The Qualitative Content Analysis Process

JAN RESEARCH METHODOLOGY
The qualitative content analysis process

Satu Elo & Helvi Kyngäs
Accepted for publication 22 November 2007
Correspondence to S. Elo: A S H . ( 2 0 0 8 ) The qualitative content analysis process. Journal of

E L O S . & K Y N G Ä
e-mail: [email protected] Advanced Nursing 62(1), 107–115
doi: 10.1111/j.1365-2648.2007.04569.x
Satu Elo PhD RN
Senior Lecturer
Abstract
Department of Nursing and Health
Administration, University of Oulu, Title. The qualitative content analysis process.
Finland Aim. This paper is a description of inductive and deductive content analysis.
Background. Content analysis is a method that may be used with either qualitative
Helvi Kyngäs PhD RN or quantitative data and in an inductive or deductive way. Qualitative content
Professor analysis is commonly used in nursing studies but little has been published on the
Department of Nursing and Health analysis process and many research books generally only provide a short description
Administration, University of Oulu,
of this method.
Finland
Discussion. When using content analysis, the aim was to build a model to describe
the phenomenon in a conceptual form. Both inductive and deductive analysis pro-
cesses are represented as three main phases: preparation, organizing and reporting.
The preparation phase is similar in both approaches. The concepts are derived from
the data in inductive content analysis. Deductive content analysis is used when the
structure of analysis is operationalized on the basis of previous knowledge.
Conclusion. Inductive content analysis is used in cases where there are no previous
studies dealing with the phenomenon or when it is fragmented. A deductive approach
is useful if the general aim was to test a previous theory in a different situation or to
compare categories at different time periods.
Keywords: concept formation, content analysis, deductive, inductive, nursing,

research methods
concerning content analysis [CINAHL and Ovid Medline(r)

Introduction
published from 1988 to 2005 was only 15 (Table 2)].
There are numerous approaches for analysing qualitative The aim of this paper was to describe inductive and
data. Content analysis is used in many studies in nursing and deductive content analysis based on theoretical knowledge
it has a long history. Even if qualitative content analysis is and to highlight some examples from studies using content
generally used in nursing studies little has been published on analysis, mainly based on content analysis of the methodo-
how to apply the method. Information retrieval on the logical papers listed in Table 1.
CINAHL and Ovid Medline(r) databases showed that con-
tent analysis was often presented as a keyword but not so
Background
often in the title. Table 1 shows how the number of papers for
which content analysis is given as a keyword has increased, Content analysis is a method of analysing written, verbal or
and most of these (70%) have been published in the 21st visual communication messages (Cole 1988). It was first used
century. The total number of methodological papers as a method for analysing hymns, newspaper and magazine
2007 The Authors. Journal compilation 2007 Blackwell Publishing Ltd 107
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S. Elo and H. Kyngäs
Table 1 Journal articles in CINAHL and Ovid Medline(r) databases In nursing it is mostly used in psychiatry, gerontological and
using content analysis as a keyword public health studies (Table 1).
Ovid Content analysis as a research method is a systematic and
CINAHL Medline(r) objective means of describing and quantifying phenomena
Journal articles n n (Krippendorff 1980, Downe-Wamboldt 1992, Sandelowski
As a keyword 7902 59,119 1995). It is also known as a method of analysing documents.
As a keyword Psychiatry/psychology 713 * Content analysis allows the researcher to test theoretical
*
and concerning: Gerontologic care 441 issues to enhance understanding of the data. Through content
*
Public health 389 analysis, it is possible to distil words into fewer content-
*
Nursing education 314
* related categories. It is assumed that when classified into the
Advanced nursing practice 310
Evidence-based practice 176 * same categories, words, phrases and the like share the same
Occupational therapy 165 * meaning (Cavanagh 1997).
*
Critical care 148 Content analysis is a research method for making replica-
*
Quality assurance 78 ble and valid inferences from data to their context, with the
*
Informatics 74 purpose of providing knowledge, new insights, a representa-
*
Emergency care 73
* tion of facts and a practical guide to action (Krippendorff
Home health care 71
Hospice/palliative care 7 * 1980). The aim is to attain a condensed and broad descrip-
Nursing administration 1 * tion of the phenomenon, and the outcome of the analysis is
Published in 2000–2007 5582 19,784 concepts or categories describing the phenomenon. Usually
2007 (January–August) 278 1312 the purpose of those concepts or categories is to build up a
2006 962 3096
model, conceptual system, conceptual map or categories. The
2005 980 3156
2004 868 2911
researcher makes a choice between the terms ‘concept’ and
2003 818 2536 ‘category’ and uses one or the other (Kyngäs & Vanhanen
2002 642 2221 1999). For example, if the purpose of the study is to develop a
2001 540 2242 theory, it is recommended that the term ‘concept’ be used as a
2000 494 2310 proxy for ‘category’. However, in this paper, when describing
1990–2000 2804 23,400
the analysis process, we use the term ‘category’ because this is
1990–1995 902 11,038
1995–2000 2180 14,318 mostly used in literature.
The method found its critics in the quantitative field, who
*Information not available.
considered it to be a simplistic technique that did not lend
itself to detailed statistical analysis, while others considered
Table 2 Number of journal articles with content analysis in the title that content analysis was not sufficiently qualitative in nature
Ovid (Morgan 1993). In the early days, the differentiation of
Journal articles CINAHL n Medline(r) n content analysis was limited to classifying it primarily as a
In a title (content anal$) 178 496 qualitative vs. quantitative research method (Hsieh & Shan-
Published in 2000–2007 100 196 non 2005). According to Weber (1990), it is possible to attain
2006 16 30 simplistic results by using any method whatsoever if skills of
2005 15 27 analysis are lacking. The truth is that this method is as easy or
2004 14 27
as difficult as the researcher determines it to be (Neundorf
2003 16 18
2002).
2002 10 15
2001 7 14 Despite criticism, content analysis has an established
2000 16 23 position in nursing research and offers researchers several
Published in 1990–1995 33 112 major benefits. One of these is that it is a content-sensitive
Published in 1995–1999 38 70 method (Krippendorff 1980), and another is its flexibility in
terms of research design (Harwood & Garry 2003). It is also
articles, advertisements and political speeches in the 19th much more than a naive technique that results in a simplistic
century (Harwood & Garry 2003). Today, content analysis description of data (Cavanagh 1997) or a counting game
has a long history of use in communication, journalism, (Downe-Wamboldt 1992). Concept analysis can be used to
sociology, psychology and business, and during the last few develop an understanding of the meaning of communication
decades its use has shown steady growth (Neundorf 2002). (Cavanagh 1997) and to identify critical processes (Lederman
108 2007 The Authors. Journal compilation 2007 Blackwell Publishing Ltd
JAN: RESEARCH METHODOLOGY The qualitative content analysis process
1991). It is concerned with meanings, intentions, conse- unit of analysis can also be a letter, word, sentence, portion of
quences and context (Downe-Wamboldt 1992). pages or words, the number of participants in discussion or
the time used for discussion (Robson 1993, Polit & Beck
2004).
Process of analysis
Graneheim and Lundman (2004) pointed out that the most
suitable unit of analysis is whole interviews or observational
Two approaches
protocols that are large enough to be considered as a whole
Content analysis is a method that may be used with either and small enough to be kept in mind as a context for meaning
qualitative or quantitative data; furthermore, it may be used unit during the analysis process. When starting the analysis,
in an inductive or deductive way. Which of these is used is the researcher must also decide whether to analyse only the
determined by the purpose of the study. If there is not enough manifest content or the latent content as well. The aim with
former knowledge about the phenomenon or if this knowl- latent content is also to notice silence, sighs, laughter, posture
edge is fragmented, the inductive approach is recommended etc. (Catanzaro 1988, Robson 1993, Morse 1994, Burns &
(Lauri & Kyngäs 2005). The categories are derived from the Grove 2005). There has been some debate as to whether
data in inductive content analysis. Deductive content analysis hidden meanings found in documents can be analysed,
is used when the structure of analysis is operationalized on because their analysis usually involves interpretation. Accord-
the basis of previous knowledge and the purpose of the study ing to Robson (1993), researchers are guided by the aim and
is theory testing (Kyngäs & Vanhanen 1999). An approach research question of the study in choosing the contents they
based on inductive data moves from the specific to the analyse.
general, so that particular instances are observed and then Next in the analytic process, the researcher strives to make
combined into a larger whole or general statement (Chinn & sense of the data and to learn ‘what is going on’ (Morse &
Kramer 1999). A deductive approach is based on an earlier Field 1995) and obtain a sense of whole (Tesch 1990,
theory or model and therefore it moves from the general to Burnard 1991). According to Dey (1993), when reading the
the specific (Burns & Grove 2005). These approaches have data the questions are:
similar preparation phases.
who is telling?
where is this happening?

Preparation phase
when did it happen?
Both inductive and deductive analysis processes are repre-
sented as three main phases: preparation, organizing and what is happening?
reporting (Figure 1). Despite this, there are no systematic
why?
rules for analysing data; the key feature of all content analysis
is that the many words of the text are classified into much The aim is to become immersed in the data, which is why
smaller content categories (Weber 1990, Burnard 1996). The the written material is read through several times (Burnard
preparation phase starts with selecting the unit of analysis 1991, Polit & Beck 2004). No insights or theories can spring
(McCain 1988, Cavanagh 1997, Guthrie et al. 2004). This forth from the data without the researcher becoming com-
can be a word or a theme (Polit & Beck 2004). Deciding on pletely familiar with them (Polit & Beck 2004). After making
what to analyse in what detail and sampling considerations sense of the data, analysis is conducted using an inductive or
are important factors before selecting the unit of analysis deductive approach (Kyngäs & Vanhanen 1999).
(Cavanagh 1997). The sample must be representative of the
universe from which it is drawn (Duncan 1989). Probability
Inductive content analysis
or judgement sampling is necessary when a document is too
large to be analysed in its entirety (GAO 1996). A unit of If the researcher has chosen to use inductive content analysis,
meaning can consist of more than one sentence and contain the next step is to organize the qualitative data. This process
several meanings. On that account, using it as a unit of includes open coding, creating categories and abstraction.
analysis makes the analysis process difficult and challenging Open coding means that notes and headings are written in the
(Catanzaro 1988, Graneheim & Lundman 2004). On the text while reading it. The written material is read through
other hand, an analysis unit that is too narrow, for example again, and as many headings as necessary are written down in
one word, may result in fragmentation (Graneheim & the margins to describe all aspects of the content (Burnard
Lundman 2004). Depending on the research question, the 1991, 1996, Hsieh & Shannon 2005). The headings are
Preparation phase
Inductive approach Deductive approach
Selecting the unit of

analysis
Making sense of the data

and whole
Organising phase
Developing analysis Developing structured

Open coding
matrice analysis matrice
Data coding according the

Coding sheets Data gathering by content
categories
Hypothesis testing,
Grouping correspondence comparison
to earlier studies etc.
Categorization
Abstraction
Reporting the analyzing process and the results
Model, conceptual system, conceptual map or categories
Figure 1 Preparation, organizing and resulting phases in the content analysis process.
collected from the margins on to coding sheets (Cole 1988, example of the abstraction process is shown in Figure 2.
Downe-Wamboldt 1992, Dey 1993) and categories are freely Inductive content analysis has been used, for example, in
generated at this stage (Burnard 1991). studies of the environment that supports well-being in older
After this open coding, the lists of categories are grouped people (Juvani et al. 2005), support networks of adolescents
under higher order headings (McCain 1988, Burnard 1991). with chronic disease (Kyngäs 2004) and men’s experiences of
The aim of grouping data was to reduce the number of heart failure (Europe & Tyni-Lenne 2004).
categories by collapsing those that are similar or dissimilar
into broader higher order categories (Burnard 1991, Downe-
Deductive content analysis
Wamboldt 1992, Dey 1993). However, Dey (1993) points
out that creating categories is not simply bringing together Deductive content analysis is often used in cases where the
observations that are similar or related; instead, data are researcher wishes to retest existing data in a new context
being classified as ‘belonging’ to a particular group and this (Catanzaro 1988). This may also involve testing categories,
implies a comparison between these data and other observa- concepts, models or hypotheses (Marshall & Rossman 1995).
tions that do not belong to the same category. The purpose of If a deductive content analysis is chosen, the next step is to
creating categories is to provide a means of describing the develop a categorization matrix (Table 3) and to code the
phenomenon, to increase understanding and to generate data according to the categories (Table 4). In deductive
knowledge (Cavanagh 1997). When formulating categories content analysis, either a structured or unconstrained matrix
by inductive content analysis, the researcher comes to a of analysis can be used, depending on the aim of the study
decision, through interpretation, as to which things to put in (Kyngäs & Vanhanen 1999). It is generally based on earlier
the same category (Dey 1993). work such as theories, models, mind maps and literature
Abstraction means formulating a general description of the reviews (Sandelowski 1995, Polit & Beck 2004, Hsieh &
research topic through generating categories (Robson 1993, Shannon 2005).
Burnard 1996, Polit & Beck 2004). Each category is named After a categorization matrix has been developed, all the
using content-characteristic words. Subcategories with simi- data are reviewed for content and coded for correspondence
lar events and incidents are grouped together as categories with or exemplification of the identified categories (Polit &
and categories are grouped as main categories (Dey 1993, Beck 2004). When using an unconstrained matrix, different
Robson 1993, Kyngäs & Vanhanen 1999). The abstraction categories are created within its bounds, following the
process continues as far as is reasonable and possible. An principles of inductive content analysis. If the matrix is
Sub-category Generic category Main category
Cold symptoms
Temperature variation
Heat symptoms
Decrease of mood
Tiredness Threats of the northern
Darkness
Weakness physical environment
Apathy
Difficulties to move outside

Snow-blindness Snow & ice
Snowbound
Figure 2 An example of the abstraction
process. Risk of fall
Table 3 An example from a categorization matrix validity in content analysis are universal to any qualitative
Dependence Worries Sadness Guilt
research design there are additional factors to take into
consideration when reporting the process of analysis and the
What kind of mental results.
well-being threats
The results are described contents of the categories, i.e. the
does diabetes have
for adolescents? meanings of the categories. The content of the categories is
described through subcategories (Marshall & Rossman
1995). Creating categories is both an empirical and a
structured, only aspects that fit the matrix of analysis are conceptual challenge, as categories must be conceptually
chosen from the data (Patton 1990, Sandelowski 1993, and empirically grounded (Dey 1993). Successful content
1995). This can also be called testing categories, concepts, analysis requires that the researcher can analyse and
models or hypotheses (Marshall & Rossman 1995). When simplify the data and form categories that reflect the subject
using a structured matrix of analysis, it is possible to choose of study in a reliable manner (Kyngäs & Vanhanen 1999).
either only the aspects from the data that fit the categoriza- Credibility of research findings also deals with how well the
tion frame or, alternatively, to choose those that do not. In categories cover the data (Graneheim & Lundman 2004).
this way, aspects that do not fit the categorization frame can It is important to make defensible inferences based on the
be used to create their own concepts, based on the principles collection of valid and reliable data (Weber 1990). To increase
of inductive content analysis. the reliability of the study, it is necessary to demonstrate a link
The choice of method depends on the aim of the study between the results and the data (Polit & Beck 2004). This is
(Catanzaro 1988, Robson 1993, Marshall & Rossman 1995). why the researcher must aim at describing the analysing
For example, categories used to describe the different process in as much detail as possible when reporting the
meanings that the concept of illness has for teenagers with results. Appendices and tables may be used to demonstrate
diabetes could be used as a frame of categorization when links between the data and results. To facilitate transfer-
analysing interviews with teenagers suffering from rheuma- ability, the researcher should give a clear description of the
toid arthritis. In this case, the aim would be to test whether context, selection and characteristics of participants, data
illness has the same meaning for teenagers suffering from collection and process of analysis (Graneheim & Lundman
rheumatoid arthritis as for those with diabetes (Kyngäs & 2004). Demonstration is needed of the reliability of the
Vanhanen 1999). Deductive content analysis has been used findings and interpretations to enable someone else to follow
for example in studies of patients’ readiness for dietary the process and procedures of the inquiry.
change (Kasila et al. 2003), self-care of older people Authentic citations could also be used to increase the
(Backman & Hentinen 2001) and mental health care (Latvala trustworthiness of the research and to point out to readers
et al. 2000). from where or from what kinds of original data categories are
formulated (Patton 1990, Sandelowski 1993). The researcher
should make sure that informants are not identified by quotes
Trustworthiness
from the data (Ford & Reutter 1990). There has been some
The analysis process and the results should be described in debate about the suitable amount of authentic citation. In our
sufficient detail so that readers have a clear understanding of experience, if there are more citations than authorial text,
how the analysis was carried out and its strengths and then the analysis process is usually incomplete.
limitations (GAO 1996). This means dissection of the The internal validity of content analysis can be assessed as
analysis process and the validity of results. Elements of face validity or by using agreement coefficients (Weber 1990).
Table 4 An example of coding the data

Dependence Worries
to the categorization matrix
What kind of mental Dependence on parents Worries about future
well-being threats Dependence on insulin Worries about health conditions
does diabetes have Dependence on nurses Worries about future occupation
for adolescents? Dependence on physicians Worries about getting a family
Dependence of regular Worries about having the energy
daily life to take care of oneself
The analysis process has been little discussed in literature,

What is already known about this topic possibly because content analysis has in the past been
• Content analysis is used in many studies in nursing and criticized for being an overly simple method. The most
it has a long history, but there has been little discussion paralysing moment in conducting content analysis is simply
of its use. getting started. Researchers should allow themselves simply
• Content analysis may be used with either qualitative or to read through each interview as many times as necessary to
quantitative data and in an inductive or deductive way. apprehend its essential features, without feeling pressured to
• Content analysis is a flexible method and there are no move forward analytically (Sandelowski 1995). They often
simple guidelines for data analysis, which makes it see the beginning of the categorization phase as chaotic,
challenging for the researcher. because at that point they possess several, seemingly uncon-
nected, pieces of information (Backman & Kyngäs 1998).
Another problem may be that narrative material is generally
What this paper adds not linear, and paragraphs from transcribed interviews may
• Content analysis is extremely well-suited to analysing contain elements relating to several categories (Dey 1993,
data on the multifaceted, sensitive phenomena char- Polit & Beck 2004). According to Glaser (1978), tolerance of
acteristic of nursing. feeling uncertain is required. To resolve the situation, it is
• The use of inductive content analysis is recommended also necessary to be prepared to go back to the data to check
when there are no previous studies dealing with the the reliability of the categories. The assumption that content
phenomenon or when knowledge is fragmented. analysis is an easy method can mislead researchers, and
• A deductive approach is useful if the aim is to test an unexpected difficulties may arise during the analysing process
earlier theory in a different situation or to compare (Glaser 1978).
categories at different time periods. Regardless of the ‘quality’ of qualitative data, its sheer
quantity can be daunting, if not overwhelming. Depending on
the level of detail, six interviews may easily run to 50–100
single-spaced pages of transcribed text (Miles & Huberman
However, there are various opinions about seeking agreement 1994). Hundreds of pages of data can lead the researcher to
(Graneheim & Lundman 2004), because each researcher think that it cannot be managed. In addition, many interest-
interpret the data according to their subjective perspective ing points that are not related to the topic under study often
and co-researchers could come up with an alternative come up when analysing the data. In that case, keeping the
interpretation (Sandelowski 1995). Content validation re- research question in mind is an essential aspect of content
quires the use of a panel of experts to support concept analysis. Even in the middle of chaos, the researcher must
production or coding issues. Graneheim and Lundman always be able to go back to the research tasks and only look
(2004) defend the value of dialogue among co-researchers for units of analysis that have relevance to them.
to agree the way in which the data are labelled. Reporting the study and presenting its results can also be
challenging, as the results are formed through a process
comprising a number of phases. Researchers often wish for
Discussion
more detailed instructions on how to carry out content
Content analysis does not proceed in a linear fashion and is analysis, but those who have already gone through the
more complex and difficult than quantitative analysis because process know that describing the analysis is often one of the
it is less standardized and formulaic (Polit & Beck 2004). most challenging phases of the study. It is possible to
There are no simple guidelines for data analysis: each inquiry describe some parts of this process in great detail, but other
is distinctive, and the results depend on the skills, insights, parts – such as the researcher’s own actions and insights –
analytic abilities and style of the investigator (Hoskins & may be difficult to put into words (Backman & Kyngäs
Mariano 2004). One challenge of content analysis is the fact 1998). Qualitative data analysis software programs can be
that it is very flexible and there is no simple, ‘right’ way of used to make content analysis more manageable and
doing it. Researchers must judge what variations are most ordered, and may facilitate new levels of analysis (Gerbic
appropriate for their particular problems (Weber 1990), and & Stacey 2005).
this makes the analysis process most challenging and inter- If qualitative data are compressed too much, the very point
esting. An enormous amount of work is required during the of maintaining the integrity of narrative materials during the
process (Polit & Beck 2004). analysis phase becomes lost. If the conclusions are merely
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The Qualitative Content Analysis Process

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JAN RESEARCH METHODOLOGY

The qualitative content analysis process

Accepted for publication 22 November 2007

Correspondence to S. Elo: A S H . ( 2 0 0 8 ) The qualitative content analysis process. Journal of

Keywords: concept formation, content analysis, deductive, inductive, nursing,

concerning content analysis [CINAHL and Ovid Medline(r)

where is this happening?

Selecting the unit of

Making sense of the data

Developing analysis Developing structured

Data coding according the

Reporting the analyzing process and the results

Model, conceptual system, conceptual map or categories

Sub-category Generic category Main category

Difficulties to move outside

Table 4 An example of coding the data

The analysis process has been little discussed in literature,

summarized without including numerous supporting ex- References

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