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Qualitative Consumer and Marketing Research

• Russell Belk - York University, Canada
• Eileen Fischer - York University, Canada
• Robert V Kozinets - University of Southern California, USA
• Description
• How is qualitative marketing and consumer research conducted today?
• What is rigorous research in this field?
• What are the new, cutting edge techniques?

Written for students, scholars, and marketing research practitioners by three qualitative marketing research pioneers, this book takes readers through the basics to an advanced understanding of the state of the art in qualitative marketing and consumer research. The book offers readers a practical guide to planning, conducting, analyzing, and writing-up research or editing multi-media presentations using both time-tested and new methods, skills, and technologies. With hands-on exercises that researchers can practice and apply, the book leads readers step-by-step through developing qualitative researching skills in creative data collection, analysis, and presentation, using illustrations drawn from the best of recent and classic research.

Whatever your background, this book will help you become a better researcher and help your research come alive for others.

See what’s new to this edition by selecting the Features tab on this page. Should you need additional information or have questions regarding the HEOA information provided for this title, including what is new to this edition, please email [email protected] . Please include your name, contact information, and the name of the title for which you would like more information. For information on the HEOA, please go to http://ed.gov/policy/highered/leg/hea08/index.html .

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'From the epicentre of academic qualitative research within business schools, the advice of this seasoned Schulich team will help students and managers sharpen workbench skills and attain deeper insights in the quest to understand and influence consumers worldwide' - John F. Sherry Professor of Marketing, University of Notre Dame

'Qualitative Consumer and Marketing Research is an accessible, conceptually substantial and practical guide to qualitative research. Written by eminent qualitative researchers from one of the world’s leading school’s of Consumer Culture Theory, the book provide a substantial introduction to all elements of the research process, including design, analysis and presentation. A particular strength of the book is the advice that it gives on getting your qualitative research noticed, accepted and published' - Andrea Davies Senior Lecturer in Marketing, University of Leicester

'Written by three leading experts in the field of qualitative research, this book fills in a long-existing gap in the qualitative consumer and marketing research literature. It is very insightful, well structured, rich on practical applications, and written in an easy-to-read style. It successfully integrates established and innovative approaches for capturing, processing and presenting data. This is an excellent book appealing to a wide audience of readers' - Elena Millan Lecturer in Consumer Research and Marketing, University of Reading

I have not adopted this book yet, but might decide to do so in future. This book may help students who are trying to design dissertations that involve marketing research. To get some student feedback, I will be lending my inspection copy to some of my students this trimester to get their feedback on it. My concern is that this book is anecdotal and so I would want to ensure students are familiar with basic research principles and terminology before moving on to this. I think it could be a good resource for students who have a firm grasp on research basics and are trying to design qualitative research beyond the standard interview.

Very easy to read - Course is for undergrads, who will be studying methods for applied more than academic research. This gives a solid theoretical framework along with practical advice on methodology and reporting for managerial purposes.

Excellent addition to a reading list for my dissertation students - both undergraduate and post graduate.

This books helps to introduce students to qualitative marketing research in a wonderful way. Chapters are written in a nearly dialogic way. This motivates students to dive into the discussion. Furthermore, examples are very helpful by illustrating different methods in a hands-on manner.

Excellent coverage of the entire area of QCR.

Belk, Fischer & Kozinets provide a succinct & contemporary introduction to qualitative marketing research methods for undergrads. The text is an excellent supplement to standard (primarily quantitative) MR texts.

Good text, written well for students from an international background

The book provides a useful, hands-on, introduction to qualitative market research. It highlights useful differences between qualitative and quantitative approaches. I say 'introduction' as the book does not seem to spend enough time identifying types of qualitative research studies. Nevertheless it does address the issues of marketing research from a management perspective which tend to be overlooked in some other works.

Recormended for the students that is working with Qualitative Research in their Master Thesis. A very welll written and usefull book

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Introduction

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Why qualitative market research is essential for understanding consumer behavior

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Highlights:

• Qualitative market research is essential for deciphering evolving consumer behavior and meeting modern marketing challenges.
• It distinguishes itself from quantitative research through its distinct approach and the types of insights it uncovers.
• It uncovers the 'why' behind consumer choices, offering insights into motivations and emotions.
• Qualitative methods include focus groups, in-depth interviews, ethnographic studies, observations, and content analysis for deep insights into consumer behavior.
• Uncover the application of this research type, its ethical considerations, challenges and benefits of adoption, and more.

What do my prospects think about my offering? What can I do to change their minds? Who can I use to make a more convincing pitch? How will a particular target audience react if I package it in this manner? These are just a few questions amid changing consumer behavior, information overload to data privacy regulations, and shortened attention spans; hurdles that marketers face today. To overcome them and thrive amidst breakneck competition, businesses are increasingly turning to qualitative market research. 

Why? Because goes beyond mere statistics, offering insights, quite literally, into the ‘why’ behind consumer behavior. By delving into the underlying motivations, attitudes, and emotions that drive choices, qualitative research equips marketers to adapt to shifting behaviors, personalize their strategies, navigate data privacy concerns, and craft compelling messages.

Moreover, understanding consumer behavior is the foundation of any marketing strategy as it shapes how products are designed, priced, promoted, and distributed. Understanding the intricate web of consumer choices helps businesses tailor their offerings, enhance customer satisfaction, and ultimately boost profitability.

How is qualitative research different from quantitative?

Qualitative research differs from quantitative research, which focuses on numerical data and statistical analysis. While quantitative research provides data on what, when, and how much, qualitative market research answers the ‘why’ and ‘how’ questions, providing deeper insights into consumer behavior. For instance, consider a market researcher trying to understand why a specific brand of smartphones is gaining popularity. 

A qualitative approach might involve conducting in-depth interviews with consumers, allowing them to express their sentiments, experiences, and the reasons they are drawn to the product. This approach unveils the intricacies of consumer preferences and the emotional factors influencing their choices, which quantitative data alone cannot provide.

What are the different ways of conducting quantitative research to understand consumer behvaior?

1. Focus groups

These involve small, diverse groups of participants engaging in guided discussions about a specific product or topic. This method is excellent for uncovering consumer perceptions and attitudes. For example, a focus group can reveal why a new cereal brand is preferred over traditional ones by analyzing consumer discussions.

2. In-depth interviews

These are one-on-one conversations online or offlline between researchers and participants. They allow for a deeper exploration of individual experiences and motivations. Interviews are often used to understand why some customers prefer online shopping over physical retail, for instance.

3. Ethnographic studies

Here, researchers immerse themselves in the consumers’ environment, observing and interacting with them. For instance, a researcher living with a family to understand their dietary habits and preferences can uncover valuable insights for a food company.

4. Mystery shoppers / Observations

Direct observations involve researchers watching consumers in their natural settings. This method is particularly useful for understanding non-verbal behaviors and interactions. For example, observing how shoppers navigate a store can reveal what influences their purchasing decisions.

5. Content analysis

This approach involves studying textual, visual, or audio materials to extract meaningful insights. Analyzing customer reviews of a product can provide an understanding of the strengths and weaknesses of that product in the eyes of consumers.

6. Online customer communities, bulletin boards, chat rooms

These enable extensive geographic input, ideal for focused interest groups. Participants use text, video, and images to discuss their online customer journeys, either in group or one-on-one settings with moderators. Bulletin boards facilitate dynamic discussions by allowing visitors to respond to posted topics.

Related reading: How to tackle challenges of conducting focus groups studies in qualitative research

What makes examining customer behavior so important?

• Purchasing power is crucial to consider. Even wealthy customers have budgets, so purchasing power plays a significant role in their buying decisions.
• Well-designed marketing campaigns can persuade customers to switch brands or choose more expensive products when they resonate with the customers’ needs.
• Personality traits like an individual’s background and upbringing shape their personality, which, in turn, affects their behavior in different situations.
• Personal preferences to some extent remain steadfast. In the realm of advertising, for example, a vegan won’t buy animal-based products.
• Economic conditions influence customer behavior. Positive conditions encourage indulgence, while negative economic situations lead to more frugal spending and increased demand for promotions.
• Peer pressure and others’ opinions tangibly impact buying and usage decisions, with the potential to drive brand advocacy or reputational damage.
• Social trends disseminated through various media platforms, determine what is popular and socially acceptable, offering opportunities for marketers to align their strategies with ongoing trends.

Benefits of using qualitative market research

• Better contextual understanding: Qualitative research uncovers the ‘why’ and ‘how’ behind situations, providing a deeper, more contextual comprehension.
• Unearthing unique insights: Open-ended questions reveal answers that quantitative surveys can’t capture, unveiling diverse perspectives.
• Context-driven: By delving into motivations and past behaviors, researchers can discern their target market’s needs and preferences.
• No tool dependency: Open-ended questions eliminate the need for scales or numerical measurements, streamlining the research process.
• Smaller sample sizes: Smaller samples enable in-depth analysis, leading to more accurate hypotheses and conclusions.
• Inspirational: Qualitative responses can inspire new research studies, fostering ongoing exploration.
• Flexibility and detail: Without reliance on scales, researchers can craft creative and detailed questions, focusing on subtleties for robust insights.

Limitations

• Researcher dependence: Qualitative research relies on researchers’ expertise, and not all may be well-versed in the subject matter.
• Lack of statistical representation: It gathers perspective-based data rather than statistical measurements, limiting comparisons but not precise measurements.
• Data replication challenges: Individual perspectives make replicating findings difficult, hindering the formation of definitive conclusions.
• Researcher bias: Both conscious and subconscious researcher biases can impact the data and influence conclusions, necessitating the use of controls in data collection to mitigate this issue. 

Related reading: Understanding consumer behavior to increase conversion

Qualitative market research in action

A prominent global health insurance provider sought to enhance its marketing effectiveness by understanding consumer behavior and attitudes across 12 countries. They catered to diverse customer segments, including students, working professionals, and retirees, offering various insurance options. Netscribes developed a comprehensive solution that involved a hybrid methodology combining telephonic and online interviews with representative customer subsets.

Over 2000 interviews gathered insights on brand preferences, perceptions, and competitive positioning, while a consumer journey analysis revealed factors influencing purchase decisions. By tracking brand health metrics yearly, the client identified preferred insurance providers, market players, claim types, competitor focus areas, and customer segments. This data empowered the client to adjust marketing strategies, refine brand messaging, and enhance product offerings, ultimately improving their marketing effectiveness.

When should you use qualitative market research?

When considering the application of qualitative research, it’s essential to align it with your business strategy, marketing objectives, and specific needs. Qualitative research is primarily aimed at comprehending a phenomenon, be it a problem, an insufficiency, or any other occurrence, by investigating its causes, motivations, objectives, and potential solutions. This is achieved by scrutinizing smaller segments of a population.

Utilize qualitative research when you seek to gain a unique understanding of a particular event or situation. It proves particularly valuable when examining how your target audience perceives specific circumstances and their emotional responses to them.

The significance of qualitative research becomes evident through several key aspects:

• Uncovering emotional bonds: It allows brands to decipher the emotional connections customers establish with their products or services.
• Identifying experience gaps: Qualitative research helps pinpoint shortcomings in customer experiences (CX) and user experiences (UX).
• Tailored experiences: It empowers brands to craft experiences that are finely tailored to their specific target audience.
• Improvement insights: Businesses can gain insights into enhancing their products, services, or overall CX.
• Sensitive topics discovery: Qualitative research reveals customer experiences associated with sensitive subjects and language.
• Competitive benchmarking: It aids businesses in understanding how customers compare their brand to competitors.
• Innovative solutions: Identifies potential solutions and innovations derived from customer attitudes and experiences.

To effectively analyze qualitative market research, begin by defining your research subject and selecting the type of research aligned with the five qualitative research categories. Develop a set of questions that will serve as the foundation for your research. During the research process, diligently record your observations, whether digitally or through other means. For example, record interviews and securely store survey data in a well-organized database.

Incorporate open-ended questions in surveys, interviews, focus groups, and similar methods. Additionally, gather supplementary research materials such as government documents, niche-related articles, images, videos, and more.

To draw meaningful insights, search for patterns or similarities within your findings. Group these insights, organizing them by demographics if applicable, to derive conclusions and propose potential solutions effectively.

Ethical considerations to bear in mind

In the realm of ethical considerations in qualitative market research, several vital aspects come to the forefront. One essential element is the need for informed consent and privacy safeguards, ensuring that participants fully comprehend the research’s purpose and their rights, while also preserving their privacy, especially when sensitive topics are involved. 

Additionally, maintaining transparency in reporting is paramount for upholding the research’s integrity, necessitating the disclosure of methodologies and any potential conflicts of interest. Ethical guidelines underscore the importance of avoiding manipulation or exploitation of participants, reinforcing the imperative adherence to ethical standards throughout the research process.

Technology applications aiding qualitative research

Studies such as these can now be significantly enhanced with the advancement of technology and science-based biometric tools, such as eye tracking and facial coding. These rely on actual versus reported behavior and attitudes providing more reliable and accurate insight. It’s by combining these advanced techniques with traditional qualitative approaches that you can truly unravel the complexities of today’s environment and gain the insight needed to develop superior shopper solutions. As we look to the future, the integration of AI, virtual reality, and enhanced data visualization techniques will undoubtedly reshape the landscape of qualitative research, making it an even more powerful tool for understanding consumer behavior.

Consumer behavior is in constant flux, evolving rapidly over time. What was effective a decade ago may no longer apply today in the complex realm of modern consumerism. In this dynamic landscape, qualitative market research emerges as a vital tool, dissecting your target market to forge a tangible strategy.

To ensure your endeavors yield valuable insights, partnering with a seasoned qualitative research agency is imperative. Netscribes has been a trusted partner for Fortune 500 companies and promising startups alike, collaborating to address industry disruptions, decipher evolving consumer trends, harness technological innovations, and expedite corporate expansion. To explore how our expertise can assist your business in conducting impactful qualitative market research studies to extract actionable consumer insights , reach out to us.

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Home Market Research

Consumer Research: Examples, Process and Scope

What is Consumer Research?

Consumer research is a part of market research in which inclination, motivation and purchase behavior of the targeted customers are identified. Consumer research helps businesses or organizations understand customer psychology and create detailed purchasing behavior profiles.

It uses research techniques to provide systematic information about what customers need. Using this information brands can make changes in their products and services, making them more customer-centric thereby increasing customer satisfaction. This will in turn help to boost business.

LEARN ABOUT: Market research vs marketing research

An organization that has an in-depth understanding about the customer decision-making process, is most likely to design a product, put a certain price tag to it, establish distribution centers and promote a product based on consumer research insights such that it produces increased consumer interest and purchases.

For example, A consumer electronics company wants to understand, thought process of a consumer when purchasing an electronic device, which can help a company to launch new products, manage the supply of the stock, etc. Carrying out a Consumer electronics survey can be useful to understand the market demand, understand the flaws in their product and also find out research problems in the various processes that influence the purchase of their goods. A consumer electronics survey can be helpful to gather information about the shopping experiences of consumers when purchasing electronics. which can enable a company to make well-informed and wise decisions regarding their products and services.

LEARN ABOUT:  Test Market Demand

Consumer Research Objectives

When a brand is developing a new product, consumer research is conducted to understand what consumers want or need in a product, what attributes are missing and what are they looking for? An efficient survey software really makes it easy for organizations to conduct efficient research.

Consumer research is conducted to improve brand equity. A brand needs to know what consumers think when buying a product or service offered by a brand. Every good business idea needs efficient consumer research for it to be successful. Consumer insights are essential to determine brand positioning among consumers.

Consumer research is conducted to boost sales. The objective of consumer research is to look into various territories of consumer psychology and understand their buying pattern, what kind of packaging they like and other similar attributes that help brands to sell their products and services better.

LEARN ABOUT: Brand health

Consumer Research Model

According to a study conducted, till a decade ago, researchers thought differently about the consumer psychology, where little or no emphasis was put on emotions, mood or the situation that could influence a customer’s buying decision.

Many believed marketing was applied economics. Consumers always took decisions based on statistics and math and evaluated goods and services rationally and then selected items from those brands that gave them the highest customer satisfaction at the lowest cost.

However, this is no longer the situation. Consumers are very well aware of brands and their competitors. A loyal customer is the one who would not only return to repeatedly purchase from a brand but also, recommend his/her family and friends to buy from the same brand even if the prices are slightly higher but provides an exceptional customer service for products purchased or services offered.

Here is where the Net Promoter Score (NPS) helps brands identify brand loyalty and customer satisfaction with their consumers. Net Promoter Score consumer survey uses a single question that is sent to customers to identify their brand loyalty and level of customer satisfaction. Response to this question is measured on a scale between 0-10 and based on this consumers can be identified as:

Detractors: Who have given a score between 0-6.

Passives: Who have given a score between 7-8.

Promoters: Who have given a score between 9-10.

Consumer market research is based on two types of research method:

1. Qualitative Consumer Research

Qualitative research  is descriptive in nature, It’s a method that uses open-ended questions , to gain meaningful insights from respondents and heavily relies on the following market research methods:

Focus Groups: Focus groups as the name suggests is a small group of highly validated subject experts who come together to analyze a product or service. Focus group comprises of 6-10 respondents. A moderator is assigned to the focus group, who helps facilitate discussions among the members to draw meaningful insights

One-to-one Interview: This is a more conversational method, where the researcher asks open-ended questions to collect data from the respondents. This method heavily depends on the expertise of the researcher. How much the researcher is able to probe with relevant questions to get maximum insights. This is a time-consuming method and can take more than one attempt to gain the desired insights.

LEARN ABOUT: Qualitative Interview

Content/ Text Analysis: Text analysis is a qualitative research method where researchers analyze social life by decoding words and images from the documents available. Researchers analyze the context in which the images are used and draw conclusions from them. Social media is an example of text analysis. In the last decade or so, inferences are drawn based on consumer behavior on social media.

Learn More: How to conduct Qualitative Research  

2.Quantitative Consumer Research

In the age of technology and information, meaningful data is more precious than platinum. Billion dollar companies have risen and fallen on how well they have been able to collect and analyze data, to draw validated insights.

Quantitative research is all about numbers and statistics. An evolved consumer who purchases regularly can vouch for how customer-centric businesses have become today. It’s all about customer satisfaction , to gain loyal customers. With just one questions companies are able to collect data, that has the power to make or break a company. Net Promoter Score question , “On a scale from 0-10 how likely are you to recommend our brand to your family or friends?”

How organic word-of-mouth is influencing consumer behavior and how they need to spend less on advertising and invest their time and resources to make sure they provide exceptional customer service.

LEARN ABOUT: Behavioral Targeting

Online surveys , questionnaires , and polls are the preferred data collection tools. Data that is obtained from consumers is then statistically, mathematically and numerically evaluated to understand consumer preference.

Learn more: How to carry out Quantitative Research

Consumer Research Process

The process of consumer research started as an extension of the process of market research . As the findings of market research is used to improve the decision-making capacity of an organization or business, similar is with consumer research.

LEARN ABOUT:  Market research industry

The consumer research process can be broken down into the following steps:

• Develop research objectives: The first step to the consumer research process is to clearly define the research objective, the purpose of research, why is the research being conducted, to understand what? A clear statement of purpose can help emphasize the purpose.
• Collect Secondary data: Collect secondary data first, it helps in understanding if research has been conducted earlier and if there are any pieces of evidence related to the subject matter that can be used by an organization to make informed decisions regarding consumers.
• Primary Research: In primary research organizations or businesses collect their own data or employ a third party to collect data on their behalf. This research makes use of various data collection methods ( qualitative and quantitative ) that helps researchers collect data first hand.

LEARN ABOUT: Best Data Collection Tools

• Collect and analyze data: Data is collected and analyzed and inference is drawn to understand consumer behavior and purchase pattern.
• Prepare report: Finally, a report is prepared for all the findings by analyzing data collected so that organizations are able to make informed decisions and think of all probabilities related to consumer behavior. By putting the study into practice, organizations can become customer-centric and manufacture products or render services that will help them achieve excellent customer satisfaction.

LEARN ABOUT: market research trends

After Consumer Research Process

Once you have been able to successfully carry out the consumer research process , investigate and break paradigms. What consumers need should be a part of market research design and should be carried out regularly. Consumer research provides more in-depth information about the needs, wants, expectations and behavior analytics of clients.  

By identifying this information successfully, strategies that are used to attract consumers can be made better and businesses can make a profit by knowing what consumers want exactly. It is also important to understand and know thoroughly the buying behavior of consumers to know their attitude towards brands and products.

The identification of consumer needs, as well as their preferences, allows a business to adapt to new business and develop a detailed marketing plan that will surely work. The following pointers can help. Completing this process will help you:

• Attract more customers  
• Set the best price for your products  
• Create the right marketing message  
• Increase the quantity that satisfies the demand of its clients  
• Increase the frequency of visits to their clients  
• Increase your sales  
• Reduce costs  
• Refine your approach to the customer service process .

LEARN ABOUT: Behavioral Research

Consumer Research Methods

Consumers are the reason for a business to run and flourish. Gathering enough information about consumers is never going to hurt any business, in fact, it will only add up to the information a business would need to associate with its consumers and manufacture products that will help their business refine and grow.

Following are consumer research methods that ensure you are in tandem with the consumers and understand their needs:

The studies of customer satisfaction

One can determine the degree of satisfaction of consumers in relation to the quality of products through:

• Informal methods such as conversations with staff about products and services according to the dashboards.   
• Past and present questionnaires/ surveys that consumers might have filled that identify their needs.   

T he investigation of the consumer decision process

It is very interesting to know the consumer’s needs, what motivates them to buy, and how is the decision-making process carried out, though:

• Deploying relevant surveys and receiving responses from a target intended audience .

Proof of concept

Businesses can test how well accepted their marketing ideas are by:

• The use of surveys to find out if current or potential consumer see your products as a rational and useful benefit.  
• Conducting personal interviews or focus group sessions with clients to understand how they respond to marketing ideas.

Knowing your market position

You can find out how your current and potential consumers see your products, and how they compare it with your competitors by:

• Sales figures talk louder than any other aspect, once you get to know the comparison in the sales figures it is easy to understand your market position within the market segment.
• Attitudes of consumers while making a purchase also helps in understanding the market hold.      

Branding tests and user experience

You can determine how your customers feel with their brands and product names by:

• The use of focus groups and surveys designed to assess emotional responses to your products and brands.  
• The participation of researchers to study the performance of their brand in the market through existing and available brand measurement research.   

Price changes

You can investigate how your customers accept or not the price changes by using formulas that measure the revenue – multiplying the number of items you sold, by the price of each item. These tests allow you to calculate if your total income increases or decreases after making the price changes by:

• Calculation of changes in the quantities of products demanded by their customers, together with changes in the price of the product.   
• Measure the impact of the price on the demand of the product according to the needs of the client.   

Social media monitoring

Another way to measure feedback and your customer service is by controlling your commitment to social media and feedback. Social networks (especially Facebook) are becoming a common element of the commercialization of many businesses and are increasingly used by their customers to provide information on customer needs, service experiences, share and file customer complaints . It can also be used to run surveys and test concepts. If handled well, it can be one of the most powerful research tools of the client management . I also recommend reading: How to conduct market research through social networks.

Customer Research Questions

Asking the right question is the most important part of conducting research. Moreover, if it’s consumer research, questions should be asked in a manner to gather maximum insights from consumers. Here are some consumer research questions for your next research:

• Who in your household takes purchasing decisions?
• Where do you go looking for ______________ (product)?
• How long does it take you to make a buying decision?
• How far are you willing to travel to buy ___________(product)?
• What features do you look for when you purchase ____________ (product)?
• What motivates you to buy_____________ (product)?

See more consumer research survey questions:

Customer satisfaction surveys

Voice of customer surveys

Product surveys

Service evaluation surveys

Mortgage Survey Questions

Importance of Consumer Research

Launching a product or offering new services can be quite an exciting time for a brand. However, there are a lot of aspects that need to be taken into consideration while a band has something new to offer to consumers.

LEARN ABOUT: User Experience Research

Here is where consumer research plays a pivotal role. The importance of consumer research cannot be emphasized more. Following points summarizes the importance of consumer research:

• To understand market readiness: However good a product or service may be, consumers have to be ready to accept it. Creating a product requires investments which in return expect ROI from product or service purchases. However, if a market is mature enough to accept this utility, it has a low chance of succeeding by tapping into market potential . Therefore, before launching a product or service, organizations need to conduct consumer research, to understand if people are ready to spend on the utility it provides.
• Identify target consumers: By conducting consumer research, brands and organizations can understand their target market based on geographic segmentation and know who exactly is interested in buying their products. According to the data or feedback received from the consumer, research brands can even customize their marketing and branding approach to better appeal to the specific consumer segment.

LEARN ABOUT: Marketing Insight

• Product/Service updates through feedback: Conducting consumer research, provides valuable feedback from consumers about the attributes and features of products and services. This feedback enables organizations to understand consumer perception and provide a more suitable solution based on actual market needs which helps them tweak their offering to perfection.

Explore more: 300 + FREE survey templates to use for your research

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Qualitative Study

Affiliations.

• 1 University of Nebraska Medical Center
• 2 GDB Research and Statistical Consulting
• 3 GDB Research and Statistical Consulting/McLaren Macomb Hospital
• PMID: 29262162
• Bookshelf ID: NBK470395

Qualitative research is a type of research that explores and provides deeper insights into real-world problems. Instead of collecting numerical data points or intervene or introduce treatments just like in quantitative research, qualitative research helps generate hypotheses as well as further investigate and understand quantitative data. Qualitative research gathers participants' experiences, perceptions, and behavior. It answers the hows and whys instead of how many or how much. It could be structured as a stand-alone study, purely relying on qualitative data or it could be part of mixed-methods research that combines qualitative and quantitative data. This review introduces the readers to some basic concepts, definitions, terminology, and application of qualitative research.

Qualitative research at its core, ask open-ended questions whose answers are not easily put into numbers such as ‘how’ and ‘why’. Due to the open-ended nature of the research questions at hand, qualitative research design is often not linear in the same way quantitative design is. One of the strengths of qualitative research is its ability to explain processes and patterns of human behavior that can be difficult to quantify. Phenomena such as experiences, attitudes, and behaviors can be difficult to accurately capture quantitatively, whereas a qualitative approach allows participants themselves to explain how, why, or what they were thinking, feeling, and experiencing at a certain time or during an event of interest. Quantifying qualitative data certainly is possible, but at its core, qualitative data is looking for themes and patterns that can be difficult to quantify and it is important to ensure that the context and narrative of qualitative work are not lost by trying to quantify something that is not meant to be quantified.

However, while qualitative research is sometimes placed in opposition to quantitative research, where they are necessarily opposites and therefore ‘compete’ against each other and the philosophical paradigms associated with each, qualitative and quantitative work are not necessarily opposites nor are they incompatible. While qualitative and quantitative approaches are different, they are not necessarily opposites, and they are certainly not mutually exclusive. For instance, qualitative research can help expand and deepen understanding of data or results obtained from quantitative analysis. For example, say a quantitative analysis has determined that there is a correlation between length of stay and level of patient satisfaction, but why does this correlation exist? This dual-focus scenario shows one way in which qualitative and quantitative research could be integrated together.

Examples of Qualitative Research Approaches

Ethnography

Ethnography as a research design has its origins in social and cultural anthropology, and involves the researcher being directly immersed in the participant’s environment. Through this immersion, the ethnographer can use a variety of data collection techniques with the aim of being able to produce a comprehensive account of the social phenomena that occurred during the research period. That is to say, the researcher’s aim with ethnography is to immerse themselves into the research population and come out of it with accounts of actions, behaviors, events, etc. through the eyes of someone involved in the population. Direct involvement of the researcher with the target population is one benefit of ethnographic research because it can then be possible to find data that is otherwise very difficult to extract and record.

Grounded Theory

Grounded Theory is the “generation of a theoretical model through the experience of observing a study population and developing a comparative analysis of their speech and behavior.” As opposed to quantitative research which is deductive and tests or verifies an existing theory, grounded theory research is inductive and therefore lends itself to research that is aiming to study social interactions or experiences. In essence, Grounded Theory’s goal is to explain for example how and why an event occurs or how and why people might behave a certain way. Through observing the population, a researcher using the Grounded Theory approach can then develop a theory to explain the phenomena of interest.

Phenomenology

Phenomenology is defined as the “study of the meaning of phenomena or the study of the particular”. At first glance, it might seem that Grounded Theory and Phenomenology are quite similar, but upon careful examination, the differences can be seen. At its core, phenomenology looks to investigate experiences from the perspective of the individual. Phenomenology is essentially looking into the ‘lived experiences’ of the participants and aims to examine how and why participants behaved a certain way, from their perspective . Herein lies one of the main differences between Grounded Theory and Phenomenology. Grounded Theory aims to develop a theory for social phenomena through an examination of various data sources whereas Phenomenology focuses on describing and explaining an event or phenomena from the perspective of those who have experienced it.

Narrative Research

One of qualitative research’s strengths lies in its ability to tell a story, often from the perspective of those directly involved in it. Reporting on qualitative research involves including details and descriptions of the setting involved and quotes from participants. This detail is called ‘thick’ or ‘rich’ description and is a strength of qualitative research. Narrative research is rife with the possibilities of ‘thick’ description as this approach weaves together a sequence of events, usually from just one or two individuals, in the hopes of creating a cohesive story, or narrative. While it might seem like a waste of time to focus on such a specific, individual level, understanding one or two people’s narratives for an event or phenomenon can help to inform researchers about the influences that helped shape that narrative. The tension or conflict of differing narratives can be “opportunities for innovation”.

Research Paradigm

Research paradigms are the assumptions, norms, and standards that underpin different approaches to research. Essentially, research paradigms are the ‘worldview’ that inform research. It is valuable for researchers, both qualitative and quantitative, to understand what paradigm they are working within because understanding the theoretical basis of research paradigms allows researchers to understand the strengths and weaknesses of the approach being used and adjust accordingly. Different paradigms have different ontology and epistemologies . Ontology is defined as the "assumptions about the nature of reality” whereas epistemology is defined as the “assumptions about the nature of knowledge” that inform the work researchers do. It is important to understand the ontological and epistemological foundations of the research paradigm researchers are working within to allow for a full understanding of the approach being used and the assumptions that underpin the approach as a whole. Further, it is crucial that researchers understand their own ontological and epistemological assumptions about the world in general because their assumptions about the world will necessarily impact how they interact with research. A discussion of the research paradigm is not complete without describing positivist, postpositivist, and constructivist philosophies.

Positivist vs Postpositivist

To further understand qualitative research, we need to discuss positivist and postpositivist frameworks. Positivism is a philosophy that the scientific method can and should be applied to social as well as natural sciences. Essentially, positivist thinking insists that the social sciences should use natural science methods in its research which stems from positivist ontology that there is an objective reality that exists that is fully independent of our perception of the world as individuals. Quantitative research is rooted in positivist philosophy, which can be seen in the value it places on concepts such as causality, generalizability, and replicability.

Conversely, postpositivists argue that social reality can never be one hundred percent explained but it could be approximated. Indeed, qualitative researchers have been insisting that there are “fundamental limits to the extent to which the methods and procedures of the natural sciences could be applied to the social world” and therefore postpositivist philosophy is often associated with qualitative research. An example of positivist versus postpositivist values in research might be that positivist philosophies value hypothesis-testing, whereas postpositivist philosophies value the ability to formulate a substantive theory.

Constructivist

Constructivism is a subcategory of postpositivism. Most researchers invested in postpositivist research are constructivist as well, meaning they think there is no objective external reality that exists but rather that reality is constructed. Constructivism is a theoretical lens that emphasizes the dynamic nature of our world. “Constructivism contends that individuals’ views are directly influenced by their experiences, and it is these individual experiences and views that shape their perspective of reality”. Essentially, Constructivist thought focuses on how ‘reality’ is not a fixed certainty and experiences, interactions, and backgrounds give people a unique view of the world. Constructivism contends, unlike in positivist views, that there is not necessarily an ‘objective’ reality we all experience. This is the ‘relativist’ ontological view that reality and the world we live in are dynamic and socially constructed. Therefore, qualitative scientific knowledge can be inductive as well as deductive.”

So why is it important to understand the differences in assumptions that different philosophies and approaches to research have? Fundamentally, the assumptions underpinning the research tools a researcher selects provide an overall base for the assumptions the rest of the research will have and can even change the role of the researcher themselves. For example, is the researcher an ‘objective’ observer such as in positivist quantitative work? Or is the researcher an active participant in the research itself, as in postpositivist qualitative work? Understanding the philosophical base of the research undertaken allows researchers to fully understand the implications of their work and their role within the research, as well as reflect on their own positionality and bias as it pertains to the research they are conducting.

Data Sampling

The better the sample represents the intended study population, the more likely the researcher is to encompass the varying factors at play. The following are examples of participant sampling and selection:

Purposive sampling- selection based on the researcher’s rationale in terms of being the most informative.

Criterion sampling-selection based on pre-identified factors.

Convenience sampling- selection based on availability.

Snowball sampling- the selection is by referral from other participants or people who know potential participants.

Extreme case sampling- targeted selection of rare cases.

Typical case sampling-selection based on regular or average participants.

Data Collection and Analysis

Qualitative research uses several techniques including interviews, focus groups, and observation. [1] [2] [3] Interviews may be unstructured, with open-ended questions on a topic and the interviewer adapts to the responses. Structured interviews have a predetermined number of questions that every participant is asked. It is usually one on one and is appropriate for sensitive topics or topics needing an in-depth exploration. Focus groups are often held with 8-12 target participants and are used when group dynamics and collective views on a topic are desired. Researchers can be a participant-observer to share the experiences of the subject or a non-participant or detached observer.

While quantitative research design prescribes a controlled environment for data collection, qualitative data collection may be in a central location or in the environment of the participants, depending on the study goals and design. Qualitative research could amount to a large amount of data. Data is transcribed which may then be coded manually or with the use of Computer Assisted Qualitative Data Analysis Software or CAQDAS such as ATLAS.ti or NVivo.

After the coding process, qualitative research results could be in various formats. It could be a synthesis and interpretation presented with excerpts from the data. Results also could be in the form of themes and theory or model development.

Dissemination

To standardize and facilitate the dissemination of qualitative research outcomes, the healthcare team can use two reporting standards. The Consolidated Criteria for Reporting Qualitative Research or COREQ is a 32-item checklist for interviews and focus groups. The Standards for Reporting Qualitative Research (SRQR) is a checklist covering a wider range of qualitative research.

Examples of Application

Many times a research question will start with qualitative research. The qualitative research will help generate the research hypothesis which can be tested with quantitative methods. After the data is collected and analyzed with quantitative methods, a set of qualitative methods can be used to dive deeper into the data for a better understanding of what the numbers truly mean and their implications. The qualitative methods can then help clarify the quantitative data and also help refine the hypothesis for future research. Furthermore, with qualitative research researchers can explore subjects that are poorly studied with quantitative methods. These include opinions, individual's actions, and social science research.

A good qualitative study design starts with a goal or objective. This should be clearly defined or stated. The target population needs to be specified. A method for obtaining information from the study population must be carefully detailed to ensure there are no omissions of part of the target population. A proper collection method should be selected which will help obtain the desired information without overly limiting the collected data because many times, the information sought is not well compartmentalized or obtained. Finally, the design should ensure adequate methods for analyzing the data. An example may help better clarify some of the various aspects of qualitative research.

A researcher wants to decrease the number of teenagers who smoke in their community. The researcher could begin by asking current teen smokers why they started smoking through structured or unstructured interviews (qualitative research). The researcher can also get together a group of current teenage smokers and conduct a focus group to help brainstorm factors that may have prevented them from starting to smoke (qualitative research).

In this example, the researcher has used qualitative research methods (interviews and focus groups) to generate a list of ideas of both why teens start to smoke as well as factors that may have prevented them from starting to smoke. Next, the researcher compiles this data. The research found that, hypothetically, peer pressure, health issues, cost, being considered “cool,” and rebellious behavior all might increase or decrease the likelihood of teens starting to smoke.

The researcher creates a survey asking teen participants to rank how important each of the above factors is in either starting smoking (for current smokers) or not smoking (for current non-smokers). This survey provides specific numbers (ranked importance of each factor) and is thus a quantitative research tool.

The researcher can use the results of the survey to focus efforts on the one or two highest-ranked factors. Let us say the researcher found that health was the major factor that keeps teens from starting to smoke, and peer pressure was the major factor that contributed to teens to start smoking. The researcher can go back to qualitative research methods to dive deeper into each of these for more information. The researcher wants to focus on how to keep teens from starting to smoke, so they focus on the peer pressure aspect.

The researcher can conduct interviews and/or focus groups (qualitative research) about what types and forms of peer pressure are commonly encountered, where the peer pressure comes from, and where smoking first starts. The researcher hypothetically finds that peer pressure often occurs after school at the local teen hangouts, mostly the local park. The researcher also hypothetically finds that peer pressure comes from older, current smokers who provide the cigarettes.

The researcher could further explore this observation made at the local teen hangouts (qualitative research) and take notes regarding who is smoking, who is not, and what observable factors are at play for peer pressure of smoking. The researcher finds a local park where many local teenagers hang out and see that a shady, overgrown area of the park is where the smokers tend to hang out. The researcher notes the smoking teenagers buy their cigarettes from a local convenience store adjacent to the park where the clerk does not check identification before selling cigarettes. These observations fall under qualitative research.

If the researcher returns to the park and counts how many individuals smoke in each region of the park, this numerical data would be quantitative research. Based on the researcher's efforts thus far, they conclude that local teen smoking and teenagers who start to smoke may decrease if there are fewer overgrown areas of the park and the local convenience store does not sell cigarettes to underage individuals.

The researcher could try to have the parks department reassess the shady areas to make them less conducive to the smokers or identify how to limit the sales of cigarettes to underage individuals by the convenience store. The researcher would then cycle back to qualitative methods of asking at-risk population their perceptions of the changes, what factors are still at play, as well as quantitative research that includes teen smoking rates in the community, the incidence of new teen smokers, among others.

Copyright © 2024, StatPearls Publishing LLC.

• Introduction
• Issues of Concern
• Clinical Significance
• Enhancing Healthcare Team Outcomes
• Review Questions

Publication types

• Study Guide

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April 3, 2024

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Weak self-control, social media and targeted advertising increase impulse buying, says study

by University of Jyväskylä

Online shopping and digital payment options have made shopping easier and more enjoyable—money can be spent almost unnoticeably. These factors predispose people to impulse purchases. A lack of budgeting and cost control may lead a consumer into financial problems.

Product returns cause costs the companies as well. Moreover, the waste and carbon footprint resulting from unnecessary consumption and the logistics of online shopping burden the environment.

A survey conducted by the Department of Social Sciences and Philosophy at the University of Jyväskylä investigated the buying behavior of and attitudes towards marketing in digital environments of Finnish people between the ages of 18 and 29. The study sample included 2,318 respondents, and it was representative of the population of young adults in Finland. The study is published in Computers in Human Behavior .

It is known that impulse purchases are a consequence of poor self-control. The survey results indicated that low self-control leads to impulse buying influenced by social media and targeted advertising. Especially those consumers who have poor self-control find social media networks and targeted advertisements as good support for their buying decisions.

"Data are collected on consumers' online activities and use of digital devices, and on this basis, advertisements are then targeted to them," says Postdoctoral Researcher Jussi Nyrhinen. For this reason, the content or context of advertisements appear as meaningful for the consumers. In social media, commercial content is enticing because it is connected not only to public figures, but also to the consumers' social contacts.

Self-control is a personal characteristic which is hard to influence. Instead, according to Nyrhinen, we can seek to prevent impulse buying by decreasing the influence of social media and targeted advertising. The use of digital devices at school should not be restricted, but students should be taught to apply media and financial literacy in digital environments.

The responsibility for problems related to targeted advertising and marketing in social media also belongs to the marketers and technology companies. However, competition drives marketers to target their advertising more and more effectively, and social media platforms seek to get their users more deeply engaged while also increasing sales. We can attempt to respond to these challenges by developing legislation and educating consumers.

Journal information: Computers in Human Behavior

Provided by University of Jyväskylä

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This paper is in the following e-collection/theme issue:

Published on 4.4.2024 in Vol 26 (2024)

Impacts of an Acute Care Telenursing Program on Discharge, Patient Experience, and Nursing Experience: Retrospective Cohort Comparison Study

Authors of this article:

Original Paper

• Courtenay R Bruce, MA, JD   ; 
• Steve Klahn, RN, MBA   ; 
• Lindsay Randle, MBA   ; 
• Xin Li, BS   ; 
• Kelkar Sayali, BS   ; 
• Barbara Johnson, BSN, MBA, DNP   ; 
• Melissa Gomez, MBA   ; 
• Meagan Howard, MHA   ; 
• Roberta Schwartz, PhD   ; 
• Farzan Sasangohar, PhD  

Houston Methodist, Houston, TX, United States

Corresponding Author:

Courtenay R Bruce, MA, JD

Houston Methodist

8100 Greenbriar Drive

Houston, TX, 77030

United States

Phone: 1 281 620 9040

Email: [email protected]

Background: Despite widespread growth of televisits and telemedicine, it is unclear how telenursing could be applied to augment nurse labor and support nursing.

Objective: This study evaluated a large-scale acute care telenurse (ACTN) program to support web-based admission and discharge processes for hospitalized patients.

Methods: A retrospective, observational cohort comparison was performed in a large academic hospital system (approximately 2100 beds) in Houston, Texas, comparing patients in our pilot units for the ACTN program (telenursing cohort) between June 15, 2022, and December 31, 2022, with patients who did not participate (nontelenursing cohort) in the same units and timeframe. We used a case mix index analysis to confirm comparable patient cases between groups. The outcomes investigated were patient experience, measured using the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHCPS) survey; nursing experience, measured by a web-based questionnaire with quantitative multiple-choice and qualitative open-ended questions; time of discharge during the day (from electronic health record data); and duration of discharge education processes.

Results: Case mix index analysis found no significant case differences between cohorts ( P =.75). For the first 4 units that rolled out in phase 1, all units experienced improvement in at least 4 and up to 7 HCAHCPS domains. Scores for “communication with doctors” and “would recommend hospital” were improved significantly ( P =.03 and P =.04, respectively) in 1 unit in phase 1. The impact of telenursing in phases 2 and 3 was mixed. However, “communication with doctors” was significantly improved in 2 units ( P =.049 and P =.002), and the overall rating of the hospital and the ”would recommend hospital” scores were significantly improved in 1 unit ( P =.02 and P =04, respectively). Of 289 nurses who were invited to participate in the survey, 106 completed the nursing experience survey (response rate 106/289, 36.7%). Of the 106 nurses, 101 (95.3%) indicated that the ACTN program was very helpful or somewhat helpful to them as bedside nurses. The only noticeable difference between the telenursing and nontelenursing cohorts for the time of day discharge was a shift in the volume of patients discharged before 2 PM compared to those discharged after 2 PM at a hospital-wide level. The ACTN admissions averaged 12 minutes and 6 seconds (SD 7 min and 29 s), and the discharges averaged 14 minutes and 51 seconds (SD 8 min and 10 s). The average duration for ACTN calls was 13 minutes and 17 seconds (SD 7 min and 52 s). Traditional cohort standard practice (nontelenursing cohort) of a bedside nurse engaging in discharge and admission processes was 45 minutes, consistent with our preimplementation time study.

Conclusions: This study shows that ACTN programs are feasible and associated with improved outcomes for patient and nursing experience and reducing time allocated to admission and discharge education.

Introduction

Telemedicine, particularly video televisits, has greatly expanded in the wake of the COVID-19 pandemic [ 1 , 2 ]. Televisits have shown promise as a robust, practical, efficacious, and scalable alternative to in-person office visits that could ameliorate labor supply shortages [ 3 , 4 ]. The published evidence suggests a generally positive attitude toward televisit appointments for chronic care, focused on addressing financial and transportation barriers and improving patients’ access to care [ 5 - 7 ]. Despite the promise shown by televisits, limited attention has been paid to applying this method in the acute care setting and, in particular, on how this promising technology can be leveraged to support nurses.

Estimates suggest that approximately 200,000 open nursing positions will become available each year between 2021 and 2031 [ 8 ]. Telenursing can augment nursing labor supply, decrease nursing workload, maintain patient and nurse safety, and positively impact nursing and patient experiences [ 9 ]. However, the impact of telenursing on outcomes in acute care settings remains a research gap.

To address this gap, this study aimed to evaluate the outcomes associated with a large-scale acute care telenurse (ACTN) program to support web-based admission and discharge processes for hospitalized patients compared to patients who did not undergo the ACTN program intervention. Admission and discharge are 2 substantive and time-consuming acute care nursing tasks that involve tedious documentation in the electronic health record (EHR) and extensive interaction with patients and families to gather history and provide patient education [ 10 , 11 ]. We aimed to develop an ACTN program to augment nursing care by conducting admission and discharge processes through telenursing in a large health system. Subsequently, we discuss the impacts on 4 end points: patient experience, nursing experience, time of discharge during the day, and length of time for discharge education processes. We hypothesized that the ACTN program would be associated with higher patient experience scores and improved nursing experience compared to standard admission and discharge practices.

This study was conducted in a large academic hospital system (approximately 2100 beds) in Houston, Texas. The preimplementation methods are reported more extensively in the studies by Hehman et al [ 12 ] and Schwartz et al [ 13 ]. Program implementation was first informed by nursing time and workload surveys and pilot implementation in 4 comparatively understaffed units. The chief innovation officer, along with nursing leaders and ACTN program administrators, met with the bedside nursing staff of these 4 understaffed units to solicit their input on where and how ACTN would add value to their workflow. Bedside nursing staff provided critical input on admission processes that could be delegated to individuals working remotely with no perceived negative impact on patient experience. We conducted participatory workflow design sessions with bedside nursing staff on the ACTN program to cocreate workflow integration points where the remote team could assist [ 13 ].

Pilot Implementation and Procedures

Before implementation, the ACTN administrators trained bedside nurses in pilot units by demonstrating the use of technology during shift huddles. Then, the trainers presented slides on contact information and available support and provided a role demarcation process map, showing what the remote telenurse staff would be doing compared to what the bedside nurses needed to do to launch and conduct discharge education. Furthermore, the trainers invited the nursing staff to observe several discharges to learn how to conduct them. A software with Health Insurance Portability and Accountability Act compliance was uploaded to iPads (Apple Inc) and stored on each unit. Handheld iPads were available, and roaming iPads were made available for patients who could not hold an iPad.

The pilot implementation was staggered in a phased rollout, consisting of 3 sequenced phases, as shown in Figure 1 . Upon admission, the acute care bedside nurse contextualized the ACTN program with patients and families by handing the patient an iPad with a preloaded remote program app (Caregility) and then pressing a soft key to allow the ACTN to enter the patient’s room via the iPad screen. The ACTN introduced themselves, completed the nursing admission profile in the EHR, placed a request for a consultation, and notified the bedside nurse that the admission was completed using secure SMS text messaging [ 13 ]. A similar process was followed for discharge workflow processes, where the ACTN completed patient education on discharge instructions, confirmed the patient’s pharmacy details, confirmed discharge transportation, and arranged for departure.

Bedside nurses used their discretion regarding which patients would be appropriate for the ACTN program. They based this determination principally on whether documentation was needed and whether the patient could benefit from the undivided attention the ACTN program could afford. Furthermore, they excluded patients from the ACTN program if the patients expressed discomfort using an iPad. After the initial rollout, patients’ input was sought on their experience with the ACTN program to identify where and how improvements could be made, and this feedback was incorporated into iterative revisions in subsequent rollouts.

Pilot Outcomes Monitoring

A retrospective, observational cohort comparison was performed, in which all patients in our pilot units for the ACTN program (telenursing cohort) between June 15, 2022, and December 31, 2022, were compared with all patients who did not participate (nontelenursing cohort) in the same units in the same timeframe.

Our primary outcomes were patient experience and nursing experience. Patient experience scope was any process observable by patients [ 14 ]. We compared patient experiences in the telenursing and nontelenursing cohorts by evaluating patients’ responses to the widely used Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey [ 15 ], which represented 8 aspects (called dimensions) of patient satisfaction. Each dimension was measured using a continuous variable (0 to 100 points).

For the telenursing cohort, we analyzed bedside nurses’ collective responses using a Forms (Microsoft Corp) survey conducted in April 2023. The survey consisted of 5 questions, asking them to indicate whether the ACTN program was helpful using a Likert scale with 5 items (very helpful to very unhelpful). Nurses were asked to provide open-ended comments to explain the reasons for their evaluation. At the end of the survey, we included 2 open-ended fields for nurses to describe opportunities for improvement in future rollouts and provide any additional comments.

Furthermore, we explored the time at which discharge occurred using the EHR admission, discharge, and transfer date and time. We compared the hour of the day the patient was discharged in the telenursing cohort with the hour of the day the patient was discharged in the nontelenursing cohort, hypothesizing a priori that patients might be discharged earlier in the day in the telenursing cohort. Finally, we analyzed the duration of discharge education for both cohorts, measured in minutes.

Data Analysis

The patient demographic data were available for all patients. To confirm that the telenursing cohort had similar patient demographics as the nontelenursing cohort (and therefore to confirm that nurse biases in patient selection for the ACTN program were unlikely), we conducted a case mix index (CMI) evaluation. We first isolated the population of both cohorts into adults (aged ≥18 y). We compared only those patients who were discharged home and excluded those who were on extracorporeal membrane oxygenation or those who underwent a tracheostomy. The remaining population was evaluated to determine whether there was a difference in patient acuity and severity. After confirming that patient acuity and severity were of no significant difference, we included the inpatient and observation populations to evaluate the intervention results.

For the patient experience data, independent sample t tests (2-tailed) were used to compare the telenursing and nontelenursing cohorts across different HCAHPS dimensions and units. Analysis was conducted using R software (R Foundation for Statistical Computing). For the nursing experience survey data, we used Excel (Microsoft Corp) to analyze the responses to multiple-choice, discrete questions and thematic analysis to evaluate the open-text fields. Thematic analysis allows for eliciting key themes that emerge based on recurring statements [ 16 ]. The analysis followed an inductive approach. This approach uses open-ended questions, allowing themes to emerge with a few previously articulated assumptions on responses. Given the limited content, CRB served as the primary coder. Coding labels were used for data contextualizing, allowing for new themes to emerge throughout the coding process, using a codebook [ 16 , 17 ]. We stored emergent patterns and themes in an electronic format.

Ethical Considerations

The hospital’s review board determined that the ACTN pilot would not be considered regulated human subjects research. All data reported in this study were aggregated and deidentified.

The demographics of the telenursing and nontelenursing cohorts were relatively similar. Both cohorts had an average age of 60 years with an SD of 16.91; had a similar distribution in race and ethnicity (approximately 92/2319, 3.96% Asian; 525/2319, 22.64% Black; 425/2319, 18.33% Hispanic; 70/2319, 3.02% Native American, declined to identify, or other categories; and 1202/2319, 51.83% White); and had a similar distribution in female participants versus male participants (1249/2319, 53.86% vs 1070/2319, 46.14%). To further understand the population, the CMI analysis for acuity and severity showed that the CMI was slightly higher in the telenursing cohort than in the nontelenursing cohort, but the difference was not statistically significant ( P =.75).

Patient Experience

Among the first 4 units that rolled out in phase 1, all units experienced improvement in at least 4 and up to 7 HCAHPS domains (Table S1 in Multimedia Appendix 1 ). On average, 6 out of 8 HCAHPS domains were improved for patients in the telenursing cohort. All 4 units experienced improvements in the “overall rating” domain, and 3 of the 4 units experienced improvements in “likelihood to recommend” domain for patients in the telenursing cohort compared to those in the nontelenursing cohort within the same units. The improvement scores ranged from 1.4% for the neurosurgery unit (36 beds) to 11.6% for the medical unit (37 beds). Furthermore, all 4 units in the first phase of roll out experienced improved scores in the “responsiveness” domain by >4 points (ranging from 5% to 10.1%). A total of 2 out of the 4 units also experienced improvements in the “communication with nurses” (ranging from 1.7% to 3%) and “communication about medicines” (ranging from 3.3% to 11.7%) domains. The 2 units that did not experience improvement in the communication domains were the combined medical and surgery neurology and neurosurgical units (36 beds). Only the neurosurgical unit showed statistically significant improvements in 2 dimensions: “communication with doctors” ( P =.03) and “would recommend hospital” ( P =.04).

For the 7 units that rolled out during phase 2, only 1 orthopedic surgery unit (28 beds) experienced improvements in every domain (ranging from 0.9% to 12.5%). Medical observation unit 1 also improved in 5 areas. However, only improvements in “communication with doctors” ( P =.002), “overall rating of hospital” ( P =.02), and “would recommend hospital” ( P =.04) were statistically significant . The remaining units experienced improvements in some domains for the telenursing cohort compared to the nontelenursing cohort, with no improvement in other domains. However, the scores for “communication with nurses” and “communication with doctors” domains were improved for most of the units that rolled out in phase 2 (Table S2 in Multimedia Appendix 1 ).

For the 2 units that rolled out in phase 3, both of which were surgical cardiac units with 36 beds, 1 unit experienced improvement in every domain except “responsiveness” (ranging from 1% to 12%). The other unit only experienced improvement in the “communication with doctors” (4.9%) and “care transitions” domains (1.1%). However, none of these improvements were statistically significant (Table S3 in Multimedia Appendix 1 ).

Nursing Experience

Of the 289 nurses who were invited to participate in the survey, 106 completed the survey (36.7% response rate). Of the 106 nurses, 101 (95.3%) indicated that the ACTN program was “very helpful” or “somewhat helpful” to them as bedside nurses.

Quantitative Findings

The main reasons nurses gave for the program’s helpfulness included that it saved them time (94/106, 88.7%), allowed them to focus on more urgent clinical needs (90/106, 84.9%), allowed them to focus on activities they felt were more in line with their skill level (55/106, 51.9%), and allowed patients to have undivided attention for their discharge education (52/106, 49.1%). Among the 5 nurses who indicated that the ACTN program was somewhat unhelpful or very unhelpful, 3 (60%) indicated that workflows were not clear or needed further refinement or clarification. Furthermore, the nurse respondents shared several barriers and provided opportunities for improvement, with 91 (85.8%) out of 106 nurses offering suggestions.

Qualitative Findings

For the free-text explanation fields, all but 3 nurses (103/106, 97.2%) provided additional comments on the ACTN program helpfulness. Three themes emerged from the qualitative analysis of the free-text comments: (1) most of the nurses’ comments reflected that telenurses help bedside nurses save time, (2) respondents indicated that extra hands provided emotional and physical support in providing patient care, and (3) respondents perceived an improvement in patient safety by having a telenurse who could “catch missed” issues.

Time Saving

One of the perceived benefits of the telenursing program was saving time. One nurse said the following:

... Just putting in home medications alone takes up so much time. This new telenurse service helps [save time]

Several nurses highlighted that admission and discharge processes are so complex and time-consuming that shifting this work to the ACTN program freed nurses to perform other activities, as reflected by this nurse:

The tele RN is able to spend as much time possible sufficiently educating an admission or discharge while allowing me time to respond to the needs of my other patients saving me time on one patient especially charting.

Emotional and Physical Support

For the second theme, several responses focused less on time management and perceived efficiencies and instead centered more on the emotional appeal and support in having an extra hand, as one nurse mentioned:

Being in such a fast-paced unit, it can be a bit stressful with so many discharges and admissions. Having a helpful hand is beneficial.

Improved Patient Safety

Finally, the third theme was perceived improvement in patient safety by having a telenurse who could “catch missed” issues (eg, an incorrectly identified pharmacy details), simultaneously allowing the primary bedside nurse to focus more intensely on other needs, essentially creating a 2-fold safety promotion. Some nurses noted that they could begin carrying out orders while the telenurses began completing the admission, facilitating quicker treatment and resolution of care needs, thereby improving the safety and quality of care. One nurse mentioned the following:

Allows [telenurses] to take on thorough and accurate admissions, while also preventing any rushing the patient might experience from the primary RN.

When asked for areas of improvement, the most recurring theme was having 24 hours of support during the weekend and during the week. The second theme for improvement was the reduced time to connect to a telenurse. The third theme was the availability of iPads. Nurses mentioned that iPads could sometimes be unavailable in patients’ rooms or they may not be fully charged.

Time of Discharge

The time of day distribution is presented in Figure 2 . The only noticeable difference between the telenursing and nontelenursing cohorts was a shift in the volume of patients discharged before 2 PM compared with those discharged after 2 PM at a hospital-wide level ( Table 1 ). At an individual unit level, these results were not consistent and could be further explored by patient population and their needs to discharge. The variation was further illustrated when reviewing the length of stay of patients in the telenursing and nontelenursing cohorts. Only 5 out of the 12 units showed a decrease in the average inpatient length of stay.

Discharge Length

The ACTN admissions averaged 12 minutes and 6 seconds (SD 7 min and 29 s), and the discharges averaged 14 minutes and 51 seconds (SD 8 min and 10 s). The average duration for ACTN calls was 13 minutes and 17 seconds (SD 7 min and 52 s). Traditional cohort standard practice of a bedside nurse engaging in discharge and admission processes was 45 minutes, consistent with our preimplementation nursing time study.

Principal Findings

Our results suggest that the ACTN program was associated with positive nursing experiences because it saved time. Furthermore, the ACTN program was associated with higher HCAHPS scores in several domains but only in the first series of units that piloted the intervention. In phase 1, the improvement in “communication with doctors” and “would recommend hospital” scores in 1 unit was statistically significant. In phase 2, the improvement in “communication with doctors” score was significant in 2 units and that in “overall rating of hospital” and “would recommend hospital” scores were significant in 1 unit. The time of day discharge was nearly the same in both the telenursing and nontelenursing cohorts. The duration for discharge processes was less than half in the ACTN cohort compared to the nonintervention cohort.

At the time of writing this paper, the United States was experiencing a critical nursing shortage that will likely reach an epidemic level in the next few decades [ 8 ]. Despite the promise shown by telenursing, to our knowledge, only 1 existing paper documents the impact of ACTN programs on HCAHPS-measured patient satisfaction using a small cohort of patients in a single, time-limited pre- and posttelenursing analysis [ 18 ]. A study by Schuelke et al [ 18 ] revealed a 6.2% increase in “communication with meds” and 12.7% increase in “communication with nursing” domain scores; other HCAHPS domains were not evaluated. This research builds upon the promising work of Schuelke et al [ 18 ], evaluating the impact of an ACTN program on several units with a much larger cohort of patients using a staggered rollout and comparing all HCAHPS domains between telenursing and nontelenursing cohorts within the same time frame and in the same units.

By conducting granular HCAHPS analyses, we identified what we believed to be a time sequence variability in that units that rolled out in phase 1 performed considerably stronger in HCAHPS impacts than units that rolled out in later phases. An explanation for this sequence effect might be that some later adopters had less potential for high effect size, given that the first 4 units of the rollout were specifically chosen for their staffing problems compared to later units. ACTN support might have augmented the staffing support to such a degree that allowed the impacts of the program to be more salient. An alternative explanation is that the early adopters and promoters tend to have greater diffusion uptake, greater saturation and adoptability, and greater impacts compared to late adopters or those resistant to adoption [ 19 , 20 ]. Our anecdotal evidence suggests that early adopters might have wanted the telenursing program to succeed; therefore, they applied consistent implementation practices to ensure success. Adopters in later stages were more aware of barriers and potential downsides and might have been more ambivalent about telenursing and, therefore, less likely to modify their behaviors to promote the telenursing program’s success.

Another interesting finding was that the ACTN program seemed to be effective for both medical and surgical units of all specialties. Phase 1 was a mix of medical and surgical units; however, all units experienced increases in scores. Phases 2 and 3 experienced mixed results, without a clear lead for one specialty over the other. This may suggest that ACTN programs are broadly applicable across acute settings and that success depends most crucially on the need and desire of unit leaders.

Our time of day discharge findings showed only a few quantitative positive efficiencies. However, our discharge duration analysis and nursing experience survey results showed that ACTN has major time-saving benefits for nurses, suggesting a discrepancy between perceived and actual time savings versus time-of-day discharge savings. One explanation for this discrepancy may be that many factors beyond nursing impact the time of the day a patient is discharged; therefore, while the bedside nurses’ time is saved, the remaining discharge processes beyond nurses remain unaffected. Specifically, there are 3 segments of time during discharge processes: (1) the time for the discharge order and medication reconciliation [ 21 ] to the time the after-visit summary (AVS) is populated and printed [ 22 ]; (2) the time the AVS is completed and printed to the time the discharge instructions are provided; and (3) the time from providing the discharge instructions to the actual discharge ( Figure 3 ). Notably, telenurses’ involvement is currently limited to only the second segment of time. Specifically, telenurses’ involvement is not initiated until the AVS is printed by the nurse, which means that telenurses cannot positively impact any discharge activity that occurs between the time the discharge order is written and the time the AVS is printed. However, there are inefficiencies and bottlenecks in discharge processes that occur well before the AVS is printed [ 23 , 24 ]. For instance, the discharging physician may write a conditional discharge order early in the morning, listing conditions that cannot be fulfilled within a few hours or it may take bedside nursing longer than anticipated time to print the AVS.

To create a wider cascade effect for positively impacting the discharge processes for all segments of time, we are currently trying to obtain greater transparency through EHR reporting in what occurs for segments 1 and 3. For instance, at present, we know that at least 2 hospitals in our 8-hospital system have high incidence rates of conditional discharge orders that should be reduced. One hospital anecdotally reports that the discharging physician identifies incorrect pharmacies, which requires a nurse to send the scripts back to the discharging pharmacist to reconcile before discharge education can occur [ 25 ]; however, the prevalence and location of these issues remain speculative. Segment 3 is a black box of time [ 26 ]—the time it takes for hospital transport or an ambulance to arrive and move the patient to their destination and the time it takes for the family to pick up the patient. All these factors impact the discharge processes and need to be fully elucidated, explored, and streamlined. Furthermore, we hope to facilitate processes that enable telenurses to print the AVS, to remove the dependency on bedside nurses to begin the discharge education process.

Limitations

This study has several noteworthy limitations. First, the study was conducted in 1 health system and the results may not be generalizable to other settings with different patient populations, processes, and implementation strategies [ 27 ]. Second, in this study, we did not control for other factors that could impact patient and provider satisfaction as well as discharge times; telenursing can only improve upon one component in a complex set of factors limiting discharge efficiency and satisfaction outcomes. Finally, participating nurses were aware of the ongoing study, and this knowledge might have affected their behavior [ 28 ].

Future Directions

After the completion of this pilot study, the ACTN admission and discharge program has been rolled out to pilot medical units and all surgical and observation units. Our rationale for expansion rested on the premise that nursing experience is important to maintain and strengthen, particularly at a time when turnover is high in the health care industry in general. It is important to reduce staff inefficiencies in workload as a means of preserving or strengthening organizational morale and cost saving. Because our nursing experience findings for the ACTN program heavily supported the program, this served as the primary motivation for expansion. The nursing experience findings, coupled with the findings related to time-savings in discharge education and modest improvement, though not negative, in the HCAHPS findings for the ACTN program compared to the nontelenursing cohort, further supported expansion.

The initial scope for expansion included a complete system-wide implementation for all admissions and discharges. Furthermore, we are planning to expand the ACTN program beyond admissions and discharges. Responsive to qualitative feedback reported earlier, the next phase of the ACTN program will add safeguards on high-risk medications by having telenurses conduct double-checks, skin assessments, hourly rounding assistance, and auditing of safety functions and educational activities. These activities were chosen because they are time-intensive for nursing staff on the patient floors. Additional support in these areas would be a staff morale booster in addition to improved efficiencies for bedside nursing. Conducting hourly rounding using the ACTN program will require more time and resources; however, conducting high-quality, uninterrupted hourly rounds is known to be effective at improving patient safety and patient experience outcomes [ 29 ]. Therefore, we suspect that the ACTN program will have some positive impacts if rounds are consistently conducted, even if conducted virtually.

In addition, the ACTNs have been motivating other specialties to adopt or consider a similar program as the ACTN program to support stretched staffing. These specialties include respiratory care, in which virtual support can quickly identify patients in need of intensive on-site support; pharmacy, in which direct communication with staff on medications and patient training can happen through virtual means; infection control, in which room environments can be reviewed through virtual audits, moving quickly from floor to floor; and guest relations and spiritual care, in which patients can be visited virtually upon patient request. Furthermore, physicians who wish to either virtually enter inpatient rooms during their clinic days or from home can quickly drop in to see patients using the virtual program. For these groups to further develop advanced inpatient telemedicine programs, additional technology will be required, including cameras that can zoom into various portions of the room and advanced sound capabilities. Future work could expand programs similar to ACTN to specialties such as respiratory therapy, pharmacy, infection prevention, and spiritual care.

Conclusions

This study provides preliminary evidence suggesting that telenursing may effectively address nursing shortages in acute care settings and positively impact patient and provider satisfaction as well as admission and discharge times. More work is needed to validate the findings in other settings, use other satisfaction metrics, and investigate the impact of telenursing on the quality of care and cost.

Acknowledgments

The authors would like to thank Jacob M Kolman, MA, ISMPP CMPP, senior scientific writer, Houston Methodist Academic Institute, for the critical review and for providing formatting feedback on this manuscript. The authors would also like to thank Amir Hossein Javid for his help with statistical analysis.

Data Availability

Data sharing is not applicable as no data sets were generated during this study.

Authors' Contributions

All authors were involved in the conceptualization, review and approval, and writing of the manuscript. LR, BJ, MG, RS, SK, and MH were extensively involved in the implementation of the project. BJ, MH, SK, and MG conducted the training. SK and XL conducted the analyses. CRB wrote and edited the manuscript, inserted and refined the citations, and provided critical feedback during implementation and analyses. CRB and FS were involved in all stages of writing and publication. All authors meaningfully contributed to the drafting, writing, brainstorming, executing, finalizing, and approving of the manuscript.

Conflicts of Interest

None declared.

Additional outcome information for Hospital Consumer Assessment of Health Care Providers and Systems, time of day discharges, and discharge education processes.

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Abbreviations

Edited by T de Azevedo Cardoso, G Eysenbach; submitted 06.11.23; peer-reviewed by C Jensen; comments to author 08.12.23; revised version received 16.01.24; accepted 17.02.24; published 04.04.24.

©Courtenay R Bruce, Steve Klahn, Lindsay Randle, Xin Li, Kelkar Sayali, Barbara Johnson, Melissa Gomez, Meagan Howard, Roberta Schwartz, Farzan Sasangohar. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 04.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

Online post-purchase customer experience: a qualitative study using NVivo software

• Published: 26 September 2022
• Volume 57 , pages 3763–3781, ( 2023 )

Cite this article

• Mehak Goyal   ORCID: orcid.org/0000-0002-2959-3159 1 &
• Pankaj Deshwal 1  

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Design/methodology/approach:

This study applies qualitative data analysis approach. 40 In-depth interviews were taken using non-probability sampling technique. then the recorded audios were transcript into MS Word file. the collected data was analysed using NVivo software by QSR International.

By presenting new insights into the field of marketing research using content analysis. To identify the factors affecting the post purchase behaviour of the customer. The same will also be helpful for the mangers to formulate strategies to better understand online customer experience and predict their future actions.

Text search query and hierarchal chart identified the various factors influencing online post purchase customer experience and also compared these factors in terms of frequency in the data set provided. Conceptual model (OPPCE) provided eight factors such as delivery, return and refund policy, customer support etc., these factors could be used by scholars and academicians for further research in this domain.

Originality:

To the knowledge of the authors, it is the first study of its kind to attempt to perform content analysis of online post purchase customer experience concept The study aims to identify various unexplored factors influencing online post purchase customer experience. qualitative approach was applied in only countable studies in extant literature, this study fills this research gap.

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Following is the interview guide.

Ques: 1 What factors motivates you to buy from an online retailer again?

Ques: 2 what services matters to you post purchase?

Ques: 3 Tell me one of your best post purchase experience?

Ques: 4 Tell me one of your worst post purchase experience?

Ques: 5 Do your Erie Taylor gives you any additional benefit?

Ques: 6 Do your favorite E retailer gives you any personalized services?

Ques: 7 Do you agree with this statement that any kind of emotional and social values are attached with the products that we purchase?

Ques: 8 Any suggestions to the online retailers for better post purchase experience anything that they’re missing on.

Ques: 9 Do you agree that refund/return policy is misused by the customer?

Ques: 10 Do you give feedbacks of the experience u got from the purchase, if yes then in what form.

Online Post-Purchase Customer Experience: A qualitative study using NVivo software .

Mehak Goyal 1 (Corresponding author).

Dr. Pankaj Deshwal 2 .

1 PhD scholar, Department of Management Studies, Netaji Subhas University of Technology, New Delhi, India. Email Address: [email protected], Phone No. 9,582,102,663.

2 Assistant Professor Department of Management Studies, Netaji Subhas University Of Technology, New Delhi, India. Email Address: [email protected], Phone no.9,013,246,582.

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Goyal, M., Deshwal, P. Online post-purchase customer experience: a qualitative study using NVivo software. Qual Quant 57 , 3763–3781 (2023). https://doi.org/10.1007/s11135-022-01492-9

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Received : 26 April 2021

Accepted : 03 July 2022

Published : 26 September 2022

Issue Date : August 2023

DOI : https://doi.org/10.1007/s11135-022-01492-9

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