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    <title>UTas ePrints - A hierarchy of evidence for assessing qualitative health research</title>
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<meta content="Objective: The objective of this study is to outline explicit criteria for assessing the contribution of qualitative empirical studies in
health and medicine, leading to a hierarchy of evidence specific to qualitative methods.
Study Design and Setting: This paper arose from a series of critical appraisal exercises based on recent qualitative research studies in
the health literature. We focused on the central methodological procedures of qualitative method (defining a research framework, sampling
and data collection, data analysis, and drawing research conclusions) to devise a hierarchy of qualitative research designs, reflecting the
reliability of study conclusions for decisions made in health practice and policy.
Results: We describe four levels of a qualitative hierarchy of evidence-for-practice. The least likely studies to produce good evidencefor-
practice are single case studies, followed by descriptive studies that may provide helpful lists of quotations but do not offer detailed
analysis. More weight is given to conceptual studies that analyze all data according to conceptual themes but may be limited by a lack
of diversity in the sample. Generalizable studies using conceptual frameworks to derive an appropriately diversified sample with analysis
accounting for all data are considered to provide the best evidence-for-practice. Explicit criteria and illustrative examples are described for
each level.
Conclusion: A hierarchy of evidence-for-practice specific to qualitative methods provides a useful guide for the critical appraisal of
papers using these methods and for defining the strength of evidence as a basis for decision making and policy generation.  2006 Elsevier
Inc. All rights reserved." name="eprints.abstract" />
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studies exploring parental beliefs and attitudes toward childhood
vaccination identifies common barriers to vaccination. J Clin Epidemiol
2005;58(11):1081e8.
[2] Mills EJ, Montori VM, Ross CP, Shea B, Wilson K, Guyatt GH. Systematically
reviewing qualitative studies complements survey design:
an exploratory study of barriers to paediatric immunisations. J Clin
Epidemiol 2005;58:1101e8.
[3] Popay J. Moving beyond floccinaucinihilipilification: enhancing the
utility of systematic reviews. J Clin Epidemiol 2005;58(11):
1079e80.
[4] Oxman A. Checklists for reviewing articles. In: Chalmers I,
Altman DG, editors. Systematic reviews. London, UK: BMJ Publishing
Group; 1995. p. 75e85.
[5] Guyatt GH, Rennie D, editors. Users’ guides to the medical literature:
a manual for evidence-based clinical practice. Chicago, IL: AMA
Press; 2001.
[6] Critical Appraisal Skills Programme. Milton Keynes Primary Care
Trust; 2002.
[7] Spencer L, Ritchie J, Lewis J, Dillon L. Quality in Qualitative Evaluation:
a framework for assessing research evidence. United Kingdom
Government Chief Social Researcher’s Office; 2003.
[8] BSA Medical Sociology Group. Criteria for the evaluation of
qualitative research papers. Accessed June 1, 2005. Available
at: http://www.tandf.co.uk/journals/pdf/qdr.pdf. Med Sociol News
1996;22.
[9] Green J, Thorogood N. Qualitative methods for health research. London:
Sage Publications; 2004.
[10] Pyett P. Innovation and compromise: responsibility and reflexivity
in research with vulnerable groups. In: Daly J, Guillemin M,
Hill S, editors. Technologies and health: critical compromises.
Melbourne: Oxford University Press; 2001. p. 136e50.
[11] Sandelowski M, Barroso J. Classifying the findings of qualitative
studies. Qual Health Res 2003;13:905e23.
[12] Campbell R, Pound P, Pope C, Britten N, Pill R, Morgan M, et al.
Evaluating meta-ethnography: a synthesis of qualitative research on
lay experiences of diabetes and diabetes care. Soc Sci Med 2003;
56:671e84.
[13] Glasziou P, Vandenbroucke J, Chalmers I. Assessing the quality of research.
BMJ 2004;328:39e41.
[14] Rice PL, Ly B, Lumley J. Childbirth and soul loss: the case of
a Hmong woman. Med J Aust 1994;160:577e8.
[15] Small R, Rice PL, Yelland J, Lumley J. Mothers in a new country: the
role of culture and communication in Vietnamese, Turkish and Filipino
women’s experiences of giving birth in Australia. Women
Health 1999;28:77e101.
[16] Rousseau N, McColl E, Newton J, Grimshaw J, Eccles M. Practice
based, longitudinal, qualitative interview study of computerised
evidence based guidelines in primary care. BMJ 2003;326:314e8.
[17] Varas-Diaz N, Serrano-Garcı´a I, Toro-Alfonso J. AIDS-related stigma
and social interaction: Puerto Ricans living with HIV/AIDS. Qual
Health Res 2005;15:169e87.
[18] Williams C. Doing health, doing gender: teenagers, diabetes and
asthma. Soc Sci Med 2000;50:387e96.
[19] Davis M, Rhodes T, Martin A. Preventing hepatitis C: ‘Common
sense’, ‘the bug’ and other perspectives from the risk narratives of
people who inject drugs. Soc Sci Med 2004;59:1807e18.
[20] Sanders T. A continuum of risk? The management of health, physical
and emotional risks by female sex workers. Sociol Health Illn
2004;26:557e74." name="eprints.referencetext" />
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health and medicine, leading to a hierarchy of evidence specific to qualitative methods.
Study Design and Setting: This paper arose from a series of critical appraisal exercises based on recent qualitative research studies in
the health literature. We focused on the central methodological procedures of qualitative method (defining a research framework, sampling
and data collection, data analysis, and drawing research conclusions) to devise a hierarchy of qualitative research designs, reflecting the
reliability of study conclusions for decisions made in health practice and policy.
Results: We describe four levels of a qualitative hierarchy of evidence-for-practice. The least likely studies to produce good evidencefor-
practice are single case studies, followed by descriptive studies that may provide helpful lists of quotations but do not offer detailed
analysis. More weight is given to conceptual studies that analyze all data according to conceptual themes but may be limited by a lack
of diversity in the sample. Generalizable studies using conceptual frameworks to derive an appropriately diversified sample with analysis
accounting for all data are considered to provide the best evidence-for-practice. Explicit criteria and illustrative examples are described for
each level.
Conclusion: A hierarchy of evidence-for-practice specific to qualitative methods provides a useful guide for the critical appraisal of
papers using these methods and for defining the strength of evidence as a basis for decision making and policy generation.  2006 Elsevier
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    <h1 class="ep_tm_pagetitle">A hierarchy of evidence for assessing qualitative health research</h1>
    <p style="margin-bottom: 1em" class="not_ep_block"><span class="person_name">Willis, Karen</span> (2007) <xhtml:em>A hierarchy of evidence for assessing qualitative health research.</xhtml:em> Journal of Clinical Epidemiology, 60 (1). pp. 43-49. ISSN 0895-4356</p><p style="margin-bottom: 1em" class="not_ep_block"></p><table style="margin-bottom: 1em" class="not_ep_block"><tr><td valign="top" style="text-align:center"><a href="http://eprints.utas.edu.au/2669/1/Qualitative_hierarchy_paper_JCE_-_Daly_et_al.pdf"><img alt="[img]" src="http://eprints.utas.edu.au/style/images/fileicons/application_pdf.png" class="ep_doc_icon" border="0" /></a></td><td valign="top"><a href="http://eprints.utas.edu.au/2669/1/Qualitative_hierarchy_paper_JCE_-_Daly_et_al.pdf"><span class="ep_document_citation">PDF</span></a> - Full text restricted - Requires a PDF viewer<br />131Kb</td><td><form method="get" accept-charset="utf-8" action="http://eprints.utas.edu.au/cgi/request_doc"><input accept-charset="utf-8" value="3527" name="docid" type="hidden" /><div class=""><input value="Request a copy" name="_action_null" class="ep_form_action_button" onclick="return EPJS_button_pushed( '_action_null' )" type="submit" /> </div></form></td></tr></table><p style="margin-bottom: 1em" class="not_ep_block">Official URL: <a href="http://dx.doi.org/10.1016/j.jclinepi.2006.03.014">http://dx.doi.org/10.1016/j.jclinepi.2006.03.014</a></p><div class="not_ep_block"><h2>Abstract</h2><p style="padding-bottom: 16px; text-align: left; margin: 1em auto 0em auto">Objective: The objective of this study is to outline explicit criteria for assessing the contribution of qualitative empirical studies in&#13;
health and medicine, leading to a hierarchy of evidence specific to qualitative methods.&#13;
Study Design and Setting: This paper arose from a series of critical appraisal exercises based on recent qualitative research studies in&#13;
the health literature. We focused on the central methodological procedures of qualitative method (defining a research framework, sampling&#13;
and data collection, data analysis, and drawing research conclusions) to devise a hierarchy of qualitative research designs, reflecting the&#13;
reliability of study conclusions for decisions made in health practice and policy.&#13;
Results: We describe four levels of a qualitative hierarchy of evidence-for-practice. The least likely studies to produce good evidencefor-&#13;
practice are single case studies, followed by descriptive studies that may provide helpful lists of quotations but do not offer detailed&#13;
analysis. More weight is given to conceptual studies that analyze all data according to conceptual themes but may be limited by a lack&#13;
of diversity in the sample. Generalizable studies using conceptual frameworks to derive an appropriately diversified sample with analysis&#13;
accounting for all data are considered to provide the best evidence-for-practice. Explicit criteria and illustrative examples are described for&#13;
each level.&#13;
Conclusion: A hierarchy of evidence-for-practice specific to qualitative methods provides a useful guide for the critical appraisal of&#13;
papers using these methods and for defining the strength of evidence as a basis for decision making and policy generation.  2006 Elsevier&#13;
Inc. All rights reserved.</p></div><table style="margin-bottom: 1em" cellpadding="3" class="not_ep_block" border="0"><tr><th valign="top" class="ep_row">Item Type:</th><td valign="top" class="ep_row">Article</td></tr><tr><th valign="top" class="ep_row">Additional Information:</th><td valign="top" class="ep_row">The definitive version is available at http://www.sciencedirect.com&#13;
</td></tr><tr><th valign="top" class="ep_row">Keywords:</th><td valign="top" class="ep_row">Qualitative research; Hierarchy of evidence; Quality indicators; Empirical studies; Qualitative evidence for clinical practice; Evidence-based&#13;
medicine&#13;
1. Introduction</td></tr><tr><th valign="top" class="ep_row">Subjects:</th><td valign="top" class="ep_row"><a href="http://eprints.utas.edu.au/view/subjects/321200.html">320000 Medical and Health Sciences &gt; 321200 Public Health and Health Services</a><br /><a href="http://eprints.utas.edu.au/view/subjects/370000.html">370000 Studies in Human Society</a></td></tr><tr><th valign="top" class="ep_row">ID Code:</th><td valign="top" class="ep_row">2669</td></tr><tr><th valign="top" class="ep_row">Deposited By:</th><td valign="top" class="ep_row"><span class="ep_name_citation"><span class="person_name">Dr Karen Willis</span></span></td></tr><tr><th valign="top" class="ep_row">Deposited On:</th><td valign="top" class="ep_row">12 Dec 2007 09:02</td></tr><tr><th valign="top" class="ep_row">Last Modified:</th><td valign="top" class="ep_row">09 Jan 2008 02:30</td></tr><tr><th valign="top" class="ep_row">ePrint Statistics:</th><td valign="top" class="ep_row"><a target="ePrintStats" href="/es/index.php?action=show_detail_eprint;id=2669;">View statistics for this ePrint</a></td></tr></table><p align="right">Repository Staff Only: <a href="http://eprints.utas.edu.au/cgi/users/home?screen=EPrint::View&amp;eprintid=2669">item control page</a></p>
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