Journal of Patient-Centered Journal of Patient-Centered 

Research and Reviews Research and Reviews 

Volume 11 Issue 1 Article 1 

4-2-2024 

Research Frameworks: Critical Components for Reporting Research Frameworks: Critical Components for Reporting 

Qualitative Health Care Research Qualitative Health Care Research 

Ann Z. George 

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George AZ. Research frameworks: critical components for reporting qualitative health care research. J 
Patient Cent Res Rev. 2024;11:4-7. doi: 10.17294/2330-0698.2068 

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4 JPCRR • Volume 11, Issue 1 • Spring 2024

Qualitative research provides valuable insights 
into health care interactions and decision-making 
processes – for example, why and how a clinician 

may ignore prevailing evidence and continue making 
clinical decisions the way they always have.1 The perception 
of qualitative health care research has improved since a 
2016 article by Greenhalgh et al. highlighted the higher 
contributions and citation rates of qualitative research 
than those of contemporaneous quantitative research.2 
The Greenhalgh et al. article was subsequently supported 
by an open letter from 76 senior academics spanning 11 
countries to the editors of the British Medical Journal.3 
Despite greater recognition and acceptance, qualitative 
research continues to have an “uneasy relationship with 
theory,”4 which contributes to poor reporting.

As an editor for the Journal of Patient-Centered Research 
and Reviews, as well as Human Resources for Health, I 
have seen several exemplary qualitative articles with 
clear and coherent reporting. On the other hand, I have 
often been concerned by a lack of rigorous reporting, 
which may reflect and reinforce the outdated perception 
of qualitative research as the “soft option.”5 Qualitative 
research is more than conducting a few semi-structured 

interviews, transcribing the audio recordings verbatim, 
coding the transcripts, and developing and reporting 
themes, including a few quotes. Qualitative research 
that benefits health care is time-consuming and labor-
intensive, requires robust design, and is rooted in theory, 
along with comprehensive reporting.6

What Is “Theory”?
So fundamental is theory to qualitative research that 
I initially toyed with titling this editorial, “Theory: the 
missing link in qualitative health care research articles,” 
before deeming that focus too broad. As far back as 
1967, Merton6 warned that “the word theory threatens 
to become meaningless.” While it cannot be overstated 
that “atheoretical” studies lack the underlying logic that 
justifies researchers’ design choices, the word theory is so 
overused that it is difficult to understand what constitutes 
an adequate theoretical foundation and what to call it. 

Theory, as used in the term theoretical foundation, refers 
to the existing body of knowledge.7,8 The existing body 
of knowledge consists of more than formal theories, 
with their explanatory and predictive characteristics, so 
theory implies more than just theories. Box 19-12 defines 
the “building blocks of formal theories.”9 Theorizing or 
theory-building starts with concepts at the most concrete, 
experiential level, becoming progressively more abstract 
until a higher-level theory is developed that explains 
the relationships between the building blocks.9 Grand 
theories are broad, representing the most abstract level 
of theorizing. Middle-range and explanatory theories are 
progressively less abstract, more specific to particular 

Corresponding author: Ann Z. George,
Phillip V. Tobias Health Sciences Building, 29 Princess of Wales 
Terrace, Parktown, Johannesburg, 2193, South Africa  
(ann.george@wits.ac.za)

Research Frameworks: Critical Components for 
Reporting Qualitative Health Care Research
Ann Z. George, PhD 

Centre for Health Science Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 
South Africa

EDITORIAL

Editorial

Abstract  Qualitative health care research can provide insights into health care practices that quantitative studies 
cannot. However, the potential of qualitative research to improve health care is undermined by reporting 
that does not explain or justify the research questions and design. The vital role of research frameworks 
for designing and conducting quality research is widely accepted, but despite many articles and books 
on the topic, confusion persists about what constitutes an adequate underpinning framework, what to 
call it, and how to use one. This editorial clarifies some of the terminology and reinforces why research 
frameworks are essential for good-quality reporting of all research, especially qualitative research. 
(J Patient Cent Res Rev. 2024;11:4-7.)

Keywords  qualitative research, health care, theory, research frameworks, theoretical frameworks, conceptual 
frameworks



aah.org/jpcrr 5Editorial

phenomena or cases (middle-range) or variables 
(explanatory), and testable. 

Box 1:  The Building Blocks of Formal Theories9

Concepts words we assign to mental representations 
of events or phenomena9,10

Constructs higher-order clusters of concepts9

Propositions expressions of relationships among 
several constructs9

Theories “sets of interrelated constructs, definitions, 
and propositions that present a systematic 
view of phenomena by specifying relations 
among variables and phenomena”11 
OR general sets “of principles that are 
independent of the specific case, situation, 
phenomenon or observation to be 
explained”12

The Importance of Research Frameworks
Researchers may draw on several elements to frame their 
research. Generally, a framework is regarded as “a set of 
ideas that you use when you are forming your decisions 
and judgements”13 or “a system of rules, ideas, or beliefs 
that is used to plan or decide something.”14 Research 
frameworks may consist of a single formal theory or part 
thereof, any combination of several theories or relevant 
constructs from different theories, models (as simplified 
representations of formal theories), concepts from the 
literature and researchers’ experiences. 

Although Merriam15 was of the view that every study 
has a framework, whether explicit or not, there are 
advantages to using an explicit framework. Research 
frameworks map “the territory being investigated,”8 thus 
helping researchers to be explicit about what informed 
their research design, from developing research questions 
and choosing appropriate methods to data analysis and 
interpretation. Using a framework makes research 
findings more meaningful12 and promotes generalizability 
by situating the study and interpreting data in more 
general terms than the study itself.16

Theoretical and Conceptual Frameworks
The variation in how the terms theoretical and 
conceptual frameworks are used may be confusing. Some 
researchers refer to only theoretical frameworks17,18 or 
conceptual frameworks,19-21 while others use the terms 
interchangeably.7 Other researchers distinguish between 
the two. For example, Miles, Huberman & Saldana8 see 
theoretical frameworks as based on formal theories and 
conceptual frameworks derived inductively from locally 
relevant concepts and variables, although they may 
include theoretical aspects. Conversely, some researchers 
believe that theoretical frameworks include formal 
theories and concepts.18 Others argue that any differences 

between the two types of frameworks are semantic 
and, instead, emphasize using a research framework to 
provide coherence across the research questions, methods 
and interpretation of the results, irrespective of what that 
framework is called.

Like Ravitch and Riggan,22 I regard conceptual 
frameworks (CFs) as the broader term. Including 
researchers’ perspectives and experiences in CFs 
provides valuable sources of originality. Novel 
perspectives guard against research repeating what has 
already been stated.23 The term theoretical framework 
(TF) may be appropriate where formal published and 
identifiable theories or parts of such theories are used.24 
However, existing formal theories alone may not 
provide the current state of relevant concepts essential 
to understanding the motivation for and logic underlying 
a study. Some researchers may argue that relevant 
concepts may be covered in the literature review, but 
what is the point of literature reviews and prior findings 
unless authors connect them to the research questions 
and design? Indeed, Sutton & Straw25 exclude literature 
reviews and lists of prior findings as an adequate 
foundation for a study, along with individual lists of 
variables or constructs (even when the constructs are 
defined), predictions or hypotheses, and diagrams that 
do not propose relationships. One or more of these 
aspects could be used in a research framework (eg, 
in a TF), and the literature review could (and should) 
focus on the theories or parts of theories (constructs), 
offer some critique of the theory and point out how they 
intend to use the theory. This would be more meaningful 
than merely describing the theory as the “background” 
to the study, without explicitly stating why and how it is 
being used. Similarly, a CF may include a discussion of 
the theories being used (basically, a TF) and a literature 
review of the current understanding of any relevant 
concepts that are not regarded as formal theory.

It may be helpful for authors to specify whether they 
are using a theoretical or a conceptual framework, but 
more importantly, authors should make explicit how they 
constructed and used their research framework. Some 
studies start with research frameworks of one type and 
end up with another type,8,22 underscoring the need for 
authors to clarify the type of framework used and how it 
informed their research. Accepting the sheer complexity 
surrounding research frameworks and lamenting the 
difficulty of reducing the confusion around these terms, 
Box 226-31 and Box 3 offer examples highlighting the 
fundamental elements of theoretical and conceptual 
frameworks while acknowledging that they share a 
common purpose.

http://www.aah.org/jpcrr


6 JPCRR • Volume 11, Issue 1 • Spring 2024

Box 2:  Examples of How Theoretical Frameworks 
May Be Used
Example 1 The Southern African Association of 

Health Educationalist’s best publication 
of 2023 reported on a non-inferiority 
randomized control trial comparing video 
demonstrations and bedside tutorials for 
teaching pediatric clinical skills.26 The 
authors combined the social cognitive 
model of sequential skill acquisition27,28 and 
Peyton’s approach to teaching procedural 
and physical examination skills29,30 to 
provide the theoretical justification for 
skill demonstrations forming the first step 
in bedside teaching. This premise formed 
the basis for the study and informed the 
interpretation of the results.

Example 2 Maxwell31 describes how a researcher used 
a theoretical framework based on three 
formal theories to understand the “day-to-
day work” of a medical group practice and 
to emphasize aspects of his results. This 
example illustrates the use of existing formal 
theories (one of which Maxwell describes as 
being less “identified than the other two”) to 
understand the phenomenon of interest and 
provide a frame of reference for interpreting 
the results.

Misconceptions About Qualitative Research
Qualitative research’s “uneasy relationship with theory”4 

may be due to several misconceptions. One possible 
misconception is that qualitative research aims to build 
theory and thus does not need theoretical grounding. The 
reality is that all qualitative research methods, not just 
Grounded Theory studies focused on theory building, 
may lead to theory construction.16 Similarly, all types 
of qualitative research, including Grounded Theory 
studies, should be guided by research frameworks.16 

Not using a research framework may also be due 
to misconceptions that qualitative research aims to 
understand people’s perspectives and experiences 
without examining them from a particular theoretical 
perspective or that theoretical foundations may influence 
researchers’ interpretations of participants’ meanings. 
In fact, in the same way that participants’ meanings 
vary, qualitative researchers’ interpretations (as opposed 
to descriptions) of participants’ meaning-making will 
differ.32,33 Research frameworks thus provide a frame of 
reference for “making sense of the data.”34

Editorial

Box 3:  Examples of How Conceptual Frameworks May Be Used
There is complexity around how conceptual frameworks are developed and used to inform research design, so consider 
the following examples: the first is based on the work of one of my doctoral students in medical education (with 
permission from Dr. Neetha Erumeda). The second is a fictitious account based on the normalization process model, 
which has been used in qualitative health care research.
Example 1 In a study evaluating a postgraduate medical training program, Dr. Erumeda constructed a conceptual 

framework based on a logic model. Logic models graphically represent causal relationships between 
programmatic inputs, activities, outputs, and outcomes linearly, and they can be based on different theories, 
eg, theories of action, which focus on programmatic inputs and activities, or theories of change, which focus 
on programmatic outcomes. Dr. Erumeda based her initial CF on a formal theory of change. She then 
selected concepts to include in her logic model, based on the literature and her experiences of teaching 
in the program being evaluated. Once she had a diagrammatic representation of her logic model and the 
concepts she would focus on, she discussed the current understanding of each concept from the literature. 
After an analysis of her results, Dr. Erumeda modified her initial CF by incorporating her findings and the 
insights. Her final logic model represented a theory of action, allowing her to offer recommendations to 
improve the training program.

Example 2 To study the implementation of a complex innovation into a health care system, one might employ the 
normalization process model, which is a representation of normalization process theory. The model 
consists of four constructs regarding the innovation: 1) how it is enacted by the people doing it (interactional 
workability), 2) how it is understood within the networks of people around it (relational integration), 3) how 
it fits with existing divisions of labor (skill set workability), and 4) how it is sponsored or controlled by the 
organization in which it is taking place (contextual integration). 
 
Constructing a conceptual framework would require researchers to consider how the innovation relates to 
each of the constructs in the model, to identify concepts that make up the constructs and to consider their 
experiences of the concepts (eg, how they conceive the prevailing work ethic or experience the managerial 
hierarchy). They may also be able to postulate tentative relationships between different constructs or 
concepts or decide to focus on particular aspects of the model, which they could explore conceptually using 
the literature. Their research design would be influenced by their areas of interest, which would, in turn, 
determine their research methods. The findings could allow them to modify their model with evidence-based 
relationships and new concepts.



aah.org/jpcrr 7

Summary
Studies informed by well-defined research frameworks can 
make a world of difference in alleviating misconceptions. 
Good qualitative reporting requires research frameworks 
that make explicit the combination of relevant theories, 
theoretical constructs and concepts that will permeate 
every aspect of the research. Irrespective of the term used, 
research frameworks are critical components of reporting 
not only qualitative but also all types of research.

Acknowledgments
In memory of Martie Sanders: supervisor, mentor, and colleague. 
My deepest gratitude for your unfailing support and guidance. I 
feel your loss.

Conflicts of Interest
None.

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© 2024 Advocate Aurora Research Institute

Editorial

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	Research Frameworks: Critical Components for Reporting Qualitative Health Care Research
	Recommended Citation

	Research Frameworks: Critical Components for Reporting Qualitative Health Care Research