, and split screen functions make this a particularly appealing method for sorting and copying data into separate files.

Software packages designed to handle qualitative data

Several software packages designed for qualitative data analysis enable complex organisation and retrieval of data. Among the most widely used are qsr nud*ist and atlas .ti. 6 , 7 This evolution has been welcomed as an important development with the potential to improve the rigour of analysis. 8 Such software can allow basic “code and retrieval” of data, and more sophisticated analysis using algorithms to identify co-occurring codes in a range of logically overlapping or nesting possibilities, annotation of the text, or the creation and amalgamation of codes. Some packages can be used to make theoretical links or search for “disconfirming evidence” (for example, by using boolean operators such as “or,” “and,” “not”). The Hypersoft package uses “hyperlinks” to capture the conceptual links which are observed between sections of the data; this can protect the narrative structure of the data to avoid the problem of decontextualisation or data fragmentation. 9

LIANE PAYNE

Using software to help with the more laborious side of analysis has many potential benefits, but some caution is advisable. The prospect of computer assisted analysis may persuade researchers (or those who fund them) that they can manage much larger amounts of data and increase the apparent “power” of their study. However, qualitative studies are not designed to be representative in terms of statistical generalisability, and they may gain little from an expanded sample size except a more cumbersome dataset. The sample size should be directed by the research question and analytical requirements, such as data saturation, rather than by the available software. In some circumstances, a single case study design may be the most successful way of generating theory. Furthermore, using a computer package may not make the analysis less time consuming, 10 although it may show that the process is systematic.

Taking the analysis forward—the role of the researcher

A computer package may be a useful aid when gathering, organising, and reorganising data and helping to find exceptions, but no package is capable of perceiving a link between theory and data or defining an appropriate structure for the analysis. To take the analysis beyond the most basic descriptive and counting exercise requires the researcher's analytical skills in moving towards hypotheses or propositions about the data.

One way of performing this next stage is called analytic induction . This involves an iterative testing and retesting of theoretical ideas using the data. Bloor described his use of this procedure in some detail (box). 11 In essence, the researcher examines a set of cases, develops hypotheses or constructs, and examines further cases to test these propositions.

Stages in the analysis of fieldnotes in a qualitative study of ear, nose, and throat surgeons' disposal decisions for children referred for possible tonsillectomy and adenoidectomy (with examples) 11 :

(1) Provisional classification—for each surgeon all cases categorised according to disposal category used (tonsillectomy and adenoidectomy or adenoidectomy alone)

(2) Identification of features of provisional cases—common features of cases in each disposal category identified (most tonsillectomy and adenoidectomy cases found to have three main clinical signs)

(3) Scrutiny of deviant cases—include in (2) or modify (1) to accommodate deviant cases (tonsillectomy and adenoidectomy performed when only two of three signs present)

(4) Identification of shared features of cases—features common to other disposal categories (history of several episodes of tonsillitis)

(5) Derivation of surgeons' decision rules—from the features common to cases (case history more important than physical examination)

(6) Derivation of surgeons' search procedures (for each decision rule)—the particular clinical signs looded for by each surgeon

Repeat steps (2) to (6) for each disposal category

Inter-rater reliability

Some researchers have found that the use of more than one analyst can improve the consistency or reliability of analyses. 5 , 12 , 13 However, the appropriateness of the concept of inter-rater reliability in qualitative research is contested. 14 None the less there may be merit in involving more than one analyst in situations where researcher bias is especially likely to be perceived to be a problem—for example, where social scientists are investigating the work of clinicians. In a study of diagnosis in cardiology, Daly et al developed a modified form of qualitative analysis involving external researchers and the cardiologists who had managed the patients. The researchers identified the main aspects of the consultations that seemed to be related to the use of echocardiography, and they developed criteria which other analysts could use to assess the raw data. The cardiologists then independently assessed each case using the raw data in order to produce an account of how and why a test was or was not ordered and with what consequences. The assessments of the cardiologists and researchers were compared statistically and the level of agreement was shown to be good. Where there was disagreement between the original researchers' analysis and that of the cardiologist, a further researcher repeated the analysis and any remaining discrepancies were resolved by discussion between the researchers and the cardiologists. Although there was an element of circularity in part of this lengthy process (in that the formal criteria used by the cardiologists were derived from the initial researchers' analysis) and it involved the derivation of quantitative gradings and statistical analysis of inter-rater agreement that are unusual in a qualitative study, this process meant that clinical critics could not argue that the findings were simply based on the subjective judgments of an individual researcher.

Applied qualitative research

The framework approach has been developed in Britain specifically for applied or policy relevant qualitative research in which the objectives of the investigation are typically set in advance and shaped by the information requirements of the funding body (for example, a health authority). 15 The timescales of applied research tend to be short and there is often a need to link the analysis with quantitative findings. For these reasons, although the framework approach reflects the original accounts and observations of the people studied (that is, “grounded” and inductive), it starts deductively from pre-set aims and objectives. The data collection tends to be more structured than would be the norm for much other qualitative research and the analytical process tends to be more explicit and more strongly informed by a priorireasoning(box). 6 The analysis is designed so that it can be viewed and assessed by people other than the primary analyst.

Five stages of data analysis in the framework approach

Familiarisation —immersion in the raw data (or typically a pragmatic selection from the data) by listening to tapes, reading transcripts, studying notes and so on, in order to list key ideas and recurrent themes

Identifying a thematic framework —identifying all the key issues, concepts, and themes by which the data can be examined and referenced. This is carried out by drawing on a priori issues and questions derived from the aims and objectives of the study as well as issues raised by the respondents themselves and views or experiences that recur in the data. The end product of this stage is a detailed index of the data, which labels the data into manageable chunks for subsequent retrieval and exploration

Indexing —applying the thematic framework or index systematically to all the data in textual form by annotating the transcripts with numerical codes from the index, usually supported by short text descriptors to elaborate the index heading. Single passages of text can often encompass a large number of different themes, each of which has to be recorded, usually in the margin of the transcript

Charting —rearranging the data according to the appropriate part of the thematic framework to which they relate, and forming charts. For example, there is likely to be a chart for each key subject area or theme with entries for several respondents. Unlike simple cut and paste methods that group verbatim text, the charts contain distilled summaries of views and experiences. Thus the charting process involves a considerable amount of abstraction and synthesis

Mapping and interpretation —using the charts to define concepts, map the range and nature of phenomena, create typologies and find associations between themes with a view to providing explanations for the findings. The process of mapping and interpretation is influenced by the original research objectives as well as by the themes that have emerged from the data themselves

Conclusions

Analysing qualitative data is not a simple or quick task. Done properly, it is systematic and rigorous, and therefore labour-intensive and time-consuming. Fielding contends that “good qualitative analysis is able to document its claim to reflect some of the truth of a phenomenon by reference to systematically gathered data,” in contrast, “poor qualitative analysis is anecdotal, unreflective, descriptive without being focused on a coherent line of inquiry.” 16 At its heart, good qualitative analysis relies on the skill, vision and integrity of the researcher doing that analysis, and as Dingwall et al have pointed out, this requires trained, and, crucially, experienced researchers. 17

Acknowledgments

The views expressed in this paper are those of the authors and do not necessarily reflect the views of the New Zealand Treasury, in the case of NM. The Treasury takes no responsibility for any errors or omissions in, or for the correctness of the information contained in this article.

This is the second in a series of three articles

Series editors: Catherine Pope and Nicholas Mays

This article is taken from the second edition of Qualitative Research in Health Care , edited by Catherine Pope and Nicholas Mays, published by BMJ Books

1. Becker HS. Sociological work. London: Allen Lane; 1971. [ Google Scholar ]
2. Miles M, Huberman A. Qualitative data analysis. London: Sage; 1984. [ Google Scholar ]
3. Glaser BG, Strauss AL. The discovery of grounded theory. Chicago: Aldine; 1967. [ Google Scholar ]
4. Becker HS, Geer B. Participant observation: the analysis of qualitative field data. In: Burgess RG, editor. Field research: a sourcebook and field manual. London: Allen and Unwin; 1982. [ Google Scholar ]
5. Perry S. Living with multiple sclerosis. Aldershot: Avebury; 1994. [ Google Scholar ]
6. Richards T, Richards L. QSR NUD*IST, version 3.0. London: Sage; 1994. [ Google Scholar ]
7. Muhr T. ATLAS.ti for Windows. Berlin: Scientific Software Development; 1997. [ Google Scholar ]
8. Kelle U, editor. Computer-aided qualitative data analysis: theory, methods and practice. London: Sage; 1995. [ Google Scholar ]
9. Dey I. Qualitative data analysis: a user friendly guide for social scientists. London: Routledge; 1993. [ Google Scholar ]
10. Lee R, Fielding N. User's experiences of qualitative data analysis software. In: Kelle U, editor. Computer aided qualitative data analysis: theory, methods and practice. London: Sage; 1995. [ Google Scholar ]
11. Bloor M. On the analysis of observational data: a discussion of the worth and uses of inductive techniques and respondent validation. Sociology. 1978;12:545–552. [ Google Scholar ]
12. Daly J, McDonald I, Willis E. Why don't you ask them? A qualitative research framework for investigating the diagnosis of cardiac normality. In: Daly J, McDonald I, Willis E, editors. Researching health care: designs, dilemmas, disciplines. London: Routledge; 1992. pp. 189–206. [ Google Scholar ]
13. Waitzkin H. The politics of medical encounters. New Haven: Yale University Press; 1991. [ Google Scholar ]
14. Armstrong D, Gosling A, Weinman J, Marteau T. The place of inter-rater reliability in qualitative research: an empirical study. Sociology. 1997;31:597–606. [ Google Scholar ]
15. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess R, editors. Analysing qualitative data. London: Routledge; 1993. pp. 173–194. [ Google Scholar ]
16. Fielding N. Ethnography. In: Fielding N, editor. Researching social life. London: Sage; 1993. pp. 155–171. [ Google Scholar ]
17. Dingwall R, Murphy E, Watson P, Greatbatch D, Parker S. Catching goldfish: quality in qualitative research. J Health Serv Res Policy. 1998;3:167–172. doi: 10.1177/135581969800300308. [ DOI ] [ PubMed ] [ Google Scholar ]
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Published: 29 October 2024

On the Journey: a qualitative study of a community-based, client-centred eating disorder recovery group

Sophia Guinness ORCID: orcid.org/0009-0001-2541-6657 1 ,
Jasmeen Dourka 1 ,
Sarah C. Galway ORCID: orcid.org/0000-0001-9249-018X 2 ,
Hannah Healey ORCID: orcid.org/0009-0004-1244-6648 3 &
Cynthia Lokker ORCID: orcid.org/0000-0003-2436-4290 4

Journal of Eating Disorders volume 12 , Article number: 169 ( 2024 ) Cite this article

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Community-based eating disorder (ED) treatment frequently includes manualized group-based psychoeducation facilitated by a mental health clinician. Body Brave, a non-profit ED organization, developed a novel, participant-guided, community-based virtual healthcare provider (HCP)-facilitated support program called On the Journey (OtJ). The program was designed for people with longstanding EDs who had previously participated in group or individual ED programs but require continued support in their recovery. The purpose of the study was to describe the development and components of OtJ and to understand participant perceptions of the program and its effect on their recovery.

Using a formative and community-engaged research design, we conducted semi-structured interviews with three OtJ facilitators and focus groups with twelve OtJ clients. Transcripts were analyzed using Braun and Clarke’s six-stage approach to reflexive thematic analysis.

Four main themes were generated from the data (1) “Designing and Evolving OtJ” (2) “Is OtJ a Treatment or Support Group?” (3) “Fostering a Safe Environment throughout Program Delivery” and (4) “The Power of Lived Experience.” Clients noted several strengths of the OtJ program: fostering a sense of community, valuing client autonomy, and providing accessible ED support.

Conclusions

Key considerations for other organizations looking to offer programming similar to OtJ include having skilled and clinically trained facilitators and prescreening discussion topics to ensure that conversations are productive towards recovery. OtJ supports people with longstanding EDs, and other organizations could consider adopting a similar model of care. This study contributes to the growing body of including lived ED experience in research.

Plain language summary

On the Journey (OtJ) is a community-based eating disorder (ED) support program that is facilitated by healthcare providers. It was created by Body Brave, a non-profit organization from Hamilton, Ontario, Canada. This program is for people who have had an ED for at least two years and want low barrier support from a qualified clinician and others facing similar struggles as they continue to recover. This study describes the creation and implementation of OtJ and describes themes from interviews of clinicians and focus groups with clients of the program. Four main themes were identified (1) “Designing and Evolving OtJ” (2) “Is OtJ a Treatment or Support Group?” (3) “Fostering a Safe Environment throughout Program Delivery” and (4) “The Power of Lived Experience.” Other ED organizations could consider implementing a similar program for their clients with longstanding EDs looking who are seeking accessible support.

Eating disorders (EDs) are serious mental illnesses characterized by disruptive behaviors and attitudes involving eating, weight, and body shape concerns [ 1 ]. In Canada, an estimated 2.9 million individuals are affected by an ED, such as anorexia nervosa, bulimia nervosa, binge ED, or other eating-related concerns [ 2 ]. EDs can have vast physical, psychological, and social impacts, contributing to poor quality of life, and are associated with some of the highest mortality rates of any mental illness [ 2 ], second only to the opioid crisis [ 3 ].

With timely access to quality treatment, approximately 52–80% of individuals recover from EDs [ 4 ]. However, there is a significant treatment gap between those who need treatment and those who are able to access the appropriate services [ 5 ]. Fewer than 20% of people with EDs receive specialized healthcare, and up to 49% of women, and 31% of men access support [ 6 ]. High costs of treatment, stigma surrounding EDs, and a lack of mental health literacy regarding warning signs and symptoms of EDs contribute to this gap in access to care [ 7 ]. Moreover, those who do not meet the stringent diagnostic criteria for an ED experience additional barriers to diagnosis and subsequent treatment pathways [ 8 ]. Designing programming that addresses these barriers (such as stigma, treatment cost, and poor mental health literacy) is of utmost importance to promote accessible treatment and support.

Psychological therapies, such as cognitive behavioral therapy-enhanced (CBT-E), are typically the first-line treatment to reduce ED symptoms, offered as structured, and often group-based, sessions in hospital-based treatment programs [ 9 ]. There is a need for continued support after discharge from intensive treatment programs, including relapse prevention programs and community support [ 10 ]. Virtually led programming and support has become increasingly popular due to COVID-19 and has been shown to be an accessible and effective way to deliver care for adolescents [ 11 ].

Though the definition of community-based programs is not widely agreed upon, Body Brave (described below) defines this as treatment and support services which are integrated within the community (versus in formal healthcare settings) to meet the diverse needs of clients who are at different points in their recovery journeys [ 9 ]. Community-based treatment and support for EDs does not necessitate access to hospital, though it can involve interdisciplinary collaboration between non-HCP personal caregivers (e.g. family members), physicians, and other healthcare providers. This facilitates low-barrier and contextually tailored treatment and supports [ 12 ].

The involvement of lived experience within ED treatment and support can be valuable to participants and is encouraged as part of quality standards for ED care in Ontario, Canada (Ontario, 2023). There are several advantages of integrating lived experience in ED programming (i.e., peer leaders as part of co-design or co-delivery of services) including: fostering a sense of normality, comfort and reciprocity among clients, as well as reciprocity between clients and facilitators [ 13 ]. Trained peer leaders have successfully implemented ED prevention programs (e.g., the Body Project), both in-person [ 14 ], and online [ 15 ]. Although the inclusion of lived experiences can be valuable, some researchers have highlighted strategies to safeguard experiences (e.g., encouraging peer leaders to be trained in an allied health profession) [ 13 ].

Low barrier community-based support is in line with the stepped care model of mental health support which is an integrative approach that begins with low-barrier and accessible interventions and escalates to more intensive options as necessary [ 16 ]. Stepped care can be a cost-effective solution for health systems and can incorporate evidence-based strategies (i.e., CBT-E) and dialectical behavioral therapy [DBT]) [ 17 ] to tackle mental health challenges such as EDs or disordered eating (DE) in a way that focuses on early intervention and preventing need for hospitalization [ 16 ]. Stepped care models can also help ensure continuity of care for folks with EDs and DE, as they can be stepped up or down based upon their needs [ 13 ]. Outpatient group-based programming can be tailored to meet the needs of people at different points in their recovery journey, which may foster the continuity of care that is needed when stepping down from higher intensity to lower intensity treatment. Community based services are one approach to bridge the gap between intensive care and prolonged recovery from an ED [ 10 ].

Body Brave is a nationally registered charitable organization (Charitable Organization No. 797943115 RR 0001) in Hamilton, Ontario, Canada that focuses on advocacy with and support for individuals with EDs or DE. Body Brave offers low intensity community-based group ED treatment and support led by healthcare professionals (including physicians, dieticians, social workers, etc.). The stepped care model which Body Brave employs is depicted in Fig. 1 : Adaptive Intensity of Care in Eating Disorder Treatment: The Stepped Care Model. Further, programs and services are provided at no cost, with the majority offered virtually, thereby providing accessible options relative to other local or provincial treatment programs. In 2017, Body Brave care providers developed On the Journey (OtJ), a healthcare provider (HCP)-facilitated support group, to continue helping clients who had completed structured treatment programs or initial support group offerings but needed continued follow-up through their recovery. The OtJ can act as a supplement to other supports at and in-between points of care modelled in Fig. 1 and can also be considered as community-based group programming within this model.

Adaptive Intensity of Care in Eating Disorder Treatment: The Stepped Care Model

Body brave creating on the Journey

OtJ was developed as a closed group program for individuals in later stages of recovery who had previously attended treatment or support programs (offered at Body Brave or elsewhere). The OtJ program covers topics chosen by the clients for maximal relevance, and these are supplemented with evidence-based resources and psychoeducation such as CBT-E and DBT [ 9 ]. The Mental Health Commission of Canada emphasizes recovery as a journey which supports individuals living with mental health conditions to live a fulfilling, hopeful, and satisfying life [ 18 ]. In alignment with this practice, facilitators screen topics for OtJ to ensure the program fosters the health and well-being of clients. For example, if clients request to talk about guilt and shame, the facilitator would ensure that this would be done in a way that honors evidence-based psychotherapy, whereas they would avoid talking about individual traumas as a main topic as that would not be appropriate in a group setting without a trauma therapist. The creators referred to the OtJ group as a “pod” in reference to a group of dolphins, a term used within existing ED research [ 19 ], as they swim alongside each other as they traverse their individual journeys. The creators felt that this was an inspiring metaphor and image of individuals connecting with others in community to travel on journeys together.

Below are details about the structure and evolution of the OtJ program:

Group size: Initially, groups had 4–8 people, which would maximize the sense of intimacy and community within the group. This initial group size was consistent with previous in-person programs successfully offered by Body Brave in terms of balancing client participation opportunities and fostering a supportive group environment. Group size expanded to 11–15 people meeting online during the COVID-19 pandemic to address increasing demand for services. All group offerings are closed versus drop-in and include the same participants for the entirety of the offering.

Selection criteria: Reserved for individuals identified by a clinical team member based on completion of Living Body Brave (a manualized initial program offered at Body Brave) or a formal treatment program at regional hospitals, thereby including clients at similar stages of recovery, allowing for exploration of participant-relevant content.

Content: Discussion topics are derived from a brainstorming exercise during the first meeting to identify those most of interest to the current group. Group facilitators review the topics to ensure that the content remains pro-recovery and rooted in evidenced-based ED interventions. Content ranges from practical skills-based tools and interventions (e.g., cognitive restructuring, chain analyses, social integration, and cognitive remediation) to addressing difficult emotions such as shame and guilt. Facilitators organize topic and theme suggestions into a curriculum for the remaining weeks, identify evidence-based materials to include, and arrange for support from other Body Brave HCPs to facilitate relevant discussions as needed (e.g., registered dietician for nutrition-based topics). All groups have support from the chief medical officer at Body Brave.

Facilitation: During all sessions, there are two facilitators; both are registered HCPs (e.g., physician, dietician, psychotherapist) with clinical training. The group is client-centered, encourages discussion, and values the lived experience of clients. Details of the structure of the 1-hour sessions are provided in Table 1 . The original components of the pod are included as supplemental materials .

The aims of this research were to:

Understand the origin, development, and evolution of the OtJ program model;

Describe the components of the OtJ model of care;

Understand client and facilitator perceptions and experiences of the OtJ program.

Study design

We used a formative approach to investigate experiences with a community-based HCP-facilitated support group, OtJ, which included individual interviews with facilitators of the support group, as well as three focus groups with OtJ clients. Formative research involves the combination of data collection and analysis alongside program development, and aims to aid in the establishment of accessible, culturally and geographical relevant interventions [ 20 ]. In the present study, integrated feedback from both the professionals facilitating the support groups, as well as from clients who participated in the OtJ program were analyzed by the research team, and, in turn, provided back to Body Brave to inform OtJ improvements. The research team did not include study participants (clients or facilitators). Ethics approval was received from the Hamilton Integrated Research Ethics Board (project #13445) prior to study recruitment.

Recruitment

First, three active OtJ facilitators/creators (referred to as facilitators throughout) were invited via email by CL to individual semi-structured interviews; all three accepted and completed an interview. Following recruitment and data collection from facilitators, clients who had participated in OtJ during Spring 2022 were recruited. During OtJ sessions, the group facilitators asked clients if the principal investigator could contact them through email about a research study. Those who agreed to be contacted were sent an email that briefly described the study. Of 22 clients who were contacted, 12 expressed interest and participated in a focus group. Of the other clients contacted, six did not respond, two declined interest and two had scheduling conflicts.

Data collection

Clients and facilitators were given a copy of the informed consent form via email prior to participation, and they provided verbal consent at the beginning of the focus groups and semi-structured interviews. Interviews with facilitators ( n = 3) were conducted in July 2022 and focus groups with clients were conducted between October 2022 and January 2023. Semi-structured interview guides were developed by the research team for interviews with facilitators and focus groups with clients. The questions were generated by the research team and designed to be open-ended. The wording and flow of questions were rearranged during the creation of each interview guide. Semi-structured interview guides are presented in Table 2 .

Focus group participants were offered to be entered into a draw for a gift card. All interviews and focus groups were conducted over Zoom, and facilitated by CL, the research director at Body Brave. For the interviews with facilitators, a member of the research team attended, took field notes, and asked additional questions. For the focus groups, at least one additional member of the research team was present to take field notes and ask additional questions if needed. All sessions were audio recorded and auto transcribed verbatim, and then cleaned. Numbers were assigned to participants to de-identify and anonymize the data which are presented in participant quotes in the results (F = facilitator, FG = focus group number, P = client number).

Throughout data collection and analysis, the research team included rapport building, reflexive journaling, and field notes for trustworthiness; keeping an audit trail for dependability; and the use of quotes for transferability. Triangulation across data (transcripts, journals, audio recordings) was incorporated into the analysis.

Data analysis

Data from interviews with facilitators and focus groups with clients were analyzed together. This decision was made during the coding process as initial codes generated from both participant types fit into similar subthemes which could be developed into meaningful themes that cohesively represented the data [ 21 ]. Interview and focus group transcripts were analyzed using Braun and Clarke’s six-stage approach to reflexive thematic analysis [ 22 , 23 ]. Reflexive thematic analysis was used given the focus on participants’ subjective experiences with OtJ [ 24 ]. This process includes (a) data familiarization, (b) coding the data, (c) initial theme generation, (d) reviewing and developing themes, (e) refining, defining, and renaming themes, (f) producing the report [ 21 ].The data were coded inductively, by assigning short phrases (or nodes) to data within each transcript using NVivo 12 (QRS International). NVivo was used solely for the organization of codes. Three authors first coded the transcripts independently. They then met to address and discuss codes and their individual biases. The authors met weekly to organize the codes into themes and subthemes. This approach is consistent with previous studies conducting group analyses of qualitative data via reflexive thematic analysis [ 25 ]. The research team met bi-weekly to generate initial themes by collating codes across all transcripts [ 23 ]. Two members of the research team acted as critical friends [ 26 ] which included challenging theme definitions and names. In congruence with the quality practice of reflexive thematic analysis [ 23 , 27 ], themes and subthemes were created based on the unique and meaningful data generated from the transcripts. Final themes and subthemes were re-worked and renamed throughout the writing process. Members of the team engaged in reflexivity about their own connection to the research project and recognized how their own experiences with Body Brave may have influenced their interpretations of the results (See supplemental file – Author Reflexivity).

Content covered in OtJ

To provide context to OtJ discussions, we conducted a word frequency analysis and word cloud visualization of the most frequently covered topics within OtJ groups. For each OtJ group offered between January 2020 and May 2022, weekly topics were extracted from group curricula documents and organized in a comprehensive master list. Repeating topics were documented in accordance with the number of times they were present. To depict the frequency of the topics discussed in OtJ groups, a word cloud was generated using Wordle [ 28 ], a software that creates word clouds from text provided by user and places more emphasis on words that occur with greater frequency.

Three facilitators, two of whom co-created the program, were interviewed, and four focus groups that included 12 OtJ clients were completed. Across all transcripts (facilitators and clients), four overarching themes were generated: (1) Designing and Evolving OtJ, (2) Is OtJ a Treatment or Support Group? (3) Fostering a Safe Environment throughout Program Delivery and (4) The Power of Lived Experience.

Theme 1: Designing and Evolving OtJ

This theme encompasses how facilitators designed and evolved OtJ across multiple seasonal offerings and includes three subthemes: (a) different from traditional treatment programs , (b) evolution and feedback loop: OtJ is constantly evolving and (c) Not a quick fix: repetition of the programming.

Different from traditional treatment programs

Through their experience at Body Brave, facilitators identified gaps in current treatment offerings for clients with EDs and DE. All facilitators perceived that it was important to foster a sense of community for clients during their recovery, and the formatting of a new program to fill existing gaps. In addition to fostering a supportive environment, the facilitators expressed the importance of having a group for individuals who felt stuck in their recovery journey and who had experience with previous treatment programs. In addition, this program was designed to support people who had “ fallen through the cracks ” with their recovery. The facilitators discussed shortcomings of current programs, which inspired the creation of OtJ. Gaps in current programming included manualized programs, which were not helpful for all clients. One facilitator explained that OtJ was designed to offer something different, stating that:

“So, I think the idea was really like let’s create something different. We’ve got these curriculum-based groups and that’s great and there’s some people that don’t want that. They don’t need that anymore” [Facilitator (F) 3].

During the inception and development of OtJ, the facilitators recognized and respected participant autonomy and role in their own recovery, which was an integral component of the program. Clients taking part in the OtJ supported this approach. For example, one client greatly appreciated that OtJ was unique and unlike other programming available, stating that:

“The whole medical world is obsessed with CBT [cognitive behavioral therapy], like nobody wants to really give people space or… work with people in a way that’s relational or involves like choice or non-direction or is just supportive. I feel like there’s such a push always for everything to be manualized and so I actually really appreciate it [on the journey] that it’s not [manualized], because I really think that [manualized] it’s a real disservice, actually, to medicine and to psychotherapy and to treatment” [Focus Group (FG) 3, Participant (P) 3].

Evolution and feedback loop: OtJ is constantly evolving

Given its unstructured and un-manualized nature, OtJ has continued to be adapted since its inception to meet client needs within Body Brave’s capacity. Throughout the programs’ delivery, facilitators recognized the need to offer separate groups for restricting- and bingeing-related EDs. Although initially developed for individuals with previous treatment experience and individuals who felt “ stuck ”, the facilitators recognized that this stratification was too vague, as EDs vary widely.

“And so there’s a lot of stuff that’s similar about everyone with an ED, and there are some pretty significant differences as well… This is going to be the first time this summer that we’re going to split them and have On the Journey for bingeing and emotional eating and on the journey for restricting and purging”. [F3]

Another way that OtJ has evolved has been the expansion in group size to meet the demand for services. One facilitator identified this, stating that during the COVID-19 pandemic, it was no longer feasible to offer in-person group programming, and demand for services increased. Originally, OtJ was designed for a small group of individuals to foster cohesion. However, the program expanded to accommodate more clients due to increased demand. Despite this increase in group size, some facilitators indicated that the sense of connection and community remained strong. This was explained by one facilitator:

“We were thinking it would remain very small to preserve that sense of intimacy within the group. But, it’s interesting that even though it is larger now [10–15 clients], people still seem to feel very much connected to each other” [F1].

Not a quick fix: repetition of the programming

Given that the OtJ program content is determined by clients in each group, no offerings are the same. Some clients said that this allowed them to choose their own destiny within the program. In addition, this resulted in clients being able to participate in multiple offerings of OtJ without redundancy. This was perceived as important to the clients and fostered a sense of support and options that are consistent with the long commitment required to recover (and maintain recovery) from an ED, opposed to “quick fixes.” One client reflected on limitations of other programs, as she stated:

“Short-term interventions are [in]consistent with ED recovery, interventions [are] long and it must be necessarily long and committed. And, and I think that makes it difficult for programs and funding to come into existence and be sustainable – because these aren’t short term interventions for ED recovery…so repeatability is important”. [FG3, P1].

The client driven content of each offering allowed clients to repeat the program more than once, without information being completely the same each wave. This idea of repeated participation in the OtJ program was recognized as an asset by facilitators; one discussed this unique aspect as OtJ is seen as a safe space for clients to return to, rather than a failure to maintain recovery.

“It’s similar individuals signing up you know, repeatedly for multiple rounds of on the journey, which I think is really cool, in that it shows that it’s meaningful to them…Whereas in maybe another program, if someone kind of kept coming back, say to [hospital-based treatment program] – that may be an indication, like oh they’re not doing well but for us seeing like all this person coming back to on the journey over and over… They’re feeling maybe a sense of safety…” [F3].

Theme 2: is OtJ a treatment or support group?

Clients in the interviews and focus groups expressed uncertainty about whether OtJ would be considered a treatment or support group. This theme includes two subthemes: (a) expectation mismatches and (b) tensions between censorship and support.

Expectation mismatches

At times, throughout the evolution of OtJ, both clients and facilitators identified that their expectations were misaligned or mismatched. For example, during various offerings of OtJ, the facilitators perceived clients as wanting a space that fostered support and community. Through brainstorming topics of interest to curate content for each week of OtJ, the facilitators found that what they thought would be most pertinent and helpful for clients did not always align with what clients wanted to focus on. This was expressed by one facilitator:

“Initial assessment of what they wanted to work on and the topics they wanted to work on were quite different from what I imagined they would want to work on so they weren’t interested in understanding more about what causes EDs, which was kind of expected, but they also weren’t really very interested in working on, you know tools and techniques for overcoming the ED.” [F1].

This contradicted what some clients thought of the program, expressing that they wished they had received more tools and treatment approaches. For example, though OtJ groups were considered supportive, some focus group clients expressed that material was redundant, and/or that it did not necessarily influence their recovery in terms of ED behaviors and symptomology.

It is important to recognize that perceptions regarding the lack of structure were not consistent across facilitators and clients. Although clients enjoyed, to some extent, the unstructured nature of OtJ, several also wanted more structure to the programming to address specific ED behaviors and symptoms. To better match their expectations, some clients recommended supplementing OtJ weekly meetings with additional activities and exercises to increase accountability with recovery-consistent behaviors including take-home activities, expressive art making and journaling.

Tensions between censorship and support

Some clients appreciated there were fewer rules within Body Brave’s programming, including OtJ, compared with other treatment or support programs regarding what could be talked about. In this way, the groups sessions were more akin to a support group than a treatment group. For example, one client said:

“There seems to be some kind of, I don’t know, gatekeeper system there [hospital treatment] that makes the environment a lot more sterile and so for that reason I do appreciate Body Brave that there’s a comfort level of maybe a little bit more informality, dare I say than other places, that’s more inviting.” [FG 3, P1].

However, the rules set out about sharing experiences could also limit how freely they felt they could share. Although clients recognized the importance of keeping a safe environment, some mentioned that it was important for them to challenge their EDs by discussing sensitive topics that could be triggering. One client brought up the idea of “hyper fragility” saying: “I mean triggering is one very important thing to consider, but also leaning into the challenges that the ED presents is also important” [FG 3, P1]. Within other ED treatment programs and supports, clients expressed that strict rules around conversations conflicted with challenging ED thoughts and behaviors:

“It’s really hard to actually talk in depth and like share openly about what’s really going on and like actually challenge some of it, if you can’t say that much…I don’t know if it could have been like a more group negotiation”. [FG 3, P1].

The brainstorming of topics allowed some clients to feel safer and more comfortable discussing more “taboo” topics. However, some clients recognized the dangers of self-selected topics. One client noted:

“I’m talking about that day with the topic was more about sexual kind of nature. I remember a participant at the very end had a very negative experience and I just feel like at the end when that came out there was this holy moly moment of why was this not caught ahead of time. Again, when you’re dealing with things like rape or sex trafficking or big topics, you never know what someone is going through behind closed doors. And there was a sense of guilt, having talked so freely about the fun aspects. So again, I don’t know if there’s a way to screen it ahead of time.” [FG 2, P2].

Theme 3: fostering a safe environment throughout program delivery

Theme three includes ways in which a safe and comfortable environment was fostered during OtJ. This includes three subthemes: (a) the importance of facilitators , (b) advantages of the at-home online environment , and (c) fostering familiarity and community.

The importance of the facilitators

The facilitators recognized the importance of their role in guiding client-driven content and moderating conversations and topics that were within their expertise and within the scope of OtJ. For example, one facilitator said:

“The topics that people want to cover are sometimes not necessarily appropriate for an online group, or sometimes…out of my scope. So, a lot of times people want to talk about trauma, which I’m not trained as a trauma therapist, and I also don’t think like a zoom group necessarily is the place to go with that.” [F2].

Across focus groups, many clients expressed the importance of having qualified and experienced facilitators. Facilitators were perceived as key stakeholders in regard to maintaining client safety, which was demonstrated through the roles taken on by facilitators while delivering OtJ.

“I feel like I felt safer coming to group knowing that the facilitator is a professional and so that I knew that if things were going in a direction that was inappropriate that it would be stopped.” [FG1, P3].

This sense of safety was expressed by most clients in relation to facilitators. However, the facilitators recognized struggles with the open-ended topics and less structured roles while leading online group sessions. One facilitator found it challenging to determine what topics may be more triggering than beneficial to clients. However, there were strategies (e.g., personal messaging online) that helped mitigate and address these concerns.

“I do find as well that it’s hard to manage sometimes; if people are feeling triggered in the group often what we’ll say is message the [second] facilitator who’s not really talking right now and kind of to go with that and to be able to step out. You know, I think it’s challenging because the things that we’re talking about could be triggering in, are hard and at the same time like I think they’re beneficial to people as well, like so.” [F2].

Advantages of the online-at home environment

There were several benefits to the OtJ program being offered virtually. Initially, the switch to OtJ being delivered virtually via Zoom was due to COVID-19 social distancing policies that restricted in-person meetings. However, clients enjoyed the group being online as it reduced barriers to care – many of which exist beyond COVID restrictions — and fostered a supportive community. One common advantage noted by clients was the elimination of geographical and transportation barriers. Many clients lived beyond driving distance to Body Brave’s physical location, but they were able to access the services.

“All of us here [are from] very different geographic locations and, yeah, EDs from a personal perspective, are so isolating and tend to make your life so small that being able to connect virtually from wherever is great” [FG1, P2].

This connection to others also helped foster community and support. The online environment seemed to mitigate body image concerns and facilitate recovery-related behaviors, as one client described:

“It’s easier to hide behind a camera. There are body image issues and self-confidence issues that if it was in person, I’d be worried that I was stressed. And I feel like I get more in my head. Of course, there’s pros to being in person too. I’m just. I’m sitting hiding on a camera right now and I feel a lot more comfortable with that.” [FG2, P1].

This increased safety was also perceived and echoed by the facilitators.

“I think it’s partly because they feel often a bit safer being in their own home environment, you know they can have their support animal right with them, and they can turn their camera off if they’re feeling stressed, and they can just choose not to participate if they’re having a bad day. So, in many ways it makes them feel a little safer I think being online.” [F1].

Beyond synchronous videoconferencing, Zoom allows for chats where clients and facilitators frequently shared supportive messages with the group. Zoom functions were set up so that clients could not message each other. The chat feature was perceived as beneficial by all clients, allowing them to participate in conversations and support others without having to verbalize. This was explained by one client:

“Being able to kind of look over it myself, or type something in if I didn’t feel like speaking out…I really appreciated that and just the fact that, like you know, we could use the little reactions and such, you know, just provide a little something else”. [FG2, P2]

Fostering familiarity and community

Community and familiarity led to positive perceptions of the OtJ program. Several factors that helped foster positive experiences were shared. Most clients said that they enjoyed, and recommended continued use of, the closed-group (the same clients each week versus drop-in group) style for OtJ. This closed group helped foster community and comfort within the program.

“And I don’t really feel comfortable in a drop-in group. I understand their importance and like the reason why they’re there, but I kind of have a tendency to be vulnerable. Or, I have a tendency to want to be vulnerable and then I pull back really far if I don’t feel like I can [be vulnerable]. On the Journey helped me to recognize that like my pain and my struggle was worth examining and worth treating and that it’s possible to do that. So I really, I can’t overstate that, honestly”. [FG2, P2]

Feeling supported by like-minded individuals was perceived as beneficial and motivational in working towards recovery, and the online format fostered community and connectedness, which was important for clients as it allowed them to share experiences and broaden their perspectives. For example, one client said:

“There was this community feel of pulling resources together and being able to kind of share your own experiences at the same time pull from others as well, which I think the experience aspect was more powerful in this group as opposed to other groups where you’re learning more about ways to deal with things…” [FG2, P2].

Theme 4: the power of lived experience

An integral aspect in developing OtJ was promoting and recognizing client autonomy in their own care and that they guided the content covered in each offering of OtJ. Not only did the brainstorming process allow for a breadth of topics to be covered, but it also meant that each offering of OtJ was different. Figure 2 is the word cloud for the content covered across offerings of OtJ which depicts the breadth of topics discussed during OtJ. Some of the most common topics included body image, self-compassion, and communication.

Word frequency image based on topics covered across twelve offerings of OtJ. Larger font represents more frequent topics

Clients appreciated having programming reflect the needs of the group. For example, one client expressed: “what I appreciate about it is certainly…that we could set our own destiny within the program” [FG3, P1]. Clients recognized their own knowledge within their support services and recovery which resulted in positive perceptions of OtJ. In addition, clients enjoyed the flexibility of the program which they thought allowed for rich conversations and connections among each other:

“to have a more specific kind of participant-based programming, which was a very loose programming allowed for that kind of deeper conversation as opposed to having to cover material and then converse about the material, it allowed for that personal connection and kind of again deeper conversation and sharing about it and I think that’s what kind of puts On the Journey separate from the other programs offered.” [FG2, P2].

In addition to facilitators, clients also recognized the redundancy of education-based programs, as well as their expertise in their own EDs. This was exemplified by one client, who said:

“I just think it’s so valuable to have a group that caters to people who already have experience with treatment or experience with - you know we’ve been around the block a few times already. Because then you’re not kind of wasting your time with all the educational component or you kind of feel like everybody else has some of that same shared experience as you.” [FG1, P3].

Overall, recognizing the expertise and experiences of clients was essential to OtJ, and was positively received by clients who participated in this HCP-facilitated support program.

In this study, we set out to examine clients’ and facilitators’ experiences and perceptions with the OtJ program. This included describing the development and components of OtJ, and gaining an understanding of participants perceptions of the OtJ program and how participation affected their recovery. In addressing these aims, we were able to identify ways to adapt and improve OtJ. The results from the study emphasize the many strengths of the OtJ program in a community setting. Our findings highlight that OtJ allows clients, in general, to experience support that builds community, fosters client autonomy, and is accessible by being offered virtually and free of charge. These qualities were especially important during the COVID-19 pandemic when there was an increase in ED hospitalizations and ED symptoms, anxiety, depression, and body changes [ 29 ]. Access to ED care also decreased during COVID-19 due to lockdowns and scarce healthcare resources [ 29 ].

Fostering community and autonomy

Community is an important component of ED recovery and was a major theme expressed by OtJ facilitators and clients. A community-based study by Mitchison and colleagues [ 30 ] demonstrated that quality of life (QoL) is influenced by social support and encouragement and participants with higher QoL made positive progress in their recovery. Establishing a supportive, pro-recovery community, which is an integral component of the OtJ, thereby supports recovery.

Fostering client autonomy regarding the content of their care and valuing individual perspectives and worldviews are key components of the OtJ program and consistent with other studies that showed autonomy in treatment was associated with reductions in drop-out rates and improved therapeutic outcomes [ 31 , 32 ]. Recognizing that each person is a “unique individual with the right to determine their own path towards mental health and well-being” is laid out in guidelines for recovery-oriented practice [ 18 ]. Though changes in ED symptoms and program retention rates were not measured in the current study, the positive experiences noted through analysis emphasize that autonomy integrated within ED support can foster positive client experiences.

The success of the OtJ also relies on qualified and skilled facilitators. Discussion topics were sourced from clients, however, facilitators reviewed these, curated evidence-based resources, and guided conversations to ensure the group remained pro-recovery. We highlight the value of working with clients, while also integrating expert knowledge, to ensure the selected content matches the needs and goals of the group [ 33 ]. From our findings, the skilled facilitators should:

Make sure all group members are comfortable with the selected topics (e.g., sexuality) and anticipate those that may be challenging for some clients to ensure appropriate supports are in place.

Recognizing their own scope of practice and knowledge is also important for facilitators to adequately provide resources or support on whatever may come up regarding the selected topics (e.g., trauma).

Having group-identified topics allows clients to repeat the OtJ program several times without redundancy, which serves as a supportive community as they continue their recovery journey.

Accessibility

Due to COVID-19, the group ran virtually via Zoom, which was widely regarded as a benefit because it eliminated some accessibility barriers and expanded group size. During the pandemic, many in-person ED treatment centers closed and access to outpatient or community-based treatment services was very limited [ 29 ]. As the length of waitlists for treatment programs grew, ED symptoms and hospitalizations were exacerbated for many individuals [ 29 ]. Providing OtJ, without pause in services related to the pandemic, was key during this time of need.

Virtual care also offers the benefit of reducing geographic and transportation barriers to accessing care. Barney and colleagues [ 34 ] reported that telemedicine was especially beneficial for emerging adults with EDs, who were frequently referred to treatment centers from a wider geographical range compared to patients seeking typical primary care. Likewise, OtJ clients benefitted from having access to support without the constraints of location. Healthcare providers in Canada have reported advantages of virtual ED treatment and support, including increased accessibility to care [ 35 ].

Opening conversations

The notion of “hyper fragility” experiences in current and previous ED treatment was discussed in one of the focus groups. Interestingly, clients perceived that group norms and rules (in OtJ as well as other support programs) often limit conversations within ED recovery. Cockell and colleagues [ 36 ] highlighted that reemergence into the “real world” (e.g., diet culture, negative self-talk) after residential ED treatment can trigger slips and relapses in ED behaviors. It is crucial to recognize that clients are often highly protected from societal triggers during treatment–which can result in relapses in ED behaviors when discharged. This concern was evident in the present study, with several participants expressing that being able to talk explicitly about ED-associated behaviors was necessary to make a full recovery. The idea of hyper-fragility in ED treatment and support should be further explored. For example, safeguarding conversations (e.g., forbidding words such as BMI, mention of weight) is common and often viewed as an important aspect of peer-support programs [ 13 ]. Exposure therapy is a common cognitive behavioral approach used in EDs and body image interventions, often in the form of mirror exposure therapy and encounters with fear food [ 37 ]. It is possible that by forbidding conversations, individuals do not have the necessary skills to cope with such topics when they inevitably are exposed to them in the “real world”, compromising sustained recovery outside of treatment settings.

Implementing and improving the OtJ program

Our findings revealed several key components others may wish to consider when implementing a program like OtJ. First, selecting facilitators who have the required specialized knowledge and competencies is crucial for effectively guiding clients towards their goals. Facilitators who have both had formal health professional or social work training as well as experience with working in the area of EDs can better understand clients’ challenges and offer appropriate strategies or tools to support their journeys effectively. Having two facilitators allows for additional support during sessions. Balancing expectations between facilitators and clients is another consideration. Our study found that while facilitators aimed to foster a community, some clients expected they would gain practical tools that facilitate recovery. Finding a middle ground by integrating both elements can create a more effective and supportive environment for clients. Regular communication and feedback can also help ensure the program meets the diverse needs of the clients. Lastly, organizations must establish robust protocols and practices to safeguard clients’ emotional and physical well-being. These measures may include a closed-group format, pre-screening of sensitive topics, assuring confidentiality, and, in online groups, ensuring that the chat feature is monitored. Prioritizing these aspects can lead to successful implementation and impactful intervention, empowering clients in their personal recovery journeys.

Moving towards a future of valuing and incorporating lived-experience and client autonomy into healthcare services, the OtJ provides an example of how a community-centered and engaged approach can result in effective programming adjustments to suit the diverse and complex needs of those struggling with EDs or DE. As depicted in the word cloud (Fig. 2 ), the most discussed topics during OtJ for participants in this study included body image, self-compassion, and community. Identifying topics of discussion when implementing OtJ can assist HCP in preparing appropriate resources to complement weekly meetings.

The strengths of this study are the inclusion of perspectives from program founders and facilitators, and clients to give a more holistic view of program evolution. The similarity in what we heard from facilitators and clients highlights that the vision for the program and the experience within the program align. A strength of both the study and the OtJ program broadly include the attention to access in program design (i.e. virtual programming, reducing barriers to access, attention to the needs of clients), taking an approach which was centered around how clients view their own needs for programming through the co-creation of session curricula of the OtJ, and meeting the need for programming that suits the needs of folks who are in between, or at different levels based on a stepped care model. The study findings allow for client voices to identify ways to improve the program at Body Brave.

Limitations

The clients of this study were living in Canada and spoke English. Given the nature of OtJ, results and outcomes are not generalizable to all individuals living with EDs. Both OtJ and the focus groups were conducted virtually. It is likely that some individuals seeking support were unintentionally excluded as Wi-Fi and a device to use videoconferencing were required to participate. For this study, we did not collect demographic information about clients (e.g., age, gender identity, ethnicity), and thus were unable to comment on characteristics of the present sample. In addition, it is likely that individuals who completed OtJ and had positive perceptions with the program were more likely to participate in the study. Although data were treated with confidentiality, participation in focus groups was not confidential and may have influenced willingness to participate. Although focus groups can offer a comfortable environment for group discussion, some individuals may not have felt comfortable voicing unique opinions or experiences [ 38 ]. We did not share the interpretation of data back to participants (e.g., member reflections) [ 26 ] which could have strengthened the validity and trustworthiness of the analysis. In addition, data were collected in reference to OtJ programming that took place during COVID-19 restrictions; clients and facilitators in the present study may have had unique experiences that differ during non-pandemic times.

Future directions

Moving forward, Body Brave will continue to find innovative ways to ensure that the experiences and voices of individuals with EDs or DE are incorporated into research and services through routine program evaluation practices and the developing evidence-based support groups. To support access to care according to needs, the organization implemented a virtual recovery support program built on the stepped care model [ 39 ]. Ongoing research includes understanding the needs and experiences of diverse populations of people with EDs and considering adaptations to programming to better meet their needs.

The value of employing lived experience in medicine has been increasingly noted as beneficial in ED literature [ 40 ]. Specifically in mental health research, lived experience is known to provide unique perspectives of those who have struggled with illnesses themselves [ 41 ]. A key component that contributes to the success of OtJ has been the ability for clients to “choose their own destiny” in the program. Moving towards a future of valuing and incorporating lived-experience and client autonomy into healthcare services, the OtJ group provides an example of how enacting a community-centered and -engaged approach can result in effective programming adjustments to suit the diverse and complex needs of those struggling with EDs or DE.

Data availability

The raw data analysed during the current study are not publicly available due identifiable information in interview transcripts. The corresponding authors have access to all data.

Beccia AL, Baek J, Austin SB, Jesdale WM, Lapane KL. Eating-related pathology at the intersection of gender identity and expression, sexual orientation, and weight status: an intersectional Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) of the growing up today study cohorts. Soc Sci Med. 2021;281:114092.

Article PubMed PubMed Central Google Scholar

Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. Am J Clin Nutr. 2019;109(5):1402–13.

Article PubMed Google Scholar

Compton WM, Han B. Substance Use disorders are deadly. Am J Psychiatry. 2022;179(1):11–3.

Castellini G, Sauro CL, Mannucci E, Ravaldi C, Rotella CM, Faravelli C, et al. Diagnostic crossover and outcome predictors in eating disorders according to DSM-IV and DSM-V proposed criteria: a 6-year follow-up study. Psychosom Med. 2011;73(3):270–9.

Kazdin AE, Fitzsimmons-Craft EE, Wilfley DE. Addressing critical gaps in the treatment of eating disorders. Int J Eat Disord. 2017;50(3):170–89.

Striegel Weissman R, Rosselli F. Reducing the burden of suffering from eating disorders: unmet treatment needs, cost of illness, and the quest for cost-effectiveness. Behav Res Ther. 2017;88:49–64.

Ali K, Farrer L, Fassnacht DB, Gulliver A, Bauer S, Griffiths KM. Perceived barriers and facilitators towards help-seeking for eating disorders: a systematic review. Int J Eat Disord. 2017;50(1):9–21.

Hoek HW, Van Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. 2003;34(4):383–96.

Hay P. Current approach to eating disorders: a clinical update. Intern Med J. 2020;50(1):24–9.

Treasure J, Oyeleye O, Bonin EM, Zipfel S, Fernandez-Aranda F. Optimising care pathways for adult anorexia nervosa. What is the evidence to guide the provision of high‐quality, cost‐effective services? Eur Eat Disorders Rev. 2021;29(3):306–15.

Article Google Scholar

Van Huysse JL, Prohaska N, Miller C, Jary J, Sturza J, Etsell K, et al. Adolescent eating disorder treatment outcomes of an in-person partial hospital program versus a virtual intensive outpatient program. Int J Eat Disord. 2023;56(1):192–202.

Barranger C, Marashi M, Marr E, Sultan Z, Warren R. Reviewing the efficacy of community-based treatment for eating disorders. Research Shop: McMaster University; 2020.

Google Scholar

Lewis HK, Foye U. From prevention to peer support: a systematic review exploring the involvement of lived-experience in eating disorder interventions. Mental Health Rev J. 2022;27(1):1–17.

Becker CB, Stice E. From efficacy to effectiveness to broad implementation: evolution of the body project. J Consult Clin Psychol. 2017;85(8):767.

Stice E, Rohde P, Shaw H, Gau JM. Clinician-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: effectiveness of these delivery modalities through 4-year follow-up. J Consult Clin Psychol. 2020;88(5):481–94.

Pehlivan MJ, Miskovic-Wheatley J, Le A, Maloney D, Research Consortium NED, Touyz S, et al. Models of care for eating disorders: findings from a rapid review. J Eat Disorders. 2022;10(1):166.

Vogel EN, Singh S, Accurso EC. A systematic review of cognitive behavior therapy and dialectical behavior therapy for adolescent eating disorders. J Eat Disord. 2021;9(1):131.

Canada MHCo. Guidelines for Recovery-Oriented Practice. 2015.

Treasure J, Parker S, Oyeleye O, Harrison A. The value of including families in the treatment of anorexia nervosa. Eur Eat Disorders Rev. 2021;29(3):393–401.

Cunningham-Erves J, Barajas C, Mayo-Gamble TL, McAfee CR, Hull PC, Sanderson M, et al. Formative research to design a culturally-appropriate cancer clinical trial education program to increase participation of African American and latino communities. BMC Public Health. 2020;20(1):1–14.

Braun V, Clarke V, Hayfield N, Davey L, Jenkinson E. Doing reflexive thematic analysis. In: Bager-Charleson S, McBeath A, editors. Supporting research in counselling and psychotherapy: qualitative, quantitative, and mixed methods research. Palgrave Macmillan, Cham; 2023. pp. 19–38.

Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101.

Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative Res Sport Exerc Health. 2019;11(4):589–97.

Braun V, Clarke V. Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern-based qualitative analytic approaches. Counselling Psychother Res. 2021;21(1):37–47.

Campbell KA, Orr E, Durepos P, Nguyen L, Li L, Whitmore C, et al. Reflexive thematic analysis for applied qualitative health research. Qualitative Rep. 2021;26(6):2011–28.

Smith B, McGannon KR. Developing rigor in qualitative research: problems and opportunities within sport and exercise psychology. Int Rev Sport Exerc Psychol. 2018;11(1):101–21.

Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Res Psychol. 2021;18(3):328–52.

Feinberg W. Beautiful word clouds 2014 [ https://www.wordle.net/

Devoe J, Han D, Anderson A, Katzman A, Patten DK, Soumbasis SB. The impact of the COVID-19 pandemic on eating disorders: a systematic review. Int J Eat Disord. 2023;56(1):5–25.

Mitchison D, Dawson L, Hand L, Mond J, Hay P. Quality of life as a vulnerability and recovery factor in eating disorders: a community-based study. BMC Psychiatry. 2016;16(1):1–13.

Steiger H, Sansfaçon J, Thaler L, Leonard N, Cottier D, Kahan E, et al. Autonomy support and autonomous motivation in the outpatient treatment of adults with an eating disorder. Int J Eat Disord. 2017;50(9):1058–66.

Vandereycken W, Vansteenkiste M. Let eating disorder patients decide: providing choice may reduce early drop-out from inpatient treatment. Eur Eat Disorders Review: Prof J Eat Disorders Association. 2009;17(3):177–83.

Bailey KA, Gammage KL, van Ingen C. Designing and implementing a positive body image program: unchartered territory with a diverse team of participants. Action Res. 2019;17(2):146–61.

Barney A, Buckelew S, Mesheriakova V, Raymond-Flesch M. The COVID-19 pandemic and rapid implementation of adolescent and young adult telemedicine: challenges and opportunities for innovation. J Adolesc Health. 2020;67(2):164–71.

Novack K, Dufour R, Picard L, Taddeo D, Nadeau P-O, Katzman DK, et al. Canadian pediatric eating disorder programs and virtual care during the COVID-19 pandemic: a mixed-methods approach to understanding clinicians’ perspectives. Ann Gen Psychiatry. 2023;22(1):16.

Cockell SJ, Zaitsoff SL, Geller J. Maintaining change following eating disorder treatment. Prof Psychology: Res Pract. 2004;35(5):527.

Butler RM, Heimberg RG. Exposure therapy for eating disorders: a systematic review. Clin Psychol Rev. 2020;78:101851.

Krueger AE, Pollmann K, Fronemann N, Foucault B. Guided user research methods for experience design—a new approach to focus groups and cultural probes. Multimodal Technol Interact. 2020;4(3):43.

Wood MD, Smith JL, Healey H, Görges M, Lokker C. Enhanced recovery support for people with eating disorders during the COVID-19 pandemic: Quality improvement using a web-based, stepped-care programme in Canada. BMJ Open Qual. 2023;12(4):e002366. https://doi.org/10.1136/bmjoq-2023-002366 .

Pellizzer ML, Wade TD. The effectiveness of lived experience involvement in eating disorder treatment: a systematic review. Int J Eat Disord. 2023;56(2):331–49.

Gatera G, Singh S. Beyond tokenism: the influence of lived experience and its future possibilities in mental health science. Nat Mental Health. 2023;1(3):151–2.

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Acknowledgements

The authors would like to acknowledge all study participants for their contributions to this research. The authors would like to thank Sonia Kumar, Dr. Karen Trollope-Kumar and Jeannine Smith for their feedback on the manuscript, as well as Dr. Aly Bailey for assistance with qualitative methodology and focus group interview guides.

This study is unfunded.

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Health and Rehabilitation Sciences, Health Professional Education, Western University, 1151 Richmond St London, Ontario, N6A 3K7, Canada

Hannah Healey

Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St W Hamilton, Ontario, L8S 4L8, Canada

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SG conceptualized, collected, and analysed data, co-drafted the manuscript and gave final approval of the version to be published. JD conceptualized, collected, and analysed data, co-drafted the manuscript and gave final approval of the version to be published. SCG analysed data, co-drafted the manuscript, and gave final approval of the version to be published. HH analysed data, co-drafted and edited the manuscript, and gave final approval of the version to be published. CL supervised, designed, and conceptualized the study, drafted the manuscript, and gave final approval of the version to be published.

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Guinness, S., Dourka, J., Galway, S.C. et al. On the Journey: a qualitative study of a community-based, client-centred eating disorder recovery group. J Eat Disord 12 , 169 (2024). https://doi.org/10.1186/s40337-024-01110-z

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Barriers of persistent long-lasting insecticidal nets utilization in Northwest Ethiopia: a qualitative study

Amlaku Nigusie Yirsaw 1 ,
Resom Berhe Gebremariam 1 ,
Wallelign Alemnew Getnet 1 ,
Adane Nigusie 1 , 5 ,
Gebeyehu Lakew 1 ,
Eyob Getachew 1 ,
Demis Getachew 3 ,
Abiyu Abadi Tareke 4 &
Muhabaw Shumye Mihret 2

BMC Public Health volume 24 , Article number: 2828 ( 2024 ) Cite this article

309 Accesses

Metrics details

Malaria continues a significant public health challenge in Ethiopia, with Long-Lasting Insecticidal Nets (LLINs) proving effective in reducing transmission. Despite their effectiveness, consistent LLIN utilization is influenced by various factors. While previous research has quantitatively analyzed LLIN ownership and usage, there is a lack of in-depth examination of the behavioral, sociocultural, socioeconomic, and distribution-related factors affecting their sustained use. This study aimed to explore barriers to persistent LLIN use among communities in northwest Ethiopia.

The study area found in Northwest Ethiopia, specifically in East Belessa District, is located at 12° 14’ 60.00” N latitude and 37° 44’ 59.99” E longitude, with an altitude between 1,200 and 1,800 m above sea level. Thirty-nine community members from five focus group discussions, along with five key informants, were interviewed between February 1st and 30th, 2020, about their use of Long-Lasting Insecticidal Nets (LLINs). An interpretive description approach was employed to explore local contexts and factors affecting LLIN utilization. Focus group participants were selected based on residency status, pregnancy, caretaking of under-five children, and experience with LLINs. Key informants included health extension workers and the woreda malaria officer. Data were organized and analyzed using Open Code Version 4.03 software, with coding and theme identification conducted accordingly.

All 44 community members from the five focus group discussions and the five key informants participated fully in the study. The study categorized its findings into three main themes: knowledge of malaria and Long-Lasting Insecticidal Nets (LLIN) use, perception of malaria threat, and barriers to sustained LLIN utilization. It identified factors spanning individual, socio-cultural, institutional, and socio-economic realms that impede consistent LLIN usage. Key hindrances include cultural misinterpretations, discomfort from heat and bed bugs, diverse net shapes, insufficient sleeping spaces, lack of awareness, inadequate distribution, neglect of vulnerable groups, misuse of non-sleeping purposes, hesitancy to hang nets, and restricted accessibility.

Conclusions

This study reveals that practical concerns, including inadequate access to LLINs, distribution issues, discomfort from net shape and warmth, and unintended uses for non-malaria purposes, impact LLIN utilization. Socio-cultural norms, housing conditions, and varied understanding of malaria also contribute to inconsistent LLIN use. Strategies like providing compatible nets and comprehensive education could improve the Long-Lasting Insecticidal Nets program’s effectiveness in the area.

Peer Review reports

Malaria poses a significant global health risk, affecting nearly 3.2 billion people and contributing to a high disease burden worldwide [ 1 , 2 ], particularly in Africa where it remains a major public health concern [ 3 ]. In Ethiopia, malaria is a central focus of public health efforts, with Long-Lasting Insecticidal Nets (LLINs) recognized as a key preventive measure against the disease [ 4 , 5 ]. LLINs are considered highly effective in reducing malaria transmission in Africa and serve as a crucial strategy in Ethiopia to lower malaria risk [ 4 , 6 ]. Despite these benefits, data from the 2015 National Malaria Indicator Survey [ 7 ], indicated that LLIN ownership and usage in Ethiopia fell short of targets, with only 64% of households possessing at least one LLIN and 40% of the population using them the previous night. The Amhara Region showed a higher LLIN ownership rate at 72.9%, but usage was still low at 43.4%, reflecting a utilization rate of just 56%, the lowest in the country. Research in rural areas has also revealed inconsistent LLIN coverage and usage [ 4 , 7 ].

A study in the Adami Tulu district of southern central Ethiopia reported that only 12% of households owned one or more LLINs [ 8 ], with various factors affecting consistent LLIN use. These factors include inadequate access to LLINs, unequal distribution, seasonal variations, mosquito prevalence, and misconceptions about malaria risk and transmission. Additionally, community norms, values, and preferences, especially concerning gender and age, contribute to low LLIN utilization [ 4 , 9 , 10 , 11 , 12 ]. In Ethiopia, LLIN usage is prioritized for children under 5 and pregnant women due to their higher vulnerability to malaria [ 5 ]. Other issues impacting utilization include net quality, efficacy perceptions, structural problems, practical considerations, and unintended uses of the nets [ 5 ]. Common reasons for irregular use include perceived low mosquito presence and discomfort, particularly in hot weather Efforts to promote LLIN use have largely focused on malaria prevention, but in areas where malaria is less perceived as a threat, net usage may decline. LLINs also deteriorate over time, with their durability ranging from 18 months to 7 years, and an average expected lifespan of 3 years [ 13 , 14 ]. A cohort study in south-central Ethiopia found that only 4% of LLINs remained functional by the end of the 24th month, with a median functional lifespan of 12 months [ 15 ]. In the Lake Tana region, matched case-control studies identified age, travel to malaria-prone areas, and limited malaria knowledge as factors linked to malaria risk, with LLIN ownership and usage remaining low. These studies highlight factors affecting malaria prevalence but do not fully address the behavioral, sociocultural, and socioeconomic reasons behind inconsistent LLIN use [ 16 , 17 ]. Therefore, investigating the factors influencing persistent LLIN utilization in specific areas, like east Belessa woreda (district), is essential for enhancing malaria elimination strategies.

This study aims to explore these context-specific barriers to inform more effective malaria control interventions. The findings will be pivotal for refining malaria strategies by identifying specific barriers to LLIN use in east Belessa woreda, enabling targeted interventions, improving distribution, and addressing issues related to access, net quality, and user misconceptions. Insights gained will support more effective resource allocation and policy adjustments, ultimately enhancing LLIN utilization and improving malaria prevention and control in the district.

Research team and reflexivity

The key informant interviews were conducted by the investigators (ANY), (RB), (WA), (AN), (GL), (EG), and (MSM). (AN) From the Institute of Public Health, whereas (DG), (AAT) from the School of Pharmacy and AMRIF Ethiopia. All investigators are male. The investigators (ANY), (RB), (WA), (AN), (GL), (EG), and (DG) had extensive experience in qualitative research data collection and analysis. The credentials of the investigator, AN was PhD, whereas ANY, RB, WA, GL, EG, and AAT were Master of Public Health (MPH) and DG, MSM was MSc. All of the investigator’s occupations are researcher and lecturer at the time of this study. Before the study’s commencement, the investigators tried to establish a relationship with the study participants. In terms of reflexivity, the investigators disclosed their identities to the participants and provided an overview of the study’s objectives, as well as the rationale behind conducting the research.

Study design

The current study utilized an interpretive description approach to investigate the local contexts and factors affecting consistent LLIN usage. An interpretive description approach serves as an effective methodological approach for thoroughly describing, interpreting, shedding light on, and qualifying and describing everyday human experiences [ 18 , 19 ]. This approach was selected to investigate the behavioral, demographic, sociocultural, economic, livelihood, and housing situations, and experiences related to net distribution within the community. The participants’ experiences with LLIN utilization were summarized and analyzed thematically.

Theoretical framework

Methodological orientation and theory.

Interpretive Description (ID) is a qualitative research methodology grounded in constructivist epistemology, making it well-suited for exploring the barriers to persistent Long-Lasting Insecticidal Nets (LLINs) utilization in Northwest Ethiopia. ID focuses on understanding complex, real-world phenomena through an interpretive lens, acknowledging that knowledge is co-constructed through interactions between researchers and participants. This methodology is particularly effective in applied health research because it aims to generate practical insights that can inform interventions. Its flexibility allows for the use of various data collection methods—such as interviews, focus groups, and observations—to capture the multifaceted nature of LLIN utilization barriers, including cultural beliefs, environmental conditions, and logistical challenges. The theoretical underpinning of ID, which emphasizes pragmatic understanding and mid-range theorization, ensures that the findings are not only contextually rich but also directly applicable to improving LLIN use in similar settings. By integrating these theoretical aspects, ID provides a comprehensive framework for examining and addressing the barriers to LLIN utilization, ultimately contributing to more effective malaria prevention strategies [ 20 , 21 ].

Participant selection/description of sample

The study group comprised key informants and focus group discussions (FGD from different groups of the community in the study area.

The study sites were deliberately chosen to encompass the perspectives and behaviors of residents residing in areas highlighted by the researchers as encountering obstacles in LLIN utilization. The sample comprised two groups: 5 focus group discussions (FGDs) and 5 key informants. The determination of the sample size was based on the richness, depth, and quantity of data collected; pertinent literature; study scope; and the level of valuable information provided by each participant [ 22 ]. persistent on saturation level., the commonly applied principle for determining qualitative sample sizes, as a result of the varied backgrounds of participants and the comprehensive scope of the study [ 23 ]. A purposive sampling technique used households selected from four kebeles. The community residents included households from diverse socioeconomic backgrounds, spanning various age groups, and genders, and pregnant and lactating women were included in the sample. They were interviewed regarding their experiences and practices regarding LLIN utilization. All study participants, comprising 39 individuals across five focus group discussions with one FGD compromising [ 7 , 8 , 9 ] participants, reported owning LLINs. Key informants were individuals knowledgeable about malaria control, LLIN distribution, and barriers of, LLIN in the study communities, possessing an understanding of living conditions and beliefs. They were one woreda (woreda is an administrative unit equivalent to a district, encompassing multiple local administrative subunits known as kebeles). Each woreda is responsible for local governance and often contains multiple kebeles) health office PHEM officer and four health extension workers (HEW) who worked in the 4 selected kebeles(local administrative unit) were enlisted to recruit participants with support from a researcher.

Rationale for participant selection

In this study examining barriers to Long-Lasting Insecticidal Nets (LLINs) utilization, the rationale for participant selection is grounded in the need to capture diverse and in-depth perspectives from multiple stakeholders within the communities experiencing LLIN utilization challenges.

Deliberate Site Selection : The study sites were chosen deliberately to include areas identified by researchers as having notable obstacles to LLIN utilization. This purposive approach ensures that the research addresses relevant contexts where barriers are most apparent, thus enhancing the study’s ability to provide actionable insights.

Sampling Methodology : A purposive sampling technique was employed to select households from four kebeles, ensuring a representative sample of the community’s diverse socioeconomic backgrounds. This sampling method was chosen to include various age groups, genders, and particularly pregnant and lactating women, who may face unique challenges related to LLIN use. This diversity is crucial for obtaining a comprehensive understanding of the barriers from different perspectives within the community [ 24 ].

Focus Group Discussions (FGDs) : Five FGDs were conducted, with each group consisting of 7–9 participants. The rationale for using FGDs was to gather collective insights and facilitate discussions that reveal shared experiences, cultural norms, and community-level barriers to LLIN utilization. FGDs allow for interaction among participants, which can surface more nuanced understandings of common barriers and potential solutions.

Key Informants : The study included five key informants—one Woreda health office PHEM officer and four health extension workers (HEWs)—who were selected based on their expertise and familiarity with LLIN distribution and malaria control. These individuals were chosen for their in-depth knowledge of the local health system, barriers to LLIN use, and understanding of community living conditions and beliefs. Their insights provide valuable context and help interpret the data gathered from community members.

Sample Size Determination : The sample size was determined with consideration of data richness, depth, and saturation, aligning with common qualitative research practices. The focus on saturation ensures that the data collected is comprehensive and that emerging themes and patterns related to LLIN utilization barriers are thoroughly explored. The varied backgrounds of participants and the study’s scope necessitated a sample size that could adequately address the research questions and provide a well-rounded understanding of the barriers [ 24 ].

Saturation Principle : Adhering to the principle of saturation, which is commonly applied in qualitative research, helps ensure that data collection continues until no new themes or information emerge. This approach confirms that the study findings are robust and reflective of the experiences and challenges faced by the community in LLIN utilization [ 24 , 25 , 26 ].

Participant description

The participants in this study comprised two key groups: community residents and key informants. The community residents were selected using purposive sampling from four kebeles, ensuring diversity in socioeconomic backgrounds, age, and gender, with particular inclusion of pregnant and lactating women. A total of 39 individuals participated in five focus group discussions (FGDs), each consisting of 7–9 participants, all of whom owned LLINs and provided insights into their experiences and practices regarding LLIN utilization. The key informants included one woreda health office PHEM officer and four health extension workers (HEWs), all of whom had extensive knowledge of malaria control, LLIN distribution, and the barriers to effective LLIN utilization in the selected kebeles. These informants provided critical perspectives on the health system’s role and challenges in promoting consistent LLIN use.

Participant selection criteria

The participant selection criteria for this study involved purposive sampling of community residents from four kebeles, ensuring diversity in socioeconomic background, age, and gender. Pregnant and lactating women were specifically included due to their unique vulnerability to malaria. All participants in the focus group discussions (FGDs) were households that owned LLINs, to gather their experiences and barriers to use. Key informants were selected based on their expertise in malaria control and LLIN distribution, including one woreda health office PHEM officer and four health extension workers (HEWs) familiar with the study areas [ 27 , 28 ].

Method of approach

The participants were approached face-to-face using an interview guide. Health extension workers (HEWs) facilitated initial contact by visiting households in the selected kebeles, explaining the study’s purpose, and inviting participants to engage in the focus group discussions (FGDs) and key informant interviews. During these face-to-face interactions, the interview guide was employed to ensure consistent and focused conversations around LLIN utilization and the barriers encountered by the participants, fostering open and structured dialogue.

Sample size

The study sample comprised a total of 44 individuals, including 39 participants in five focus group discussions (FGDs), with each group consisting of 7 to 9 participants. Additionally, 5 key informants were included: one PHEM officer from the Woreda health office and four health extension workers (HEWs) from the selected kebeles. The sample size was determined based on the principle of data saturation [ 29 , 30 ], ensuring that sufficient depth and richness of information were gathered to comprehensively explore the barriers to LLIN utilization.

Key informants

The key informants for the study included five individuals selected for their expertise in malaria control and LLIN distribution. These informants comprised one Woreda health office PHEM officer and four health extension workers (HEWs) from the study’s selected kebeles. Their inclusion was critical due to their deep understanding of the local health system, malaria control strategies, and community challenges related to LLIN use. The key informants provided valuable insights into the logistical and administrative barriers to LLIN distribution, as well as their observations of community behaviors and beliefs regarding LLIN utilization.

Focus group discussions (FGDs)

Five focus group discussions (FGDs) were conducted with a total of 39 participants, each group consisting of 7 to 9 individuals. The participants were community members from diverse socioeconomic backgrounds, including various age groups and genders, with a particular focus on households that owned LLINs. Pregnant and lactating women were specifically included to capture their unique experiences with LLIN use. The FGDs provided a platform for participants to discuss their collective experiences, challenges, and practices regarding LLIN utilization. This method encouraged open dialogue and interaction, allowing for the identification of shared barriers within the community.

Saturation in qualitative data collection

Saturation in qualitative data collection refers to the point at which no new information or themes emerge from additional data. It is a commonly applied principle used to determine when data collection can cease because sufficient depth and richness of the phenomenon under study have been captured. Saturation ensures that the study has adequately explored the research questions and that further data gathering would likely yield redundant insights rather than novel findings. In practice, researchers often assess saturation by continuously analyzing data as it is collected, ensuring that emerging themes are fully developed and that participant contributions no longer introduce new patterns or variations. Saturation is essential for ensuring the validity and completeness of qualitative research findings [ 24 , 25 , 26 ].

Non-participation

No individuals refused in this study.

Study setting and populations

The study was conducted in the East Belessa District of Northwest Ethiopia, specifically in four kebeles (local administrative units): Gohalla, Shamish, Zuy-Hamusit, and Achikane. It took place from February 1st to February 30th, 2020. The district is situated at a latitude of 12° 14’ 60.00” N and a longitude of 37° 44’ 59.99” E, with an altitude ranging between 1,200 and 1,800 m above sea level [ 31 ].

The population of East Belessa District is predominantly Amhara, and agriculture is the primary economic activity. Most residents engage in farming, cultivating key crops such as teff, maize, and barley, while livestock rearing is also widespread, supporting household livelihoods. The majority of the population practices Orthodox Christianity (97.25%) [ 32 ].

Malaria is a significant health risk in this district, with the disease being the leading cause of illness in 2019. By June 2019, Long-Lasting Insecticidal Nets (LLINs) had been distributed to nearly all households [ 33 ]. The district experiences two malaria transmission seasons: the major season from September to December and the minor season from April to May. During these periods, many residents migrate to lowland malaria-prone areas for work. A trend analysis (2015–2019) in an east Belessa district showed 33,594 malaria cases, predominantly Plasmodium falciparum (81%) and P. vivax (19%). The analysis indicated a shift, with Plasmodium falciparum cases decreasing and P. vivax cases increasing from 2015 to 2016 [ 34 ].

The setting of the data collection

The data were collected in a quiet, secure, and comfortable place with minimum sound disturbance and voice to maintain the quality of the recording and facilitate open discussion. Interviewees determined the time and place of the interview.

The setting of the study area

The study was conducted in four kebeles within a specific region of Northwest Ethiopia known for its malaria-endemic areas and challenges in Long-Lasting Insecticidal Nets (LLINs) utilization. These kebeles were deliberately chosen based on the researchers’ assessment of significant obstacles to LLIN use among community members. The area is characterized by diverse socioeconomic conditions, with residents facing various environmental and behavioral barriers to malaria prevention. The local health infrastructure, including the presence of health extension workers (HEWs) and a woreda health office, provided essential support for both malaria control efforts and the study. The rural setting, coupled with its unique cultural and socioeconomic dynamics, made it an ideal site for investigating the persistent barriers to LLIN utilization.

Presence of non-participants

There are no other participants in the study except the participants and researchers.

Data collection

Interview guide.

The guide was adopted from previous research and modified in to suitable way considering research objectives [ 35 ]. The interview guides included broad questions with suggested probes for KIIs and FGDs (additional file 1 ) separately. The interview guide was first prepared in English and then translated into the local language, Amharic. The interviews were carried out in Amharic and each interview. The interview questionnaire centered on exploring factors contributing to inconsistent LLIN usage, disparities in LLIN usage among household members, suitability of nets with sleeping areas, duration of LLIN use during sleep, accessibility and distribution of ITNs, perceived advantages and shortcomings of LLINs, perceived threat, knowledge of malaria and malaria prevention and correct LLIN utilization. Interviewers received training on employing the questionnaire, asking open-ended questions, and probing for more detail. Questions were asked consistently across all interviews. Each interview session was recorded using a digital voice recorder.

Number of interviews conducted

A total of five key informant interviews were conducted with individuals knowledgeable about malaria control and LLIN distribution. Additionally, five focus group discussions (FGDs) were held with community members, comprising 39 participants in total. These interviews and FGDs were designed to gather comprehensive insights into the barriers to LLIN utilization in the selected kebeles.

Repeat interviews

Repeat interviews were not carried out.

Audio recording

The research used audio recording to collect the data.

Field notes

The investigators made field notes during and after the interview. We made field notes for documenting needed contextual information. We contributed rich descriptive detail about the context of statements made, supplementing the recorded and transcribed participant statements and infusing the record with more significant meaning. In addition, we made field notes to clarify who the speaker was when recorded voices sounded similar. And to describe changes in body language, long pauses, facial expressions, making or losing eye contact, or other events that can help interpret the meaning from the context of what is said.

Duration of the interview

The duration of the interviews, on average, from 20 min to one and a half hour.

Data saturation

In the current study, the term data saturation refers to the point in data collection when new interviews produce little or no new information to address the research question. No new information shall exist to get a higher degree of saturation. Based on the existing literature, a minimum of 12 interviews is typically needed. We also applied the more conservative approaches of operationalizing saturation to be confident enough in our conclusion of reaching saturation [ 36 ].

Transcripts returned

The transcripts were not returned to participants for comment and correction because the principal investigators had a prolonged engagement in the data collection process.

Data analysis

Two experienced researchers conducted the data analysis. One held an MPH in Health Promotion and Health Behavior, and the other was an Assistant Professor of Health Promotion. Both had received formal training in qualitative data analysis using software and had extensive experience in the field. Their expertise included teaching qualitative research methods and analysis to students, as well as facilitating and delivering qualitative data analysis training for public health professionals, lecturers, and researchers.

The first author, alongside local translators, transcribed the interviews verbatim from Amharic to English (supplementary File 1 ). Thematic analysis, a flexible method for identifying, examining, and presenting data patterns, was used. It is suitable for both essentialist (realist) and constructionist approaches [ 37 ]. The data were content-coded for thematic analysis, with coding conducted using a hybrid approach that incorporated both insights from existing literature and emergent data [ 38 , 39 ]. Themes were then derived from the data.

The coded data were analyzed by conducting queries to assess the frequency of key concepts, themes, and relationships. Themes were used to summarize participant responses, with quotes taken from interviews to provide context. Word Clouds were also generated to visually illustrate key findings. Both textual and structural analyses were employed to gain deeper insights into the barriers to Long-Lasting Insecticidal Net (LLIN) utilization [ 40 ]. Textual analysis , explored the meaning, themes, and patterns within the responses, examining how language reflects cultural and social contexts [ 41 ]. Structural analysis , meanwhile, focuses on the organization and framework of the content, analyzing the underlying relationships within the text [ 42 ]. Additionally, thematic analysis was employed to understand participants’ experiences with the inconsistent use of LLINs and how they interpreted these experiences [ 43 ]. To ensure the study’s trustworthiness, a rigorous process was followed to confirm the credibility, transferability, dependability, and conformability of the findings.

Number of data coders

Two individuals have performed the coding independently after repeatedly reading the transcribed document.

Description of the coding tree

All tape-recorded data interviews and field notes were transcribed verbatim to Amharic (the local language) after repeatedly listening to the records and then translated into English. The translated transcription documents were imported into Open Code 4.03 software for coding.

The analysis used the four theme development phases: (1) Familiarization with the data, (2) Revisit research objectives, (3) Develop a framework, and (4) Identify patterns and Connections. Central themes were constructed based on the natural meaning of the categories. The investigators cross-checked the themes that emerged after analysis with the respective quotes in each theme. The findings were reported by a detailed description and interpretation of the themes’ meanings. Direct quotes from the participants were also included in the write-up of the findings to provide clear images for readers. The overall data analysis used an inductive approach, i.e., a data-driven coding process through the research team discussion was performed to identify themes. Finally, these study findings were reported based on the consolidated criteria for reporting qualitative research (COREQ) guidelines (additional file 2 ).

Derivation of themes

The theme and sub-themes were derived from the data.

Software used

Open code 4.03 software was used to manage the data.

Participant checking

Participant checking , also known as member checking or respondent validation, involves returning to participants to review and confirm the accuracy of the data or interpretations derived from their contributions. In the context of this study, participant checking would involve sharing key findings or summaries of the interviews and focus group discussions with the participants to ensure that their views were accurately represented and interpreted. This process helps validate the research findings, enhances the credibility and trustworthiness of the data, and provides participants with an opportunity to clarify or expand upon their responses, ensuring that their perspectives are fully and accurately captured.

Trustworthiness

In the current study on barriers to persistent Long-Lasting Insecticidal Nets (LLINs) utilization in Northwest Ethiopia, trustworthiness is ensured through multiple strategies. Credibility is achieved by conducting face-to-face interviews and focus group discussions with a diverse sample of community members and key informants, and by employing member checking to validate data accuracy. Transferability is supported by providing detailed descriptions of the study setting, participant demographics, and contextual factors, enabling readers to assess the relevance of the findings to other similar settings. Dependability is maintained through thorough documentation of the research process, including participant selection, data collection methods, and analytical procedures, ensuring transparency and replicability. Conformability is addressed by using triangulation to cross-verify findings from different data sources and maintaining detailed field notes and an audit trail to document research decisions and minimize bias. These strategies collectively enhance the study’s reliability and validity, ensuring that the findings accurately reflect the participants’ experiences with LLIN utilization.

Socio-demographic characteristics of participants

A total of five Focus Group Discussions (FGDs) involving 39 participants, with an average of 7–9 participants in each, were conducted. Aged between 20 and 53 years (Table 1) . Sixteen (41%) of the FGD participants had received formal education. The majority (89.8%) of the FGD participants identified as Orthodox Christians, while the remaining 10.2% were Muslims. Among them, 32 (82%) were housewives and the remaining seven (18%) were farmers, with seven (18%) being male and 32 (82%) female. Additionally, five Key Informant Interviews (KIIs) were conducted as part of the study. All of the key informants were literate, with ages ranging from 26 to 32 years. 40% of the KII participants identified as Orthodox Christians, and all of them (100%) were employed in government positions.

Key findings

Based on the data from this study, the primary focus of the study was categorized broadly into three key themes, namely knowledge about malaria and Insecticide-treated net utilization, perceived threat of malaria, and Barriers to consistent LLIN use (Table 2). In addition, each key theme was categorized into eight sub-themes namely: Understanding of malaria causes, symptoms, and prevention, Awareness of LLIN utilization and benefit, Misconceptions and lack of knowledge about malaria, Perception of malaria severity and susceptibility, Access and Distribution Barriers, Cultural and Behavioral Barriers, preference for shape and sleeping arrangements, Beliefs and Attitudes.

Knowledge about malaria and insecticide-treated net utilization

In our focus group discussion and key informant interview, the majority of participants are knowledgeable about the causes, symptoms, transmission, and prevention methods of malaria, including the advantages of using LLINs.

The focus group discussion indicated that the participants had a clear understanding of the effectiveness of LLINs) for protection against mosquitoes.

One participant remarked on the protective benefits of LLINs, saying,

“It helps us avoid being infected by mosquitoes.” (Male farmer , FGD) .

Another participant highlighted the broader usefulness of LLINs, stating,

“The bed net is used to protect us from spiders , flies , and other insects.” (FGD , WDA) .

In contrast to this from focus group discussion and KII, some of the participants don’t know the importance of malaria prevention, dispelling myths or misconceptions about LLINs. Insufficient knowledge about malaria and motivation to hang LLINs. Malaria was caused by starvation, overwork, food shortage/starvation, Cold, water pollution, and drowning in tap water.

“Causes of malaria are starvation , and overwork” (FGD , WDA) .

They also said that LLINs are used for other purposes rather than malaria prevention such as for wrapping, screwdrivers, camshafts, brackets, and troubleshooters.

“Used for wrapping , screwdriver , camshaft , bracket , and troubleshooter” (FGD , Pw , and Uf caretaker) .

Perceived threat (susceptibility and severity) of malaria

With focus group discussion findings in the district, malaria was commonly recognized as a serious illness, leading to active community engagement. Many participants acknowledged their vulnerability to malaria and understood its potentially fatal consequences if left untreated. Pregnant women and children under the age of five were particularly acknowledged as highly susceptible to malaria.

“Malaria is a very serious disease that can lead to death” (Female FGD , WDA).

In contrast to that some focus group discussions think they are not vulnerable and that malaria is not a serious disease, they think even when they get malaria I am not going to a health facility because malaria can be treated by eating food.

“Malaria isn’t a serious illness in my view , so when I or my family members get sick , we don’t go to health facilities. Instead , we use traditional medicines and eat specific foods , believing that malaria is a minor disease that can be easily treated this way“(female FGD , WDA) .

Access and distribution barriers

The findings from our focus group discussions and key informant interviews shed light on a significant issue regarding the accessibility and distribution of LLINs within households in our study areas. While nearly all households possess at least one LLIN, our research indicates that these nets often fail to adequately accommodate the entire family, resulting in a disparity between the number of nets available and the size of the household.

This gap in accessibility directly correlates with the number of sleeping spaces within the household. Despite the presence of LLINs, a majority of family members are left without protection, as the nets do not cater to the full extent of the household’s sleeping arrangements. Additionally, the situation was exacerbated by certain individuals, particularly men engaged in farming and pastoralist activity. Out of the total population of 149,100 in the district [ 44 ], approximately 9,001 individuals are pastoralists. Given the significance of this subgroup, we acknowledge that their LLIN usage might differ from that of the predominantly sedentary farming population. Who opt to sleep outdoors due to the demands of their work. Consequently, they forego the use of LLINs, further reducing the overall coverage and effectiveness of malaria prevention efforts.

A common sentiment expressed by participants in our discussions was the inadequacy of LLIN’s accessibility and distribution in our study areas. Key challenges include the failure to align distribution with household size and sleeping arrangements, resulting in unequal protection among family members. Furthermore, there was a notable lack of prioritization for vulnerable groups in the distribution process, exacerbating the issue of underutilization.

“All family members do not sleep on ITN because the bed net is not accessible for in family size , example I have seven families but I received only two”(Female FGD , WDA) .

Cultural and behavioral barriers

The majority of focus group discussions and key informant interviews Address cultural obstacles to encourage acceptance and consistent utilization of LLINs, while also tackling alternative purposes for LLINs that could hinder their effective deployment for malaria prevention. In the majority of focus group discussions and key informant interviews misconceptions regarding LLINs such as concerns about generating warmth and attracting bed bugs, and discomfort due to the shape of LLIN.

“ Most of the time the communities said that it creates bed bug and warm ( female KII , Shamash kebele).

Preference for shape and sleeping arrangements

In households where there was limited space for sleeping, hanging LLINs can be difficult. Crowded sleeping areas may not have enough room to properly hang and use LLINs for all family members, leading to uneven protection against mosquitoes and malaria.

“Some family members sleep on the floor , so we don’t use LLINs because it’s uncomfortable to stretch out on the floor with them” (female FGD , WDA).

Traditional rectangular-shaped LLINs are commonly used and distributed. They provide coverage over beds or sleeping mats and can accommodate multiple sleepers. However, conical-shaped LLINs, which taper towards the bottom, have gained popularity due to their ease of installation and improved airflow due to this most of the participants in FGD and KII said that they selected conical-shaped LLINs rather than rectangular by this reason most participants do not use the available and the distributed LLINs.

“It would be ideal if bed nets came in a circle rather than a rectangular shape. And it’s good to have bed net every year” (female FGD , WDA).

Beliefs and attitudes

LLINs for purposes beyond malaria prevention emerged as a notable challenge during our FGDs and KIIs. Alongside factors like cultural beliefs that discourage LLIN use, this phenomenon poses an additional barrier to consistent LLIN utilization across our study sites.

Participants shared instances where LLINs were repurposed for tasks unrelated to malaria prevention, such as using them for wrapping, as tools, or for general household needs. This diversion of LLINs away from their intended purpose reflects a broader issue of awareness and understanding regarding their significance in combating malaria. Most participants in both FGDs and KIIs stated that LLINs were being utilized for alternative purposes, such as carrying donkey loads, making straw strips, constructing camshafts, assembling straws for storage, and spinning vegetables, rather than preventing malaria.

“They use it for many purposes for other purposes than expected e.g. straw , rope , and padding” (female KII , Woreda malaria officer) .

In our focus group discussion and key informant interview, most of the participants believed that GOD prevents malaria and even if malaria has a chance to happen we prevent it with GOD’s permission due to this most people do not use malaria prevention strategies including ITN utilization.

“They think that they may not acquire a disease if God does not permit and GOD will treat the disease” (female KII , Shamash kebele).

This study offers valuable insights into the barriers to LLIN utilization, which are essential for advancing malaria control efforts in Ethiopia. The findings can aid the National Malaria Control Program (NMCP) and other partners in designing more effective, localized interventions by addressing specific issues such as access barriers, net quality, and user misconceptions. Improved resource allocation and targeted strategies will enhance the efficiency and impact of malaria control programs. Additionally, the results can refine national policies, boost community engagement, and guide future research. Health professionals, managers, administrators, and policymakers can use these insights to develop strategies that enhance LLIN effectiveness. Furthermore, these findings are applicable in various settings with similar socio-political contexts, both within Ethiopia and in other regions facing analogous challenges [ 45 ].

Mosquito control is crucial in efforts to reduce, eliminate, or eradicate malaria, especially in the absence of a highly effective, long-lasting, and easily administered vaccine. To date, only two mosquito control strategies have proven effective on a large scale: indoor residual spraying (IRS) and long-lasting insecticide-treated nets (LLINs) [ 46 , 47 ].

LLINs as serving purposes beyond malaria prevention, particularly in providing a peaceful night’s rest by effectively shielding sleepers from bothersome insects, demonstrates a multifaceted understanding among participants. This underscores the importance of considering the broader implications of LLIN usage beyond its primary objective of disease prevention. Incorporating such insights into public health strategies can lead to more comprehensive approaches that address the varied needs and priorities of communities affected by malaria and other vector-borne diseases. The current study revealed to explore Barriers to persistent long-lasting insecticidal nets utilization in northwest Ethiopia.

In east Belessa district, most participant’s exhibit understanding regarding the causes, symptoms, transmission, and prevention methods of malaria, including the advantages of using LLINs. Participants recognized malaria as being transmitted through the bite of anopheles mosquitoes, manifesting symptoms such as fever, headache, chills, shivering, and joint pain. Prevention strategies mentioned by participants included eliminating stagnant water, appropriately disposing of waste materials, and using insecticide-treated nets. Comparable knowledge was reported in Ethiopia [ 48 , 49 ]. and Nigeria [ 50 ].

In contrast, a minority of participants lack understanding about the causes, symptoms, transmission, and prevention methods of malaria. Some wrongly attribute malaria caused by factors such as starvation, overwork, food shortage, cold weather, water pollution, and drowning in tap water, while also holding misconceptions about its preventability. Additionally, there are misconceptions about malaria prevention being linked to maintaining cleanliness and dietary habits, as well as repurposing LLINs for household items like wrapping, screwdrivers, camshafts, brackets, and troubleshooting tools.

At the household level, nearly every household possesses at least one LLIN However, not all members of the household have access to LLINs proportionate to the family size, similar to observations made in Nigeria [ 51 ].

In contrast, in certain regions, a portion of households lacks at least one LLIN within their premises. Research conducted in Nigeria, Ethiopia, and Malawi revealed that 13.2%, 19.3%, and 64.7% of the surveyed population, respectively, did not possess at least one LLIN during the study period [ 52 , 53 , 54 ]. LLINs were noted as generally available to community members throughout the region, although there were occasional cases where households were omitted from the household census list. Despite this, there were lingering concerns regarding whether there were enough nets to accommodate all family members who slept in separate beds. In addition to providing LLINs, it is important to conduct regular health education sessions with individuals to address community concerns regarding potential adverse reactions like burning, itching, and discomfort associated with using LLINs. These perceived side effects might impact the acceptance of Insecticide Treated Clothing, especially among children.

Malaria was commonly regarded as a significant illness and acknowledged as an issue of communal importance necessitating collective efforts within the district. Many participants held the belief that they were susceptible to contracting malaria and perceived it as a severe illness. They believed that if left untreated, malaria could result in fatalities. Malaria is severe in special vulnerable groups including pregnant mothers and under-five children.

Cultural and practical challenges surrounding Long-Lasting Insecticidal Nets (LLINs) were identified as significant barriers to consistent usage. These challenges include concerns about warmth, discomfort due to their shape, limited sleeping space, and misconceptions about their effectiveness. Additionally, issues such as unequal distribution based on household size and insufficient prioritization of vulnerable groups also hinder LLIN use.

Further barriers, as highlighted in focus group discussions (FGD) and key informant interviews (KII), encompass a range of practical concerns including inadequate understanding of malaria, reluctance to hang LLINs, and the misuse of LLINs for non-malaria purposes.

In this research, both key informants and participants in focus group discussions expressed a preference for circular-shaped nets than rectangular ones because they are adaptable to any sleeping area and easy to use. This preference was also noted in other studies [ 39 ]. Other studies have also highlighted the difficulties and limitations associated with rectangular nets, including the complexities involved in their installation, the requirement for ample space, and their effectiveness primarily being restricted to beds within mud houses (despite the potential damage caused to mud walls during installation) [ 9 , 38 , 39 ].

Our research confirmed that the most frequent alternative uses of nets were linked to the current local livelihood and socio-economic circumstances, with these alternative uses being most prevalent during the harvest season and used for vegetable spinning rather than malaria prevention, donkey load purpose, and straw assembly and straw storages. Other studies have reported comparable instances of nets being repurposed for different uses [ 39 , 55 , 56 ].

In our study, participants repurposed LLINs for alternative uses when they felt that the nets were no longer serving their primary function effectively, either due to aging or a decrease in mosquito-killing effectiveness. Comparable observations were documented in other research studies as well [ 35 , 39 , 57 ]. The practice of repurposing LLINs is becoming more prevalent in villages located in East Belessa. Studies conducted in other regions of Ethiopia and across Africa have also found that residents repurpose nets for various purposes [ 9 , 11 , 35 , 39 , 58 ].

Even when newly acquired, we noticed that nets were being utilized for a variety of unintended purposes. Similar misuse was observed in other Ethiopian communities and different parts of Africa [ 35 , 59 ]. In our study, reasons given for the improper use of LLINs included the belief that malaria is not a severe illness, reliance on divine protection, skepticism about the efficacy of bed nets in preventing malaria, and the challenge of hanging nets in every sleeping area. Comparable perceptions leading to net misuse have been documented in other research studies as well [ 35 , 39 ].

In our study, alternative uses for LLINs besides malaria prevention were noted, such as using them to eliminate and deter arthropods, shield against insects, and offer protection from dust and debris, particularly for infants. These alternative uses, especially in addressing bedbug issues, motivated residents to regularly utilize nets in the early stages. Comparable studies conducted in African regions also observed similar patterns [ 35 , 39 ].

A major obstacle to the consistent use of bed nets in the study communities was the nets’ inability to effectively guard against bedbug and flea infestations after a short period. Similar studies in Ethiopia, Uganda, Ruanda [ 35 , 38 , 39 , 58 ].

Our research identified the main hurdles concerning LLIN distribution, which encompassed inadequate provision of nets relative to household size, uneven allocation, and delays in timely replacements. Similar difficulties were documented in research conducted in Ethiopia and Zanzibar [ 9 , 35 , 60 ]. Additionally, the conclusions drawn from other research align with the observation that, in addition to factors such as soiling, aging, and degradation of LLINs, there exists a belief that the insecticidal potency of LLINs diminishes following washing [ 9 , 39 ].

Residents’ lack of understanding regarding LLINs, malaria transmission, and vectors led to misconceptions and indifference, resulting in non-adherence to net usage. Additionally, a shift in behavior away from using LLINs due to the perceived low risk of malaria, the habit of saving nets for later use, lack of awareness, and negligence were factors contributing to irregular LLIN usage. Moreover, ambiguous information regarding the longevity of LLINs hindered their utilization. Similar findings were echoed in comparable studies [ 11 , 35 , 39 , 61 ]. Misinterpretations about the ongoing efficacy of insecticides following multiple washes presented substantial obstacles to consistent usage. Comparable misunderstandings were noted in other Ethiopian and Ghanaian communities [ 35 , 39 , 62 ].

The reluctance to consistently use mosquito nets was attributed to the lack of suitable sleeping arrangements, such as beds, and the presence of ill-fitting bed structures. Even in modest dwellings with thatched roofs, the use of rectangular nets was found to be impractical. Comparable observations were noted in other research studies [ 38 , 55 ]. In our study, participants suggested that promoting more consistent LLIN usage could be achieved by distributing circular nets in red instead of rectangular ones in blue. A comparable suggestion was also recorded in research conducted in other areas like Ethiopia and Uganda [ 58 , 63 ].

Limitations

The findings of this study are specific to the study area and should not be generalized to other regions.

This study identifies several key factors influencing the consistent use of Long-Lasting Insecticidal Nets (LLINs) in the study area. Practical concerns significantly impact LLIN utilization, including issues related to access and distribution, such as insufficient availability of nets relative to family size and challenges with the distribution process. Additionally, preferences for net shapes other than rectangular, discomfort due to warmth, creating bed bugs, and the size of LLINs also affect their use. The study also highlights unintended uses of LLINs for non-malaria purposes as a significant barrier. Beyond these practical concerns, socio-cultural norms, housing conditions, working environment and varying levels of understanding about malaria and LLINs further contribute to inconsistent usage.

From this study, we recommend: [ 1 ] enhancing distribution networks is crucial to ensure that Long-Lasting Insecticidal Nets (LLINs) reach the most vulnerable populations, including children under five and pregnant women [ 2 ]. Distribution strategies should be tailored to meet the specific needs of different communities to improve access [ 3 ]. Addressing net quality is also essential; LLINs should be of high quality, durable, and effective throughout their expected lifespan to ensure user satisfaction and adherence [ 4 ]. Misconceptions about LLINs must be addressed through comprehensive educational campaigns that clarify their effectiveness and proper use while increasing community awareness about malaria vectors [ 5 ]. Engaging local leaders and community health workers in advocacy and education can help overcome cultural and socio-economic barriers to LLIN use, leveraging their influence to promote consistent usage [ 6 ]. establishing a robust system for regular monitoring and evaluation of LLIN programs will help identify and address emerging issues promptly, using feedback to continually enhance the effectiveness of interventions.

Data availability

The datasets employed in the current study can be available from the corresponding author upon reasonable request.

Abbreviations

Ethiopian Demographic Health Survey

Focus Group Discussion

Information, Education, and Communication

Long lasting Insecticide Treated Net

Key Informant Interview

Pregnant Women

Regional, Health, Bureau

Under Five Children

World, Health, Organization

Moon TD, Hayes CB, Blevins M, Lopez ML, Green AF, Gonzalez-Calvo L, et al. Factors associated with the use of mosquito bed nets: results from two cross-sectional household surveys in Zambézia Province. Mozambique. 2016;15:1–10.

Google Scholar

Organization WH. Malaria eradication: benefits, future scenarios and feasibility. A report of the Strategic Advisory Group on Malaria Eradication. World Health Organization; 2020.

Okoyo C, Mwandawiro C, Kihara J, Simiyu E, Gitonga CW, Noor AM, et al. Comparing insecticide-treated bed net use to Plasmodium falciparum infection among schoolchildren living near Lake Victoria. Kenya. 2015;14:1–6.

Taffese HS, Hemming-Schroeder E, Koepfli C, Tesfaye G, Lee M-c, Kazura J et al. Malaria epidemiology and interventions in Ethiopia from 2001 to 2016. 2018;7(06):1–9.

Nega D, Abera A, Gidey B, Mekasha S, Abebe A, Dillu D et al. Baseline malaria prevalence at the targeted pre-elimination districts in Ethiopia. 2021;21:1–11.

Birhanu Z, Abebe L, Sudhakar M, Dissanayake G, Yihdego Y, Alemayehu G et al. Access to and use gaps of insecticide-treated nets among communities in Jimma Zone, southwestern Ethiopia: baseline results from malaria education interventions. 2015;15:1–11.

MoH FJEPHI. Ethiopia national malaria indicator survey 2015. 2017.

Hailu A, Lindtjørn B, Deressa W, Gari T, Loha E, Robberstad BJM. Equity in long-lasting insecticidal nets and indoor residual spraying for malaria prevention in a rural South Central Ethiopia. 2016;15:1–11.

Eisele TP, Keating J, Littrell M, Larsen D. Macintyre KJTAjotm, hygiene. Assessment of insecticide-treated bednet use among children and pregnant women across 15 countries using standardized national surveys. 2009;80(2):209–14.

Ernst KC, Hayden MH, Olsen H, Cavanaugh JL, Ruberto I, Agawo M et al. Comparing ownership and use of bed nets at two sites with differential malaria transmission in western Kenya. 2016;15:1–16.

Linn SY, Maung TM, Tripathy JP, Shewade HD, Oo SM, Linn Z et al. Barriers in distribution, ownership and utilization of insecticide-treated mosquito nets among migrant population in Myanmar, 2016: a mixed methods study. 2019;18:1–16.

Allan R, O’Reilly L, Gilbos V. Kilian AJTAjotm, hygiene. An observational study of material durability of three world health organization–recommended long-lasting insecticidal nets in eastern Chad. 2012;87(3):407.

Kilian A, Byamukama W, Pigeon O, Gimnig J, Atieli F, Koekemoer L et al. Evidence for a useful life of more than three years for a polyester-based long-lasting insecticidal mosquito net in Western Uganda. 2011;10:1–13.

Solomon T, Loha E, Deressa W, Balkew M, Gari T, Overgaard HJ et al. Bed nets used to protect against malaria do not last long in a semi-arid area of Ethiopia: a cohort study. 2018;17(1):1–14.

Yitayew AE, Enyew HD, Goshu YAJMR, Treatment. Utilization and associated factors of insecticide treated bed net among pregnant women attending antenatal clinic of Addis Zemen hospital, North-western Ethiopia: An institutional based study. 2018;2018.

Mekuria M, Binegde DN, Derega J, Teferi Bala E, Tesfa B, Deriba BSJEHI. Insecticide-treated bed net utilization and associated factors among households in Ilu Galan District, Oromia Region. Ethiopia. 2022;16:11786302221078122.

Hall E, Chai W, Albrecht JAJAjohe. A qualitative phenomenological exploration of teachers’ experience with nutrition education. 2016;47(3):136–48.

Groenewald TJIjoqm. A phenomenological research design illustrated. 2004;3(1):42–55.

Thorne S, Kirkham SR. MacDonald-Emes JJRin, health. Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge. 1997;20(2):169–77.

Liamputtong P, Ezzy D. Qualitative research methods. Oxford university press Melbourne; 2005.

Vasileiou K, Barnett J, Thorpe S, Young TJB. Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period. 2018;18:1–18.

Guest G, Bunce A, Johnson LJF. How many interviews are enough? An experiment with data saturation and variability. 2006;18(1):59–82.

Tong A, Sainsbury P, Craig JJI. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. 2007;19(6):349–57.

Popay J, Rogers A, Williams GJQ. Rationale and standards for the systematic review of qualitative literature in health services research. 1998;8(3):341–51.

Blumer H. Critiques of research in the social sciences: an appraisal of Thomas and Znaniecki’s the Polish peasant in Europe. and America: Transaction; 1979.

Côté L, Turgeon JJM. Appraising qualitative research articles in medicine and medical education. 2005;27(1):71 – 5.

Mays N, Pope CJB. Assess Qual Qualitative Res. 2000;320(7226):50–2.

CAS Google Scholar

Morgan DLJQhr. Practical strategies for combining qualitative and quantitative methods: Applications to health research. 1998;8(3):362 – 76.

Sim JJJoan. Collecting and analysing qualitative data: issues raised by the focus group. 1998;28(2):345–52.

http://www.oired.vt.edu/amarew/extension/extension.pdf . 2010-06-12.

1994 population and housing census of ethiopia result in Amhara region. 1994.

Organization WGWH. 2019. World malaria report 2019. Geneva: World Health Organization;. World malaria report 2019.

office ebwh. woreda health office 5 year malaria report. 2019.

Malede A, Aemero M, Gari SR, Kloos H, Alemu KJBPH. Barriers of persistent long-lasting insecticidal nets utilization in villages around Lake Tana, Northwest Ethiopia: a qualitative study. 2019;19:1–11.

GUIDE AP. IMPLEMENTATION RESEARCH IN HEALTH.

Braun V, Clarke VJQ. Using Thematic Anal Psychol. 2006;3(2):77–101.

Strachan CE, Nuwa A, Muhangi D, Okui AP, Helinski ME, Tibenderana JKJM. What drives the consistent use of long-lasting insecticidal nets over time? A multi-method qualitative study in mid-western Uganda. 2016;15(1):1–12.

Doda Z, Solomon T, Loha E, Gari T, Lindtjørn BJM. A qualitative study of use of long-lasting insecticidal nets (LLINs) for intended and unintended purposes in Adami Tullu, East Shewa Zone. Ethiopia. 2018;17(1):1–14.

Padilla-Díaz MJI. Phenomenology in educational qualitative research: Philosophy as science or philosophical science. 2015;1(2):101 – 10.

Bryman A. Social research methods. Oxford University Press; 2016.

Gee JP. How to do discourse analysis: a toolkit. Hoboken. NJ: Taylor & Francis; 2014.

Book Google Scholar

Larkin M, Flowers P, Smith, JAJIpa. Interpretative phenomenological analysis: Theory, method and research. 2021:1-100.

woreda population size. Eat belessa woreda: East beless woreda health office base line population; 2019.

Polit DF, Beck CTJI. Generalization in quantitative and qualitative research: myths and strategies. 2010;47(11):1451–8.

Lengeler CJCdosr. Insecticide-treated bed nets and curtains for preventing malaria. 2004(2).

Pluess B, Tanser FC, Lengeler C, Sharp BLJC. Indoor residual spraying for preventing malaria. 2010(4).

Fuge TG, Ayanto SY, Gurmamo FLJMJ. Assessment of knowledge, attitude and practice about malaria and ITNs utilization among pregnant women in Shashogo District. South Ethiopia. 2015;14:1–9.

Tesfay K, Yohannes M, Mardu F, Berhe B, Negash HJPO. Assessment of community knowledge, practice, and determinants of malaria case households in the rural area of Raya Azebo district, Northern Ethiopia, 2017. 2019;14(10):e0222427.

Oladokun A, Oladokun R, Adesina OJAHS. Knowledge and utilization of malaria control measures by pregnant and newly delivered mothers in Ibadan. Nigeria. 2011;11(4):573–7.

Kilian A, Koenker H, Baba E, Onyefunafoa EO, Selby RA, Lokko K, et al. Universal coverage with insecticide-treated nets - applying the revised indicators for ownership and use to the Nigeria 2010 malaria indicator survey data. Malar J. 2013;12:314.

Article PubMed PubMed Central Google Scholar

Watiro AH, Awoke W. Insecticide-treated net ownership and utilization and factors that influence their use in Itang, Gambella region, Ethiopia: cross-sectional study. Risk Manage Healthc Policy. 2016;9:101–12.

Article Google Scholar

Kabaghe AN, Chipeta MG, McCann RS, Terlouw DJ, Tizifa T, Truwah Z, et al. Access and adequate utilization of malaria control interventions in rural Malawi: a descriptive quantitative study. Malar J. 2018;17(1):104.

Dagne G, Deressa WJE. Knowledge and utilization of insecticide treated mosquito nets among freely supplied households in Wonago Woreda. Souther Ethiopia. 2008;22(1):34–41.

Monroe A, Harvey SA, Lam Y, Muhangi D, Loll D, Kabali AT, et al. People will say that I am proud: a qualitative study of barriers to bed net use away from home in four. Ugandan Districts. 2014;13:1–8.

Loll DK, Berthe S, Faye SL, Wone I, Koenker H, Arnold B et al. User-determined end of net life in Senegal: a qualitative assessment of decision-making related to the retirement of expired nets. 2013;12:1–9.

Koenker H, Kilian A, Zegers de Beyl C, Onyefunafoa EO, Selby RA, Abeku T et al. What happens to lost nets: a multi-country analysis of reasons for LLIN attrition using 14 household surveys in four countries. 2014;13:1–10.

Ingabire CM, Rulisa A, Van Kempen L, Muvunyi C, Koenraadt CJ, Van Vugt M et al. Factors impeding the acceptability and use of malaria preventive measures: implications for malaria elimination in eastern Rwanda. 2015;14:1–11.

Eisele TP, Thwing J, Keating JJP. Claims about the misuse of insecticide-treated mosquito nets: are these evidence-based? 2011;8(4):e1001019.

Bauch JA, Gu JJ, Msellem M, Mårtensson A, Ali AS, Gosling R et al. Perception of malaria risk in a setting of reduced malaria transmission: a qualitative study in Zanzibar. 2013;12(1):1–10.

Hwang J, Graves PM, Jima D, Reithinger R, Kachur SP. one EMWGJP. Knowledge of malaria and its association with malaria-related behaviors—results from the malaria indicator survey, Ethiopia, 2007. 2010;5(7):e11692.

Adongo PB, Kirkwood B, Kendall CJTM, Health I. How local community knowledge about malaria affects insecticide-treated net use in northern Ghana. 2005;10(4):366–78.

Baume CA, Reithinger R, Woldehanna SJMJ. Factors associated with use and non-use of mosquito nets owned in Oromia and Amhara regional states. Ethiopia. 2009;8:1–11.

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Acknowledgements

We would like to thank the University of Gondar for the ethical letter. We are also very grateful to all data collectors and study participants for their genuine contribution.

The authors have also declared that no financial support in the research, authorship, and publication of this article was received.

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Amlaku Nigusie Yirsaw, Resom Berhe Gebremariam, Wallelign Alemnew Getnet, Adane Nigusie, Gebeyehu Lakew & Eyob Getachew

Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

Muhabaw Shumye Mihret

Department of Pharmacy, College of Medicine and Health Sciences, Gondar, Ethiopia

Demis Getachew

Amref Health Africa in Ethiopia, SLL project, COVID-19 vaccine/EPI technical assistant at West Gondar zonal health department, Addis Ababa, Ethiopia

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ANY: designed the study, performed analysis and interpretation of data, and drafted and revised the manuscriptRB, WA, AN, GL, EG, DG & MSM: participated in the data analysis and revised subsequent drafts of the paper. All authors read and approved the final version of the manuscript.

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The ethical clearance was obtained from the Institutional Review Board (IRB) of the University of Gondar (UOG) through the Department of Health Education and Behavioral Sciences, College of Medicine and Health Sciences. The formal letter has been written for East Belessa woreda health office. The ethical letter had been written to the Woreda Health Bureau. Written informed consent from the respondents was then obtained after giving respondents adequate information on the aim of the study, potential risks and benefits of being a participant, and the rights of the respondents. The privacy and confidentiality issues had been secured throughout the processes.

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Yirsaw, A.N., Gebremariam, R.B., Getnet, W.A. et al. Barriers of persistent long-lasting insecticidal nets utilization in Northwest Ethiopia: a qualitative study. BMC Public Health 24 , 2828 (2024). https://doi.org/10.1186/s12889-024-20319-w

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