Smith, J., Firth, J. (2011) Qualitative data analysis: application of the framework approach.

Nurse Researcher, 18 (2): 52-62

Key Words:
Qualitative research, framework approach, patient experiences

Abstract
Qualitative methods are invaluable for exploring the complexities of healthcare, and in
particular patient experiences. There are a diverse range of qualitative methods
incorporating different ontological and epistemological perspectives. One method of data
analysis that appears to be gaining popularity among healthcare researchers is the
framework approach. We will outline the framework approach, discuss its relative merits and
provide a working example of its application.
Introduction
The framework approach was developed in the 1980’s by social policy researchers at the
National Centre for Social Research as a method to analyse qualitative data applied to policy
research. In this context the research brief is commissioned, aims and objectives are highly
focussed and the researchers’ work with structured topic guides in order to identify patterns
within the data. This contrasts with entirely inductive approaches, such as grounded theory,
were the research design is not strictly predefined but developmental in response to the data
obtained and ongoing analysis. More recently, the framework approach appears to be
gaining popularity as a means of analysing qualitative data derived from healthcare research.
The principles of the framework approach can be used to undertake qualitative data analysis
systematically. This enables the researcher to explore data in depth while simultaneously
maintaining an effective and transparent audit trail, enhancing the rigour of the analytical
processes (Ritchie and Lewis 2003). Ensuring data analysis is explicitly described enhances
the credibility of the findings. This article will provide an overview of the framework approach
as a means of analysing qualitative data. To illustrate its application, we will draw on a study
undertaken by one of the authors (JS) as part of her programme of doctoral research
investigating parents’ management of their child’s hydrocephalus and shunt.

Context
Delivering healthcare that is responsive to individual needs is an integral part of the United
Kingdom National Health Service modernisation agenda. In relation to people with long-term
conditions policy directives emphasise actively involving patients in the management of their
condition, valuing their expertise and working collaboratively with patients (Department of
Health (DH) 2001, DH 2005, DH 2007). The potential benefits of this involvement include:
empowering patients to take control of their health needs, better understanding between
patients and healthcare professionals, and patients influencing the healthcare agenda
(Simpson 2006). Eliciting and valuing the patient experience is one way of fostering greater
understanding between patients and professionals. When the patient is a child, this includes
understanding the views and experiences of their parents. Qualitative approaches are
appropriate for exploring the complexities of health and well-being and can facilitate a deep
understanding of the patient experience.

Debates about the epistemological and ontological perspectives underpinning qualitative

methods can overshadow the need to ensure that qualitative studies are methodologically
robust. Published qualitative research often lacks transparency in relation to the analytical
processes employed, which hinders the ability of the reader to critically appraise the study’s
findings (Maggs-Rapport 2001). In addition detailed published examples describing the

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stages of the data analysis have the potential to assist the novice researcher to develop the
skills required to undertake qualitative data analysis.

Approaches to qualitative data analysis

Methods for undertaking qualitative data analysis can be divided into three categories:
• Socio-linguistic methods that explore the use and meaning of language such as
discourse and conversation analysis;
• Methods that focus on developing theory, typified by grounded theory;
• Methods that describe and interpret participants’ views such as content and thematic
analysis.

Despite the diversity of qualitative methods, data is often obtained through participant
interviews. The subsequent analysis is based on a common set of principles: transcribing
the interviews; immersing oneself within the data to gain detailed insights of the phenomena
being explored; developing a data coding system; and linking codes or units of data to form
overarching categories/ themes which may lead to the development of theory (Morse and
Richards 2002). Analytical frameworks such as the framework approach (Ritchie and Lewis
2003) and thematic networks (Attride-Stirling 2001) are gaining popularity because they
systematically and explicitly apply the principles of undertaking qualitative analysis to a
series of interconnected stages that guide the process.

An overview of the framework approach

Generating themes from data is a common feature of qualitative methods and a widely used
analytical method. Thematic analysis is an interpretive process, whereby data is
systematically searched to identify patterns within the data in order to provide an illuminating
description of the phenomenon. The process results in the development of meaningful
themes without explicitly generating theory (Tesch 1990). Thematic analysis can provide rich
and insightful understandings of complex phenomena, be applied across a range of
theoretical and epistemological approaches, and expand on or test existing theory (Braun
and Clark 2006). However, thematic analysis has been criticised for lacking depth,
fragmenting the phenomena being studied, being subjective and lacking transparency in
relation to the development of themes, which can result in difficulties when judging the rigour
of the findings (Attride-Stirling 2001).

The framework approach has many similarities to thematic analysis, particularly in the initial
stages when recurring and significant themes are identified. However, analytical frameworks
such as thematic networks and the framework approach appear to have a greater emphasis

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on making the process of data analysis transparent and illustrating the linkage between the
stages of the analysis (Pope et al 2000, Ritchie and Lewis 2003, Braun and Clark 2006).
Central to the analytical processes within the framework approach is a series of
interconnected stages that enables the researcher to move back and forth across the data
until a coherent account emerges (Ritchie and Lewis 2003). This results in the constant
refinement of themes which may lead to the development of a conceptual framework.

Application of the framework approach

We independently chose the framework approach to underpin data analysis for a range of
reasons. First, the framework approach is particularly suited to the analysis of cross-
sectional descriptive data enabling different aspects of the phenomena under investigation to
be captured (Ritchie and Lewis 2003). Second, one of the advantages of the framework
approach is that researchers’ interpretations of participants’ experiences are transparent
(Ritchie and Lewis 2003). Third, for novice researchers moving from data management to
developing the analysis sufficiently to answer the research questions posed can be a
daunting and bewildering task. The interconnected stages within the framework approach
explicitly describe the processes that guide the systematic analysis of data from the
development of descriptive to explanatory accounts.

In the example we will use to illustrate the stages of analysis, JS conducted in-depth
interviews to elicit parents’ perceptions of living with a child with hydrocephalus. Shunts, the
main treatment for hydrocephalus, are problematic in that they are prone to malfunctioning
which for some children can be life threatening. Detecting shunt failure is not straightforward
because the signs and symptoms are variable, subtle and often idiosyncratic to the individual
child. Common symptoms such as headache, vomiting, and drowsiness are similar
presenting symptoms of many childhood illnesses, particularly viral infections. An interview
topic guide enabled the interviewer to: explore parents’ perceptions of living with their child
with hydrocephalus; and examine parents’ decision-making in relation to identifying shunt
malfunction and seeking healthcare advice for their child. The interviews were conducted
face to face, either with individual parents or jointly where both parents participated.
Interviews were transcribed verbatim. The next stage of the research applied the framework
approach described by Ritchie and Lewis (2003). Table 1 briefly outlines the stages of the
framework approach.

Insert table 1

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Data management using a case and theme based approach
Codes and categories were developed by considering each line, phrase or paragraph of the
transcript in an attempt to summarise what parents were describing. The process initially
involved using printed versions of the transcripts with key phrases highlighted and comments
written in the margins to record preliminary thoughts. Key phrases were summarised using
participants own words (in-vivo codes). Categories were developed from these in-vivo
codes. In-vivo codes are advocated within the framework approach as a means of staying
‘true’ to the data (Ritchie and Lewis 2003). Initial thoughts began to develop into more formal
ideas from which a coding matrix was generated. The coding index enabled changes to be
tracked and progress to be recorded. An example of the coding matrix highlighting the
processes involved in identifying codes and categories is presented in figure 1.

Insert figure 1

Identifying and testing a thematic framework

The coding matrix was developed from four family interview transcripts, which appeared to
represent a range of experiences. These parents had different experiences in relation to the
frequency of shunt complications including one family whose older child had not had any
problems with their shunt. The coding matrix and transcripts from which it was derived were
reviewed by two experienced researchers as part of the ongoing measures taken to ensure
the rigour of the study. Changes were tracked by maintaining a research journal and adding
notes to the margins of the matrix. Each in-vivo code initially formed a potential category but
as coding progressed and the number of categories developed they were grouped together
into broader categories. Similar categories were eventually brought together to form initial
themes. These categories and themes formed a coding index that was used as a means of
organised the whole data set. However, the coding index was constantly refined throughout
the process of data analysis as new insights emerged. An example of the coding index is
presented in figure 2.

Insert figure 2

Unlike policy driven research, the interview topic guide in healthcare researcher may be less
tightly focussed and a qualitative software package such as NVivo®
(www.qsrinternational.com/solutions) can aid data retrieval when searching for patterns
within the data. Initial data management was a paper based exercise using written notes
and memos, which were subsequently transferred into an NVivo® data base. As data
management progressed, NVivo® was used more intuitively with the process of tagging data

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into relevant categories shifting from a paper based exercise to directly coding data in
NVivo®. Data management using the coding retrieval and search facilities within NVivo® was
the first stage of more in-depth analysis because it facilitated preliminary thoughts to emerge
across cases and develop linkages between categories and initial themes, while retaining
links to the original data.

Coding matrices can be created using Word® or Excel® spread sheets but the process can be
unwieldy and problematic when large volumes of data are involved. Since this research was
undertaken, the National Centre for Social Research has developed a computer aided
qualitative data package specifically to assist in the application of the framework approach.
The package can be used to summarise data into a series of matrices from which it is
possible to conduct case based and thematic analysis (www.natcen.ac.uk). This may
overcome some of the inherent difficulties faced when trying to manage large volumes of
data using spread sheets. Clearly both the software and training provided by the centre has
cost implications, which will need to be factored into applications for research funding.

Development of descriptive and explanatory accounts

Descriptive accounts involve summarising and synthesising the range and diversity of coded
data by refining initial themes and categories. A crucial element within qualitative analysis is
the critical thinking that occurs in relation to how participants’ descriptions are coded, links
between codes and categories, and links between categories and themes (Ritchie and Lewis
2003). Remaining true to participants’ descriptions is a fundamental principle within the
framework approach and central when developing more abstract concepts. For the novice
researcher the movement from in-vivo codes and initial categories and themes to more
abstract concepts can seem incompatible and contradictory. Two linked processes were
undertaken to reconcile these tensions. First, data was synthesised by refining the initial
themes and categories until the ‘whole picture’ emerged whilst remaining grounded in
participant’s description. This was achieved by constantly referring back to the original
transcripts and checking meaning across interviews using Nvivo® search functions. Second,
abstract concepts were developed through the identification of key dimensions of the
synthesised data, and making associations between themes and concepts. Figure 3
provides an example of the process of moving from the initial themes and categories in the
coding index, and the links between the refined categories and final themes from which the
core concepts emerged.

Insert figure 3

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Explanatory accounts began with reflecting back on the original data as a whole, and the
analytical stages, in order to ensure the experiences and beliefs of parents were accurately
reflected and to minimise the possibility of misinterpretation. Through the application of the
framework approach three core concepts were developed that appeared to reflect parents’
accounts of living with a child with hydrocephalus. The development of the core concept
labelled uncertainty has been used to illustrate the application of the framework approach
throughout this paper. The other core concepts were becoming an expert and living a normal
life. The final stages of the framework approach involved making sense of the concepts and
themes in terms of participants’ lives and experiences. This was achieved by exploring the
relationship between the core concepts and the established literature and theoretical
perspectives relating to living with a child with a long-term condition.

Once the nature of the phenomena has been described and concepts have been identified,
typologies may emerge which explain how concepts operate (Ritchie and Lewis 2003).
Parents’ accounts of living with their child with hydrocephalus suggest the constantly
vigilance in observing their child for illness symptoms because of the unpredictable nature of
shunt malfunction is relentless. The way in which parents respond to illness episodes in their
child was considered by linking their accounts to the concept of uncertainty. Four possible
typologies that reflect an individuals’ perception of their level of confidence and control when
faced with uncertainty have been identified as; overwhelming uncertainty, role uncertainty,
pervasive uncertainty, minimal uncertainty (Penrod 2007). Parents’ lack of control in relation
to preventing shunt function positioned them in the typology described as overwhelming
uncertainty. This may explain the reason parents’ accounts of living with their child with
hydrocephalus were dominated by the possibility that their child’s shunt could malfunction at
any time.

Our experiences of undertaking qualitative data analysis share similarities with the
experiences of other novice qualitative researchers (Li and Seale 2007). The first challenge
related to the process of attaching labels to preliminary codes which were initially abstract in
nature and did not fully represent the extracts from which they were derived. Although our
enthusiasm remained throughout, we grossly underestimated the time required to undertake
the early the stages of the analysis. Yet these stages are essential if the findings are to be
credible. In our separate studies we valued working with experienced researchers who were
willing to challenge assumptions and decisions at each stage of the analysis, adding to the
rigour of the research. Sufficient time needs to be allocated to evaluating initial thoughts and
reflecting on the relationships between ideas and participants’ accounts. Asking the question
‘what are participants really trying to describe?’ when considering sections of the data and

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using participants own words whenever possible assisted with ensuring the process of
labelling the data reflected participants’ accounts.

For part-time students, other work commitments can make it difficult to re-engage with the
data after a period away from the data but can prevent over-immersion. Retuning to data
analysis after a time-out period and reading all the transcripts again to consider the
phenomena as a whole resulted in the process of data analysis becoming much more
meaningful. Forward and backward movement between the data as a whole, individual
participant accounts and cross linkage with initial categories resulted in the emergence of the
final categories and the development of the final conceptual framework that describes
parents’ accounts. This iterative process resonates with the central tenant of the framework
approach that the interconnected stages are not linear, but a scaffold that guides the analysis
(Ritchie and Lewis 2003).

Conclusion
We have found the framework approach a valuable tool for data analysis in qualitative
healthcare research. For researchers engaging with qualitative research for the first time, it
provides an effective route map for the journey and facilities both a case and theme based
approach to data analysis. We have given examples where the context of the patient
experiences has been retained while exploring associations and explanations within the data
and drawing on existing theories and established literature. The process enables the
researcher to track decisions which ensures links between the original data and findings are
maintained and transparent. This adds to the rigour of the research process and enhances
the validity of the findings.

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References
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57 (6): 238 - 245
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Table 1: Overview of the framework approach (adapted from Ritchie and Lewis 2003)

Stages
Data management Descriptive accounts Explanatory accounts

• Becoming familiar • Summarising and • Developing associations/

with the data (reading synthesising the patterns within concepts and
and re-reading) range and diversity of themes
coded data by
• Identifying initial • Reflecting back on the
refining initial themes
themes/ categories original data and analytical
and categories
stages in order to ensure
Processes

• Developing a coding
• Identify association participant accounts are
index
between the themes accurately presented thereby
• Assigning data to the until the ‘whole reducing the possibility of
themes and picture’ emerges misinterpretation
categories in the
• Developing more • Interpreting and explaining
coding index
abstract concepts the concepts and themes
• Seeking wider application of
concepts and themes

Continuum

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Figure 1: Example of the coding matrix used to identify codes and categories

Interview transcript: Description Preliminary Initial

Family 11, child 5 years, many (in-vivo codes) thoughts (what categories*
hospital admissions, 3 shunt is this about)
revisions

‘You know if your child is being ‘know …your Knowing Recognising

sick whether they are poorly or child’ something is when the
not’. Dad wrong child is ill

‘out of hours that they tend to ‘unsure’ Uncertainty Uncertainty:

keep her in … I think it is the out whether to access out of when to
of hours that we find difficult, if access out of hours services access
we are unsure…. hours services services
if we go out of hours service we ‘know will be Experience/
know that we will be admitted. admitted’ views of out of Views about
So we tend to wait a bit longer’. ‘wait a bit’ hours services services
Mum Trying to decide
what to do Making
decisions

* some of the initial categories became themes (for example recognising when the child is ill)
or core concepts (for example uncertainty)

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Figure 2: An example of the coding index

Initial themes Initial categories

Uncertainty Immediate impact of the condition

Long-term effects of the condition
Child becoming independent
Child’s development
Embarking on family activities
Responding to the Recognising when the child is ill
child’s needs Experiences of shunt complications
Beliefs about the signs of shunt malfunction
Recognising when the child’s illness is due to shunt
malfunction
Feelings relating to the possibility of child’s shunt
malfunctioning
Seeking help for child
Taking precautions to protect child because of having a
shunt
Making allowances for child because of hydrocephalus
Explaining hydrocephalus to child
Supporting child to develop
Making decisions Making choices about treatment options
Beliefs about involvement in healthcare decisions
Deciding if illness is due to shunt problem or not
Deciding when to access healthcare services
Lifestyle choices
Family activities
Factors that influence decision making
Feelings about making decisions

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 Figure 3: Developing the core concept, labelled uncertainty, and the final themes
within the concept

Initial Initial categories Refined Final themes Core Concept

themes categories
Parents • Anxiety about child becoming ill
concerns • Anxiety about recognising Shunt related
shunt malfunction concerns
• Worry about others being Detecting
able to recognise shunt Concerns about shunt
malfunction the child’s future malfunction
• Anxious about child’s future

Support • Sources of
systems information/support Support needs
• Barriers to gaining
information
• Aids to gaining information
• Barriers to accessing
support systems
Receptiveness
• Aids to accessing support of
systems professionals
• Experiences of healthcare interacting with
professionals ability to the child and
recognise shunt family
malfunctions
• Experiences of healthcare Barriers and
facilitators UNCERTAINTY
system in relation to
meeting the needs of the relating to
child and family support
systems
• Interactions with healthcare
professionals
• Experiences of working in
Perceptions of
partnership with healthcare Reactions to
service
professionals child being
provision in
• Experiences of the ability of relation to diagnosed with
education system to meet meeting the hydrocephalus
the needs of the child and needs of the
family child and family
• Experiences of voluntary
support agencies

Uncertainty • Immediate effects of the Reactions to the

condition diagnosis
• Long-term effects of the
condition The impact on
• Child becoming the child’s
independent Uncertain future and
• Child’s development effects of gaining
• Embarking on family hydrocephalus independence
activities for the child and
family

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