Short Reports

Phenomenology for primary care researchers

Robert Mash, Febisola Ajudua, Sebaka Malope, Doreen Kaura

Received: 26 Feb. 2025; Accepted: 07 Apr. 2025; Published: 28 May 2025

Copyright: © 2025. The Author(s). Licensee: AOSIS.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Primary care researchers often turn to qualitative methodologies to explore people’s perspectives and experiences. Phenomenology is appropriate when the focus is on lived experiences, rather than ideas, beliefs, opinions or perceptions. Phenomenology has its roots in German philosophy and the social sciences, and doctoral students as well as researchers in the health sciences may struggle to understand the paradigm and apply it practically. This article attempts to make sense of the paradigm and two of its key threads, namely descriptive and interpretive phenomenology. The key principles of both approaches and the practical methodological steps are outlined. In addition, examples are given, and the two approaches are compared. Finally, the article discusses trustworthiness and quality criteria in phenomenology.

Keywords: primary care; methodology; phenomenology; descriptive phenomenology; interpretive phenomenology; research methods.

Introduction

Primary care researchers often turn to qualitative methodologies to explore questions related to people’s ideas, beliefs, opinions, perceptions, satisfaction and experiences. Phenomenology is one of the qualitative methods that such researchers are embracing, and yet it is frequently misunderstood. It is not uncommon for peer reviewers to question whether the study design is really phenomenology. In this article, we outline the phenomenological approach to qualitative research for primary care and family medicine researchers embedded in the health sciences. We have attempted to plot a practical path that doctoral researchers can follow while maintaining connection to the theoretical and philosophical roots.

A phenomenon has been defined ‘as something that exists and can be seen, felt, tasted, etc., especially something unusual or interesting’.¹ For primary care researchers, this might be how patients experience a condition or health care, for example, the experience of living with diabetes or attending the clinic when you are pregnant. It could also focus on the experience of healthcare workers, for example, the experience of working in a field hospital during the coronavirus disease 2019 (COVID-19) pandemic. Understanding subjective experiences can contribute to improved holistic care.

Research questions might be phrased as ‘What is it like to experience …?’ or ‘How do people experience …?’ and then focus on the phenomenon of interest.

Phenomenology as a research paradigm

Phenomenology was conceptualised by German philosophers in the 19th century who were interested in exploring people’s lived experiences.² They were moving away from the positivist paradigm, which remains the dominant paradigm in health sciences, towards what is now called the interpretive-hermeneutic paradigm. Much of the methodological discourse on phenomenology emanates from the social sciences and has only more recently been embraced by the health sciences, particularly in nursing.

In this paradigm, reality is not seen as a single objective truth that can be measured but as multiple subjective truths that are socially constructed and can be observed, described, explored and interpreted.³ The same phenomenon can be experienced differently by people, and all these experiences are valid. New knowledge is constructed through interacting with these multiple realities and interpreting them. The methodology, therefore, is characterised by an approach that is explorative, creative and reflective and seeks to understand what people experience regarding the phenomenon of interest.

It should be emphasised that the focus is on the nature of this lived experience and what it means to people, and not on the causes of the experience or the extent of the phenomenon. For example, for people living with diabetes, the focus would be on people’s experience of the condition and not on why they have diabetes or how many people have diabetes. Likewise, if the focus is on people’s opinions, beliefs or perceptions, this would not be phenomenology. For example, asking healthcare workers their perceptions of why people struggle to use insulin would not be phenomenology, as they are not reporting on their own lived experience. Such study designs are often labelled as exploratory descriptive qualitative studies. Primary care and family medicine researchers, however, tend to be practical and are usually not interested in a phenomenon for its own sake but because the findings will have implications for improving people’s health and wellness, the quality of care or patient safety.

Within phenomenology, there are also different traditions and approaches. Descriptive (also known as transcendental) and interpretive (also known as hermeneutic) phenomenology will be described in this article.⁴ One of the key differences in these traditions is that descriptive phenomenology intends to describe the essential characteristics or essence of a particular phenomenon. There is a belief that the essential essence can be distilled and described. On the other hand, interpretive phenomenology intends to explore the meaning of the phenomenon to people in a particular historical and social context while accepting that such meaning is dynamic and forever changing. Table 1 juxtaposes key methodological differences between these approaches, which are further described in the following sections.

Descriptive phenomenology

Descriptive phenomenology intends to explore people’s conscious experience of a phenomenon and describe its critical or universal components. A key principle is called reduction, where the researcher attempts to remove all assumptions, judgements and presuppositions about the phenomenon and to focus on describing the direct, immediate, lived experience and get to the universal essence of the phenomenon. This is also referred to as bracketing or removing one’s own perspective from the research process.

Therefore, in data collection and analysis, the researcher tries to ‘bracket’ or remove their own experiences, biases or assumptions from the process (also referred to as epoché in some articles). They attempt to suspend their common-sense assumptions, predispositions based on past events or suppositions based on prior theories. When using descriptive phenomenology, begin by bracketing to be aware of and set aside your own assumptions. How such reflexivity was attempted should be described in the report. One way of doing this is to consciously adopt the stance of a stranger who has never encountered this phenomenon before when collecting data.

Intentionality is a key concept in descriptive phenomenology. Researchers understand that our consciousness does not exist in isolation, but our thoughts, perceptions and experiences are always directed towards an object, event or situation. Consciousness is always intentional and focused on something. The subject of the research with their consciousness is always connected to the object being experienced. The focus is on understanding how things appear to us and how they are experienced.

Both Giorgi and Colaizzi have described very similar processes in the analysis of data:^5,6

• Step 1: Immerse yourself in the data as a whole by reading all the transcripts in their entirety.
• Step 2: Go back to each transcript and extract significant statements or identify meaning units that reflect different aspects of the participant’s experiences, thoughts, feelings and perceptions regarding the phenomenon.
• Step 3: Re-formulate these statements or transform these meaning units into a more concise and abstract summary of what was experienced.
• Step 4: Cluster these statements into groups or categories based on how they connect and reflect a broader pattern in the data.
• Step 5: Based on these categories, the researcher describes the key themes and identifies the essence of the phenomenon. The themes should be described comprehensively with a rich description.

Colaizzi goes on to recommend participant validation as the next step with a final integration of the themes into a coherent theoretical understanding of the phenomenon. Box 1 provides an example of a published study using descriptive phenomenology.

In some ways, this approach is a bridge between a more positivist mindset and an interpretivist one. The idea that a phenomenon has universal components and the attempt to separate oneself from it implies a belief that one can stand back and describe a phenomenon in isolation from oneself, the context and change over time. Interpretive phenomenology grew out of descriptive phenomenology and may have more utility for primary care researchers.

Interpretive phenomenology

Interpretive phenomenology goes beyond describing the essence of the phenomenon to making sense of what it means for the people involved.⁸ Attention is also given to the historical, cultural and social context which influences how people attribute meaning. The importance of language is acknowledged, as meaning can literally be lost in translation.

In interpretive phenomenology, the idea that one can somehow separate oneself from the phenomenon and describe its essence from a distance is negated. The phenomenon is seen as dynamic, constantly evolving while existing in individual consciousness. One may be able to interpret meaning at a point in time, but one never arrives at a final truth. You are always on a journey, and the truth is a moving target interpreted from multiple realities.

For the same reasons, the intersubjectivity of the researcher and the researched is embraced, and bracketing is not seen as possible. While the researcher focuses on collecting and interpreting the data, they understand that they cannot isolate themselves from their own presuppositions and experiences. The researcher co-constructs their interpretation with participants while constantly being aware of and reflecting on their own experience and position. A reflective journal of one’s own history and experience with the phenomenon can be helpful. Sometimes one’s own position can be revealed by having a colleague interview you about your own experience or perceptions. In this approach, a researcher with prior experience in a phenomenon will be more suited to use interpretive phenomenology because they have insight into the phenomenon.

Study setting

All research studies should describe the setting. In qualitative studies, this is particularly important to inform the reader and enable a judgement about the transferability of the findings. In interpretive phenomenology, the historical, cultural and social context in which people experience the phenomenon is of special importance.

Study population, sample size and sampling

The study population should be defined in terms of who has a lived experience of the phenomenon. People are purposefully selected because they have a lived, unique and diverse experience of the phenomenon. The intention is maximum variation in the sampling to explore all the different ways in which people have experienced the phenomenon. The concept of saturation is used to determine the sample size so that people’s lived experiences are explored until no new insights are obtained.

Data collection

Data is usually collected by interviewing people with the experience you are interested in. Unstructured in-depth interviews may be of more value than semi-structured ones, as there are no prior assumptions about the critical components of the experience that should be explored. The interview guide in semi-structured interviews will plan the topics to explore. In unstructured interviews, after the initial question, the interviewer will explore whatever aspects of the experience the person sees as important. Remember that the focus is on the actual experience, an account of how they lived through the experience, rather than their abstract conceptualisations about it. Ask for stories, accounts or specific examples of experiences. An opening question should be constructed that is aligned with this intention and stated in the methods when you report on the study. The goal is to allow participants to tell a story while expressing their thoughts, emotions and reflections and to provide deep insights into the phenomenon under study.

The interviewer must have good communication skills to enable an in-depth conversation while following the person’s story. Typically, an interview will last an hour. The communication style will be one of openness, acceptance, non-judgement and curiosity. Communication skills in active listening, open questions and clarification will be important. The interview will be recorded and a verbatim transcript will be created and checked.

Data analysis

Data collection and analysis may be concurrent. In addition, follow-up interviews with the same people may validate their transcript, gather more data or check the interpretation. Researchers should be cautious of rushing to conclusions and should hold their initial analytical ideas lightly. Analysis will focus more on what is being experienced (events and emotions) and what it means to the individuals, rather than trying to uncover universal aspects of the phenomenon as in descriptive phenomenology. From an ethical perspective, the exploration of what the experience means for the person can raise difficult or challenging emotions, and psychological support may be needed or anticipated.⁹

All statements should be treated as equally important while developing meanings and clustering themes. No elements of the experience should be arbitrarily excluded because they seem bizarre, irrational or contradictory. The researcher should not edit or order the nature of people’s experiences to make them more coherent.

It is necessary to note that the choice of philosophical perspective, whether descriptive or interpretive, influences the choice of data analysis framework. In either case, qualitative data analysis software, such as ATLAS.ti, can assist the process and make the audit trail easy to follow. In broad terms, the data analysis process follows these steps^10,11:

• Familiarise yourself with all the data. By listening again to the tapes as well as reading and re-reading the transcripts, you immerse yourself in the participants’ experiences.
• Return to each transcript individually. From the data, make notes on language, emotions, events and the emergent meanings of the experiences. Be aware of your own reactions and make notes to assist personal reflexivity.
• Identify initial emergent themes from your notes on the transcript that capture the core aspects of the experiences and what they mean.
• Search for connections between themes in the transcript and refine the themes through grouping, splitting, combining or discarding themes.
• Synthesise themes across all transcripts and ensure they are distinct and communicate the essence of the phenomenon and how people made sense of it.
• Write up the themes as a narrative that grounds them in the data and aligns with the research question and the principles of interpretive phenomenology (e.g. historical context, researcher’s reflexivity). The researchers must provide a rich, detailed account of participants’ experiences through direct quotations that illustrate the emergent meanings and themes. In the health sciences, the discussion section of an original research article is then used to discuss how these themes relate to existing literature.

Box 2 summarises a published example of interpretive phenomenology.

Trustworthiness

Van Manan is one of the thought leaders in interpretive phenomenology and has described a 6-step approach as shown in Table 2.¹³ Some authors say that they used this approach to guide data analysis; however, the steps guide the whole approach to the methods. The traditional criteria for trustworthiness in qualitative studies can be applied to phenomenology, as shown in Table 3.¹⁴

De Witt has also attempted to provide a framework for the critical appraisal of rigour in interpretive phenomenology, as shown in Table 4.¹⁵ While these elements are embedded in the phenomenological approach, they do not all seem easy or practical to implement. Resonance and actualisation cannot be judged without engaging current or future readers of the work, and even then, it is not clear how these would be determined. Balanced integration appears to expect that the methods and findings will align with the key principles of phenomenology, derived from the original philosophers. Openness and concreteness appear more applicable to judging the rigour of a manuscript or report.

Conclusion

The field of phenomenology has different traditions, and it may be difficult to completely hold fast to one approach. The field is defined by a focus on exploring people’s lived experiences, rather than their ideas, beliefs, or perspectives. Primary care researchers may struggle with the underlying philosophical debates while seeking practical guidance on how to conduct rigorous phenomenology. This article provides an overview of the research paradigm while outlining the practical steps needed to conduct primary care and family medicine research.

Acknowledgements

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article. R.M. declares that he is the Editor-in-Chief and D.K. is a section editor of the African Journal of Primary Health Care & Family Medicine. The peer review process for this submission was handled independently, and the authors had no involvement in the editorial decision-making process for this article. The authors has no other competing interests to declare.

R.M. drafted the article, which was then edited and revised by F.A., S.M. and D.K. All authors approved the final manuscript.

This publication was funded by the NIHR (NIHR158451) using UK international development funding from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government. See: https://www.nihr.ac.uk/nihr-global-health-research-branding-guide.

The views and opinions expressed in this article are those of the authors. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article’s results, findings and content.

References