Reflections on the use of qualitative research methods: it’s not ‘fluffy’

Carolyn A Chew-Graham

doi:10.3399/bjgp25X742449

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Qualitative research and clinical trials
Matthew J. Ridd

Published on: 06 June 2025

Published on: (6 June 2025)
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Qualitative research and clinical trials
Matthew J. Ridd, GP and Professor of Primary Health Care, University of Bristol
I enjoyed the focus of the June 2025 BJGP issue on qualitative research and agree with the reflections shared by Professor Chew-Graham.¹ I too cut my teeth in research by interviewing GPs, in my case about the value of continuity of patient care. It seemed obvious to me that the only way to really understand what we ended up describing as the “two sides of the coin”² (everything, even continuity, has upsides and downsides) was through analysis of in depth interviews.

I would also like to highlight the value of qualitative research nested within clinical trials.³ Had it not been for the interviews we conducted with parents and children who took part in the Best Emollients for Eczema (BEE) study, our conclusions may have been very different. The trial showed that lotions, creams, gels and ointments were equally effective at treating childhood eczema,⁴ which could have been summarised as, “prescribe any/the cheapest, they are all the same”. But the interviews highlighted how varied opinions were about the same type of emollient.⁵ One size did not fit all and so instead our recommendation was to offer choice (a moisturiser decision aid to support this is available from www.bristol.ac.uk/eczema).

Another more recent example is from the Amitriptyline for post-herpetic neuralgia (ATHENA) study.⁶ While the trial findings...
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I enjoyed the focus of the June 2025 BJGP issue on qualitative research and agree with the reflections shared by Professor Chew-Graham.¹ I too cut my teeth in research by interviewing GPs, in my case about the value of continuity of patient care. It seemed obvious to me that the only way to really understand what we ended up describing as the “two sides of the coin”² (everything, even continuity, has upsides and downsides) was through analysis of in depth interviews.

I would also like to highlight the value of qualitative research nested within clinical trials.³ Had it not been for the interviews we conducted with parents and children who took part in the Best Emollients for Eczema (BEE) study, our conclusions may have been very different. The trial showed that lotions, creams, gels and ointments were equally effective at treating childhood eczema,⁴ which could have been summarised as, “prescribe any/the cheapest, they are all the same”. But the interviews highlighted how varied opinions were about the same type of emollient.⁵ One size did not fit all and so instead our recommendation was to offer choice (a moisturiser decision aid to support this is available from www.bristol.ac.uk/eczema).

Another more recent example is from the Amitriptyline for post-herpetic neuralgia (ATHENA) study.⁶ While the trial findings are still awaited, interviews with people with recent experience of shingles highlighted how, unlike other Pharmacy First conditions, for many it is anything but a minor illness. Participants shared life-changing effects and responses, including changing their job.⁷

For all the importance of quantitative research including observational studies, narratives often have an impact by conveying people's experiences in a way that numbers can't. Go to the media with the results from any research and they will always ask for the case study – the individual’s story.

Despite these and many other examples, there is still misunderstanding and prejudice around the paradigm. I once chaired a PhD viva where one of the examiners questioned whether the excellent thesis could be nominated for a prize, “because it was only qualitative research”. After all, what possible value could there be to someone being able to tell their story in their own words and have their experiences validated by being listened to? The everyday and undervalued work of general practice itself.

References
1. Chew-Graham CA. Reflections on the use of qualitative research methods: it’s not ‘fluffy’. Br J Gen Pract 2025;75(755):244-45. doi: 10.3399/bjgp25X742449
2. Ridd M, Shaw A, Salisbury C. 'Two sides of the coin'--the value of personal continuity to GPs: a qualitative interview study. Fam Pract 2006;23:461-68.
3. Snowdon C. Qualitative and mixed methods research in trials. Trials 2015;16(1):558. doi: 10.1186/s13063-015-1084-4
4. Ridd MJ, Santer M, MacNeill SJ, et al. Effectiveness and safety of lotion, cream, gel, and ointment emollients for childhood eczema: a pragmatic, randomised, phase 4, superiority trial. Lancet Child Adolesc Health 2022;6(8):522-32. doi: 10.1016/S2352-4642(22)00146-8.
5. Sutton E, Shaw A, Ridd MJ, et al. How parents and children evaluate emollients for childhood eczema: a qualitative study. Br J Gen Pract 2022; 72(719):e390-e397. DOI: 10.3399/BJGP.2021.0630
6. Wells S, MacNeill SJ, Liu Y, et al. Amitriptyline for the prevention of post herpetic neuralgia: study protocol for the ATHENA study. Skin Health Dis 2025;5(1):1-8. doi: 10.1093/skinhd/vzaf002
7. Rees S, Ridd M, Hunt L, et al. ‘Everyone has heard of it, but no one knows what it is’: a qualitative study of patient understandings and experiences of herpes zoster. Br J Gen Pract 2025;75(751):e137-e42. doi: 10.3399/bjgp.2024.0025

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Competing Interests: Funding and disclaimer MJR is funded by an NIHR Research Professorship (NIHR303123). The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care.