Qualitative content analysis in nursing research: concepts ...

1 Nurse Education Today (2004) 24, 105 112. Nurse Education Today Qualitative content analysis in nursing research : concepts , procedures and measures to achieve trustworthiness Graneheim*, B. Lundman Department of nursing , Ume . a University, Ume . a 90187, Sweden Accepted 8 October 2003. KEYWORDS Summary Qualitative content analysis as described in published literature shows Credibility; conflicting opinions and unsolved issues regarding meaning and use of concepts , Dependability; procedures and interpretation. This paper provides an overview of important Latent content ; concepts (manifest and latent content , unit of analysis , meaning unit, condensation, Manifest content ; abstraction, content area, code, category and theme) related to Qualitative content nursing ; analysis ; illustrates the use of concepts related to the research procedure; and Qualitative content proposes measures to achieve trustworthiness (credibility, dependability and trans- analysis ; ferability) throughout the steps of the research procedure.

2 Interpretation in Transferability; Qualitative content analysis is discussed in light of Watzlawick et al.'s [Pragmatics Trustworthiness of Human Communication. A Study of Interactional Patterns, Pathologies and Paradoxes. Norton & Company, New York, London] theory of communication. c 2003 Elsevier Ltd. All rights reserved. Introduction rently, two principal uses of content analysis are evident. One is a quantitative approach often used Initially content analysis dealt with the objective, in, for example, media research , and the other is a systematic and quantitative description of the Qualitative approach often used in, for example, manifest content of communication' (Berelson, nursing research and education.)

3 Qualitative con- 1952, p. 18) but, over time, it has expanded to also tent analysis in nursing research and education has include interpretations of latent content . Many been applied to a variety of data and to various authors, from a variety of research traditions, have depths of interpretation (for example, O'Brien addressed content analysis (for example, Berelson, et al., 1997; Latter et al., 2000; Berg and Welander 1952; Krippendorff, 1980; Findahl and Ho ijer, Hansson, 2000; So derberg and Lundman, 2001). 1981; Woods and Catanzaro, 1988; Downe-Wam- A review of literature based on common data- boldt, 1992; Burnard, 1991, 1996; Polit and Hun- bases (Cinahl, Medline and Sociological Abstracts).

4 Gler, 1999). The first descriptions date from the as well as references from articles and books shows 1950s and are predominately quantitative. Cur- different opinions and unsolved issues regarding meaning and use of concepts , procedures and in- * terpretation in Qualitative content analysis . The Corresponding author. Tel.: +46-90-786-9258; fax: +46-90- 786-9169. diversities can be understood partly from a histor- E-mail address: ( ical point of view and partly from various beliefs of Graneheim). the nature of reality among researchers.. 0260-6917/$ - see front matter c 2003 Elsevier Ltd.

5 All rights reserved. 106 Graneheim, B. Lundman An assumption underlying our paper is that re- One of the most basic decisions when using ality can be interpreted in various ways and the content analysis is selecting the unit of analysis . In understanding is dependent on subjective inter- the literature, unit of analysis refers to a great pretation. Qualitative research , based on data variety of objects of study, for example, a person, from narratives and observations, requires under- a program, an organisation, a classroom or a clinic standing and co-operation between the researcher (Mertens, 1998), or a community, state or nation and the participants, such that texts based on in- (Patton, 1987).

6 Other authors have considered the terviews and observations are mutual, contextual unit of analysis as interviews or diaries in their and value bound (Lincoln and Guba, 1985; Mishler, entity, and the amount of space allocated to a 1986). Thus, our presumption is that a text always topic or an interaction under study (Downe-Wam- involves multiple meanings and there is always boldt, 1992). Parts of the text that are abstracted some degree of interpretation when approaching a and coded (Weber, 1990), or every word or phrase text. This is an essential issue when discussing written in the transcript (Feeley and Gottlieb, trustworthiness of findings in Qualitative content 1998), have also been considered as units of anal- analysis .

7 Ysis. We suggest that the most suitable unit of Another issue is that concepts within the quan- analysis is whole interviews or observational pro- titative research tradition still predominate when tocols that are large enough to be considered a describing Qualitative content analysis (for exam- whole and small enough to be possible to keep in ple, Krippendorff, 1980; Burnard, 1991; Downe- mind as a context for the meaning unit, during the Wamboldt, 1992), especially the use of concepts analysis process. describing trustworthiness. This causes confusion A meaning unit, that is, the constellation of and paradigmatic uncertainty among authors and words or statements that relate to the same cen- readers of scientific papers.

8 Tral meaning, has been referred to as a content The purpose of this paper was threefold: first, to unit or coding unit (Baxter, 1991), an idea unit provide an overview of concepts of importance (Kovach, 1991), a textual unit (Krippendorff, related to Qualitative content analysis in nursing 1980), a keyword and phrase (Lichstein and Young, research ; second, to illustrate the use of concepts 1996), a unit of analysis (Downe-Wamboldt, 1992), related to the research procedure; and third, to and a theme (Polit and Hungler, 1991). We consider address measures to achieve trustworthiness.

9 A meaning unit as words, sentences or paragraphs containing aspects related to each other through their content and context. Overview of concepts In the literature, shortening the text includes the concepts of reduction (Findahl and Ho ijer, The following provides an overview of concepts 1981), distillation (Cavanagh, 1997) and conden- related to Qualitative content analysis and is to be sation (Coffey and Atkinson, 1996). Reduction re- seen as a contribution to a debate rather than an fers to decreasing the size, but it indicates nothing endeavour to find consensus.

10 First, we present about the quality of what remains. Distillation various uses of concepts found in the literature, deals with the abstracted quality of a text, which and then we give reasons for our stance. The con- we see as a further step in the analysis process. We cepts are manifest and latent content , unit of prefer condensation, as it refers to a process of analysis , meaning unit, condensing, abstracting, shortening while still preserving the core. content area, code, category and theme. The process whereby condensed text is ab- A basic issue when performing Qualitative con- stracted has been called aggregation (Barrosso, tent analysis is to decide whether the analysis 1997) and grouping together under higher order should focus on manifest or latent content .