interviews research limitations

The Interview Method In Psychology

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Interviews involve a conversation with a purpose, but have some distinct features compared to ordinary conversation, such as being scheduled in advance, having an asymmetry in outcome goals between interviewer and interviewee, and often following a question-answer format.

Interviews are different from questionnaires as they involve social interaction. Unlike questionnaire methods, researchers need training in interviewing (which costs money).

How Do Interviews Work?

Researchers can ask different types of questions, generating different types of data . For example, closed questions provide people with a fixed set of responses, whereas open questions allow people to express what they think in their own words.

The researcher will often record interviews, and the data will be written up as a transcript (a written account of interview questions and answers) which can be analyzed later.

It should be noted that interviews may not be the best method for researching sensitive topics (e.g., truancy in schools, discrimination, etc.) as people may feel more comfortable completing a questionnaire in private.

There are different types of interviews, with a key distinction being the extent of structure. Semi-structured is most common in psychology research. Unstructured interviews have a free-flowing style, while structured interviews involve preset questions asked in a particular order.

Structured Interview

A structured interview is a quantitative research method where the interviewer a set of prepared closed-ended questions in the form of an interview schedule, which he/she reads out exactly as worded.

Interviews schedules have a standardized format, meaning the same questions are asked to each interviewee in the same order (see Fig. 1).

   Figure 1. An example of an interview schedule

The interviewer will not deviate from the interview schedule (except to clarify the meaning of the question) or probe beyond the answers received.  Replies are recorded on a questionnaire, and the order and wording of questions, and sometimes the range of alternative answers, is preset by the researcher.

A structured interview is also known as a formal interview (like a job interview).

• Structured interviews are easy to replicate as a fixed set of closed questions are used, which are easy to quantify – this means it is easy to test for reliability .
• Structured interviews are fairly quick to conduct which means that many interviews can take place within a short amount of time. This means a large sample can be obtained, resulting in the findings being representative and having the ability to be generalized to a large population.

Limitations

• Structured interviews are not flexible. This means new questions cannot be asked impromptu (i.e., during the interview), as an interview schedule must be followed.
• The answers from structured interviews lack detail as only closed questions are asked, which generates quantitative data . This means a researcher won’t know why a person behaves a certain way.

Unstructured Interview

Unstructured interviews do not use any set questions, instead, the interviewer asks open-ended questions based on a specific research topic, and will try to let the interview flow like a natural conversation. The interviewer modifies his or her questions to suit the candidate’s specific experiences.

Unstructured interviews are sometimes referred to as ‘discovery interviews’ and are more like a ‘guided conservation’ than a strictly structured interview. They are sometimes called informal interviews.

Unstructured interviews are most useful in qualitative research to analyze attitudes and values. Though they rarely provide a valid basis for generalization, their main advantage is that they enable the researcher to probe social actors’ subjective points of view.

Interviewer Self-Disclosure

Interviewer self-disclosure involves the interviewer revealing personal information or opinions during the research interview. This may increase rapport but risks changing dynamics away from a focus on facilitating the interviewee’s account.

In unstructured interviews, the informal conversational style may deliberately include elements of interviewer self-disclosure, mirroring ordinary conversation dynamics.

Interviewer self-disclosure risks changing the dynamics away from facilitation of interviewee accounts. It should not be ruled out entirely but requires skillful handling informed by reflection.

• An informal interviewing style with some interviewer self-disclosure may increase rapport and participant openness. However, it also increases the chance of the participant converging opinions with the interviewer.
• Complete interviewer neutrality is unlikely. However, excessive informality and self-disclosure risk the interview becoming more of an ordinary conversation and producing consensus accounts.
• Overly personal disclosures could also be seen as irrelevant and intrusive by participants. They may invite increased intimacy on uncomfortable topics.
• The safest approach seems to be to avoid interviewer self-disclosures in most cases. Where an informal style is used, disclosures require careful judgment and substantial interviewing experience.
• If asked for personal opinions during an interview, the interviewer could highlight the defined roles and defer that discussion until after the interview.
• Unstructured interviews are more flexible as questions can be adapted and changed depending on the respondents’ answers. The interview can deviate from the interview schedule.
• Unstructured interviews generate qualitative data through the use of open questions. This allows the respondent to talk in some depth, choosing their own words. This helps the researcher develop a real sense of a person’s understanding of a situation.
• They also have increased validity because it gives the interviewer the opportunity to probe for a deeper understanding, ask for clarification & allow the interviewee to steer the direction of the interview, etc. Interviewers have the chance to clarify any questions of participants during the interview.
• It can be time-consuming to conduct an unstructured interview and analyze the qualitative data (using methods such as thematic analysis).
• Employing and training interviewers is expensive and not as cheap as collecting data via questionnaires . For example, certain skills may be needed by the interviewer. These include the ability to establish rapport and knowing when to probe.
• Interviews inevitably co-construct data through researchers’ agenda-setting and question-framing. Techniques like open questions provide only limited remedies.

Focus Group Interview

Focus group interview is a qualitative approach where a group of respondents are interviewed together, used to gain an in‐depth understanding of social issues.

This type of interview is often referred to as a focus group because the job of the interviewer ( or moderator ) is to bring the group to focus on the issue at hand. Initially, the goal was to reach a consensus among the group, but with the development of techniques for analyzing group qualitative data, there is less emphasis on consensus building.

The method aims to obtain data from a purposely selected group of individuals rather than from a statistically representative sample of a broader population.

The role of the interview moderator is to make sure the group interacts with each other and do not drift off-topic. Ideally, the moderator will be similar to the participants in terms of appearance, have adequate knowledge of the topic being discussed, and exercise mild unobtrusive control over dominant talkers and shy participants.

A researcher must be highly skilled to conduct a focus group interview. For example, the moderator may need certain skills, including the ability to establish rapport and know when to probe.

• Group interviews generate qualitative narrative data through the use of open questions. This allows the respondents to talk in some depth, choosing their own words. This helps the researcher develop a real sense of a person’s understanding of a situation. Qualitative data also includes observational data, such as body language and facial expressions.
• Group responses are helpful when you want to elicit perspectives on a collective experience, encourage diversity of thought, reduce researcher bias, and gather a wider range of contextualized views.
• They also have increased validity because some participants may feel more comfortable being with others as they are used to talking in groups in real life (i.e., it’s more natural).
• When participants have common experiences, focus groups allow them to build on each other’s comments to provide richer contextual data representing a wider range of views than individual interviews.
• Focus groups are a type of group interview method used in market research and consumer psychology that are cost – effective for gathering the views of consumers .
• The researcher must ensure that they keep all the interviewees” details confidential and respect their privacy. This is difficult when using a group interview. For example, the researcher cannot guarantee that the other people in the group will keep information private.
• Group interviews are less reliable as they use open questions and may deviate from the interview schedule, making them difficult to repeat.
• It is important to note that there are some potential pitfalls of focus groups, such as conformity, social desirability, and oppositional behavior, that can reduce the usefulness of the data collected.

For example, group interviews may sometimes lack validity as participants may lie to impress the other group members. They may conform to peer pressure and give false answers.

To avoid these pitfalls, the interviewer needs to have a good understanding of how people function in groups as well as how to lead the group in a productive discussion.

Semi-Structured Interview

Semi-structured interviews lie between structured and unstructured interviews. The interviewer prepares a set of same questions to be answered by all interviewees. Additional questions might be asked during the interview to clarify or expand certain issues.

In semi-structured interviews, the interviewer has more freedom to digress and probe beyond the answers. The interview guide contains a list of questions and topics that need to be covered during the conversation, usually in a particular order.

Semi-structured interviews are most useful to address the ‘what’, ‘how’, and ‘why’ research questions. Both qualitative and quantitative analyses can be performed on data collected during semi-structured interviews.

• Semi-structured interviews allow respondents to answer more on their terms in an informal setting yet provide uniform information making them ideal for qualitative analysis.
• The flexible nature of semi-structured interviews allows ideas to be introduced and explored during the interview based on the respondents’ answers.
• Semi-structured interviews can provide reliable and comparable qualitative data. Allows the interviewer to probe answers, where the interviewee is asked to clarify or expand on the answers provided.
• The data generated remain fundamentally shaped by the interview context itself. Analysis rarely acknowledges this endemic co-construction.
• They are more time-consuming (to conduct, transcribe, and analyze) than structured interviews.
• The quality of findings is more dependent on the individual skills of the interviewer than in structured interviews. Skill is required to probe effectively while avoiding biasing responses.

The Interviewer Effect

Face-to-face interviews raise methodological problems. These stem from the fact that interviewers are themselves role players, and their perceived status may influence the replies of the respondents.

Because an interview is a social interaction, the interviewer’s appearance or behavior may influence the respondent’s answers. This is a problem as it can bias the results of the study and make them invalid.

For example, the gender, ethnicity, body language, age, and social status of the interview can all create an interviewer effect. If there is a perceived status disparity between the interviewer and the interviewee, the results of interviews have to be interpreted with care. This is pertinent for sensitive topics such as health.

For example, if a researcher was investigating sexism amongst males, would a female interview be preferable to a male? It is possible that if a female interviewer was used, male participants might lie (i.e., pretend they are not sexist) to impress the interviewer, thus creating an interviewer effect.

Flooding interviews with researcher’s agenda

The interactional nature of interviews means the researcher fundamentally shapes the discourse, rather than just neutrally collecting it. This shapes what is talked about and how participants can respond.

• The interviewer’s assumptions, interests, and categories don’t just shape the specific interview questions asked. They also shape the framing, task instructions, recruitment, and ongoing responses/prompts.
• This flooding of the interview interaction with the researcher’s agenda makes it very difficult to separate out what comes from the participant vs. what is aligned with the interviewer’s concerns.
• So the participant’s talk ends up being fundamentally shaped by the interviewer rather than being a more natural reflection of the participant’s own orientations or practices.
• This effect is hard to avoid because interviews inherently involve the researcher setting an agenda. But it does mean the talk extracted may say more about the interview process than the reality it is supposed to reflect.

Interview Design

First, you must choose whether to use a structured or non-structured interview.

Characteristics of Interviewers

Next, you must consider who will be the interviewer, and this will depend on what type of person is being interviewed. There are several variables to consider:

• Gender and age : This can greatly affect respondents’ answers, particularly on personal issues.
• Personal characteristics : Some people are easier to get on with than others. Also, the interviewer’s accent and appearance (e.g., clothing) can affect the rapport between the interviewer and interviewee.
• Language : The interviewer’s language should be appropriate to the vocabulary of the group of people being studied. For example, the researcher must change the questions’ language to match the respondents’ social background” age / educational level / social class/ethnicity, etc.
• Ethnicity : People may have difficulty interviewing people from different ethnic groups.
• Interviewer expertise should match research sensitivity – inexperienced students should avoid interviewing highly vulnerable groups.

Interview Location

The location of a research interview can influence the way in which the interviewer and interviewee relate and may exaggerate a power dynamic in one direction or another. It is usual to offer interviewees a choice of location as part of facilitating their comfort and encouraging participation.

However, the safety of the interviewer is an overriding consideration and, as mentioned, a minimal requirement should be that a responsible person knows where the interviewer has gone and when they are due back.

Remote Interviews

The COVID-19 pandemic necessitated remote interviewing for research continuity. However online interview platforms provide increased flexibility even under normal conditions.

They enable access to participant groups across geographical distances without travel costs or arrangements. Online interviews can be efficiently scheduled to align with researcher and interviewee availability.

There are practical considerations in setting up remote interviews. Interviewees require access to internet and an online platform such as Zoom, Microsoft Teams or Skype through which to connect.

Certain modifications help build initial rapport in the remote format. Allowing time at the start of the interview for casual conversation while testing audio/video quality helps participants settle in. Minor delays can disrupt turn-taking flow, so alerting participants to speak slightly slower than usual minimizes accidental interruptions.

Keeping remote interviews under an hour avoids fatigue for stare at a screen. Seeking advanced ethical clearance for verbal consent at the interview start saves participant time. Adapting to the remote context shows care for interviewees and aids rich discussion.

However, it remains important to critically reflect on how removing in-person dynamics may shape the co-created data. Perhaps some nuances of trust and disclosure differ over video.

Vulnerable Groups

The interviewer must ensure that they take special care when interviewing vulnerable groups, such as children. For example, children have a limited attention span, so lengthy interviews should be avoided.

Developing an Interview Schedule

An interview schedule is a list of pre-planned, structured questions that have been prepared, to serve as a guide for interviewers, researchers and investigators in collecting information or data about a specific topic or issue.

• List the key themes or topics that must be covered to address your research questions. This will form the basic content.
• Organize the content logically, such as chronologically following the interviewee’s experiences. Place more sensitive topics later in the interview.
• Develop the list of content into actual questions and prompts. Carefully word each question – keep them open-ended, non-leading, and focused on examples.
• Add prompts to remind you to cover areas of interest.
• Pilot test the interview schedule to check it generates useful data and revise as needed.
• Be prepared to refine the schedule throughout data collection as you learn which questions work better.
• Practice skills like asking follow-up questions to get depth and detail. Stay flexible to depart from the schedule when needed.
• Keep questions brief and clear. Avoid multi-part questions that risk confusing interviewees.
• Listen actively during interviews to determine which pre-planned questions can be skipped based on information the participant has already provided.

The key is balancing preparation with the flexibility to adapt questions based on each interview interaction. With practice, you’ll gain skills to conduct productive interviews that obtain rich qualitative data.

The Power of Silence

Strategic use of silence is a key technique to generate interviewee-led data, but it requires judgment about appropriate timing and duration to maintain mutual understanding.

• Unlike ordinary conversation, the interviewer aims to facilitate the interviewee’s contribution without interrupting. This often means resisting the urge to speak at the end of the interviewee’s turn construction units (TCUs).
• Leaving a silence after a TCU encourages the interviewee to provide more material without being led by the interviewer. However, this simple technique requires confidence, as silence can feel socially awkward.
• Allowing longer silences (e.g. 24 seconds) later in interviews can work well, but early on even short silences may disrupt rapport if they cause misalignment between speakers.
• Silence also allows interviewees time to think before answering. Rushing to re-ask or amend questions can limit responses.
• Blunt backchannels like “mm hm” also avoid interrupting flow. Interruptions, especially to finish an interviewee’s turn, are problematic as they make the ownership of perspectives unclear.
• If interviewers incorrectly complete turns, an upside is it can produce extended interviewee narratives correcting the record. However, silence would have been better to let interviewees shape their own accounts.

Recording & Transcription

Design choices.

Design choices around recording and engaging closely with transcripts influence analytic insights, as well as practical feasibility. Weighing up relevant tradeoffs is key.

• Audio recording is standard, but video better captures contextual details, which is useful for some topics/analysis approaches. Participants may find video invasive for sensitive research.
• Digital formats enable the sharing of anonymized clips. Additional microphones reduce audio issues.
• Doing all transcription is time-consuming. Outsourcing can save researcher effort but needs confidentiality assurances. Always carefully check outsourced transcripts.
• Online platform auto-captioning can facilitate rapid analysis, but accuracy limitations mean full transcripts remain ideal. Software cleans up caption file formatting.
• Verbatim transcripts best capture nuanced meaning, but the level of detail needed depends on the analysis approach. Referring back to recordings is still advisable during analysis.
• Transcripts versus recordings highlight different interaction elements. Transcripts make overt disagreements clearer through the wording itself. Recordings better convey tone affiliativeness.

Transcribing Interviews & Focus Groups

Here are the steps for transcribing interviews:

• Play back audio/video files to develop an overall understanding of the interview
• Format the transcription document:
• Add line numbers
• Separate interviewer questions and interviewee responses
• Use formatting like bold, italics, etc. to highlight key passages
• Provide sentence-level clarity in the interviewee’s responses while preserving their authentic voice and word choices
• Break longer passages into smaller paragraphs to help with coding
• If translating the interview to another language, use qualified translators and back-translate where possible
• Select a notation system to indicate pauses, emphasis, laughter, interruptions, etc., and adapt it as needed for your data
• Insert screenshots, photos, or documents discussed in the interview at the relevant point in the transcript
• Read through multiple times, revising formatting and notations
• Double-check the accuracy of transcription against audio/videos
• De-identify transcript by removing identifying participant details

The goal is to produce a formatted written record of the verbal interview exchange that captures the meaning and highlights important passages ready for the coding process. Careful transcription is the vital first step in analysis.

Coding Transcripts

The goal of transcription and coding is to systematically transform interview responses into a set of codes and themes that capture key concepts, experiences and beliefs expressed by participants. Taking care with transcription and coding procedures enhances the validity of qualitative analysis .

• Read through the transcript multiple times to become immersed in the details
• Identify manifest/obvious codes and latent/underlying meaning codes
• Highlight insightful participant quotes that capture key concepts (in vivo codes)
• Create a codebook to organize and define codes with examples
• Use an iterative cycle of inductive (data-driven) coding and deductive (theory-driven) coding
• Refine codebook with clear definitions and examples as you code more transcripts
• Collaborate with other coders to establish the reliability of codes

Ethical Issues

Informed consent.

The participant information sheet must give potential interviewees a good idea of what is involved if taking part in the research.

This will include the general topics covered in the interview, where the interview might take place, how long it is expected to last, how it will be recorded, the ways in which participants’ anonymity will be managed, and incentives offered.

It might be considered good practice to consider true informed consent in interview research to require two distinguishable stages:

• Consent to undertake and record the interview and
• Consent to use the material in research after the interview has been conducted and the content known, or even after the interviewee has seen a copy of the transcript and has had a chance to remove sections, if desired.

Power and Vulnerability

• Early feminist views that sensitivity could equalize power differences are likely naive. The interviewer and interviewee inhabit different knowledge spheres and social categories, indicating structural disparities.
• Power fluctuates within interviews. Researchers rely on participation, yet interviewees control openness and can undermine data collection. Assumptions should be avoided.
• Interviews on sensitive topics may feel like quasi-counseling. Interviewers must refrain from dual roles, instead supplying support service details to all participants.
• Interviewees recruited for trauma experiences may reveal more than anticipated. While generating analytic insights, this risks leaving them feeling exposed.
• Ultimately, power balances resist reconciliation. But reflexively analyzing operations of power serves to qualify rather than nullify situtated qualitative accounts.

Some groups, like those with mental health issues, extreme views, or criminal backgrounds, risk being discredited – treated skeptically by researchers.

This creates tensions with qualitative approaches, often having an empathetic ethos seeking to center subjective perspectives. Analysis should balance openness to offered accounts with critically examining stakes and motivations behind them.

Potter, J., & Hepburn, A. (2005). Qualitative interviews in psychology: Problems and possibilities.  Qualitative research in Psychology ,  2 (4), 281-307.

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Madill, A. (2011). Interaction in the semi-structured interview: A comparative analysis of the use of and response to indirect complaints. Qualitative Research in Psychology, 8 (4), 333–353.

Maryudi, A., & Fisher, M. (2020). The power in the interview: A practical guide for identifying the critical role of actor interests in environment research. Forest and Society, 4 (1), 142–150

O’Key, V., Hugh-Jones, S., & Madill, A. (2009). Recruiting and engaging with people in deprived locales: Interviewing families about their eating patterns. Social Psychological Review, 11 (20), 30–35.

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Schaeffer, N. C. (1991). Conversation with a purpose— Or conversation? Interaction in the standardized interview. In P. P. Biemer, R. M. Groves, L. E. Lyberg, & N. A. Mathiowetz (Eds.), Measurement errors in surveys (pp. 367–391). Wiley.

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• Types of Interviews in Research | Guide & Examples

Types of Interviews in Research | Guide & Examples

Published on March 10, 2022 by Tegan George . Revised on June 22, 2023.

An interview is a qualitative research method that relies on asking questions in order to collect data . Interviews involve two or more people, one of whom is the interviewer asking the questions.

There are several types of interviews, often differentiated by their level of structure.

• Structured interviews have predetermined questions asked in a predetermined order.
• Unstructured interviews are more free-flowing.
• Semi-structured interviews fall in between.

Interviews are commonly used in market research, social science, and ethnographic research .

Table of contents

What is a structured interview, what is a semi-structured interview, what is an unstructured interview, what is a focus group, examples of interview questions, advantages and disadvantages of interviews, other interesting articles, frequently asked questions about types of interviews.

Structured interviews have predetermined questions in a set order. They are often closed-ended, featuring dichotomous (yes/no) or multiple-choice questions. While open-ended structured interviews exist, they are much less common. The types of questions asked make structured interviews a predominantly quantitative tool.

Asking set questions in a set order can help you see patterns among responses, and it allows you to easily compare responses between participants while keeping other factors constant. This can mitigate   research biases and lead to higher reliability and validity. However, structured interviews can be overly formal, as well as limited in scope and flexibility.

• You feel very comfortable with your topic. This will help you formulate your questions most effectively.
• You have limited time or resources. Structured interviews are a bit more straightforward to analyze because of their closed-ended nature, and can be a doable undertaking for an individual.
• Your research question depends on holding environmental conditions between participants constant.

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Semi-structured interviews are a blend of structured and unstructured interviews. While the interviewer has a general plan for what they want to ask, the questions do not have to follow a particular phrasing or order.

Semi-structured interviews are often open-ended, allowing for flexibility, but follow a predetermined thematic framework, giving a sense of order. For this reason, they are often considered “the best of both worlds.”

However, if the questions differ substantially between participants, it can be challenging to look for patterns, lessening the generalizability and validity of your results.

• You have prior interview experience. It’s easier than you think to accidentally ask a leading question when coming up with questions on the fly. Overall, spontaneous questions are much more difficult than they may seem.
• Your research question is exploratory in nature. The answers you receive can help guide your future research.

An unstructured interview is the most flexible type of interview. The questions and the order in which they are asked are not set. Instead, the interview can proceed more spontaneously, based on the participant’s previous answers.

Unstructured interviews are by definition open-ended. This flexibility can help you gather detailed information on your topic, while still allowing you to observe patterns between participants.

However, so much flexibility means that they can be very challenging to conduct properly. You must be very careful not to ask leading questions, as biased responses can lead to lower reliability or even invalidate your research.

• You have a solid background in your research topic and have conducted interviews before.
• Your research question is exploratory in nature, and you are seeking descriptive data that will deepen and contextualize your initial hypotheses.
• Your research necessitates forming a deeper connection with your participants, encouraging them to feel comfortable revealing their true opinions and emotions.

A focus group brings together a group of participants to answer questions on a topic of interest in a moderated setting. Focus groups are qualitative in nature and often study the group’s dynamic and body language in addition to their answers. Responses can guide future research on consumer products and services, human behavior, or controversial topics.

Focus groups can provide more nuanced and unfiltered feedback than individual interviews and are easier to organize than experiments or large surveys . However, their small size leads to low external validity and the temptation as a researcher to “cherry-pick” responses that fit your hypotheses.

• Your research focuses on the dynamics of group discussion or real-time responses to your topic.
• Your questions are complex and rooted in feelings, opinions, and perceptions that cannot be answered with a “yes” or “no.”
• Your topic is exploratory in nature, and you are seeking information that will help you uncover new questions or future research ideas.

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Depending on the type of interview you are conducting, your questions will differ in style, phrasing, and intention. Structured interview questions are set and precise, while the other types of interviews allow for more open-endedness and flexibility.

Here are some examples.

• Semi-structured
• Unstructured
• Focus group
• Do you like dogs? Yes/No
• Do you associate dogs with feeling: happy; somewhat happy; neutral; somewhat unhappy; unhappy
• If yes, name one attribute of dogs that you like.
• If no, name one attribute of dogs that you don’t like.
• What feelings do dogs bring out in you?
• When you think more deeply about this, what experiences would you say your feelings are rooted in?

Interviews are a great research tool. They allow you to gather rich information and draw more detailed conclusions than other research methods, taking into consideration nonverbal cues, off-the-cuff reactions, and emotional responses.

However, they can also be time-consuming and deceptively challenging to conduct properly. Smaller sample sizes can cause their validity and reliability to suffer, and there is an inherent risk of interviewer effect arising from accidentally leading questions.

Here are some advantages and disadvantages of each type of interview that can help you decide if you’d like to utilize this research method.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Student’s  t -distribution
• Normal distribution
• Null and Alternative Hypotheses
• Chi square tests
• Confidence interval
• Quartiles & Quantiles
• Cluster sampling
• Stratified sampling
• Data cleansing
• Reproducibility vs Replicability
• Peer review
• Prospective cohort study

Research bias

• Implicit bias
• Cognitive bias
• Placebo effect
• Hawthorne effect
• Hindsight bias
• Affect heuristic
• Social desirability bias

The four most common types of interviews are:

• Structured interviews : The questions are predetermined in both topic and order. 
• Semi-structured interviews : A few questions are predetermined, but other questions aren’t planned.
• Unstructured interviews : None of the questions are predetermined.
• Focus group interviews : The questions are presented to a group instead of one individual.

The interviewer effect is a type of bias that emerges when a characteristic of an interviewer (race, age, gender identity, etc.) influences the responses given by the interviewee.

There is a risk of an interviewer effect in all types of interviews , but it can be mitigated by writing really high-quality interview questions.

Social desirability bias is the tendency for interview participants to give responses that will be viewed favorably by the interviewer or other participants. It occurs in all types of interviews and surveys , but is most common in semi-structured interviews , unstructured interviews , and focus groups .

Social desirability bias can be mitigated by ensuring participants feel at ease and comfortable sharing their views. Make sure to pay attention to your own body language and any physical or verbal cues, such as nodding or widening your eyes.

This type of bias can also occur in observations if the participants know they’re being observed. They might alter their behavior accordingly.

A focus group is a research method that brings together a small group of people to answer questions in a moderated setting. The group is chosen due to predefined demographic traits, and the questions are designed to shed light on a topic of interest. It is one of 4 types of interviews .

Quantitative research deals with numbers and statistics, while qualitative research deals with words and meanings.

Quantitative methods allow you to systematically measure variables and test hypotheses . Qualitative methods allow you to explore concepts and experiences in more detail.

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Chapter 10: Qualitative Data Collection & Analysis Methods

10.7 Strengths and Weaknesses of Qualitative Interviews

As the preceding sections have suggested, qualitative interviews are an excellent way to gather detailed information. Whatever topic is of interest to the researcher can be explored in much more depth by employing this method than with almost any other method. Not only are participants given the opportunity to elaborate in a way that is not possible with other methods, such as survey research, but, in addition, they are able share information with researchers in their own words and from their own perspectives, rather than attempting to fit those perspectives into the perhaps limited response options provided by the researcher. Because qualitative interviews are designed to elicit detailed information, they are especially useful when a researcher’s aim is to study social processes, or the “how” of various phenomena. Yet another, and sometimes overlooked, benefit of qualitative interviews that occurs in person is that researchers can make observations beyond those that a respondent is orally reporting. A respondent’s body language, and even her or his choice of time and location for the interview, might provide a researcher with useful data.

As with quantitative survey research, qualitative interviews rely on respondents’ ability to accurately and honestly recall whatever details about their lives, circumstances, thoughts, opinions, or behaviors are being examined. Qualitative interviewing is also time-intensive and can be quite expensive. Creating an interview guide, identifying a sample, and conducting interviews are just the beginning of the process. Transcribing interviews is labor-intensive, even before coding begins. It is also not uncommon to offer respondents some monetary incentive or thank-you for participating, because you are asking for more of the participants’ time than if you had mailed them a questionnaire containing closed-ended questions. Conducting qualitative interviews is not only labor intensive but also emotionally taxing. Researchers embarking on a qualitative interview project with a subject that is sensitive in nature should keep in mind their own abilities to listen to stories that may be difficult to hear.

Research Methods for the Social Sciences: An Introduction Copyright © 2020 by Valerie Sheppard is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Qualitative Interviewing

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• Sally Nathan 2 ,
• Christy Newman 3 &
• Kari Lancaster 3  

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Qualitative interviewing is a foundational method in qualitative research and is widely used in health research and the social sciences. Both qualitative semi-structured and in-depth unstructured interviews use verbal communication, mostly in face-to-face interactions, to collect data about the attitudes, beliefs, and experiences of participants. Interviews are an accessible, often affordable, and effective method to understand the socially situated world of research participants. The approach is typically informed by an interpretive framework where the data collected is not viewed as evidence of the truth or reality of a situation or experience but rather a context-bound subjective insight from the participants. The researcher needs to be open to new insights and to privilege the participant’s experience in data collection. The data from qualitative interviews is not generalizable, but its exploratory nature permits the collection of rich data which can answer questions about which little is already known. This chapter introduces the reader to qualitative interviewing, the range of traditions within which interviewing is utilized as a method, and highlights the advantages and some of the challenges and misconceptions in its application. The chapter also provides practical guidance on planning and conducting interview studies. Three case examples are presented to highlight the benefits and risks in the use of interviewing with different participants, providing situated insights as well as advice about how to go about learning to interview if you are a novice.

• In-depth interviews
• Semi-structured interviews
• Qualitative interviewing
• Interview study design
• Interview methodology
• Interview method

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Nathan, S., Newman, C., Lancaster, K. (2019). Qualitative Interviewing. In: Liamputtong, P. (eds) Handbook of Research Methods in Health Social Sciences. Springer, Singapore. https://doi.org/10.1007/978-981-10-5251-4_77

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• Published: 05 October 2018

Interviews and focus groups in qualitative research: an update for the digital age

• P. Gill 1 &
• J. Baillie 2  

British Dental Journal volume  225 ,  pages 668–672 ( 2018 ) Cite this article

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Highlights that qualitative research is used increasingly in dentistry. Interviews and focus groups remain the most common qualitative methods of data collection.

Suggests the advent of digital technologies has transformed how qualitative research can now be undertaken.

Suggests interviews and focus groups can offer significant, meaningful insight into participants' experiences, beliefs and perspectives, which can help to inform developments in dental practice.

Qualitative research is used increasingly in dentistry, due to its potential to provide meaningful, in-depth insights into participants' experiences, perspectives, beliefs and behaviours. These insights can subsequently help to inform developments in dental practice and further related research. The most common methods of data collection used in qualitative research are interviews and focus groups. While these are primarily conducted face-to-face, the ongoing evolution of digital technologies, such as video chat and online forums, has further transformed these methods of data collection. This paper therefore discusses interviews and focus groups in detail, outlines how they can be used in practice, how digital technologies can further inform the data collection process, and what these methods can offer dentistry.

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Introduction

Traditionally, research in dentistry has primarily been quantitative in nature. 1 However, in recent years, there has been a growing interest in qualitative research within the profession, due to its potential to further inform developments in practice, policy, education and training. Consequently, in 2008, the British Dental Journal (BDJ) published a four paper qualitative research series, 2 , 3 , 4 , 5 to help increase awareness and understanding of this particular methodological approach.

Since the papers were originally published, two scoping reviews have demonstrated the ongoing proliferation in the use of qualitative research within the field of oral healthcare. 1 , 6 To date, the original four paper series continue to be well cited and two of the main papers remain widely accessed among the BDJ readership. 2 , 3 The potential value of well-conducted qualitative research to evidence-based practice is now also widely recognised by service providers, policy makers, funding bodies and those who commission, support and use healthcare research.

Besides increasing standalone use, qualitative methods are now also routinely incorporated into larger mixed method study designs, such as clinical trials, as they can offer additional, meaningful insights into complex problems that simply could not be provided by quantitative methods alone. Qualitative methods can also be used to further facilitate in-depth understanding of important aspects of clinical trial processes, such as recruitment. For example, Ellis et al . investigated why edentulous older patients, dissatisfied with conventional dentures, decline implant treatment, despite its established efficacy, and frequently refuse to participate in related randomised clinical trials, even when financial constraints are removed. 7 Through the use of focus groups in Canada and the UK, the authors found that fears of pain and potential complications, along with perceived embarrassment, exacerbated by age, are common reasons why older patients typically refuse dental implants. 7

The last decade has also seen further developments in qualitative research, due to the ongoing evolution of digital technologies. These developments have transformed how researchers can access and share information, communicate and collaborate, recruit and engage participants, collect and analyse data and disseminate and translate research findings. 8 Where appropriate, such technologies are therefore capable of extending and enhancing how qualitative research is undertaken. 9 For example, it is now possible to collect qualitative data via instant messaging, email or online/video chat, using appropriate online platforms.

These innovative approaches to research are therefore cost-effective, convenient, reduce geographical constraints and are often useful for accessing 'hard to reach' participants (for example, those who are immobile or socially isolated). 8 , 9 However, digital technologies are still relatively new and constantly evolving and therefore present a variety of pragmatic and methodological challenges. Furthermore, given their very nature, their use in many qualitative studies and/or with certain participant groups may be inappropriate and should therefore always be carefully considered. While it is beyond the scope of this paper to provide a detailed explication regarding the use of digital technologies in qualitative research, insight is provided into how such technologies can be used to facilitate the data collection process in interviews and focus groups.

In light of such developments, it is perhaps therefore timely to update the main paper 3 of the original BDJ series. As with the previous publications, this paper has been purposely written in an accessible style, to enhance readability, particularly for those who are new to qualitative research. While the focus remains on the most common qualitative methods of data collection – interviews and focus groups – appropriate revisions have been made to provide a novel perspective, and should therefore be helpful to those who would like to know more about qualitative research. This paper specifically focuses on undertaking qualitative research with adult participants only.

Overview of qualitative research

Qualitative research is an approach that focuses on people and their experiences, behaviours and opinions. 10 , 11 The qualitative researcher seeks to answer questions of 'how' and 'why', providing detailed insight and understanding, 11 which quantitative methods cannot reach. 12 Within qualitative research, there are distinct methodologies influencing how the researcher approaches the research question, data collection and data analysis. 13 For example, phenomenological studies focus on the lived experience of individuals, explored through their description of the phenomenon. Ethnographic studies explore the culture of a group and typically involve the use of multiple methods to uncover the issues. 14

While methodology is the 'thinking tool', the methods are the 'doing tools'; 13 the ways in which data are collected and analysed. There are multiple qualitative data collection methods, including interviews, focus groups, observations, documentary analysis, participant diaries, photography and videography. Two of the most commonly used qualitative methods are interviews and focus groups, which are explored in this article. The data generated through these methods can be analysed in one of many ways, according to the methodological approach chosen. A common approach is thematic data analysis, involving the identification of themes and subthemes across the data set. Further information on approaches to qualitative data analysis has been discussed elsewhere. 1

Qualitative research is an evolving and adaptable approach, used by different disciplines for different purposes. Traditionally, qualitative data, specifically interviews, focus groups and observations, have been collected face-to-face with participants. In more recent years, digital technologies have contributed to the ongoing evolution of qualitative research. Digital technologies offer researchers different ways of recruiting participants and collecting data, and offer participants opportunities to be involved in research that is not necessarily face-to-face.

Research interviews are a fundamental qualitative research method 15 and are utilised across methodological approaches. Interviews enable the researcher to learn in depth about the perspectives, experiences, beliefs and motivations of the participant. 3 , 16 Examples include, exploring patients' perspectives of fear/anxiety triggers in dental treatment, 17 patients' experiences of oral health and diabetes, 18 and dental students' motivations for their choice of career. 19

Interviews may be structured, semi-structured or unstructured, 3 according to the purpose of the study, with less structured interviews facilitating a more in depth and flexible interviewing approach. 20 Structured interviews are similar to verbal questionnaires and are used if the researcher requires clarification on a topic; however they produce less in-depth data about a participant's experience. 3 Unstructured interviews may be used when little is known about a topic and involves the researcher asking an opening question; 3 the participant then leads the discussion. 20 Semi-structured interviews are commonly used in healthcare research, enabling the researcher to ask predetermined questions, 20 while ensuring the participant discusses issues they feel are important.

Interviews can be undertaken face-to-face or using digital methods when the researcher and participant are in different locations. Audio-recording the interview, with the consent of the participant, is essential for all interviews regardless of the medium as it enables accurate transcription; the process of turning the audio file into a word-for-word transcript. This transcript is the data, which the researcher then analyses according to the chosen approach.

Types of interview

Qualitative studies often utilise one-to-one, face-to-face interviews with research participants. This involves arranging a mutually convenient time and place to meet the participant, signing a consent form and audio-recording the interview. However, digital technologies have expanded the potential for interviews in research, enabling individuals to participate in qualitative research regardless of location.

Telephone interviews can be a useful alternative to face-to-face interviews and are commonly used in qualitative research. They enable participants from different geographical areas to participate and may be less onerous for participants than meeting a researcher in person. 15 A qualitative study explored patients' perspectives of dental implants and utilised telephone interviews due to the quality of the data that could be yielded. 21 The researcher needs to consider how they will audio record the interview, which can be facilitated by purchasing a recorder that connects directly to the telephone. One potential disadvantage of telephone interviews is the inability of the interviewer and researcher to see each other. This is resolved using software for audio and video calls online – such as Skype – to conduct interviews with participants in qualitative studies. Advantages of this approach include being able to see the participant if video calls are used, enabling observation of non-verbal communication, and the software can be free to use. However, participants are required to have a device and internet connection, as well as being computer literate, potentially limiting who can participate in the study. One qualitative study explored the role of dental hygienists in reducing oral health disparities in Canada. 22 The researcher conducted interviews using Skype, which enabled dental hygienists from across Canada to be interviewed within the research budget, accommodating the participants' schedules. 22

A less commonly used approach to qualitative interviews is the use of social virtual worlds. A qualitative study accessed a social virtual world – Second Life – to explore the health literacy skills of individuals who use social virtual worlds to access health information. 23 The researcher created an avatar and interview room, and undertook interviews with participants using voice and text methods. 23 This approach to recruitment and data collection enables individuals from diverse geographical locations to participate, while remaining anonymous if they wish. Furthermore, for interviews conducted using text methods, transcription of the interview is not required as the researcher can save the written conversation with the participant, with the participant's consent. However, the researcher and participant need to be familiar with how the social virtual world works to engage in an interview this way.

Conducting an interview

Ensuring informed consent before any interview is a fundamental aspect of the research process. Participants in research must be afforded autonomy and respect; consent should be informed and voluntary. 24 Individuals should have the opportunity to read an information sheet about the study, ask questions, understand how their data will be stored and used, and know that they are free to withdraw at any point without reprisal. The qualitative researcher should take written consent before undertaking the interview. In a face-to-face interview, this is straightforward: the researcher and participant both sign copies of the consent form, keeping one each. However, this approach is less straightforward when the researcher and participant do not meet in person. A recent protocol paper outlined an approach for taking consent for telephone interviews, which involved: audio recording the participant agreeing to each point on the consent form; the researcher signing the consent form and keeping a copy; and posting a copy to the participant. 25 This process could be replicated in other interview studies using digital methods.

There are advantages and disadvantages of using face-to-face and digital methods for research interviews. Ultimately, for both approaches, the quality of the interview is determined by the researcher. 16 Appropriate training and preparation are thus required. Healthcare professionals can use their interpersonal communication skills when undertaking a research interview, particularly questioning, listening and conversing. 3 However, the purpose of an interview is to gain information about the study topic, 26 rather than offering help and advice. 3 The researcher therefore needs to listen attentively to participants, enabling them to describe their experience without interruption. 3 The use of active listening skills also help to facilitate the interview. 14 Spradley outlined elements and strategies for research interviews, 27 which are a useful guide for qualitative researchers:

Greeting and explaining the project/interview

Asking descriptive (broad), structural (explore response to descriptive) and contrast (difference between) questions

Asymmetry between the researcher and participant talking

Expressing interest and cultural ignorance

Repeating, restating and incorporating the participant's words when asking questions

Creating hypothetical situations

Asking friendly questions

Knowing when to leave.

For semi-structured interviews, a topic guide (also called an interview schedule) is used to guide the content of the interview – an example of a topic guide is outlined in Box 1 . The topic guide, usually based on the research questions, existing literature and, for healthcare professionals, their clinical experience, is developed by the research team. The topic guide should include open ended questions that elicit in-depth information, and offer participants the opportunity to talk about issues important to them. This is vital in qualitative research where the researcher is interested in exploring the experiences and perspectives of participants. It can be useful for qualitative researchers to pilot the topic guide with the first participants, 10 to ensure the questions are relevant and understandable, and amending the questions if required.

Regardless of the medium of interview, the researcher must consider the setting of the interview. For face-to-face interviews, this could be in the participant's home, in an office or another mutually convenient location. A quiet location is preferable to promote confidentiality, enable the researcher and participant to concentrate on the conversation, and to facilitate accurate audio-recording of the interview. For interviews using digital methods the same principles apply: a quiet, private space where the researcher and participant feel comfortable and confident to participate in an interview.

Box 1: Example of a topic guide

Study focus: Parents' experiences of brushing their child's (aged 0–5) teeth

1. Can you tell me about your experience of cleaning your child's teeth?

How old was your child when you started cleaning their teeth?

Why did you start cleaning their teeth at that point?

How often do you brush their teeth?

What do you use to brush their teeth and why?

2. Could you explain how you find cleaning your child's teeth?

Do you find anything difficult?

What makes cleaning their teeth easier for you?

3. How has your experience of cleaning your child's teeth changed over time?

Has it become easier or harder?

Have you changed how often and how you clean their teeth? If so, why?

4. Could you describe how your child finds having their teeth cleaned?

What do they enjoy about having their teeth cleaned?

Is there anything they find upsetting about having their teeth cleaned?

5. Where do you look for information/advice about cleaning your child's teeth?

What did your health visitor tell you about cleaning your child's teeth? (If anything)

What has the dentist told you about caring for your child's teeth? (If visited)

Have any family members given you advice about how to clean your child's teeth? If so, what did they tell you? Did you follow their advice?

6. Is there anything else you would like to discuss about this?

Focus groups

A focus group is a moderated group discussion on a pre-defined topic, for research purposes. 28 , 29 While not aligned to a particular qualitative methodology (for example, grounded theory or phenomenology) as such, focus groups are used increasingly in healthcare research, as they are useful for exploring collective perspectives, attitudes, behaviours and experiences. Consequently, they can yield rich, in-depth data and illuminate agreement and inconsistencies 28 within and, where appropriate, between groups. Examples include public perceptions of dental implants and subsequent impact on help-seeking and decision making, 30 and general dental practitioners' views on patient safety in dentistry. 31

Focus groups can be used alone or in conjunction with other methods, such as interviews or observations, and can therefore help to confirm, extend or enrich understanding and provide alternative insights. 28 The social interaction between participants often results in lively discussion and can therefore facilitate the collection of rich, meaningful data. However, they are complex to organise and manage, due to the number of participants, and may also be inappropriate for exploring particularly sensitive issues that many participants may feel uncomfortable about discussing in a group environment.

Focus groups are primarily undertaken face-to-face but can now also be undertaken online, using appropriate technologies such as email, bulletin boards, online research communities, chat rooms, discussion forums, social media and video conferencing. 32 Using such technologies, data collection can also be synchronous (for example, online discussions in 'real time') or, unlike traditional face-to-face focus groups, asynchronous (for example, online/email discussions in 'non-real time'). While many of the fundamental principles of focus group research are the same, regardless of how they are conducted, a number of subtle nuances are associated with the online medium. 32 Some of which are discussed further in the following sections.

Focus group considerations

Some key considerations associated with face-to-face focus groups are: how many participants are required; should participants within each group know each other (or not) and how many focus groups are needed within a single study? These issues are much debated and there is no definitive answer. However, the number of focus groups required will largely depend on the topic area, the depth and breadth of data needed, the desired level of participation required 29 and the necessity (or not) for data saturation.

The optimum group size is around six to eight participants (excluding researchers) but can work effectively with between three and 14 participants. 3 If the group is too small, it may limit discussion, but if it is too large, it may become disorganised and difficult to manage. It is, however, prudent to over-recruit for a focus group by approximately two to three participants, to allow for potential non-attenders. For many researchers, particularly novice researchers, group size may also be informed by pragmatic considerations, such as the type of study, resources available and moderator experience. 28 Similar size and mix considerations exist for online focus groups. Typically, synchronous online focus groups will have around three to eight participants but, as the discussion does not happen simultaneously, asynchronous groups may have as many as 10–30 participants. 33

The topic area and potential group interaction should guide group composition considerations. Pre-existing groups, where participants know each other (for example, work colleagues) may be easier to recruit, have shared experiences and may enjoy a familiarity, which facilitates discussion and/or the ability to challenge each other courteously. 3 However, if there is a potential power imbalance within the group or if existing group norms and hierarchies may adversely affect the ability of participants to speak freely, then 'stranger groups' (that is, where participants do not already know each other) may be more appropriate. 34 , 35

Focus group management

Face-to-face focus groups should normally be conducted by two researchers; a moderator and an observer. 28 The moderator facilitates group discussion, while the observer typically monitors group dynamics, behaviours, non-verbal cues, seating arrangements and speaking order, which is essential for transcription and analysis. The same principles of informed consent, as discussed in the interview section, also apply to focus groups, regardless of medium. However, the consent process for online discussions will probably be managed somewhat differently. For example, while an appropriate participant information leaflet (and consent form) would still be required, the process is likely to be managed electronically (for example, via email) and would need to specifically address issues relating to technology (for example, anonymity and use, storage and access to online data). 32

The venue in which a face to face focus group is conducted should be of a suitable size, private, quiet, free from distractions and in a collectively convenient location. It should also be conducted at a time appropriate for participants, 28 as this is likely to promote attendance. As with interviews, the same ethical considerations apply (as discussed earlier). However, online focus groups may present additional ethical challenges associated with issues such as informed consent, appropriate access and secure data storage. Further guidance can be found elsewhere. 8 , 32

Before the focus group commences, the researchers should establish rapport with participants, as this will help to put them at ease and result in a more meaningful discussion. Consequently, researchers should introduce themselves, provide further clarity about the study and how the process will work in practice and outline the 'ground rules'. Ground rules are designed to assist, not hinder, group discussion and typically include: 3 , 28 , 29

Discussions within the group are confidential to the group

Only one person can speak at a time

All participants should have sufficient opportunity to contribute

There should be no unnecessary interruptions while someone is speaking

Everyone can be expected to be listened to and their views respected

Challenging contrary opinions is appropriate, but ridiculing is not.

Moderating a focus group requires considered management and good interpersonal skills to help guide the discussion and, where appropriate, keep it sufficiently focused. Avoid, therefore, participating, leading, expressing personal opinions or correcting participants' knowledge 3 , 28 as this may bias the process. A relaxed, interested demeanour will also help participants to feel comfortable and promote candid discourse. Moderators should also prevent the discussion being dominated by any one person, ensure differences of opinions are discussed fairly and, if required, encourage reticent participants to contribute. 3 Asking open questions, reflecting on significant issues, inviting further debate, probing responses accordingly, and seeking further clarification, as and where appropriate, will help to obtain sufficient depth and insight into the topic area.

Moderating online focus groups requires comparable skills, particularly if the discussion is synchronous, as the discussion may be dominated by those who can type proficiently. 36 It is therefore important that sufficient time and respect is accorded to those who may not be able to type as quickly. Asynchronous discussions are usually less problematic in this respect, as interactions are less instant. However, moderating an asynchronous discussion presents additional challenges, particularly if participants are geographically dispersed, as they may be online at different times. Consequently, the moderator will not always be present and the discussion may therefore need to occur over several days, which can be difficult to manage and facilitate and invariably requires considerable flexibility. 32 It is also worth recognising that establishing rapport with participants via online medium is often more challenging than via face-to-face and may therefore require additional time, skills, effort and consideration.

As with research interviews, focus groups should be guided by an appropriate interview schedule, as discussed earlier in the paper. For example, the schedule will usually be informed by the review of the literature and study aims, and will merely provide a topic guide to help inform subsequent discussions. To provide a verbatim account of the discussion, focus groups must be recorded, using an audio-recorder with a good quality multi-directional microphone. While videotaping is possible, some participants may find it obtrusive, 3 which may adversely affect group dynamics. The use (or not) of a video recorder, should therefore be carefully considered.

At the end of the focus group, a few minutes should be spent rounding up and reflecting on the discussion. 28 Depending on the topic area, it is possible that some participants may have revealed deeply personal issues and may therefore require further help and support, such as a constructive debrief or possibly even referral on to a relevant third party. It is also possible that some participants may feel that the discussion did not adequately reflect their views and, consequently, may no longer wish to be associated with the study. 28 Such occurrences are likely to be uncommon, but should they arise, it is important to further discuss any concerns and, if appropriate, offer them the opportunity to withdraw (including any data relating to them) from the study. Immediately after the discussion, researchers should compile notes regarding thoughts and ideas about the focus group, which can assist with data analysis and, if appropriate, any further data collection.

Qualitative research is increasingly being utilised within dental research to explore the experiences, perspectives, motivations and beliefs of participants. The contributions of qualitative research to evidence-based practice are increasingly being recognised, both as standalone research and as part of larger mixed-method studies, including clinical trials. Interviews and focus groups remain commonly used data collection methods in qualitative research, and with the advent of digital technologies, their utilisation continues to evolve. However, digital methods of qualitative data collection present additional methodological, ethical and practical considerations, but also potentially offer considerable flexibility to participants and researchers. Consequently, regardless of format, qualitative methods have significant potential to inform important areas of dental practice, policy and further related research.

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Gill, P., Baillie, J. Interviews and focus groups in qualitative research: an update for the digital age. Br Dent J 225 , 668–672 (2018). https://doi.org/10.1038/sj.bdj.2018.815

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Advantages and Disadvantages of Interview in Research

Approaching the Respondent- according to the Interviewer’s Manual, the introductory tasks of the interviewer are: tell the interviewer is and whom he or she represents; telling him about what the study is, in a way to stimulate his interest. The interviewer has also ensured at this stage that his answers are confidential; tell the respondent how he was chosen; use letters and clippings of surveys in order to show the importance of the study to the respondent. The interviewer must be adaptable, friendly, responsive, and should make the interviewer feel at ease to say anything, even if it is irrelevant.

Dealing with Refusal- there can be plenty of reasons for refusing for an interview, for example, a respondent may feel that surveys are a waste of time, or may express anti-government feeling. It is the interviewer’s job to determine the reason for the refusal of the interview and attempt to overcome it.

Conducting the Interview- the questions should be asked as worded for all respondents in order to avoid misinterpretation of the question. Clarification of the question should also be avoided for the same reason. However, the questions can be repeated in case of misunderstanding. The questions should be asked in the same order as mentioned in the questionnaire, as a particular question might not make sense if the questions before they are skipped. The interviewers must be very careful to be neutral before starting the interview so as not to lead the respondent, hence minimizing bias.

listing out the advantages of interview studies, which are noted below:

• It provides flexibility to the interviewers
• The interview has a better response rate than mailed questions, and the people who cannot read and write can also answer the questions.
• The interviewer can judge the non-verbal behavior of the respondent.
• The interviewer can decide the place for an interview in a private and silent place, unlike the ones conducted through emails which can have a completely different environment.
• The interviewer can control over the order of the question, as in the questionnaire, and can judge the spontaneity of the respondent as well.

There are certain disadvantages of interview studies as well which are:

• Conducting interview studies can be very costly as well as very time-consuming.
• An interview can cause biases. For example, the respondent’s answers can be affected by his reaction to the interviewer’s race, class, age or physical appearance.
• Interview studies provide less anonymity, which is a big concern for many respondents.
• There is a lack of accessibility to respondents (unlike conducting mailed questionnaire study) since the respondents can be in around any corner of the world or country.

INTERVIEW AS SOCIAL INTERACTION

The interview subjects to the same rules and regulations of other instances of social interaction. It is believed that conducting interview studies has possibilities for all sorts of bias, inconsistency, and inaccuracies and hence many researchers are critical of the surveys and interviews. T.R. William says that in certain societies there may be patterns of people saying one thing, but doing another. He also believes that the responses should be interpreted in context and two social contexts should not be compared to each other. Derek L. Phillips says that the survey method itself can manipulate the data, and show the results that actually does not exist in the population in real. Social research becomes very difficult due to the variability in human behavior and attitude. Other errors that can be caused in social research include-

• deliberate lying, because the respondent does not want to give a socially undesirable answer;
• unconscious mistakes, which mostly occurs when the respondent has socially undesirable traits that he does not want to accept;
• when the respondent accidentally misunderstands the question and responds incorrectly;
• when the respondent is unable to remember certain details.

Apart from the errors caused by the responder, there are also certain errors made by the interviewers that may include-

• errors made by altering the questionnaire, through changing some words or omitting certain questions;
• biased, irrelevant, inadequate or unnecessary probing;
• recording errors, or consciously making errors in recording.

Bailey, K. (1994). Interview Studies in Methods of social research. Simonand Schuster, 4th ed. The Free Press, New York NY 10020.Ch8. Pp.173-213.

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After reading this article you will learn about the advantages and disadvantages of the interview method of conducting social research.

Advantages of the Interview Method :

(1) The personal interviews, compared especially to questionnaires usually yield a high percentage of returns.

(2) The interview method can be made to yield an almost perfect sample of the general population because practically everyone can be reached by and can respond to this approach. It will be remembered that the questionnaire approach is severely limited by the fact that only the literate persons can be covered by it.

Again, the observational approach is also subject to limitations because many things or facts cannot be observed on the spot.

(3) The information secured through interviews is likely to be more correct compared to that secured through other techniques. The interviewer who is present on the spot can clear up the seemingly inaccurate or irrelevant answers by explaining the questions to the informant. If the informant deliberately falsifies replies, the interviewer is able to effectively check them and use special devices to verify the replies.

(4) The interviewer can collect supplementary information about the informant’s personal characteristics and environment which is often of great value in interpreting results. Interview is a much more flexible approach, allowing for posing of new questions or check-questions if such a need arises.

Its flexibility makes the interview a superior technique for the exploration of areas where there is little basis for knowing what questions to ask and how to formulate them.

(5) In as much as the interviewer is present on the spot, he can observe the facial expressions and gestures etc., of the informants as also the existing pressures obtaining in the interview-situation. The facility of such observations helps the interviewer to evaluate the meaning of the verbal replies given by informants.

For example, hesitation, particular inhibitive reactions etc., may give rise to certain doubts about the reliability of the responses and the interviewer may then ask indirect questions to verify his doubts.

(6) Scoring and test-devices can be used, the interviewer acting as experimenter. At the same time, visual stimuli to which the informant may react can be presented.

(7) The use of interview method ensures greater number of usable returns compared to other methods. Returned visits to complete items on the schedule or to correct mistakes can usually be made without annoying the informant.

(8) The interviewer can usually control which person or persons will answer the questions. This is not possible in the mailed questionnaire approach. If so desired and warranted group discussions may also be held.

(9) A personal interview may take long enough to allow the informant to become oriented to the topic under investigation. Thus, recall of relevant information is facilitated. The informant can be made to devote more time if, as is the case, the interviewer is present on the spot to elicit and record the information.

The interviewer’s presence is a double headed weapon, the advantageous aspect of it being that face-to-face contact provides enough stimulation to the respondent to probe deeper within himself. As we have suggested, interviewer acts as a catalyst.

(10) The interviewer may catch the informant off his guard and thus secure the most spontaneous reactions than would be the case if mailed questionnaire were used.

(11) The interview method allows for many facilities which aid on the spot adjustments and thus ensure rich response material. For example, the interviewer can carefully sandwich the questions about which the informant is likely to be sensitive.

The interviewer can also change the subject by observing informant’s reactions or give explanations if the interviewee needs them. In other words, a delicate situation can usually be handled more effectively by personal interview method.

(12) The language of the interview can be adapted to the ability or educational level of the person interviewed. Therefore, it is comparatively easy to avoid misinterpretations or misleading questions.

(13) The interview is a more appropriate technique for revealing information about complex, emotionally-laden subjects or for probing the sentiments underlying an expressed opinion.

Major Limitations of the Interview Method :

(1) In terms of cost, energy and time, the interview approach poses a heavy demand. The transportation cost and the time required to cover addresses in a large area as also possibility of non-availability or ‘not at home’, may make the interview method uneconomical and often inoperable.

(2) The efficacy of interviews depends on a thorough training and skill of interviewers as also on a rigorous supervision over them. Failing this, data recorded may be inaccurate and incomplete.

(3) The human equation may distort the returns. If an interviewer has a certain bias, he may unconsciously devise questions so as to secure confirmation of his views.

(4) The presence of the interviewer on the spot may over stimulate the respondent, sometimes even to the extent that he may give imaginary information just to make it interesting. He may tell things about which he may not himself be very sure.

He may also get emotionally involved with the interviewer and give answers that he anticipates would please the interviewer. It is also possible that the interviewer’s presence may inhibit free responses because there is no anonymity. The respondent may hesitate to give correct answers for the fear that it would adversely affect his image. Some fear of this information being used against him may grip him.

(5) In the interview method, the organization required for selecting, training and supervising a field staff is more complex.

(6) It is the usual experience that costs per interview are higher when field investigators are employed. This is especially so when the area to be covered is widely spread out.

(7) The personal interview usually takes more time. Sometimes, the interview lasts for hours on end and the interviewer cannot check the free flow of the respondent’s replies for fear that it may disrupt the ‘rapport.’ Added to this is the time spent for journeys to and fro to the addresses and the possibility of not always being able to meet them.

(8) Effective interview presupposes proper rapport with the respondent and controlling of interview atmosphere in a manner that would facilitate free and frank responses. This is often a very difficult requirement, it needs time, skills and often resources.

Secondly, it is not always possible for the interviewer to judge whether the interview atmosphere is how it should ideally be and whether or not ‘rapport’ has been established.

(9) Interviewing may also introduce systematic errors. For example, if the interviews are conducted at their homes during the day, a majority of informants will be housewives. Now if the information is to be obtained from the male members, most of the field-work will have to be done in the evening or on holidays. If this be the case, only a few hours can be used per week for interviewing.

(10) Many actions human beings carry out are not easily verbalized, but easily observed. Through observation a social process may be followed as it develops. Verbal techniques such as interview may give valuable reports, but post hoc, unless one is dealing with rather unusual respondents capable of acting and being interviewed at the same time.

Some of the prerequisites that ensure successful interviewing. The quality of interviewing depends, firstly on a proper study-design. It should be noted that even the most skilled interviewer will not be able to collect valid and useful data, if the schedule of questions is inadequate or unrelated to the objectives of research.

If a well-designed, standardized schedule can elicit the required information, a staff of ordinary men and women, properly selected, and trained, can serve well enough.

Within the limits of a study-design, there is some room for the art of interviewing to come into play. Interviewing is an art governed by certain scientific principles. The interviewer’s art consists in creating a situation wherein the respondents’ answers will be reliable and valid.

This ideal requires a permissive situation in which the respondent is encouraged to voice his frank opinion without the fear of his attitudes being revealed to others.

The basic requirement of successful interviewing, understandably, is to create a friendly atmosphere; on of trust and confidence that will put the respondent at ease. Through subsequent stages, the interviewer’s art consists in asking questions properly and intelligently, in obtaining a valid and meaningful response and in recording the responses accurately and completely.

Let us consider how the interviewer can create a friendly interview atmosphere. It is the interviewer’s approach that really does the trick. The interviewer should introduce himself briefly and explain clearly the purpose of his study.

Interviewer’s approach should be positive. His aim should be to interview everyone included in the sample. It is possible that a small proportion of respondents will be suspicious or hostile and the large number may require a little encouragement and persuasion.

Many people ar6 flattered to be selected for an interview. The interviewer should answer any legitimate questions and clear any doubt the respondent has. He should also if need be, explain that the respondent should not be afraid of being identified and that interview is not a test and that the interviewer just wants to know how people feel about certain issues and the only way to find out, is to ask them.

The interviewer’s manners should be friendly, courteous, conversational and unbiased. He should represent the golden mean — neither too grim, nor too effusive, neither too talkative nor too timid. The main idea should be to put the respondent at ease so that he will talk freely and fully.

It helps if the interview starts with the casual conversation about weather, pets or children. An informal conversational interview, above all, is dependent upon a thorough mastery by the interviewer over the actual questions in the schedule.

He should be able to ask them conversationally rather than real them stiffly. He should know what questions are coming next so that there will be no awkward disruption of smooth interaction. Fundamentally, the interviewer’s job is that of a reporter.

He should not act as an adviser, custodian of morality, curio-seeker or debator. He should not show surprise or disapproval of a respondent’s answer. He should show an interested disposition toward his respondent’s opinion. On his own, he should never divulge his own. The interviewer must keep the direction of interview in his Own hand, discouraging irrelevant conversation and trying to keep the respondent on the track.

Next, we turn to consider how the interviewer should ask his questions. The interviewer must be alert to the importance of asking each question exactly as it is worded unless the interview is unstructured. Interviewers should remember that even a slight rewording of a question can so change the stimulus as to elicit answers in a different frame of reference.

The interviewer should refrain from giving unwarranted explanation of questions because this also may change the frame of reference, or inject bias into the response. If each interviewer were permitted to vary the questions according to his sweet will, the resulting responses recorded by different interviewers may not be comparable.

If at all the interviewer has to offer any explanation to the respondents, he should offer only those that he has specifically been authorized to do. Should the respondent fail to understand the question, the interviewer may advisedly repeat it slowly and with proper emphasis.

Questions must be asked in the sequence they appear on the schedule. Varying this order will change the respondent’s frame of reference since each question sets up a frame of reference for the following questions. Thus, if the sequences vary from interviewer to interviewer, the responses will not be comparable. The interviewer must make it a point to ask every question, unless directions permit skipping a few.

It may seem that the respondent has given his opinion on a subsequent question in answering an earlier question, but he must nevertheless ask the question in order to be sure.

A question may appear to be naive or inapplicable but the interviewer should never omit asking it. Wherever necessary and appropriate, the interviewer should preface the question with certain conversational phrases to maintain continuity and tempo.

We shall now consider another important requirement of successful interviewing. It is often difficult as interviewers have often experienced, to obtain a specific complete response. This is perhaps the most difficult part of his job. Respondents often qualify or hedge their opinions.

They often answer, ‘do not know’ just to avoid thinking about the question, they misinterpret the question, divert the process of interview by launching off an irrelevant discussion or they give self-contradictory answers. In all these cases the interviewer has to probe deeper.

The test of a good interviewer is that he is alert to incomplete or nonspecific answers. Each interviewer must understand fully the overall objective of each question and what it is precisely trying to measure. A pre-test on the interviewers helps to equip them with such understanding.

The interviewer should be able to ask himself after every reply the respondent gives whether the question is completely answered. If the respondent’s answer is vague or diffuse or incomplete, effective probe questions should be asked.

The interviewer must be careful at every stage, not to suggest a possible reply, that is, the interviewer should riot ask leading questions (i.e., put words into the subject’s mouth). The “don’t know” reply is another problem of the interviewer.

Sometimes, this response may be due to a genuine lack of opinion or knowledge, but at other times it may be a cloak wittingly or unwittingly used by the interviewee to hide many attitudes, fear, reluctance, vague opinions, lack of understanding, etc. The interviewer should distinguish between the different types of’ don’t-know response’ and repeat the questions with suitable assurances.

An important consideration in successful interviewing relates to recording the responses of interviewees. There are two chief means of recording responses during the interview. If the question is a fixed alternative one, the interviewer need only mark or check an appropriate category. But if the question is open-ended, the interviewer is expected to record the response, verbatim.

On pre-coded schedules, errors and omissions in recording the replies are a frequent source of interview-error. In the midst of various tasks that the interviewer is supposed to perform in the course of interviews, viz., trying to pin the respondent down to a specific answer, remembering the sequence of questions, observing facial expressions etc., the interviewer may sometimes neglect to indicate the respondent’s reply to some item, overlook a particular question or check the wrong category, etc.

Even the best interviewer should, therefore, make it a habit to inspect each interview to make sure that it is filled in accurately and completely.

If any information is lacking he should go back and ask the respondent for it. He should correct the errors and omissions in the schedules on the spot. If he has recorded verbatim replies only sketchily, he should correct the weakness right there. It is not at all proper to wait until later in the day or until he returns home at night, since by then he may have forgotten quite a few crucial circumstances of the interview.

The interviewer should understand that the omission or inaccurate reporting of a single answer can make the entire interview worthless since the schedule is designed as an integral whole.

In reporting responses to open-ended or free answer questions, the interviewer should give complete, verbatim reporting. It may often be difficult to fulfill this requirement, but apart from obvious irrelevancies and repetitions, this should be the goal.

It is necessary that the interviewers have some idea of the coding process. This will ensure that they are able to record responses in such a manner that the coders will be able to reconstruct the whole set of responses correctly in a codified form.

The interviewer should ideally quote the respondents exactly. Paraphrasing the replies, summarizing them in one’s own words or “polishing up” any slang or cursing etc., not only might distort the respondent’s meanings and emphases but also miss the tenor of his replies.

Although it is frequently difficult to record responses verbatim without using short­hand, a few simple techniques can greatly increase the interviewer’s speed and honest reproduction.

The interviewer can ask the subject to wait until the interviewer has written the last thought but this may slow down the interview and may have certain adverse effects. In order not to slow up the interview, the interviewer should be prepared to write at the same time as the respondent talks.

This may prevent him from watching the expressions of the respondent but some adjustments have got to be made. The interviewer may also use common abbreviations. He may also use a telegraphic style of recording. In doing so, the interviewer must not make the recording incomprehensible to the coders.

One final point related to successful interviewing is, how to minimize bias introduced by the interviewer. Known as the interviewer-“bias”, it refers to systematic differences from interviewer to interviewer or occasionally systematic errors on the part of the interviewers in the selection of the samples (e.g., in quota sampling where the selection of interviewees is left to the interviewers), in asking questions, eliciting and recording responses.

Much of what we call interviewer-bias, can be more correctly described as interviewer- differences which are inherent in the fact that interviewers are human beings and not machines and thus they do not work identically or infallibly.

The fact that respondents too are human beings with differing perceptions, judgements, etc., simply enhances the differences that would occur if different interviewers were dealing with physical rather than human materials. It is too much to expect, therefore, that the interviewers will return complete, comparable and valid reports.

Even assuming an unbiased selection of respondents, bias in the interview-situation may stem from two sources:

(a) Respondent’s perception of the interviewer.

(b) Interviewer’s perception of the respondent.

‘Perception’ here points to the manner in which the relation between the interviewer and respondent is influenced and modified by their wishes, expectations and personality structure.

There is a sizable experimental evidence to prove that bias may result under certain conditions in spite of anything the interviewer may do to eliminate it. Respondents have been shown to frequently answer differently when interviewed by people from different social strata or ethnic group or nationality group. For example, the working-class respondents are less likely to talk freely to middle-class interviewers.

The magnitude of these effects naturally varies with the way in which the respondents perceive the situation. The biasing effects can often be reduced by altering the respondent’s perception of the situation, e.g., by assuring him that his identity will not be revealed but these effects can seldom be completely eliminated.

The interviewers should dress inconspicuously so that their appearance will not adversely sensitize certain categories of respondents.

The staff in a large-scale research project should be instructed to interview the respondent privately (unless the whole group is to be interviewed) so that his opinions will not be affected by the presence of some third person and to adopt an informal and conversational attitude in an effort to achieve the best possible ‘report.’

It should be noted that not all interview-biasing effects operate through the respondent’s perception by an interviewer. Some respondents may be totally immune to the most crucial biasing’s characteristics of the interviewer. The other dimension, we must consider in this context, is the interviewer’s perception of the respondent.

This is as important a source of bias as the respondent’s perception of the interviewer. No matter how standardized the schedule and how rigidly the interviewer is instructed, he still has much opportunity to exercise freedom of choice during the actual interview.

Thus, it is often his perception of the respondent that determines the manner in which he asks questions, the way in which he probes, his classification of responses to pre-coded questions and his recording of verbatim answers.

The interviewers often have strong expectations from respondents and as such, stereotypes are likely to come into play during the interview. On the basis of their past experience, judgements or prior answers received from other respondents, the interviewers may often quite unconsciously assume that they are inferior to him or that they are hostile, deceptive or ignorant, etc.

Such expectations will affect their performance. For example, a ‘No response’ from an educated well-to-do respondent may be probed into on the assumption that an opinion may be lurking somewhere or the interviewer may think that the respondents do not mean what they say.

Experiments have shown that the interviewers tend to select from long verbatim answers those parts that most closely conform to their expectations, beliefs or opinions and discard the rest.

An important source of bias arises from the interviewer’s perception of the situation. If he sees the results of the study as a possible threat to his interests, he is likely to introduce bias. Such difficulties can be overcome by proper motivation and supervision.

The interviewers being human, such biasing’s factors can never be overcome completely. Of Course, their effects can be reduced by standardizing the interview so that the interviewer has as little free choice as possible. If interviewers are given clear and standard instructions on questioning procedures, on the classification of responses etc., their biases will have lesser chances of operation.

It should not be overlooked, however, that if the interviewer’s freedom is restricted, correspondingly, the opportunities for effective use of his insight are restricted too. The more responsibilities the interviewer is given for questioning and evaluating the respondent’s opinions, the more likely it is that bias will result. This calls for a very careful selection of some middle course.

In so far as bias, in the sense of different interviewers not returning exactly the same responses from equivalent respondents, can never be totally eliminated, the main responsibility of the director of the research project is to select, train and supervise his staff in such a way that any net result of bias will be at a minimum.

He must be aware of the possibilities of bias at various points so that he is in a position to discount their effects in his analysis.

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Strengths and Weaknesses of Qualitative Interviews

As the preceding sections have suggested, qualitative interviews are an excellent way to gather detailed information. Whatever topic is of interest to the researcher employing this method can be explored in much more depth than with almost any other method. Not only are participants given the opportunity to elaborate in a way that is not possible with other methods such as survey research, but they also are able share information with researchers in their own words and from their own perspectives rather than being asked to fit those perspectives into the perhaps limited response options provided by the researcher. And because qualitative interviews are designed to elicit detailed information, they are especially useful when a researcher’s aim is to study social processes, or the “how” of various phenomena. Yet another, and sometimes overlooked, benefit of qualitative interviews that occurs in person is that researchers can make observations beyond those that a respondent is orally reporting. A respondent’s body language, and even her or his choice of time and location for the interview, might provide a researcher with useful data.

Of course, all these benefits do not come without some drawbacks. As with quantitative survey research, qualitative interviews rely on respondents’ ability to accurately and honestly recall whatever details about their lives, circumstances, thoughts, opinions, or behaviors that are being asked about. As Esterberg (2002) puts it, “If you want to know about what people actually do, rather than what they say they do, you should probably use observation [instead of interviews].” 1 Further, as you may have already guessed, qualitative interviewing is time intensive and can be quite expensive. Creating an interview guide, identifying a sample, and conducting interviews are just the beginning. Transcribing interviews is labor intensive—and that’s before coding even begins. It is also not uncommon to offer respondents some monetary incentive or thank-you for participating. Keep in mind that you are asking for more of participants’ time than if you’d simply mailed them a questionnaire containing closed-ended questions. Conducting qualitative interviews is not only labor intensive but also emotionally taxing. When I interviewed young workers about their sexual harassment experiences, I heard stories that were shocking, infuriating, and sad. Seeing and hearing the impact that harassment had had on respondents was difficult. Researchers embarking on a qualitative interview project should keep in mind their own abilities to hear stories that may be difficult to hear.

KEY TAKEAWAYS

• In-depth interviews are semi-structured interviews where the researcher has topics and questions in mind to ask, but questions are open ended and flow according to how the participant responds to each.
• Interview guides can vary in format but should contain some outline of the topics you hope to cover during the course of an interview.
• NVivo and Atlasti are computer programs that qualitative researchers use to help them with organizing, sorting, and analyzing their data.
• Qualitative interviews allow respondents to share information in their own words and are useful for gathering detailed information and understanding social processes.
• Drawbacks of qualitative interviews include reliance on respondents’ accuracy and their intensity in terms of time, expense, and possible emotional strain.
• Based on a research question you have identified through earlier exercises in this text, write a few open-ended questions you could ask were you to conduct in-depth interviews on the topic. Now critique your questions. Are any of them yes/no questions? Are any of them leading?
• Read the open-ended questions you just created, and answer them as though you were an interview participant. Were your questions easy to answer or fairly difficult? How did you feel talking about the topics you asked yourself to discuss? How might respondents feel talking about them?
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Interviews can be defined as a qualitative research technique which involves “conducting intensive individual interviews with a small number of respondents to explore their perspectives on a particular idea, program or situation.” [1]

There are three different formats of interviews: structured, semi-structured and unstructured.

Structured interviews consist of a series of pre-determined questions that all interviewees answer in the same order. Data analysis usually tends to be more straightforward because researcher can compare and contrast different answers given to the same questions.

Unstructured interviews are usually the least reliable from research viewpoint, because no questions are prepared prior to the interview and data collection is conducted in an informal manner. Unstructured interviews can be associated with a high level of bias and comparison of answers given by different respondents tends to be difficult due to the differences in formulation of questions.

Semi-structured interviews contain the components of both, structured and unstructured interviews. In semi-structured interviews, interviewer prepares a set of same questions to be answered by all interviewees. At the same time, additional questions might be asked during interviews to clarify and/or further expand certain issues.

Advantages of interviews include possibilities of collecting detailed information about research questions.  Moreover, in in this type of primary data collection researcher has direct control over the flow of process and she has a chance to clarify certain issues during the process if needed. Disadvantages, on the other hand, include longer time requirements and difficulties associated with arranging an appropriate time with perspective sample group members to conduct interviews.

When conducting interviews you should have an open mind and refrain from displaying disagreements in any forms when viewpoints expressed by interviewees contradict your own ideas. Moreover, timing and environment for interviews need to be scheduled effectively. Specifically, interviews need to be conducted in a relaxed environment, free of any forms of pressure for interviewees whatsoever.

Respected scholars warn that “in conducting an interview the interviewer should attempt to create a friendly, non-threatening atmosphere. Much as one does with a cover letter, the interviewer should give a brief, casual introduction to the study; stress the importance of the person’s participation; and assure anonymity, or at least confidentiality, when possible.” [2]

There is a risk of interviewee bias during the primary data collection process and this would seriously compromise the validity of the project findings. Some interviewer bias can be avoided by ensuring that the interviewer does not overreact to responses of the interviewee. Other steps that can be taken to help avoid or reduce interviewer bias include having the interviewer dress inconspicuously and appropriately for the environment and holding the interview in a private setting.  [3]

My e-book, The Ultimate Guide to Writing a Dissertation in Business Studies: a step by step assistance offers practical assistance to complete a dissertation with minimum or no stress. The e-book covers all stages of writing a dissertation starting from the selection to the research area to submitting the completed version of the work within the deadline.John Dudovskiy

[1] Boyce, C. & Neale, P. (2006) “Conducting in-depth Interviews: A Guide for Designing and Conducting In-Depth Interviews”, Pathfinder International Tool Series

[2] Connaway, L.S.& Powell, R.P.(2010) “Basic Research Methods for Librarians” ABC-CLIO

[3] Connaway, L.S.& Powell, R.P.(2010) “Basic Research Methods for Librarians” ABC-CLIO

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Home » Limitations in Research – Types, Examples and Writing Guide

Limitations in Research – Types, Examples and Writing Guide

Table of Contents

Limitations in Research

Limitations in research refer to the factors that may affect the results, conclusions , and generalizability of a study. These limitations can arise from various sources, such as the design of the study, the sampling methods used, the measurement tools employed, and the limitations of the data analysis techniques.

Types of Limitations in Research

Types of Limitations in Research are as follows:

Sample Size Limitations

This refers to the size of the group of people or subjects that are being studied. If the sample size is too small, then the results may not be representative of the population being studied. This can lead to a lack of generalizability of the results.

Time Limitations

Time limitations can be a constraint on the research process . This could mean that the study is unable to be conducted for a long enough period of time to observe the long-term effects of an intervention, or to collect enough data to draw accurate conclusions.

Selection Bias

This refers to a type of bias that can occur when the selection of participants in a study is not random. This can lead to a biased sample that is not representative of the population being studied.

Confounding Variables

Confounding variables are factors that can influence the outcome of a study, but are not being measured or controlled for. These can lead to inaccurate conclusions or a lack of clarity in the results.

Measurement Error

This refers to inaccuracies in the measurement of variables, such as using a faulty instrument or scale. This can lead to inaccurate results or a lack of validity in the study.

Ethical Limitations

Ethical limitations refer to the ethical constraints placed on research studies. For example, certain studies may not be allowed to be conducted due to ethical concerns, such as studies that involve harm to participants.

Examples of Limitations in Research

Some Examples of Limitations in Research are as follows:

Research Title: “The Effectiveness of Machine Learning Algorithms in Predicting Customer Behavior”

Limitations:

• The study only considered a limited number of machine learning algorithms and did not explore the effectiveness of other algorithms.
• The study used a specific dataset, which may not be representative of all customer behaviors or demographics.
• The study did not consider the potential ethical implications of using machine learning algorithms in predicting customer behavior.

Research Title: “The Impact of Online Learning on Student Performance in Computer Science Courses”

• The study was conducted during the COVID-19 pandemic, which may have affected the results due to the unique circumstances of remote learning.
• The study only included students from a single university, which may limit the generalizability of the findings to other institutions.
• The study did not consider the impact of individual differences, such as prior knowledge or motivation, on student performance in online learning environments.

Research Title: “The Effect of Gamification on User Engagement in Mobile Health Applications”

• The study only tested a specific gamification strategy and did not explore the effectiveness of other gamification techniques.
• The study relied on self-reported measures of user engagement, which may be subject to social desirability bias or measurement errors.
• The study only included a specific demographic group (e.g., young adults) and may not be generalizable to other populations with different preferences or needs.

How to Write Limitations in Research

When writing about the limitations of a research study, it is important to be honest and clear about the potential weaknesses of your work. Here are some tips for writing about limitations in research:

• Identify the limitations: Start by identifying the potential limitations of your research. These may include sample size, selection bias, measurement error, or other issues that could affect the validity and reliability of your findings.
• Be honest and objective: When describing the limitations of your research, be honest and objective. Do not try to minimize or downplay the limitations, but also do not exaggerate them. Be clear and concise in your description of the limitations.
• Provide context: It is important to provide context for the limitations of your research. For example, if your sample size was small, explain why this was the case and how it may have affected your results. Providing context can help readers understand the limitations in a broader context.
• Discuss implications : Discuss the implications of the limitations for your research findings. For example, if there was a selection bias in your sample, explain how this may have affected the generalizability of your findings. This can help readers understand the limitations in terms of their impact on the overall validity of your research.
• Provide suggestions for future research : Finally, provide suggestions for future research that can address the limitations of your study. This can help readers understand how your research fits into the broader field and can provide a roadmap for future studies.

Purpose of Limitations in Research

There are several purposes of limitations in research. Here are some of the most important ones:

• To acknowledge the boundaries of the study : Limitations help to define the scope of the research project and set realistic expectations for the findings. They can help to clarify what the study is not intended to address.
• To identify potential sources of bias: Limitations can help researchers identify potential sources of bias in their research design, data collection, or analysis. This can help to improve the validity and reliability of the findings.
• To provide opportunities for future research: Limitations can highlight areas for future research and suggest avenues for further exploration. This can help to advance knowledge in a particular field.
• To demonstrate transparency and accountability: By acknowledging the limitations of their research, researchers can demonstrate transparency and accountability to their readers, peers, and funders. This can help to build trust and credibility in the research community.
• To encourage critical thinking: Limitations can encourage readers to critically evaluate the study’s findings and consider alternative explanations or interpretations. This can help to promote a more nuanced and sophisticated understanding of the topic under investigation.

When to Write Limitations in Research

Limitations should be included in research when they help to provide a more complete understanding of the study’s results and implications. A limitation is any factor that could potentially impact the accuracy, reliability, or generalizability of the study’s findings.

It is important to identify and discuss limitations in research because doing so helps to ensure that the results are interpreted appropriately and that any conclusions drawn are supported by the available evidence. Limitations can also suggest areas for future research, highlight potential biases or confounding factors that may have affected the results, and provide context for the study’s findings.

Generally, limitations should be discussed in the conclusion section of a research paper or thesis, although they may also be mentioned in other sections, such as the introduction or methods. The specific limitations that are discussed will depend on the nature of the study, the research question being investigated, and the data that was collected.

Examples of limitations that might be discussed in research include sample size limitations, data collection methods, the validity and reliability of measures used, and potential biases or confounding factors that could have affected the results. It is important to note that limitations should not be used as a justification for poor research design or methodology, but rather as a way to enhance the understanding and interpretation of the study’s findings.

Importance of Limitations in Research

Here are some reasons why limitations are important in research:

• Enhances the credibility of research: Limitations highlight the potential weaknesses and threats to validity, which helps readers to understand the scope and boundaries of the study. This improves the credibility of research by acknowledging its limitations and providing a clear picture of what can and cannot be concluded from the study.
• Facilitates replication: By highlighting the limitations, researchers can provide detailed information about the study’s methodology, data collection, and analysis. This information helps other researchers to replicate the study and test the validity of the findings, which enhances the reliability of research.
• Guides future research : Limitations provide insights into areas for future research by identifying gaps or areas that require further investigation. This can help researchers to design more comprehensive and effective studies that build on existing knowledge.
• Provides a balanced view: Limitations help to provide a balanced view of the research by highlighting both strengths and weaknesses. This ensures that readers have a clear understanding of the study’s limitations and can make informed decisions about the generalizability and applicability of the findings.

Advantages of Limitations in Research

Here are some potential advantages of limitations in research:

• Focus : Limitations can help researchers focus their study on a specific area or population, which can make the research more relevant and useful.
• Realism : Limitations can make a study more realistic by reflecting the practical constraints and challenges of conducting research in the real world.
• Innovation : Limitations can spur researchers to be more innovative and creative in their research design and methodology, as they search for ways to work around the limitations.
• Rigor : Limitations can actually increase the rigor and credibility of a study, as researchers are forced to carefully consider the potential sources of bias and error, and address them to the best of their abilities.
• Generalizability : Limitations can actually improve the generalizability of a study by ensuring that it is not overly focused on a specific sample or situation, and that the results can be applied more broadly.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Best Practices for Reducing Bias in the Interview Process

Ilana bergelson.

Department of Urology, University of Iowa, Iowa City, USA

Elizabeth Takacs

Purpose of review.

Objective measures of residency applicants do not correlate to success within residency. While industry and business utilize standardized interviews with blinding and structured questions, residency programs have yet to uniformly incorporate these techniques. This review focuses on an in-depth evaluation of these practices and how they impact interview formatting and resident selection.

Recent Findings

Structured interviews use standardized questions that are behaviorally or situationally anchored. This requires careful creation of a scoring rubric and interviewer training, ultimately leading to improved interrater agreements and biases as compared to traditional interviews. Blinded interviews eliminate even further biases, such as halo, horn, and affinity bias. This has also been seen in using multiple interviewers, such as in the multiple mini-interview format, which also contributes to increased diversity in programs. These structured formats can be adopted to the virtual interviews as well.

There is growing literature that using structured interviews reduces bias, increases diversity, and recruits successful residents. Further research to measure the extent of incorporating this method into residency interviews will be needed in the future.

Introduction

Optimizing the criteria to rank residency applicants is a difficult task. The National Residency Matching Program (NRMP) is designed to be applicant-centric, with the overarching goal to provide favorable outcomes to the applicant while providing opportunity for programs to match high-quality candidates. From a program’s perspective, the NRMP is composed of three phases: the screening of applicants, the interview, and the creation of the rank list. While it is easy to compare candidates based on objective measures, these do not always reflect qualities required to be a successful resident or physician. Prior studies have demonstrated that objective measures such as Alpha Omega Alpha status, United States Medical Licensing Exams (USMLE), and class rank do not correlate with residency performance measures [ 1 ]. Due to the variability of these factors to predict success and recognition of the importance of the non-cognitive traits, most programs place increased emphasis on candidate interviews to assess fit [ 2 ].

Unfortunately, the interview process lacks standardization across residency programs. Industry and business have more standardized interviews and utilize best practices that include blinded interviewers, use of structured questions (situational and/or behavioral anchored questions), and skills testing. Due to residency interview heterogeneity, studies evaluating the interview as a predictor of success have failed to reliably predict who will perform well during residency. Additionally, resident success has many components, such that isolating any one factor, such as the interview, may be problematic and argues for a more holistic approach to resident selection [ 3 ]. Nevertheless, there are multiple ways the application review and interview can be standardized to promote transparency and improve resident selection.

Residency programs have begun adopting best practices from business models for interviewing, which include standardized questions, situational and/or behavioral anchored questions, blinded interviewers, and use of the multiple mini-interview (MMI) model. The focus of this review is to take a more in-depth look at practices that have become standard in business and to review the available data on the impact of these practices in resident selection.

Unstructured Versus Structured Interviews

Unstructured interviews are those in which questions are not set in advance and represent a free-flowing discussion that is conversational in nature. The course of an unstructured interview often depends on the candidate’s replies and may offer opportunities to divert away from topics that are important to applicant selection. While unstructured interviews may involve specific questions such as “tell me about a recent book you read” or “tell me about your research,” the questions do not seek to determine specific applicant attributes and may vary significantly between applicants. Due to their free-form nature, unstructured interviews may be prone to biased or illegal questions. Additionally, due to a lack of a specific scoring rubric, unstructured interviews are open to multiple biases in answer interpretation and as such generally show limited validity [ 4 ]. For the applicant, unstructured interviews allow more freedom to choose a response, with some studies reporting higher interviewee satisfaction with these questions [ 5 ].

In contrast to the unstructured interview, structured interviews use standardized questions that are written prior to an interview, are asked of every candidate, and are scored using an established rubric. Standardized questions may be behaviorally or situationally anchored [ 5 ]. Due to their uniformity, standardized interviews have higher interrater reliability and are less prone to biased or illegal questions.

Behavioral questions ask the candidate to discuss a specific response to a prior experience, which can provide insight into how an applicant may behave in the future [ 5 ]. Not only does the candidate’s response reflect a possible prediction of future behavior, it can also demonstrate the knowledge, priorities, and values of the candidate [ 5 ]. Questions are specifically targeted to reflect qualities the program is searching for (Table ​ (Table1) 1 ) [ 5 – 7 ].

Behavioral questions and character traits [ 5 – 7 ]

Situational questions require an applicant to predict how they would act in a hypothetical situation and are intended to reflect a realistic scenario the applicant may encounter during residency; this can provide insight into priorities and values [ 5 ]. For example, asking what an applicant would do when receiving sole credit for something they worked on with a colleague can provide insight into the integrity of a candidate [ 4 ]. These types of questions can be especially helpful for fellowships, as applicants would already have the clinical experience of residency to draw from [ 5 ].

Using standardized questions provides a method to recruit candidates with characteristics that ultimately correlate to resident success and good performance. Indeed, structured interview scores have demonstrated an ability to predict which students perform better with regard to communication skills, patient care, and professionalism in surgical and non-surgical specialties [ 8 •]. In fields such as radiology, non-cognitive abilities that can be evaluated in behavioral questions, such as conscientiousness or confidence, are thought to critically influence success in residency and even influence cognitive performance [ 1 ]. This has also been demonstrated in obstetrics and gynecology, where studies have shown that resident clinical performance after 1 year had a positive correlation with the rank list percentile that was generated using a structured interview process [ 9 ].

Creating Effective Structured Interviews

To be effective, standardized interview questions should be designed in a methodical manner. The first step in standardizing the interview process is determining which core values predict resident success in a particular program. To that end, educational leaders and faculty within the department should come to a consensus on the main qualities they seek in a resident. From there, questions can be formatted to elicit those traits during the interview process. Some programs have used personality assessment inventories to establish these qualities. Examples include openness to experience, humility, conscientiousness, and honesty. Further program-specific additions can be included, such as potential for success in an urban versus rural environment [ 10 ].

Once key attributes have been chosen and questions have been selected, a scoring rubric can be created. The scoring of each question is important as it helps define what makes a high-performing versus low-performing answer. Once a scoring system is determined, interviewers can be trained to review the questions, score applicant responses, and ensure they do not revise the questions during the interview [ 11 ]. Questions and the grading rubric should be further scrutinized through mock interviews with current residents, including discussing responses of the mock interviewee and modifying the questions and rubric prior to formal implementation [ 12 ]. Interviewer training itself is critical, as adequate training leads to improved interrater agreements [ 13 ]. Figure  1 demonstrates the steps to develop a behavioral interview question.

Example of standardized question to evaluate communication with scoring criteria

Rating the responses of the applicants can come with errors that ultimately reduce validity. For example, central tendency error involves interviewers not rating students at the extremes of a scale but rather placing all applicants in the middle; leniency versus severity refers to interviewers who either give all applicants high marks or give everyone low marks; contrast effects involve comparing one applicant to another rather than solely focusing on the rubric for each interviewee. These rating errors reflect the importance of training and providing feedback to interviewers [ 4 ].

Blinded Interviewers

Blinding the interviewers to the application prior to meeting with a candidate is intended to eliminate various biases within the interview process (Table ​ (Table2) 2 ) [ 14 , 15 ]. In addition to grades and test scores, aspects of the application that can either introduce or exacerbate bias include photographs, demographics, letters of recommendation, selection to medical honor societies, and even hobbies. Impressions of candidates can be formed prematurely, with the interview then serving to simply confirm (or contradict) those impressions [ 16 •]. Importantly, application blinding may also decrease implicit bias against applicants who identify as underrepresented in medicine [ 17 ].

Examples of bias [ 14 , 15 ]

Despite the proven success of these various interview tactics, their use in resident selection remains limited, with only 5% of general surgery programs using standardized interview questions and less than 20% using even a limited amount of blinding (e.g., blinding of photograph) [ 2 ]. Some programs have continued to rely on unblinded interviews and prioritize USMLE scores and course grades in ranking [ 18 ]. Due to their potential benefits and ability to standardize the interview process, it is critical that programs become familiar with the various interview practices so that they can select the best applicants while minimizing the significant bias in traditional interview formats.

Multiple Mini-interview (MMI)

The use of multiple interviews by multiple interviewers provides an opportunity to ask the applicant more varied questions and also allows for the averaging out of potential interviewer bias leading to more consistent applicant scoring and ability to predict applicant success [ 7 ]. Training of the interviewers in interviewing techniques, scoring, and avoiding bias is also likely to decrease scoring variability. Similarly, the use of the same group of interviewers for all candidates should be encouraged in order to limit variance in scoring amongst certain faculty [ 19 ].

One interview method that incorporates multiple interviewers and has had growing frequency in medical school interviews as well as residency interviews is the MMI model. This system provides multiple interviews in the form of 6–12 stations, each of which evaluates a non-medical question designed to assess specific non-academic applicant qualities [ 20 ]. While the MMI format can intimidate some candidates, others find that it provides an opportunity to demonstrate traits that would not be observed in an unstructured interview, such as multitasking, efficiency, flexibility, interpersonal skills, and ethical decision-making [ 21 ]. Furthermore, MMI has been shown to have increased reliability as shown in a study of five California medical schools that showed inter-interviewer consistency was higher for MMIs than traditional interviews which were unstructured and had a 1:1 ratio of interviewer to applicant [ 22 ].

The MMI format is also versatile enough to incorporate technical competencies even through a virtual platform. In general surgery interviews, MMI platforms have been designed to test traits such as communication and empathy but also clinical knowledge and surgical aptitude through anatomy questions and surgical skills (knot tying and suturing). Thus, MMIs are not only versatile, but also have an ability to evaluate cognitive traits and practical skills [ 23 ].

MMI also has the potential to reduce resident attrition. For example, in evaluating students applying to midwifery programs in Australia, attrition rates and grades were compared for admitted students using academic rank and MMI scores obtained before and after the incorporation of MMIs into their selection program. The authors found that when using MMIs, enrolled students had not only higher grades but significantly lower attrition rates. MMI was better suited to show applicants’ passion and commitment, which then led to similar mindsets of accepted applicants as well as a support network [ 24 ]. Furthermore, attrition rates have been found to be higher in female residents in general surgery programs [ 25 ]. Perhaps with greater diversity, which is associated with use of standardized interviews, the number of women can increase in surgical specialties and thus reduce attrition rate in this setting as well.

Impact of Interview Best Practices on Bias and Diversity

An imperative of all training programs is to produce a cohort of physicians with broad and diverse experiences representative of the patient populations they treat. To better address diversity within surgical residencies, particularly regarding women and those who are underrepresented in medicine, it is important that interviews be designed to minimize bias against any one portion of the applicant pool. Diverse backgrounds and cultures within a program enhance research, innovation, and collaboration as well as benefit patients [ 26 ]. Patients have shown greater satisfaction and reception when they share ethnicity or background with their provider, and underrepresented minorities in medicine often go on to work in underserved communities [ 27 ].

All interviewers undoubtedly have elements of implicit bias; Table ​ Table2 2 describes the common subtypes of implicit bias [ 14 ]. While it is difficult to eliminate bias in the interview process, unstructured or “traditional” interviews are more likely to risk bias toward candidates than structured interviews. Studies have demonstrated that Hispanic and Black applicants receive scores one quarter of a standard deviation lower than Caucasian applicants [ 28 ]. “Like me” bias is just one example of increased subjectivity with unstructured interviews, where interviewers prefer candidates who may look like, speak like, or share personal experiences with the interviewer [ 29 ].

Furthermore, unstructured interviews provide opportunities to ask inappropriate or illegal questions, including those that center on religion, child planning, and sexual orientation [ 30 ]. Inappropriate questions tend to be disproportionately directed toward certain groups, with women more likely to get questions regarding marital status and to be questioned and interrupted than male counterparts [ 28 , 31 ].

Structured interviews, conversely, have been shown to decrease bias in the application process. Faculty trained in behavior-based interviews for fellowship applications demonstrated that there were reduced racial biases in candidate evaluations due to scoring rubrics [ 12 ]. Furthermore, as structured questions are determined prior to the interview and involve training of interviewers, structured interviews are less prone to illegal and inappropriate questions [ 32 ]. Interviewers can ask additional questions such as “could you be more specific?” with the caveat that probing should be minimized and kept consistent between applications. This way the risk of prompting the applicant toward a response is reduced [ 4 ].

Implementing Interview Types During the Virtual Interview Process

An added complexity to creating standardized interviews is incorporating a virtual platform. Even prior to the move toward virtual interviews instituted during the COVID-19 pandemic, studies on virtual interviews showed that they provided several advantages over in-person interviews, including decreased cost, reduction in time away from commitments for applicants and staff, and ability to interview at more programs. A significant limitation, for applicants and for programs, is the inability to interact informally, which allows applicants to evaluate the environment of the hospital and the surrounding community [ 33 •]. Following their abrupt implementation in 2020 during the COVID-19 pandemic, virtual interviews have remained in place and likely will remain in place in some form into the future due to their significant benefits in reducing applicant cost and improving interview efficiency. Although these types of interviews are in their relative infancy in the resident selection process, studies have found that standardized questions and scoring rubrics that have been used in person can still be applied to a virtual interview setting without degrading interview quality [ 34 ].

The virtual format may also allow for further interview innovation in the form of standardized video interviews. For medical student applicants, the Association of American Medical Colleges (AAMC) has trialed a standardized video interview (SVI) that includes recording of applicant responses, scoring, and subsequent release to the Electronic Residency Application Service (ERAS) application. Though early data in the pilot was promising, the program was not continued after the 2020 cycle due to lack of interest [ 35 ]. There is limited evidence supporting the utility of this type of interview in residency training, and one study found that these interviews did not add significant benefit as the scores did not associate with other candidate attributes such as professionalism [ 32 ]. Similarly, a separate study found no correlation between standardized video interviews and faculty scores on traits such as communication and professionalism. Granted, there was no standardization in what the faculty asked, and they were not blinded to academic performance of the applicants [ 36 ]. While there was an evaluation of six emergency medicine programs that demonstrated a positive linear correlation between the SVI score and the traditional interview score, it was a very low r coefficient; thus the authors concluded that the SVI was not adequate to replace the interview itself [ 37 ].

Conclusions: Future Steps in Urology and Beyond

The shift to structured interviews in urology has been slow. Within the last decade, studies consistent with other specialties demonstrated that urology program directors prioritized USMLE scores, reference letters, and away rotations at the program director’s institution as the key factors in choosing applicants [ 38 ]. More recently, a survey of urology programs found < 10% blinded the recruitment team at the screening step, with < 20% blinding the recruitment team during the interview itself [ 39 ]. In 2020 our program began using structured interview questions and blinded interviewers to all but the personal statement and letters of recommendation. After querying faculty and interviewees, we have found that most interviewers do not miss the additional information, and applicants feel that they are able to have more eye contact with faculty who are not looking down at the application during the interview. Structured behavioral interview questions have allowed us to focus on the key attributes important to our program. With time we hope to see that inclusion of these metrics helps diversify our resident cohort, improve resident satisfaction with the training program, and produce successful future urologists.

Despite the slow transition in urology and other fields, there is a growing body of literature in support of standardized interviews for evaluating key candidate traits that ultimately lead to resident success and reducing bias while increasing diversity. With time, the hope is that programs will continue incorporating these types of interviews in the resident selection process.

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The authors have no financial or non-financial interests to disclose.

This article does not contain any studies with human or animal subjects performed by any of the authors.

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• Published: 03 April 2024

The environmental awareness of nurses as environmentally sustainable health care leaders: a mixed method analysis

• Olga María Luque-Alcaraz   ORCID: orcid.org/0000-0003-1598-1422 1 , 2 , 3 , 5 ,
• Pilar Aparicio-Martínez   ORCID: orcid.org/0000-0002-2940-8697 3 , 4 ,
• Antonio Gomera   ORCID: orcid.org/0000-0003-0603-3017 2 &
• Manuel Vaquero-Abellán   ORCID: orcid.org/0000-0002-0602-317X 2 , 3 , 4  

BMC Nursing volume  23 , Article number:  229 ( 2024 ) Cite this article

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People worldwide are concerned with the possibility of climate change, microplastics, air pollution, and extreme weather affecting human health. Countries are implementing measures to reduce environmental impacts. Nurses play a vital role, primarily through Green Teams, in the process of promoting sustainable practices and minimizing the environmental footprint of health care facilities. Despite existing knowledge on this topic, assessing nurses’ environmental awareness and behavior, including the barriers they face, is crucial with regard to improving sustainable health care practices.

To analyze the environmental awareness and behavior of nurses, especially nurse leaders, as members of the Green Team and to identify areas for improvement with regard to the creation of a sustainable environment.

A sequential mixed-method study was conducted to investigate Spanish nurses. The study utilized an online survey and interviews, including participant observation. An online survey was administered to collect quantitative data regarding environmental awareness and behavior. Qualitative interviews were conducted with environmental nurses in specific regions, with a focus on Andalusia, Spain.

Most of the surveyed nurses ( N  = 314) exhibited moderate environmental awareness (70.4%), but their environmental behavior and activities in the workplace were limited (52.23% of participants rarely performed relevant actions, and 35.03% indicated that doing so was difficult). Nurses who exhibited higher levels of environmental awareness were more likely to engage in sustainable behaviors such as waste reduction, energy conservation, and environmentally conscious purchasing decisions ( p  < 0.05). Additionally, the adjusted model indicated that nurses’ environmental behavior and activities in the workplace depend on the frequency of their environmental behaviors outside work as well as their sustainable knowledge ( p  < 0.01). The results of the qualitative study ( N  = 10) highlighted certain limitations in their daily practices related to environmental sustainability, including a lack of time, a lack of bins and the pandemic. Additionally, sustainable environmental behavior on the part of nursing leadership and the Green Team must be improved.

Conclusions

This study revealed that most nurses have adequate knowledge, attitudes, and behaviors related to environmental sustainability both inside and outside the workplace. Limitations were associated with their knowledge and behaviors outside of work. This study also highlighted the barriers and difficulties that nurses face in their attempts to engage in adequate environmental behaviors in the workplace. Based on these findings, interventions led by nurses and the Green Team should be developed to promote sustainable behaviors among nurses and address the barriers and limitations identified in this research.

Graphical Abstract

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Introduction

The impact of climate change on human society is a global concern, especially with regard to microplastics, resource shortages, air pollution, droughts, and extreme weather. Such consequences affect human health both directly and indirectly, resulting in an increase in pathologies and a deterioration in medical attention [ 1 , 2 ]. In this context, diverse measures aimed at reducing the environmental impact of daily activities and minimizing the ecological footprint thereof [ 3 ] have been implemented by multiple countries [ 4 , 5 , 6 , 7 ]; these activities have been framed as environmental regulations in line with the Sustainable Development Goals (SDGs) [ 8 ].

The SDGs are being integrated into governments and a variety of other contexts, including the health care system. Spain is dedicated to such a goal, i.e., that of promoting a greener and more democratic health care transition. To achieve this goal, strategic plans have been developed to mitigate the effects of climate change [ 9 , 10 ]. One specific such program is the Strategic Health and Environment Plan (PESMA) [ 11 ], whose aim is to enhance the synergy between health and the environment innovatively by assessing the impact of the population in terms of 14 environmental indicators [ 12 ].

One such indicator focuses on the resources and support needed for sustainable practices, especially for nurses, due to the impact of the environment on their work [ 13 , 14 ]. The PESMA highlights the fact that health care providers should be included in strategies to reduce carbon footprints, build resilience to address the challenges associated with climate change and embrace a leadership role in the task of promoting sustainable health care practices [ 13 , 14 , 15 , 16 ]. Another critical aspect of PESMA focuses on education, training, and incentives that can promote sustainable behavior among health care workers, especially nurses [ 17 , 18 ]. As frontline health care workers, nurses have a unique opportunity to advocate for sustainable practices and reduce the environmental impact of the health care system. Nurses’ knowledge and behavior are limited despite the fact that nurses have positive attitudes toward environmental sustainability [ 19 ].

This situation stands in contrast to the role of nurses in the creation of more sustainable hospitals via the “Green Team” [ 20 ]. The Green Team, which originated in the United States of America a decade ago, is a committee that is responsible for finding and implementing sustainability projects to decrease the environmental impacts of daily operations. Members of various departments collaborate with sustainability staff to detect opportunities, spread awareness, and promote staff involvement in line with the Committee’s mission [ 21 ]. The team, which typically consists of and is led by nurses, aims to increase awareness of the health care industry’s effect on the environment and to develop tactics to mitigate the adverse environmental effects of hospitals.

In Spain, Green Teams, which span multiple disciplines and usually led by nursing professionals, are committed to sustainable change in health care [ 22 ]. Environmental nursing leaders on Green Teams control environmental sustainability in health care settings and provide education, resources, and support to other professionals with regard to the implementation of sustainable practices [ 23 ]. Accordingly, all nurses can contribute to the tasks of mitigating the impact of climate change on public health outcomes and promoting sustainable health for all [ 24 ]. These actions improve nurses’ knowledge, attitudes, and behavior in terms of sustainability and promote sustainable practices in health care settings, thus leading to a better understanding of the barriers faced by nurses in this context [ 24 , 25 , 26 ].

However, measuring and identifying nurses’ environmental awareness is essential for the promotion of sustainable hospitals [ 27 , 28 ]. Multidimensional indicators have been proposed for this purpose [ 16 ], the responsibility for which lies with nurse leaders on Green Teams. Nurses are responsible for promoting sustainability in health care organizations, as discussed by Kallio et al. (2018) [ 29 ], as well as for promoting nursing competencies related to environmental sustainability [ 30 ]. Several studies, including Harris et al. (2009) and Phiri et al. (2022), have examined nurses’ roles in environmental health and the effects of their leadership on the promotion of sustainability, especially during the COVID-19 pandemic, thereby emphasizing the importance of leadership [ 31 , 32 ].

As Ojemeni et al. (2019) discussed, leadership effectiveness in Green Teams, nursing teams and health care organizations must prioritize quality control and health care improvement to ensure sustainable development [ 33 ].

The topic of environmental management in health care organizations has been studied extensively, and an environmental or ecological model of care for promoting sustainability has been proposed [ 34 ]. As environmental creators and leaders on Green Teams, nurses are vital for minimizing hazardous waste in health care settings and improving awareness [ 35 ].

Although nurses have some degree of existing knowledge and awareness of sustainability, it is crucial to assess their proficiency in environmental matters and to gauge their environmental awareness. Such an evaluation can help identify areas for improvement within clinical management units [ 20 , 33 , 36 ]. Education and training programs can effectively promote sustainable behavior among nurses, but interventions should also address the barriers they face in their attempts to implement sustainable practices [ 37 ]. Therefore, it is imperative to examine the factors that foster sustainable behavior among nurses and to identify effective interventions that can promote sustainable health care practices and minimize the environmental footprint of health care facilities. Accordingly, this study aimed to analyze the environmental awareness and behavior of nurses, especially nurse leaders, as members of the Green Team and to identify areas for improvement with regard to creating a sustainable environment.

Study design

A sequential mixed-method study was conducted based on an online survey and interviews with a representative sample of Spanish nurses, including participant observation.

The study was divided into two phases. In the first phase, a cross-sectional, descriptive exploratory analysis was performed; this analysis relied on the results revealed using the Nurse’s Environmental Awareness Tool in Spanish (NEAT-es) [ 38 ], which was divided into three subscales: nursing awareness scale (NAS), environmental behaviors outside the workplace (PEB) and sustainable behaviors in the workplace (NPEB). In the second phase, qualitative interviews with environmental nurses (see Supplementary file 1 ) were conducted in regions featuring specific environmental units that were available in person (Andalusia).

Participants

The participants were recruited from public and private institutions associated with the National Health System, particularly from the nursing staff. The scope of the study focused on Spain, and the sample included all the nursing staff who completed the questionnaire and met the inclusion criteria.

The sampling process focused on the population of nurses in Spain in 2020, which was estimated to consist of 388,153 nurses. Therefore, a random sample of 314 participating individuals was sufficient to estimate the population with 95% confidence and an accuracy of +/- 2% units, which was expected to account for approximately 90% of the overall population. The inclusion and exclusion criteria used for the sample focused on nursing staff, nursing care auxiliary technicians, and students with relevant degrees, as this members of this group have the most significant presence in the health system and engage in direct and daily contact with environmental management in health centers (hospitals, primary care centers, sociosanitary centers and others). The remaining health and nonhealth personnel were excluded.

Additionally, the person from each unit who served as the environmental coordinator and other nurses from the ward who were members of the Green Team were asked to participate in the interviews and observations. The environmental coordinators, most of who were nursing supervisors, were determined based on the number of members of the Green Team and the sampling calculation used for the observational study. The interviews took place after various sessions, talks, or courses pertaining to environmental sustainability at the clinical management units.

Data collection

An intentional sampling process was implemented, and the data collection period spanned from November 2019 to March 2021. The observational data were collected in Spain via messages and posts on social media with the goal of quantifying nurses’ environmental awareness.

The initial sample of qualitative study included five environmental nursing leaders (NLs), 14 registered nurses (RNs), and ten nursing undergraduates. The final sample was reduced when the interviews reached data saturation ( N  = 10, five NLs, and five RNs). Before the interviews, a focal group composed of one nurse, one physician, two engineers and a psychologist was tested using the questions included in this research as part of a pilot study ( Supplementary file 1 ). These interviews were conducted at the beginning of the participant’s shift, usually in the morning, and they featured a median time of 30 min, a minimum of 20 min and a maximum of one hour per participant.

One researcher (O.A.L.) also observed nurses during their daily work after the interview from a position within the ward as an added team member or staff member. Nevertheless, the observer did not highlight mistakes or sustainability issues during the observation process. No other researcher was involved in this step of the ethnographic analysis to avoid bias with regard to observing a variety of tasks ranging from preparing medication to implementing treatments.

The data collected through the interviews were recorded on a Samsung Galaxy 31 A, and observations were collected in a field notebook based on the Google Keep and Evernote mobile applications from November 2019 to mid-March 2021. This study was conducted at a regional level 1 hospital in southern Spain, particularly in various clinical management units (neurosurgery, internal medicine, cardiology, traumatology, and COVID-19 units, among others), and it focused on nursing supervisors, who are the leaders who bear responsibility for environmental awareness (NLs), and registered nurses (RNs) who were members of the Green Team.

Data analysis

The quantitative data were analyzed by reference to descriptive statistics, including the mean, standard deviation (SD), and 95% confidence interval (CI); the relative frequencies of the variables were also analyzed. Normalization tests, Kolmogorov‒Smirnov tests with Lilliefors correction, and Q‒Q tests were used to compare the goodness-of-fit to an average data distribution with regard to continuous or discrete quantitative variables. The comparison of two or three independent means was performed using Student’s t test and analyses of variance for each variable. The Χ 2 test with Yates’ correction was used to compare percentages and Pearson’s correlation (r) coefficients across the quantitative variables. Finally, associations among the NPEB and the other variables were studied through multiple linear regression. Participant observation was used to support the qualitative study of the reflective ethnographic type [ 39 , 40 ], and this process ended when the data reached saturation. Two researchers developed transcripts for the interviews based on the recorded interviews and added descriptions based on the notes from the field notebook. The identification of themes and patrons was based on a process of triangulation among the researchers and by cross-checking the results. The interviews with nurses were analyzed to summarize the content analysis and identify keywords and concurrency among the terms. The themes thus identified included Green Teams, sustainable environmental behaviors, environment awareness, leadership barriers and limitations and areas for improvement.

EPIDAT (version 4.2) and SPSS (version 25) software were used to support the quantitative analysis. The computer program ATLAS.ti (version 22) and the Office Package with Microsoft Word Excel (version 2019) were used for the interviews and the visualization of the keywords based on the themes identified based on the records, observations and field notebooks.

Nurses’ awareness, knowledge, attitudes and skills.

The ages of the Spanish staff, mainly nurses, included in this study ( N  = 314) ranged from 19 to 68, with a mean age of 37.02 ± 12.7, CI = 95%, 35.6–38.4 years); in addition, 76.4% of these participants were women with more than 20 years of working experience (35.1%), and the majority were registered nurses (70.4%). Moreover, 113 (36%) participants worked at a local or regional hospital (30%) and were employees of a public institution (85.3%). Half of the nurses (157) worked only a morning shift (Table  1 ) in Andalusia, Madrid, or Catalonia (62.4%). The diverse autonomous regions on which this research focused were homogenously distributed and structured in line with the population. The analysis of these areas was also based on the specific inclusion of environmental units led by nurses (Andalusia, Madrid, and Catalonia), in contrast with regions featuring undetermined units or leaders related to this topic (such as Valencia) (37.5%).

Regarding nursing awareness, nurses scored higher on the PEB (31.83 ± 8.02 CI 95% 30.94–32.72 with regard to frequency vs. 32.36 ± 7.15 CI 95% 31.57–33.15 with respect to difficulty) than on the NAS (26.13 ± 9.91 CI 95% 25.03–27.23 with regard to knowledge vs. 47.39 ± 5.97 CI 95% 46.73–48.05 with respect to impact) and the NPEB (23.82 ± 6.45 CI 95% 23.10-24.53 with regard to frequency vs. 25.71 ± 6.31 CI 95% 25.01–26.41 with respect to difficulty). These results indicated that environmental knowledge among the Spanish population was limited (55.7%), although the nurses included in this research were aware of their potential impact on the environment (70.4%). The PEB subscale focused mostly on following environmental guidelines in their homes (57.3%) because these sustainable domestic tasks are easier for them (63.1%) than tasks in the professional field. The second subscale, NPEB, indicated that sustainable activities such as recycling were easy for the participants (57.6%), but sometimes they engaged in such activities less frequently than they would like (52.2%) (Fig.  1 and Fig.  2 ).

Representation of the frequency of nursing environmental behavior

Difficulty of engaging in adequate environmental behaviors

The sociodemographic variables indicated differences among the NEAT subscales (Table  2 ). Gender, working experience (with a median value of 10 years), and the position held in the institution and region were relevant with regard to environmental knowledge ( p  < 0.01), environmental behavior outside the workplace ( p  < 0.01), and environmental behavior in the workplace ( p  < 0.01).

The NPEB was associated with the worst scores, thereby reflecting the nurses’ environmental behavior and activities in the workplace (52.23% rarely performed relevant activities, and 35.03% indicated that doing so was difficult) (Fig.  1 and Fig.  2 ). The NPEB values pertaining to environmental behavior were positively linked to age ( r  = 0.412; p  < 0.001), NAS knowledge ( r  = 0.526; p  < 0.001), PEB frequency ( r  = 0. 57; p  < 0.001), PEB difficulty ( r  = 0.329; p  < 0.001), and finally, difficulty performing adequate environmental behaviors ( r  = 0.499; p  < 0.001). Additionally, the value of the NPEB with regard to the difficulty of performing adequate environmental behaviors was positively associated with age ( r  = 0.149; p  = 0.008), NAS knowledge ( r  = 0.249; p  < 0.001), PEB frequency ( r  = 0. 244; p  < 0.001) and PEB difficulty ( r  = 0.442; p  < 0.001).

Based on the relevance of certain sociodemographic variables, the nurses’ environmental awareness (NAS) and their behavior outside the workplace (PEB), linear multiple regression was performed to investigate nursing behavior in the workplace (NPEB). The initial model (square sum = 488.655; p  < 0.0001) indicated that age, the impact of nursing awareness (NAS), and the frequency of sustainable behaviors outside the workplace (PEB) were not relevant to nursing behavior in the workplace (NPEB) in terms of the frequency of performing adequate behavior or the difficulties experienced ( p  > 0.05). Based on these results, the adjusted model was calculated (Table  3 ), indicating that NPEB depends on PEB frequency and NAS knowledge ( p  < 0.01).

Nursing environmental behavior in the context of Green Teams: Barriers and areas for improvement.

The participants in the qualitative study ( N  = 10) included nine women and one man; their median age was 49 years; they exhibited an interval quartile range of 35–60; they had levels of working experience ranging between 20 and 30 years, and they worked only in the mornings (7/10). Furthermore, the group including nurses and nursing supervisors (5/10) exhibited higher levels of education (see Supplementary file 2 ). The themes identified via repetition and associations during the interviews and observations indicated links among nurses’ responsibilities on the Green Team since they conformed to the nature of such teams (i). This team and nursing leaders identified sustainable environmental behavior (ii) that could improve environmental awareness (iii), knowledge, aptitude, and skills. The nurses who are responsible for sustainable changes should be the leaders (iv), and the relevant barriers and limitations (v) and areas for improvement (vi) in diverse areas should be identified simultaneously.

Green teams were linked to nursing responsibilities in the context of environmental sustainability.

In the interviews, the Green Teams, led by environmental leader nurses and comprising various staff members, were identified as crucial committees dedicated to enhancing environmental awareness and knowledge among hospital staff. Participants indicated that these teams facilitated regular meetings to discuss sustainable practices and played a pivotal role in testing behaviors and knowledge related to environmental sustainability. The Green Teams were highlighted as platforms for fostering collaboration and discussion surrounding sustainable practices. Participants noted that these teams facilitated the main purpose of the team and its members to improve the hospital staff’s knowledge and attitudes via meetings (RN 2,3 and NL 1,3). Subsequently, the NL also indicated a key role of the team in the testing of behaviors and knowledge. The behavior of registered nurses should be tested using questions according to the NLs. Also, the NLs are included in disponibility of of proper disposal methods for medical waste:

“So, where is the rubbish bin for medicines, that white one that you showed in the session that is used for the remains of medicines that we do not give to patients?” [(NL5)]

By such comments, it can be inferred that the Green Team not only disseminates information, manages the training and measures knowledge but also ensures that staff members understand and adhere to best practices in waste management. These tasks of the NLs and other RNs in the Green Team contribute to the overall efficiency and effectiveness of environmental sustainability efforts within the hospital.

Sustainable environmental behaviors were emerged by Green Teams.

The results of the analysis indicated some degree of resistance among the nurses working at the clinical management units with regard to their lack of competencies, especially those pertaining to knowledge, skills and attitudes. The comments from the interviews highlighted potential factors contributing to this resistance, including age-related differences, varying levels of awareness, and challenges in applying the principles of reduce, reuse, and recycle (the three Rs). For instance, one repetitive comment expressed a sentiment of uncertainty, stating “It is what is, but we don’t know it or what to do with it” (RN 3,4,5, and NL 2,3).

“We know what the light packing is, and they (maintenance people) installed it to reduce the lights and reduce the expense and cost, but we don’t know what to do with the rubbish bins” [(NL 4)]

This comment highlights a disconnect between awareness of specific sustainable initiatives and the practical knowledge to implement them effectively. All comments reflect the importance of addressing knowledge gaps and providing practical guidance to support nurses in adopting sustainable environmental behaviours. By acknowledging and addressing these challenges, healthcare facilities can enhance their environmental stewardship efforts and promote a culture of sustainability among staff members.

Environmental awareness were drawn from the nursing responsibilities that led to the creation of the Green Team.

The comments indicated that environmental awareness among nurses was influenced by training sessions and courses on environmental sustainability. After receiving training featuring lectures and courses on environmental sustainability, the leaders also reflected on the ways in which nurses put the recommendations made during the environmental sustainability courses into practice. Moreover, the leaders indicated that education should be beyond formal training sessions. The environmental leaders were interested in supplementing these courses with environmental education practices for the general population, as noted, for example, in reports of discharge from patient care or cycling on the ward. These activities indicated the ideal of including a holistic approach to sustainability within the healthcare setting.

Relevant statements included, “We have to separate residues according to the material… light plastic goes to… it is important for the unit and all of us” (NL 2,5). One key point that the referees and registered nurses highlighted pertained to the climate, particularly the lack of water (NL 1–5 and RN 1,2).

“The drought is getting worse; I don’t know how we are going to keep up… we hope it rains soon” [(RN1)]

Overall, the interviews shed light on the efforts to foster environmental awareness among nurses through formal training and practical integration into everyday practices. These observations emphasize the importance of ongoing education and action in addressing environmental concerns within healthcare settings.

Leadership, which was linked by comments to the Green Teams.

The interviews revealed that leadership, particularly within the context of Green Teams, is crucial in promoting environmental awareness and fostering a culture of sustainability among nursing staff. All the participants ( n  = 10) indicated that the presence of adequate knowledge, meetings and awareness among nursing staff were the most important factors. These factors were identified as key drivers in promoting sustainable practices within the healthcare environment. NLs indicated the importance of creating a supportive working environment where nurses feel comfortable asking questions and seeking clarification without fear of negative feedback. Relevant statements included, “It is key to receive feedback from the nurses and provide a good working environment so that they can ask questions and reflect without negative comments” (NL 1,2,4, and RN 1,2). This working environment allowed the registered nurses to ask for help regarding the three Rs:

“Could you remind me (referring to the environmental coordinator) how the sustainable guidelines were included in the discharge report for the continuity of care; I remember some things from the course you gave us, but I want to convey it completely to my patient” [(RN2)]

Barriers and limitations, were drawn from nurses’ responsibilities.

Several nurses indicated that the difficulties they encountered with regard to performing environmental behaviors pertained to the lack of time, adequate bins, and space as well as the limited number of nurses per patient in the wards. Despite these challenges, participants noted a positive outcome in the form of increased awareness of sustainability issues among nurses, indicating a growing recognition of the importance of environmental stewardship within the healthcare setting. One factor that increased the barriers to environmental adequacy was the pandemic, which increased waste and rubbish. Despite these challenges, participants noted a positive outcome in the form of increased awareness of sustainability issues among nurses, indicating a growing recognition of the importance of environmental stewardship within the healthcare setting. Relevant statements included “There are not enough green rubbish bins for COVID waste” (EL 1,4,5 and RN1,2) and “How are we going to recycle if we don’t even have time to care for patients?” (RN 1,2 and NL 3).

All these comments indicated the barriers the nurses faced, but they also suggested possibilities for improvement. The pandemic, despite overloading nurses, also improved their awareness.

Areas subject to improvement emerged from nursing responsibilities, limitations and leadership.

Nurses indicated that despite their general levels of environmental awareness and the courses they had received, participants performed better regarding their recycling behaviors at home than at the hospital. Participants acknowledged performing better in recycling practices within their personal spaces, suggesting a potential gap in translating theoretical knowledge into practical action within the healthcare environment. Relevant statements included “It’s just that I recycle almost everything in my house, especially glass…, but here, there is no time…” (RN 1,4,5).

Moreover, time constraints emerged as a significant barrier impeding nurses’ ability to engage fully in environmental sustainability efforts. Participants cited the demanding nature of their work, particularly in the context of patient care responsibilities, as limiting their capacity to prioritize sustainability initiatives. This highlights the need for strategies to streamline environmental practices and integrate them seamlessly into nurses’ daily routines without adding undue burden.

Some statements also highlighted nurses’ willingness to improve paperwork and records. Nurses recognized the importance of incorporating environmental considerations into patient discharge reports and other documentation processes but sought further guidance on how to effectively implement these practices. Relevant statements included “Can you tell me how the patient’s continuity care report upon discharge was included in the recommendations for environmental sustainability… I want to do the report well with what you gave us in the clinical session the other day…” [(NL4)]

These comments indicated the opportunities for improvement in fostering a culture of environmental sustainability within the hospital setting. By addressing the identified challenges and providing targeted support and guidance, especially the lack of time, nurses can contribute to environmental stewardship efforts more effectively.

The current research highlights the relevance of nurses as promoters of environmentally sustainable behaviors in their roles as members of Green Teams and important leaders. The findings suggest that nurses exhibit acceptable knowledge, attitudes, and behaviors with regard to environmental sustainability both inside and outside the workplace. These results are complemented by a qualitative analysis indicating that such behaviors originate from nursing responsibility, Green Teams, leadership identification of barriers and areas of improvement. Both analyses highlight the fact that environmental nursing behavior in the workplace depends on sustainable behaviors outside the workplace. The qualitative analysis also identifies diverse barriers to the task of promoting sustainable behavior within the workplace, such as the COVID-19 pandemic and the need for more time to be allocated to this process. One key point identified by both analyses is that nurses have acceptable levels of knowledge; however, their attitudes, although as yet imperfect, are improving.

Several studies of nurses’ awareness of environmental sustainability have revealed that nurses exhibit moderate levels of awareness and a considerable degree of concern regarding the health impacts of climate change [ 37 , 42 , 43 ], as reflected in the NEAT-es results.

Interestingly, the participants exhibited a tendency to perform environmentally sustainable behaviors more consistently in their personal lives than in professional settings. These results are consistent with previous research on registered nurse and nursing students [ 36 , 41 , 42 ]. According to Swedish research, nurses generally recognize environmental issues but may lack awareness of the environmental impact of health care [ 43 ]. Polivka Barbara J. et al. (2012) highlighted the gap between nurses’ knowledge of sustainability and workplace behaviors, thereby emphasizing the need for education and training programs to promote sustainable practices [ 44 ]. These issues were also observed in a study conducted in Taiwan, which revealed that while nursing students exhibit positive attitudes toward sustainability, their knowledge and behaviors are inadequate [ 45 ].

By conducting qualitative analysis, this research also identified multiple barriers to the adoption of sustainable practices among nurses, including time constraints, disruptions caused by the COVID-19 pandemic, a lack of bins, and a lack of health care personnel. These findings are in line with those reported in other research, but certain barriers (in terms of resources, time, and support) to the implementation of sustainable practices in the workplace remain [ 29 ]. This study suggests that interventions should be designed to address these barriers and promote sustainable behavior among nurses, a suggestion which is consistent with the current research. These findings highlight the importance of comprehending nurses’ perspectives on environmental sustainability in health care contexts as well as the necessity for targeted interventions and support mechanisms [ 46 ]. The tasks assigned to nursing leaders and the Green Team involved addressing these barriers and promoting sustainable practices among nurses in the context of their professional roles. Environmental nursing leaders seem to be crucial with regard to establishing a more environmentally conscious health care environment, which is in line with recommendations to create a greener health care system [ 21 , 31 ]. Despite the results of the interviews, some global qualitative studies of nurses’ views on environmental issues have exhibited variations across countries [ 47 , 48 ]. In Sweden, nurses already exhibit pro-sustainability attitudes before the introduction of the 2030 SDGs [ 16 ]. However, the integration of environmental sustainability education into nursing programs can prepare future nurses more effectively to address the challenges associated with climate change and promote sustainable health outcomes [ 49 ].

Limitations

Although this investigation provides valuable insights, it is important to acknowledge its limitations. First, the study was conducted during the COVID-19 pandemic in Spain, which may have influenced the results due to the unique circumstances and stressors faced by health care workers during this period. Additionally, the assessment of nurses’ environmental awareness was performed on a larger scale, i.e., across multiple regions, and therefore may not accurately reflect individual attitudes and behaviors since the qualitative investigations focused on a specific region. However, this approach was adopted to minimize the risk of the ecological fallacy. Future studies could explore individual perspectives and experiences by reference to more diverse and representative samples.

Despite these limitations, this research is highly relevant because it sheds light on the role of nurses in the task of promoting environmental sustainability in health care settings. The research also emphasized the role of nursing leadership in the tasks of promoting environmental sustainability and providing nurses with the necessary resources and support to implement sustainable practices.

In conclusion, while nurses generally exhibit acceptable levels of knowledge, attitudes, and behaviors regarding environmental sustainability, a notable gap persists in terms of the frequency of sustainable actions within the professional settings in which they operate. This finding highlights the importance of closely aligning nurses’ personal and professional sustainability practices.

The qualitative analysis conducted as part of this study identified several barriers to the adoption of sustainable practices among nurses, including time constraints, disruptions resulting from the COVID-19 pandemic, issues with waste disposal, and challenges related to health care personnel. Despite the fact that these findings are in line with those reported in previous research, persistent barriers such as limited resources, time, and support hinder the implementation of sustainable practices in the workplace. Therefore, interventions aimed at addressing these barriers and promoting sustainable behavior among nurses are essential, as highlighted by both current research and the corresponding qualitative insights. Therefore, nursing leaders and Green Teams are pivotal with regard to overcoming these barriers and fostering sustainable practices within health care environments. Environmental nursing leaders in particular are instrumental to the cultivation of a more environmentally conscious health care system, thereby aligning with recommendations for greener health care practices.

Data availability

The datasets used and/or analyzed as part of the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank the Excellent Official Nursing School and all the professionals who participated in this research for their support.

This research received no external funding; however, the project did receive an award from the Excellent Official Nursing School in Cordoba, Spain, in 2020.

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A.G. and M. V-A. conceived and designed the study, and O.M. L. and P.A-M. acquired the data, analyzed and interpreted the data, and drafted the article. The publication and supervision of the article were the responsibility of A.G. and M. V-A. All authors contributed equally to the writing and preparation of the final manuscript.

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Luque-Alcaraz, O.M., Aparicio-Martínez, P., Gomera, A. et al. The environmental awareness of nurses as environmentally sustainable health care leaders: a mixed method analysis. BMC Nurs 23 , 229 (2024). https://doi.org/10.1186/s12912-024-01895-z

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Why Taiwan Was So Prepared for a Powerful Earthquake

Decades of learning from disasters, tightening building codes and increasing public awareness may have helped its people better weather strong quakes.

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Chris Buckley reported from the city of Hualien, Meaghan Tobin from Taipei, in Taiwan.

• April 4, 2024

When the largest earthquake in Taiwan in half a century struck off its east coast, the buildings in the closest city, Hualien, swayed and rocked. As more than 300 aftershocks rocked the island over the next 24 hours to Thursday morning, the buildings shook again and again.

But for the most part, they stood.

Even the two buildings that suffered the most damage remained largely intact, allowing residents to climb to safety out the windows of upper stories. One of them, the rounded, red brick Uranus Building, which leaned precariously after its first floors collapsed, was mostly drawing curious onlookers.

The building is a reminder of how much Taiwan has prepared for disasters like the magnitude-7.4 earthquake that jolted the island on Wednesday. Perhaps because of improvements in building codes, greater public awareness and highly trained search-and-rescue operations — and, likely, a dose of good luck — the casualty figures were relatively low. By Thursday, 10 people had died and more than 1,000 others were injured. Several dozen were missing.

“Similar level earthquakes in other societies have killed far more people,” said Daniel Aldrich , a director of the Global Resilience Institute at Northeastern University. Of Taiwan, he added: “And most of these deaths, it seems, have come from rock slides and boulders, rather than building collapses.”

Across the island, rail traffic had resumed by Thursday, including trains to Hualien. Workers who had been stuck in a rock quarry were lifted out by helicopter. Roads were slowly being repaired. Hundreds of people were stranded at a hotel near a national park because of a blocked road, but they were visited by rescuers and medics.

On Thursday in Hualien city, the area around the Uranus Building was sealed off, while construction workers tried to prevent the leaning structure from toppling completely. First they placed three-legged concrete blocks that resembled giant Lego pieces in front of the building, and then they piled dirt and rocks on top of those blocks with excavators.

“We came to see for ourselves how serious it was, why it has tilted,” said Chang Mei-chu, 66, a retiree who rode a scooter with her husband Lai Yung-chi, 72, to the building on Thursday. Mr. Lai said he was a retired builder who used to install power and water pipes in buildings, and so he knew about building standards. The couple’s apartment, near Hualien’s train station, had not been badly damaged, he said.

“I wasn’t worried about our building, because I know they paid attention to earthquake resistance when building it. I watched them pour the cement to make sure,” Mr. Lai said. “There have been improvements. After each earthquake, they raise the standards some more.”

It was possible to walk for city blocks without seeing clear signs of the powerful earthquake. Many buildings remained intact, some of them old and weather-worn; others modern, multistory concrete-and-glass structures. Shops were open, selling coffee, ice cream and betel nuts. Next to the Uranus Building, a popular night market with food stalls offering fried seafood, dumplings and sweets was up and running by Thursday evening.

Earthquakes are unavoidable in Taiwan, which sits on multiple active faults. Decades of work learning from other disasters, implementing strict building codes and increasing public awareness have gone into helping its people weather frequent strong quakes.

Not far from the Uranus Building, for example, officials had inspected a building with cracked pillars and concluded that it was dangerous to stay in. Residents were given 15 minutes to dash inside and retrieve as many belongings as they could. Some ran out with computers, while others threw bags of clothes out of windows onto the street, which was also still littered with broken glass and cement fragments from the quake.

One of its residents, Chen Ching-ming, a preacher at a church next door, said he thought the building might be torn down. He was able to salvage a TV and some bedding, which now sat on the sidewalk, and was preparing to go back in for more. “I’ll lose a lot of valuable things — a fridge, a microwave, a washing machine,” he said. “All gone.”

Requirements for earthquake resistance have been built into Taiwan’s building codes since 1974. In the decades since, the writers of Taiwan’s building code also applied lessons learned from other major earthquakes around the world, including in Mexico and Los Angeles, to strengthen Taiwan’s code.

After more than 2,400 people were killed and at least 10,000 others injured during the Chi-Chi quake of 1999, thousands of buildings built before the quake were reviewed and reinforced. After another strong quake in 2018 in Hualien, the government ordered a new round of building inspections. Since then, multiple updates to the building code have been released.

“We have retrofitted more than 10,000 school buildings in the last 20 years,” said Chung-Che Chou, the director general of the National Center for Research on Earthquake Engineering in Taipei.

The government had also helped reinforce private apartment buildings over the past six years by adding new steel braces and increasing column and beam sizes, Dr. Chou said. Not far from the buildings that partially collapsed in Hualien, some of the older buildings that had been retrofitted in this way survived Wednesday’s quake, he said.

The result of all this is that even Taiwan’s tallest skyscrapers can withstand regular seismic jolts. The capital city’s most iconic building, Taipei 101, once the tallest building in the world, was engineered to stand through typhoon winds and frequent quakes. Still, some experts say that more needs to be done to either strengthen or demolish structures that don’t meet standards, and such calls have grown louder in the wake of the latest earthquake.

Taiwan has another major reason to protect its infrastructure: It is home to the majority of production for the Taiwan Semiconductor Manufacturing Company, the world’s largest maker of advanced computer chips. The supply chain for electronics from smartphones to cars to fighter jets rests on the output of TSMC’s factories, which make these chips in facilities that cost billions of dollars to build.

The 1999 quake also prompted TSMC to take extra steps to insulate its factories from earthquake damage. The company made major structural adjustments and adopted new technologies like early warning systems. When another large quake struck the southern city of Kaohsiung in February 2016, TSMC’s two nearby factories survived without structural damage.

Taiwan has made strides in its response to disasters, experts say. In the first 24 hours after the quake, rescuers freed hundreds of people who were trapped in cars in between rockfalls on the highway and stranded on mountain ledges in rock quarries.

“After years of hard work on capacity building, the overall performance of the island has improved significantly,” said Bruce Wong, an emergency management consultant in Hong Kong. Taiwan’s rescue teams have come to specialize in complex efforts, he said, and it has also been able to tap the skills of trained volunteers.

Taiwan’s resilience also stems from a strong civil society that is involved in public preparedness for disasters.

Ou Chi-hu, a member of a group of Taiwanese military veterans, was helping distribute water and other supplies at a school that was serving as a shelter for displaced residents in Hualien. He said that people had learned from the 1999 earthquake how to be more prepared.

“They know to shelter in a corner of the room or somewhere else safer,” he said. Many residents also keep a bag of essentials next to their beds, and own fire extinguishers, he added.

Around him, a dozen or so other charities and groups were offering residents food, money, counseling and childcare. The Tzu Chi Foundation, a large Taiwanese Buddhist charity, provided tents for families to use inside the school hall so they could have more privacy. Huang Yu-chi, a disaster relief manager with the foundation, said nonprofits had learned from earlier disasters.

“Now we’re more systematic and have a better idea of disaster prevention,” Mr. Huang said.

Mike Ives contributed reporting from Seoul.

Chris Buckley , the chief China correspondent for The Times, reports on China and Taiwan from Taipei, focused on politics, social change and security and military issues. More about Chris Buckley

Meaghan Tobin is a technology correspondent for The Times based in Taipei, covering business and tech stories in Asia with a focus on China. More about Meaghan Tobin

Siyi Zhao is a reporter and researcher who covers news in mainland China for The Times in Seoul. More about Siyi Zhao

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