qualitative research in pharmacy education

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A Review of the Quality Indicators of Rigor in Qualitative Research

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1 William Carey University School of Pharmacy, Biloxi, Mississippi.
2 Louisiana State University, School of Medicine, New Orleans, Louisiana.
PMID: 32292186
PMCID: PMC7055404
DOI: 10.5688/ajpe7120

Attributes of rigor and quality and suggested best practices for qualitative research design as they relate to the steps of designing, conducting, and reporting qualitative research in health professions educational scholarship are presented. A research question must be clear and focused and supported by a strong conceptual framework, both of which contribute to the selection of appropriate research methods that enhance trustworthiness and minimize researcher bias inherent in qualitative methodologies. Qualitative data collection and analyses are often modified through an iterative approach to answering the research question. Researcher reflexivity, essentially a researcher's insight into their own biases and rationale for decision-making as the study progresses, is critical to rigor. This article reviews common standards of rigor, quality scholarship criteria, and best practices for qualitative research from design through dissemination.

Keywords: best practices; qualitative research design; quality; standards of rigor.

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Denzin Norman, Lincoln YS. The Sage Handbook of Qualitative Research. 4th ed. Los Angeles, CA: Sage Publications; 2011.
Anderson C. Presenting and evaluating qualitative research. Am J Pharm Educ . 2010; 74(8):Article 141. - PMC - PubMed
Santiago-Delefosse M, Gavin A, Bruchez C, Roux P, Stephen SL. Quality of qualitative research in the health sciences: analysis of the common criteria present in 58 assessment guidelines by expert users. Soc Sci Med. 2016;148:142-51. - PubMed
O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med . 2014;89(9):1245-1251. - PubMed
Morse JM. Qualitative Health Research: Challenges for the 21st Century. Qual Health Res. 2002;12(1):116-129. - PubMed

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Home > Colleges and Schools > Education > ELWD > Faculty Pubs > 63

Educational Leadership & Workforce Development Faculty Publications

Qualitative research in pharmacy education: an exploration of pharmacy education researchers' perceptions and experiences conducting qualitative research.

Antonio A. Bush Mauriell Amechi , Old Dominion University Follow Adam Persky

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10.5688/ajpe7129

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American Journal of Pharmaceutical Education

Conclusion. The application of rigorous qualitative research in pharmacy education holds great potential in addressing complex and evolving healthcare problems. This work provides empirical evidence of the ongoing anecdotal dialogue that has long existed in pharmacy education concerning why some researchers are hesitant to conduct qualitative research, the challenges encountered by those who employ qualitative approaches, and the benefits qualitative approaches provide.

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Original Publication Citation

Bush, A. A., Amechi, M., & Persky, A. (2020). Qualitative research in pharmacy education: An exploration of pharmacy education researchers' perceptions and experiences conducting qualitative research. American Journal of Pharmaceutical Education, 84 (3), 334-344. doi:10.5688/ajpe7129

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Bush, Antonio A.; Amechi, Mauriell; and Persky, Adam, "Qualitative Research in Pharmacy Education: An Exploration of Pharmacy Education Researchers' Perceptions and Experiences Conducting Qualitative Research" (2020). Educational Leadership & Workforce Development Faculty Publications . 63. https://digitalcommons.odu.edu/efl_fac_pubs/63

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Research Designs and Methodologies Related to Pharmacy Practice

The need for evidence to inform policy and practice in pharmacy is becoming increasingly important. In parallel, clinical pharmacy and practice research is evolving. Research evidence should be used to identify new areas for improved health service delivery and rigorously evaluate new services in pharmacy. The generation of such evidence through practice-based research should be predicated on appropriate use of robust and rigorous methodologies. In addition to the quantitative and qualitative approaches used in pharmacy practice research, mixed methods and other novel approaches are increasingly being applied in pharmacy practice research. Approaches such as discrete choice experiments, Delphi techniques, and simulated client technique are now commonly used in pharmacy practice research. Therefore, pharmacy practice researchers need to be competent in the selection, application, and interpretation of these methodological and analytical approaches. This chapter focuses on introducing traditional and novel study designs and methodologies that are particularly pertinent to contemporary clinical pharmacy and practice research. This chapter will introduce the fundamentals and structures of these methodologies, but more details regarding the different approaches may be found within the Encyclopedia.

Learning Objectives

• Discuss the value of pharmacy practice research to evidence-based practice and policy.
• Describe the classifications and types of study designs commonly used in pharmacy practice research.
• Discuss the concepts and structure of common study designs used in pharmacy practice research including experimental, quasi-experimental, observational, qualitative, and mixed method designs.
• Discuss the important considerations for conducting pharmacy practice research in terms of study design, data collection, data analyses, and ethical considerations.

Introduction to Research Methodologies Used in Pharmacy Practice

The mission of pharmacy profession and the role of pharmacists in healthcare have evolved toward patient-centered care in the last few decades. Pharmacists with their expertise in drug therapy and accessibility to the public have unprecedented opportunities to assume increasing responsibility for direct patient care ( Bond, 2006 ). New cognitive pharmaceutical services and new roles for pharmacists continue to emerge.

In the era of evidence-based practice and health services, it is not just adequate to propose those new pharmacy services or new roles without evidence of their benefit ( Awaisu and Alsalimy, 2015 , Bond, 2006 ). New pharmacy services and new roles must be proven to be feasible, acceptable, cost-effective, and increase health outcomes. Pharmacy practice research provides such evidence and can confirm the value of a new service, inform policy, and result in practice changes ( Bond, 2006 , Chen and Hughes, 2016 ). Research evidence should be used to identify new areas for improved health service delivery and rigorously evaluate new services. The research used to generate such evidence should be grounded in robust and rigorous methodologies ( Chen and Hughes, 2016 ). Traditionally, common quantitative and qualitative methods such as randomized controlled trials, cohort study, case control study, questionnaire-based surveys, and phenomenology using qualitative interviews have been used in pharmacy. However, in recent years, novel and more complex methods are being developed and utilized. Pharmacy practice researchers need to know how these old and new methodological approaches should be selected, applied, and interpreted in addressing research problems.

Various study designs, including, but not limited to experimental, quasi-experimental, observational, qualitative, and mixed method designs, have been used in pharmacy practice research. Furthermore, different classification systems (e.g., quantitative vs. qualitative, experimental vs. observational, descriptive vs. analytical study designs) have been used in the literature. The choice of a study design to answer a research question in pharmacy practice research is driven by several factors, including the type of the research question or the research hypothesis, expertise of the investigator, availability of data, and funding opportunities. Pharmacy practice researchers need to be competent in the selection, design, application, and interpretation of these methodological and analytical approaches. Today, many of the research methods used in pharmacy practice research have been adapted from fields such as sociology, anthropology, psychology, economics, and other disciplines. This paradigm shift has led to a greater emphasis on the appropriate choice of a specific research design or method to answer a specific research question ( Chen and Hughes, 2016 ). Consequently, pharmacy practice researchers should place an emphasis on the reliability of the methods selected, the correct interpretation of their findings, the testing of a specific hypothesis, and the internal validity of their data, among other considerations. Novice and early career researchers should be familiar and have sound foundation in a variety of methods applied in pharmacy practice research, which will be covered in this chapter and other chapters in this Encyclopedia. We do believe that more experienced researchers should focus on certain methods in order to advance research in our discipline.

Core Quantitative and Qualitative Approaches Used in Pharmacy Practice Research

Traditionally, core quantitative approaches used in pharmacy practice research include nonexperiments, quasi-experimental designs, and true experimental designs such as prospective randomized controlled intervention trials. Nonexperiments also include observational study designs that are often described as pharmacoepidemiologic study designs such as case–control study, cohort study, nested case–control study, and cross-sectional study ( Etminan, 2004 , Etminan and Samii, 2004 ). In recent years, conventional qualitative approaches and their philosophical paradigms are increasingly been used in pharmacy. These include the five qualitative approaches to inquiry: narrative research, phenomenology, grounded theory, ethnography, and case study. These qualitative methods are often difficult for pharmacy practice researchers to comprehend, and researchers tend to describe the methods of data collection such as individual interviews and focus group discussions as qualitative methods of inquiry. These data collection methods are briefly described later in this chapter, among others. Furthermore, there is an increasing importance on the appropriate selection and use of mixed method approach ( Hadi et al., 2013 ; Hadi and Closs, 2016a , Hadi and Closs, 2016b ), which are often designed and applied wrongly. Finally, it is worthwhile to be familiar with novel research methodologies such as discrete choice experiments, Delphi techniques, simulated client technique, and nominal group techniques, which fall between quantitative and qualitative approaches, often with no clear differentiation on where they belong. Although called “novel” in the context of this chapter, these methods are not new in other relevant disciplines, but new and not commonly used in pharmacy practice research.

Research Question and Selection of Study Design

Pharmacy practice researchers begin by conception of a research idea or identifying a research question and defining a hypothesis based on the question. The researcher then selects a study design that will be suitable to answer the research question. The study design should be appropriately selected prior to initiation of any research investigation. Selecting an inappropriate study design may potentially undermine the validity of a study in its entirety. Investigators are encouraged to critically think about the possible study designs to ensure that the research question is adequately addressed and should be able to adequately justify their choice. These study designs have been variously classified and one common classification system is quantitative vs. qualitative study designs. Study designs play a major role in determining the scientific value of research studies. Inappropriate choice of a study design is impossible to correct after completion of the study. Therefore, thorough planning is required to avoid unconvincing results and invalid conclusions. Good understanding of basic study design concepts will aid researchers in conducting robust and rigorous practice-based research. This chapter introduces the structure and the fundamentals of common study designs used in pharmacy practice research and discusses the important considerations for conducting pharmacy practice research in terms of study design, data collection, data analyses, and ethical considerations.

Classification of Research Methodologies Used in Pharmacy Practice

Various classifications for research designs and methods used in pharmacy practice have been used in the literature. The following are some of the approaches for the classification of research designs:

Case example: Investigators were looking for the association between acute myocardial infarction and smoking status, type of tobacco, amount of smoke, etc. ( Teo et al., 2006 ). Another example of a case–control study from published literature is the study investigating the association between the use of phenylpropanolamine and the risk of hemorrhagic stroke ( Kernan et al., 2000 ).

Case example: Investigators were interested to determine the long-term effectiveness of influenza vaccines in elderly people; they recruited cohorts of vaccinated and unvaccinated community-dwelling elderly ( Nichol et al., 2007 ).

Case example: A case report was written by a physician who contracted Severe Acute Respiratory Syndrome (SARS) during an outbreak in Hong Kong ( Wu and Sung, 2003 ). Another example is an ecological study examining diet and sunlight as risks for prostate cancer mortality ( Colli and Colli, 2006 ). Chim et al. conducted a large population-based survey in Australia to determine what community members think about the factors that do and should influence government spending on prescribed medicines ( Chim et al., 2017 ).

Case example: A group of investigators carried out a study to establish an association between the use of traditional eye medicines (TEM) and corneal ulcers. In this case, both case–control and cohort study designs are applicable. In an example of a case control study, Archibugi et al. aimed to investigate the association between aspirin and statin exclusive and combined and pancreatic ductal adenocarcinoma occurrence ( Archibugi et al., 2017 ). Another example of a cohort study is a study carried out by Wei et al. in which they investigated whether or not acid-suppression medicines increased the risk of bacterial gastroenteritis ( Wei et al., 2017 ).

Case examples: Investigators conducted a study about the newer versus older antihypertensive agents in African hypertensive patients (NOAAH) trial (nct01030458) to compare the efficacy of single-pill combinations of newer versus older antihypertensive agents (i.e., a single-pill combination of newer drugs, not involving a diuretic, with a combination of older drugs including a diuretic) ( Odili et al., 2012 ). In a crossover design, a group of investigators evaluated the effect of spironolactone on nonresolving central serous chorioretinopathy ( Bousquet et al., 2015 ).

Case examples: Prashanth et al. aimed to understand if (and how) a package of interventions targeting primary health centers and community participation platforms affect utilization and access to generic medicines for people with noncommunicable diseases using quasi-experimental design approach ( Prashanth et al., 2016 ).

c. Observational design—It involves only observation of natural phenomena and does not involve investigator intervention. Typically, this study design investigates associations and not causation. Examples include cohort study and case–control study. These studies can explore an association between a pharmacologic agent and a disease of interest. Case examples: Please see previous examples of these.

Case examples: Please see experimental studies, and case–control and cohort study designs.

Case examples: Investigators in Canada explored the lived experiences of youth who are prescribed antipsychotics by conducting interpretative phenomenology study ( Murphy et al., 2015 ).

Case examples: Shiyanbola et al. combined focus group discussion with a survey tool to investigate patients' perceived value and use of quality measures in evaluating and choosing community pharmacies ( Shiyanbola and Mort, 2015 ).

Below is a brief description of traditional and novel pharmacoepidemiologic study designs. Several examples of pharmacoepidemiologic study designs are provided above. Some descriptive studies including case reports, case series, and ecological studies will not be described in this chapter.

a. Case–control studies—In this design, patients (those who develop the disease or outcome of interest) are identified and control patients (those who do not develop the disease or outcome of interest) are sampled at random from the original cohort that gives rise to the cases ( Etminan and Samii, 2004 , Newman et al., 2013 ). The distribution of exposure to certain risk factors between the cases and the controls is then explored, and an odds ratio (OR) is calculated.
b. Cohort studies—This can be described as a study in which a group of exposed subjects and a group of unexposed subjects are followed over time and the incidence of the disease or outcome of interest in the exposed group is compared with that in the unexposed group ( Etminan and Samii, 2004 , Hulley et al., 2013 ).
c. Case-crossover studies—The case-crossover may be considered comparable to a crossover randomized controlled trial in which the patients act as their own control ( Etminan and Samii, 2004 ). Pattern of exposure among the cases is compared between event time and control time. The between-patient confounding that occurs in a classic case-control study is circumvented in this design. Tubiana et al. evaluated the role of antibiotic prophylaxis and assessed the relation between invasive dental procedures and oral streptococcal infective endocarditis, using a nationwide population-based cohort and a case-crossover study design ( Tubiana et al., 2017 ).
d. Case–time control studies—This design is an extension of the case-crossover design, but includes a control group ( Etminan and Samii, 2004 ). A group of researchers assessed medication-related hospitalization. They used the case–time control study design to investigate the associations between 12 high risk medication categories (e.g., antidiabetic agents, diuretics, benzodiazepine hypnotics) and unplanned hospitalizations ( Lin et al., 2017 ).
e. Nested case–control studies—In this design, a cohort of individuals is followed during certain time periods until a certain outcome is reached and the analysis is conducted as a case–control study in which cases are matched to only a sample of control subjects ( Etminan, 2004 ). de Jong et al. examined the association between interferon-β (IFN-β) and potential adverse events using population-based health administrative data in Canada ( De Jong et al., 2017 ).
f. Cross-sectional studies—In this type of study, the investigator measures the outcome of interest and the exposures among the study participants at the same time ( Hulley et al., 2013 , Setia, 2016b ). It provides a snapshot of a situation for a particular period.

Quantitative Research Designs in Pharmacy Practice

A wide range of quantitative methods are commonly applied in pharmacy practice research. These methods are widely used in published pharmacy practice literature to explore appropriateness of medicines use, appropriateness and quality of prescribing, and medication safety, through analyzing existing datasets, direct observation, or self-report ( Green and Norris, 2015 ). Pharmacy practice research questions also seek to determine the knowledge, behaviors, attitudes, and practices of pharmacists, other healthcare providers, patients, policy-makers, regulators, and the general public. Quantitative methods are also used in evaluating the effect of new pharmacy services and interventions to improve medicines use. These practice research projects provide valuable insights about how medicines are used, and how to maximize their benefits and minimize their harmful effects. In the context of this chapter, quantitative study designs will be broadly classified into three: (1) observational, (2) experimental and quasi experimental, and (3) other designs.

Observational Study Designs

Pharmacoepidemiology is a “relatively new science that explores drug efficacy or toxicity using large observational study designs” ( Etminan, 2004 , Etminan and Samii, 2004 ). These study designs explore drug use studies that usually cannot be answered using randomized controlled trials or other experimental designs. In several instances, experimental study designs may not be suitable or feasible; in such circumstances, observational study designs are applied ( Cummings et al., 2013 ). As the name implies, observational studies involve merely observing the subjects in a noncontrolled setting, without investigator intervention or manipulating other aspects of the study. Therefore, observational studies are nonexperimental. The observation of the variables of interest can be prospective, retrospective, or current depending on the type of the observational study.

In pharmacoepidemiology and other areas of pharmacy practice, researchers are often interested in measuring the relationships between exposure to a drug and its efficacy, toxicity, or other outcomes of interest using observational study designs. It is worthwhile to note that observational study designs investigate association, but, in most cases, not causation. Here, we provide descriptions of some commonly used study designs in pharmacoepidemiology and pharmacy practice research in general.

Case–Control Studies

Case–control study design is used to determine association between risk factors or exposures and outcomes. It is a useful design to study exposures in rare diseases or diseases that take long time to develop ( Newman et al., 2013 ). It investigates exposures in individuals with and those without the outcome of interest. Nevertheless, case–control studies can help to identify harmful or beneficial exposures. Furthermore, the outcome of interest can be undesirable (e.g., mortality) or desirable (e.g., microbiological cure). As the name suggests, in a case–control study design, there are two groups of subjects: (1) cases (individuals with the outcome of interest) and (2) controls (individuals without the outcome of interest) ( Newman et al., 2013 ). Cases are randomly selected based on prespecified eligibility criteria from a population of interest. Appropriate representative controls for the cases selected are then identified. The researchers then retrospectively investigate possible exposures to the risk factor. Fig. 1 represents a schematic diagram of a case–control study.

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Case–control study design.

Case–control studies are relatively inexpensive, less time-consuming to conduct, allow investigation of several possible exposures or associations, and are suitable for rare diseases. Selection of the control group is a critical component of case–control studies. Case–control studies have several drawbacks: confounding must be controlled, subject to recall, observation, and selection biases.

OR is the measure of association used for the analysis of case–control studies. This is defined as the odds of exposure to a factor in those with a condition or disease compared with those who do not have the condition or disease.

Cohort Studies

Similar to case–control studies, cohort studies determine an association between exposures/factors and development of an outcome of interest. As previously described, a cohort study is a study in which a group of exposed subjects and a group of unexposed subjects are followed over time to measure and compare the rate of a disease or an outcome of interest in both groups ( Etminan and Samii, 2004 , Hulley et al., 2013 ). A cohort study can be prospective (most common) or retrospective. While a case–control study begins with patients with and those without the outcome of interest (e.g., diseased and nondiseased patients), a cohort study begins with exposed and unexposed patients (e.g., patients with and those without certain risk factor) ( Hulley et al., 2013 , Setia, 2016a ). In a cohort study, both the exposed and the unexposed subjects are members of a larger cohort in which subjects may enter and exit the cohort at different periods in time ( Etminan and Samii, 2004 , Hulley et al., 2013 ).

Typically, a cohort study should have a defined time zero, which is defined as the time of entry into the cohort ( Etminan and Samii, 2004 ). The cohort (a group of exposed and unexposed subjects, who are free of the outcome at time zero) is followed for a certain period until the outcome of interest occurs. In addition, information or data related to all potential confounders or covariates should also be collected as failure to account for these can bias the results and over- or underestimates the risk estimate. There are two types of cohort studies: retrospective cohort and prospective cohort studies.

Retrospective cohort study, also known as historical cohort study, begins and ends in the present, while looking backward to collect information about exposure that occurred in the past ( Fig. 2 ). Historical cohort studies are relatively less time-consuming and less expensive than prospective cohort studies ( Etminan and Samii, 2004 , Hulley et al., 2013 , Setia, 2016a ). In addition, there is no loss to follow-up and researchers can investigate issues not amenable to intervention study designs. However, these studies are only as good as the data available, the investigator has limited control of confounding variables, and it is prone to recall bias.

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Retrospective (historical) cohort study design.

On the other hand, prospective cohort study, also known as longitudinal cohort study, begins in the present and progresses forward, collecting data from enrolled subjects whose outcomes fall in the future ( Etminan and Samii, 2004 , Hulley et al., 2013 , Setia, 2016a ) ( Fig. 3 ). Prospective cohort studies are easier to plan for data collection, have low recall bias, and the researcher has a better control of confounding factors. On the other hand, it is difficult to study rare conditions; they are more prone to selection bias, more time-consuming, expensive, and loss of subjects to follow-up is common.

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Prospective (longitudinal) cohort study design.

Relative risk (RR) is the measure of association used for the analysis of a cohort study. This is defined as the risk of an event or development of an event relative to exposure (i.e., the risk of subjects developing a condition when exposed to a risk factor compared with subjects who have not been exposed to the risk factor).

Case-Crossover Studies

This is a relatively new design in the field of epidemiology in which the patients act as their own controls ( Maclure, 1991 ). In this design, there is a case and a control element both of which come from the same subject. In other words, each case serves as its own control. It can be considered equivalent to a crossover RCT with a washout period ( Etminan and Samii, 2004 ). Pattern of exposure to the risk factor is compared between the event time and the control time ( Etminan and Samii, 2004 ). Case-crossover study design is useful to investigate triggers within an individual. For instance, it is applicable when studying a transient exposure or risk factor. However, determination of the period of the control and case components is a crucial and challenging aspect of a case-crossover study design. Since the patients serve as their own controls, the interindividual variability that is inherent in classic case–control studies is eliminated. This is important in studies involving progressive disease states in which disease severity may differ between patients such as multiple sclerosis. OR is estimated using techniques such as Mantel–Haenszel statistics and logistic regression.

Cross-Sectional Studies

Cross-sectional studies also known as prevalence studies identify the prevalence or characteristics of a condition in a group of individuals. This design provides a snapshot of the prevalence or the characteristics of the study subjects in a single time point. The study investigator measures the outcomes and the exposures in the study subjects simultaneously ( Etminan and Samii, 2004 , Hulley et al., 2013 , Setia, 2016b ). Hence, cross-sectional studies do not follow up patients to observe outcomes or exposures of interest. Data are often collected through surveys. Cross-sectional design cannot provide cause and effect relationships between certain exposures and outcomes of interest.

Experimental and Quasi-Experimental Study Designs

In a typical experimental study design, the investigator assigns subjects to the intervention and control/comparison groups in an effort to determine the effects of the intervention ( Cummings et al., 2013 ). Since the investigator has the opportunity to control various aspects of the experiment, this allows the researcher to determine the causal link between exposure to the intervention and outcome of interest. The researcher either randomly or conveniently assigns the subjects to an experimental group and a control group. When the investigator performs randomization, the study is considered a true experiment (see Fig. 4 ). On the other hand, if subjects are assigned into groups without randomization, the study is considered a quasi-experiment (refer to Fig. 5 ). As with experimental designs, quasi-experimental designs also attempt to demonstrate a causal link between the intervention and the outcome of interest. Due to the challenges of conducting a true experimental design, the quasi-experimental study designs have been consistently used in pharmacist intervention research.

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True experimental study design.

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Quasi experimental study design.

RCTs are considered the gold standard of experimental study designs in pharmacy practice and evidence-based research ( Cummings et al., 2013 ). The investigator randomly assigns a representative sample of the study population into an experimental group and a control group ( Fig. 4 ). Randomization in RCT is to minimize confounding and selection bias; it enables attainment of similar experimental and control groups, thereby isolating the effect of the intervention. The experimental group receives the treatment or intervention (e.g., a new drug or pharmaceutical care for treatment of a certain disease), while the control group receives a placebo treatment, no treatment, or usual care treatment depending on the objective of the study ( Cummings et al., 2013 ). These groups are then followed prospectively over time to observe the outcomes of interest that are hypothesized to be affected by the treatment or intervention. The result of the study is considered to have high internal validity if significant changes on the outcome variable occur in the experimental group, but not the control group. The investigator can infer that the treatment or intervention is the most probable cause of the changes observed in the intervention group. The unit of randomization in RCTs is usually the patient, but can sometimes be clusters to circumvent the drawbacks of contamination.

RCTs are very challenging to undertake and pharmacy practice researchers should ensure design of robust experiments, while considering all essential elements and adhering to best practices. For instance, to determine the impact of a cognitive pharmaceutical service, the selection of a representative sample of the population is a prime consideration in an RCT. Moreover, RCTs are expensive, labor-intensive, and highly prone to attrition bias or loss to follow-up.

In pharmacy practice research, it is often difficult to comply with the stringent requirements of true experimental designs such as RCTs, due to logistic reasons and/or ethical considerations ( Grady et al., 2013 , Krass, 2016 ). Whenever true experimental models are not feasible to be applied in pharmacy practice research, the researcher should endeavor to use a more robust quasi-experimental design. For instance, when randomization is not feasible, the researcher can choose from a range of quasi-experimental designs that are non-randomized and often noncontrolled ( Grady et al., 2013 , Krass, 2016 ). Quasi-experimental studies used in pharmacy literature may be classified into five major categories: (1) quasi-experimental design without control groups (i.e., one group pre–posttest design); (2) quasi-experimental design that use control groups with no pretest; (3) quasi-experimental design that use control groups and pretests (i.e., nonequivalent control group design with dependent pretests and posttests) (see Fig. 5 ); (4) interrupted time series and; (5) stepped wedge designs ( Brown and Lilford, 2006 , Grady et al., 2013 , Harris et al., 2006 ).

The one group pretest posttest design and the nonequivalent control group design ( Fig. 5 ) are the most commonly applied quasi-experimental designs in practice-based research literature. These designs have been commonly used to evaluate the effect of pharmacist interventions in medications management in general and specific disease states management. The lack of randomization and/or the lack of control group is a major weakness and a threat to internal validity in quasi-experimental designs ( Grady et al., 2013 ). The observed changes could be due to some effects other than the treatment.

Other Quantitative Study Designs

In addition to the common observational, experimental, and quasi-experimental designs described above, there are other designs that are used in pharmacy. These research methods include, but are not limited to, simulated client technique, discrete choice experiments, and Delphi techniques. These methods, which are considered relatively new to pharmacy, are now commonly used in pharmacy practice research. In this chapter, we briefly describe these methods and their application in pharmacy. However, a more detailed description of their components and the nitty gritty of their application in pharmacy practice are available elsewhere within this textbook.

Simulated Client Method

The use of simulated client or simulated patient (mystery shopper) method to assess practices or behaviors in pharmacy practice has received much attention in recent times ( Watson et al., 2004 , Watson et al., 2006 ). “A simulated patient is an individual who is trained to visit a pharmacy (or drug store) to enact a scenario that tests a specific behavior of the pharmacist or pharmacy staff” ( Watson et al., 2006 ). A review by Watson et al. demonstrated the versatility and applicability of this method to pharmacy practice research in both developing and developed countries ( Watson et al., 2006 ). The investigators also identified some important characteristics that should be taken into consideration in designing studies that use this technique.

This method can be used to assess wide range of cognitive pharmacy services including counseling and advice provision, treatment of minor ailments, provision of nonprescription medicines, and public health pharmacy, among other things. This method can be a robust and rigorous method of assessing pharmacy practice if used appropriately ( Watson et al., 2006 , Xu et al., 2012 ). More recent developments have documented that the simulated patient methods have been used to provide formative feedback in addition to assessing practice behavior of pharmacists and their staff ( Xu et al., 2012 ).

In a case example, a group of investigators evaluated Qatari pharmacists' prescribing, labeling, dispensing, and counseling practices in response to acute community-acquired gastroenteritis ( Ibrahim et al., 2016 ). In another example, the investigators documented the state of insomnia management at community pharmacies in Pakistan ( Hussain et al., 2013 ).

Discrete Choice Experiments

Evidence in healthcare suggests that understanding consumers' preferences can help policy-makers to design services to match their views and preferences ( Ryan, 2004 ). Traditionally, studies to understand patients' and consumers' preferences for pharmaceutical services used opinion or satisfaction survey instruments. Nevertheless, such satisfaction surveys lack the ability to identify the drivers of satisfaction or the relative importance of the different characteristics of the service ( Vass et al., 2016 ). Discrete choice experiments are a novel survey-based method in pharmacy that are predicated on economic theories that allow systematic quantification of preferences to help identify which attributes of a good or service consumers like, the relative value of each attribute, and the balance between the different attributes ( Naik Panvelkar et al., 2010 , Ryan, 2004 , Vass et al., 2016 ). In-depth description of this method and its essential elements are described in another chapter in the Encyclopedia.

Qualitative Research Designs in Pharmacy Practice

Qualitative research methodology is applied to investigate a problem that has unmeasurable variables, to get a comprehensive understanding of the topic, through discussing it with the involved individuals, and to recognize the natural context in which the investigated issue takes place ( Creswell, 2013 ). The use of qualitative research methodology is becoming increasingly common across diverse health-related disciplines, including pharmacy practice. This is because of its ability to describe social processes and behaviors associated with patients or healthcare professionals, which strengthen the research impact ( McLaughlin et al., 2016 ). Therefore, pharmacy researchers and practitioners need to be better oriented to qualitative research methods ( Behar-Horenstein et al., 2018 ).

In the following section, interpretative frameworks and philosophical orientations, methodologies, data collection and analysis methods, approaches to ensure rigor, and ethical considerations in qualitative research are briefly discussed ( Cohen et al., 2013 , Creswell, 2013 ).

Interpretative Framework and Philosophical Assumptions of Qualitative Research

Interpretative frameworks.

Interpretative frameworks are the conceptual structures for comprehension, which form researcher's reasoning and views of truth and knowledge ( Babbie, 2015 ). Different scholars have categorized qualitative research paradigms or interpretative frameworks differently. The following are examples of interpretative framework categories that are used in health science research based on the categorization of Creswell (2013) : (1) social constructivism (interpretivism) framework; (2) post-positivism framework; (3) transformative, feminist, critical frameworks and disabilities theories; (4) postmodern frameworks; (5) pragmatism frameworks.

Philosophical Assumptions

Philosophical assumptions are theories and perspectives about ontology, epistemology, axiology, and methodology, which underpin the interpretative frameworks selected by qualitative researchers ( Cohen et al., 2013 ). As with interpretative framework, there are numerous means to categorize the philosophical assumptions that are folded within interpretative framework. The following are explanations of philosophical assumptions based on the categorization of Creswell (2013) :

1. Ontological assumptions, which define the nature of reality
2. Epistemological assumptions, which clarify means for knowing reality
3. Axiological assumptions, which explain the role and influence of researcher values
4. Methodological assumptions, which identify approaches to inquiry

It is important that a qualitative researcher understands how interpretative frameworks (e.g., social constructivism, post-positivism, and pragmatic interpretative frameworks) are differentiated because of their underpinning philosophical assumptions (i.e., ontological, epistemological, axiological, and methodological assumptions).

Approaches to Inquiry (Methodology)

It is important that qualitative researchers understand the differences between the characteristics of the five qualitative approaches to inquiry, in order to select an approach to inquiry and attain methodological congruence ( Creswell, 2013 ). The five approaches to qualitative research inquiry are:

a. Narrative research: Describes participants' written and spoken stories about their experiences with a phenomenon being investigated, while considering the chronological connection of the phenomenon's series of events ( Anderson and Kirkpatrick, 2016 , Creswell, 2013 , Czarniawska, 2004 ).
b. Phenomenological research: Describes the essence of participants' common experiences of a phenomenon, so that the description is a general essence rather than an individual experience ( Creswell, 2013 , Giorgi, 1997 , Moustakas, 1994 ).
c. Grounded theory research: Aims to generate a theory grounded in participants' data that conceptually explain a social phenomenon, which could involve social processes, or actions or interactions ( Creswell, 2013 , Strauss and Corbin, 1990 , Woods et al., 2016 ).
d. Ethnographic research: Involves describing the shared patterns of values, behaviors, and beliefs of culture-sharing participants ( Creswell, 2013 , Harris, 1968 , Rosenfeld et al., 2017 ).
e. Case study research: Provides an in-depth examination of a real-life contemporary phenomenon that researchers cannot change over time, to illustrate the significance of another general topic ( Baker, 2011 , Creswell, 2013 , de León-Castañeda et al., 2018 , Mukhalalati, 2016 , Yin, 2014 ).

Data Collection and Analysis Methods in Qualitative Research

Data collection tools in qualitative research can be categorized into the following fundamental categories ( Creswell, 2013 ):

a. Observation
b. Documents
c. Individual semi-structured interviews
d. Focus groups (FGs)
e. Audio-visual materials
f. Emails chat rooms, weblogs, social media, and instant messaging.
a. Topic guides: Topic guides guide the discussions in focus groups and individual interviews, and contain open-ended questions and probes, to enable the researcher to understand the complete picture, based on participant views and experiences. They are developed based on the literature review, aim and objectives, research questions, and propositions ( Kleiber, 2004 ).
b. Audio recording of FGs and interviews: Audio recording of discussions that take place in interviews and FGs is essential for managing and analyzing data, and for increasing the accuracy of data collection and analysis, and ultimately enhancing the dependability and credibility of the research ( Rosenthal, 2016 , Tuckett, 2005 ).
c. Transcription of FGs and interviews recording: Verbatim transcription refers to the word-for-word conversion of oral words from an audio-recorded format into a scripted text format. Transcribing data is considered as the first data reduction step because it generates texts that can be examined and rechecked ( Miles et al., 2014 , Grossoehme, 2014 ).

Data analysis comprises several fundamental steps, including reading the transcribed text, arranging data, coding data deductively based on prefigured themes or inductively to produce emergent themes, and then summarizing the codes into themes, and finally presenting the analyzed data as results ( Cohen et al., 2013 , Crabtree and Miller, 1999 , Pope et al., 2000 ).

The most commonly used data analysis methods in health science research are:

Thematic analysis is characterized by identifying, analyzing, and reporting themes that are available in the data ( Braun and Clarke, 2006 , Castleberry and Nolen, 2018 ).

Content analysis comprises systematic coding followed by quantification of the analyzed data in a logical and unbiased way ( Berelson, 1952 , Vaismoradi et al., 2013 ).

Discourse analysis emphasizes the core format and the structure of texts to examine the assumptions and concealed aspirations behind discourses ( Brown and Yule, 1983 , Gee, 2004 ).

Quality Perspectives in Qualitative Research

Qualitative research validation involves ensuring the rigor of the utilized data collection, management, and analysis methods, by utilizing approaches to ensure the quality. In pharmacy practice research, Hadi and Closs, 2016a , Hadi and Closs, 2016b argued that quality in qualitative research topic has not been discussed widely in the literature, and therefore Hadi and Closs, 2016a , Hadi and Closs, 2016b suggested using several trustworthiness criteria to ensure the rigor of qualitative study. The trustworthiness criteria for ensuring quality in qualitative research ( Lincoln and Guba, 1985 ) are:

This criterion aims to ensure that the results are true and increases the possibility that the conclusions are credible ( Cohen and Crabtree, 2008 ).

This criterion aims to indicate that the research results are repeatable and consistent, in order to support the conclusions of the research ( Cohen and Crabtree, 2008 ).

This criterion aims to confirm the neutrality in interpretation by ensuring that the perspectives of participants, not the bias of researchers, influence the results ( Krefting, 1991 ).

This criterion involves identifying the contexts to which the study results can be generalized, and indicating if the study conclusions can be applied in similar setting ( Yin, 2014 ).

Reflexivity implies revealing and evaluating the effect and biases that researchers can possibly bring to research process, by explaining the researcher's opinion, feelings, and experience with the phenomenon in question, and explaining the influence of this experience on research methods, findings, and write-ups ( Creswell, 2013 , Krefting, 1991 , Lincoln and Guba, 1985 ).

Ethical Considerations

Obtaining an ethical approval from the Institutional Review Board (IRB) is required before conducting the qualitative research ( Creswell, 2013 ). The key ethical issues that need to be considered are:

Informed consent refers to the decision taken by a competent individual to voluntarily participate in a research, after adequately understanding the research. Participant information leaflet is usually distributed to participants before they consent to participate in the research to clarify them the voluntary nature of research participation, the aim and objectives of the research, the rights of the respondents and the potential risks and harms, the data collection, management and storage conditions, and the right of participants to withdraw from the research ( Jefford and Moore, 2008 ).

The anonymity is usually ensured by not disclosing names of participants and by utilizing a code system to identify them during data collection, management, analysis, and in the writing up of the research. The confidentiality of participants and data is ensured by using a code system to identify participants, and by storing all data in a locked cabinet and a password-protected computer for a specified period of time ( Creswell, 2013 ).

Power imbalance is caused by the fact that participants have the experience about the investigated phenomenon, and researchers need to obtain information about these experiences. The power imbalance is usually associated with interaction between the researcher and participants during recruitment stage, and during data collection, analysis, interpretation, and validation stages. Hence, researchers should take suitable measures at each stage to decrease the influence of possible power imbalance, and should enhance trust with participants ( Karnieli-Miller et al., 2009 , Yardley, 2000 ).

Mixed Methods in Pharmacy Practice Research

Research studies in pharmacy practice usually utilize single-method research designs. However, often these report numerous limitations and may not adequately answer the research question. Therefore, the combination of more than one research method to answer certain research questions has become increasingly common in pharmacy practice research ( Ryan et al., 2015 ). Mixed methods research design is now a popular and widely used research paradigm in pharmacy practice research fields ( Hadi et al., 2013 , Hadi et al., 2014 ; Hadi and Closs, 2016a , Hadi and Closs, 2016b , Ryan et al., 2015 ). Mixed methods research allows the expansion of the scope of research to offset the weaknesses of using either quantitative or qualitative approach alone ( Creswell et al., 2004 , Hadi et al., 2013 ; Hadi and Closs, 2016a , Hadi and Closs, 2016b , Pluye and Hong, 2014 ). Typically, qualitative and quantitative data are collected concurrently or sequentially in order to increase the validity and the comprehensiveness of the study findings ( Creswell et al., 2004 , Hadi et al., 2013 ; Hadi and Closs, 2016a , Hadi and Closs, 2016b , Pluye and Hong, 2014 , Ryan et al., 2015 ). The mixed method approach provides an expanded understanding of phenomenon under investigation through the comparison between qualitative and quantitative data ( Hadi et al., 2013 ; Hadi and Closs, 2016a , Hadi and Closs, 2016b , Pluye and Hong, 2014 ).

This section provides an overview and application of mixed method research in pharmacy practice. However, considerations in selecting, designing, and analyzing mixed methods research studies as well as the various typologies of mixed methods research are discussed elsewhere. Johnson et al. (2007) proposed the following definition for mixed methods research: “The type of research in which a researcher or team of researchers combines elements of qualitative and quantitative research approaches (e.g., use of qualitative and quantitative viewpoints, data collection, analysis, inference techniques) for the broad purpose of breadth and depth of understanding and corroboration.”

Mixed methods design allows the viewpoints of participants to be reflected, enables methodological flexibility, and promotes multidisciplinary teamwork ( Ryan et al., 2015 ). Furthermore, the approach allows a more holistic understanding of the research question. However, its major limitations include: need for wide range of research expertise across the research team members, highly labor-intensive, and the complexity of data integration.

Scholars believe that it is challenging to provide researchers with a step-by-step guide on how to undertake a mixed methods study and that this is driven by the specific research question ( Ryan et al., 2015 ). Nevertheless, the investigator should precisely determine the type of qualitative and quantitative methods to be employed, the order of data collection to be undertaken, the data collection instruments to be used, and the method of data analysis ( Ryan et al., 2015 ). This approach encompasses a synthesis of findings from both quantitative and qualitative components, which is achieved through integration of the findings from each approach ( Hadi et al., 2013 ; Hadi and Closs, 2016a , Hadi and Closs, 2016b , Pluye and Hong, 2014 ).

Different models or typologies for mixed methods research have been described in the literature. The most common typologies used in pharmacy practice and health services research include: concurrent or convergent parallel design, exploratory sequential design, explanatory sequential design, and the embedded design ( Hadi et al., 2013 , Pluye and Hong, 2014 ). Scholars believe that there are several factors to consider when selecting the typology or model of mixed methods research to use. These factors include: the order of qualitative and quantitative data collection (concurrent vs. sequential); priority of data (i.e., which type of data has priority between quantitative and qualitative data); purpose of integration of the data (e.g., triangulation); and number of data strands ( Hadi et al., 2013 , Pluye and Hong, 2014 ). In mixed methods research, integration of qualitative and quantitative findings is critical, and this research approach does not simply involve the collection of these data ( Ryan et al., 2015 ).

Summary and Take-Home Messages

• In the era of evidence-based practice, it is not sufficient to propose new pharmacy services or roles without evidence of their benefit.
• New pharmacy services and new roles must be proven to be feasible, acceptable, beneficial, and cost-effective.
• Practice-based research provides such evidence and can inform policy, confirm the value of the new service, and change practice.
• Various study designs, including, but not limited to experimental, quasi-experimental, observational, qualitative, and mixed-methods designs, have been used in pharmacy practice research.
• Pharmacy practice researchers need to be competent in the selection, design, application, and interpretation of these methodological and analytical approaches.
• The choice of any study design in pharmacy practice research is driven by the expertise of the investigator, type of research question or hypothesis, data availability, time orientation, ethical issues, and availability of funding.

There is a great demand for innovation and quality in pharmacy practice. These can be achieved partly through robust and well-designed pharmacy practice research. Pharmacy students, practitioners, educators, and policy-makers are exposed to a variety of research designs and methods. We need to have the best evidence (e.g., in policy, regulation, practice) for making decisions about the optimal research design that ensures delivering an ultimate pharmacy practice and a quality patient care.

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Qualitative Research in Pharmacy Education: An Exploration of Pharmacy Education Researchers\u27 Perceptions and Experiences Conducting Qualitative Research

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A qualitative analysis of health service problems and the strategies used to manage them in the COVID-19 pandemic: exploiting generic and context-specific approaches

Hania Rahimi-Ardabili 1 ,
Farah Magrabi 1 ,
Brenton Sanderson 1 , 2 ,
Thilo Schuler 1 , 3 &
Enrico Coiera 1

BMC Health Services Research volume 24 , Article number: 1067 ( 2024 ) Cite this article

Metrics details

The COVID-19 pandemic disrupted health systems around the globe. Lessons from health systems responses to these challenges may help design effective and sustainable health system responses for future challenges. This study aimed to 1/ identify the broad types of health system challenges faced during the pandemic and 2/ develop a typology of health system response to these challenges.

Semi-structured one-on-one online interviews explored the experience of 19 health professionals during COVID-19 in a large state health system in Australia. Data were analysed using constant comparative analysis utilising a sociotechnical system lens.

Participants described four overarching challenges: 1/ System overload, 2/ Barriers to decision-making, 3/ Education or training gaps, and 4/ Limitations of existing services. The limited time often available to respond meant that specific and well-designed strategies were often not possible, and more generic strategies that relied on the workforce to modify solutions and repair unexpected gaps were common. For example, generic responses to system overload included working longer hours, whilst specific strategies utilised pre-existing technical resources (e.g. converting non-emergency wards into COVID-19 wards).

During the pandemic, it was often not possible to rely on mature strategies to frame responses, and more generic, emergent approaches were commonly required when urgent responses were needed. The degree to which specific strategies were ready-to-hand appeared to dictate how much a strategy relied on such generic approaches. The workforce played a pivotal role in enabling emergent responses that required dealing with uncertainties.

Peer Review reports

The COVID-19 pandemic has posed a significant challenge to health systems worldwide, and many have struggled to cope, especially in the early stages [ 1 ]. The global consequences of COVID-19 on health systems are measured in loss or impairment of lives [ 2 ], healthcare professional burnout [ 3 ], reduced services, and delayed care [ 4 , 5 ].

Unfortunately, it is highly probable that health systems will confront many more such crises, with climate change risks amongst these [ 6 ]. Understanding what was common to successful COVID-19 strategies, and what was shared amongst failed ones could be instructive as we prepare for the future. The pandemic affected every aspect of operations from planning and procurement to care delivery [ 7 , 8 ]. Services, processes and tools were repurposed or created ad hoc, often from the ground up [ 9 , 10 ]. Hospitals for instance, responded by repurposing existing facilities and wards, and implementing strategies to cope with sudden rises in patient numbers that overwhelmed existing critical care services such as intensive care units [ 11 , 12 ]. The initial phase of the pandemic witnessed immediate actions, some of which succeeded such as the development of mRNA vaccines [ 13 ] and others that failed such as certain COVID-19 contact tracing applications [ 14 ].

The challenges healthcare professionals experienced during the COVID-19 pandemic has had some attention in the research literature. For example, a 2021 systematic review examining the COVID-19 burden on healthcare workers from nine different countries identified four main challenges of inadequate preparedness; emotional challenges; insufficient equipment and information; and work burnout [ 15 ].

This study goes beyond describing the challenges faced, and examines the responses to these problems using the lens of sociotechnical system theory (STS) [ 16 ]. STS thinking sees system processes as the emergent outcome of interactions between people and technology [ 16 ].

Using first-hand stories from healthcare professionals, this study first describes the different health service problems experienced by health professionals during the pandemic. Next, we attempt to categorise the different strategies they employed to deal with these problems, exploring how people and technologies came together to craft responses to these problems during the pandemic. We develop a typology of responses that identifies the different roles for generic (general-purpose strategies), and specific (local or health service-specific) approaches. Identifying the circumstances in which each of these strategy types was used may assist in preparedness and guide future crisis responses.

A series of semi-structured interviews explored the firsthand experiences of healthcare professionals in either developing or making COVID-19 pandemic responses. We utilised a qualitative and interpretive approach, which aims to generate new hypotheses by exploring emergent relationships between descriptions of phenomena [ 17 , 18 ]. This manuscript follows the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines (See Additional file 1 for the checklist).

Participants and setting

Health system staff from a variety of professional groups and levels of seniority were recruited. Health professionals who had been involved in the pandemic response in New South Wales (NSW) were eligible for interviews. These included medical specialists (e.g. respiratory physicians), nurses and midwives, general practitioners (GPs), allied health workers (e.g. physiotherapists working in ICUs), health service executives and administrative staff, and paramedics. Participants were selected from a diverse range of health professions and services, including hospitals, public health organisations, and laboratories, in both public and private sectors as well as rural and urban settings. Our target sample size of 20 was informed by a systematic review of 14 qualitative studies that explored the experiences of healthcare professionals during the pandemic and concluded that on average, past studies reached data saturation with approximately 15 participants [ 19 ].

NSW is an Australian state with over eight million people. It includes about 9,600 full-time equivalent GPs [ 20 ] and 2000 registered pharmacies [ 21 ] governed by the federal government [ 22 ]. Further, NSW Health is the public health system for the state and includes NSW Ambulance, NSW Health Pathology, eHealth NSW, Health Protection NSW (public health legislation and surveillance), and Local Health Districts (LHDs) [ 23 ]. LHDs encompass hospitals, home hospitals, hospital pharmacies, aged health and disabilities, mental health, aboriginal health, drug health, and public health including immunisation [ 24 ]. During 2020-21, NSW had a total of 228 public hospitals and 210 private hospitals [ 25 ], and over 150 pathology collection centres [ 26 ]. Participants in this study were from general practices and community pharmacies, as well as NSW Health, including NSW Ambulance, Health Pathology (including COVID-19 testing centres), eHealth NSW, hospitals, hospital pharmacies, and immunisation services.

The research team (E.C., B.S., T.S., F.M.) initiated purposive recruitment with a convenience sample [ 27 , 28 ], identifying potential participants within their health system networks. Once enrolled, we used snowballing where participants were asked to forward the study invitation email to others who might be interested. Participants did not have any pre-existing relationship with the interviewer (H.R.-A.) who invited them via email. Transcripts were deidentified by H.R.-A. before sharing them with the other core analysis team (E.C., F.M).

Ethics and consent

Ethics approval was obtained from the Macquarie University Ethics Committee (ID: 11187) prior to commencing the study. Participants provided written informed consent prior to data collection.

Data collection

Data were collected between April and September 2022. At the time of the interview, the COVID-19 vaccine was freely available to the community, and health services in NSW have been providing in-person services in addition to tele-consultation. One-on-one interviews were conducted online using videoconferencing software (Zoom Video Communications, Inc. 2023) with each session lasting an average of 51 min (range: 27–73 min). One of the researchers (H.R-A.) with experience in qualitative interviews was responsible for conducting the interviews. Interviews were transcribed using an AI-based transcription tool (rev.com). A subset of four transcripts were manually checked for transcription accuracy (H.R-A.). Data collection and preliminary analysis were concurrent, with emerging themes from initial analysis reshaping subsequent interview questions and recruitment. Emerging themes about the use of different types of strategies led to new probe questions about strategy and whether such responses were new to the setting. The bulk of the analysis was conducted after data collection.

After the interviewer introduced herself and the reasons for conducting the research (identifying potential approaches for a crises ready health system) participants were asked about: (1) The challenges they faced while providing clinical services during the entire stages of the pandemic; (2) Specific health service responses that they were involved with and (3) what they did differently to pre COVID-19 practices (See Additional file 2 for the initial version of the interview guide).

Data analysis

Data were analysed using constant comparative analysis [ 29 ]. Two early transcripts were open-coded line-by-line to identify emerging concepts and themes (By H.R-A.). To ensure generalisability, these early codes were discussed and refined with a second analyst (E.C.). Codes were further refined and extended during the study by comparing similar categories across participants. An axial coding approach was taken, looking at connections between categories in terms of causation, strategies, consequences, context, and related conditions [ 29 ]. This process continued until all transcripts were coded. Both inductive and deductive approaches were utilised for coding and conceptualising the themes and frameworks.

Data coding was supported by QRS International NVivo ® 12 Software. Visualisation of code connections, codes and data was undertaken using Microsoft Excel. Some codes were grouped into more general constructs, and others were separated into several distinct codes. H.R-A. created memos of each transcript including key quotes, cross-indexed back to the transcripts and documented all process changes in an audit trail.

Reflexivity

Authors (E.C., B.S., T.S.; males) have a clinical background (medical doctors) and two are currently in clinical practice (B.S., T.S.). E.C. (PhD), F.M. (PhD, female) and H.R-A. (PhD, female) were academic researchers at the time of the study. All authors are experienced health system researchers, with prior experience in qualitative research. The interviewer and principal analyst (H.R.-A.) who had no previous contact with any of the participants, deidentified the transcripts before sharing them with other team members. Three participants were willing to provide feedback on the initial analyses.

Analytic framework

We analysed data to identify the types of (1) problems faced by participants or their health services during the COVID-19 pandemic; and (2) the type of health service responses employed to manage these problems. The analysis of health service responses was undertaken using the lens of STS theory which emphasises that system processes are the inevitable consequence of interaction between the people and technology, and that studying either in isolation leads to reductionism that fails to explain how the real world works adequately [ 16 ]. Thus, technological processes were analysed alongside human processes, each shaping the other in a continuous process of human-technology interaction [ 30 , 31 ]. For example, if a participant discussed technology, we probed for human processes related to the technology. We sought to understand the context that led to different social and technical response patterns with specific attention to human and technology interactions. Two researchers (H. R-A. and E.C.) analysed the health service responses reported by interviewees, and differences in interpretation were resolved by discussion.

Participant characteristics

Of 28 invited health professionals, 19 participated in our study. Participants who were involved in the pandemic response were GPs ( n = 2), pharmacists ( n = 2), specialists (e.g. emergency physician and respiratory physician), ( n = 3), nurses and midwives ( n = 3), allied health workers (e.g. physiotherapist and social worker working in ICU) ( n = 3), pathologists ( n = 2), a paramedic ( n = 1), a clerical officer ( n = 1) and public health implementation officer/ managers ( n = 2).

Health service problem types

Participants identified four broad classes of challenges faced by their health services during COVID-19. A summary of challenges is provided below, and a detailed description with example quotes from participants available in Additional File 3 .

Health system overload . The ability for health services to meet the needs of the population as the pandemic unfolded was often compromised because of an imbalance between the supply and demand for resources. System overload was often the result.

Barriers to decision-making : In the rapidly unfolding pandemic, evidence was not being generated and distributed as quickly as health services required, and the communication pathways to share information were sometimes suboptimal.

Education and training gaps : The need to train the public and health service staff as services responded to the pandemic was triggered both by the arrival of new evidence and best-practice guidance needing to be shared widely, or by staff working in roles that were new to them.

Limitations of existing services : Faced with multiple and concurrent challenges, many existing services or care models were found to be inadequate.

Health service response types

Respondents provided a rich account of the different strategies employed to meet the problems faced during the early years of the pandemic, with multiple examples across all four problem types (Additional file 4 ).

High-level analysis of these responses identified that human organisational responses were apparently shaped by the degree of technology maturity and availability. We observed differences in the use of generic responses (applicable to many settings) and specific responses (designed to serve a given service, its unique characteristics and the problems it faced). In this section below, we contrast examples of general and specific responses, presented for each problem type to explore why these strategic differences might have been adopted. Example responses are cross-referenced to relevant quote IDs in brackets, indicating each code’s cell address and item number in the Excel sheet - Additional file 4 as “([Cell address]#[item number when available])”.

Health system overload

Generic overload management strategies: Respondents described increasing the hours worked by staff (quote IDs H03#1, H20, H21), redeploying staff to critical services (quote ID H03#2), hiring new staff (quote IDs H03#3, H20#2, H21#4) or retraining existing staff (quote IDs H14#3, H15#2) to address imbalances between service supply and demand. Work pattern changes included delaying non-urgent care (quote IDs H03#9, H13#7, H66), altering staff/patient ratios in hospitals (quote IDs H03#12, H35#2,6,7), and fast-tracking patient discharge in tandem with home monitoring and support packs for COVID-19 patients (quote ID H03#11). Clinical staff working under difficult circumstances or longer hours were supported with access to accommodation, peer and mental health support (quote IDs H15#7, H21#3, H27#2, H35#5).

The choice of generic responses appeared to be driven by time constraints necessitating immediate solutions (quote ID H20#2). For example, outsourcing recruitment was more expedient than developing new internal processes: “ they hired an external company to I guess source more [staff who] didn’t have the experience that we had it was yeah that’s what effectively led for those long [vaccine] lines… the expectation was the training would come in the same day… the workforce was ignored… it would be much helpful to know that like in two months we’re wrapping up to be 1500 [vaccinations] yeah we would have tried extra hard to train more people [Pharmacist – 14].”

Specific overload management strategies: Overload strategies were sometimes quite specific to the health service experiencing stress. Batch testing of pooled samples for polymerase chain reaction (PCR) tests was undertaken to improve the throughput of otherwise overloaded laboratory services (quote ID H07#1). Rapid antigen tests (RATs) were used in hospitals to reduce the number of PCR tests for likely-negative individuals and for symptomatic positive patients, and allow ill patients to receive COVID-19 treatment without delay (quote ID H07#2):

What a rapid test would do with someone who is symptomatic would be that if you turn positive on a RAT you are COVID positive , so what that would end up doing was then that would decrease the amount of PCR that we were doing… If we had access to them [RATs] in Delta [variant phase] a testing capacity for PCRs would have dropped , identification of COVID positive patients who have been much faster , and that would have changed our treatment or discharge plans for these patients a lot quicker [ICU Nurse – 13].

Other specific responses were increasing hospital capacity by converting non-emergency wards into COVID-19 wards (quote ID H08#1), creating temporary wards (e.g. tents in hospital car parks) (quote ID H18), and facilitating hospital discharge by providing bus services to take patients home (quote ID H55). Emergency co-ordination centres assisted in identifying beds for patients across a region (quote ID H03#10), and respiratory clinics were set up in the community to support keeping patients at home (quote ID H60#2).

Barriers to decision-making

Generic decision-making strategies: Health services adopted several generic strategies to improve data capture, and dissemination of new evidence and local data. A respondent explained how a generic electronic medical record system (EMR) was customised to capture COVID-19 specific information (quote ID H56). “ We had to make EMR kind of work for us [Emergency physician – 09].” The respondent and their colleagues “ had to sort of come up with a process … to mark that you’ve had COVID and then not test you .” General purpose strategies required staff to be vigilant for problems during their application: “people were good at that. It was just realising that it [problem] was coming. So sort of working out. Oh hang on this is going to be a problem as we go forward. So what do we do? [Emergency physician – 09] . ”

Non-specific technologies such as email, Zoom, and Microsoft Teams were often used to enhance team communication. Communication processes were also enhanced by scheduling regular daily staff meetings at hospitals (quote IDs H09#1, H14#11), and weekly meetings for GPs to speak directly with those involved in pandemic management from the public health system (quote ID H09#4). Microsoft SharePoint was used to gather information about staff activities, such as where and when they treated COVID-19 patients, to assist with infection control and for patient managements (quote IDs H47, H48#2, H49).

Specific decision-making strategies: To provide local best practice guidance, expert support teams were created to assist with troubleshooting (quote ID H09#3), local protocols were developed and updated potentially daily (quote IDs H09#2, H68#1,), and interdisciplinary collaborations (e.g. pharmacists working with nurses) developed local workflow models (quote ID H17#1). Such activities required significant effort (quote ID H09#2): “ a working group that met like daily seven days a week for months and months and months to put together the [local protocol and updates] response [Transplant nephrologist – 18]. ”

Education and training gaps

Generic training strategies: Virtual training packages were used to maximise the dissemination of educational materials where local training was not feasible (quote ID H57). Peer support networks were developed to support information sharing where training was not available (quote IDs H03#4, H34 #5, H15#2). Adaptations of such solutions required significant human effort e.g. peer support meant senior staff had to be “there every step of the way [Emergency nurse – 13]. ”

Specific training strategies: Many of the responses designed to educate the health system workforce and the community were highly targeted (quote ID H15#2). Specific training programs were instituted to meet urgent needs, e.g. training clinicians in the use of PPE and hand hygiene. Consumers received highly targeted educational messages, such as requests to avoid unnecessary calling of ambulances, and simple social distancing rules and masking advice (quote IDs H22, H25, H26). Pharmacies provided in-house RATs for members of the public who did not understand the testing process (quote ID H25).

Limitations of existing services

Generic service strategies: The early stages of the pandemic saw a flurry of new or extended health services, often implemented under significant time and resource limitations. Periods of public health mandated lockdowns and work-from-home arrangements relied upon general purpose technologies (quote IDs H3#13, H14#5). Virtual consultations were delivered over channels of varying sophistication from telephone to online telecare products (quote IDs H13#3, H44#2, H52#1, H62#1). When there was lack of supply or limited access to manufactured PCR kits for COVID-19, specialised experts using general PCR techniques “try and put together a rapid PCR type of [solution/reagent] which they didn’t have [Pathology manager – 26] ” (quote ID H64#2).

Specific service strategies: Context-specific responses to service limitations included massive expansion of contact tracing capabilities, new measures such as routine COVID-19 surveillance of clinical staff (quote ID H14#6), and the use of QR (quick response) codes in public venues to support rapid contact tracing (quote ID H14#15). COVID-19 focussed respiratory clinics (quote ID H60#2) and PCR testing facilities appeared in the community for the first time. Specialist vaccination hubs and expanded community pharmacy services such as home delivery of medications were other specific responses. Hospital emergency services expanded their triage functions by creating specialised COVID-19 assessment areas with staff in full PPE, either using repurposed hospital space or in carparks outside the emergency departments or clinics (quote ID H03#11, H13#1,2, H14#13). Laboratories took advantage of manufactured PCR kits when available (quote ID H064#4): “you just opened the box and you put it together and you go [Pathology manager – 26].”

General to specific strategies . Many early responses to the pandemic involved the use of general strategies that sought to optimise responses from existing services (such as reconfiguring rostering or using general-purpose software):

The use of general solutions seemed to coincide with urgency and lack of time or resources to craft a more specific local solution (e.g. quote ID H20#2).

General solutions also could thus be seen to “buy time” whilst uncertainty remained about the best way forward, and better more specific solutions were being developed (e.g. quote IDs H03#13, H14#5). Pre-existing SARS infection control protocols were widely used early on and adapted to local circumstances or evolving knowledge. Generic information and communication tools were used to patch together information processes whilst more sophisticated solutions could be developed (e.g. quote IDs H13#3, H44#2, H52#1, H62#1) [ 32 ].

It is the nature of such generic responses that they are never a perfect fit to a specific task or context. Consequently, some adaptation or localisation is required to better meet these local needs. Such “fitting work” [ 33 ] often fell to local staff, and could take the form of workarounds (e.g. to make standard computer systems work in a new setting) or the addition of local changes (e.g. to a PPE protocol [ 34 ]) (e.g. quote IDs H47, H48#2, H49, H56).

The need for fitting work imposes additional load on staff (e.g. quote IDs H03#1, H20, H21) to “ make things work here right now ” and could be a contributor to the high levels of staff burnout reported through the pandemic.

Specific to general strategies . Highly local solutions to pandemic challenges were often needed where services provided highly specialised services. For example, the details of changes to the workflow for laboratory processing of high volumes of PCR tests would not have wide applicability beyond the laboratory setting.

The use of specific solutions appeared to coincide with unique local problems, or some capacity to develop new specific solutions whilst generic solutions “ held the fort ” (quote ID H64 #2).

Nonetheless, general lessons from such specific responses can sometimes be drawn e.g. in the approach taken to agree upon the specific solution and how it is subsequently communicated. For example, public health services had to rapidly expand their workforce in support of contact tracing, and their use of external recruitment agencies could be adopted by very different parts of the health system.

This study has examined the challenges faced during the COVID-19 pandemic, and health system responses to those challenges in Australia.

Clearly the challenges faced during the pandemic were not uniform, and different health services found themselves better or less well prepared or capable of responding than others [ 35 ]. Our analysis of these responses identified what appeared to be two quite different response pathways that played distinct roles in crisis management – the adoption of general strategies which could be used across a wide variety of settings, or the use or creation of highly targeted context specific responses.

What lessons can be learned from these broad responses? Given the nature of crises, each will bring novel and likely unanticipated challenges.

When faced with requirements to dramatically alter the duties and workflows of existing health services, especially when constrained by time, resource or knowledge, health services can turn to general-purpose strategies to reconfigure their existing workforce, and adopt ready to hand general purpose technologies. Whilst not ideal, these strategies support quick responses and buy time for more targeted solutions to emerge.

Crisis preparedness could thus focus on understanding the range of general-purpose tools and processes that can quickly be brought to hand. Adaptation protocols might provide guidance on localisation processes that optimise speed, quality, impact on staff, or cost. For example, protocols might describe processes of problem identification, workaround development, and team communication approaches that facilitate these tasks. In developing such protocols, we should not forget that while some services must develop highly localised solutions, they nevertheless can be a rich source of lessons about general approaches to identifying issues, designing solutions, and enacting them effectively. During the pandemic, innovations commonly involved combining pre-existing services.

Theoretical frameworks for system resilience describe the importance of flexibility and adaptability to respond to unexpected and escalating situations [ 36 , 37 ]. Generic competencies are often team-based and include information management, communication and coordination, decision-making, and effect control [ 36 ]. Responses when managing the early phase of health emergencies should be simple and generic, such as using generic international guidance [ 38 ]. The Interactive Systems Framework (ISF) for dissemination and implementation distinguishes innovation-specific capacity and general capacity [ 39 ]. Various implementation frameworks suggest general organisational capacity building is an essential step in the early phase of implementation [ 40 ]. Such approaches emphasise that stabilising a situation and maintaining organizational function are key to managing uncertainty while developing specific responses.

Limitations

The problems and system responses reported in this study may lack representativeness because of the small sample size of interviewees, the focus on a single albeit large health system in Australia, and the potential for recruitment biases introduced by convenience and snowballing sampling. Different nations had distinct experiences during COVID-19, such as variations in public health measures adopted, access to vaccines, lockdowns, government policy, and health impacts of the virus on their population. Thus, these findings may not be generalisable to other health system settings. Respondents detailed challenges and system responses with many examples. We anticipated achieving theoretical saturation with 20 participants but during the analysis phase did not do so. This may be due to the richness of innovations during COVID-19 or the diverse selection of participants [ 41 , 42 ]. Failure to saturate suggests that interviewing additional participants could likely identify new examples and issues that might have uncovered additional issues. However, the concept of data saturation in qualitative studies is currently under debate [ 43 ].

Health services have a range of different response strategies available to them when faced with novel challenges, and selection of a strategy can be guided by the circumstances and the availability of ready-to-hand specific strategies. The workforce is pivotal in enabling emergent responses that require dealing with uncertainties. Recognising the important role that general purpose strategies play when time is short (e.g. emergencies) and specific solutions are not yet available suggests that health services can invest in formalising protocols for solution design and focus on workforce support, including team communication and supporting solution implementation. Such capabilities should enhance health system preparedness for crises such as new pandemics or climate-change triggered events. Much can also be learnt about the construction of context-specific solutions, a deeper exploration of when to employ such approaches and how to support them to best prepare for future crises.

Data availability

The complete datasets generated and analysed during the current study are not publicly available because consent was not obtained from study participants for data to be made public but are available from the corresponding author on reasonable request subject to approval from the Macquarie University Ethics Committee. Part of the deidentified data is provided as a supplementary file.

Abbreviations

Electronic medical record system

General practitioner

Intensive care unit

Polymerase Chain Reaction

Personal protective equipment, RAT: Rapid antigen tests

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Acknowledgements

The authors thank K-lynn Smith and Yvonne Zurynski for their valuable feedback on the manuscript.

The project was conducted with funding from the National Health and Medical Research Council: Partnership Centre for Health System Sustainability; and Centre of Research Excellence in Digital Health (APP1134919).

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Hania Rahimi-Ardabili, Farah Magrabi, Brenton Sanderson, Thilo Schuler & Enrico Coiera

Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, NSW, Australia

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Contributions

E.C., B.S., T.S. and F.M. conceptualised the study. H.R.-A. developed the study protocol and collected data, E.C. and H.R.-A. analyzed the data. E.C. and H.R.-A. prepared the original draft, and all authors contributed to the final drafts of the manuscript.

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Correspondence to Enrico Coiera .

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Ethics approval and consent to participate.

Ethics approval was obtained from the Macquarie University Ethics Committee prior to commencing the study (ID: 11187). All participants provided written informed consent prior to data collection.

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Rahimi-Ardabili, H., Magrabi, F., Sanderson, B. et al. A qualitative analysis of health service problems and the strategies used to manage them in the COVID-19 pandemic: exploiting generic and context-specific approaches. BMC Health Serv Res 24 , 1067 (2024). https://doi.org/10.1186/s12913-024-11499-7

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A Review of the Quality Indicators of Rigor in Qualitative Research

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INTRODUCTION

Qualitative research involves the studied use and collection of a variety of empirical materials – case study; personal experience; introspection; life story; interview; artifacts; cultural texts and productions; observational, historical, interactional, and visual texts – that describe the routine and problematic moments and meanings in individual lives. Accordingly, qualitative researchers deploy a wide range of interconnected interpretative practices, hoping always to get a better understanding of the subject matter at hand. It is understood, however, that each practice makes the world visible in a different way. Hence there is frequently a commitment to using more than one interpretative practice in any study. 1

BEST PRACTICES: STEP-WISE APPROACH

Step 1: identifying a research topic.

Step 2: Qualitative Study Design

Step 3: data analysis, step 4: drawing valid conclusions, step 5: reporting research results, article metrics, related articles.

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An Exploration of Pharmacy Education Researchers' Perceptions and Experiences Conducting Qualitative Research
The application of rigorous qualitative research in pharmacy education holds great potential in addressing complex and evolving healthcare problems. This work provides empirical evidence of the ongoing anecdotal dialogue that has long existed in pharmacy education concerning why some researchers are hesitant to conduct qualitative research, the ...
Qualitative Research in Pharmacy Education: An Exploration of Pharmacy
The application of rigorous qualitative research in pharmacy education holds great po-tential in addressing complex and evolving healthcare problems. This work provides empirical evi-dence of the ongoing anecdotal dialogue that has long existed in pharmacy education concerning why
Guidance for Qualitative Research Manuscripts in Pharmacy Education
The goal of this Best Practice Review is to support researchers in successfully preparing and publishing qualitative research in pharmacy education. Standard practice from the literature and journals' guidance from related fields were reviewed, and recommendations and resources applicable to qualitative research in pharmacy education were compiled for researchers planning to conduct and ...
Conducting and presenting qualitative research in pharmacy education
Fittingly, pharmacy education research in the academic setting has grown rapidly to provide innovative solutions to these challenges. One approach for addressing these challenges includes the collection and analysis of qualitative research (QR). Though a useful methodological tool, many pharmacy educators are not trained to appropriately ...
Qualitative Research in Pharmacy Education ...
QUALITATIVE RESEARCH IN PHARMACY EDUCATION UsingArtifactsandQualitativeMethodologytoExplorePharmacyStudents' Learning Practices Ruth Edwards, EdD, MRPharmS,a John I ...
Conducting and presenting qualitative research in pharmacy education
Methodological literature review. QR offers many advantages for pharmacy education researchers. However, prior to delving into QR projects it is important to understand the key distinctions of the approach, role of the researcher, and the significance of situating the study so that the research question, data collection techniques, and analysis procedures are aligned.
Guidance for Qualitative Research Manuscripts in Pharmacy Education
1. Introduction. This article reviews best practices and available resources and compiles recommendations for publishing qualitative research manuscripts in the field of pharmacy education. The objective of this review is to support researchers in successfully preparing, conducting, and reporting qualitative research for publication. 2.
American Journal of Pharmaceutical Education
1. Introduction. This article reviews best practices and available resources and compiles recommendations for publishing qualitative research manu-scripts in the field of pharmacy education. The objective of this review is to support researchers in successfully preparing, conducting, and reporting qualitative research for publication. 2.
PDF Qualitative Research in Pharmacy Education
A Review of the Quality Indicators of Rigor in Qualitative Research. siana State University, School of Medicine, New Orleans, LouisianaSubmit. ed April 22, 2018; accepted March 18, 2019; published ...
An Exploration of Pharmacy Education Researchers' Perceptions and
Objective. To investigate pharmacy education researchers' experiences in conducting qualitative research and their perceptions of qualitative research in pharmacy education Methods. A phenomenological approach was used to conduct one-time, in-depth interviews with 19 participants from 12 schools and colleges of pharmacy.
A Review of the Quality Indicators of Rigor in Qualitative Research
Abstract. Attributes of rigor and quality and suggested best practices for qualitative research design as they relate to the steps of designing, conducting, and reporting qualitative research in health professions educational scholarship are presented. A research question must be clear and focused and supported by a strong conceptual framework ...
Guidance for Qualitative Research Manuscripts in Pharmacy Education
The goal of this Best Practice Review is to support researchers in successfully preparing and publishing qualitative research in pharmacy education. Standard practice from the literature and ...
QUALITATIVE RESEARCH IN PHARMACY EDUCATION A Review of the Quality
. Attributes of rigor and quality and suggested best practices for qualitative research design as they relate to the steps of designing, conducting, and reporting qualitative research in health professions educational scholarship are presented. A research question must be clear and focused and supported by a strong conceptual framework, both of which contribute to the selection of appropriate ...
QUALITATIVE RESEARCH IN PHARMACY EDUCATION
The application of rigorous qualitative research in pharmacy education holds great potential in addressing complex and evolving healthcare problems. This work provides empirical evidence of the ongoing anecdotal dialogue that has long existed in pharmacy education concerning why some researchers are hesitant to conduct qualitative research, the ...
A Roadmap for Educational Research in Pharmacy
Examples of qualitative research in pharmacy education include the work of Warholak and colleagues, who used semi-structured interviews to examine the science of safety in pharmacy curricula. 47 In addition, Suda and colleagues used focus groups to examine perceptions of effective study strategies and materials in pharmacy education. 48 When ...
"Qualitative Research in Pharmacy Education: An Exploration of Pharmacy
Objective. To investigate pharmacy education researchers' experiences in conducting qualitative research and their perceptions of qualitative research in pharmacy education Methods. A phenomenological approach was used to conduct one-time, in-depth interviews with 19 participants from 12 schools and colleges of pharmacy. Interview transcripts were coded and themes were identified using a ...
Home Page: American Journal of Pharmaceutical Education
QUALITATIVE RESEARCH IN PHARMACY EDUCATION. A Review of the Quality Indicators of Rigor in Qualitative Research. Johnson et al. ... The mission of AACP is to lead and partner with our members in advancing pharmacy education, research, scholarship, practice and service to improve societal health. More Opens in new window . Metrics. Metrics. 3.3.
Conducting and presenting qualitative research in pharmacy education
The objective of this study was to describe the data being used to support poster presentations in pharmacy education scholarship. Research and education posters presented at the 2020 American Association of Colleges of Pharmacy Annual Meeting were unitized to isolate text to be coded, and 2 coders categorized the quantitative and qualitative data by type and source.
Research Designs and Methodologies Related to Pharmacy Practice
Qualitative Research Designs in Pharmacy Practice. Qualitative research methodology is applied to investigate a problem that has unmeasurable variables, to get a comprehensive understanding of the topic, through discussing it with the involved individuals, and to recognize the natural context in which the investigated issue takes place ...
QUALITATIVE RESEARCH IN PHARMACY EDUCATION Overview and Prospect of
28. Gardner DM. The immense value of qualitative research to pharmacy. Can Pharm J (Ott). 2016;149(4):195. 29. Anderson C. Presenting and evaluating qualitative research. Am J Pharm Educ. 2010;74(8):Article 141. 30. Rosenthal M. Qualitative research methods: why, when, and how to conduct interviews and focus groups in pharmacy research.
Community pharmacy & primary care integration: qualitative study on
1. Background. Health systems are under pressure predominantly due to an increase in demand (World Health Organisation, Citation 2022), insufficient infrastructure, the rapid development of health technology and a lack of human resources to provide quality services (European Observatory on Health Systems and Policies, Citation 2018).Integration is defined by the World Health Organisation (WHO ...
Qualitative Research in Pharmacy Education: An Exploration of Pharmacy
Objective. To investigate pharmacy education researchers' experiences in conducting qualitative research and their perceptions of qualitative research in pharmacy education Methods. A phenomenological approach was used to conduct one-time, in-depth
Presenting and Evaluating Qualitative Research
The purpose of this paper is to help authors to think about ways to present qualitative research papers in the American Journal of Pharmaceutical Education. It also discusses methods for reviewers to assess the rigour, quality, and usefulness of qualitative research. Examples of different ways to present data from interviews, observations, and focus groups are included. The paper concludes ...
Digital Tools for English Language Learning in Pharmacy Education Programs
The research combines quantitative assessments and qualitative analyses to investigate the impact of various digital tools on language learning outcomes, student engagement, and the practical application of acquired skills in pharmacy education programs. In response to the increasing demand for effective English language communication skills in the pharmaceutical domain, this study explores ...
A qualitative analysis of health service problems and the strategies
Background The COVID-19 pandemic disrupted health systems around the globe. Lessons from health systems responses to these challenges may help design effective and sustainable health system responses for future challenges. This study aimed to 1/ identify the broad types of health system challenges faced during the pandemic and 2/ develop a typology of health system response to these challenges ...
Research Assistant Professor in the Department of Pharmacology and Pharmacy
Work type: Full-time Department: Department of Pharmacology and Pharmacy (21300) Categories: Professoriate Staff Research Assistant Professor in the Department of Pharmacology and Pharmacy (Ref.: 528940). This position has been established and funded as a component of The Hong Kong Jockey Club Inclusive Employment Support Project for Persons with disabilities.
A Review of the Quality Indicators of Rigor in Qualitative Research
Within the past 20 years, qualitative research in health professions education has increased significantly, both in practice and publication. Today, one can pick up most any issue of a wide variety of health professions education journals and find at least one article that includes some type of qualitative research, whether a full study or the inclusion of a qualitative component within a ...

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Research Designs and Methodologies Related to Pharmacy Practice

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Research Question and Selection of Study Design

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A qualitative analysis of health service problems and the strategies used to manage them in the COVID-19 pandemic: exploiting generic and context-specific approaches

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Data collection

Data analysis

Reflexivity

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Participant characteristics

Health service problem types

Health service response types

Health system overload

Barriers to decision-making

Education and training gaps

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Data availability

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A Review of the Quality Indicators of Rigor in Qualitative Research