Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness
Introduction
Initially content analysis dealt with ‘the objective, systematic and quantitative description of the manifest content of communication’ (Berelson, 1952, p. 18) but, over time, it has expanded to also include interpretations of latent content. Many authors, from a variety of research traditions, have addressed content analysis (for example, Berelson, 1952; Krippendorff, 1980; Findahl and Höijer, 1981; Woods and Catanzaro, 1988; Downe-Wamboldt, 1992; Burnard, 1991, Burnard, 1996; Polit and Hungler, 1999). The first descriptions date from the 1950s and are predominately quantitative. Currently, two principal uses of content analysis are evident. One is a quantitative approach often used in, for example, media research, and the other is a qualitative approach often used in, for example, nursing research and education. Qualitative content analysis in nursing research and education has been applied to a variety of data and to various depths of interpretation (for example, O’Brien et al., 1997; Latter et al., 2000; Berg and Welander Hansson, 2000; Söderberg and Lundman, 2001).
A review of literature based on common databases (Cinahl, Medline and Sociological Abstracts) as well as references from articles and books shows different opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation in qualitative content analysis. The diversities can be understood partly from a historical point of view and partly from various beliefs of the nature of reality among researchers.
An assumption underlying our paper is that reality can be interpreted in various ways and the understanding is dependent on subjective interpretation. Qualitative research, based on data from narratives and observations, requires understanding and co-operation between the researcher and the participants, such that texts based on interviews and observations are mutual, contextual and value bound (Lincoln and Guba, 1985; Mishler, 1986). Thus, our presumption is that a text always involves multiple meanings and there is always some degree of interpretation when approaching a text. This is an essential issue when discussing trustworthiness of findings in qualitative content analysis.
Another issue is that concepts within the quantitative research tradition still predominate when describing qualitative content analysis (for example, Krippendorff, 1980; Burnard, 1991; Downe-Wamboldt, 1992), especially the use of concepts describing trustworthiness. This causes confusion and paradigmatic uncertainty among authors and readers of scientific papers.
The purpose of this paper was threefold: first, to provide an overview of concepts of importance related to qualitative content analysis in nursing research; second, to illustrate the use of concepts related to the research procedure; and third, to address measures to achieve trustworthiness.
Section snippets
Overview of concepts
The following provides an overview of concepts related to qualitative content analysis and is to be seen as a contribution to a debate rather than an endeavour to find consensus. First, we present various uses of concepts found in the literature, and then we give reasons for our stance. The concepts are manifest and latent content, unit of analysis, meaning unit, condensing, abstracting, content area, code, category and theme.
A basic issue when performing qualitative content analysis is to
Illustrations of the use of concepts
In the following we illustrate the use of concepts and analysis procedures for two texts based on interviews and observations respectively. One rationale behind giving two examples is to show various ways to develop themes. The processes of analysis are described and shown in Figure 1, Figure 2, Figure 3. Even if these descriptions point to a linear process, it is important to bear in mind that the process of analysis involves a back and forth movement between the whole and parts of the text.
Measures for achieving trustworthiness
Research findings should be as trustworthy as possible and every research study must be evaluated in relation to the procedures used to generate the findings. The use of concepts for describing trustworthiness differs between the qualitative and the quantitative research traditions. Within the tradition of qualitative content analysis, use of concepts related to the quantitative tradition, such as validity, reliability and generalisability, is still common (for example, Downe-Wamboldt, 1992;
Reflections
When discussing meaning and use of concepts, procedures and interpretation related to qualitative content analysis, it is valuable to consider whether qualitative content analysis is a separate method or tool used within different forms of qualitative analysis. On one hand, a method that is so inexact that it fits into different research fields, methodological approaches and data can be seen as merely a tool. On the other hand, it can be assumed that qualitative content analysis has specific
Acknowledgements
We are grateful to our colleagues at the Department of Nursing for fruitful reflections that helped us to clarify our thoughts and for valuable suggestions for making the message clearer.
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