course in qualitative research methods

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• Short Courses in Qualitative Research Methods

Oxford Qualitative Courses: Short Courses in Qualitative Research Methods

Expert teaching from specialists in qualitative research methods

Short courses:

• Introduction to Qualitative Research Methods
• Introduction to doing Qualitative Interviews
• Introduction to Analysing Qualitative Data
• Introduction to conversation analysis and health care encounters
• Learning with the book: an introduction to qualitative research methods for health research

The University of Oxford's expert-led programme of short courses in qualitative research methods aims to equip participants with the knowledge and skills to design, conduct, and interpret qualitative research. Through these short courses we share the experience, knowledge and enthusiasm of our research-active tutors

Our courses are particularly suited to those who are planning or working on projects with a qualitative research component, our aims are to:

• Equip health and care professionals, researchers and policy makers with an understanding of the different approaches to qualitative research
• Support the development of core skills such as interviewing, ethnographic observation, running focus groups (whether virtual or face-to-face), conversation analysis, meta-ethnography, and qualitative data analysis.

This highly-regarded programme is delivered in online and face-to-face formats to suit a range of learners.  We use a mixture of lectures and small group work, delivered by our team of qualitative researchers from the University of Oxford’s  Medical Sociology and Health Experiences Research Group . Our group has run these successful courses for almost twenty years alongside active involvement in qualitative research on a variety of different topics, ranging from studies of personal experiences of health conditions and of healthcare practice, to evaluations of organisational change. Our group also includes qualitative methodologists at the forefront of developing qualitative methods including conversation analysis and evidence synthesis.

Findings from our group’s research on patient experiences, together with supported video, audio and text extracts, have been compiled to form the multi-award winning heathtalk.org website and its sister site socialcaretalk.org. Our portfolio of research and expertise informs current local, national and international healthcare policy and research. 

The syllabuses of our qualitative courses draw on a wide range of expertise from within our research group, including the disciplinary areas of medical sociology, anthropology, and public policy. 

Teaching team

Our courses are led by a highly experienced and research-active teaching team. Our team have a range of specialities and skills spanning the breadth of qualitative research methods, ensuring that each session is led by a knowledgeable expert in the field. As well as being accomplished researchers, our team are skilled at communicating qualitative research methods to people in an accessible and clear way. Our team are friendly and approachable and will be available to offer tailored feedback during the course. Our participants regularly emphasise that our teaching team are a highlight of our courses.

Who are OUR courses for?

Our courses are suited to a wide range of professions, including:

• Health and care professionals
• Undergraduate and postgraduate students
• Academics and researchers interested in health research
• Marketing and communications professionals
• Health and care advisers

What do participants think?

New: Online Resources

Our teaching team have collated a series of freely available online resources for anyone looking for learning opportunities. 

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Got a question? Contact us:

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Email:  [email protected]

Short courses

Qualitative Research Methods in Health

• 10am - 1pm each day

Cost: £1,500

Book a place.

Please email [email protected]  if you wish to apply for this course. The next course will start on 3 October 2024

This course aims to equip you with the knowledge and skills to understand, design and conduct high quality qualitative research.

The course will help you:

• gain a clear understanding of the principles of qualitative research
• practise skills including interviewing, running a focus group, data analysis, and developing and presenting a research protocol

This course will be delivered online over 10 Thursday mornings from 3 October to 12 December.

This course is run by researchers from the UCL Centre for Excellence in Qualitative Research, within the Research Department of Primary Care and Population Health (PCPH).

Who it's for

This course is for: 

• Master's level students, PhD students and research staff who need to design and conduct a qualitative study
• those who wish to know how to assess the quality of qualitative research (e.g. funders, journal editors, ethical committee members etc.)

You don't need to have any previous experience of qualitative research, but you will need to do some preparation before each session.

Course content

Lead: Julia Bailey and Tom Witney

This workshop will help you understand the basis on which qualitative methodology is selected as a research approach.

• learn about the philosophical debates around qualitative research
• contrast qualitative and quantitative approaches
• discuss the place of qualitative research in health and medicine

You'll also critique a published paper of a qualitative study. This will help you reflect on a completed study and consider not only the methodological approach and selection of methods, but also practical aspects such as sampling, what counts as data, the position of the researcher, data analysis, and application of findings.

Learning objectives

By the end of this workshop you'll be able to:

• describe key features of qualitative research
• explain the rationale for key features of qualitative research design 
• know when qualitative or quantitative study designs are appropriate 
• understand how ‘theory’ is relevant for qualitative research

Leads: Harpreet Sihre and Silvie Cooper

On this workshop you'll learn about qualitative research interviewing techniques and developing topic guides.

You'll explore structured, semi-structured and in-depth interview methods and their application, using real world examples. However, the emphasis will be on semi-structured interview techniques.

You'll also learn about and discuss:

• the importance of different communication styles and researcher reflexivity
• practical issues such as structuring questions, building rapport and dealing with challenging interviews

You'll be encouraged to think of an area of research around which you'll structure and produce a topic guide for use in a practical session. You'll also get the opportunity to practice your newly developed interviewing skills.

As far as possible, the workshop is tailored towards research that those attending are planning/doing.

By the end of this workshop you'll be able to:

• describe and distinguish between structured, semi-structured and 'in-depth' interviewing
• formulate and construct a topic guide
• apply and evaluate some key interviewing skills

Lead: Tom Witney and Fiona Aspinal

This workshop will introduce you to focus groups - a key qualitative research method.

You'll learn about the:

• different stages of the research process where focus groups can be used
• types of research questions that lend themselves to this approach
• practicalities of sampling, convening and conducting focus groups, including issues to consider when researching sensitive topics

You'll also practise your communication and group facilitation skills.

You'll be encouraged to think of an area of research around which you'll structure and produce a topic guide for use in a practical session.

• explain when and how to use focus groups
• design a topic guide for a focus group study
• organise and facilitate a focus group

Leads: Nathan Davies and Fiona Stevenson

On this workshop you'll discuss a range of ways of conducting qualitative data analysis and the rationales for different approaches.

You'll be encouraged to critically reflect on how decisions made throughout research affect the type and extent of analysis possible. The importance of decisions about transcription are also stressed.

You'll consider the place of data management software in qualitative analysis. You won't be taught how to use particular software packages, but you'll discuss the advantages and disadvantages of using these.

You'll conduct a thematic analysis on a piece of data, and reflect on and consider the best approach for your own work.

Please note: this workshop does not provide training in the use of Computer Assisted Qualitative Data Analysis packages

• distinguish between different types of qualitative data analysis
• recognise the importance of decisions relating to transcribing, reflexivity, field notes, double coding and data management
• consider various approaches to analysis
• understand the principles and practicalities of conducting a basic thematic analysis
• evaluate the benefits of Computer Assisted Qualitative Data Analysis for your projects

Leads: Jane Wilcock and Stephanie Kumpunen

In this interactive workshop you'll plan your own qualitative study design.

You'll work on your own and in small and large groups, with an experienced tutor. You'll also have the opportunity for one-to-one and small group discussions and advice on qualitative study design.

The first day is spent planning your study in a structured way. On the second day you'll present your study design proposal to tutors and other students in small groups, and discuss research issues arising from the proposed studies.

• write clear research questions
• understand the principles of (and debates about) quality in qualitative research
• plan a qualitative research study, specifying the details of how a study will be carried out
• present a four-slide summary of your study design
• discuss the rationale for chosen study designs

Teaching and assessment

The course is highly interactive, involving a range of teaching techniques including group work, practical tasks and discussion.

It will be run with a mixture of synchronous, online learning (e.g. presentations, small group discussions) and asynchronous learning (pre-recorded videos, readings, preparatory writing/planning).

You'll receive help designing and planning your own qualitative research project. You'll then present your design proposals and receive feedback from course tutors and peers at the end of the course.

You'll be required to do some preparation before each session (reading and/or watching videos).

How to apply

To apply for this course you’ll need to complete a short application form.

Your application will be judged on your suitability for the course and how much you're likely to benefit. Priority will be given to people who are actively planning or conducting qualitative research.

Please email [email protected]  if you’d like to be added to the waiting list. When booking opens and there are spaces available for the course, you'll be emailed the application form.

Cancellation policy

Cancellations must be received in writing at least two weeks before the start of the event and will be subject to an administration charge of 20% of the course fee. Unfortunately, no refunds will be made within two weeks of the course date. Any refund will be made by UCL to you within 30 days of your cancellation and be paid to you in the same way as you paid for your order.

We reserve the right to cancel teaching if necessary and will, in such event, make a full refund of the registration fee. PCPH Events will not be liable for any additional incurred costs.

Further information

If you have any questions about the course content, please email Fiona Stevenson ( [email protected] ) or Julia Bailey ( [email protected] ).

For administrative queries, please contact Lynda Russell-Whitaker ( [email protected] ).

Course team

Julia Bailey - joint Course Director

Julia is an Associate Professor at the e-Health Unit at UCL and a sexual health speciality doctor in South East London. Her research interests include sexual health, e-Health, doctor-patient interaction, science communication and social science in medicine (qualitative methodologies). View Julia’s IRIS profile for more information about her work and publications.

Fiona Stevenson - joint Course Director

Fiona is a Professor of Medical Sociology and Co-Director of e-Health Unit at UCL. She’s currently Head of the Department of Primary Care and Population Health at UCL. Her research is broadly encompassed by the overarching theme of perceptions, communication and interactions about treatment. Her methodological expertise lies in qualitative methods, both in relation to thematic analysis of interviews and focus groups and conversation analysis of interactional data. She has expertise in conducting original research as well as implementing research findings into practice. View Fiona’s IRIS profile for more information about her work and publications.

Nathan Davies

Nathan is an Associate Professor and Alzheimer’s Society Fellow based in the Centre for Ageing Population Studies at UCL. His main research interests are in older adults, dementia, and supporting family carers. He's a qualitative researcher leading on several qualitative studies, which explore sensitive topics, including end of life care. In addition to experience of interviews, focus groups and various types of qualitative analysis, he has extensive experience of co-design, co-production and consensus-based methods. View Nathan’s IRIS profile for more information about his work and publications.

Jane Wilcock

Jane is a Senior Research Associate in the Centre for Ageing & Population Studies, UCL. Her main research interests are in dementia, ageing, emergent technologies and trials of complex interventions in primary care and community settings. A mixed-methods researcher, Jane has experience of a variety of study designs such as RCTs, interview and focus group studies, nominal group techniques and co-design of interventions. In addition, she is a methodology expert for the NIHR Research Design Service London. View Jane’s IRIS profile for more information about her work and publications.

Silvie Cooper

Silvie is a Lecturer (Teaching) in the Department of Applied Health Research at UCL. Her research interests include capacity building for health research, management of chronic pain, digital health, and patient education, using qualitative, mixed methods, and translational research approaches. Alongside her research, she designs and teaches on a variety of health and social science courses for undergraduates, postgraduates and professionals. Topics include research and evaluation methods, the social aspects of health and illness, and the impact of context, practice and policy on healthcare experiences. View Silvie’s IRIS profile for more information about her works and publications.

Harpreet Sihre

Harpreet formerly completed her PhD at the Institute of Applied Health Research, University of Birmingham, where she researched the lived experiences of South Asian women with severe postnatal psychiatric illnesses using Interpretative Phenomenological Analysis. She then worked at the Unit of Social and Community Psychiatry on an NIHR-funded study researching accessibility and acceptability of Perinatal Mental Health Services.

Harpreet’s research interests encompass mental health, perinatal mental health, access to services and equality, diversity and inclusion, using qualitative research methods. Harpreet has taught on both undergraduate and postgraduate courses, including small group teaching and lecturing at the University of Birmingham and Queen Mary University. View Harpreet’s IRIS profile for more information about her work and publications.

Tom is a Research Fellow at the department of  Primary Care and Population Health . He is a qualitative health researcher, with a particular interest in sexual health and relationship intimacy. His current work focuses on improving access to sexual health for trans and gender diverse people and supporting uptake of chlamydia retesting following a diagnosis. View Tom’s Iris profile for more information about his work and publications.

Fiona Aspinal

Fiona is based in the Department of Applied Health Research for the NIHR ARC North Thames as 'Senior Research Associate in Qualitative Methods Applied to Organisational Research in Health' where, as part of the ARC North Thames' Research Partnership Team, she helps to facilitate and support health and social care research with local, regional and national relevance. She is also the social care research lead for NIHR CRN North Thames.

Her areas of research interest are: Qualitative research and evaluation of complex health and social care interventions and organisations; The experience and outcomes of integrated care policy and practice for staff, service users and informal carers; Social and community health care for adults, including people with dementia; Social care research infrastructure/skills.

At UCL, in addition to the Qualitative Research Methods in Health short course, Fiona teaches on research methods and social science courses and modules, such as the BSc Population Health Sciences, the Medicine MBBS BSc and the Population Health MSc. She also supervises undergraduate and postgraduate students. View Fiona’s Iris profile for more information about her work and publications.

Stephanie Kumpunen

Stephanie is a THIS Institute Doctoral Fellow at UCL and a Senior Fellow in Health Policy at Nuffield Trust (a London-based health and care think tank). Her research focuses on the organisation of Primary Care and community-based health and care services.

Stephanie has led on a number of qualitative studies and mixed-methods evaluations. She has a particular interest in rapid qualitative approaches; namely rapid ethnographies that inform health and care service improvement. View Stephanie’s UCL profile for more information about her work and publications.

“The course is a really a great opportunity to read, reflect, discuss and share research, which is helpful for personal and professional development.” [Academic Clinical Fellow, Spring 2022]

“This session really helped me to organise my thoughts and put together a coherent plan for future research. It will make writing my protocol very easy!” [PhD Student, Spring 2022]

“It was such an excellent course. The information and materials provided were straight to the point and helpful, the working atmosphere was inspiring and constructive, and the tasks were interesting and activating. Thank you to all tutors!” [Clinical Research Programme Coordinator, Spring 2022]

“Great tutors, great reading material. It was very interesting to hear other peoples' experiences. Although this course was virtual, there were plenty of opportunities for interaction. I now have a better understanding and I am confident to run my study. I would recommend this course to anyone who wants an intro in qual research.” [Pre-Doctoral Research Fellow, 2021]

"I have a more clear understanding of the basics of qual methods, terminology and ways it may fit into my own research." [Researcher, 2019] 

Course information last modified: 22 Apr 2024, 13:33

Length and time commitment

• Time commitment: 10am - 1pm each day
• Course length: 10 weeks

Contact information

• Lynda Russell-Whitaker
• [email protected]

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Qualitative Research: Design, Implementation and Methods

DESIGN X440.2

Get an introduction to what qualitative research is, the types of qualitative research methods, the appropriate situations to apply qualitative methods, and how to conduct your own qualitative research. You learn to build a research protocol and use various techniques to design, conduct, analyze and present an informative research study.

At the end of the course, you are expected to conduct your own qualitative research study . To that end, you develop a research plan based on the given situation, collect data using qualitative methodologies , engage with various techniques for coding and analyzing qualitative data effectively, and present the data and insights in a manner that is best aligned with the goals of the research.

Prerequisites: None.

Course Outline

Course Objectives

• Understand what constitutes qualitative research, how it differs from quantitative research and when to apply qualitative research methods
• Identify and formulate appropriate qualitative research plans
• Apply qualitative research data collection techniques
• Develop coding schemes for analysis of qualitative data
• Present qualitative data to inform and influence

What You Learn

• Developing qualitative research questions
• Building a research protocol
• Observing, listening and probing: the core skills of a qualitative researcher
• Qualitative sampling and participant recruitment
• Understanding an overview of the qualitative data analysis process
• Communicating your findings, from summary to interpretation
• Presenting qualitative results

How You Learn

We are online! All of the design classes are conducted online and include video classes, mentor-led learning and peer-to-peer support through our student online platform, Canvas. 

• Reading assignments
• Quizzes at instructor’s discretion
• Small-group activities
• Homework assignments
• Capstone project

Is This Course Right for You?

This course is intended for students in the Professional Program in User Experience (UX) Design , or anybody interested in obtaining skills in qualitative research. You do not need preexisting research experience for this course. Our experienced instructors provide practical information, leverage their qualitative research skills and monitor your development along with peer-to-peer support on our student online platform.

Summer 2024 enrollment opens on March 18!

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Course details

• Mon 04 Nov 2024 to 08 Nov 2024
• Mon 23 Jun 2025 to 27 Jun 2025

Qualitative Research Methods

Introducing qualitative research

This module will provide an introductory overview of the principles and practice of qualitative research. Students will explore how people make sense of their lives, and recognise ways in which qualitative research bridges the gap between scientific evidence and clinical practice by examining the attitudes, beliefs, and preferences of both patients and practitioners. Participants will be introduced to the concepts underpinning qualitative research, learn to collect data using fundamental methods, including observation, interview and focus groups and become familiar with the techniques of thematic qualitative data analysis.

The last date for receipt of complete applications is 5pm Friday 7th June 2024. Regrettably, late applications cannot be accepted.

The overall aims of this module are to enable students to:

• Use qualitative research in evidence based practice;
• Understand commonly used qualitative methodologies in health care;
• Understand the ways in which qualitative and quantitative approaches can be combined;
• Discuss the issues involved in systematic review and synthesis of qualitative research;
• Describe steps to design, data collection and analysis for a qualitative project;
• Use qualitative methods, including observation, interviews and focus groups;
• Conduct thematic qualitative data analysis;
• Write up qualitative research results.

Comments from previous participants:

"All tutors had both solid theoretical understanding of their topic and wide practical knowledge of the application of the approach being taught in practice. This course was a good mix of theory, opportunities to practice new skills, and application of theory into (one's own) practice."

Programme details

This module is run over an eight week cycle where the first week is spent working on introductory activities using a Virtual Learning Environment, the second week is spent in Oxford for the face to face teaching week (this takes place on the dates advertised), there are then four Post-Oxford activities (delivered through the VLE) which are designed to help you write your assignment. You then have a week of personal study and you will be required to submit your assignment electronically the following week (usually on a Tuesday at 14:00 UK Local Time).

Recommended reading

• Ziebland, S., Coulter, A., Calabrese, J. and Locock, L.(Editors). (2013) Understanding and Using Health Experiences. Improving patient care. Oxford: OUP.

Details of funding opportunities, including grants, bursaries, loans, scholarships and benefit information are available on our financial assistance page.

If you are an employee of the University of Oxford and have a valid University staff card you may be eligible to receive a 10% discount on the full stand-alone fee. To take advantage of this offer please submit a scan/photocopy of your staff card along with your application. Your card should be valid for a further six months after attending the course.

Dr Anne-Marie Boylan

Module coordinator.

Anne-Marie Boylan is a Departmental Lecturer and Senior Research Fellow based in the Nuffield Department of Primary Care Health Sciences.

Assessment methods

Assessment will be based on submission of a written assignment which should not exceed 4,000 words.

Academic Credit

Applicants may take this course for academic credit. The University of Oxford Department for Continuing Education offers Credit Accumulation and Transfer Scheme (CATS) points for this course. Participants attending at least 80% of the taught course and successfully completing assessed assignments are eligible to earn credit equivalent to 20 CATS points which may be counted towards a postgraduate qualification.

Applicants can choose not to take the course for academic credit and will therefore not be eligible to undertake the academic assignment offered to students taking the course for credit. Applicants cannot receive CATS (Credit Accumulation and Transfer Scheme) points or equivalence. Credit cannot be attributed retrospectively. CATS accreditation is required if you wish for the course to count towards a further qualification in the future.

A Certificate of Completion is issued at the end of the course.

Applicants registered to attend ‘not for credit’ who subsequently wish to register for academic credit and complete the assignment are required to submit additional information, which must be received one calendar month in advance of the course start date. Please contact us for more details.

Please contact [email protected] if you have any questions.

Application

This course requires you to complete the application form and to attach a copy of your CV. If you are applying to take this course for academic credit you will also be required to provide a reference. Please note that if you are not applying to take the course for academic credit then you do not need to submit a reference.

Please ensure you read the guidance notes which appear when you click on the symbols as you progress through the application form, as any errors resulting from failure to do so may delay your application.

• Short Course Application Form
• Terms and Conditions

Selection criteria

Admissions Criteria: To apply for the course you should:

• Be a graduate or have successfully completed a professional training course
• Have professional work experience in the health service or a health-related field
• Be able to combine intensive classroom learning with the application of the principles and practices of evidence-based health care within the work place
• Have a good working knowledge of email, internet, word processing and Windows applications (for communications with course members, course team and administration)
• Show evidence of the ability to commit time to study and an employer's commitment to make time available to study, complete course work and attend course and university events and modules.
• Be able to demonstrate English Language proficiency at the University’s higher level . 

Accommodation

Accommodation is available at the Rewley House Residential Centre , within the Department for Continuing Education, in central Oxford. The comfortable, en-suite, study-bedrooms have been rated as 4-Star Campus accommodation under the Quality In Tourism scheme , and come with tea- and coffee-making facilities, free Wi-Fi access and Freeview TV. Guests can take advantage of the excellent dining facilities and common room bar, where they may relax and network with others on the programme.

IT requirements

Please ensure that you have access to a computer that meets the specifications detailed on our technical support page.

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Qualitative Research Methods

• Description

This course offers a hands-on opportunity for doctoral and advanced masters students to experience the practice of qualitative research. We will address the nature of qualitative research in the administrative and policy sciences, with ample opportunities to discuss the implications of the choices made in designing, implementing and reporting on the findings of a “mock” project which we will determine in class, with your input. The course will require a considerable investment of time, with intensive reading and writing, recurrent team discussions based on assignments, and individual fieldwork (with journal writing before, during and after site visits). The course is a program requirement for doctoral students. For all masters students, it will help develop skills to collect qualitative data during capstone projects and for policy/finance students interested in a methods course sequence, it will also serve as a good complement to the available quantitative courses.  For all students, understanding the basics of qualitative research will make you a better researcher (independent of whether your research is only qualitative or only quantitative) and will increase your research competency by offering a foundation to do mixed methods.

Either one of the following: PADM-GP.2171 Program Analysis and Evaluation, PADM-GP 2172 Advanced Empirical Methods for Policy Analysis, PHD-GP 5902 Research Methods, an upper level research methods undergraduate course, or more than 3 years experience of research in a university or other research institution.  Masters students must fill an application and be approved to take the course.  The application is found on the Course Highlights page.

Spring 2024 PHD-GP 5905.001

Download Syllabus

Spring 2022 PHD-GP 5905.001

Spring 2021 phd-gp 5905.001.

Qualitative Research Methods and Research Writing

Note: This exam date is subjected to change based on seat availability. You can check final exam date on your hall ticket.

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Return to: 4140 Department of Educational Policy Studies    

A Graduate Certificate in Qualitative Research in Education is available from the College of Education and Human Development to eligible students enrolled in a doctoral program at Georgia State University. To earn the certificate, students must complete a minimum of eight 3-credit-hour doctoral-level qualitative research methods courses with a collective GPA of 3.5 or higher in those courses, with no grade lower than a B in any course to be counted toward the certificate.

In addition, students must successfully defend a qualitative research dissertation. A faculty member from the Research, Measurement and Statistics (RMS) program of the Department of Educational Policy Studies is required to be on the student’s dissertation committee.

Certificate Requirements

Four of the eight courses must be the following.

• EPRS 8500 - Qualitative/Interpretive Research in Education I 3 Credit Hours
• EPRS 8510 - Qualitative Research in Education II 3 Credit Hours
• EPRS 8520 - Qualitative Research in Education III 3 Credit Hours
• EPSF 9260 - Epistemology and Learning 3 Credit Hours

Remaining Four Courses

• EPRS 8450 - Popular Culture as a Qualitative Text 3 Credit Hours
• EPRS 8640 - Case Study Methods 3 Credit Hours
• EPRS 8700 - Visual Research Methods 3 Credit Hours
• EPRS 9120 - Poststructural Inquiry 3 Credit Hours
• EPRS 9380 - Discourse Analysis 3 Credit Hours
• ECE 9380 - Discourse Analysis 3 Credit Hours
• EPRS 9400 - Writing Qualitative Research Manuscripts 3 Credit Hours
• EPRS 9820 - Advanced Qualitative Data Analysis 3 Credit Hours
• EPRS 9830 - Research Ethics in the Professional and Social Sciences 3 Credit Hours
• EPRS 9920 - Seminar in Special Topics in Qualitative Research 3 Credit Hours
• EPSF 9850 - Historical Research in American Education 3 Credit Hours
• EPSF 9930 - Philosophical Analysis and Method 3 Credit Hours
• Other Qualitative Methods courses as approved by the Certificate Coordinator and the Department Chair.

Eligibility

In order to be eligible to earn the certificate, students must:

• be enrolled in a doctoral program at Georgia State University
• have completed at least three courses from the College of Education and Human Development Doctoral Research Core, with a collective GPA in those courses of 3.5 or higher
• submit the application to the Department of Educational Policy Studies, with the endorsement of an RMS faculty member, prior to defending the prospectus.

Normal Time to Complete Program

Two additional semesters with 5 total courses is estimated to be additional coursework which would be included within the doctoral program timeframe because it is likely that at least 4 courses meet both the certificate and doctoral requirements. The certificate program requires 8 courses. Courses beyond the three courses in the doctoral core which meet the certificate requirements may be included in the doctoral program of study for the student based on each student’s individualized program. Typically, at least one course meeting certificate requirements beyond the three from the doctoral core would be included in the student’s doctoral program for the student’s doctoral degree.

Learning Outcomes and Assessments

The RMS faculty evaluate students on the following learning outcomes for the certificate:

• Addresses the research question(s) with appropriate methodology
• Demonstrates knowledge of previous research and/or literature in the field
• Document adheres to the standards of quality writing
• Oral presentation communicates research in a manner appropriate for the material and audience
• Potential for contribution to the discipline
• Demonstrates knowledge in the field of the certificate program in the dissertation defense

On-Time Graduation Rates

On-time graduation rate is 100% based on the College of Education and Human Development doctoral program time-frame.

Program Costs

Current information is available at sfs.gsu.edu/tuition-fees/what-it-costs/ .

Occupations

The Qualitative Research in Education Certificate aids in the preparation of students to be employed as:

• Area, Ethnic, and Cultural Studies Teachers, Postsecondary (SOC 25-1062)
• Education Teachers, Postsecondary (SOC 25-1081)
• Historians (SOC 19-3093)
• Program Analysts (SOC 13-1111)
• Social Scientists and Related Workers, All Other (SOC 19-3099)
• Social Science Research Assistants (SOC 19-4061)

You can find additional information on the Standard Occupational Classification (SOC) and occupational profiles on these professions at the U.S. Bureau of Labor Statistics and O*Net websites: www.bls.gov/soc and www.onetcenter.org .

Other Certificate Information

There is no state or accrediting agency that requires tracking placement rates. Students who receive a certificate also complete the doctoral program which is a higher credentialed program; thus, calculation of median loan debt for the certificate program is not required.

Traditions and innovations in qualitative criminological research methods

• Published: 25 April 2024

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• Olga Petintseva   ORCID: orcid.org/0000-0001-9187-4253 1 , 2 &
• Rita Faria   ORCID: orcid.org/0000-0003-0093-0550 3  

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In recent years, qualitative research methods in criminology have experienced a notable resurgence. This is evidenced by various scholarly endeavors, including the publication of works such as ‘Qualitative Research in Criminology: Cutting-Edge Methods’ (edited by Faria & Dodge, 2022 ), ‘ Liquid Criminology. Doing imaginative criminological research ’ (edited by Hviid Jacobsen & Walklate, 2016 ), ‘The Routledge Handbook of Qualitative Criminology ’ (edited by Copes & Miller, 2015 ), ‘ Qualitative Research in Criminology’ (Treadwell, 2019 ). The establishment of journals such as Qualitative Criminology and initiatives like the Working Group on Qualitative Research Methodologies and Epistemologies at the European Society of Criminology, or the the Qualitative Research Network in Criminology & Criminal Justice (QRN-CCJ) also signify a renewed recognition of the importance of qualitative approaches in understanding complex criminologically relevant phenomena. More recently, the CrimRxiv Consortium started a curation hub on qualitative criminology aimed at spotlighting studies based on non-numeric data.

Diverse criminological subfields such as global and green criminology, cultural criminology, and narrative criminology, have not only enriched our understanding of the respective topics but have also paved the way for innovative qualitative methodologies. Creative, reflexive and interventionist epistemologies and methodologies proved to be prerequisite, in order to imaginatively (Mills, 1959 ; Young, 2011 ) understand the contemporary social harms of dislocation, surveillance, incarceration, impoverishment, mind-numbing consumerism, experiences of uprooting and existential uncertainty, environmental degradation, global pandemics, the dynamics of social movements, and polarization. Moreover, research into the ever more present online world and online identities, the call for new approaches to data collection and analysis, the use of sensory methods, co-creation strategies, appeals to sensitivity to diversity and reflexivity from researchers - all of this has influenced greatly the panorama in qualitative research, particularly so in the study of crime and deviance, victimization and harm, crime control and related topics.

However, despite many innovations, qualitative researchers continue to grapple with numerous challenges. This includes navigating ethical considerations and the relatively recent data protection regulations, accessing and recruiting participants for studies on sensitive topics, and overcoming difficulties in publishing (Dodge & Parker, 2023 ). Qualitative research remains labor-intensive and requires tailor-made approaches. Numbers still push policy, the field of criminology still suffers from ‘methodological fetisjism’ and is easily seduced by actuarial tendencies, in which dominant research methods contribute to mystification of social realities and the politics of everyday life (Ferrell, 2009 ; Young, 2011 ). To complement knowledge produced employing rather detached methods of criminological inquiry, the aim of qualitative approaches is to foreground meaning, performance, unpredictability, engagement, reflexivity, creativity and, eventually, progressive transformations. Of course, such approaches exhibit great variation across different subfields, epistemological traditions, and geographical contexts. This diversity highlights the need to critically interrogate familiar epistemological frameworks and research agendas shaped by Global-North perspectives. Therefore, this special issue of Crime Law and Social Change focuses on qualitative research ‘from the periphery.’

By periphery, we refer not only to marginalized topics and populations within criminological discourse but also to innovative methodological approaches and underrepresented geographic traditions. The collection of papers featured in this special issue embodies this commitment to exploring the ‘periphery’ of qualitative criminological research, explicitly offering broadly relevant methodological insights, drawing on authors’ research experiences. More subtly, it also intends to red flag the peripheric interest that scientific journals have in qualitative research.

The first paper, A farewell to the lone hero researcher: Team research and writing , Sveinung Sandberg and Lucero Ibarra Rojas challenge the archetype of the lone hero researcher and advocate for collaborative approaches to qualitative research. Drawing upon their experiences in Mexico and Norway, the authors argue for the importance of team research and writing, as a means of addressing power differentials and promoting diversity.

In Rich scholar, poor scholar: inequalities in research capacity, “knowledge” abysses, and the value of unconventional approaches to research David Rodriguez Goyes and May-Len Skilbrei examine material inequalities in research capacity and propose unconventional approaches to data collection. Their paper highlights the global disparities in knowledge production and advocates for innovative methods that democratize access to meaningful data, using examples from their research in Colombia and Russia.

Janeille Zorina Matthews’ contribution titled Creating the Demand for Better Crime Policy: Qualitative Frame Analysis as a Vehicle for Social Transformation explores the potential of Qualitative Frame Analysis (QFA) as a tool for shaping crime discourse and informing policy. By analyzing framing strategies in Antigua and Barbuda, Matthews demonstrates the transformative power of qualitative methodologies in challenging dominant narratives.

In Ethnographic semantics and documentary method in criminology. A combination of reconstructive approaches using the example of Municipal Law Enforcement Services Ina Hennen introduces the documentary method and ethnographic semantics as two complementary approaches, based on her research with German Municipal Law Enforcement Services. Through an ethnomethodological design, Hennen illustrates how these methodologies deepen our understanding of security practices in public spaces.

Next, in their Mapmaking as visual storytelling: The movement and emotion of managing sex work in the urban landscape , Sara Jordenö and Amber Horning-Ruf foreground visual storytelling methods. Their interdisciplinary approach combines psychogeography and mapmaking to elucidate the emotional and spatial dynamics of sex work in urban landscapes, offering insights into the lived experiences and social relations of sex workers.

Finally, an original approach is presented in Lorenzo Natali’s The social perception of environmental victimization. A visual and sensory methodological proposal . Natali proposes a visual and sensory methodology for studying environmental victimization, highlighting the perspectives of those affected by environmental harm and employs photo elicitation and itinerant soliloquy to deepen our understanding and challenge familiar perspectives.

The reality in which we set up our inquiries is ever evolving and so does the need to understand and respond to the current complexities of crime, control, conflicts, and threats. From the specter of totalitarianism to the existential threat of global warming, radicalization, and the challenges of artificial intelligence, the current sociopolitical landscape underscores the urgency of mobilizing engaged qualitative research to understand and address pressing issues. The ever-shifting nature of current social, political, and technological phenomena needs to be addressed by qualitative methods which, by their nature, are especially well-suited to offer new theories and explanations based on detailed and nuanced accounts of complex phenomena. In that sense, discussions of critical and creative qualitative methodologies such as the ones presented in this special issue serve, in the first place, as meeting spaces for researchers working on seemingly distant topics, as fora for addressing epistemological and ethical questions and reimagining the boundaries of qualitative criminological research. Only last and least as mere methodological-technical discussions.

Data availability

Not applicable.

Copes, H., & Miller, J. M. (Eds.). (2015). The Routledge handbook of qualitative criminology . Routledge.

Dodge, M., & Parker, J. (2023). What now and how? Publishing the qualitative journal article. In R. Faria, & M. Dodge (Eds.), Qualitative Research in Criminology. Cutting-edge methods (pp. 241–253). Springer.

Faria, R., & Dodge, M. (Eds.). (2022). Qualitative Research in Criminology. Cutting-edge methods . Springer.

Ferrell, J. (2009). Kill method. A provocation. Journal of Theoretical and Philosophical Criminology , 1 (1), 1–22.

Google Scholar  

Hviid Jacobsen, M., & Walklate, S. (Eds.). (2016). Liquid Criminology. Doing imaginative criminological research . Routledge.

Mills, C. W. (1959). The sociological imagination . Oxford University Press.

Treadwell, J. (2019). Qualitative Research in Criminology, In P. Atkinson, S. Delamont, A. Cernat, J.W. Sakshaug, & R.A. Williams (Eds.), SAGE Research Methods Foundations https://doi.org/10.4135/9781526421036847209 .

Young, J. (2011). Criminological imagination . Polity.

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Vrije Universiteit Brussel, CRiS (Crime in Society Research Group), Brussels, Belgium

Olga Petintseva

National Institute for Criminology and Criminalistics, Brussels, Belgium

CIJ – Center for Interdisciplinary Research on Justice, University of Porto, Porto, Portugal

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This is an editors’ introduction to the special issue ‘Traditions and innovations in qualitative research in criminology’, edited by Rita Faria and Olga Petintseva.

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Petintseva, O., Faria, R. Traditions and innovations in qualitative criminological research methods. Crime Law Soc Change (2024). https://doi.org/10.1007/s10611-024-10153-x

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The multidisciplinary, cross-school SSRM minor draws on faculty from the College of Arts and Sciences, the School of Education, the School of Public and Environmental Affairs and other IUB units to provide students the opportunity to pursue a broad-based and comprehensive training program in social science research methods. The minor is open to Ph.D. students at Indiana University (IUB and IUPUI campuses). The program emphasizes advanced training in qualitative and quantitative methods for the analysis of social science data. Course offerings span diverse perspectives on data collection and analysis strategies. The course of study must include at least one course outside of the major field, and all coursework for the minor is in addition to any courses required for the major field. As a result, the minor in Social Science Research Methods is especially useful to those interested in moving beyond the required methodological coursework of their disciplinary specialization to acquire a multifaceted view of approaches to social science phenomena.

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Four courses for a minimum of twelve (12) hours of credit in courses approved for the Social Science Research Methods program, including at least one course outside the major field of study. A minimum of one course must be from area A (Methods of Qualitative Data Analysis) and a minimum of one course must come from area B (Methods of Quantitative Data Analysis). No more than six (6) credits can be transferred in from another institution. Courses taken to fulfill the requirements for the major field of study cannot also be counted towards the minor in Social Science Research Methods. Students must officially declare the minor during the early phase on their Ph.D. studies by consulting with the major advisor and the director of the minor. Courses outside the currently approved list may be considered for the minor in consultation with the director. The director of the minor retains formal authority for approving each minor student's course plan.

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Foundational Courses in Qualitative Research Methods (Group A)

Note: no more than one foundational course from Group A can count towards the minor

African-American and African Diaspora Studies:

AAAD-A 709 Qualitative and Ethnographic Methods in AAADS (4 cr.) 

Anthropology:

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CJUS-P 680  Seminar: Issues in Criminal Justice (3 cr.)  Topic: Qualitative Methods

Education: 

EDUC-Y 611 Qualitative Inquiry in Education (3 cr.)

GEOG-G 576  Qualitative Methods in Geography (3 cr.) 

Media School:

MSCH-J 651   Qualitative Research Methods (3 cr.) 

Political Science: 

POLS-Y 579 Qualitative Methods in Political Research (3 cr.)

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SPEA-V 710  Topics in Public Policy (3 cr.)  Topic: Qualitative Research Methods

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SPH-F 650   Seminar: Human Development & Family Studies (3 cr.)  Topic: Interpretive Qualitative Research Methods

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EDUC-Y 650 Topical Seminar in Educational Inquiry (3 cr.) Topics: Mixed Methodology; Digital Tools for Qualitative Inquiry; Life Story Methodology

EDUC-P 674  Advanced Topical Seminar in Learning Sciences (3 cr.)  Topic: Issues and Applications in Qualitative Coding

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Folklore and Ethnomusicology:

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GEOG-G 538 Geographic Information Systems (3 cr.)

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Information and Library Science:

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ILS-Z 642  Content Analysis for the Web (3 cr.)    

MSCH-T 510  Research Methods in Message Analysis (3 cr.)

Second Language Studies:

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SOC-S 652 Topics in Qualitative Methods (3 cr.)  Topics: Archival Methods; Ethnography; In-Depth Interviewing

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ANTH-A 506  Anthropological Statistics (3 cr.)

BUS-G 651  Econometric Methods in Business I

ECON-E 571 Econometrics I - Statistical Foundations (3 cr.)

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GEOG–G 588 Applied Spatial Statistics (3 cr.)

MSCH-J 502 Data Analysis for Journalists (3 cr.)

MSCH-J 600 Quantitative Research Methods (3cr.)

MSCH-T 602 Topical Seminar in Telecommunications Processes and Effects (3 cr.)   Topic: Introduction to Statistics in Media Research

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POLS-Y 575 Political Data Analysis I (3 cr.)

POLS-Y 576  Political Data Analysis II (3 cr.)

Psychological and Brain Sciences:

PSY-P 553   Advanced Statistics in Psychology I (3 cr.)

PSY-P 554   Advanced Statistics in Psychology II (3 cr.)

Public and Environmental Affairs

SPEA-V 706   Statistics for Research in Public Affairs I (3 cr.)

SPEA-V 707   Statistics for Research in Public Affairs II (3 cr.)

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SPH-Q 602  Multivariate Statistical Analysis (3 cr.)

SPH-Q 603  Categorical Data Analysis (3 cr.)

SOC-S 554  Stat Techniques in Sociology I (3 cr.)

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Statistics:

STAT-S 501  Statistical Methods I (3 cr.)       

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STAT-S 520   Introduction to Statistics (3 cr.)

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BUS-G 652  Econometric Methods in Business II

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COGS-Q 560   Experimental Methods in Cognitive Science (3 cr.)

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ECON-E 626 Game Theory (3 cr.)

ECON-E 627 Experimental Economics (3 cr.)

ECON-E 671 Econometrics 3 – Nonlinear and Simultaneous Models (3 cr.)

ECON-E 672 Macroeconometrics (3 cr.)

ECON-E 673 Microeconometrics (3 cr.)

ECON-E 724 Seminar in Economic Theory (3-6 cr.)  Topic: Bayesian Methods; Experimental Economics; Finance Econometrics; Network Formation Games; Time Series Topics

EDUC-Y 525  Survey Research Methodology (3 cr.)

EDUC-Y 535  Evaluation Models & Techniques (3 cr.) 

EDUC-Y 617  Psychometric Theory (3 cr.)

EDUC-Y 637  Categorical Data Analysis (3 cr.)

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EDUC-Y 645  Covariance Structure Analysis (3 cr.)

EDUC-Y 655  Longitudinal Data Analysis (3 cr.)

GEOG–G 504 Advanced Quantitative Methods in Geography (3 cr.)

GEOG-G 513  Advanced Economic Geography (3 cr.)

GEOG-G 589   Advanced Geospatial Data Analysis (3 cr.)

ILS-Z 639   Social Media Mining (3 cr.)

POLS-Y 577  Advanced Topics in Political Data Analysis (3 cr.)  Topic: Contextual Political Analysis; Dynamic Analysis; Time Series Analysis; Experimental Research Design and Methods; Maximum Likelihood Estimation.

PSY-P 533   Introduction to Bayesian Data Analysis I (3 cr.)

PSY-P 534   Introduction to Bayesian Data Analysis II (3 cr.)

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PSY-P 557 Representation of Structure in Psychological Data (3 cr.)

PSY-P 648  Choice Behavior (3 cr.)

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PSY-P 657  Topical Seminar (3 cr.)  Topic: Time Series; Categorical Data Analysis

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Content Analysis vs Thematic Analysis

Content analysis and thematic analysis are two widely used methods in qualitative research for analyzing textual data. While they share similarities, they also have distinct approaches and goals like:

• Content analysis involves analyzing content to identify recurring patterns, while thematic analysis focuses on uncovering the deeper meanings and concepts within the data.
• In content analysis, researchers use a structured approach to categorize the content, whereas thematic analysis allows for a more flexible and exploratory coding process.
• While content analysis looks at surface-level characteristics, thematic analysis goes beyond to explore the underlying significance and implications of the data.
• Content analysis is suitable for handling large and varied datasets, while thematic analysis is best suited for qualitative data, such as text or visuals.
• Content analysis is commonly employed in fields like media studies and marketing research, whereas thematic analysis finds extensive use in social sciences and psychology.

In this guide, we will explore the differences between content analysis and thematic analysis in-depth to understand their applications, and how they are used to derive meaning from qualitative data.

What is Content Analysis?

Content analysis is a method used to systematically analyze the content of textual, visual, or audio material. It involves identifying and quantifying specific elements within the data to draw inferences and conclusions. Essentially, it focuses on the manifest content, such as words, phrases, or themes that are explicitly present in the text. Researchers often use content analysis to categorize and analyze large volumes of data efficiently, making it useful for studying patterns, trends, and relationships within a body of text.

What is Thematic Analysis?

Thematic analysis, on the other hand, is a qualitative method used to identify, analyze, and interpret patterns or themes within textual data. Unlike content analysis, thematic analysis aims to uncover underlying meanings and concepts rather than focusing solely on surface-level content. It involves a process of coding and categorizing data to identify recurring themes or patterns that reflect the experiences, perspectives, or phenomena being studied. Thematic analysis is like a versatile tool that helps researchers understand different types of qualitative data. It’s great for checking complex and detailed ideas or experiences to find patterns and deeper meanings.

Content Analysis Vs Thematic Analysis : Focus and Purpose

Content analysis.

• Focus : Content analysis primarily focuses on quantifying and categorizing the content of the data. It aims to systematically analyze the text or media content to identify patterns, trends, and frequencies within the dataset.
• Purpose : The purpose of content analysis is to provide a structured and systematic overview of the data. By categorizing and quantifying the content, researchers can gain insights into the prevalence of specific themes or topics, the frequency of certain behaviors or messages, or the distribution of content across different categories or sources.

Thematic Analysis

• Focus : Thematic analysis focuses on identifying, analyzing, and reporting patterns (themes) within the data. It aims to uncover the underlying meanings, concepts, and experiences present in the dataset.
• Purpose : The purpose of thematic analysis is to provide a rich and detailed account of the data’s themes and their significance. By exploring the patterns and relationships between different themes, researchers can gain insights into the complexity and depth of the data, as well as the experiences and perspectives of the participants.

Overall, while both content analysis and thematic analysis involve analyzing patterns within data, they differ in their focus and purpose. Content analysis is more structured and quantitative, focusing on the content itself, while thematic analysis is more interpretative and qualitative, focusing on uncovering underlying meanings and concepts.

Content Analysis Vs Thematic Analysis : Coding Process

Content analysis coding process.

• Development of Coding Scheme : In content analysis, researchers begin by developing a coding scheme or framework based on predetermined categories or concepts relevant to the research question. These categories are often derived from existing theories, literature, or research objectives.
• Coding the Data : Researchers systematically code the data into these predefined categories or codes. This coding process involves assigning each unit of analysis (e.g., text segments, media content) to one or more categories based on its content or attributes.
• Quantitative Analysis : Once the data is coded, researchers conduct quantitative analysis by calculating frequencies and distributions of codes within each category. This analysis allows researchers to quantify and describe patterns, trends, or relationships in the data based on the frequency of occurrence of specific codes or categories.

Thematic Analysis Coding Process

• Open Coding : Thematic analysis begins with an open-coding approach, where researchers engage in a flexible and exploratory coding process. They immerse themselves in the data, reading and re-reading it to identify initial codes that capture meaningful concepts, ideas, or patterns.
• Identifying Themes : Codes are then grouped into themes based on similarities and patterns observed in the data. Researchers look for recurring ideas, concepts, or narratives across different data segments and organize related codes into overarching themes.
• Iterative Process : Thematic analysis involves an iterative process of coding and theme development. Researchers continuously refine and define themes as they progress through the analysis, revisiting and revising codes and themes to ensure they accurately reflect the data.
• Thematic Map : The final output of thematic analysis is often represented as a thematic map or narrative, where themes are described, supported by illustrative quotes or examples from the data, and interpreted in relation to the research question or objectives.

Comparison of Coding Processes

• Content Analysis : The coding process in content analysis is more structured and deductive, guided by predetermined categories or concepts. It focuses on quantifying and describing patterns in the data based on predefined criteria.
• Thematic Analysis : In contrast, the coding process in thematic analysis is more flexible and inductive, allowing themes to emerge organically from the data. It emphasizes the interpretation and understanding of underlying meanings and patterns, with themes evolving throughout the analysis process.

Content Analysis Vs Thematic Analysis: Level of Interpretation

In Content Analysis Interpretation tends to be more focused on surface-level characteristics and numerical or statistical summaries derived from the data. Researchers aim to objectively identify and quantify patterns, frequencies, or relationships within the content. The interpretation involves understanding the significance of these numerical findings in relation to the research objectives or hypotheses. While content analysis emphasizes objectivity in coding and analysis, interpretation still requires researchers to contextualize the numerical summaries within the broader research context and draw meaningful conclusions from the data. However, the interpretation in content analysis is generally less subjective compared to thematic analysis, as it relies more on quantifiable data points and statistical techniques.

Interpretation in thematic analysis is more nuanced and subjective, focusing on uncovering deeper meanings, patterns, and insights within the qualitative data. Researchers engage in a process of exploration and reflection to identify and interpret themes that emerge from the data. This interpretation involves understanding the context, connections, and implications of the identified themes, as well as considering the perspectives and experiences of the participants. Thematic analysis encourages researchers to delve into the underlying meanings and nuances of the data, often requiring a more reflexive and iterative approach to interpretation. Researchers may draw on their own insights, theoretical frameworks, and contextual understanding to make sense of the themes and their significance within the broader research context. While thematic analysis prioritizes depth and richness of interpretation, it also acknowledges the subjectivity inherent in the process, as interpretations may vary depending on the researcher’s perspectives and biases.

Content Analysis Vs Thematic Analysis: Data Types

• Content Analysis: Often used with large datasets, including quantitative data, text, audio, video, or images. It is suitable for analyzing a wide range of content, such as media articles, social media posts, interviews, surveys, etc.
• Thematic Analysis: Primarily used with qualitative textual or visual data, such as interview transcripts, focus group discussions, open-ended survey responses, diaries, or field notes. It focuses on in-depth analysis of the content rather than numerical quantification.

Both content analysis and thematic analysis can be applied to different types of data, they are often used with distinct types of content sources. Content analysis is suitable for large datasets with diverse content types, while thematic analysis is tailored for qualitative textual or visual data sources that require in-depth exploration and interpretation.

Content Analysis Vs Thematic Analysis: Research Context

Content analysis for research context.

Content analysis is commonly used in media studies, communication research, marketing research, and content-based analysis in various disciplines. It is particularly useful for studying media representations, content trends, and public discourse.

In media studies and communication research, content analysis allows researchers to systematically analyze and quantify media content, such as news articles, advertisements, television programs, or social media posts. It enables the study of media representations, framing effects, content trends, and changes in public discourse over time. In marketing research, content analysis can be used to analyze advertising campaigns, brand messaging, consumer reviews, or social media engagement to understand consumer perceptions, preferences, and behavior.

Thematic Analysis for Research Context

Thematic analysis is widely used in social sciences, psychology, health sciences, and other qualitative research domains. It is suitable for exploring complex phenomena, understanding participants’ perspectives, and generating rich qualitative insights.

In social sciences and psychology, thematic analysis allows researchers to explore and interpret the underlying meanings, patterns, and experiences within qualitative data sources, such as interview transcripts, focus group discussions, or open-ended survey responses. It provides a flexible and in-depth approach to understanding complex phenomena, such as human behavior, emotions, beliefs, or social interactions. In health sciences, thematic analysis is often used to explore patients’ experiences, healthcare professionals’ perspectives, or the impact of interventions on health outcomes, providing valuable insights for improving healthcare practices and policies.

Content Analysis vs Thematic Analysis: Comparison Overview

When to use content analysis.

Content analysis is a valuable research method that can be used in various contexts. Some situations where content analysis is particularly useful:

• Understanding Communication Patterns : Content analysis is beneficial when researchers aim to understand communication patterns, such as language use, themes, and trends, within textual, visual, or audio content. This method allows for systematic analysis of communication materials, such as media content, speeches, social media posts, or customer reviews, to uncover underlying messages and patterns.
• Exploring Media Representation : Content analysis is often used to examine how certain topics, groups, or events are portrayed in the media. Researchers can analyze news articles, advertisements, films, or television programs to explore themes, stereotypes, biases, or framing techniques used in media representation.
• Evaluating Public Opinion : Content analysis can be employed to assess public opinion on specific issues or topics by analyzing online discussions, social media conversations, or comments on news articles. Researchers can identify prevalent attitudes, sentiments, and opinions expressed in textual data to gain insights into public perceptions and discourse.
• Assessing Organizational Communication : Content analysis is valuable for studying organizational communication within businesses, institutions, or government agencies. Researchers can analyze internal documents, such as emails, memos, or reports, to understand communication patterns, organizational culture, leadership styles, and decision-making processes.
• Examining Historical Documents : Content analysis can be used in historical research to analyze primary sources, such as letters, diaries, newspapers, or government records. Researchers can uncover historical trends, ideologies, or societal changes by systematically analyzing textual content from different time periods.
• Monitoring Brand Perception : Content analysis is useful for businesses and marketers to monitor brand perception and sentiment by analyzing customer feedback, product reviews, or social media mentions. Researchers can identify trends, common issues, and customer preferences to inform marketing strategies and brand management efforts.

When to use Thematic Analysis?

Thematic analysis is a qualitative research method used to identify, analyze, and report patterns or themes within data. Some situations where thematic analysis is particularly appropriate:

• Exploring Complex Phenomena : Thematic analysis is suitable when researchers aim to explore complex phenomena or experiences in depth. It allows for a flexible and in-depth exploration of rich qualitative data, such as interview transcripts, focus group discussions, or open-ended survey responses, to uncover underlying meanings and patterns.
• Understanding Participant Perspectives : Thematic analysis is valuable for understanding participant perspectives, beliefs, and experiences on a particular topic. It enables researchers to identify common themes and variations in participants’ responses, providing insights into how individuals perceive and make sense of their experiences.
• Examining Social or Cultural Constructs : Thematic analysis is useful for examining social or cultural constructs, such as identity, power dynamics, or social norms. Researchers can analyze qualitative data to identify recurring themes related to these constructs, gaining insights into how they are constructed and enacted in social contexts.
• Generating Hypotheses for Further Research : Thematic analysis can be used in exploratory research to generate hypotheses or research questions for further investigation. By systematically analyzing qualitative data, researchers can identify emerging themes and patterns that warrant further exploration through quantitative or qualitative research methods.
• Evaluating Program or Intervention Outcomes : Thematic analysis is applicable for evaluating the outcomes of programs, interventions, or interventions. Researchers can analyze qualitative data, such as interviews with participants or stakeholders, to identify themes related to program effectiveness, impact, or implementation challenges.

Content analysis and thematic analysis are essential tools in qualitative research for understanding textual data. Content analysis focuses on counting and categorizing elements to study trends, while thematic analysis digs deeper to uncover meanings and patterns. The choice between these methods depends on the research goals and the level of depth required in interpreting the data. Both approaches offer valuable insights into qualitative data analysis, making them indispensable in various research contexts.

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• Published: 06 May 2024

Applying the Consolidated Framework for Implementation Research to investigate factors of implementing alcohol screening and brief intervention among primary care physicians and nurses in Hong Kong, China: an exploratory sequential mixed-method study

• Paul Shing-fong Chan 1 ,
• Yuan Fang 2 ,
• Yao Jie Xie 3 ,
• Martin Chi-sang Wong 1 ,
• Per Nilsen 4 ,
• Sau-fong Leung 3 ,
• Kin Cheung 3 ,
• Zixin Wang 1   na1 &
• Eng-kiong Yeoh 1   na1  

Implementation Science Communications volume  5 , Article number:  52 ( 2024 ) Cite this article

Metrics details

Alcohol screening and brief intervention (SBI) is an evidence-based intervention recommended by the World Health Organization. This study applied the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers of SBI implementation in primary care settings in Hong Kong, China.

This was a sequential mixed-method study. In-depth interviews of 21 physicians and 20 nurses working in the primary care settings from the public and private sectors were first conducted to identify CFIR constructs that were relevant to SBI implementation in the Chinese context and potential factors not covered by the CFIR. A questionnaire was then developed based on the qualitative findings to investigate factors associated with SBI implementation among 282 physicians and 295 nurses.

The in-depth interviews identified 22 CFIR constructs that were facilitators or barriers of SBI implementation in Hong Kong. In addition, the stigmatization of alcohol dependence was a barrier and the belief that it was important for people to control the amount of alcohol intake in any situation was mentioned as a facilitator to implement SBI. In the survey, 22% of the participants implemented SBI in the past year. Factors associated with the SBI implementation echoed most of the qualitative findings. Among physicians and nurses in both sectors, they were more likely to implement SBI when perceiving stronger evidence supporting SBI, better knowledge and self-efficacy to implement SBI, more available resources, and clearer planning for SBI implementation in the clinics but less likely to do so when perceiving SBI implementation to be complicated and of higher cost, and drinking approved by the Chinese culture. Participants were more likely to implement SBI when perceiving SBI fit better with the existing practice and better leadership engagement in the public sector, but not in the private sector. Perceiving a stronger need and greater importance to implement SBI were associated with higher likelihood of SBI implementation among physicians, but not among nurses. Perceiving better organizational culture supporting SBI was positively associated with SBI implementation among nurses, but not among physicians.

Conclusions

There was a significant gap between SBI evidence and its implementation. Some strategies to improve SBI implementation may be different between physicians and nurses and between those in the public and private sectors. The CFIR is a useful framework for understanding facilitators and barriers of SBI implementation in primary care settings.

Peer Review reports

Contributions to the literature

This was the first original study investigating the implementation of alcohol screening and brief intervention and its facilitators and barriers in the Chinese context.

This was the first original study applying the Consolidated Framework for Implementation Research to understand SBI implementation in primary care settings.

By integrating qualitative and quantitative methods and data, this study gained both breadth and depth of understanding of SBI implementation in the Chinese context.

Some facilitators and barriers of SBI implementation were different between physicians and nurses, and between healthcare providers in the public and private sectors.

Introduction

Worldwide, alcohol consumption is a leading cause of premature death and disability [ 1 , 2 ]. A recent report showed that 9.3% of Chinese adults were heavy drinkers [ 3 ]. In Hong Kong, China, the study site, 70.5% of the people aged 18-64 years drank alcohol in the past year [ 4 ]. Among these drinkers, the prevalence of problematic alcohol consumption and binge drinking assessed with the Alcohol Use Disorders Identification Test (AUDIT) was 5% and 25%, respectively, in the last year [ 4 ]. Therefore, prevention and reduction of alcohol-related harm is a public health priority in Hong Kong.

Several meta-analyses have shown that Alcohol Screening and Brief Intervention (SBI), which refers to screening using standardized questions followed by brief and standardized advice or counseling for those exceeding certain drinking limits, could significantly reduce alcohol consumption among patients in primary care settings [ 5 , 6 , 7 , 8 ]. Cost-effectiveness analyses have also demonstrated that SBI led to significant savings on healthcare resources [ 9 , 10 ]. Therefore, the World Health Organization (WHO) and other national health authorities strongly recommend SBI implementation in primary care settings [ 11 , 12 , 13 , 14 ]. However, there was a significant SBI research-practice gap, i.e. between evidence of SBI effectiveness and actual implementation of SBI in routine practice [ 15 , 16 , 17 , 18 , 19 ]. A recent systematic review showed that the practice rate was low among physicians in most countries on a regular basis (e.g., 17.2% in Finland, and 32.0% in the United States) [ 20 ]. The systematic review did not find any studies looking at SBI implementation in the Chinese context. A knowledge gap hence existed.

In Hong Kong, health services are provided by the public and private sectors [ 21 ]. In the public sector, primary care services are mainly provided by the General Out-Patient Clinic and Family Medicine Integrated/Specialist Clinic under the jurisdiction of the Hospital Authority. In the private sector, these services are provided by the General Out-Patient Clinic and Family Medicine Integrated/Specialist Clinic in private hospitals as well as clinics where physicians practice as solo or with partners/group practice [ 21 ]. The Hong Kong Department of Health produces a manual for primary care health professionals to conduct SBI and occasionally conducts SBI training workshops [ 22 , 23 ]. In Hong Kong, the roles of physicians and nurses are different in primary care settings. The physicians are responsible for providing diagnoses/examinations, ordering tests, discussing test results, and prescribing medication/providing treatment, whilst the nurses are mainly responsible for recording patients’ medical information, carrying out health assessments, administering medication and treatment, and providing health education. As compared to the private sector, the job duties of physicians and nurses in the public sector are more hierarchical, more centrally assigned, and less flexible. However, there was no study investigating the implementation of SBI in Hong Kong.

The Consolidated Framework for Implementation Research (CFIR) (2009 version) is widely used to guide the systematic assessment of facilitators and barriers (determinants) that influence the implementation of many different evidence-based practices [ 24 , 25 ]. The CFIR consists of five domains (i.e., types of determinants) that can be applied across the spectrum of implementation research [ 24 , 25 ]: intervention characteristics (features of an intervention), inner setting (features of the organization), outer setting (features of external context or environment), characteristics of individuals (individuals involved in implementation), and implementation process (strategies or tactics) [ 24 ]. Each domain consists of a number of constructs. However, there is a dearth of studies applying the CFIR to study facilitators and barriers of SBI implementation in primary care settings [ 20 ]. Most published studies have focused on barriers and facilitators to SBI implementation under two of the five CFIR domains, characteristics of individuals (e.g., healthcare professionals’ knowledge, belief, and self-efficacy) and inner settings (e.g., available resources to deliver SBI) [ 20 ]. Potential factors of SBI implementation in the other three domains (intervention characteristics, outer settings, and implementation process) have been less studied [ 20 ].

To address the knowledge gaps, this study aimed to apply the CFIR to identify facilitators and barriers of SBI implementation among physicians and nurses in primary care settings in Hong Kong, China.

Study design

This study applied the 2009 version of CFIR [ 25 ] to identify facilitators and barriers of SBI implementation among physicians and nurses in primary care settings in Hong Kong, China. This study adopted an exploratory sequential mixed-method design. In-depth interviews of physicians and nurses were first conducted to identify CFIR constructs that were relevant to SBI implementation in the Chinese context and potential determinants not covered by the CFIR. This study was conducted between July 2021 and October 2022. As there was no study conducted to investigate the SBI implementation in Hong Kong, we first conducted the qualitative interview study to gather relevant information and identify the relevant CFIR constructs for SBI implementation in the local context and the results of the qualitative study aided the design of the quantitative survey. Ethics approval was obtained from the Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong (SBRE-20-691).

Qualitative study

Qualitative semi-structured face-to-face interviews were conducted with physicians and nurses working in primary care settings in Hong Kong. Interviews were conducted from July to December 2021.

Participants

Participants were full-time or part-time physicians and nurses working in the public sectors (General Out-Patient Clinic and Family Medicine Integrated/Specialist Clinic), or private sectors (General Out-Patient Clinic, Family Medicine Integrated/Specialist Clinic, clinics where physicians practice as solo or with partners/group practice). Physician interns or student nurses were excluded.

Recruitment and data collection

A quota sampling in line with the study inclusion criteria was adopted to ensure diversity among the participants. The population of subjects was divided into quotas based on physicians or nurses, gender (male or female), and type of clinics (public/private General Out-patient Clinic, public/private Family Medicine Integrated/Specialist Clinic, and private clinics as solo or group practice). Therefore, the predetermined sample size would be at least 2*2*6 = 24.

A face-to-face, semi-structured, individual in-depth interview with open-ended interview questions was conducted in Cantonese with eligible participants. Written informed consent was obtained prior to the interviews. Before the interview, participants were briefed about the interview procedure and they could seek clarifications. The interviews were conducted in quiet places with privacy to protect participants’ confidentiality and were audio-recorded with participants’ consent. Each interview lasted between 1.5 to 2 hours. A supermarket coupon valued at HK$150 (US$19.5) was given to each participant as a token of appreciation for their participation in the study.

Development of the interview guide

A panel consisting of three experts in health system research and public health was formed to develop the interview guide. We used open-ended questions which were adapted from the interview guide tool developed by the CFIR expert team [ 26 ] to collect facilitators and barriers and group them under relevant CFIR constructs. Some prompts were given to encourage the participants to think more and give sufficient information. There was flexibility for the participants to talk about new ideas brought up during the interview or elaborate on the points that were meaningful to them which would drive their answers deeper. The interview guide was pilot tested among three physicians and three nurses to assess the clarity and relevancy of the questions. Based on their comments, the panel revised and finalized the interview guide.

Data analysis

The interviews were transcribed verbatim after each interview and imported into Nvivo 12 for analysis. Transcripts were analyzed by directed content analysis. It is an approach that utilizes a framework or theory to guide the analysis. A 5-step approach was developed based on previous studies [ 27 , 28 , 29 ], including (i) familiarization, (ii) indexing and coding, (iii) developing new codes, (iv) charting, and (v) identifying themes. At first, each coder conducted multiple reviews of the transcripts to familiarize themselves with the data and gain a deep understanding of the data. In step 2, the coders highlighted those parts of the text that, on first impression, appeared to be related to the predetermined codes based on the CFIR framework. The highlighted texts were then coded accordingly. Two coders coded 10 transcripts first to achieve consensus on coding. They discussed the coding process. When disagreement occurred, the original transcript was referred to understanding participants' meanings. After achieving consensus on coding for the first 10 transcripts, they coded all transcripts independently. After all transcripts were coded, the two coders reviewed the coding results, and any discrepancies were resolved through discussions. In step 3, any text that could not be categorized with the initial coding scheme would be given a new code. The data collection process continued until data saturation–when adding further data showed no new information and the extra collected data were redundant. When the new code was not produced in the last three interviews, saturation was achieved and data collection stopped. This process of achieving saturation was used in previous studies [ 30 , 31 ]. In step 4, once all the data had been coded, the text from transcripts for each participant and codes were abstracted and inserted into the corresponding cell in the data matrix. Finally, similar verbatim words/sentences (meaning units) representing the same idea were grouped to form a theme.

Quantitative study

A cross-sectional survey study was conducted among physicians and nurses in primary care settings from July to October 2022.

Participants and data collection

The inclusion and exclusion criteria were the same as those in the qualitative study. A flowchart of participant recruitment was shown in Fig.  1 . Upon completion of the survey. Each participant received a supermarket coupon of HK$50 (US$6.5) as a token of appreciation.

Flowchart of participant recruitment

Physicians in the public sector

All public hospitals in Hong Kong are managed by the Hospital Authority. They are organized into seven hospital clusters based on their locations [ 32 ]. We approached all chiefs of service of these seven clusters and four of them were willing to support our study. Facilitated by the chiefs of service, a link to access an online questionnaire was sent to physicians working in the General Out-patient Clinics, and Family Medicine Integrated/Specialist Clinics within the clusters through email. Before starting the online survey, participants read a statement indicating that participation was voluntary, refusal to participate would have no effect on them, and the survey would not collect personal identifying information. Online informed consent was obtained. Among 640 physicians in the public sector being invited, 137 completed the survey (response rate: 21.4%).

Physicians in the private sector

A list of all physicians (4511 in total) working in the primary care settings in the private sector was retrieved from the government webpage [ 33 ] and entered into an Excel file. Using the function of selecting random cells, 680 physicians were randomly selected from the list. Hard copies of the questionnaires with a quick response (QR) code to access the same online questionnaire were sent to their contact addresses. Participants could return hard copies of the questionnaire with the written consent form by mail, or provide online consent and complete the online questionnaire. A total of 145 physicians in the private sector completed the survey, the response rate was 21.3%.

The Association of Hong Kong Nursing Staff keeps the contact information of all nurses who applied for membership in the Association in Hong Kong. Facilitated by the Association, 500 nurses working in the public sector and another 500 nurses working in the private sector in the primary care settings were randomly selected from their database. A link to access the same online questionnaire was sent to them through email. With online informed consent, 140 (response rate: 28%) and 155 (response rate: 31%) nurses in the public and private sectors completed the online survey, respectively.

Development of the questionnaire

The same panel developed the questionnaire. The qualitative study identified 22 constructs of CFIR that were relevant to SBI implementation among primary care providers in Hong Kong. The panel adapted validated measurements and constructed questions to measure these constructs. The questionnaire was pilot tested among five physicians and five nurses to assess its clarity and readability. All the physicians and nurses in the pilot study indicated that the items of the questionnaire were easy to understand and the length of the questionnaire was acceptable. These physicians and nurses did not participate in the actual survey. The panel finalized the questionnaire based on their comments.

We created the online questionnaire using Qualtrics, a commonly used online survey platform. The survey consisted of 71 items (approximately 10 items per page for 7 pages) and required around 20 minutes to complete. The Qualtrics performed a completeness check before the questionnaire was submitted. Participants were able to review and change their responses using a Back button. All data were stored in the Qualtrics server and protected by a password.

Background characteristics

Participants reported background information which included gender, age, number of years working in the current workplace, current employment status, training status in the Hong Kong Academy of Medicine (for physicians), job position/rank (for nurses), public/private sector, and whether they drank alcohol in the past year.

SBI implementation

Participants were asked to estimate the proportion of patients they screened for alcohol consumption using the AUDIT and gave standard intervention according to the SBI protocol in the past year (response categories: 0%, 1-25%, 26-50%, 51-75%, >75%). SBI implementation was defined as providing both screening using AUDIT and standard interventions based on SBI protocol.

CFIR constructs

We measured 22 constructs under all five CFIR domains. Details of the measurements were presented in Supplementary Tables 1 and 2 . Reliabilities measured by Cronbach’s alpha of the scales measuring CFIR constructs were acceptable (0.65-0.85) (Supplementary table 1 ).

Attitudes toward drinking in the Chinese culture

We added attitudes toward drinking in the Chinese culture since the participants in the qualitative interview study reported that some beliefs in the Chinese culture might affect people’s drinking. We adapted item/subscale from the validated Chinese version of the Cultural Attitudes Toward Drinking Scale (CADS) to measure social approval for drinking (1 item) and functions of drinking (5 items) [ 34 ]. The Cronbach’s alpha of the Functions of Drinking subscale was 0.79. In addition, two single items were constructed to measure the influence of moderation on drinking proposed by Confucian and Taoist philosophies and the stigma-related issue of addressing drinking problems (response categories were 1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree).

Sample size planning

There were four groups of participants (physicians or nurses in the public or private sectors). The target sample size is 150 per group. As an illustration of the statistical power, given a power of 0.8 and an alpha of 0.05, such sample size could detect the smallest between-group difference of 11.8% for SBI implementation, assuming 10-30% implemented SBI in the reference group. Assuming 10-30% in the reference group (without a facilitator) implemented SBI, the sample size (n=150) would give the smallest ratio of 2.53 between those with and without such a facilitator (PASS 11.0, NCSS, LLC).

Statistical analysis

Given the differences in roles of sectors and professions, the analyses were conducted separately for the public versus private sector and physicians versus nurses. Differences in SBI implementation and CFIR constructs between physicians/nurses in the public sector and the private sector were compared using logistic regression or ANCOVA, after adjusting background characteristics with significant between-group differences. Using SBI implementation in the last year as the dependent variable, and background characteristics as independent variables, odds ratio (OR) predicting the dependent variable were obtained using logistic regression models. After adjusting those sociodemographic characteristics with p <0.05 in the univariate analysis, the associations between the independent variables of interest (e.g., CFIR constructs) and the dependent variable were then obtained by adjusted odds ratio (AOR), and respective 95% confidence interval (CI) were derived from the analyses. Each AOR was obtained by fitting a single logistic regression model, which involved one of the independent variables and the significant sociodemographic variables. SPSS version 26.0 (Chicago, IL, United States) was used for data analysis, and p <0.05 were considered as statistically significant.

A total of 25 physicians and 24 nurses were approached, of which five physicians and three nurses refused to participate due to unavailability or lack of interest in the study. Finally, 20 physicians and 21 nurses completed the interviews. Nearly half of them were female (51.2%) and worked in the public sector (51.2%). The majority were aged 20-40 years (78.1%) (Table 1 ).

CFIR determinants of the implementation of SBI

Sample quotes of the interviews were presented in Table 2 .

Intervention characteristics

Evidence strength and quality

Some participants were unsure about the efficacy of SBI (15/41 participants). They expressed their concerns about how much the patients would benefit from receiving SBI (10/41 participants). They would need concrete evidence before making decisions on how much effort should be put into this work (9/41 participants). On the other hand, some participants said that they felt confident to use SBI as they knew that the efficacy of SBI was supported by randomized controlled trials (19/41 participants).

Relative advantage

Participants reported that they mainly relied on their previous experiences and knowledge in order to address alcohol use with the patients (30/41 participants). They did not think that SBI was more effective than their own approach (20/41 participants). Several of them used the CAGE (Cut, Annoyed, Guilty, Eye-opener) questions [ 35 ] (8/41 participants). A few participants admitted that using a standard tool, like the AUDIT, was good for record-keeping and follow-up in the future (7/41 participants).

Adaptability

Participants thought that SBI did not fit well with the way they work in the clinic and felt it was inappropriate to screen all patients in general practice (25/41 participants). There would be interruptions in their routine work (24/41 participants).

Although the procedures of doing SBI were easy to understand, the participants thought that it was complex to some extent, especially calculating alcohol units intake (20/41 participants). Some participants reported that assessing patients’ stage of change and giving different types of brief interventions were also complicated (25/41 participants).

There was consensus that using SBI was time-consuming, especially if the patients were heavy drinkers and standardized advice or interventions were needed (32/41 participants). They should also document the patients’ answers and what sort of advice they had been provided (15/41 participants). This would further increase their burden in terms of administrative or management costs (24/41 participants).

Outer setting

Patient needs

The participants agreed that their patients were willing to answer questions related to alcohol consumption and they believed that the patients thought that the physicians/nurses cared about them by asking such questions (25/41 participants). If the patients showed certain specific symptoms or signs related to alcohol drinking, they acted as a trigger for discussion of lifestyle issues including alcohol drinking (23/41 participants).

Cosmopolitanism

Participants reported that it was easy to refer patients to specialized addiction care/ treatment or community alcohol service (27/41 participants). They knew some referral services were available both provided by the government or community bodies (32/41 participants). On the other hand, they suggested that such referral services should be increased to reduce the waiting time for patients in order to receive timely treatment (26/41 participants).

External policy and incentives

The participants reported that there was no government policy to support preventive medicine in primary care settings, such as using SBI (26/41 participants). Additionally, the lack of training on SBI provided by the government, and the lack of public education campaigns were also reported as barriers (19/41 participants).

Inner setting

Networks and communication

Participants reported that the staff in the clinic did not have expectations of each other to use SBI (25/41 participants). Additionally, a lack of inter-professional cooperation in the delivery of SBI in their clinic was reported as a barrier (29/41 participants). The participants expressed a need for health professionals or social workers who were responsible for alcohol issues in their workplace (28/41 participants).

Tension for change

While some participants expressed there was a need for using SBI, especially those in the public sector (15/41 participants), other participants deemed that there was no tension about implementing SBI right now (24/41 participants). They thought that alcohol was not a critical issue for most of their patients (27/41 participants). Additionally, SBI was only recommended by the Department of Health but was not a must (17/41 participants).

Relative priority

Low priority for alcohol issues was reported (29/41 participants). Participants noted that patients usually have several health problems and there are always competing demands, leaving limited time for alcohol issues (26/41 participants).

Leadership engagement

Participants reported that their supervisors/managers/senior colleagues seldom talked about SBI with them (25/41 participants). There was a lack of concrete instructions, encouragement, or support to help patients reduce drinking (31/41 participants).

Organizational culture

The staff was not willing to make changes in their routine work using innovative approaches, even evidence-based practices (18/41 participants). If they were not required or did not have clear instructions to do it, they would not do it in the end (25/41 participants). On the other hand, participants believed that most of the staff had a sense of cooperation to provide high-quality care to the patients (27/41 participants).

Goals and feedback

The participants did not notice any goals of using SBI in their workplace (28/41 participants). They did not receive feedback from their supervisors or work reports on how they performed (30/41 participants).

Available resources

Participants reported that there was a lack of printed SBI materials or health information related to alcohol drinking for patients in the workplace (22/41 participants). They also expressed that there was no training provided in their workplace (29/41 participants). Participants wondered that although SBI was highly recommended by the government, there was a lack of training for implementing SBI in the clinic (25/41 participants).

Characteristics of individuals

Knowledge about the intervention

Although some participants said that they knew very well about SBI (23/41 participants), a lack of knowledge or low awareness of SBI recommended was still reported as a barrier by some participants (13/41 participants). Additionally, participants expressed a lack of alcohol training when they studied in medical school (8/41 participants).

Belief about the intervention

The belief that they have the responsibility and right to ask their patients about drinking was reported as a facilitator (17/41 participants). They viewed this task as within their role working in the primary care settings (18/41 participants). However, they did not think using SBI was rewarding because it takes time and the change in the patient’s alcohol consumption may also take a long time to occur (12/41 participants).

Self-efficacy

Having confidence in using SBI was reported by participants who stated using SBI in the past few months (13/41 participants). Some participants expressed a lack of confidence in using the SBI to change the patient’s drinking behavior (14/41 participants). Such issues include using the AUDIT to screen patients and explaining risks to health from different levels of alcohol consumption. They could offer many suggestions to the patients but their efforts did not necessarily lead to anything good to happen (7/41 participants).

Most participants reported there were no concrete plans for implementing SBI. The lack of a plan implied a lack of guidelines for implementing the SBI (34/41 participants).

Participants reported a lack of champions for SBI, who actively support and promote SBI. The staff generally did not take an active interest in implementing SBI (35/41 participants).

Participants also reported a lack of consistency in implementing SBI that was aligned with the clinic’s mission and strategic plan (26/41 participants).

Reflecting and evaluating

There was a lack of good communication about how different changes are related to SBI, e.g., frequency of using SBI among staff, and a lack of data to guide their clinic to implement SBI (e.g., performance reviews, and assessments) (33/41 participants).

Additional new code

Social context.

Based on our data analysis, two themes could not be classified into any of the CFIR constructs. A new code, social context, was created.

The value of moderation proposed by Confucianism/ Taoism to control drinking

Some participants reported that it was important that people should control the amount of alcohol they drank in any situation (17/41 participants). They believed that every behavior should not be done to an excess amount, which is consistent with the ideas of moderation, proposed by Confucianism/Taoism, a philosophy and ethical system that has had a significant influence on Chinese culture.

Stigmatization of alcohol dependence

Some participants thought that it was difficult for the patients to admit they had alcohol problems or dependence, making it challenging to discuss alcohol issues with them (15/41 participants). In Hong Kong, there was the term ‘alcohol ghost’, in Cantonese ‘酒鬼zau2 gwai2’. Simply translated to English, this word describes a person with alcohol problems as just like a ghost. Patients had the fear of being labeled in such a way. Additionally, alcohol problems were treated in psychiatric services or drug addiction treatment centres. Patients avoided the perceived stigma of mental health problems or mixing with drug addicts (15/41 participants).

Background characteristics of physicians and nurses were presented in Table 3 . As compared to physicians in the public sector, those in the private sector were older (>50 years: 34.5% versus 10.2%, p <0.001), working in the current clinic for a longer time (>20 years: 23.4% versus 5.1%, p <0.001), more likely to be part-time employed (14.5% versus 6.6%, p =0.03) and without training in HKAM (51.0% versus 0%, p <0.001). As compared to nurses in the public sector, those in the private sector had longer service time in the current clinic (>20 years: 8.4% versus 2.9%, p =0.004) (Table 3 ).

After controlling for background characteristics with significant between-group differences, there was no significant difference in SBI implementation in the past year between physicians/nurses in public and private sectors (physicians: 16.8% versus 14.5%, p=0.93; nurses: 30% versus 26.5%, p=0.53) (Table 4 ). Among physicians and nurses who had performed SBI in the past year, they only provided it to 1-25% of their patients.

The mean and standard deviation (SD) of scales/items of CFIR constructs were presented in Table 4 . A higher score indicated higher perception of this factor being present/relevant (Supplementary table 3 ). As compared to physicians/nurses in the private sector, those working in the public sector believed that SBI fit less well in their clinics (physicians: p =.02, nurses: p =0.03), perceived a higher cost to implement SBI (physicians: p =.008, nurses: p =.01), but had more available resources to implement SBI (physicians: p =0.02, nurses: p =0.02). Physicians in the public sector perceived a higher need to implement SBI (tension for change) ( p =0.03) and better leadership engagement ( p =0.04), as compared to those in the private sector. Nurses in the private sector perceived that it was easier to refer patients with alcohol problems ( p =.03) compared to nurses in the public sector (Table 4 ).

Factors associated with SBI implementation

Physicians and nurses who were older were less likely to implement SBI compared to their younger counterparts. Nurses working in the public sector for a shorter time were more likely to implement SBI. In the private sector, registered nurses were more likely to implement SBI than enrolled nurses (Table 5 ).

Univariate associations between independent variables of interest (CFIR constructs and attitudes toward drinking) and SBI implementation were presented in Supplementary Table 4 . Among physicians and nurses in both sectors, participants were more likely to implement SBI when perceiving stronger evidence supporting SBI (AOR: 1.25-1.36, p =0.03-0.04), better knowledge (AOR: 1.19-1.61, p =0.02-0.04) and self-efficacy (AOR: 1.12-1.18, p =0.02-0.04) to implement SBI, more available resources (AOR: 1.17-1.35, p =0.003-0.04) and clearer planning for SBI implementation in the clinics (AOR: 1,29-1.59, p =0.01-0.03) were reported. Participants in both sectors were less likely to implement SBI when perceiving SBI implementation to be complicated (AOR: 0.70-0.82, p =0.01-0.04) and of higher cost (AOR: 0.46-0.61, p =0.02-0.04), and drinking approved by Chinese culture (AOR: 0.27-0.50, p =0.001-0.02) were reported. Participants were more likely to implement SBI when perceiving SBI fit better with the existing practice in their clinics (adaptability) (AOR: 1.40 & 1.55, p =0.02 & 0.008) and better leadership engagement supporting SBI (AOR: 1.91 & 1.75, p =0.03 & 0.02) were reported among physicians and nurses in the public sector, but not among those in the private sector. Participants were more likely to implement SBI when perceiving a strong need (AOR: 1.95 & 2.09, p =0.01) and greater importance to implement SBI (AOR: 2.08 & 2.17, p =0.03 & 0.02) in their clinics were reported among physicians in both public and private sectors, but not among nurses. Participants were more likely to implement SBI when perceiving an organizational culture supporting SBI was reported among nurses in public and private sectors (AOR: 1.31 & 1.22, p =0.001 & 0.004), but not among physicians (Table 6 ).

This is the first original study investigating facilitators and barriers to implementing SBI among primary care providers in China. We applied the 2009 version of CFIR as the theoretical framework, which provided a comprehensive and standardized list of implementation-related constructs that may be relevant to explain why there is an SBI research-practice gap, between evidence for SBI and its use in routine primary care practice. By integrating qualitative and quantitative methods and data, this study gained both breadth and depth of understanding of SBI implementation in China. Our results suggested that some facilitators and barriers of SBI implementation were different between physicians and nurses, and between healthcare providers in the public and private sectors. The findings have implications for service planning and policymaking.

There was a large gap between SBI implementation and its recommendation in Hong Kong, as only 14.5-16.8% of physicians and 26.5-30.0% of nurses implemented SBI in the past year. Even among primary care providers who have implemented SBI, the coverage of SBI was quite low among their patients. The level of SBI implementation in Hong Kong was worse than that in other countries, such as Sweden (36.1%) [ 36 ], the United Kingdom (40.0%) [ 37 ], or Canada (75.0%) [ 38 ]. There is hence a strong need to improve SBI implementation in primary care settings in Hong Kong.

The facilitators and barriers identified by this study provided some implications to improve SBI implementation. Among CFIR constructs identified in the qualitative part of the study, the quantitative study findings confirmed that perceiving stronger evidence supporting SBI, better knowledge and self-efficacy to implement SBI, more available resources, and clearer planning for SBI implementation in the clinics were common facilitators among both physicians and nurses in both sectors. Such findings were similar to those observed among physicians and nurses in some Western countries [ 39 , 40 , 41 , 42 ]. Based on the CFIR-ERIC (Expert Recommendations for Implementing Change) tool for matching determinants and strategies to address these determinants [ 26 , 43 ], some strategies may be useful to enhance these facilitators. These strategies included identifying and preparing champions, conducting educational meetings, and capturing and sharing local knowledge [ 44 ]. It is important to identify and prepare some physicians/nurses (champions) who dedicate themselves to allocating useful SBI resources to physicians and nurses, supporting, marketing, and driving through the implementation of SBI, overcoming indifference or resistance that the SBI implementation may provoke in the clinics. Educational meetings with physicians, nurses, as well as administrators should be conducted to share information about SBI (e.g., evidence, content, and progress of implementation) with them. It is also necessary to capture successful cases from implementation sites on how physicians and nurses have made SBI work and share them with other colleagues, which would increase their self-efficacy in implementing SBI.

In line with the findings in the United Kingdom, Slovenia, the United States, New Zealand, and Germany, common barriers applied to four sub-groups included the perceptions that SBI implementation was complicated and of high cost [ 45 , 46 , 47 , 48 , 49 ]. Based on the CFIR-ERIC matching tool, strategies to address these barriers include accessing new funding, promoting adaptability, and developing a formal implementation blueprint [ 44 ]. Accessing new funding sources could involve new uses of existing money or accessing block grants for SBI delivery, such as employing new staff to facilitate the implementation. Promoting adaptability is to identify the ways SBI can be tailored to meet local needs and clarify which elements of SBI must be maintained to preserve fidelity. Developing a formal implementation blueprint includes all goals and strategies for implementing SBI. The blueprint should include the aim/purpose of the implementation, timeframe, milestones, and appropriate performance/progress measures. Apart from the CFIR constructs, physicians’ or nurses’ acceptance of drinking was found to be a barrier to implementing SBI. Regular meetings/seminars about up-to-date findings on the harms of alcohol should be organized for physicians and nurses.

Perceiving SBI fit better with the existing practice in their clinics and better leadership engagement supporting SBI were facilitators only in the public sector, but not in the private sector. In the public sector, physicians and nurses have to complete a certain amount of consultation assigned by their supervisors on time. Therefore, they have less flexibility in work arrangements than those working in the private sector. In addition to identifying and preparing champions and promoting adaptability, conducting local consensus discussions is a potentially useful strategy recommended by the CFIR-ERIC matching tool to address these barriers [ 44 ]. Managers or supervisors should hold discussions with physicians and nurses that address whether the alcohol problem is crucial among their patients in the clinic and how SBI should be implemented appropriately to address this problem.

In line with our qualitative findings, perceiving a stronger need and greater importance to implement SBI were facilitators only among physicians, but not among nurses. Compared to nurses, physicians usually have less time to communicate with their patients. Perceiving needs and importance of SBI implementation would be crucial factors for physicians’ decision to implement such practice, especially when the patients present multiple health problems. In addition to conducting local consensus discussions, strategies generated from the CFIR-ERIC tool include conducting local needs assessment and assessing for readiness [ 44 ]. With updated data about patients’ drinking habits and their diseases related to alcohol consumption, there is a need to assess various aspects of the clinic to determine its degree of readiness to implement, such as whether physicians have sufficient knowledge about SBI, their confidence in using SBI, availability of resources and so on.

Furthermore, perceiving an organizational culture supporting SBI was a unique facilitator in nurses. Research has shown that organizational culture is a key factor to improve nurse performance [ 50 ]. Organizational culture includes but is not limited to leadership, cooperation among nurses, organizational structure, systems and rewards, and job design [ 50 ]. Developing organizational culture is a recognized instrument tool for improving the work performance of nurses, emphasizing core values necessary for individual and organizational effectiveness [ 51 ].

This study had several limitations. First, similar to previous studies targeting physicians and nurses, the response rate was relatively low [ 52 , 53 ], and we only covered four out of seven clusters of public sectors. Selection bias existed for the recruitment of survey participants. Cautious should be taken when generalizing the findings to primary care providers in Hong Kong. Second, some measurements were self-constructed by this study and were not validated by external studies. However, the reliability of these measurements was acceptable. Third, SBI practice might be over-reported due to social desirability. Fourth, this study was conducted during the COVID-19 pandemic. However, the impact of COVID-19 on SBI implementation may be limited as no informant mentioned it as a barrier in the qualitative study. The qualitative study was conducted from July to December 2021 when COVID-19 was stable and well-controlled in Hong Kong. The number of local infected cases was very low during this period and the services provided in the primary care settings resumed normal. This might explain why no informants in the qualitative study mentioned COVID-19 as a barrier of SBI implementation.Fifth, this was a cross-sectional study and could not establish causal relationships. Sixth, among physicians and nurses who had performed SBI in the past year, they only provided it to 1-25% of their patients. The “1-25%” is a large interval. In the survey, the participants were asked to estimate the proportion of their patients who were asked about their alcohol consumption using the AUDIT or received brief intervention. The participants were provided the following response categories: (i) 0%, (ii) 1-25%, (iii) 26-50%, (iv) 51-75%, (v) >75%. Seventh, the survey results showed that there was still a proportion of people who reported that they did not know SBI very well. Lack of knowledge might affect the validity of their responses related to SBI. Finally, after the completion of our study, a new version of the CFIR was published in October 2022 [ 54 ]. The 2022 version included 32 new constructs (e.g., critical incidents in the outer setting, information technology infrastructure in the inner setting, COM-B system in the characteristics of individuals, and adapting in the implementation process) [ 54 ]. It was a limitation that we did not include these new constructs in this study. Interestingly, two constructs identified by our qualitative part that could not be covered by the 2009 version could match two new constructs in the updated version of CFIR. Stigmatization of alcohol dependence could be matched to social pressure, and the value of moderation proposed by Confucianism and Taoism in controlling drinking in the Chinese context could be matched to local attitudes.

There was a significant gap between SBI evidence and SBI implementation in primary care settings in Hong Kong, China. Only 22% of the participants had performed SBI at least one episode in the past year. Evidence strength, knowledge, self-efficacy, available resources, and planning were facilitators of SBI implementation in all sub-groups of participants, whilst cost, complexity, and drinking approved by the Chinese culture were barriers applicable to all participants. Additionally, a few unique facilitators were found for type of sectors and professions, i.e,, adaptability and leadership engagement for the public sector, relative priority and tension for change for physicians, and organizational culture for nurses. Implementation strategies should be developed targeting different groups of healthcare providers in an attempt to improve the implementation of SBI in the future.

Availability of data and materials

The data presented in this study are available from the corresponding author upon request. The data are not publicly available as they contain sensitive personal behaviors.

World Health Organization. Factsheets: Alcohol. Available from: https://www.who.int/news-room/fact-sheets/detail/alcohol .

Griswold MG, Fullman N, Hawley C, Arian N, Zimsen SRM, Tymeson HD, et al. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10152):1015–35.

Article   Google Scholar  

Ding LJ, Liang YJ, Tan ECK, Hu Y, Zhang C, Liu YX, et al. Smoking, heavy drinking, physical inactivity, and obesity among middle-aged and older adults in China: cross-sectional findings from the baseline survey of CHARLS 2011-2012. BMC Public Health. 2020;20(1).

Department of Health. Behavioural Risk Factor Survey (April 2016). 2017 Available from: https://www.chp.gov.hk/files/pdf/brfa_report_april_2016_eng.pdf .

Ballesteros J, Duffy JC, Querejeta I, Arino J, Gonzalez-Pinto A. Efficacy of brief interventions for hazardous drinkers in primary care: Systematic review and meta-analyses. Alcohol Clin Exp Res. 2004;28(4):608–18.

Article   PubMed   Google Scholar  

Bertholet N, Daeppen JB, Wietlisbach V, Fleming M, Burnand B. Reduction of alcohol consumption by brief alcohol intervention in primary care - Systematic review and meta-analysis. Arch Intern Med. 2005;165(9):986–95.

Kaner EFS, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Db Syst Rev. 2018(2).

Moyer A, Finney JW, Swearingen CE, Vergun P. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction. 2002;97(3):279–92.

Angus C, Scafato E, Ghirini S, Torbica A, Ferre F, Struzzo P, et al. Cost-effectiveness of a programme of screening and brief interventions for alcohol in primary care in Italy. BMC Fam Pract. 2014;15.

Purshouse RC, Brennan A, Rafia R, Latimer NR, Archer RJ, Angus CR, et al. Modelling the cost-effectiveness of alcohol screening and brief interventions in primary care in England. Alcohol Alcoholism. 2013;48(2):180–8.

Moyer VA, Preventive Services Task F. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. preventive services task force recommendation statement. Ann Intern Med. 2013;159(3):210-8.

World Health Organization. Global Status Report on Noncommunicable Diseases 2014 [Available from: https://www.who.int/nmh/publications/ncd-status-report-2014/en .

National Institute for Health and Clinical Excellence (NICE). Alcohol-use-disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. London: National Institute for Health and Clinical Excellence (NICE); 2011. Available from: https://www.nice.org.uk/guidance/cg115 .

Royal Australian College of General Practitioners (RACGP). Smoking, Nutrition, Alcohol and Physical Activity (SNAP)— a population health guide to behavioural risk factors in general practice, 2nd edition. East Melbourne: Royal Australian College of General Practitioners; 2015. Available from: https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/snap .

Seppanen KK, Aalto M, Seppa K. Institutionalization of brief alcohol intervention in primary health care-the Finnish case. Alcohol Clin Exp Res. 2012;36(8):1456–61.

Ockene JK, Adams A, Hurley TG, Wheeler EV, Hebert JR. Brief physician- and nurse practitioner–delivered counseling for high-risk drinkers. Arch Intern Med. 1999;159(18):2198–205.

Article   CAS   PubMed   Google Scholar  

Aalto M, Hyvonen S, Seppa K. Do primary care physicians’ own AUDIT scores predict their use of brief alcohol intervention? A cross-sectional survey. Drug Alcohol Depen. 2006;83(2):169–73.

Israel Y, Hollander O, Sanchez-Craig M, Booker S, Miller V, Gingrich R et al. Screening for problem drinking and counseling by the primary care physician-nurse team. 1996;20(8): 1443-1450.

Costa M, Yaya I, Mora M, Marcellin F, Villotitch A, Berenger C, et al. Barriers and levers in screening and care for alcohol use disorders among French general practitioners: results from a computer-assisted telephone interview-based survey. Alcohol Treat Q. 2019;37(2):207–24.

Chan PSF, Fang Y, Wong MCS, Huang JJ, Wang ZX, Yeoh EK. Using Consolidated Framework for Implementation Research to investigate facilitators and barriers of implementing alcohol screening and brief intervention among primary care health professionals: a systematic review. Implement Sci. 2021;16(1).

Hong Kong Government. Overview of the Health Care System in Hong Kong. Available from: https://www.gov.hk/en/residents/health/hosp/overview.htm .

Hong Kong Department of Health. Useful Information. Available from: https://www.dh.gov.hk/english/useful/useful_cme/useful_cmeni2310.html .

Hong Kong Department of Health. Alcohol Fails Toolkits [Available from: https://www.change4health.gov.hk/en/alcoholfails/toolkits.html .

Keith RE, Crosson JC, O'Malley AS, Cromp D, Taylor EF. Using the Consolidated Framework for Implementation Research (CFIR) to produce actionable findings: a rapid-cycle evaluation approach to improving implementation. Implement Sci. 2017;12.

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4.

Consolidated Framework for Implementation Research: Strategy design. Available from: https://cfirguide.org/choosing-strategies .

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.

Assarroudi A, Nabavi FH, Armat MR, Ebadi A, Vaismoradi M. Directed qualitative content analysis: the description and elaboration of its underpinning methods and data analysis process. J Res Nurs. 2018;23(1):42–55.

Article   PubMed   PubMed Central   Google Scholar  

Wei H, Watson J. Healthcare interprofessional team members’ perspectives on human caring: a directed content analysis study. Int J Nurs Sci. 2019;6(1):17–23.

PubMed   Google Scholar  

Sabzmakan L, Morowatisharifabad MA, Mohammadi E, Mazloomy-Mahmoodabad SS, Rabiei K, Naseri MH, et al. Behavioral determinants of cardiovascular diseases risk factors: a qualitative directed content analysis. Arya Atheroscler. 2014;10(2):71–81.

PubMed   PubMed Central   Google Scholar  

Low LL, Ab Rahim FI, Johari MZ, Abdullah Z, Aziz SHA, Suhaimi NA, et al. Assessing receptiveness to change among primary healthcare providers by adopting the consolidated framework for implementation research (CFIR). BMC Health Serv Res. 2019;19.

Hong Kong Hospital Authority. Clusters, Hospitals & Institutions. Available from: https://www.ha.org.hk/visitor/template101.asp .

Hong Kong Health Bureau. Primary Care Directory. Available from: https://apps.pcdirectory.gov.hk/Public/TC/AdvancedSearch?ProfID=RMP .

Chang J, Shrake E, Rhee S. Patterns of alcohol use and attitudes toward drinking among Chinese and Korean American college students. J Ethn Subst Abuse. 2008;7(3):341-56. Keyword Heading Alcohol use Attitudes toward drinking Chinese and Korean college student.

King M. At risk drinking among general-practice attenders - validation of the cage questionnaire. Psychol Med. 1986;16(1):213–7.

Holmqvist M, Bendtsen P, Spak F, Rommelsjo A, Geirsson M, Nilsen P. Asking patients about their drinking - A national survey among primary health care physicians and nurses in Sweden. Addict Behav. 2008;33(2):301–14.

Wilson GB, Lock CA, Heather N, Cassidy P, Christie MM, Kaner EF. Intervention against Excessive Alcohol Consumption in Primary Health Care: A Survey of GPs’ Attitudes and Practices in England 10 Years On. Alcohol Alcoholism. 2011;46(5):570–7.

Rush B, Bass M, Stewart M, Mccracken E, Labreque M, Bondy S. Detecting, preventing, and managing patients alcohol-problems. Can Fam Phys. 1994;40:1557–66.

CAS   Google Scholar  

McAvoy BR, Donovan RJ, Jalleh G, Saunders JB, Wutzke SE, Lee N, et al. General practitioners, prevention and alcohol-a powerful cocktail? Facilitators and inhibitors of practising preventive medicine in general and early intervention for alcohol in particular: A 12-nation key informant and general practitioner study. Drugs. 2001;.8(2).

Geirsson M, Bendtsen P, Spak F. Attitudes of Swedish general practitioners and nurses to working with lifestyle change, with special reference to alcohol consumption. Alcohol Alcoholism. 2005;40(5):388–93.

Miquel L, Lopez-Pelayo H, Nuno L, Arbesu JA, Zarco J, Manthey J, et al. Barriers to implement screening for alcohol consumption in Spanish hypertensive patients. Fam Pract. 2018;35(3):295–301.

Friedmann PD, McCullough D, Chin MH, Saitz R. Screening and intervention for alcohol problems - A national survey of primary care physicians and psychiatrists. J Gen Intern Med. 2000;15(2):84–91.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Waltz TJ, Powell BJ, Fernandez ME, Abadie B, Damschroder LJ. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implement Sci. 2019;14.

Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015;10.

Rapley T, May C, Frances Kaner E. Still a difficult business? Negotiating alcohol-related problems in general practice consultations. Soc Sci Med. 2006;63(9):2418–28.

Susic T, J K, M K, Email Susic T, tonka, poplas sm, et al. Why do general practitioners not screen and intervene regarding alcohol consumption in Slovenia? A focus group study. 2010.

Miller PM, Stockdell R, Nemeth L, Feifer C, Jenkins RG, Liszka H, Ornstein S, Nietert PJ, et al. Initial steps taken by nine primary care practices to implement alcohol screening guidelines with hypertensive patients: The AA-TRIP project. 2006.

Book   Google Scholar  

Mules T, Taylor J, Price R, Walker L, Singh B, Newsam P, et al. Addressing patient alcohol use: a view from general practice. J Prim Health Care. 2012;4(3):217–22.

Kraus L, Schulte B, Manthey J, Rehm J. Alcohol screening and alcohol interventions among patients with hypertension in primary health care: an empirical survey of German general practitioners. Addict Res Theory. 2017;25(4):285–92.

Ekasari PA, Noermijati N, Dewanto A. Organizational culture: a key factor to improve nurse performance. Enfermería Clínica. 2020;30:118–22.

Banaszak-Holl J, Castle NG, Lin MK, Shrivastwa N, Spreitzer G. The Role of Organizational Culture in Retaining Nursing Workforce. Gerontol. 2013;55:462–71.

Fang Y, Wang HH, Liang M, Yeung MS, Leung C, Chan CH, et al. The adoption of hypertension reference framework: An investigation among primary care physicians of Hong Kong. 2018.

Wong MC, Wang HH, Kwan MW, Chan WM, Fan CK, Liang M,, et al. The adoption of the Reference Framework for diabetes care among primary care physicians in primary care settings: A cross-sectional study. 2016.

Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022;17(75).

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Acknowledgments

The authors would like to express their gratitude to all the participants for their engagement in this study.

This study was funded by: (1) the Direct Grant for Research, The Chinese University of Hong Kong (Ref#: 2019.23); (2) The Centre for Health Systems and Policy Research is funded by the Tung Foundation.

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Zixin Wang and Eng-kiong Yeoh contributed equally as corresponding authors.

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Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China

Paul Shing-fong Chan, Martin Chi-sang Wong, Zixin Wang & Eng-kiong Yeoh

Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China

School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China

Yao Jie Xie, Sau-fong Leung & Kin Cheung

Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden

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Conceptualization: PSFC, ZW, EKY; methodology: PSFC, ZW, EKY; data collection: PSFC, YJX, MCSW, SFL, KC; data curation: PSFC, ZW; formal analysis: PSFC, ZW, YF; project administration: PSFC, ZW, EKY; writing-original draft preparation: PSFC, ZW, YF; writing-review and editing: PSFC, ZW, YF, PN. All authors have read and agreed to the published version of the manuscript.

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Chan, P.Sf., Fang, Y., Xie, Y.J. et al. Applying the Consolidated Framework for Implementation Research to investigate factors of implementing alcohol screening and brief intervention among primary care physicians and nurses in Hong Kong, China: an exploratory sequential mixed-method study. Implement Sci Commun 5 , 52 (2024). https://doi.org/10.1186/s43058-024-00590-z

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Health system lessons from the global fund-supported procurement and supply chain investments in Zimbabwe: a mixed methods study

• Abaleng Lesego 1 ,
• Lawrence P. O. Were 1 , 2 ,
• Tsion Tsegaye 1 ,
• Rafiu Idris 3 ,
• Linden Morrison 3 ,
• Tatjana Peterson 3 ,
• Sheza Elhussein 3 ,
• Esther Antonio 4 ,
• Godfrey Magwindiri 4 ,
• Ivan Dumba 5 ,
• Cleyland Mtambirwa 5 ,
• Newman Madzikwa 5 ,
• Raiva Simbi 5 ,
• Misheck Ndlovu 6 &
• Tom Achoki 1  

BMC Health Services Research volume  24 , Article number:  557 ( 2024 ) Cite this article

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The Global Fund partnered with the Zimbabwean government to provide end-to-end support to strengthen the procurement and supply chain within the health system. This was accomplished through a series of strategic investments that included infrastructure and fleet improvement, training of personnel, modern equipment acquisition and warehouse optimisation. This assessment sought to determine the effects of the project on the health system.

This study employed a mixed methods design combining quantitative and qualitative research methods. The quantitative part entailed a descriptive analysis of procurement and supply chain data from the Zimbabwe healthcare system covering 2018 – 2021. The qualitative part comprised key informant interviews using a structured interview guide. Informants included health system stakeholders privy to the Global Fund-supported initiatives in Zimbabwe. The data collected through the interviews were transcribed in full and subjected to thematic content analysis.

Approximately 90% of public health facilities were covered by the procurement and distribution system. Timeliness of order fulfillment (within 90 days) at the facility level improved from an average of 42% to over 90% within the 4-year implementation period. Stockout rates for HIV drugs and test kits declined by 14% and 49% respectively. Population coverage for HIV treatment for both adults and children remained consistently high despite the increasing prevalence of people living with HIV. The value of expired commodities was reduced by 93% over the 4-year period.

Majority of the system stakeholders interviewed agreed that support from Global Fund was instrumental in improving the country's procurement and supply chain capacity. Key areas include improved infrastructure and equipment, data and information systems, health workforce and financing. Many of the participants also cited the Global Fund-supported warehouse optimization as critical to improving inventory management practices.

It is imperative for governments and donors keen to strengthen health systems to pay close attention to the procurement and distribution of medicines and health commodities. There is need to collaborate through joint planning and implementation to optimize the available resources. Organizational autonomy and sharing of best practices in management while strengthening accountability systems are fundamentally important in the efforts to build institutional capacity.

Peer Review reports

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), together with its Zimbabwean national and international stakeholders have continued to invest in health system strengthening to improve public health in the country. These investments have been guided by systemwide strategic assessments to understand the fundamental challenges facing the Zimbabwean health system [ 1 , 2 , 3 , 4 ].

Given the strategic importance of access to essential medicines, vaccines, and other health technologies as a strategic pillar of any health system [ 4 , 5 ], the Global Fund supported the Ministry of Health and Child Care (MOHCC) through the United Nations Development Program (UNDP) to undertake a comprehensive assessment of the national procurement and supply chain management (PSCM) system in 2013 [ 6 ]. This assessment aimed to develop a strategic vision and costed action plan for improvement. This covered both upstream and downstream aspects of PSCM. The strategic purpose was to help the MOHCC launch a coordinated approach to invest in PSCM improvements and enhance coordination and cooperation in managing all health commodities across the health system [ 3 , 6 , 7 ].

Subsequently, the Global Fund supported several initiatives aimed at the realization of the improvements proposed by the comprehensive assessment undertaken by UNDP [ 6 ]. These initiatives primarily encompassed end-to-end supply chain assistance in critical areas, including demand quantification and forecasting, warehousing capacity development, fleet improvement, distribution systems, and waste management systems. Other support aspects focused on warehouse optimization, data and information management systems, and personnel training [ 7 , 8 ]. In general, warehouse optimization is the process of improving the efficiency and effectiveness of warehouse operations. It involved refining workflows, leveraging technology, enhancing spatial utilization, and ensuring precise inventory management [ 6 , 7 ].

More specifically, the Global Fund provided funds for the construction of warehouses for the National Pharmaceutical Company of Zimbabwe (NATPHARM) to facilitate the smooth handling of health commodities. Additionally, this support extended to water supplies (in terms of sinking boreholes) for various warehouses, water tanks, and booster pumps for the other branches. Global Fund also supported NATPHARM in constructing two incinerators in the two main cities, Harare, and Bulawayo to handle pharmaceutical waste effectively [ 9 , 10 ].

Through Global Fund support, NATPHARM also received modern warehouse equipment such as forklifts, pallet jacks and rolling ladders, and data and information management system support for better visibility and effective handling of health commodities. The support further extended to optimising the Harare branch warehouse with modern receiving and transit capabilities to serve other feeder locations and the procurement of modern delivery trucks to facilitate the distribution of commodities. Global Fund support also extended to personnel training and retention for the effective functioning of NATPHARM and the broader procurement and supply system [ 3 , 6 , 9 ].

Focusing on quality assurance and safety of medicines and other health commodities, Global Fund supported the Medicines Control Authority of Zimbabwe (MCAZ) to develop capacity in quality testing of all commodities procured through grants. MCAZ was also supported with the installation of solar panels that allowed for an uninterrupted power supply to facilitate smooth operations at the organization. The Global Fund support was also critical in the upgrading of the biology and chemistry laboratories to attain WHO prequalification standards [ 8 , 9 , 11 ]. Similarly, there was direct support from the Global Fund to facilitate pharmacovigilance activities, such as adverse drug reactions reporting using electronic systems. All these measures were meant to ensure that the medicines and health commodities consumed in the Zimbabwean health system were safe and quality-assured [ 4 , 5 , 9 , 11 ].

The overarching project by the Global Fund to support the Zimbabwean government was designed and implemented in response to the nationally identified gaps and opportunities that were established through various research and consultative efforts [ 3 , 4 , 6 , 8 ]. The project was kickstarted in the first quarter of 2019 and continued through 2021, with various project components being implemented in a phased approach to achieve the national targets [ 3 , 4 , 7 , 10 , 11 ]. To ensure effective coordination, accountability, and avoidance of duplicative efforts, the project was designed and implemented in close coordination with other partners represented in the National Health Development Partners Coordination Forum (HDPCF), Health Sector Technical Working Group (HSTWG), and the Global Fund Country Coordination Mechanism (CCM), among others [ 3 , 4 , 6 , 8 , 10 ]. There was regular reporting to the respective coordination mechanisms to track progress as well as troubleshoot any implementation issues as they arose [ 6 , 9 ].

Overall, the gaps identified through the various assessments commissioned by the Global Fund included a lack of effective coordination, poor inventory and order management, human resource constraints, and warehousing and storage inefficiencies [ 12 , 13 ]. Therefore, the focus of the Global Fund support was to retool the Zimbabwean PSCM system to be efficient, cost-effective and responsive to the population's health needs, particularly in the face of global epidemics and pandemics such as HIV/AIDS and COVID-19 [ 14 , 15 , 16 , 17 , 18 ].

In an attempt to resolve these issues, healthcare systems around the world are working on streamlining their supply chains through various health system strengthening measures [ 19 , 20 , 21 , 22 ]. Therefore, the objective of this analysis was to assess the overall effects of the Global Fund-supported investments in the Zimbabwean PSCM system and document the lessons learned to inform future programming efforts to strengthen healthcare systems.

The assessment covered a period of 2018 -2021 and employed both qualitative and quantitative research methods. Figure 1 . illustrates the convergent mixed methods study design that was applied. In this study design, both the qualitative and quantitative data collection and analyses are implemented simultaneously, and the insights merged to provide a fuller picture [ 23 ].

Convergent mixed methods design

The quantitative part of the study entailed collecting and analysing administrative data covering priority indicators that are routinely reported on the Zimbabwe PSCM. Meanwhile, the qualitative part comprised of key informant interviews (KII) focusing on stakeholders within the healthcare system to give perspective to the observed data trends. Insight from the two parts of the analysis were merged and subjected to comparative assessment and interpretation to ensure that a consistent picture emerged [ 23 , 24 ]. More details on the methods are provided in later sections.

Analytical framework

The overall analytical approach espoused in this assessment was anchored on the logical relationships of the building blocks of the health system as described by the World Health Organization (WHO) health system framework [ 5 ]. Figure 2 shows the analytical framework, which illustrates the results chain cascading from the Global Fund-supported initiatives to the expected improvements in intermediate and long-term outcomes related to PSCM, including the availability of medicines, reduced wastage, and overall improvements in population-level coverage [ 4 , 5 ].

Analytic framework

Overall, the framework graphically displays the results Global Fund intended to achieve through its support to the Zimbabwean PSCM. The "theory of change" that underlies the Global Fund’s strategy is revealed through the arrows in the diagram that identify “causal” linkages through which various intermediate results interact to make progress toward the overall goal of improving health system performance [ 3 , 5 ].

Quantitative research

The quantitative research entailed a detailed descriptive analysis of the operational data that was routinely reported across the Zimbabwe PSCM system. Table 1 . shows some of the key performance indicators (KPI) that were considered in our analysis.

Data collection, management and analysis

The data used in this analysis were obtained from the routinely reported operational data that included the NATPHARM-operated warehouses and healthcare facilities in the country. The data were extracted from the various data management systems operated by the different institutions, cleaned, and collated into a comprehensive dataset in the form of a spreadsheet covering the period of the assessment. The database was examined for completeness and accuracy by cross-referencing the corresponding progress reports for specific periods. Trends of priority indicators were compared over time, as they related to Global Fund support to the PSCM space.

Qualitative research

The qualitative assessment entailed KIIs with health system stakeholders who were knowledgeable and intimately involved in the Global Fund-supported initiatives and its intended beneficiaries. This included provincial and district management teams, hospital and clinic personnel, and other stakeholders in the Zimbabwe health system. Informed consent was obtained from each study participant involved in the study. The data collection protocol ensured that all study participants fully understood the objectives of the study and consented verbally to provide the required information.

As previously stated, the literature review helped map and identify critical organisations involved in the PSCM space, and more specifically, those involved in the procurement and health system strengthening activities supported by the Global Fund. A full list of those organisations is provided on Table  2 .

Sampling techniques

Convenience purposive sampling was used to select key informants and in-depth interviews [ 23 ]. Our sample was supplemented using snowball sampling methods (also called chain sampling). The initial respondents referred other potential respondents until no new information was forthcoming or achieved saturation. Efforts were made to be all-inclusive, involving various stakeholder groups and organisations intimately linked to the operations of the Zimbabwe PSCM landscape.

This comprised of KIIs using a structured interview guide that covered various thematic areas relevant to the assessment to obtain a comprehensive perspective of the impact of the Global Fund-supported initiatives in the country. In its development, testing and validation, the key informant guide was pretested and adapted to ensure suitability for the task. In view of the restrictions imposed to prevent the spread of COVID-19 infections at the time of the study, some KIIs were conducted online using multimedia channels such as Zoom, Skype, and telephonically.

Three research assistants supported the two project leaders in conducting the KIIs. After each interview, all notes taken by the research assistant were checked by the two project leaders to ensure completeness and readability to minimise recording errors. In addition, a tape recorder was used for interviews to assist with reference post data collection. All the recordings were stored in a pin-protected cloud storage which was only accessible by the two project evaluation leaders. Qualitative data obtained from the KIIs were transcribed in full and then manually analysed applying thematic content analysis. Where there was a divergence of opinion, an agreement was established through discussion with three members of the project evaluation team. In thematic analysis, data from interview transcripts were grouped into similar concepts. This approach was appropriate for semi-structured expert interviews as it is used to code text with a predefined coding system that can then be refined and completed with new themes emerging [ 23 , 24 ]. Our initial coding system was defined during the desk review stage and continuously updated in the successive phases of data collection employing a deductive approach of qualitative research. The emerging themes were not preconceived (desk review) but emerged from the data during the coding process, while the global themes were the highest-order themes that emerged from the data and were broad enough to capture the essence of the entire dataset [ 23 ]. The codes are presented in a tabular format in the results section below.

This section presents both the quantitative and qualitative research results from the study. The quantitative results comprise of trends of the priority operational PSCM indicators for the relevant period. The qualitative results present the perspectives of the key health stakeholders involved in the Zimbabwe healthcare system.

Quantitative results

Table 3 shows that the total warehouse capacity across the Zimbabwean health system increased by 37.8% between 2018 and 2021.

Of the 1500 public health facilities in Zimbabwe coverage by the PSCM system was consistently high between the years 2018 and 2021, averaging 94%, and increasing by 13.6% over the same period. However, order fulfillment rate within 90 days, for 1410 reporting health facilities was consistently below 50% from 2018 to 2020, despite the reported high coverage for the health facilities by the PSCM in the country. Notably, this indicator showed remarkable improvement to 91% in 2021, from an average of 42% from the previous three years. More specifically, the order fill rate for Tenofovir 300mg/ lamivudine 300mg/efavirenz 600mg (TLE 600mg) improved despite the significant drop observed in 2020. However, when comparing 2018 and 2021, the order fill rate for this specific HIV drug increased by around 36.5%, while the stockout rates for the same drug at the central stores declined by about 14.5% over the same period.

Table 3 further shows a 44% drop of order fill rates for the Determine HIV Test Kit between 2018 and 2020 for the 1410 reporting health facilities, only to recover in the year 2021, where order fill rates improved to 83%. At the same time, the stockout rates for the Determine HIV Test Kit at the central stores declined by 49% between 2018 and 2021.

Figure  3 shows the estimated average population coverage for HIV treatment for adults and children, from 2018 to 2020, at 92% and 71%, respectively. The figure shows that there was limited variation in the population level coverage over the years, despite the estimated increase in the number of people living with HIV over the same period. The national target for this indicator is 95%.

Adult and paediatric HIV treatment population coverage

Figure  4 shows the proportion of the value of the expired stock in the 7 warehouses, over three years, between 2019 and 2021, which demonstrates a declining trend over time. The highest expiry was in quarter 4 2019 at 1.9%, compared with the lowest in quarter 3 2021 at 0.1%. This represents a 93% reduction in value of expired stock.

Percentage value of expired stock

Figure  5 shows the combined stock-taking variance valued in United States Dollar terms across 7 warehouses over a three-year period. The stock variance shows a declining trend over the three-year period to negligible values at the end of 2021.

Stock-taking variance

Figure  6 shows the temporal trend of the number of days that it took NATPHARM to resolve the stock variances across the different warehouses in the country. Overall, there is a decline from the average of 8 days from the December 2018 stocktake (with Harare warehouse as an outliner at 25 days), to an average of 1 day in the December 2021 stocktake, where all warehouses converge.

Duration to resolve stock variance

Table 4 shows the funding levels in USD$ to support the diagnostic capacity for Covid-19, comprising of the polymerase chain reaction test (PCR) and rapid diagnostic tests (RDT). The table further shows the PSCM related costs, the total test done, and positive cases identified over the two-year period. The total funding between 2020 and 2021 increased by 290%, with testing levels increasing by 490% over the same period. The average Covid-19 positivity rate in 2020 was 6.4% while the positivity rate for 2021, was 3.1%, indicating a greater than 50% drop.

Qualitative results

Most of the participants interviewed acknowledged that the Global Fund support to NATPHARM and the broader Zimbabwean health system had been central in improving the overall performance of the health system through improved availability of essential medicines and other health commodities. This was largely achieved by ramping up the various components of the PSCM value chain and related operations, leading to efficiency, effectiveness and reliability.

Table 5 shows the codes, emerging and global themes from the thematic content analysis. The emerging themes revolved around the lack of infrastructure and equipment curtailing warehouse operations before the Global Fund support. Data gaps and poor product visibility were also emerging themes, as were the effects of the old fleet on the overall supply and distribution system. Similarly, issues of infrastructure, capacity, and personnel training gaps emerged as crucial themes hindering quality assurance within the PSCM. Global themes also largely focused on infrastructural inadequacy leading to underperformance. Improvements leading to better handling of commodities; data and information systems, enhancing visibility and supporting accuracy in forecasts; improvements in the distribution systems enabled by newer fleets also featured as global themes. Similarly, better trained and motivated personnel, able to perform critical functions; capacity to ensure the quality and safety of medicines and other health commodities; and the need for effective multistakeholder partnerships to improve effectiveness and sustainability of health systems, were key themes.

NATPHARM operations

According to the NATPHARM management, warehouse improvement and optimisation exercise resulted in better visibility and improved efficiency in the operations related to the commodity handling across the entire value chain. More specifically, the processes related to stock taking improved markedly over time according to the reports presented by various organizations that had been commissioned to undertake the stock audits.

“ …. warehouse optimisation supported implementing an inventory management system which conformed with bin location and variant codes, according to different donors. The result was improved, faster and more accurate stock takes, a sharp reduction of variances and more streamlined order processing ” Participant, NATPHARM.

Further, it was reported by various participants that order processing and deliveries had improved to be timely and on schedule as a result of the improved visibility and efficiency harnessed across the PSCM. Similarly, there was consensus that receiving processes and documentation had significantly improved through the support offered by Global Fund particularly towards warehouse optimization. The improvements in the data management systems and related trainings were also cited as contributory to the overall trend that was observed.

“ Reporting quality has greatly improved and is now timely, accurate and complete. This helps in accurate forecasting of demand, which in turn avoids unnecessary wastage and expiries” Participant MOHCC.

There was consensus from the majority of participants interviewed that the fleet improvements had improved the availability of essential commodities vital for the effective management of high burden diseases; HIV/AIDS, Malaria and Tuberculosis in Zimbabwe. According to participants from a local health facility, this was evidenced by low stockout rates for the key commodities needed to manage these three conditions effectively. The new fleet was reported to facilitate deliveries from various warehouses to the recipient health facilities on a regular basis. This level of distributional access coupled with better demand forecasting as a result of improved data use, was noted as critical in the improved availability of medicines and health commodities at the health facility levels.

Further, respondents in the leadership of NATPHARM revealed that the Global Fund support had benefited the overall financial position of the organisation by tapping into efficiencies harnessed through the various measures that have been implemented. Some of the support measures that resulted in efficiency improvements include, the warehouse optimization, pharmaceutical waste management and fleet improvements, which ultimately reduced operational costs.

For example, it was noted that running a newer fleet of vehicles led to lower maintenance and fuelling costs than previously was the case, when deliveries were done using older vehicles. Similarly, it was noted that pharmaceutical waste resulting from expired medicines and other health commodities was expensive to store and dispose, particularly when engaging third party organizations. However, this additional cost was reportedly in the decline, as a result of the investment in the incinerators for waste management.

“ The provision of incinerators for waste management has resulted in huge savings in terms of the cost of waste destruction. It has also resulted in significant compliance with environmental health regulations.”, Participant, NATPHARM.

MCAZ operations

Majority of the participants agreed that the Global Fund support to MCAZ strengthened its overall capacity to handle the requisite safety and quality assurance needs to effectively support the procurement functions for medicines and other health commodities within the country and regionally. The installation of solar panels to provide uninterrupted electricity power supply for the operations of the organization was cited as a huge advantage allowing for improved performance, in a country where power supply is unreliable. Similarly, other participants cited, the support for MCAZ laboratories to obtain the WHO prequalification status, as a major step towards effectiveness and sustainability for the organization; citing the fact that MCAZ is offering quality assurance services regionally at a fee.

“ We [MCAZ] now have the capacity to conduct the safety and quality assurance tests needed to support the procurement of commodities in the country and the region. We [MCAZ] even recently won the tender to support the regional procurement activities ”, Participant, MCAZ.

Based on the results framework provided in Fig.  3 , there is clear evidence that the Global Fund-supported initiatives resulted in positive improvements in the overall performance of the Zimbabwean PSCM system. However, it is important to recognise some of the assessment’s limitations in interpreting these findings. First, the results reported are for a limited observation period and a limited set of indicators, which are largely confined to the national level analysis, missing out on granular subnational and commodity-specific analysis that could be more informative. Secondly, this study was not conceptualised before the onset of the intervention reported here (i.e., Global Fund-supported initiatives), and therefore, no specific steps were taken to develop an appropriate prospective research design and data collection strategy to support a more rigorous assessment. Therefore, the study relied on secondary PSCM data that were sparse and covered a limited period. Third, the study could be subject to confounding relationships with other concurrent interventions being implemented by other health system stakeholders that have direct or indirect effects on the PSCM system, complicating impact attribution to specific interventions. Forth, the analysis focused only on a narrow subset of medicines and commodities related to HIV/AIDS and COVID-19. However, despite these limitations, every effort has been made to use the most up-to-date and complete information available, including validation using official reports and collaborative reported data with key informant interviews.

The estimated population coverage for HIV treatment for both adults and children remained consistently high despite the increasing prevalence in the country. It was estimated that adults living with HIV increased by 10% from a baseline of 2018, to reach 1.3M in 2020, while children living with HIV increased by 24%, from a baseline of 2018, to reach 75 000 in 2020 [ 3 , 4 , 9 ]. As a key last mile population outcome, it can be rightly assumed that high HIV treatment coverage in the Zimbabwean system emanated from strengthened inventory management functionality and improved delivery of orders supported by a modern fleet of vehicles, which allowed for meeting the supply target of four quarterly rounds [ 3 , 8 ]. Population coverage is an important performance measure for a health system. It unites two important concepts; need and utilisation of an intervention to improve health [ 25 ]. In our case, the intervention is HIV treatment and the population in need is those living with HIV needing treatment; and the proportion with access and able to use the treatment they need, represents population coverage. This is a fundamentally important consideration as various health systems, including low- and middle-income countries, are making universal health coverage (UHC) efforts. There is no question, that improved access to essential medicines and other health technologies is a fundamental cornerstone towards UHC [ 1 , 5 , 26 ].

Other intermediate indicators that are critical for progress towards improved availability of medicines and other health commodities and hence UHC, also showed significant improvements that could be attributed to Global Fund-supported initiatives. For example, reduced wastage and decreasing value of expired health commodities reported, point towards improving efficiency across the value chain. As noted earlier, efficiency is one of the fundamental expectations of an effective health system outlined in the WHO health system framework [ 3 , 5 ]. The diminishing value of expiries could be ascribed to various factors, including the improved workflow processes and data accuracy at NATPHARM. This improvement which is associated with better visibility of commodities across the value chain could be attributed to investments made by Global Fund such as the enterprise resource planning platform, coupled with concomitant training and supervision.

Through Global Fund’s assistance to NATPHARM, automation of tasks such as stock management, ordering, and other operational activities was central and contributory to driving the observed improvements in the handling of commodities; reduction of wastage and expiries and improving availability. Similarly, better inventory management and warehouse optimization activities such as decongestion resulted in quicker, timely, more accurate, and well-documented stock takes, improving overall commodity management.

Variances between stock on hand and physical counts were used to determine whether facilities are conducting period checks on their stocks and therefore calculating monthly consumption of commodities accurately. As such the variance across commodities should be zero. Low variance indicates that the stocks at hand are generally similar and do not vary widely from the physical stock counts, while high variance indicates that the respective values have greater variability and are more widely dispersed from one another. There is clear evidence pointing towards the reduction in stock variances when comparing stock on hand and physical counts across the different warehouses in the country over time. This trend can be attributed to better visibility of commodities at the warehouses and training of personnel which was supported by the Global Fund [ 2 , 9 ]. Similarly, the number of days it took the NATPHARM personnel to resolve stock variances showed a dramatic reduction, from an average of 8 days to 1 day in a span of 3 years. This observed trend could also further support the claim that overall, the Global Fund supported initiatives produced the desired results.

With the advent of Covid-19, the effects of the Global Fund support on the PSCM became evident considering the robust response the country was able to mount particularly in terms of diagnostics [ 9 ]. The country was able to rapidly roll out COVID-19 testing, reaching many people between 2020 and 2021. Similarly, the Covid-19 positivity rates declined from 6.4% to about 3.1% over the same period. High positivity rates may indicate that the health system is only testing the sickest patients who seek medical attention and is not casting a wide enough net to know how much of the virus is spreading within its communities. A low rate of positivity on the other hand, can be seen as a sign that a health system has sufficient testing capacity for the size of the Covid-19 outbreak and is testing enough of its population to make informed decisions about reopening the economy. The WHO guidance is that countries which have conducted extensive testing for COVID-19, should remain at 5% or lower positivity rate for at least 14 days.

Safe pharmaceutical waste management and disposal is a primary consideration of any effective health system in completing the PSCM loop [ 27 ]. The Global Fund supported the investment in MOHCC operated incinerators. These investments could largely be associated with reduction in the cost of storage, handling and disposal of the expired stock, particularly when considering that certain space was rented from third parties which often charged a premium. Safe pharmaceutical waste disposal also became more priority with the increased supplies that resulted from the efforts to tackle the Covid-19 pandemic.

Despite signs of progress, there was temporary faltering of indicators- namely, order fill and stockout rates; associated with key commodities for effective management of HIV in the year 2020, warranting an explanation. The drop in Tenofovir/Lamivudine/Efavirenz (TLE 600mg) in 2020 could be linked to several factors. In the year 2019, the Zimbabwe MOHCC adopted new treatment regimens containing Dolutegravir. This means, newly HIV positive clients were started on Dolutegravir regimen as standard of care rather than the previous first line treatment which then surged Tenofovir/Lamivudine/Dolutegravir 50mg order fill rate, while having the opposite effect on the old regimen. Lastly, the effects of COVID-19 pandemic cannot be underestimated as the global supply chain systems were logged with delays which caused disruptions and inefficiencies in health systems in many countries [ 28 ]. In the same period, Determine HIV Test Kit rebounded from stocking out in central stores because of strengthened warehouse optimization activities, including better inventory management, purposeful stock taking, and approval processes contributed to the lowering of stockout rates.

The Global Fund-supported initiatives were also instrumental in building capacity by training key personnel for the effective implementation of activities related to the procurement and supply chain management function [ 8 , 29 , 30 ]. Better quantification and forecasting capabilities (due to data availability through e-LMIS and personnel training), improved warehousing capacity to hold a wide portfolio of products, and direct delivery to facilities through a modern fleet could have contributed to the high population coverage reported [ 26 , 30 , 31 ]. According to the WHO health system framework, effective leadership is required to coordinate all the functions of the health system in order to achieve the desired outcomes [ 5 ]. Therefore, it is sensible to conclude that, the reported health system improvements could not have happened without effective leadership and well-trained staff tasked with coordination and management across the PSCM value chain. It can be further inferred that the training and capacity development measures offered to the NATPHARM personnel were consequential in supporting the broader health system to meet its overall objectives, including improving PSCM performance [ 2 , 7 , 29 ].

Similarly, adequate infrastructure, equipment, data, and information management systems are crucial ingredients for a well-functioning health system, according to the WHO health system framework [ 4 , 5 , 9 ]. The Global Fund-supported initiatives were central in supporting these aspects of the health system through improved warehousing capacity, of modern equipment, installation of solar panels, fleet improvement and deployment of an electronic-logistic management information system (e-LMIS). The cumulative benefits of these investments include optimised procurement and distribution of commodities leading to a reduction in stockout rates and timely order refills to meet the population health needs [ 9 ].

Based on these findings, it would be reasonable to conclude that the Global Fund-supported initiatives in Zimbabwe contributed positively to strengthening the health system, particularly through the improved performance of the various indicators linked to the PSCM system at national and regional warehouses, as well as health facilities. Considering the prevailing health needs in the country, the implementation of this project and the manner of investments provide a basis and playbook for further support to make progress. This is particularly true considering the various competing priorities in the Zimbabwean healthcare system amidst resource constraints [ 3 , 6 , 8 ]. This was largely underpinned on the overarching focus on UHC and the critical role that an effective PSCM plays towards that very objective [ 3 , 12 , 13 , 14 ].

The Global Fund-supported project in Zimbabwe worked through the existing national coordination mechanisms where various key stakeholders, including MOHCC and NATPHARM, were involved in all key strategic planning and implementation decisions, ensuring country leadership and ownership. It was clear from the outset that this approach required sound partnership, transparency, and accountability among all the involved stakeholders, to deliberate and find common ground, guided by the overarching objective to make progress towards UHC.

The question of securing the gains and ensuring sustainability is fundamental for donor supported health programs in low- and middle- income countries. To make progress, it is imperative for health system stakeholders, including governments and donor organizations that are keen to sustainably strengthen health systems to pay close attention to critical areas like the procurement and distribution of health commodities. It is critical to collaborate with key stakeholders through joint planning and implementation to optimize the available resources. Organizational autonomy coupled with strong data driven accountability systems and the sharing of best management practices are fundamentally important in this discourse.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request and once written permission is obtained from NATPHARM.

Abbreviations

Country Coordination Mechanism

Health Development Partners Coordination Forum

Health Sector Technical Working Group

Key Informant Interview

Medicines Control Authority of Zimbabwe

Ministry of Health and Child Care

National Pharmaceutical Company of Zimbabwe

Polymerase Chain Reaction

Procurement and Supply Chain Management

Rapid Diagnostic Tests

Tenofovir Lamivudine Efavirenz

Universal Health Coverage

United Nations Development Program

World Health Organization

UNDP. Healthy systems for healthy people: UNDP and Global Fund support to strengthen financial and risk management for the delivery of health services in Zimbabwe. New York: United Nations Development Programme; 2020.

UNDP. Healthy systems for healthy people: UNDP and Global Fund support to strengthen the national health management information system. New York: United Nations Development Programme; 2020.

MOHCC. Investment case for the national health strategy 2021-2025. Harare: Accelerating investments towards Universal Health Coverage; 2020.

Google Scholar  

MOHCC. National health strategy 2021–2025. Harare: Ministry of Health and Child Care; 2020.

WHO. Everybody business: strengthening health systems to improve health outcomes: WHO’s framework. Geneva: WHO; 2007.

Group EH. Comprehensive assessment of the supply chain for health commodities in the public sector in Zimbabwe. Harare: United Nations Development Programme; 2013.

MOHCC. Analysis and findings from the Zimbabwe supply chain human resource assessment. Harare: Ministry of Health and Child Care; 2012.

UNDP. Healthy systems for healthy people: the impact of UNDP-managed Global Fund investments in procurement and supply chain systems in Zimbabwe. Harare: United Nations Development Programme ; 2020.

Global Fund. Audit report: Global Fund Grants in Zimbabwe. Geneva: The Global Fund; 2020

MOHCC. Zimbabwe electronic logistics management information system baseline assessment report December 2018 to January 2019. Harare: Ministry of Health and Child Care ; 2019.

MOHCC. Zimbabwe comprehensive laboratory assessment. Harare: Ministry of Health and Child Care; 2016.

Privett N, Gonsalvez D. The top ten global health supply chain issues: perspectives from the field. ORHC. 2014;3(4):226–30. https://doi.org/10.1016/j.orhc.2014.09.002 .

Article   Google Scholar  

Yadav P. Health product supply chains in developing countries: diagnosis of the root causes of underperformance and an agenda for reform. Health Syst Reform. 2015;1(2):142–54. https://doi.org/10.4161/23288604.2014.968005 .

Article   PubMed   Google Scholar  

Seidman G, Atun R. Do changes to supply chains and procurement processes yield cost savings and improve availability of pharmaceuticals, vaccines or health products? A systematic review of evidence from low-income and middle-income countries. BMJ Global Health. 2017;2:e000243.

Article   PubMed   PubMed Central   Google Scholar  

Windisch R, Waiswa P, Neuhann F, Scheibe F, Savigny DD. Scaling up antiretroviral therapy in Uganda: using supply chain management to appraise health systems strengthening. Global Health. 2011;7:25. https://doi.org/10.1186/1744-8603-7-25 .

Cyn-Young P, Kijin K, Susann R, Steven B, Woo KJ, Tayag MC, et al. This brief examines the global shortage of the personal protective equipment (PPE) needed to tackle COVID-19 and suggests policy implications. Manila: Asian Development Bank; 2020.

Dai T, Zaman MH, Padula WV, Davidson PM. Supply chain failures amid Covid-19 signal a new pillar for global health preparedness. J Clin Nurs. 2021;30(1–2):e1–3. https://doi.org/10.1111/jocn.15400 .

Ghaffar A, Rashidian A, Khan W, Tariq M. Verbalising importance of supply chain management in access to health services. J Pharm Policy Pract. 2021;14(Suppl 1):91. https://doi.org/10.1186/s40545-021-00352-5 . ( 1–3 ).

Jahre M, Dumoulin L, Greenhalgh LB, Hudspeth C, Limlim P, Spindler A. Improving health in developing countries: reducing complexity of drug supply chains. JHLSCM. 2012;2(1):54–84. https://doi.org/10.1108/20426741211226000 .

Vledder M, Friedman J, Sjoblom M, Brown T, Yadav P. Improving supply chain for essential drugs in low-income countries: results from a large scale randomized experiment in Zambia. Health Syst Reform. 2019;5(2):158–77. https://doi.org/10.1080/23288604.2019.1596050 .

Agrawal P, Barton I, Bianco RD, Hovig D, Sarley D, Yadav P. Moving medicine, moving minds: helping developing countries overcome barriers to outsourcing health commodity distribution to boost supply chain performance and strengthen health systems. Glob Health Sci Pract. 2016;4(3):359–65. https://doi.org/10.9745/GHSP-D-16-00130 .

Arora M, Gigras Y. Importance of supply chain management in healthcare of third world countries. IJSOM. 2018;5(1):101–6. https://doi.org/10.22034/2018.1.7 .

Creswell J, Creswell JD. Research design: qualitative, quantitative, and mixed methods approaches. London: Sage; 2018.

Achoki T, Lesego A. The imperative for systems thinking to promote access to medicines, efficient delivery, and cost-effectiveness when implementing health financing reforms: a qualitative study. Int J Equity Health. 2017;16:53. https://doi.org/10.1186/s12939-017-0550-x . (1-13).

Colson KE, Dwyer-Lindgren L, Achoki T, Fullman N, Schneider M, Mulenga P, et al. Benchmarking health system performance across districts in Zambia: a systematic analysis of levels and trends in key maternal and child health interventions from 1990 to 2010. BMC Med. 2015;13:69. https://doi.org/10.1186/s12916-015-0308-5 . 1-14.

Githendu P, Morrison L, Silaa R, Pothapregada S, Asiimwe S, Idris R, et al. Transformation of the Tanzania medical stores department through global fund support: an impact assessment study. BMJ Open. 2020;10(e040276):1–12. https://doi.org/10.1136/bmjopen-2020-040276 .

MOHCC. Infection Control and Waste Management Plan (ICWMP). Harare: Ministry of Health and Child Care; 2022.

Moosavi J, Fathollahi-Fard AM, Dulebenets MA. Supply chain disruption during the COVID-19 pandemic: recognizing potential disruption management strategies. Int J Disaster Risk Reduct. 2022;75:102983. https://doi.org/10.1016/j.ijdrr.2022.102983 .

Albano GL, Ballarin A, Sparro M. Framework agreements and repeated purchases: the basic economics and a case study on the acquisition of it services. In: International Public Procurement Conference. Milan: The International Public Procurement Conference; 2010.

OECD. Manual for framework agreements. Paris: Organization for Economic Co-operation and Development; 2014.

Arney L, Yadav P, Miller R, Wilkerson T. Strategic contracting practices to improve procurement of health commodities. Glob Health Sci Pract. 2014;2(3):295–306. https://doi.org/10.9745/GHSP-D-14-00068 .

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Acknowledgements

The authors would like to thank the participants from the different organizations in Zimbabwe that provided feedback during the study. They are also grateful to the management of the various organizations that allowed their staff to participate and provided premises and other resources that were used during the interviews. Gratitude to Sarah Gurrib who proofread the manuscript and offered useful comments.

The study was funded by the Global Fund to Fight AIDs, Tuberculosis and Malaria. The funder had no role in the study design, data collection, data analysis, data interpretation, or writing of the article. All authors had full access to study data and had final responsibility for the decision to submit for publication.

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Africa Institute for Health Policy, P.O. Box 57266-00200, Nairobi, Kenya

Abaleng Lesego, Lawrence P. O. Were, Tsion Tsegaye & Tom Achoki

Department of Health Sciences & Department of Global Health, Boston University, Boston, U.S.A.

Lawrence P. O. Were

Global Fund to Fight AIDs, Tuberculosis and Malaria, Geneva, Switzerland

Rafiu Idris, Linden Morrison, Tatjana Peterson & Sheza Elhussein

PricewaterhouseCoopers, Harare, Zimbabwe

Esther Antonio & Godfrey Magwindiri

National Pharmaceutical Company of Zimbabwe, Harare, Zimbabwe

Ivan Dumba, Cleyland Mtambirwa, Newman Madzikwa & Raiva Simbi

Medicines Control Authority of Zimbabwe, Harare, Zimbabwe

Misheck Ndlovu

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Contributions

Tom Achoki (TA), Rafiu Idris (RI), Lawrence Were (LW) and Abaleng Lesego (AL) conceptualized and designed the study. AL, TA, and Godfrey Magwindiri (GM) collected and analyzed data. TA and AL drafted the manuscript. Tsion Tsegaye (TT), Linden Morrison (LM), Tatjana Peterson (TP), Sheza Elhussein (SE), Esther Antonio(EA), Ivan Dumba (ID), Cleyland Mtambirwa (CM), Newman Madzikwa(NM), Raiva Simbi (RS), Misheck Ndlovu (MN) and LW did the critical revisions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tom Achoki .

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Ethics approval and consent to participate.

Ethical approval including the consent procedure for participants was obtained from the Ethics Committee of the MOHCC Department of Research and NATPHARM, Harare Zimbabwe. The conduct and methods of this study adhered to the tenets outlined in the Declaration of Helsinki. Informed consent was obtained from each study participant involved in the study. The data collection protocol ensured that all study participants fully understood the objectives of the study and consented in writing to provide the required information. Before the interview commenced, the participants also consented verbally and confirmed that they had understood the objectives of the study and that they could opt out of the interview at any time without prejudice. No sensitive or personally identifying information was collected regarding the study participants.

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Not applicable.

Competing Interests

RI, LM, TP and SE declare that they are fulltime employees at the Global Fund to Fight AIDs, Tuberculosis and Malaria. EA and GM declare that they are fulltime employees at PricewaterhouseCoopers. ID, CM, NM and RS are fulltime employees at National Pharmaceutical Company of Zimbabwe. The rest of the authors declare that they have no competing interests.

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Lesego, A., Were, L.P.O., Tsegaye, T. et al. Health system lessons from the global fund-supported procurement and supply chain investments in Zimbabwe: a mixed methods study. BMC Health Serv Res 24 , 557 (2024). https://doi.org/10.1186/s12913-024-11028-6

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Received : 06 March 2023

Accepted : 22 April 2024

Published : 01 May 2024

DOI : https://doi.org/10.1186/s12913-024-11028-6

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