Advancing the Community of Qualitative Research in Health Professions Education: What’s the role of conceptual frameworks in qualitative research?

Editor’s Note: The following post is part of a series of Peer Reviewer Resources written by some of Academic Medicine‘s top peer reviewers. Read other peer review posts.

By: Bridget C. O’Brien, PhD, associate professor in the Department of Medicine and the Office of Research and Development in Medical Education at the University of California, San Francisco

When I submitted my first qualitative manuscript to a medical education journal, I was surprised by the divergent requests from my reviewers. One reviewer asked for more frequency counts, another wanted all numbers removed. Both reviewers pushed me to think about how I defined a “theme.” I struggled to identify criteria other than frequency counts with a cut point (e.g., if mentioned by 5 or more students) and pondered bigger questions about how to make the analytic process more transparent and how to demonstrate rigor, particularly for reviewers with such different conceptualizations of qualitative research. These questions led me to a project that resulted in the recently published “Standards for Reporting Qualitative Research” or SRQR. The goal of these standards is to provide reviewers and researchers a basic understanding of what qualitative research is, what needs to be reported (and how this differs from quantitative research), and examples of how to report these elements. I see these guidelines as a foundation for building a stronger community of qualitative research.  There are, however, a number of challenging topics within qualitative research that the guidelines do not discuss in depth. I’ll pose one here in hopes of sparking further discussion within our research community.

How and when to use a conceptual framework 

This is a gnarly topic because the framework can come into play at the very beginning of the research, during the process of data collection and analysis, or after analysis is completed. Use of a guiding framework may seem antithetical to the “inductive,” or theory-building,” approach frequently associated with qualitative research, but this view is an unfortunate oversimplification of the difference between qualitative and quantitative research. Labeling such work as deductive or inductive is less important than explaining how the investigators use the theory. Novice qualitative investigators often shy away from conceptual frameworks to avoid imposing preexisting conceptions on their research participants and miss the opportunity to use qualitative research to explore existing theories and frameworks in a new context.

A few suggestions to address this topic:

  1. Invest time and effort upfront figuring out your phenomenon of interest. Too often investigators claim “there’s nothing in the literature on this so we need to do an exploratory qualitative study.”  Typically “the literature” they reviewed did not include theoretical/conceptual or empirical papers on a totally different, but conceptually similar, topic. Most phenomena lend themselves to exploration through at least a few different frameworks or theoretical perspectives. It is worth considering what each may or may not offer with respect to your research question and how you might ask questions or focus observations based on an existing framework.
  2. Be clear about your purpose. If you really want to understand how people perceive, conceptualize, make sense of, or experience something in their own words, then you may be less concerned with a guiding conceptual framework. But if you want to generate ideas or insights or concepts that generalize beyond this specific group of people—if you want to advance or build theory—you’ll want to be clear how your work connects to existing theory.
  3. You might begin with a guiding framework, but discover that it doesn’t really fit the data you are collecting. This can happen and it is okay to abandon a framework that doesn’t work at all, but avoid throwing the baby out with the bathwater. Make sure to explore why the framework isn’t working and consider what you can learn from this. Your contribution might be a modification or expansion of an existing framework.
  4. Alternately you may begin with open-ended questions and realize part way through that certain ideas or themes surfacing during data collection and analysis resonate with an existing theory or framework. Here you may choose to delve into the theory in greater depth and revise your data collection process to align with theory. This path makes it easier to connect your work to a larger body of research, but will also narrow your focus and potentially exclude other interesting perspectives. Instead, you may choose to stay the course and continue with the existing data collection process. This option keeps more doors open but may make it more difficult to connect your findings to existing frameworks. Either path is okay, but should be selected intentionally, based on decisions made throughout data analysis.

Qualitative research is fundamentally about gaining insight and constructing meaning or understanding of a phenomenon. Investigators can use conceptual frameworks in multiple ways to make sense of their data, but must pay careful attention to the relationship between the framework and their data to ensure the spirit and integrity of both are preserved.