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Qualitative approaches

An overview of three
different approaches to the
interpretation of qualitative
data. Part 1: theoretical
issues
In this paper, the first of two, Helena Priest, Paula Roberts and Leslie
Woods discuss the essential features and methods inherent within three
approaches to the interpretation of qualitative data. An overview of three
methodologies commonly used in nursing and healthcare research is
presented: grounded theory, qualitative content analysis and narrative
analysis. The paper considers the philosophical bases of the three
methods and the principles inherent within each analytical approach.
Key stages and steps are presented and described

Keywords: methodological choice, qualitative methods, grounded

theory, qualitative content analysis, narrative analysis

Introduction and aims

One of the most challenging aspects of conducting qualitative research
lies in the analysis of the data. Unfortunately, for the novice researcher
there remains, within the literature, a lack of detailed guidance
concerning how qualitative data should be handled and analysed (with
one or two exceptions, for example, Miles & Huberman 1994, Strauss
and Corbin 1998). The aim of this article is to provide an overview of
three different approaches that can be used to analyse and interpret
data. These are: grounded theory analysis, content analysis and
narrative analysis. In this paper, we provide a brief outline of the
philosophical basis to each approach, along with key analytical
principles. Then, in Part 2 (Woods et al 2002, published in this issue
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of Nurse Researcher), using a generic interview extract, we aim to

demonstrate how the different approaches might be applied to a
common data set.
It is acknowledged that many approaches to the generation and analysis
of qualitative data are available and popular in healthcare research.
Notable approaches include descriptive phenomenology, drawing, for
example, upon the work of Colaizzi (1978), Giorgi (1985) and van
Kamm (1969), and interpretive phenomenological approaches, drawing,
for example, upon the work of Heidegger (1962). However, this paper
aims to introduce and describe alternative approaches that, because they
are less frequently used, may not initially be considered by the novice
researcher, but which have much to offer in enabling exploration and
understanding of qualitative data.

Grounded theory
Background philosophy
Of the three approaches discussed in this paper, grounded theory
(Glaser and Strauss 1967), which has its conceptual orientation in
symbolic interactionism (Blumer 1969), is probably the most familiar
to nurse researchers. Nusbaum and Chenitz (1990) explain that
symbolic interactionism holds that human beings are acting rather
than just responding beings and that human action is purposeful and
based on the meanings that the individual has for them. Consequently,
data must be collected in the natural context using a variety of methods
such as interview and observation. Grounded theory aims to generate
theory through inductive examination of data in subject areas that may
be difficult to access with traditional quantitative research methods
(Rennie et al 1988).
In terms of analysing and collecting data, Glaser and Strauss (1967)
describe a set of systematic procedures that they term the constant
comparative method. In essence, this is an iterative process involving
concurrently collecting and analysing data with the ultimate aim of
generating a theory (during the actual research) that is grounded in
the natural context in which the inquiry takes place (Strauss and Corbin
1994). Unfortunately, this is not as straightforward or as simple as it
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Qualitative approaches
may sound. For inexperienced and experienced researchers alike, the
notion of collecting data, coding and categorising it, writing memos
about emerging ideas and concepts, determining a core category, and
constantly recycling through the stages to eventually generate a cogent
theory is, to say the least, challenging. Consequently, it is not
surprising to find, when examining published nursing research
claiming to use this approach, that often what studies describe as
grounded theory is limited primarily to the utilisation of the now
well-known analytical procedures and not to the development of any
substantive theory per se.
One explanation for this phenomenon may be to do with McLeods
(1995) assertion that grounded theory provides a set of analytic
techniques that can be seen as representing procedures that are
consistent with, or have been assimilated into, most other approaches
to qualitative research. This may go some way towards explaining why
some novice researchers are attracted to grounded theory as an
approach to qualitative enquiry. Whereas some other traditions tend to
describe analytical strategies from first principles, grounded theory
follows a very structured and systematic approach to the creative
process. This systematisation to qualitative data analysis has its
advocates and its opponents. On the one hand, those in favour point to
the necessity for qualitative researchers, from whatever tradition, to
clearly demonstrate systematic methods to data analysis that are both
reliable and replicable (Miles and Huberman 1994). This has much to
do with the historical status of qualitative research in the scientific
community and about gaining legitimacy. However, Silverman (1993)
warns that used unintelligently, such procedures and techniques can
degenerate into a collection of empty categories that have limited
value in theory generation. Moreover, others point out the
methodological dangers associated with the systematisation of data
analysis through set procedures or the use of computer software
packages (Coffey et al 1996). Whatever the view held, however, there
can be little doubt that grounded theory techniques are increasingly
being used as an analytic framework by qualitative researchers.
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Grounded theory fundamental analytic principles

This section can give only the briefest of overviews of the analytic
principles adopted within grounded theory. It will draw primarily on the
work of Strauss and Corbin (1998) as a template, and readers are strongly
urged to refer to the original text for a fuller exposition if they wish to
pursue this approach.
Grounded theory uses three sets of coding procedures that help the
analyst break down the original data, conceptualise it and re-arrange it
in new ways. The three coding stages are termed open coding, axial
coding and selective coding (Strauss and Corbin 1998). The ultimate aim
of utilising these procedures is to allow a systematic, dense, explanatory
theory to be developed. It is important to point out that coding in the three
stages does not necessarily follow in sequence. Indeed, Strauss and
Corbin (1998) point out that in any one coding session it is possible to
move between different forms of coding. Given the purpose of this paper
this section will focus primarily on open and axial coding.

Open coding
This is the first part of the analytic process and primarily involves
fracturing: taking the data apart and examining the discrete parts for
differences and similarities. By the data we mean a sentence or paragraph
of speech from an interview or an observation. While this process is
underway the analyst will ask questions of the data; for example, when
reading a transcript about the core concepts of nursing, an analyst might
ask: What is the basis for this point of view? Do other participants hold
similar beliefs? Is there a specific theme or concept to which this issue
relates? It is questioning of this nature that leads to new discoveries being
made in the data. This process is characteristic of the constant
comparative method described by Glaser and Strauss (1967). The aim
of this stage of analysis is to identify discrete concepts, which are the
basic units of analysis in grounded theory (Strauss and Corbin 1998). By
looking for similarities and asking questions, concepts that are in essence
very similar can eventually be labelled with the same name. Each concept
can then be defined in terms of a set of discrete properties and dimensions
to add clarity and understanding. In due time, the list of concepts
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Qualitative approaches
generated has to be sorted into groups of similar or related phenomena,
which in turn become categories. According to Strauss and Corbin
(1998), categories have conceptual power because they can pull together
other groups of concepts or sub-categories. It is this feature that moves
open coding on to axial coding.

Axial coding
Whereas open coding is used to break down the data and to identify first
level concepts and categories, axial coding is the term used to denote
the way in which connections are made in new ways between categories
and sub-categories. Strauss and Corbin (1998) describe the key
difference of this stage as being the identification of specific features,
such as the conditions that give rise to the phenomenon and the context
in which the concept is embedded, which in turn help to give precision
to a category or sub-category. They note that open and axial coding can
occur in tandem even though they are distinct analytical procedures. To
help to clarify the point of axial coding Strauss and Corbin (1998)
describe an organisational scheme they call a paradigm, in which a
phenomenon is analysed in terms of its context, conditions and
consequences. That is to say, as an analyst you are guided to think about
what caused the phenomenon to occur: the context in which the
phenomenon occurred; what intervening conditions were present; and
what actions and consequences arose as a result.
While use of a paradigm may seem somewhat complicated, it does
serve the very useful purpose of promoting a systematic approach to
adding precision and density to your analysis (Strauss and Corbin 1998).
As axial coding proceeds, patterns in the data become apparent (N.B.
they do not just appear), and it is possible to generate tentative hypotheses
or statements of relationships between phenomena. The next stage is to
verify if these statements hold true against the rest of the data you have
collected, or if they can be used as a focus for future data collection.
However, as Strauss and Corbin (1998) importantly point out, this phase
is not simply about seeking confirmation of relationships, but also
involves looking for instances where there are variations and
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contradictions in the data. Whereas in some quantitative research designs

the discovery of competing perspectives might bring the results of
analysis into dispute, in grounded theory such findings do not necessarily
negate hypotheses (although they might if the evidence is sufficient), but
add variation and depth to understanding of the phenomenon (Strauss
and Corbin 1998).

Selective coding
The final phase of coding in the grounded-theory approach is called
selective coding. This stage involves identifying one or two core
categories to which all other sub-categories relate and building a
conceptual framework from which to develop a grounded theory. It is
this final integration of codes and categories into a coherent theory that
is probably the greatest challenge and, ironically, probably one reason
why many studies compromise this stage of analysis. That is to say that
many analysts will often choose to present their findings thematically,
based around the categories that have been developed following grounded
theory techniques, instead of developing a true grounded theory. It is
beyond the scope of this article to discuss the reasons for this
phenomenon or to enter into wider methodological debate about the
implications for the grounded theory method, but readers should be aware
that some studies described as grounded theory often fail to develop
any substantive theory. Those wishing to explore the grounded theory
approach further will find numerous examples of its application, along
with methodological critique, in the nursing literature.
The following section gives an overview of an alternative approach
to data analysis, namely qualitative content analysis.

Qualitative content analysis

Background philosophy
Content analysis originated in the 1950s as a quantitative approach to
analysing the content of media text to enable similar results to be
established across a group of text coders (Berelson 1952). However, this
quantitative method, whereby text is broken down into quantifiable units,
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Qualitative approaches
was challenged by a further development. Kracauer (1953) argued that
text loses its meaning through radical reduction which reduces it to
distinct words, and advocated a qualitative approach to content analysis
whereby meanings and insights are elicited from the text more
holistically. A new form of content analysis, qualitative content analysis,
also known as ethnographic content analysis, developed (Altheide 1996).
Qualitative content analysis facilitates contextual meaning in text through
the development of emergent themes (Bryman 2001) derived from textual
data. Repetition of coding produces the significance of particular themes
(Burton 2000). Qualitative content analysis may be derived through
manifest content, whereby respondents actual words form concepts, or
through latent content, whereby concepts are derived from the
interpretation and judgement of participants responses (Wood 2001).
Content analysis is a widely used method of eliciting meaning from text,
and is increasingly undertaken through computerised software packages
(see Woods and Roberts 2000).

Content analysis fundamental analytic principles

Content analysis facilitates the production of core constructs from
textual data through a systematic method of reduction and analysis
(see Miles and Huberman 1994). Exploratory studies particularly lend
themselves to content analysis in that it gets the answers to the
question to which it is applied (Carney 1973). In exploratory studies
such categories may be formulated from question areas in interview
schedules or questionnaires (see Weber 1990, Cavanagh 1997). Text
is coded into established categories to support the generation of ideas.
The number of times a similar piece of text or idea unit is attributed
to a particular category can then be counted. The method lends itself
particularly to qualitative computerised analysis where large sections
of text can be rapidly coded (for a more in-depth discussion on the use
of computerised software in qualitative research see Roberts and
Woods 2000).
Using qualitative computerised software packages, analytic categories,
or master codes, can be created prior to coding (Mishler 1990). From
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these sub-codes or analytic variables emerge. In addition, a further

analytic category or free node is usually established to enable the
analysis of data that do not readily fit into existing analytic categories.
Thereafter, a process of first-level coding can begin through line-by-line
analysis whereby highlighted chunks of varying size, for example,
phrases, sentences, or whole sections (Miles and Huberman 1994), are
pasted to particular analytic categories. Thus several paragraphs of text
can be reduced through content coding.
Through content analysis, this process progresses to second-level
coding whereby a more detailed indexing is undertaken. Concepts are
then further explored and indexed according to content in a process
known as nesting (QSR NUD*IST guide, 1997). In some computer
programs, for example, QSR NUD*IST, this process facilitates the
development of visual index trees, an indexing system that contains the
master codes or core nodes and their subsequent concept formation
comprising sub-categories or branch nodes for a whole project.
Following data reduction, constructs are formulated through a process
of interpretation based on the contextual settings from which data were
derived (Parahoo 1997). The process of data analysis becomes one of
continual checking and questioning of emerging themes (Marshall and
Rossman 1989). In order to substantiate derived themes, a reverse process
ensues to delve into distinct data sets in order to derive sources of
supportive evidence and ascertain direct quotations from transcripts (the
process of generating theory and evidence with the assistance of QSR
NUD*IST4 is described more fully in Woods and Roberts 2000).
Content analysis is a particularly reliable means of analysing qualitative
data in that reliability of coding decisions can be confirmed by revisiting
previously coded data periodically to check the stability over time (see
Roberts 1999). Additionally, computerised data analysis packages
enhance coding rules in that the computer provides perfect coder
reliability in applying the rules built into the program (Robson 1994).
Furthermore, line-by-line numbering, inbuilt in such programs, assists
inter-coder reliability. However, it is important to be aware that an overemphasis on standardization may detract from contextual meaning
(Burton 2000).
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Qualitative approaches
The final section in this paper gives an overview of a third approach
to the analysis of qualitative data, namely narrative analysis.

Narrative analysis
Background philosophy
Communication through telling stories is a natural human impulse (White
1981). Through telling their stories, people can express their identity,
relationships and emotions. Furthermore, they can order and orientate
life events, in some cases gaining a sense of perspective upon these
events, and can often solve problems (McLeod 1997). Bruner (1986)
claimed that narrative knowledge (that is, knowledge derived from stories)
was as essential as paradigmatic knowledge (knowledge gained from
science) in enabling people to make sense of the world. Despite this, the
use of narrative had, until the 1970s, been little regarded by researchers,
including those in nursing and health care (McLeod 2001). Since that
time, an increase in popularity in using narratives as sources of research
data has led to the conclusion that narrative has rapidly become an
extraordinarily rich site of interdisciplinary study (DeVault 1994). Hence,
the growing use of narrative analysis in counselling, psychotherapy, and
healthcare research can readily be understood.
Narrative analysis does not have a single heritage or methodology, and
has been described as being unclear about its epistemological influences
(Redwood 1999). It draws, among other sources, upon philosophy,
anthropology, sociology, psychology, sociolinguistics (McLeod and
Balamoutsou 2000), ethnomethodology and literary criticism (Torode
1998). Such diversity has led to the development of a wide range of
approaches to, and uses of, narrative as a form of qualitative research.
Whichever approach is used, however, the function of narrative analysis
is to consider the potential of stories to give meaning to peoples lives,
and the treatment of data as stories (Emden 1998a).
The terms narrative and story are sometimes considered equivalent
terms and used interchangeably (Polkinghorne 1988, Wiltshire 1995),
although a narrative can be taken to be greater than, and more structured
than, a story. McCance et al (2001) note that the interview, and in
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particular the unstructured interview, is the data-generation method most

often selected by researchers using narratives. A narrative may, thus, be
any extended segment of talk in which an interviewee is telling a story
(Lucas 1997). However, narrative analysis can be applied to any form of
textual data, such as that provided by diaries, journals, or written accounts
of critical incidents, in addition to data generated from interviews.

Narrative analysis fundamental analytic principles

Sandelowski (1991) has noted that although nurses conducting
qualitative studies typically create conditions in which stories are told
they have not, until recently, adequately considered methods for analysing
and understanding such stories. Within any set of textual data stories may
be found. How then may narrative analysis be used to make
interpretations of meaning within such data? There is a view that formal
how to do it manuals are unhelpful, because individual researchers must
create their own method (McLeod and Balamoutsou 2000). While this
may be desirable, the aspiring narrative analyst may prefer, initially, to
follow a set procedure.
As a general principle, within any story, a beginning, middle and end
can be identified (Riessman 1993). Furthermore, a plot or core story, in
other words, the main point or meaning that the teller wishes to convey,
can be determined. Emden (1998b) describes a procedure that may be
applied to transcribed interview data in order to arrive at this core story.
First, the text is read several times. Interviewer questions and comments
are deleted, as are words that detract from the key idea of each sentence
or group of sentences. The remaining text is read for sense, and any
further detracting words or phrases deleted. This procedure is repeated
as often as necessary until fragments of themes (sub-plots) remain. These
sub-plots are moved together to create a coherent core story. Emden
(1998b) recommends that, at this point, the core story is returned to the
interview participant for correcting or developing as necessary.
Alternatively, McLeod and Balamoutsou (2000) describe a step-bystep procedure in which the whole transcript is analysed for the presence
of stories before segments of text are selected for more detailed microanalysis. These text segments are transformed from their prose form into
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stanzas (Gee 1986, 1991) such that the text reads as a poem. The structure
of the selected story can then be analysed according to its elements.
Labov and Waletzky (1967), for example, suggest that the key elements
of a story are: abstract, orientation, complicating action, resolution,
evaluation and coda. However, such a method, with its micro-focus on
language and grammar, may be less useful to a nurse researcher than an
approach that explores the function and importance of the narrative for
the teller, such as that outlined by Emden (1998b).
Finally, as with many other qualitative analysis methods, computer
software is becoming available to assist with the management of data
and the identification of narratives within text. Torode (1998), for
example, used the Code-A-Text computer software (Cartwright 1997) to
bring a new precision to narrative analysis, through the identification of
stories within stories.

Conclusion
This paper has given an overview of the background, philosophy, and
fundamental analytical principles inherent within three qualitative
research approaches. Paper 2 (Woods et al 2002, published in this issue
of Nurse Researcher) goes on to illustrate, with reference to a section of
text, how the three approaches can be applied to the practical analysis of
interview data.
Helena Priest PhD, MSc, BA, RMN, Dip N, Dip N Ed, Lecturer, Keele
University, Staffordshire, England
Paula Roberts PhD, MA Ed Mgmt, RMN, RGN, Cert Ed, Cert HEd,
ILTM, Senior Lecturer, Keele University, Staffordshire, England, and
Editor, Nurse Researcher
Leslie Woods PhD, BSc(Hons), Cert Ed, RGN, DN Cert, Lecturer,
University of Liverpool, England

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