qualitative research questions examples in sport

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A Qualitative Study of 11 World-Class Team-Sport Athletes’ Experiences Answering Subjective Questionnaires: A Key Ingredient for ‘Visible’ Health and Performance Monitoring?

Alan mccall.

1 Arsenal Performance and Research Team, Arsenal Football Club, London, UK

2 School of Sport and Exercise Sciences, Edinburgh Napier University, Edinburgh, UK

3 School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW Australia

4 Medical Department, Football Australia, Sydney, NSW Australia

Adrian Wolfberg

5 Weatherhead School of Management, Case Western Reserve University, Cleveland, OH USA

Andreas Ivarsson

6 School of Health and Welfare, Halmstad University, Halmstad, Sweden

7 Department of Sport Science and Physical Education, University of Agder, Agder, Norway

Gregory Dupont

8 School of Sport and Exercise, Liverpool John Moores University, Liverpool, UK

Amelie Larocque

9 University of Ottawa Law School, Ottawa, ON Canada

10 Geneva Graduate Institute of International Studies and Academy of International Humanitarian Law and Human Rights, Geneva, Switzerland

Johann Bilsborough

11 New England Patriots, National Football League, Foxborough, MA USA

Athlete monitoring trends appear to be favouring objective over subjective measures. One reason of potentially several is that subjective monitoring affords athletes to give dishonest responses. Indeed, athletes have never been systematically researched to understand why they are honest or not.

Because we do not know what motivates professional athletes to be honest or not when responding to subjective monitoring, our objective is to explore the motives for why the athlete may or may not respond honestly.

A qualitative and phenomenological approach was used, interviewing 11 world-class team-sport athletes (five women, six men) about their experiences when asked to respond to subjective monitoring questionnaires. Interview transcripts were read in full and significant quotations/statements extracted. Meanings were formulated for each interviewees’ story and assigned codes. Codes were reflected upon and labelled as categories, with similar categories grouped into an overall theme. Themes were examined, articulated, re-interpreted, re-formulated, and written as a thematic story, drawing on elements reported from different athletes creating a blended story, allowing readers a feel for what it is like to live the experience.

Overall, four key themes emerged: (i) pursuit of the ideal-self, (ii) individual barriers to athlete engagement, (iii) social facilitators to athlete engagement; and (iv) feeling compassion from performance staff.

Conclusions

Our main insight is that athletes’ emotions play a major role in whether they respond honestly or not, with these emotions being driven at least in part by the performance staff asking the questions.

Introduction

In 2023, athlete health and performance monitoring continues to be one of the hottest topics in sports science and medicine (referred to herein after as ‘performance’) research as well as one of the most commonly used strategies by performance staff, for example, scientists, fitness coaches, doctors, physiotherapists, psychologists, etc. Athlete monitoring can include either or both ‘ objective’ and ‘subjective’ measures. Objective monitoring typically involves the use of technology and wearables to measure various surrogates of, for example, athletic performance (such as sports-specific fitness assessments), physiological levels (including maximal oxygen uptake, muscle force and power, heart-rate, etc.,) and biochemical status (by extracting blood, saliva, urinary markers, etc.,) . In contradistinction, subjective monitoring provides insight into psychosocial and psychobiological factors internal to the athlete such as mental fatigue, effort, perceived stress symptoms, well-being, and motivation [ 1 ]. These factors are typically assessed using self-report tools like the Rating of Perceived Exertion (RPE), wellness items, perceptions of pain, psychological readiness, etc.

Importantly, objective and subjective monitoring are not interchangeable and give very different information [ 1 ]. Objective measures typically fragment observations to allow quantitative precision of metrics in isolation, whereas subjective measures reflect the blended input of multiple channels of information internal to the athlete [ 2 ]. Unfortunately, in athlete monitoring, and particularly in our experience in professional team-sports, performance staff and researchers seem to be relying more and more on objective monitoring. This trend is worrisome because subjective information has been shown to reflect acute and chronic training loads with superior sensitivity and consistency compared with objective ones [ 3 ]. Even a concept referred to as ‘invisible monitoring’ has been proposed, albeit with well meaning, to “lessen the burden on athletes” [ 4 ]. However, the operational definition of invisible monitoring has been stated as “gathering as much information about the athlete, their performance and their current training status, without them even knowing you’re doing it, in order to answer coach or performance driven questions” [ 4 ]. Invisible monitoring implies removing the athlete entirely from the monitoring process, but with this approach the consequence could be amassing unnecessary data that does not even reflect how the athlete actually feels, thus, increasing the likelihood of making ill-informed decisions about athletes’ full spectrum of health and performance capabilities.

Literature Review

Literature on subjective monitoring of athletes mentions the likelihood of athletes’ not giving honest responses, but the current literature is limited in its empirical justification of such claims [ 1 , 2 ]. In a study by Neupert et al. [ 5 ] in which nine female sprint water-sport athletes were interviewed, the majority of interviewees said that they responded honestly to training-monitoring questions. On the other hand, interviews including eight athletes from various high-level individual and team sports by Saw et al. [ 6 ] revealed that half of the athletes admitted withholding the truth on occasions through fear of punishment for not filling subjective questionnaires. To our knowledge there are no studies investigating athletes from the world’s major professional team-sports, for example, association football, rugby, basketball, American football, and baseball.

While not in a sports context, psychotherapy research may offer some additional valuable insights to further explore this topic and extend the work by Neupert et al. [ 5 ] and Saw et al. [ 6 ]. Instead of ‘honesty or dishonesty’, psychotherapy typically discusses this as ‘patient/client disclosure’ and its counterparts, i.e., concealment, secrets and lies [ 7 ]. In a psychotherapy review, Farber [ 7 ] explains that all patients at least occasionally conceal information or lie, with concealment being far more common than outright lying, and most of the time patients are actually quite open and honest. Patients concealing information or lying tends to be spontaneous ‘of the moment’ reactions, with other factors affecting responses that include: patients’ general comfort level in revealing stressful information; the nature of the patients’ character type; therapists’ responsiveness to disclosures, their experiences of previous disclosures (i.e., were they helpful in the past), and demographic factors such as ethnicity and culture (i.e., different cultures with different norms about what is appropriate to disclose). These insights appear to correspond with the earlier work in sports [ 5 , 6 ], but require further investigation to advance knowledge in the sports domain.

In the area of sports performance, there are also anecdotal claims of athletes being dishonest in response to subjective monitoring questionnaires by performance staff and researchers at conferences and on social media. However, for claims of subjective monitoring ‘not being worth the effort because athletes tell lies’ there are also some anecdotal claims of the opposite experience, where staff and researchers’ perception and experiences are that the athletes they work with do provide open and honest responses. Hence, to our knowledge, the gap in the literature is that there are few, if any, systematic studies particularly in professional team-sports to shed light on why athletes do or do not tell the truth, nor what would drive them to be honest or dishonest. We have no advanced, a priori, theoretical or empirical knowledge as to what is going on in the context of the athletes’ minds regarding what is motivating them to answer honestly or not, and this should be investigated to better understand the phenomenon and to guide practical strategies.

Although sparsely investigated in sports performance literature, there are some studies [ 6 , 8 – 10 ] lending support to the notion that athlete monitoring strategies should ideally be easy and quick where athletes are educated on what is being done and why as well as being adequately communicated to in follow-ups about the information they provide. However, a survey published in 2022 by Neupert and colleagues [ 11 ] found that feedback processes from monitoring strategies were largely felt to be ineffective, with 44% of respondents stating that athletes did not receive sufficient feedback, and in some cases the collected data were never even discussed with the athletes and/or coaches. This further supports the literature gap about athletes being honest or not, as we do not why, only that they may be or may not be.

Given the clear gap in the literature about professional team-sport athletes being honest or not or indeed what motivates their level of honesty in response to subjective monitoring, the current debate in sports performance lacks scientific investigation, and, consequently, provides little value to performance staff and their team management. While it has also been suggested that athletes’ responses might be dependent upon the wording of the questions [ 12 ], we take a step back from questionnaire phraseology and the logistics of a protocol, and delve into athletes’ experiences of answering subjective monitoring questionnaires. Therefore, the focus for us is not on the data collection format of the monitoring process through the questionnaire itself, but rather it is an exploratory study about the perspective and experiences of the athlete at the receiving end of the process. What is it about the experiences of the athletes that makes them want to engage honestly or alternatively to withdraw and disengage? Hence, our research question is, why do athletes respond honestly or not when being asked to respond to subjective monitoring questionnaires? This should bring us more in direct contact with the athletes when being asked these questions.

To improve transparency, the Standards for Reporting Qualitative Research (SRQR) [ 13 ] (21 items) and the Consolidated Criteria for Reporting Qualitative Studies (COREQ) [ 14 ] (COREQ) (32-item checklist) were applied.

Research Team and Reflexivity

The present authors comprise one female (AL) and five males (AM, JB, AW, GD, AI). AL (Msc) is an experienced delegate working and researching in the humanitarian sector, skilled in international law, foreign affairs and human rights. AM, JB and GD are PhD sport scientists and researchers, each with over 20 years’ experience as staff and researchers in world-class-level team sports. This experience includes leading and/or consulting in performance and research departments, and being part of national and international championship winning teams including men’s French, Scottish, Spanish leagues, National cups, UEFA Champions League, FIFA World Cup and NFL Superbowl. AI is a PhD psychology researcher and sport psychology consultant practising in world class and elite level sports teams. AM, JB, GD and AI are all experienced in conducting and publishing quantitative research, while AI is also experienced in qualitative research methods. AW is a PhD phenomenologist and qualitative researcher with almost 20 years’ experience working in the field and research in the organizational behaviour area.

Authors AM, JB, GD and AI have experience with subjective monitoring, which has been overall positive in regards to obtaining engagement from athletes. However, we also clarify that in our experience this is not automatically positive; we have had to work hard and consistently to get the buy-in from athletes, some of whom can be particularly argumentative, dismissive or unengaging. However, our experience ‘selling’ subjective measures in practice has taught us that obtaining honest responses from athletes relies not only on the athletes answering but also how we as staff approach subjective monitoring. What drove the initial idea to investigate the phenomenon of subjective monitoring were the differences in AM’s typically eventual, overall positive experience with subjective athlete monitoring, while being aware of the constant reports of negative experiences and criticisms from different groups in practice, research, social media and, anecdotally, at conferences, etc.

Study Design

A phenomenological approach was chosen as the most appropriate using a series of one-to-one interviews to investigate the phenomenon of ‘athletes experiences when being asked to respond to subjective athlete monitoring questionnaires’, for example, s-RPE, wellness, sleep, fatigue, muscle soreness, psychological readiness, etc. Phenomenology is powerful in helping to understand a person’s experiences, which in this current study design involves the athletes’ experiences.

Sample Selection

Purposive sampling was chosen to identify and invite persons to be interviewed. To determine who to include in our sample, we used our own professional network and knowledge of team-sport athletes and sports staff—both performance staff and technical/tactical coaches—who we knew were working with athletes, and who would be willing to participate as interviewees. Because the study’s context is the application of the sports performance role in professional sports, we targeted athletes competing in the major professional team sports, i.e., Association Football, American Football, Basketball, Major League Baseball, Rugby Union and Rugby League. To achieve some diversity in the sample, we sought to include interviewees with varying experience levels by inviting those in any of the following three career stages: (1) world class youth level, i.e., competing at international team level; (2) world-class in the ‘prime’ of their careers, i.e., currently competing as first-team regulars in the best league and international competitions in the world, winning or at least being finalists in at least one major tournament defined as a “one time sporting event of an international scale organized by a ‘special authority’ and yielding extremely high levels of media coverage” [ 15 ]; and, (3) world-class but recently retired, i.e., having competed as first-team regulars in the best leagues and international competitions in the world, winning or at least being finalists in at least one major tournament and being chosen as the ‘best player’ in their sport at national or international level at least once. We therefore excluded athletes who did not have extensive experience in the phenomenon under study—responding to data collection efforts to assess subjective measures. We followed the criteria and decision-tree to qualify as a ‘world-class athlete’ defined by McKay and colleagues [ 16 ]. After identifying potential athletes, we either contacted them directly or via colleagues in our network. We aimed to continue athlete interviews until we deemed saturation was reached, i.e., when interviewees introduced no new perspectives on the topic [ 17 ].

Eighteen world-class team-sport athletes were invited for interview. Invited athletes included seven athletes from women’s sport teams and 11 from men’s sports teams, competing in the top leagues of countries covering six continents. Represented team-sports included association football (four female, four male), American football (one male), basketball (one female, one male), baseball (one male), rugby union (two female, two male), rugby league (two male). Four (one female, three male) invited athletes were recently retired (within 15 years), and two were youth athletes (one female, one male, both over 16 years old but less than 18 years old).

Altogether, 12 athletes accepted to be interviewed; however, one was excluded as the athlete’s level in English speaking made it difficult to conduct the interview in the same way as with the others. Therefore, in total, 11 athletes were interviewed and the transcriptions of their interviews included for thematic analysis. See Table ​ Table1 1 for athlete demographic profiles.

Overview of athletes’ profiles; demographics and athletic honours

Athletes were interviewed online using Microsoft Teams video call, and the appropriate day/time was negotiated to coincide with their schedule. The actual setting of athletes varied from in their own home to a training facility or team hotel prior the morning of a competitive match. Interviews were not audio or video recorded. The intention to record an interview can influence the decisions interviewees take about the information they share [ 18 ], and an effective interview is in part about enabling an environment in which interviewees feel comfortable to say what they want [ 19 ]. Indeed data quality with appropriately trained interviewers between audio-recorded transcripts and interview scripts written directly after an interview have been shown to be comparable in the detail captured [ 18 ]. Given the high-profile nature of the athletes—i.e., world-class with significant media attention surrounding them, and that, with the exception of one of them, they did not have any prior knowledge of or relationship with the interviewer(s)—it was decided by AM, JB and AI that athletes would likely be more open and willing to be ‘interviewed’ without a recording. Hand-written notes were taken during the interviews and typed up in their entirety within 30 min of completing the interviews. AM conducted nine out of the 11 interviews and two were performed by two alternative interviewers, not in the principal research group. While one athlete was proficient in English, this person requested to be interviewed in their mother tongue to ensure they fully understood and in return were understood by the interviewer and optimizing a two-way conversation. In the other instance, the athlete did not speak English. For these interviews, the additional interviewers performed a pilot interview with AM to ensure interviews and questions were structured, delivered and performed in as close a manner as AM would have done. These additional interviewers were fluent in English and translated from the native language to English after the cessation of the interview with the athletes. These two additional interviewers comprised a sport scientist and a sports physician experienced in working with world-class athletes and in scientific research. As with the principal research group, both had similar experiences and assumptions regarding subjective monitoring. Neither had any prior relationship with the athlete they interviewed. Interviews lasted between 30 and 45 min.

Data Collection Methods and Data Collection Instruments and Technologies

The interviews took place over a 1-year period from March 2021 to March 2022. An initial semi-structured interview guide was prepared taking into consideration aspects important for interview design [ 12 ]. The initial semi-structured interview was prepared by AM and AI and piloted with two athletes who were not involved in the study and known to AM. No changes were made to the initial interview guide.

Typed electronic records of the interviews were transferred onto Microsoft Excel. Files comprised separate columns where important full texts of interviews were winnowed to extract ‘quotations/statements’ deemed to be important and of interest, with additional columns prepared for the thematic analysis. Data analysis included (i) first pass : creating a code, (ii) second pass : converting the code to a category, and (iii) determination of each category into an overall theme , which is explained below, in data analysis. All raw interviews and participant information were de-identified and stored securely on Microsoft OneDrive by AM. Both AM and AI had access to a secure, private OneDrive shared folder.

Data Analysis

Deriving findings from the interviews requires recovering a theme(s) that is embodied and dramatized in the evolving meanings of the work [ 20 ]. The specific process performed by AM was based on accepted guidelines for qualitative research analysis [ 20 , 21 ]; First , the interviews were read in full to acquire a feeling for their ideas and to gain a deeper understanding. Second , significant quotations/statements were extracted by identifying key words and sentences relating to the phenomenon being investigated. Third , meanings for these statements were formulated. This process was repeated for each of the persons’ ‘stories’. Fourth , the quotations were re-read and reflected upon for each person separately, and a code assigned by writing a short sentence. Fifth , these short sentence codes were reflected upon to assign the most appropriate descriptive wording and labelled as a ‘category’. Sixth , a small number, typically five to eight, of overall ‘themes’ were generated to be shaped into a general description of the phenomenon, i.e., essence description [ 22 , 23 ], displaying the perspectives of the persons.

After this six-step process was completed, the quotations, codes, categories and themes generated were reviewed by AI, who created notes where clarification and further discussion were needed. AM and AI then collaboratively reflected on and discussed each theme, category, code and quotation. Themes and their relevant categories were then further reviewed by AW, who collaboratively reflected with AM and AI to generate the final agreed upon themes. The themes were then examined, articulated, re-interpreted and re-formulated [ 22 ], and eventually written as a thematic story, drawing on elements reported from different athletes to create a blended story, allowing the reader to get a feel for what it is like to live the experience [ 24 ].

Steps have been taken by our research team to maximize and demonstrate the validity of the study [ 20 ]: (i) Member checking where a final report was returned to interviewees to determine whether or not they felt it accurately reflected their experiences and the insights they gave. (ii) Clarifying the bias of the researcher(s)— in the ‘reflexivity’ section of our article we clarify the potential bias that principal researcher AM and the research team may bring to the study through their own experiences and beliefs. (iii) By presenting negative/discrepant information , i.e., in the narrative we discuss ‘surprising’ codes that went contrary to our potential bias. (iv) Spending prolonged time in the field— we have provided earlier, a detailed overview of our credentials working in the practical setting, which demonstrate our in-depth understanding of the phenomenon under study. (v) Peer debriefing— where an independent person is located to review and ask questions about the qualitative study so that the account resonates with people other than the researcher. (vi) An external auditor— as distinct from a peer debriefer, the auditor is not familiar with the researcher or the project and provides an independent ‘peer’ review of the project.

Four themes emerged from the data analysis of the interviews. These were pursuit of ideal self, individual barriers to athlete engagement, social facilitators to athlete engagement, and experiencing compassion from the performance staff (see Figs. ​ Figs.1, 1 , ​ ,2, 2 , ​ ,3 3 and ​ and4). 4 ). The ensuing text describes each of these themes with quotations from athletes used to support the athletes’ claims, illustrate ideas, and illuminate experience [ 25 ].

Factors supporting the theme ‘pursuit of ideal self’

Factors supporting the theme ‘individual barriers to athlete engagement’

Factors supporting the theme ‘social facilitators to athlete engagement’

Factors supporting the theme ‘experiencing compassion from the performance staff’

Pursuit of Ideal Self

‘Ideal self’ is a driver for intentional change [ 26 ] and was a key theme of discussion by athletes, i.e., the athletes’ preferred future regarding their professional sporting goals. Their pursuit—their motivational drive to improve and become a better athlete and curiosity about what they can do to achieve this—was described by all of the interviewees as an important part of their reasoning when deciding how to respond to subjective monitoring questionnaires. The pursuit of the ideal-self theme is grouped into three categories: drive to be better; curiosity about new processes; and growing self-awareness. Quotes from three of the athletes expressing this motivational drive are:

• “ We are so competitive, if we think something will give us an edge and we don’t take it, then there is something seriously wrong” (A7).
• “I am a player who always took care of my body and I understood quickly that this type of information was for my benefit” (A5).
• “I'm an inquisitive person, I like to know why we are doing things. The more I know for myself, I can put it into my own regimen and learn how to care of myself” (A4).

Athletes also described the importance of recognizing that their real, current self evolves over a career as they become more aware of themselves, their bodies, and their goals. Several athletes discussed how, in general, their approach has been one of being willing to answer honestly. They understood that some athletes may be reluctant to give honest responses depending on each individual persons’ circumstances and past experiences, and acknowledged that they themselves had experienced similar reluctant feelings throughout their careers. One athlete said:

• ”How players respond depends on their experience and age, like the younger and older players…not everyone recognises that being tired or finding a session hard is just a normal part of training and being an athlete.. you learn this with experience” (A8).

Another athlete had a similar reflection:

• “I can see how some people could give a dishonest answer but it comes down to that person and being professional” (A1) .

Two athletes described the change in response pattern as:

• “How you respond to changes throughout your career, depending what stage you are at the more honest you will be” (A10).
• “I’m old enough now to know that they’re [staff] not going to make me run more [i.e., based on the response they give], as I get older I get to understand the process better, once we get to that point it’s easy to be honest” (A11).

Individual Barriers to Athlete Engagement

Individual barriers to athlete engagement can refer to intrapersonal aspects related to negative emotions, such as the negative effect of fear, and perceptions of doubt and scepticism about handing over personal subjective information about how they are feeling. More specifically, fear about mistreatment or dismissing of the athletes’ responses, i.e., their own data, is among the strongest mechanisms for the unwillingness to engage with honest responses to subjective monitoring questionnaires. The individual barriers theme is grouped into four categories: not being treated like human beings; feeling sceptical of intentions; fear of feelings being dismissed; and fear of overactive responses in response to feelings.

Athletes consistently described the importance of feeling like they are being considered and treated as human beings, where their own unique concerns, fears, desires and needs are considered, and the awareness that they are dealing with their own ‘things’ inside and outside of the sporting team. As an example, two athletes explained the importance of not being recognized as individual human beings:

• “Acknowledge who people are, recognise and celebrate people, their cultures, families, what’s important to them. We have a lot of nationalities, Pacific Islanders, English, Irish, Australians…, if you can make them feel important and that the organisation is a family, they will get a sense of belonging and buy in to what the organisation is trying to do” (A7).
• “Understand what else is going on and respond to the circumstances like travel and other stresses [family, social]….you can't tell different types of stress with the external load sensors, what about family, social stresses, travel, too” (A4).

The concept of ‘invisible monitoring’ came up in the interviews. Upon learning what this strategy entails, one athlete reacted with some confusion that this was actually used in teams:

• “I’d feel like a robot. You need to know people care for you. Don’t try and take the human out of it…. Human interaction is so important” (A2).

The second athlete discussing this concept reacted angrily:

• “I’m not a f**king science experiment, invisible monitoring to me, is cr*p, it’s my body, I need to know what is going on… these staff only care about themselves, making themselves look better and getting an increase in salary”. (A11).

Although treating athletes as the individual human beings that they are was described as being key to getting honest responses, it was acknowledged as a potential limitation in certain circumstances:

• “ The human aspect [to subjective monitoring] is definitely a limitation…. If we are angry, you’re more likely to get a short or very reactive reply… but human interaction is so important, especially when it’s someone I like to talk to" (A2).

There was a feeling of being sceptical about the intended use of the information, for example, being used against them before their contract negotiations, or match selection, when asked through subjective monitoring. This scepticism played prominently in athletes’ minds when deciding whether or not to respond honestly. Scepticism was particularly heightened when questionnaires were introduced without prior warning or consultation with the athletes themselves, for example, through formal or informal communications, education sessions, etc.

One athlete reflected,

• “I ask myself how honest should I be?…how is this going to be used?” (A4).

Another athlete described their thoughts when being asked;

• “I’m always trying to be honest, but I’m also thinking how trustable are the staff?” (A9).

A third athlete stated:

• ”If it’s something you’ve never asked me before or I don’t know you, I’ll be like ‘what the h*ll’… is ‘xxxx’[e.g. the coach] going to see this?… if you rock up randomly and ask me these questions, I’m going to think ‘this is a bit weird’, what are you going to do with my information? (A8).

Another reason for the scepticism, especially without information about how the results are used, was related to the perceived impact on the chance of playing. One athlete stated that:

• "We might think that we won’t train or play depending on how we answer” (A5).

Another athlete reflected:

• “ Some players might not be comfortable with them [the staff] because they are wary of them” (A10).

One athlete discussed a specific experience they had where their subjective information had been used against them:

• “I’m pretty good at keeping my cards close to my chest, in x [the league], people [performance staff] can be so variable across the league and other teams, not many are in it for us [i.e. to improve the players’ health and/or performance levels], those guys in [the team], they’re there to sell themselves first and then worry about me, they want a better contract so they used the information to make themselves look better… they definitely presented everything negatively about me at the end of the season, they used it to make them look better; ‘he’s lazy, he’s out of shape, he hasn’t been reporting properly… I’ll now go to the GM [General Manager] and tell them if I don’t trust the staff and that he [i.e. the staff] might not trust me but just so he’s [the GM] aware there might be some mismatches in what he’s told” (A11).

A fear of their feelings being dismissed or staff over-reacting also drove their thought process about whether or not to respond honestly. One athlete expressed:

• “Your reaction to our responses is important, if we can tell that you are not taking us seriously we won’t answer properly… don’t antagonise us and don’t judge our answers” (A2).

Another athlete described a specific experience of perceiving their feelings being dismissed at times when not in the starting squad for a match and being asked to rate how hard sessions were and how they were feeling:

• “If you’re in the practice squad, they [performance staff] wouldn’t give a s**t, they [performance staff] would only care about the guys who were going to be playing, so why even ask us because whatever we said it didn’t even matter” (A11).

Social Facilitators to Athlete Engagement

Social facilitators to athlete engagement was one distinct theme that emerged. Social facilitators refer to perceptions by the athletes based on their experiences and beliefs about what staff within the performance team do, and/or can do to improve athlete engagement through facilitating the provision of information/data. These social facilitators are grouped into four categories that reflect different types of preferred actions: being communicated to about what will change; feeling time and commitments as a pro athlete are respected; simple, fast and efficient methods of collection; and demonstrable change and impact to the training program.

Being informed prior to the implementation of subjective questionnaires and educated about what change(s) will happen based on their information was highlighted by athletes as a key element of obtaining honest and accurate responses. One athlete, for example, discussed this importance especially when players are not familiar with subjective questionnaires:

• “Professional players are not used to it [answering scales], if they didn’t start these when they were youth players… How players respond probably depends on their age and experience, like the young and older players… not everyone recognises that being tired or finding a session hard is just a normal part of training and being an athlete (A5).

About the relevance of educating the athletes another reflected:

• “Educating us on what you are doing and why would help us understand and more likely then to buy into it…expose the next generation to the methods, and the work you are doing” (A8) .

Similar reflections were provided by another two athletes who stated:

• “We want to know why we are doing things, to see how we are feeling and if something needs to be changed (A4).
• “Educate the players why you’re doing it, xxxx [the head of performance) did a lot of talking to everyone, as a group, to the individual players… It’s a lot of trial and error, trying to get the guys to do it… be persistent but you have to learn the persistence needed for each player… explaining on an individual level is important, explain to us the context, what it means to us [i.e. each individual player], how it will benefits us, you’re doing it to make our career better, little things like that” (A11).

Athletes discussed their feelings and reactions to either experiencing no impact or experiencing positive impact, for example, changes to the training programme, based on the information they provide in subjective monitoring questionnaires. Having a demonstrable meaning or purpose to the information they are providing was key to giving honest responses. One athlete said:

“The biggest thing is why? What changes are happening”? (A1) .

When there are no meaningful changes or a positive impact to the programme, athletes described the following scenarios;

• “ Poor quality information or lack of practical information in a simple way we can understand are the main reasons why in my opinion, players do not answer correctly [i.e. with deliberately misleading responses]” (A5).
• ”If you don’t come to see me, or I don’t see changes to my program or preparation I’ll just put anything. If you don’t react to the questionnaires, then I’m done…. I have experience where staff don’t follow the results… then I am not honest all of the time” (A3).
• “I need to see validation of what they [staff] are doing with the results, if nothing changes from 2 weeks before I can tell you don’t give a cr*p…I’ll then just give you a different score than I really feel, probably like 1 or 2 points different just because I know you are expecting something to be different, but it’s not really how I feel [i.e., deliberately misleading response]” (A11).

However, when positive changes are seen and felt by the athletes, they were more prone to buy in to the process and give honest responses. One athlete stated:

• “ If my information is acted upon [i.e. used to improve the training program] then I’ll tell the truth, regardless of the person” (A3).

Another athlete explained:

• “…we want to see that our workouts are adjusted based on our feedback… as soon as we understood that it’s impacting our personal programmes, we were much happier to buy in…. as it gets more consistent we become more likely to be honest” (A2).

A third athlete expressed:

• “The staff need to use the information and communicate it back to us… like 15 min pre-meeting in the morning. It would be good to get feedback from the coach if they change something based on how we are feeling, like ‘you boys are tired so we changed this or that'” (A9).

A strong desire for the subjective monitoring to be seamlessly integrated into the overall training programme was discussed by the athletes. In general, most athletes’ experiences centred around how quick, simple and timely the questionnaires are and that they believe the staff genuinely respect their time and other commitments they have as professional athletes. Three quotes from the athletes illustrating this:

• “ Overdoing it especially the wellness questionnaire can be a bad thing… if it’s too regular I would give the same answers or maybe only differ by one point” (A9).

Another athlete explained,

• “I don't want to be annoyed every morning by someone asking me all the time, like a nagging thing” (A1).
• “ The simpler you make things for us, the better, we have enough going on being a professional player” ( A10).
• “You maybe have about 5% of our time with our full attention, everyone’s trying to get to us, so make the most of it” (A11).

Interestingly, it also shone through that an ‘integrated process’ is subject to individual athlete preferences;

• “It definitely depends on the individual person ” [about how they will respond] (A1).

Although most athletes preferred to be asked subjective questionnaires in-person, this was not the case for everyone, as illustrated by three of the athletes below:

• “I prefer the phone [to answer wellness questionnaires], as we are always on our phones, and it’s easy” (A1).
• “I prefer the app, it’s in my own time, it becomes routine, it’s just me and I can be totally honest” (A10).
• “I like when people talk to me, I feel like they care” (A2).

Experiencing Compassion from the Performance Staff.

Athletes expressed feelings about needing and experiencing compassion from the performance staff to be key to getting honest responses to subjective monitoring. The theme of compassion is grouped into three categories: feeling genuinely cared for by performance staff; feeling genuine passion and effort from the performance staff; and feeling actively involved by the performance staff, in particular, where the sports staff are able to demonstrate their passion, work ethic, commitment and authenticity to the individual athletes and the group as a whole. One athlete expressed the importance of relationships:

• “ Build relationships with us, we want to see how passionate you are about your role in the organisation…. then you will gain our respect” (A7).

Another athlete highlighted the importance of empathy:

• ”Build relationships and convince us that you have our best interests at heart” (A10).

The importance of empathy and recognizing the emotional state of the athletes at the time of being asked and how these questions may stir specific emotions was emphasized by two athletes:

• “ Emotions talk… if we are angry, you’re more likely to get a short or reactive reply” (A2). “One negative thing is that for wellness questionnaires it can bring the athletes mind to a particular soreness, all of a sudden I’d be drawn to focus on that hammy [hamstring] soreness and amplify it.. does it feel worse because I am focusing on it now?” (A7).

A feeling of consistency was often described by athletes as a key part of their decision to be accurate and honest with regard to subjective questionnaires as well as their experience and growing self-awareness. This same consistency was highlighted as also being able to recognise potentially negative emotions and to answer without giving in to these.

• “Emotions talk, as it gets more consistent [i.e. the whole subjective monitoring process] we become more likely to be honest” (A2).

The susceptibility of responding to someone with whom you do not have a good relationship was exemplified by one of the athletes:

• “I’ll be honest with my national team coach because I trust him, but I’ll ask if he is giving the data to [name] in my club team, because I don’t want him to see it, I don’t know what he does with my information” (A7).

The ability of the staff to create an environment where the athletes feel at ease, genuinely cared for, and involved in a conversation about their subjective feelings helps athletes to believe that the persons asking the questions have their best interests at heart. This was stated by several of the athletes:

• “It’s nice to know people care for you, don’t try and take the human out of it” (A2).

Another athlete expressed:

• “I appreciated that staff were listening and taking an interest in how I was feeling or any complaints I had….this made me feel comfortable to invest and answer honestly” (A5).

One athlete explained that, as long as a trusting relationship had been built with the main person responsible for acting on the information, they would be honest, no matter who asked them the subjective questions:

• “I would tell anyone [an honest response] because I knew they would tell xxxx [the head of performance] anyway and I knew he was in it for us and would use the information to make us better” (A11).

Also the importance of involving the athletes in the process was stressed. One athlete said:

• ”Other factors are involved, like a big game coming up.. if my hammies are sore I’ll probably want to water it down a bit, but if you speak to me, involve me in the process like saying ‘ok, how can we modify this training session to keep you fresh for the game” (A7)

How staff can work to establish a high-quality relationship was illustrated by one of the athletes:

• ”Build person to person relationships, have a conversation while you’re in the gym, like ‘how did you feel there mate?.. it’s like you’re having a coffee with them’” (A7).

The purpose of this study was to understand why world-class professional team-sport athletes—both men and women—are honest or not when asked to respond to subjective monitoring questionnaires. In our findings, we identified four themes regarding why athletes are honest or not in responding to subjective monitoring instruments. All four are related to the athletes’ emotions. Just because performance staff must deal with emotions does not mean that subjective monitoring cannot be valid indicators of performance. These emotional needs provide insight into what performance staff can do to address these needs and achieve meaningful results from subjective monitoring.

What our study reveals is that not only are athletes driven by emotion, but, just as importantly, these can be the direct result of the relationship between the performance staff and the athlete, highlighting the importance of this interaction. Table ​ Table2 2 and the section below divide the emotional needs into temporal and spatial ones that athletes possess and how performance staff can respond in order to be responsive to these emotions.

Attending to athletes’ temporal and spatial needs

Attending to Athletes’ Temporal Needs

Athletes have emotional needs that occur temporally, in the present and are targeted towards the future, which need to be fulfilled to facilitate honesty in responding to subjective monitoring instruments.

Performance Staff Encouragement in Athletes’ Achieving their Future Ideal Self

The athletes interviewed described their pursuit to become the best athlete they can, which aligns with the concept of the ‘ideal self’. The ideal self represents the preferred future and importance of a person’s dreams or aspirations in motivating change or the development driver of intentional change in one’s behaviour, emotions, perceptions and attitudes [ 27 ]. Creating a positive vision can facilitate perceptions of hope [ 27 – 29 ], which in turn stimulates the parasympathetic nervous system, resulting in increased openness, cognitive power, and flexibility [ 27 ]. When the ideal self is envisioned by the individual, it can guide actions and decisions in a direction that facilitates improved self-satisfaction through articulation and direction towards the emergence of a new state of being with self-actualization as a core quality [ 26 ]. The athletes interviewed consistently described their own growing self-awareness as important in their evolution of becoming the athlete they want to become, i.e. realizing who they actually are at that present moment in time. In accordance with the ideal self, acknowledging the current, i.e., real, self, and the discrepancy between this and the ideal self, is a powerful motivator for change [ 26 ]. Feeling and believing that performance staff are doing their best to genuinely help them achieve their ideal self appears to be a strong motivator for honest engagement in subjective monitoring practices.

Performance Staff Mitigation of Athletes’ Fear in the Present

The athletes interviewed stated their own internal barriers that negatively affect their ability to be open and honest when responding to subjective monitoring questionnaires [ 26 ]. These barriers included feelings of fear that the information they provide may be misused and/or their responses may be dismissed as trivial, made fun of or misinterpreted, for example, performance staff over-reacting, as well as scepticism about the overall intentions of performance staff. Such feelings led athletes to describe potential but significant trust issues with performance staff. A major issue for performance staff is trying to obtain honest responses from athletes who have perceptions of fear. Such fear can alter a person’s perception of the environment to be more threatening than it really is, resulting in defensive or hostile actions, in the person being more likely to withdraw or inhibit new thoughts and alternative ways to approach a situation [ 26 ]. The feelings described by the athletes in our study correspond to a fear that links closely with the psychotherapy literature, where the most common self-reported motives for lies and concealment of information are to avoid both shame and the therapist’s over-reaction or that the therapist will not understand a particular issue [ 7 ]. The person’s—for example in our study, the athlete’s—experience, either good or bad, will drive how the person reacts in future [ 7 ]. Our findings demonstrate that claims of the proper wording of questions in subjective monitoring questionnaires as the basis for inaccurate responses due to misinterpretation is not the entire explanation for why answers may be dishonest, but rather that they relate to an intentional dishonest response. Our findings extend those by Neurpert et al. [ 5 ] that emergence of emotions such as fear may result in deliberate dishonesty and strongly suggest that a consideration must include the emotions invoked in athletes through the performance staff’s communication behaviours and actions with them.

Attending to Athletes’ Spatial Needs

Athletes also have emotional needs that, when fulfilled, support honesty in responding to subjective monitoring instruments that occur spatially in the information flow and in the interaction between performance staff and athletes.

Performance Staff Transparency and Information Flow Feedback with Athletes

The theme ‘social facilitators for athlete engagement’ described by our athletes centred around their experiences and subsequent emotions invoked about how subjective monitoring is implemented and facilitated in their team. Athletes explained how the performance staff’s methods and approaches to subjective monitoring can drive concealment, honesty or outright lying, i.e., how performance staff affect athlete ‘engagement’ in the process. Engagement can be described as the simultaneous employment and expression of a person’s preferred, i.e., ideal, self in task behaviours promoting connections to work and to others, and personal presence, whether physical, cognitive, or emotional [ 30 ]. ‘Disengagement’ refers to the uncoupling of selves from work roles where people withdraw and defend themselves physically, cognitively, and/or emotionally [ 30 , 31 ]. The athletes’ experiences suggest that performance staff do not always facilitate—intentionally or unintentionally—an engaging process, and/or an environment that fosters honest and open responses. Our findings support previous research that a process facilitating subjective monitoring should be simple, efficient and, by design, engaging. However, our study provides additional insight into ‘why’ it should be this way, i.e., it is an opportunity to elicit positive emotions that actually motivate athletes’ to be honest. Additionally, we demonstrate a deeper appreciation of the impact that transparency can have in convincing athletes to be honest. While research has suggested the importance of educating and communicating with athletes on what is being done in regards to subjective monitoring questionnaires, we show ‘why’ this is actually important. Specifically, a two-step process must occur: first, athletes need to experience and therefore believe that there is meaning/purpose to what they are being asked to do; and second, once they are convinced of the meaning, this then needs to be demonstrated through consistent behaviour and action of the performance staff through feedback and impact to training. Meaningfulness specifically refers to the extent that people derive meaning from their work and feel that they are receiving a return on investment, where they feel worthwhile, useful, valuable and not taken for granted [ 31 ]. This is essentially what the athletes in our study are seeking, and by doing so, the return on investment for the efforts of the performance staff themselves will be honest engagement; in other words, everybody wins.

Performance Staff Development of an Interpersonal, Cooperative Relationship with Athletes

Athletes' desire that performance staff treat them with compassion, represents an important behaviour of the performance staff that can elicit positive emotions through feeling convinced about staff intentions and therefore opening up athletes’ honesty. Compassion can be described as consisting of three principal components: (1) empathizing with the other, (2) caring for the other, and (3) acting in response to the other’s feelings [ 32 , 33 ]. Essentially, compassion can be viewed as noticing another’s need or desire, and by ‘coaching them with compassion’, we are focusing on invoking the ideal self to initiate and guide the change process [ 33 ]. Compassion’s function is the maintenance of cooperative relationships [ 34 ], and to be successful, the coach, i.e., performance practitioner in our example, must establish and cultivate a trusting relationship with the athlete so they discuss their hopes and dreams openly, and develop in them a sense of safety to explore new thinking and development [ 35 ]. For the athletes in this study, an essential part of feeling compassion from performance staff was being actively involved in both the subjective and the overall monitoring process. While getting buy-in from players is not always easy, the trend to remove the athlete from the process, for example, through ‘invisible monitoring’, does not appear to correspond with how athletes see the full benefits of a health and performance monitoring program. Based on our results, it is more likely that ‘visible’ monitoring where athletes are actively involved, for example, through coaching with compassion, will arouse positive emotions and healthy psychophysiological systems helping them become more open to new possibilities, grow and renew themselves, leading to favourable outcomes at the individual, dyad, group and organizational levels [ 33 ].

Limitations

For the reasons stated in the Methods section, the authors of this study made the intentional decision not to record interviews. It is always a risk doing so because not all information will be captured by the interviewer. However, the benefits outweigh this risk by acquiring thick descriptions of the phenomenon of interest. Consequently, we have taken several steps to maximize and demonstrate the qualitative validity of our findings and our interpretive discussion. We implemented ‘member checking’ to ensure the athletes interviewed felt our account of their experiences was accurate. We clarified researcher bias based on our own personal views and experience in the reflexivity section earlier in our article. Additionally, we included both a peer debriefer and an external auditor to review and provide feedback on the manuscript prior to submission. We also acknowledge that we focused specifically on world-class professional team sport athletes and the experiences of amateur or semi-professional team sport athletes as well as individual sport athletes and/or athletes competing at elite, amateur or recreational levels may have different and/or unique experiences that relate specifically to them. We also realise that we have interviewed athletes only, and interviewing of performance staff to understand their experiences and the potential mutual role that both parties might play should be explored.

Practical Application

This study does not prescribe generalized methodologies, sets of techniques, or rules for acting as seen in ‘typical’ practical applications; rather, through an analytic way of thinking, we provide performance staff with insights that can strengthen the relationship between thoughtfulness and tact.

Cultivating trusting relationships with athletes and creating an environment that facilitates openness and honesty appear to be what athletes are seeking from performance staff. As performance staff we clearly need to have self-awareness around how athletes might perceive and experience our behaviours and actions toward them and our power to invoke either negative or positive emotions in them. We can elicit positive emotions through helping athletes to become the best athlete they can, i.e., to be their ‘ideal self’, by behaving and acting genuinely and with consistency in a way that convinces athletes that we are genuinely there to help them and not just in it for ourselves.

We should reflect on our subjective monitoring protocols, being aware about which questionnaire(s) we use, how we implement them and when we ask questions. These are more than purely ‘logistical’ matters, but rather correspond to how an athlete will react emotionally and dictate their responses. Ultimately, we should ask ourselves, are we truly caring for the athlete? Are we really acting in response to how each individual person is feeling in the present and caring for their future? Are we coaching them with compassion? Overall, performance staff being aware of and tapping into athletes’ pursuit of their ideal selves and accompanying them on their journey to bridge the gap between their real and ideal self may represent a potentially powerful strategy for staff to get honest buy-in from athletes.

Future Directions

Our insights open up new and exciting areas for scientific investigation, in particular towards a deeper understanding of athletes’ pursuit of their ideal selves and how we can most effectively help them to transition toward their preferred future including their dreams, hopes and desires. This represents an exciting area for future research into athlete engagement and the role of emotions in providing honest responses. The implications are not only to be found in subjective monitoring but could be extended to the entire athlete preparation domain, and how we engage and build relationships with athletes throughout the entire health and performance process.

While other qualitative methodological studies cited in this article have studied athlete perceptions, our study is one of the few, to our knowledge, to describe and attempt to understand the “why” of whether athletes respond honestly to subjective monitoring questionnaires. Our findings revealed that the honesty of athlete responses may be largely driven by the emotions invoked within them in response to the behaviours and actions of performance staff asking the questions, with negative emotions fostering dishonesty and positive ones encouraging honesty. Positive emotions are experienced by athletes when they are convinced that performance staff are genuinely doing their best to help them to become the best athlete that they can be, that their time and effort is being respected, and that there is demonstrable meaning to them participating in subjective monitoring processes.

Acknowledgements

There are several people who have been integral to the successful completion of this project. We have decided not to name each person as this could open up the possibility of identifying potential athletes who have participated, for example, people linked to teams, nationalities, etc. We acknowledge and express our gratitude to everyone who has helped in this study and have sent them individual notes to explain why we will not include their names in the acknowledgments, but thank them on a personal basis.

Declarations

No funding was received for this project.

Alan McCall, Andreas Ivarsson, Gregory Dupont and Johann Bilsborough acknowledge their overall positive experience with implementing subjective monitoring questionnaires with athletes (albeit not necessarily easy). Adrian Wolfberg and Amelie Laroque declare no conflicts of interest.

Verbal informed consent was obtained from the athletes and ethical approval was granted through Edinburgh Napier University Ethics Committee (SAS/0080). Participants gave verbal informed consent after receiving a detailed explanation of the project. The study complied with the latest guidelines set out in the Declaration of Helsinki, apart from registration in a publicly accessible database.

AM and JB conceived the idea for the project and prepared the initial design drafts. AI and AW reviewed and provided feedback on the initial design and AM, JB, AI and AW worked on various versions including the version following feedback from peer debriefer until a final protocol was developed. AM and AW prepared the data collation sheet. AM conducted the interviews. JB was present for two interviews. AM piloted the interview with athletes and with two additional interviewers for the interviews conducted in other languages ( n  = 2). AM performed the initial thematic analysis. AI reviewed and AM and AI collaborated to define first full themes. AW reviewed this and together AM, AI, AW prepared the final thematic analysis for review by JB, GD and AL. AM drafted the first version of a manuscript, JB and AI provided input into this first version. Thereafter AM, AI and AW worked on five drafts of a manuscript. Draft 6 was reviewed by all authors who were involved until the final manuscript was submitted.

Adrian Wolfberg and Andreas Ivarsson are joint second authors.

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Qualitative Research in Sport and Physical Activity

• Ian Jones - Bournemouth University, UK
• Lorraine Brown - Bournemouth University, UK
• Immy Holloway - Bournemouth University, UK
• Description

• early steps in the research process

• choosing your an approach

• methods of data collection

• analysing the data

• writing up and disseminating your findings.

This is essential reading for undergraduate and Masters students carrying out a qualitative research project in sport and physical activity and for PhD students looking to refresh their knowledge.   PART ONE: INTRODUCING QUALITATIVE RESEARCH IN SPORT   Qualitative Research and Its Use in Sport and Physical Activity The Main Characteristics of Qualitative Research

This is a 'must have' book for aspiring qualitative researchers in the field of sport and physical activity. The book is well structured, providing the researcher with a step-by-step guide to the processes that need to occur to undertake methodologically sound qualitative research. It is intellectual and yet pragmatic which makes this a book that I will recommend to my PhD students and colleagues alike. Murray Drummond Professor in Sport, Health and Physical Education, Flinders University

This text provides students with an excellent foundation for understanding qualitative research studies and for conducting their own qualitative inquiries, in fields ranging from sport management and marketing to sport sociology and psychology. Paul M. Pedersen Professor and Director, Sport Management Doctoral Program, Indiana University-Bloomington

This book, whilst fairly basic, gives a good overview of qualitative research methods for sport and exercise. This works very well for this introductory research methods module.

This text provides all the relevant details our students will need when planning their research projects. The ethical considerations will be a must for them as it sets out the project in small concise steps.

wonderful book. Focuses on an interesting angles

A useful text that provides learners with relevant information when starting a research project. Further reading would be recommended to explore factors in greater depth. However much of the content is subject specific allowing readers to apply to there own research project.

Very useful book. Split in to easily manageable sections. The students comment it helps them in their assignments.

I have given this book as good overview on Qualitative research methods for students during their independent studies. It allows them to consider the type of methods available to them when making decisions on their research methodology.

I would recommend this text to students searching for a comprehensive overview of appropriate techniques to qualitative research from all levels of degree study. Especially useful for independent projects, a good read.

Really interesting, clear and structured nicely. Will be informing the library to acquire a copy.

This is a useful text in addition to other Research Methods texts. Offers expertise and good views on Qualitative Research as well as providing learners with an alternative angle from which to understand the topic. Excellent to use for further reading due to the plethora of references throughout the text.

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Sport Psychology Research Methods: Qualitative vs Quantitative

Qualitative and Quantitative

Qualitative and quantitative research methods are two commonly used psychological research approaches with very different procedures and objectives. It is important for researchers to understand the differences between these two modes of research in order to determine which approach is best suited to adequately address the research question. The greatest distinctions between these two fundamentally different research techniques are the genesis of theory and the role that theory plays in the mechanics of research. In the quantitative technique, the research effort begins with a theory: a statement that tries to explain observed phenomena. The theory is then operationalized (that is, stated in terms that can be statistically tested) through hypothesis. Data is gathered, statistical tests are completed, and the results are interpreted. The results either support the hypothesis or they do not. (Downey & Ireland, 1979)

Quantitative research is experimental and objective whereas qualitative research is explorative and is not in numerical form. Quantitative research is used to identify evidence of cause and effect relationships and is used to collect data from a larger population than qualitative research (Downey & Ireland, 1979). Aliaga and Gunderson (2000), explain that qualitative research is ‘Explaining phenomena by collecting numerical data that are analyzed using mathematically based methods’. It is used to quantify attitudes, opinions, behaviors, and other defined variables – and generalize results from a larger sample population.

Quantitative data collection methods are much more structured than qualitative data collection methods. Data collection methods used in qualitative research includes focus groups, triads, dyads, interviews and observation (Creswell, 2013). Qualitative data is descriptive, which is more difficult to analyze then quantitative data which is categorized, ranked, or in units of measurement. One benefit of qualitative research is the ability to observe, collect, and reach data that other methods cannot obtain. It also provides researchers with flexibility in conveying a story without the constraints of formal academic structure (Creswell, 2013). However, Berkwits and Inui (1998) explain that qualitative research is suspect in its usefulness to provide a generalize foundations for clinical decisions and policies.

Qualitative methods derive from a variety of psychological research disciplines and traditions (Crabtree & Miller, 2012). Different in many ways from quantitative research; yet qualitative research does have a quantitative connection. Qualitative research, also recognized as preliminary exploratory research, is used to capture communicative information not conveyed in quantitative data about beliefs, feelings, values, and motivations that trigger behaviors. They are used to learn directly from the participant what is important to them, to provide the context necessary to understand quantitative findings, and to identify variables important for future clinical studies (Crabtree & Miller, 2012). Qualitative research provides insights into the problem and helps to develop ideas or hypotheses for potential quantitative research.

Examining Qualitative Research

Qualitative research is primarily used in investigative research to explore a phenomenon. Creswell (2013) explains that qualitative methods should be used to study complex subjects and topics. Some subjects in which qualitative analysis is the methodology of choice include but are not limited to education, biology, behavior, health care, psychology, human resources, as well as societal issues such as cultural and racial issues, social norms and stigmas. The use of qualitative research is appropriate when the researcher wants to answer questions or solve a problem by collecting data to generate a theory or hypothesis.  Qualitative research uses context and a non-judgmental approach to attempt to understand the phenomena in question from the subject’s point of view and is used to capture expressive information not conveyed in quantitative data about beliefs, values, feelings, and motivations that underlie behaviors (Berkwits & Inui, 1998). Qualitative research is a form of inquiry that analyzes information observed in natural settings.

Qualitative Research is also used to uncover trends in thought and opinions, and dive deeper into the problem. Qualitative data collection methods vary using unstructured or semi-structured techniques. Some common methods include focus groups (group discussions), individual interviews, and participation/observations. The sample size is typically small, and respondents are selected to fulfill a given quota. There are four philosophical assumptions of qualitative methodology recognized in psychological research: ontology, epistemology, axiology, and methodology.

Qualitative research comes from a variety of psychological research disciplines and traditions (Crabtree & Miller, 2012). It is a unique research approach because it allows research access to information that goes beyond quantitative measure. However, the main weakness of the qualitative approach is that it is difficult to provide generalizable foundation for scientific decisions and procedures behaviors (Berkwits & Inui, 1998). It is important to mention that some qualitative approaches use technical methods (such as statistical content analysis) to determine the significance of findings, while others rely on researchers thoughtful reflection (Crabtree & Miller, 2012).

Examining Quantitative Research

Quantitative research is experimental and objective. The objective of quantitative research is essentially to collect numerical data to explain a particular phenomenon (Hoe and Hoare, 2012). By using measurable data researchers are able to formulate facts and uncover patterns in research. The quantitative approach involves a systematic empirical investigation of a phenomenon using numerical data. It is used to identify evidence of cause and effect relationships, as well as collect data from a larger population than qualitative research (Downey & Ireland, 1979).

When conducting a quantitative study researchers use statistical tests to analyze research data. Quantitative data collection methods include various forms of surveys, face-to-face interviews, telephone interviews, longitudinal studies, website interceptors, online polls, and systematic observations. For researchers using the quantitative technique, data is primary and context is secondary. This means that researchers gather data that can be counted, but the context in which the data is observed is not very important to the process. The data is analyzed and rational conclusions are drawn from the interpretation of the resulting numbers (Downey & Ireland, 1979).

Researches elect to use quantitative research when their research problem and questions are best suited to being answered using quantitative methods. Quantitative research is designed to quantify a research problem by way of generating numerical data or data that can be transformed into useable statistics. There are four main types of research questions best suited for quantitative research. The first type of question is a question demanding a qualitative answer (Hoe and Hoare, 2012). For example, how many I/O psychology students are currently enrolled at Capella. The second type of questions is when numerical can only be studies using quantitative methods (Hoe and Hoare, 2012). For example, is the number of I/O psychology students enrolled at Capella rising or falling? The third type of question concerns understanding the state of a phenomenon, such as the contributing factors (Hoe and Hoare, 2012). For example, what factors predict the recruitment of I/O psychology students to attend online universities? The final type of question best suited for quantitative methods is the testing of hypotheses?

There are three quantitative research approaches: (1) experimental, (2) quasi-experimental, and (3) non-experimental. Variables are the foundation of quantitative research. Variables are something that takes on different values or categories. The experimental approach is used to study the cause and effect relationship of variables, specifically the independent and dependent variables. This approach involves the use of true random assignments of variables for analysis. The defining characteristic of the experimental approach involves the manipulation of the independent variable. The quasi-experimental approach is similar to the experimental approach however the main difference is that it does not include the use of randomly assigned variables. The final quantitative research approach, non-experimental, is a comparative approach that differs from experimental because there is no manipulation of the independent variable or random assignment of variables (Leedy & Ormrod, 2013). Sources of references: Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Newbury Park, CA: Sage Publications. Leedy, P. D., & Ormrod, J. E. (2013). The nature and tools of research. Practical research: Planning and design , 1-26.

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• Volume 52, Issue 22
• Rigorous qualitative research in sports, exercise and musculoskeletal medicine journals is important and relevant
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• http://orcid.org/0000-0001-6325-2705 Susan C Slade 1 , 2 ,
• Shilpa Patel 3 ,
• Martin Underwood 3 ,
• Jennifer L Keating 1
• 1 Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences , Monash University , Melbourne , Victoria , Australia
• 2 La Trobe Centre for Sport and Exercise Medicine Research , School of Allied Health/College of Science, Health and Engineering, La Trobe University , Melbourne , Victoria , Australia
• 3 Division of Health Sciences, Warwick Clinical Trials Unit , Warwick Medical School, University of Warwick , Coventry , UK
• Correspondence to Dr Susan C Slade, Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3128, Australia; susan.slade{at}monash.edu

https://doi.org/10.1136/bjsports-2017-097833

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• qualitative
• methodology

Qualitative research enables inquiry into processes and beliefs through exploration of narratives, personal experiences and language. 1 Its findings can inform and improve healthcare decisions by providing information about peoples’ perceptions, beliefs, experiences and behaviour, and augment quantitative analyses of effectiveness data. The results of qualitative research can inform stakeholders about facilitators and obstacles to exercise, motivation and adherence, the influence of experiences, beliefs, disability and capability on physical activity, exercise engagement and performance, and to test strategies that maximise physical performance.

High-quality qualitative research can also enrich interpretation of quantitative analyses and be pooled in metasyntheses for evaluation of strength of evidence; contribute to the development and implementation of clinical decision support aids, outcome measures and clinical practice guidelines 2 such as the UK National Institute for Health and Care Excellence guidelines ( www.nice.org.uk ) and Ottawa Panel guidelines for knee osteoarthritis 3 ; and inform health and social care. 4

In 2000, just 0.6% of papers in 170 general medical, mental health and nursing journals reported qualitative research. Between 1999 and 2008, the proportion of qualitative studies in 20 high-impact general medical and health services and policy research journals remained consistently low. 5 Our audit and assessment of Scopus top 10 journals in ‘physical therapy, sports therapy and rehabilitation’ identified few qualitative publications. These ranged from zero to three per journal from January 2017 to August 2017. Other journals publishing reports in the field of exercise and sports medicine had better representation of qualitative research into exercise prescription for low back pain: for example, Journal of Physiotherapy (n=3), Clinical Rehabilitation (n=7) and Physiotherapy (n=11).

In sport and exercise research, qualitative analysis is fundamental to understanding factors such as exercise adherence, the nature of effective training, non-response to interventions and stakeholder priorities. 6 Qualitative Research in Sport, Exercise and Health is the first international journal dedicated solely to qualitative research in sport and exercise psychology, sport sociology, sports coaching, and sports and exercise medicine. Greater representation of qualitative research in BJSM would enhance the scope of its publications. Strategies that enhance the research rigour and credibility of qualitative research reports may promote acceptance of qualitative studies across a wider spectrum of journals.

Reporting guidelines

All research reports need to demonstrate that the work meets accepted standards for scientific rigour. Reporting guidelines and checklists such as the Consolidated criteria for Reporting Qualitative research (COREQ) 7  guide the complete and transparent reporting of qualitative studies. A comprehensive study report provides the detail that readers need to appraise the credibility of findings. Formalised checklists create uniformity across publications and enable replication and validation, and facilitate translation of key findings to practice.

Risk of bias/trustworthiness

Items likely to be important to consider for risk of bias/assessment of internal validity are sampling strategies, adequacy (often termed saturation) of data collection to support theory development, participant protection, researcher bias, data collection methods designed to enhance accuracy, explicit analysis procedures, clarity in the links between data and results, and selective reporting bias.

Qualitative metasynthesis

A synthesis of evidence from qualitative research can provide ‘strength of evidence’ and benefits when qualitative data are available in peer-reviewed publications. 8 Comprehensive reporting is guided by the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) 9 statement. Assessment of overall confidence in review findings is guided by the Confidence in the Evidence from Reviews of Qualitative Research. 9

The Equator Network: repository for reporting guidelines

Reporting guidelines are available on the Equator Network ( www.equator.org ). As an overview, empirical studies should include the headings of title and abstract, background, methods (theoretical framework, research team characteristics, participant selection, ethical issues, setting, data collection and analysis), results (synthesis, interpretation and links to empirical data), discussion and other (conflicts of interest, funding). 7 For metasynthesis, recommended headings are aim, synthesis method, eligibility criteria, data sources, search strategy, study selection, appraisal, data extraction and analysis steps, coding, theme derivation, supporting quotations, synthesis output and discussion. 10

Conclusion and recommendations

We encourage and support a higher profile of empirical qualitative studies and metasyntheses in BJSM and representation of stakeholder beliefs and experiences. It would advance reporting practices if authors submit, and editors require, manuscripts that comply with published reporting guidelines (COREQ for empirical studies; ENTREQ for metasyntheses). The quality of qualitative research publications might be advanced if reviewers use standardised reporting guidelines, and risk of bias assessment items that evaluate internal validity when reviewing manuscripts for publication. This would be facilitated by guideline checklists that are returned with manuscript review. We recommend and support a BJSM policy that requires completion of reporting guideline checklists for manuscript submission.

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Contributors All authors have contributed to this editorial and approved the final manuscript.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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Qualitative Research Questions: Gain Powerful Insights + 25 Examples

We review the basics of qualitative research questions, including their key components, how to craft them effectively, & 25 example questions.

Einstein was many things—a physicist, a philosopher, and, undoubtedly, a mastermind. He also had an incredible way with words. His quote, "Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted," is particularly poignant when it comes to research. 

Some inquiries call for a quantitative approach, for counting and measuring data in order to arrive at general conclusions. Other investigations, like qualitative research, rely on deep exploration and understanding of individual cases in order to develop a greater understanding of the whole. That’s what we’re going to focus on today.

Qualitative research questions focus on the "how" and "why" of things, rather than the "what". They ask about people's experiences and perceptions , and can be used to explore a wide range of topics.

The following article will discuss the basics of qualitative research questions, including their key components, and how to craft them effectively. You'll also find 25 examples of effective qualitative research questions you can use as inspiration for your own studies.

Let’s get started!

What are qualitative research questions, and when are they used?

When researchers set out to conduct a study on a certain topic, their research is chiefly directed by an overarching question . This question provides focus for the study and helps determine what kind of data will be collected.

By starting with a question, we gain parameters and objectives for our line of research. What are we studying? For what purpose? How will we know when we’ve achieved our goals?

Of course, some of these questions can be described as quantitative in nature. When a research question is quantitative, it usually seeks to measure or calculate something in a systematic way.

For example:

• How many people in our town use the library?
• What is the average income of families in our city?
• How much does the average person weigh?

Other research questions, however—and the ones we will be focusing on in this article—are qualitative in nature. Qualitative research questions are open-ended and seek to explore a given topic in-depth.

According to the Australian & New Zealand Journal of Psychiatry , “Qualitative research aims to address questions concerned with developing an understanding of the meaning and experience dimensions of humans’ lives and social worlds.”

This type of research can be used to gain a better understanding of people’s thoughts, feelings and experiences by “addressing questions beyond ‘what works’, towards ‘what works for whom when, how and why, and focusing on intervention improvement rather than accreditation,” states one paper in Neurological Research and Practice .

Qualitative questions often produce rich data that can help researchers develop hypotheses for further quantitative study.

• What are people’s thoughts on the new library?
• How does it feel to be a first-generation student at our school?
• How do people feel about the changes taking place in our town?

As stated by a paper in Human Reproduction , “...‘qualitative’ methods are used to answer questions about experience, meaning, and perspective, most often from the standpoint of the participant. These data are usually not amenable to counting or measuring.”

Both quantitative and qualitative questions have their uses; in fact, they often complement each other. A well-designed research study will include a mix of both types of questions in order to gain a fuller understanding of the topic at hand.

If you would like to recruit unlimited participants for qualitative research for free and only pay for the interview you conduct, try using Respondent  today. 

Crafting qualitative research questions for powerful insights

Now that we have a basic understanding of what qualitative research questions are and when they are used, let’s take a look at how you can begin crafting your own.

According to a study in the International Journal of Qualitative Studies in Education, there is a certain process researchers should follow when crafting their questions, which we’ll explore in more depth.

1. Beginning the process 

Start with a point of interest or curiosity, and pose a draft question or ‘self-question’. What do you want to know about the topic at hand? What is your specific curiosity? You may find it helpful to begin by writing several questions.

For example, if you’re interested in understanding how your customer base feels about a recent change to your product, you might ask: 

• What made you decide to try the new product?
• How do you feel about the change?
• What do you think of the new design/functionality?
• What benefits do you see in the change?

2. Create one overarching, guiding question 

At this point, narrow down the draft questions into one specific question. “Sometimes, these broader research questions are not stated as questions, but rather as goals for the study.”

As an example of this, you might narrow down these three questions: 

into the following question: 

• What are our customers’ thoughts on the recent change to our product?

3. Theoretical framing 

As you read the relevant literature and apply theory to your research, the question should be altered to achieve better outcomes. Experts agree that pursuing a qualitative line of inquiry should open up the possibility for questioning your original theories and altering the conceptual framework with which the research began.

If we continue with the current example, it’s possible you may uncover new data that informs your research and changes your question. For instance, you may discover that customers’ feelings about the change are not just a reaction to the change itself, but also to how it was implemented. In this case, your question would need to reflect this new information: 

• How did customers react to the process of the change, as well as the change itself?

4. Ethical considerations 

A study in the International Journal of Qualitative Studies in Education stresses that ethics are “a central issue when a researcher proposes to study the lives of others, especially marginalized populations.” Consider how your question or inquiry will affect the people it relates to—their lives and their safety. Shape your question to avoid physical, emotional, or mental upset for the focus group.

In analyzing your question from this perspective, if you feel that it may cause harm, you should consider changing the question or ending your research project. Perhaps you’ve discovered that your question encourages harmful or invasive questioning, in which case you should reformulate it.

5. Writing the question 

The actual process of writing the question comes only after considering the above points. The purpose of crafting your research questions is to delve into what your study is specifically about” Remember that qualitative research questions are not trying to find the cause of an effect, but rather to explore the effect itself.

Your questions should be clear, concise, and understandable to those outside of your field. In addition, they should generate rich data. The questions you choose will also depend on the type of research you are conducting: 

• If you’re doing a phenomenological study, your questions might be open-ended, in order to allow participants to share their experiences in their own words.
• If you’re doing a grounded-theory study, your questions might be focused on generating a list of categories or themes.
• If you’re doing ethnography, your questions might be about understanding the culture you’re studying.

Whenyou have well-written questions, it is much easier to develop your research design and collect data that accurately reflects your inquiry.

In writing your questions, it may help you to refer to this simple flowchart process for constructing questions:

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25 examples of expertly crafted qualitative research questions

It's easy enough to cover the theory of writing a qualitative research question, but sometimes it's best if you can see the process in practice. In this section, we'll list 25 examples of B2B and B2C-related qualitative questions.

Let's begin with five questions. We'll show you the question, explain why it's considered qualitative, and then give you an example of how it can be used in research.

1. What is the customer's perception of our company's brand?

Qualitative research questions are often open-ended and invite respondents to share their thoughts and feelings on a subject. This question is qualitative because it seeks customer feedback on the company's brand. 

This question can be used in research to understand how customers feel about the company's branding, what they like and don't like about it, and whether they would recommend it to others.

2. Why do customers buy our product?

This question is also qualitative because it seeks to understand the customer's motivations for purchasing a product. It can be used in research to identify the reasons  customers buy a certain product, what needs or desires the product fulfills for them, and how they feel about the purchase after using the product.

3. How do our customers interact with our products?

Again, this question is qualitative because it seeks to understand customer behavior. In this case, it can be used in research to see how customers use the product, how they interact with it, and what emotions or thoughts the product evokes in them.

4. What are our customers' biggest frustrations with our products?

By seeking to understand customer frustrations, this question is qualitative and can provide valuable insights. It can be used in research to help identify areas in which the company needs to make improvements with its products.

5. How do our customers feel about our customer service?

Rather than asking why customers like or dislike something, this question asks how they feel. This qualitative question can provide insights into customer satisfaction or dissatisfaction with a company. 

This type of question can be used in research to understand what customers think of the company's customer service and whether they feel it meets their needs.

20 more examples to refer to when writing your question

Now that you’re aware of what makes certain questions qualitative, let's move into 20 more examples of qualitative research questions:

• How do your customers react when updates are made to your app interface?
• How do customers feel when they complete their purchase through your ecommerce site?
• What are your customers' main frustrations with your service?
• How do people feel about the quality of your products compared to those of your competitors?
• What motivates customers to refer their friends and family members to your product or service?
• What are the main benefits your customers receive from using your product or service?
• How do people feel when they finish a purchase on your website?
• What are the main motivations behind customer loyalty to your brand?
• How does your app make people feel emotionally?
• For younger generations using your app, how does it make them feel about themselves?
• What reputation do people associate with your brand?
• How inclusive do people find your app?
• In what ways are your customers' experiences unique to them?
• What are the main areas of improvement your customers would like to see in your product or service?
• How do people feel about their interactions with your tech team?
• What are the top five reasons people use your online marketplace?
• How does using your app make people feel in terms of connectedness?
• What emotions do people experience when they're using your product or service?
• Aside from the features of your product, what else about it attracts customers?
• How does your company culture make people feel?

As you can see, these kinds of questions are completely open-ended. In a way, they allow the research and discoveries made along the way to direct the research. The questions are merely a starting point from which to explore.

This video offers tips on how to write good qualitative research questions, produced by Qualitative Research Expert, Kimberly Baker.

Wrap-up: crafting your own qualitative research questions.

Over the course of this article, we've explored what qualitative research questions are, why they matter, and how they should be written. Hopefully you now have a clear understanding of how to craft your own.

Remember, qualitative research questions should always be designed to explore a certain experience or phenomena in-depth, in order to generate powerful insights. As you write your questions, be sure to keep the following in mind:

• Are you being inclusive of all relevant perspectives?
• Are your questions specific enough to generate clear answers?
• Will your questions allow for an in-depth exploration of the topic at hand?
• Do the questions reflect your research goals and objectives?

If you can answer "yes" to all of the questions above, and you've followed the tips for writing qualitative research questions we shared in this article, then you're well on your way to crafting powerful queries that will yield valuable insights.

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Asking the right questions in the right way is the key to research success. That’s true for not just the discussion guide but for every step of a research project. Following are 100+ questions that will take you from defining your research objective through  screening and participant discussions.

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International Society of Qualitative Research in Sport and Exercise

Welcome to the International Society of Qualitative Research in Sport and Exercise ( QRSE ). Founded in 2020, QRSE is a professional organization devoted to promoting, advancing and connecting qualitative research in the sport and exercise sciences. Given that we already have excellent sport and exercise societies the question becomes, ‘ Why another society’?  

In 2009 the journal Qualitative Research in Sport, Exercise and Health (QRSEH) was established. Not long after the International Conference on Qualitative Research in Sport and Exercise became a biennial event. The Routledge book series Qualitative Research in Sport and Physical Activity was also established. Since establishing the journal, conference, and book series numerous scholars across the world have asked if a society dedicated to qualitative research in sport and exercise was going to be established. The simple answer for some time was ‘No’. However, as time progressed and dialogues unfolded with hundreds of sport and exercise scholars at conferences, meetings, and over social media, it became clear there was a real need for a new society that complements others but which is distinctly qualitative and connects researchers from different disciplines.

QRSE was therefore established to provide both an international home solely dedicated to qualitative research and a forum that brings together researchers from different disciplines. It is open to all methods, methodologies, traditions, epistemologies, ontologies, and empirical work that fall under the umbrella of qualitative research. QRSE is also multidisciplinary by bringing together researchers interested in qualitative research from the disciplines of sport and exercise psychology, sociology of sport, sport coaching, sport pedagogy, leisure studies, sport management, sport policy, sport and exercise medicine, and others. 

MISSION STATEMENT

We strive to:

Promote qualitative research in the sport and exercise sciences

Advance excellence in qualitative research and teaching 

Provide a forum for networking, knowledge sharing, collaboration, lobbying, and fostering supportive relationships and communities 

FOUNDING MEMBERS

Brett Smith & Toni Williams

83 Qualitative Research Questions & Examples

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Qualitative research questions help you understand consumer sentiment. They’re strategically designed to show organizations how and why people feel the way they do about a brand, product, or service. It looks beyond the numbers and is one of the most telling types of market research a company can do.

The UK Data Service describes this perfectly, saying, “The value of qualitative research is that it gives a voice to the lived experience .”

Read on to see seven use cases and 83 qualitative research questions, with the added bonus of examples that show how to get similar insights faster with Similarweb Research Intelligence.

What is a qualitative research question?

A qualitative research question explores a topic in-depth, aiming to better understand the subject through interviews, observations, and other non-numerical data. Qualitative research questions are open-ended, helping to uncover a target audience’s opinions, beliefs, and motivations.

How to choose qualitative research questions?

Choosing the right qualitative research questions can be incremental to the success of your research and the findings you uncover. Here’s my six-step process for choosing the best qualitative research questions.

• Start by understanding the purpose of your research. What do you want to learn? What outcome are you hoping to achieve?
• Consider who you are researching. What are their experiences, attitudes, and beliefs? How can you best capture these in your research questions ?
• Keep your questions open-ended . Qualitative research questions should not be too narrow or too broad. Aim to ask specific questions to provide meaningful answers but broad enough to allow for exploration.
• Balance your research questions. You don’t want all of your questions to be the same type. Aim to mix up your questions to get a variety of answers.
• Ensure your research questions are ethical and free from bias. Always have a second (and third) person check for unconscious bias.
• Consider the language you use. Your questions should be written in a way that is clear and easy to understand. Avoid using jargon , acronyms, or overly technical language.

Types of qualitative research questions

For a question to be considered qualitative, it usually needs to be open-ended. However, as I’ll explain, there can sometimes be a slight cross-over between quantitative and qualitative research questions.

Open-ended questions

These allow for a wide range of responses and can be formatted with multiple-choice answers or a free-text box to collect additional details. The next two types of qualitative questions are considered open questions, but each has its own style and purpose.

• Probing questions are used to delve deeper into a respondent’s thoughts, such as “Can you tell me more about why you feel that way?”
• Comparative questions ask people to compare two or more items, such as “Which product do you prefer and why?” These qualitative questions are highly useful for understanding brand awareness , competitive analysis , and more.

Closed-ended questions

These ask respondents to choose from a predetermined set of responses, such as “On a scale of 1-5, how satisfied are you with the new product?” While they’re traditionally quantitative, adding a free text box that asks for extra comments into why a specific rating was chosen will provide qualitative insights alongside their respective quantitative research question responses.

• Ranking questions get people to rank items in order of preference, such as “Please rank these products in terms of quality.” They’re advantageous in many scenarios, like product development, competitive analysis, and brand awareness.
• Likert scale questions ask people to rate items on a scale, such as “On a scale of 1-5, how satisfied are you with the new product?” Ideal for placement on websites and emails to gather quick, snappy feedback.

Qualitative research question examples

There are many applications of qualitative research and lots of ways you can put your findings to work for the success of your business. Here’s a summary of the most common use cases for qualitative questions and examples to ask.

Qualitative questions for identifying customer needs and motivations

These types of questions help you find out why customers choose products or services and what they are looking for when making a purchase.

• What factors do you consider when deciding to buy a product?
• What would make you choose one product or service over another?
• What are the most important elements of a product that you would buy?
• What features do you look for when purchasing a product?
• What qualities do you look for in a company’s products?
• Do you prefer localized or global brands when making a purchase?
• How do you determine the value of a product?
• What do you think is the most important factor when choosing a product?
• How do you decide if a product or service is worth the money?
• Do you have any specific expectations when purchasing a product?
• Do you prefer to purchase products or services online or in person?
• What kind of customer service do you expect when buying a product?
• How do you decide when it is time to switch to a different product?
• Where do you research products before you decide to buy?
• What do you think is the most important customer value when making a purchase?

Qualitative research questions to enhance customer experience

Use these questions to reveal insights into how customers interact with a company’s products or services and how those experiences can be improved.

• What aspects of our product or service do customers find most valuable?
• How do customers perceive our customer service?
• What factors are most important to customers when purchasing?
• What do customers think of our brand?
• What do customers think of our current marketing efforts?
• How do customers feel about the features and benefits of our product?
• How do customers feel about the price of our product or service?
• How could we improve the customer experience?
• What do customers think of our website or app?
• What do customers think of our customer support?
• What could we do to make our product or service easier to use?
• What do customers think of our competitors?
• What is your preferred way to access our site?
• How do customers feel about our delivery/shipping times?
• What do customers think of our loyalty programs?

Qualitative research question example for customer experience

• ‍♀️ Question: What is your preferred way to access our site?
• Insight sought: How mobile-dominant are consumers? Should you invest more in mobile optimization or mobile marketing?
• Challenges with traditional qualitative research methods: While using this type of question is ideal if you have a large database to survey when placed on a site or sent to a limited customer list, it only gives you a point-in-time perspective from a limited group of people.
• A new approach: You can get better, broader insights quicker with Similarweb Digital Research Intelligence. To fully inform your research, you need to know preferences at the industry or market level.
• ⏰ Time to insight: 30 seconds
• ✅ How it’s done: Similarweb offers multiple ways to answer this question without going through a lengthy qualitative research process. 

First, I’m going to do a website market analysis of the banking credit and lending market in the finance sector to get a clearer picture of industry benchmarks.

Here, I can view device preferences across any industry or market instantly. It shows me the device distribution for any country across any period. This clearly answers the question of how mobile dominate my target audience is , with 59.79% opting to access site via a desktop vs. 40.21% via mobile

I then use the trends section to show me the exact split between mobile and web traffic for each key player in my space. Let’s say I’m about to embark on a competitive campaign that targets customers of Chase and Bank of America ; I can see both their audiences are highly desktop dominant compared with others in their space .

Qualitative question examples for developing new products or services

Research questions like this can help you understand customer pain points and give you insights to develop products that meet those needs.

• What is the primary reason you would choose to purchase a product from our company?
• How do you currently use products or services that are similar to ours?
• Is there anything that could be improved with products currently on the market?
• What features would you like to see added to our products?
• How do you prefer to contact a customer service team?
• What do you think sets our company apart from our competitors?
• What other product or service offerings would like to see us offer?
• What type of information would help you make decisions about buying a product?
• What type of advertising methods are most effective in getting your attention?
• What is the biggest deterrent to purchasing products from us?

Qualitative research question example for service development

• ‍♀️ Question: What type of advertising methods are most effective in getting your attention?
• Insight sought: The marketing channels and/or content that performs best with a target audience .
• Challenges with traditional qualitative research methods: When using qualitative research surveys to answer questions like this, the sample size is limited, and bias could be at play.
• A better approach: The most authentic insights come from viewing real actions and results that take place in the digital world. No questions or answers are needed to uncover this intel, and the information you seek is readily available in less than a minute.
• ⏰ Time to insight: 5 minutes
• ✅ How it’s done: There are a few ways to approach this. You can either take an industry-wide perspective or hone in on specific competitors to unpack their individual successes. Here, I’ll quickly show a snapshot with a whole market perspective.

Using the market analysis element of Similarweb Digital Intelligence, I select my industry or market, which I’ve kept as banking and credit. A quick click into marketing channels shows me which channels drive the highest traffic in my market. Taking direct traffic out of the equation, for now, I can see that referrals and organic traffic are the two highest-performing channels in this market.

Similarweb allows me to view the specific referral partners and pages across these channels. 

Looking closely at referrals in this market, I’ve chosen chase.com and its five closest rivals . I select referrals in the channel traffic element of marketing channels. I see that Capital One is a clear winner, gaining almost 25 million visits due to referral partnerships.

Next, I get to see exactly who is referring traffic to Capital One and the total traffic share for each referrer. I can see the growth as a percentage and how that has changed, along with an engagement score that rates the average engagement level of that audience segment. This is particularly useful when deciding on which new referral partnerships to pursue.  

Once I’ve identified the channels and campaigns that yield the best results, I can then use Similarweb to dive into the various ad creatives and content that have the greatest impact.

These ads are just a few of those listed in the creatives section from my competitive website analysis of Capital One. You can filter this list by the specific campaign, publishers, and ad networks to view those that matter to you most. You can also discover video ad creatives in the same place too.

In just five minutes ⏰ 

• I’ve captured audience loyalty statistics across my market
• Spotted the most competitive players
• Identified the marketing channels my audience is most responsive to
• I know which content and campaigns are driving the highest traffic volume
• I’ve created a target list for new referral partners and have been able to prioritize this based on results and engagement figures from my rivals
• I can see the types of creatives that my target audience is responding to, giving me ideas for ways to generate effective copy for future campaigns

Qualitative questions to determine pricing strategies

Companies need to make sure pricing stays relevant and competitive. Use these questions to determine customer perceptions on pricing and develop pricing strategies to maximize profits and reduce churn.

• How do you feel about our pricing structure?
• How does our pricing compare to other similar products?
• What value do you feel you get from our pricing?
• How could we make our pricing more attractive?
• What would be an ideal price for our product?
• Which features of our product that you would like to see priced differently?
• What discounts or deals would you like to see us offer?
• How do you feel about the amount you have to pay for our product?

Get Faster Answers to Qualitative Research Questions with Similarweb Today

Qualitative research question example for determining pricing strategies.

• ‍♀️ Question: What discounts or deals would you like to see us offer?
• Insight sought: The promotions or campaigns that resonate with your target audience.
• Challenges with traditional qualitative research methods: Consumers don’t always recall the types of ads or campaigns they respond to. Over time, their needs and habits change. Your sample size is limited to those you ask, leaving a huge pool of unknowns at play.
• A better approach: While qualitative insights are good to know, you get the most accurate picture of the highest-performing promotion and campaigns by looking at data collected directly from the web. These analytics are real-world, real-time, and based on the collective actions of many, instead of the limited survey group you approach. By getting a complete picture across an entire market, your decisions are better informed and more aligned with current market trends and behaviors.
• ✅ How it’s done: Similarweb’s Popular Pages feature shows the content, products, campaigns, and pages with the highest growth for any website. So, if you’re trying to unpack the successes of others in your space and find out what content resonates with a target audience, there’s a far quicker way to get answers to these questions with Similarweb.

Here, I’m using Capital One as an example site. I can see trending pages on their site showing the largest increase in page views. Other filters include campaign, best-performing, and new–each of which shows you page URLs, share of traffic, and growth as a percentage. This page is particularly useful for staying on top of trending topics , campaigns, and new content being pushed out in a market by key competitors.

Qualitative research questions for product development teams

It’s vital to stay in touch with changing consumer needs. These questions can also be used for new product or service development, but this time, it’s from the perspective of a product manager or development team. 

• What are customers’ primary needs and wants for this product?
• What do customers think of our current product offerings?
• What is the most important feature or benefit of our product?
• How can we improve our product to meet customers’ needs better?
• What do customers like or dislike about our competitors’ products?
• What do customers look for when deciding between our product and a competitor’s?
• How have customer needs and wants for this product changed over time?
• What motivates customers to purchase this product?
• What is the most important thing customers want from this product?
• What features or benefits are most important when selecting a product?
• What do customers perceive to be our product’s pros and cons?
• What would make customers switch from a competitor’s product to ours?
• How do customers perceive our product in comparison to similar products?
• What do customers think of our pricing and value proposition?
• What do customers think of our product’s design, usability, and aesthetics?

Qualitative questions examples to understand customer segments

Market segmentation seeks to create groups of consumers with shared characteristics. Use these questions to learn more about different customer segments and how to target them with tailored messaging.

• What motivates customers to make a purchase?
• How do customers perceive our brand in comparison to our competitors?
• How do customers feel about our product quality?
• How do customers define quality in our products?
• What factors influence customers’ purchasing decisions ?
• What are the most important aspects of customer service?
• What do customers think of our customer service?
• What do customers think of our pricing?
• How do customers rate our product offerings?
• How do customers prefer to make purchases (online, in-store, etc.)?

Qualitative research question example for understanding customer segments

• ‍♀️ Question: Which social media channels are you most active on?
• Insight sought: Formulate a social media strategy . Specifically, the social media channels most likely to succeed with a target audience.
• Challenges with traditional qualitative research methods: Qualitative research question responses are limited to those you ask, giving you a limited sample size. Questions like this are usually at risk of some bias, and this may not be reflective of real-world actions.
• A better approach: Get a complete picture of social media preferences for an entire market or specific audience belonging to rival firms. Insights are available in real-time, and are based on the actions of many, not a select group of participants. Data is readily available, easy to understand, and expandable at a moment’s notice.
• ✅ How it’s done: Using Similarweb’s website analysis feature, you can get a clear breakdown of social media stats for your audience using the marketing channels element. It shows the percentage of visits from each channel to your site, respective growth, and specific referral pages by each platform. All data is expandable, meaning you can select any platform, period, and region to drill down and get more accurate intel, instantly.

This example shows me Bank of America’s social media distribution, with YouTube , Linkedin , and Facebook taking the top three spots, and accounting for almost 80% of traffic being driven from social media.

When doing any type of market research, it’s important to benchmark performance against industry averages and perform a social media competitive analysis to verify rival performance across the same channels.

Qualitative questions to inform competitive analysis

Organizations must assess market sentiment toward other players to compete and beat rival firms. Whether you want to increase market share , challenge industry leaders , or reduce churn, understanding how people view you vs. the competition is key.

• What is the overall perception of our competitors’ product offerings in the market?
• What attributes do our competitors prioritize in their customer experience?
• What strategies do our competitors use to differentiate their products from ours?
• How do our competitors position their products in relation to ours?
• How do our competitors’ pricing models compare to ours?
• What do consumers think of our competitors’ product quality?
• What do consumers think of our competitors’ customer service?
• What are the key drivers of purchase decisions in our market?
• What is the impact of our competitors’ marketing campaigns on our market share ? 10. How do our competitors leverage social media to promote their products?

Qualitative research question example for competitive analysis

• ‍♀️ Question: What other companies do you shop with for x?
• Insight sought: W ho are your competitors? Which of your rival’s sites do your customers visit? How loyal are consumers in your market?
• Challenges with traditional qualitative research methods:  Sample size is limited, and customers could be unwilling to reveal which competitors they shop with, or how often they around. Where finances are involved, people can act with reluctance or bias, and be unwilling to reveal other suppliers they do business with.
• A better approach: Get a complete picture of your audience’s loyalty, see who else they shop with, and how many other sites they visit in your competitive group. Find out the size of the untapped opportunity and which players are doing a better job at attracting unique visitors – without having to ask people to reveal their preferences.
• ✅ How it’s done: Similarweb website analysis shows you the competitive sites your audience visits, giving you access to data that shows cross-visitation habits, audience loyalty, and untapped potential in a matter of minutes.

Using the audience interests element of Similarweb website analysis, you can view the cross-browsing behaviors of a website’s audience instantly. You can see a matrix that shows the percentage of visitors on a target site and any rival site they may have visited.

With the Similarweb audience overlap feature, view the cross-visitation habits of an audience across specific websites. In this example, I chose chase.com and its four closest competitors to review. For each intersection, you see the number of unique visitors and the overall proportion of each site’s audience it represents. It also shows the volume of unreached potential visitors.

Here, you can see a direct comparison of the audience loyalty represented in a bar graph. It shows a breakdown of each site’s audience based on how many other sites they have visited. Those sites with the highest loyalty show fewer additional sites visited.

From the perspective of chase.com, I can see 47% of their visitors do not visit rival sites. 33% of their audience visited 1 or more sites in this group, 14% visited 2 or more sites, 4% visited 3 or more sites, and just 0.8% viewed all sites in this comparison. 

How to answer qualitative research questions with Similarweb

Similarweb Research Intelligence drastically improves market research efficiency and time to insight. Both of these can impact the bottom line and the pace at which organizations can adapt and flex when markets shift, and rivals change tactics.

Outdated practices, while still useful, take time . And with a quicker, more efficient way to garner similar insights, opting for the fast lane puts you at a competitive advantage.

With a birds-eye view of the actions and behaviors of companies and consumers across a market , you can answer certain research questions without the need to plan, do, and review extensive qualitative market research .

Wrapping up

Qualitative research methods have been around for centuries. From designing the questions to finding the best distribution channels, collecting and analyzing findings takes time to get the insights you need. Similarweb Digital Research Intelligence drastically improves efficiency and time to insight. Both of which impact the bottom line and the pace at which organizations can adapt and flex when markets shift.

Similarweb’s suite of digital intelligence solutions offers unbiased, accurate, honest insights you can trust for analyzing any industry, market, or audience.

• Methodologies used for data collection are robust, transparent, and trustworthy.
• Clear presentation of data via an easy-to-use, intuitive platform.
• It updates dynamically–giving you the freshest data about an industry or market.
• Data is available via an API – so you can plug into platforms like Tableau or PowerBI to streamline your analyses.
• Filter and refine results according to your needs.

Are quantitative or qualitative research questions best?

Both have their place and purpose in market research. Qualitative research questions seek to provide details, whereas quantitative market research gives you numerical statistics that are easier and quicker to analyze. You get more flexibility with qualitative questions, and they’re non-directional.

What are the advantages of qualitative research?

Qualitative research is advantageous because it allows researchers to better understand their subject matter by exploring people’s attitudes, behaviors, and motivations in a particular context. It also allows researchers to uncover new insights that may not have been discovered with quantitative research methods.

What are some of the challenges of qualitative research?

Qualitative research can be time-consuming and costly, typically involving in-depth interviews and focus groups. Additionally, there are challenges associated with the reliability and validity of the collected data, as there is no universal standard for interpreting the results.

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Research Questionnaire

Questionnaire generator.

When a researcher creates a research paper using the scientific method they will need to use a gathering method that is adjacent to the research topic. This means that the researcher will use a quantitative research method for a quantitive topic and a qualitative method for a qualitative  one.  The research questionnaire is one of the quantitative data-gathering methods a researcher can use in their research paper.

1. Market Research Questionnaire Template Example

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What Is a Research Questionnaire?

A research questionnaire is a physical or digital questionnaire that researchers use to obtain quantitative data. The research questionnaire is a more in-depth version of a survey   as its questions often delve deeper than survey questions .

How to Write a Research Questionnaire

A well-made research questionnaire can effectively and efficiently gather data from the population. Creating a good research questionnaire does not require that many writing skills , soft skills , or hard skills , it just requires the person to properly understand the data set they are looking for.

Step 1: Select a Topic or Theme for the Research Questionnaire

Begin by choosing a topic or theme   for the research questionnaire as this will provide much-needed context for the research questionnaire. Not only that but the topic will also dictate the tone of the questions in the questionnaire.

Step 2: Obtain or Use a Research Questionnaire Outline

You may opt to use a research questionnaire outline or outline format for your research questionnaire. This outline will provide you with a structure you can use to easily make your research questionnaire.

Step 3: Create your Research Questionnaire

Start by creating questions that will help provide you with the necessary data to prove or disprove your research question. You may conduct brainstorming sessions to formulate the questions for your research questionnaire.

Step 4: Edit and Have Someone Proofread the Questionnaire

After you have created and completed the research questionnaire, you must edit the contents of the questionnaire. Not only that but it is wise to have someone proofread the contents of your questionnaire before deploying the questionnaire. 

How does a research questionnaire help businesses?

A successful business or company utilizes research questionnaires to not only obtain data from their customers but also to gather data about the performance and quality of the employees in the business. The research questionnaire provides the business or company with actionable data, which they can use to improve the product, service, or commodity to obtain more customers.

Do I need to provide a consent form when I ask someone to answer the research questionnaire?

Yes, consent is very important as without this the data you have gathered from your questionnaires or surveys are useless. Therefore it is important to provide a consent form with your research questionnaire when you are asking a participant to answer the document.

What type of answers are allowed in the research questionnaire?

Research questionnaires can host a multitude of types of questions each with its specific way of answering.  A questionnaire can use multiple-choice questions, open-ended questions, and closed questions. Just be sure to properly pace the questions as having too many different types of answering styles can demotivate or distract the target audience, which might lead to errors.

A research questionnaire is a data-gathering document people can use to obtain information and data from a specific group of people. Well-made and crafted research questionnaires will provide much-needed information one can use to answer a specific research question.

Text prompt

• Instructive
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Create a fun quiz to find out which historical figure you're most like in your study habits

Design a survey to discover students' favorite school subjects and why they love them.

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

Published on 31.5.2024 in Vol 26 (2024)

This is a member publication of University of Oxford (Jisc)

How Informal Carers Support Video Consulting in Physiotherapy, Heart Failure, and Cancer: Qualitative Study Using Linguistic Ethnography

Authors of this article:

Original Paper

• Lucas Martinus Seuren 1, 2 , PhD   ; 
• Sara Shaw 1 , PhD  

1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom

2 Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada

Corresponding Author:

Lucas Martinus Seuren, PhD

Nuffield Department of Primary Care Health Sciences

University of Oxford

Radcliffe Observatory Quarter

Woodstock Road

Oxford, OX2 6GG

United Kingdom

Phone: 1 4372607372

Email: [email protected]

Background: Informal carers play an important role in the everyday care of patients and the delivery of health care services. They aid patients in transportation to and from appointments, and they provide assistance during the appointments (eg, answering questions on the patient’s behalf). Video consultations are often seen as a way of providing patients with easier access to care. However, few studies have considered how this affects the role of informal carers and how they are needed to make video consultations safe and feasible.

Objective: This study aims to identify how informal carers, usually friends or family who provide unpaid assistance, support patients and clinicians during video consultations.

Methods: We conducted an in-depth analysis of the communication in a sample of video consultations drawn from 7 clinical settings across 4 National Health Service Trusts in the United Kingdom. The data set consisted of 52 video consultation recordings (of patients with diabetes, gestational diabetes, cancer, heart failure, orthopedic problems, long-term pain, and neuromuscular rehabilitation) and interviews with all participants involved in these consultations. Using Linguistic Ethnography, which embeds detailed analysis of verbal and nonverbal communication in the context of the interaction, we examined the interactional, technological, and clinical work carers did to facilitate video consultations and help patients and clinicians overcome challenges of the remote and video-mediated context.

Results: Most patients (40/52, 77%) participated in the video consultation without support from an informal carer. Only 23% (12/52) of the consultations involved an informal carer. In addition to facilitating the clinical interaction (eg, answering questions on behalf of the patient), we identified 3 types of work that informal carers did: facilitating the use of technology; addressing problems when the patient could not hear or understand the clinician; and assisting with physical examinations, acting as the eyes, ears, and hands of the clinician. Carers often stayed in the background, monitoring the consultation to identify situations where they might be needed. In doing so, copresent carers reassured patients and helped them conduct the activities that make up a consultation. However, carers did not necessarily help patients solve all the challenges of a video consultation (eg, aiming the camera while laying hands on the patient during an examination). We compared cases where an informal carer was copresent with cases where the patient was alone, which showed that carers provided an important safety net, particularly for patients who were frail and experienced mobility difficulties.

Conclusions: Informal carers play a critical role in making video consultations safe and feasible, particularly for patients with limited technological experience or complex needs. Guidance and research on video consulting need to consider the availability and work done by informal carers and how they can be supported in providing patients access to digital health care services.

Introduction

Video consulting has become an established health care service model since the outbreak of the COVID-19 pandemic [ 1 ]. Video consultations have been shown to be safe and effective in a range of clinical settings [ 2 - 6 ]. Patients and clinicians have largely reported positive experiences, particularly in secondary and tertiary care [ 7 - 10 ], with some patients even preferring video consultations over face-to-face consultations, especially for follow-up appointments and where a trusted relationship with the provider is already in place [ 11 ]. Given the policy push for remote health care services to continue beyond the COVID-19 pandemic [ 12 - 14 ], it is clear that video consulting is here to stay. However, significant concerns remain around when video consulting is feasible and appropriate (eg, for which patients and in which clinical settings) [ 15 - 17 ]. Some patients still do not have access to the necessary technology (ie, smartphone, tablet, or computer and high-quality internet) [ 18 , 19 ] and they may also lack the experience, confidence, or ability to use it for a medical consultation [ 20 - 22 ]. In these situations, carers, either professional or informal (eg, family and friends), can provide assistance [ 23 , 24 ].

There is extensive literature on video consulting, documenting the benefits and challenges for patients and clinicians [ 5 ]. However, very few studies address how informal carers participate in video consultations [ 25 , 26 ]. This is surprising, given that informal carers play an important role in patient care. Informal carers, usually family or friends, “[provide] unpaid care and support to a family member, friend or neighbour who is disabled, has an illness or long-term condition, or who needs extra help as they grow older” [ 27 ]. In the United Kingdom, approximately 6 million people provide unpaid care, many of whom play a vital role in coordinating and supporting care received by the person they care for [ 28 , 29 ]. Therefore, it is important to understand the role they play in supporting and delivering video-consulting services.

Contemporary health care systems and policy makers have been pushing a transition to patient-centered or person-centered care, that is, care that is “respectful and responsive to individual preferences, needs and values” [ 30 ]. However, person-centered care has often been taken to only mean patient-centered care. Guidelines do not always address family or carers, and where they do, they merely highlight that practitioners must involve carers in patient care, for example, by asking them to clarify the patient’s wishes [ 31 ]. In other words, the focus in person-centered care is still on the patient. Nevertheless, informal carers play a central role in the delivery of care, supporting patients (to varying degrees and in varying situations) with their needs and care. Carers may deliver up to 90% of the care and support for patients in the community [ 32 ]. Therefore, it is potentially important for guidance on video consultations to take carers, and the support of carers, into account. Given that the work done by carers can cause a significant mental and physical strain [ 33 ], practitioners and policy makers need to consider the preferences, needs, and values of patients and carers.

Health communication research has shown that carers sometimes play an active role in making in-person consultations work: carers may speak on behalf of the patient (eg, to provide additional medical or other information for children or patients who lack capacity), alongside the patient (eg, when planning a next appointment), or with the patient (eg, to help them answer questions about their medication) [ 34 - 36 ]. However, having a carer copresent, that is, physically with the patient in the consultation, can be challenging as patients, clinicians, and carers report that they have trouble managing turn-taking [ 37 ]. This raises questions regarding when the carer is able to talk, what they can talk about, and how they can determine this.

Participation problems may be more pronounced in video consultations. From research outside the health care setting, we know that it can be difficult for carers to facilitate a conversation over video [ 38 ]. The camera restricts the field of view, and generally, only 1 person is visible at a time on each end [ 39 ]. The clinical context adds additional challenges, with participants having to manage new interactional skills (eg, how to begin a video consultation) and accomplish activities that are constrained by the lack of physical copresence (eg, conducting a physical examination) [ 5 , 40 , 41 ].

To date, only 1 study has investigated how the constraints of technology affect communication in health care where informal carers are copresent, focusing on postoperative cancer consultations in the Netherlands and showing that carers often remain offscreen and do not actively participate, and when they do, they mostly talk to the patient [ 42 ]. Several other studies have investigated how professional carers (eg, copresent nurses or primary care physicians) participate in video consultations, with a focus on how these professional Despite their crucial role in health care delivery, informal carers have not yet benefited from the advancements made in this field [ 29 ].

Overall, there is a need to understand how informal carers support video consultations when they are copresent with the patient. This study focuses on how informal carers support patients and clinicians during video consultations. Our focus is on the work (either interactional, clinical, or technological) that informal carers do to make video consultations work to provide key insights into how they affect the feasibility of video consulting. To support our analysis, we compared the consultations where informal carers provided support and the reflections of participants in subsequent interviews with consultations where patients were alone and the reflections of those participants.

Study Design

We conducted a qualitative, multimethods study using Linguistic Ethnography, which combines ethnographic approaches (ie, observation and interviews) with the close inspection of interactional data [ 43 ]. We used ethnography of communication [ 44 ] to guide our understanding of how the context of video consultations (eg, restricted visual field) may shape the ways in which patients, carers, and clinicians communicate over video. We combined this with conversation analysis, an inductive method that investigates the turn-by-turn construction of a conversation, to understand the communication practices (verbal and nonverbal) that make up a video consultation [ 45 ]. Combining these methods enabled us to show how the interactions in video consultations shape, and are shaped by, the wider sociocultural and clinical contexts (eg, established clinical routines, policy, and technology in use) [ 46 ].

For this study, we conducted secondary analysis of qualitative data that were previously collected for 3 separate studies on video consultations in different clinical settings across 4 National Health Service clinics in the United Kingdom (1 in Oxford and 3 in London):

• Supporting Consultations in Remote Physiotherapy (SCiP; 2021-2022) was funded by the National Institute for Health Research to investigate the feasibility and practicalities of video consultations for physiotherapy.
• Virtual Online Consultations: Advantages and Limitations (VOCAL; 2015-2017) was funded by the National Institute for Health Research and investigated (gestational) diabetes and cancer.
• Oxford Telehealth Qualitative Study (OTQS; 2015-2017) was funded by the Wellcome Trust to investigate the feasibility of video consulting in a specialist nurse service for patients with heart failure.

Data were chosen for convenience, having been collected as part of research studies that had already been conducted by members of the larger research team and available for secondary analysis [ 47 , 48 ].

Data Collection

We analyzed all 52 video recordings of video consultations that were recorded across the 3 studies. Data for VOCAL and OTQS were collected from 2015 to 2017 (refer to the study by Shaw et al [ 5 ] for an overview), and data for SCiP were collected from 2021 to 2022 (refer to the study by Seuren et al [ 47 ] for an overview).

In all 3 studies, recruitment was done based on convenience. For VOCAL and OTQS, which took place before the COVID-19 pandemic when video consulting was still relatively unfamiliar, patient participants were recruited in collaboration with clinical staff to ensure that patients were suitable to have a video consultation. The aim was to create a sample with a range of experiences with video consultations, “seeking maximum variety in clinical, ethnic and personal circumstances.” Patients were initially contacted by their clinician, after which the research team sent out an invitation letter [ 5 ]. For SCiP, data collection took place between August 2021 and March 2022, during the COVID-19 pandemic. Initially, clinicians reached out to any patient who had an upcoming appointment by video. Those who showed an interest in the study were subsequently contacted by a member of the research team to explain the details of the study [ 47 ]. For all studies, exclusion criteria were the inability to give informed consent and comorbidity preventing participation. For VOCAL and OTQS, additional exclusion criteria were no 3G internet access at home and lack of familiarity with technology [ 5 ].

Video consultations for VOCAL and OTQS were recorded using small digital camcorders (Sony Handycam DCR-SR72; Sony Corporation) and a handheld iPad (Apple Inc), combined with a commercially available screen-capture software tool (ACA Systems), which was run directly from an encrypted USB memory stick. Whenever feasible, both the patient’s and the clinician’s end of the consultation had been recorded, capturing the consultations and the context in which they took place. The total data set from VOCAL and OTQS consisted of 37 video recordings and transcripts of the video consultations (cancer: 12/37, 32%; diabetes: 12/37, 32%; heart failure: 7/37, 19%; and gestational diabetes: 6/37, 16%), 35 transcripts of semistructured interviews conducted with staff and 26 transcripts of semistructured interviews conducted with patients involved in these consultations ( Table 1 ) [ 5 ].

Video consultations for SCiP were recorded by the clinical team in the 2 National Health Service Trusts using the built-in recording option in Microsoft Teams (Microsoft Corp). The total data set consisted of 15 video recordings and transcripts of video consultations (neuromuscular rehabilitation: 5/15, 33%; long-term pain: 1/15, 7%; and orthopedics: 9/15, 60%), 15 transcripts of semistructured interviews with patients and 7 transcripts of semistructured interviews with clinicians involved in these consultations ( Table 2 ) [ 47 ].

a There was only one participant; hence, there is no IQR.

An initial exploration of the 52 recorded video consultations across all 3 studies showed that informal carers performed a range of seemingly vital tasks in some (but not all) video consultations (12/52, 23%; eg, holding the tablet and laying hands on the patient). This raised questions about the role of carers in video consultations. We collected all instances in our video data where carers were involved at any point during a video consultation and corresponding interview data in which participants in these video consultations reflected on the work carers do. As a routine practice in conversation analysis [ 49 , 50 ], we then built “collections” of similar cases [ 51 ], organizing the data based on the type of work done by carers. To further refine our analysis, we compared our findings with consultations where no carer was present (40/52, 77%), combining researcher observations of potentially risky situations (eg, an older patient nearly fell) with clinician reflections on these consultations to identify cases where the lack of a copresent carer might have negatively affected the quality of care. On the basis of these collections, we then analyzed the qualitative interviews deductively using thematic analysis [ 52 ]. Themes were identified based on our analysis of the consultations and used deductively to analyze the interviews. We examined how participants talked about the 3 key themes, aiming to discern whether participants’ reflections were in line with our findings of the consultations (eg, when and why do patients require assistance with technology) or whether they offered complementary (eg, additional work done by informal carers outside of the consultation) or even contradicting viewpoints (eg, informal carers not being able to offer support). Our analysis focused on the conversation analysis of the consultations, with supporting reflections from the participants.

As all data were selected for convenience, the consultations that involved a carer and those that did not involve a carer were not matched regarding, for example, clinical context, patient demographics, or type of technology used.

We transcribed all video consultations orthographically and subsequently used established conventions for verbal and nonverbal communication [ 53 , 54 ] for the data in our collections. This is a routine practice in conversation analysis and, for this paper, enabled us to track how and why carers assist in video consultations. In the Results section, we present simplified extracts from transcripts, providing orthographic transcripts complemented with notations for silence and overlapping talk to maintain legibility. We added screengrabs to allow readers to appreciate the context of consultations and how participants use their bodies and material objects (eg, how they move and hold a tablet). All interviews were transcribed orthographically. We extracted screengrabs using Adobe Premiere Pro 2023 (Adobe Inc), adding a video filter and facial blur to deidentify participants. Subsequently, we combined these screengrabs with the transcript in Adobe InDesign 2023 (Adobe Inc) and exported these at 600 dots per inch to generate the figures.

Ethical Considerations

All studies received ethics approval for detailed analysis of video recordings of video consultations and audio recordings of interviews. VOCAL was approved by the National Research Ethics Committee London-City Road and Hampstead in December 2014 (14/LO/1883), OTQS by the South Central-Berkshire Research Ethics Committee in September 2015 (15/SC/0553), and SCiP by the East Midland-Nottingham 1 Research Ethics Committee in April 2021 (21/EM/0082). All participating staff and patients provided their informed consent to be audio and video recorded during consultations and interviews and for the data to be used for research purposes, including secondary analysis.

Patients were initially approached by a member of their clinical care team. After signaling an interest in the study, the patient’s contact information was forwarded to a member of the research team. The author provided the patient with an information sheet to review. After providing an opportunity to ask questions, patients were asked if they wanted to participate, and if they agreed, they were asked to sign the consent form. For VOCAL and OTQS, patients provided consent during an in-person conversation with a member of the research team. For SCiP, to comply with infection control procedures during the COVID-19 pandemic, patients provided verbal consent during a video call. Participants did not receive compensation for participation in any of the 3 studies.

All transcriptions were anonymized by removing identifying data and replacing names with descriptions (eg, NAME, where someone’s name is used). Participants consented to the analysis of the raw (ie, recognizable) video data. For publication, video data were anonymized using a visual filter and blur effect in Adobe Premiere Pro 2023.

Main Findings

Of the 52 video consultations in our data, 12 (23%) involved a copresent carer: 8 (67%) with patients with cancer, 3 (25%) with patients with heart failure, and 1 (8%) with a patient consulting for physiotherapy. None of the patients with gestational diabetes had a copresent carer. In these 12 consultations, we identified three main types of work that carers performed: (1) facilitating the use of the technology, (2) helping the patient hear or understand what the clinician said, and (3) assisting the patient with and performing parts of the physical examination. Carers performed these tasks through the use of verbal and nonverbal communication strategies, as seen in the data extracts, screengrabs, and participants’ reported experiences in the following sections. Furthermore, we found that in 10% (5/52) of the consultations the patient did not have a carer copresent, but either the patient or clinician expressed concerns regarding safety during the consultation (eg, a patient saying, “I’m not sure if I’ll be able to get back up again”) or the clinician, during the interview afterward, commented that they felt they might have put the patient in an unsafe situation.

Facilitating the Use of Technology in Video Consultations

Informal carers facilitated the use of technology for video consultations in 2 ways: they provided patients access to the technology, and their presence and perceived expertise provided patients with confidence and reassurance for using the technology.

In our data, some patients (5/52, 10%) either did not have the technology or had never used it for video chat. Therefore, they relied on carers to set up, and sometimes provide, the technology. This facilitation involved activities such as the carer bringing a tablet for the patient to use, registering a Skype (Skype Technologies) account, adding the clinician as a contact on Skype or FaceTime (Apple Inc), talking to the clinician beforehand regarding any practicalities, and explaining to the patient what to expect from the video consultation. For the patients who lacked experience with video-mediated communication, carers provided a sense of reassurance if something went wrong or if there were difficulties. This was evident both in how the informal carers acted in the consultations and how they discussed their experiences during the interviews. An older patient explained before her oncology consultation that she only agreed to a video consultation if her husband would be there:

First uh, I was a bit uh, I said uh, if he’s here it’s fine. I haven’t got any problem.

Another older patient stated after her heart failure consultation that, while she could learn to use the technology, she relied on her daughter being there and would not have been able to do it on her own:

Patient: that’s what I really think, that for me,... it’s easy. Because I don’t have to sit here and think, what if I do something wrong? Carer: no Patient: for people, old people on their own, entirely different. Carer: yeah. it is entirely different. Patient: And I would not be able to do it on my own. ... I wouldn't have the confidence.

During consultations, we found that carers often facilitated the use of technology while being silent (ie, nonspeaking) and offscreen. This involved carers performing 3 types of background activities that allowed the patient to consult with the clinician via video: they handled the “preopening,” the work people do before they start a video consultation [ 55 ]; they handled the camera allowing the patient and clinician to adequately see each other; and they made sure that the patient and clinician could hear each other.

In 8 (67%) of the 12 consultations, carers took care of the “preopening” [ 55 ]: they set up the technology, logged in, and answered the call from the clinician when using a program such as Skype or FaceTime. Then, the patient took over when the consultation started.

In the example in Figure 1 , the patient had never used FaceTime before and did not own a video communication technology (eg, a smartphone or tablet). The carer brought a tablet with her, signed into FaceTime, and held it ready for use. When the clinician called via video, the carer explained to the patient that they would accept the call (line 1). Then, she swiped to answer, pointed out to the patient when the connection was established (line 7) and answered the video call with a "hello, conveying to the clinician that the connection had been established and they were ready [ 56 ]. The carer stayed out of the frame (refer to screengrab 2 in Figure 1 ) and hence out of the interaction [ 42 , 57 ], allowing the patient to conduct her consultation while still remaining available in the background.

In 7 (58%) of the 12 consultations, carers did additional background work that enabled patients to talk to their clinician. This included making sure that the patient and clinician could adequately see and hear each other, for example, by acting as a cameraperson: positioning the technology and framing the patient throughout the consultation [ 38 ] to maintain a “talking heads” configuration for the patient and clinician [ 39 ], a setup in which both participants are visible from the shoulders up. In 71% (5/7) of these consultations, the carer held a tablet or smartphone, moving this to frame the patient while remaining outside the frame themselves. In 29% (2/7) of these consultations, the patient used a desktop PC, so the carer moved the patient instead of the technology.

In the example in Figure 2 , from the start of an oncology consultation, the patient was at the left edge of the field of view of the camera and only half of her face was visible to the clinician. As soon as the physician told the patient to “move slightly” (line 3), the carer turned toward the patient and began to pull their chair. At the point where the physician completed his request (line 8), the patient was visible in the center of the screen. Our recording of the clinician’s end does not capture the screen. However, on the screen on the patient’s side, we can see that initially only the right half of her face is visible, and the carer then adjusts the chair so that the patient is centered and fully visible.

In 4 (33%) of the 12 consultations, the carers acted as a technological facilitator to ensure the audio and video were working. Carers did most of this work at the start of the consultation. This was the first point where participants could determine whether the sound and video were working. In the example in Figure 3 , the carer answered the clinician’s call when he appeared on screen by saying “hello” (line 1), but the clinician did not respond. The carer treated this silence as indicating a problem: she said “hello” again but this time with a more questioning intonation (a strong rising pitch on the “o”), a typical communication strategy for testing if someone can still hear [ 58 ].

After the clinician had said “hi” (line 4), he asked whether the patient (and carer) could hear him (line 8). The patient and carer confirmed (lines 9-10), and the carer checked whether the clinician could hear them. In other words, before the consultation began, the carer and clinician ensured that the technology was working and that the patient and clinician could see and hear each other. It was only when the physician had confirmed (line 14), that the consultation proceeded in a usual manner. At this point, the carer faded into the background.

Staying largely in the background (and so invisible to the clinician), carers typically maintained an active role, helping to address any problems (eg, lost connection or microphone on mute) that arose during the consultation. In these instances, carers temporarily became active participants while fixing the problem. In the example in Figure 4 , the physician asked the patient “how are you.” However, a technical disruption occurred and his turn was cut off after “ho.” After a few seconds of silence, the physician said, “what happened” (line 3), taking the lack of response by the patient as indicative of a problem. It was the carer who then switched to become an active coparticipant, asking if the physician could hear them (line 5). Once all parties had established that they could see and hear each other, the physician acknowledged (line 13) [ 59 ] and repeated the question.

Overall, carers in our data made video consultations feasible by facilitating the use of technology. Much of this work involved carers moving from being coparticipants to listening in the background, often unobservable to the clinician. They did this either by self-selecting to respond to a clinician’s question ( Figures 3 and 4 ) or by being selected by the clinician to answer a question. After responding, they would visually move out of the screen, or at least, no longer respond or take turns.

Making the Interaction Work in Video Consultations

Patients in our study occasionally had problems with hearing or understanding the clinician (eg, due to soft or distorted sound). Such problems happen routinely in any form of conversation [ 60 ], and people have a large array of repair strategies to fix them [ 61 , 62 ]. Normally, when trouble arises, recipients ask the speaker to repeat or clarify (part of) their turn (eg, by repeating the part of the turn they did hear or using exclamations such as “sorry,” “what,” or “huh” [ 63 - 65 ]). During in-person consultations, if patients have problems, they can ask the clinician to clarify [ 66 ].

In our video consultation data, we found that 25% (3/12) of the patients relied on their carer to help them hear or understand the clinician’s talk (in all 3 consultations, the quality of the call was problematic, eg, low volume and distortions). The example in Figure 5 illustrates how carers perform this type of interactional repair. In lines 1 to 4, the physician checked that the patient had seen one of his registrars the week before at an in-person consultation. At this point, the volume was low, making it hard to hear. Moving into the physician’s turn, the patient started squinting (refer to screengrab 1 in Figure 5 ), indicating she had a problem. When the physician finished his question, the patient remained silent for 700 milliseconds (a substantial amount of time, given the usual response time for face-to-face interaction being 0-200 milliseconds [ 67 ]), indicating difficulty [ 68 ]. Instead of answering, the patient turned to the carer (refer to screengrab 2 in Figure 5 ), softly asking “what?” (indicated with the degree symbols) and expecting the carer to perform an interactional repair on the physician’s question. The carer (offscreen) repeated the physician’s verification question in line 8. Once the patient could answer, she started to nod, turned her gaze toward the physician (line 9), and answered (line 11) loudly, thereby making clear her response was now directed to the physician.

While this was a brief interaction, the carer in this example played a crucial role in the successful communication between the physician and the patient. The patient mobilized the carer to help her hear what the physician said. Akin to an interpreter, the carer “animated” the physician’s talk [ 57 ]. Similar examples using indirect communication (eg, physically turning to the carer when something was unclear) were evident across our data set, where patients sought help from carers to enable repair and continuation of the interaction.

Making Physical Examination Possible in Video Consultations

The final area where carers made a vital contribution to video consultations was during physical examinations. The inability of clinicians to lay hands on the patient is one of the main concerns among clinicians and patients about video consultation [ 69 - 71 ]. Instead, patients have to describe and show their body and, where available, use their own devices such as oximeters (a device that people clip onto their finger to measure their blood oxygen saturation and heart rate) [ 40 , 72 ].

Carers supported remote physical examinations in 8 (67%) of the 12 video consultations in our data. This included helping to make the relevant parts of a patient’s body visible, acting as the clinician’s hands to perform tactile examinations and providing visual assessments, and assisting the patient with operating equipment such as blood pressure meters. Support was typically for patients who were frail, in cases where they were either unable to bend over (eg, due to the nature of their condition) or unable to move their tablet or laptop at the same time as moving their body (a complex sociotechnical task that was particularly challenging for those experiencing chronic illness) [ 72 ].

Figure 6 illustrates how carers can play a vital role in the feasibility of a physical examination. The patient had recently undergone surgery to remove a tumor and had complained to the physician about pain in her abdomen around the scar. The physician asked to examine the scar, requesting her to stand up (lines 1-3). The patient did not respond to this request. Instead, she waited for the carer to help out. After 1.3 seconds of silence, the physician made his request again, but at the same time, the carer said “hold on.” Then, the carer helped the patient lift her sweater and aimed the camera toward the scar, allowing the physician to perform a visual assessment (lines 16-19).

In the example in Figure 6 , the role of the carer was crucial for making the physical examination work. With limited physical capacity (and technological literacy), the patient was unable to hold the tablet and show the clinician her abdomen. It was only with the help of her carer that she could provide a sufficiently clear view for the physician to perform a visual assessment remotely.

At times, clinicians relied on a carer to lay hands on the patient on their behalf during video consultations. In the heart failure consultations—both routine follow-up consultations—the specialist nurse wanted to check whether the patients had fluid build-up (edema) in their legs and ankles by pressing their thumb on the patient’s leg and check whether this leaves an indentation. Carers played a vital role in performing these remote assessments, which involved patients who were frail, with restricted mobility and breathlessness, and for whom moving could cause severe discomfort [ 72 ]. Figure 7 illustrates an example in which the patient had just measured her blood oxygen saturation with an oximeter. Then, the nurse addressed the carer directly, announcing that she wanted to check the patient’s legs (lines 1-4). Depicting how the carer should hold her hand (lines 11-16) [ 72 , 73 ], she explained how to press (lines 18-19). The carer followed these instructions and pressed the patient’s legs several times. Using the camera on the back of the tablet, she not only performed the examination but also did so while simultaneously monitoring what the nurse could see (refer to screengrabs 2 to 4 in Figure 7 ). The carer’s presence meant that the nurse was able to make a good assessment of the patient’s legs, telling the carer that “you’re doing a good job, and I can see it really clearly on the screen.”

In total, 2 (4%) of the 52 cases in our wider data set of video consultations flagged questions regarding the safety of physical assessment where carers were not present. Figure 8 illustrates the example of a neuromuscular physiotherapy consultation with a patient with Charcot-Marie-Tooth disease (a neurological disorder that causes damage to the peripheral nerves leading to muscle weakness and atrophy), who struggled with walking and balance. At one point, the clinician asked the patient to stand up so that she could see her walk while holding onto a wall. The patient had to push herself from the bed, had difficulty standing up without losing her balance, and had to use both hands to help herself. In hindsight, the clinician acknowledged that this may have been too difficult.

We identified a similar case in our heart failure data, where an older patient raised her leg to the camera, allowing her nurse to assess whether there was any swelling ( Figure 9 ). The patient needed to stand and had to hold on to the chair in front of her to maintain her balance, but the uncomfortable position caused abdominal cramps and led her to drop her leg. This raised questions regarding safety while also placing limits on what was only a brief visual assessment.

Furthermore, carers helped some patients (2/12, 10%) operate measuring devices during examination. This was particularly relevant in remote heart failure consultations, in which all 7 patients needed to measure their oxygen saturation, blood pressure, and heart rate. All 7 patients were able to use the oximeter; however, operating a blood pressure meter proved challenging for 2 patients, both experiencing frailty. In both cases, the patient’s carer placed the cuff on their arm, held the monitor up to the screen to display the results, and adjusted positions so that the patient’s blood pressure measurements could be obtained from both sitting and standing positions ( Figure 10 ).

Remote physical examinations are complex sociotechnical tasks, involving (in our data) at least 3 people, multiple devices at both ends of the call, and a series of instructions and interactions conducted over a video consultation [ 72 ]. Hence, while carers were often needed to make physical examinations work, the assistance of a carer did not make them straightforward. In 1 consultation, video largely restricted the examination to a visual inspection. As the carer from Figure 6 reported after the consultation, with an in-person consultation, “[the patient] could probably explain more where it hurts and [the physician] could, you know, feel why it’s, you know, still tender.” Furthermore, doing the examination while making it visible to the clinician can be challenging for the carer [ 72 ]. This was summarized by the carer from Figure 1 as follows:

Well, look at me, fannying about just trying to get a picture of your leg. I mean it’s not a matchstick. I just could not picture. But it’s partly, because I’m holding it and I can’t see what I’m looking at.

Principal Findings

Our findings demonstrate that, for some video consultations with some patients, informal carers play an important role in supporting setting up and running a video consultation. While most patients (40/52, 77%) in our data completed the consultation on their own, informal carers were the linchpin that made the video consultation safe and feasible, especially when the patients lacked technological literacy or experienced high frailty. We demonstrated this using recordings and observations to show 3 types of work that carers perform. First, they help patients use video technology by setting up everything beforehand and acting as technological support, providing patients with the confidence to even commit to using video. Second, where patients struggle to hear or understand the clinician, carers perform the interactional repair work, repeating or clarifying the clinician’s words. Third, where physical assessments are needed, carers can lay hands on the patient’s or the clinician’s behalf or assist the patient with using the technology (either video technology or examination equipment). Even where patients seemed to manage on their own, patients performed maneuvers that put them at risk of falling, and this was not always clear to the remote clinician. Copresent carers provide an important safety net, making video consultations safe and feasible.

Comparison With Previous Research

There is an extensive body of research on the feasibility and acceptability of video consultations [ 6 - 10 ], which indicates that some patients may need assistance from carers [ 74 ]. However, to date, no study has investigated the work informal carers do to support video consultations. A total of 3 health communication studies have used robust methods for analyzing interaction to demonstrate how carers, whether professional or informal, can be involved in a consultation. Two (67%) of these 3 studies documented that nurses and general practitioners play an essential role in making physical examinations work when patients talk to a remote consultant [ 74 , 75 ]. One study on follow-up consultations after surgery showed that informal carers mostly act as bystanders: they remain invisible to the clinician and only occasionally facilitate the consultation [ 42 ].

Our study adds to this growing body of literature, demonstrating that informal carers may take a more active role than that of a bystander: in our data, they are attentive to the interaction, moving into and out of the field of view of the camera as needed; performing a range of technical, interactional, and clinical tasks; and taking a more active role depending on the needs of both the patient and clinician. Discrepancies between our findings and previous studies can be accounted for in many ways. First, as both the 3 previous studies and our study are qualitative in nature, they prioritize analytical depth, which mandates small patient samples that are not necessarily representative, and these are prone to bias in recruitment processes. Second, all studies have taken place in different geographical locations, at different points in time (eg, before or during the COVID-19 pandemic), and in different clinical settings, with patients with different sociodemographic backgrounds. While the methods may be transferable, more research is needed to appreciate to what extent the findings transfer.

The important role of carers is not limited to video consulting. For in-person consultations, research has shown that carers can be actively involved, talking about, alongside, or with the patients, to provide clinicians with relevant information [ 34 - 36 ]. Findings from our study extend this, demonstrating not only the other types of work that carers do to support video consultations but also how the technology shapes this work.

Videoconferencing technologies and the visual angle of webcams are designed for one-to-one conversations [ 39 ]. These aspects of technology add to the complexity of the interactional dynamics that already exist for triadic consultations (ie, involving a patient, clinician, and informal carer), where participants may struggle with turn-taking [ 34 , 35 ]. Because of this added complexity, video consultations have a continuously shifting participation framework (ie, the roles of patient, clinician, and carer as, for example, an active coparticipant of overhearer) [ 57 ], where carers move in and out of a variety of interactional and technical support roles. Depending on the situation (eg, the patient’s capacity and willingness to talk on their own behalf), carers may be expected to be more or less active coparticipants during consultations. Being offscreen makes carers less available for the clinician. They are more likely to act as overhearers [ 42 ], which can be beneficial in cases where patients wish to interact with the clinician themselves, but it may also be detrimental when patients need more continuous support. Therefore, our findings contribute to not only our appreciation of the important role of carers in the delivery of health care services but also the interactional organization of video consultations. Future research should investigate systematically how the affordances of the technology, particularly the camera’s field of view, affect the norms regarding participation, quality of care, and participant satisfaction.

Meaning of the Study

Our findings suggest that when considering the feasibility of video consultations, some important considerations need to be taken into account. Video consulting has often only been considered a suitable service model for patients with technological competence and experience, where the goal of the consultation is expected to be relatively straightforward (eg, sharing test results and routine follow-up). However, our study shows that this unnecessarily limits to application of video for 2 reasons. First, where patients have a lack of experience with or have anxiety around technology, informal carers can help overcome technological or interactional difficulties. Furthermore, they offer reassurance, making patients comfortable with doing a video consultation. Help may not be needed, but where it would be needed, it would be available [ 76 ]. Second, where the goal of the consultation is more complex (eg, involves a physical assessment), video can still be an appropriate option if the patient has adequate support. Assessments in a video consultation often require the patient to move the camera around to frame themselves in a way that they are adequately visible to the clinician while performing movements that may be difficult for them to do safely or using devices that they are not familiar with (eg, oximeters). Copresent carers can overcome some of these challenges, for example, by taking care of the camera or laying hands on the patient, where patients are comfortable with that.

Since the outbreak of the COVID-19 pandemic, video consultations have become a more routinely used service model. While many patients and providers are moving back to in-person delivery of (health) care, hybrid service models that involve remote options, including video consultation, are likely to constitute the new normal. However, despite the routinization of video-consulting services, clinicians still have limited evidence on when they are a feasible and safe option. While the literature is growing quickly and many organizations have proposed guidelines, these often ignore the role of informal carers. Further rollout of this new service model needs to consider not only what patients themselves can do but also what informal carers can do. Given the important role that informal carers have in health care management, particularly for certain groups of patients (eg, young children, patients with high frailty, or patients who lack capacity), it is logical to assume that their role can be transferred to video-consulting models. The additional work for carers will have to be weighed against the potential benefits for each specific clinical context and each individual patient.

The importance of carers for making some video consultations work raises important questions for those providing and supporting services. Not all patients will have access to an informal carer, and those who have may not always want a carer to be present during the consultation. A systematic review found that patients are not necessarily as involved during consultations where they are accompanied by a carer, and while most patients say they appreciate having someone with them, they want to be able to decide whether a carer will be present during the consultation [ 77 ]. Patients should feel comfortable asking for their carer to leave the room at any point during a consultation. However, this might put an unnecessary burden on the patient. It may be necessary for clinicians to create opportunities to talk to the patient privately.

Strengths and Limitations

Physiotherapy consultations in our data set were conducted during the COVID-19 pandemic, with heart failure and diabetes consultations conducted before the pandemic when video consulting was not a routine service model and few patients, carers, or clinicians had experience with it. Given the uptake and learning around video consultations during the COVID-19 pandemic, it is possible that patients involved in heart failure and cancer consultations needed more support with the technology than they would now. The prepandemic data were also likely to involve early-adopter clinicians who were supportive of video consultations as a new service model. Furthermore, participants in our data set used mainly Skype (Microsoft Corporation) and FaceTime (Apple Inc), whereas video consultations now often take place on dedicated platforms such as Teams (Microsoft Corporation), Attend Anywhere, or AccuRx. Some of these platforms affect the opening of video consultations, with patients expected to join a virtual waiting room before joining the consultation with their clinician. In addition, we focused on the positive experiences of patients and carers, without actively considering whether and when clinical staff are receptive to carer involvement. Despite these limitations, we anticipate that many of our findings are transferable to current video-consulting services. Our use of methods focused on interaction and communication has enabled us to demonstrate in detail the active role that carers played in some video consultations. While the exact role of carers may differ during and after the COVID-19 pandemic, it is highly likely that some patients (eg, older patients, those experiencing frailty, or those with multimorbidity) will continue to need assistance.

To our knowledge, this study is the first to use robust methods for analyzing communication in triadic video consultations (ie, among clinician, patient, and informal carer) across multiple clinical settings. Doing so has allowed us to show in detail not only that carers play a vital role in making video consulting work but also how they go about doing this. Our work adds to the existing literature by highlighting the interactional complexity of these consultations, demonstrating the sociotechnical nature of the work undertaken by informal carers, and underscoring the importance of focusing on the microlevel organization of consultations where carers are (and are not) involved [ 46 , 50 ]. Our work was exploratory in nature, relying on secondary analysis; future studies could investigate how the presence of carers affects the overall experience of patients and clinical staff with health care services, the patient-carer relationship, and the health outcomes for patients.

Conclusions

Video consulting remains a viable service option but depends on patient access to technology and their ability to use it. While many patients can manage a video consultation on their own, some (continue to) require assistance. In these circumstances, informal carers can play a unique, and often invisible, role in making video consultations work. To date, research and guidelines have not adequately considered the work of informal carers. This urgently needs addressing, not only to support the policy vision of the spread of video-consulting services but also to make visible and enable the informal carers (and the patients and clinicians they support) in this often vital role.

Acknowledgments

The authors are grateful to Marissa Bird and Joe Wherton for commenting on an earlier draft of this paper. The authors would like to thank Joe Wherton, Chrysanthi Papoutsi, Trish Greenhalgh, Christine A’Court, Gita Ramdharry, Anthony Gilbert, and Jackie Walumbe for their support in collecting the data used in this paper. This project was funded by UK Research and Innovation via the Economic and Social Research Council (ES/V010069/1), Wellcome Trust (WT104830MA), National Institute for Health Research (NIHR) Biomedical Research Centre (BRC-1215-20008), and the NIHR under its Research for Patient Benefit (PB-PG-1216-20012) and Policy Research Programme (grant NIHR202067). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Data Availability

The data sets generated and analyzed during this study are not publicly available due to confidentiality and sensitivity of the material but are available from the corresponding author on reasonable request.

Authors' Contributions

LMS was the principal investigator for this study and led data collection and formal analysis and wrote the first draft of the manuscript. SS provided supervision as a co–principal investigator and supported the review and editing of the manuscript. Both authors were involved in all aspects of the study design and funding acquisition and have reviewed and approved the final manuscript.

Conflicts of Interest

None declared.

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Abbreviations

Edited by T de Azevedo Cardoso; submitted 08.08.23; peer-reviewed by P Traulsen, G Gauhe, T Halkowski, S White; comments to author 06.10.23; revised version received 24.11.23; accepted 19.04.24; published 31.05.24.

©Lucas Martinus Seuren, Sara Shaw. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 31.05.2024.

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