Corresponding Author: A.J. Kleinheksel, The Medical College of Georgia at Augusta University, 1120 15th St., GB 3353, Augusta, GA 30912. Tel: 706-721-0105. Fax: 706-721-2030. Email: ude.atsugua@leskehnielka.
Received 2018 Apr 17; Accepted 2019 Feb 20. Copyright © 2020 American Association of Colleges of PharmacyObjective. In the course of daily teaching responsibilities, pharmacy educators collect rich data that can provide valuable insight into student learning. This article describes the qualitative data analysis method of content analysis, which can be useful to pharmacy educators because of its application in the investigation of a wide variety of data sources, including textual, visual, and audio files.
Findings. Both manifest and latent content analysis approaches are described, with several examples used to illustrate the processes. This article also offers insights into the variety of relevant terms and visualizations found in the content analysis literature. Finally, common threats to the reliability and validity of content analysis are discussed, along with suitable strategies to mitigate these risks during analysis.
Summary. This review of content analysis as a qualitative data analysis method will provide clarity and actionable instruction for both novice and experienced pharmacy education researchers.
Keywords: content analysis, educational research, latent, manifest, qualitative data analysisThe Academy’s growing interest in qualitative research indicates an important shift in the field’s scientific paradigm. Whereas health science researchers have historically looked to quantitative methods to answer their questions, this shift signals that a purely positivist, objective approach is no longer sufficient to answer pharmacy education’s research questions. Educators who want to study their teaching and students’ learning will find content analysis an easily accessible, robust method of qualitative data analysis that can yield rigorous results for both publication and the improvement of their educational practice. Content analysis is a method designed to identify and interpret meaning in recorded forms of communication by isolating small pieces of the data that represent salient concepts and then applying or creating a framework to organize the pieces in a way that can be used to describe or explain a phenomenon. 1 Content analysis is particularly useful in situations where there is a large amount of unanalyzed textual data, such as those many pharmacy educators have already collected as part of their teaching practice. Because of its accessibility, content analysis is also an appropriate qualitative method for pharmacy educators with limited experience in educational research. This article will introduce and illustrate the process of content analysis as a way to analyze existing data, but also as an approach that may lead pharmacy educators to ask new types of research questions.
Content analysis is a well-established data analysis method that has evolved in its treatment of textual data. Content analysis was originally introduced as a strictly quantitative method, recording counts to measure the observed frequency of pre-identified targets in consumer research. 1 However, as the naturalistic qualitative paradigm became more prevalent in social sciences research and researchers became increasingly interested in the way people behave in natural settings, the process of content analysis was adapted into a more interesting and meaningful approach. Content analysis has the potential to be a useful method in pharmacy education because it can help educational researchers develop a deeper understanding of a particular phenomenon by providing structure in a large amount of textual data through a systematic process of interpretation. It also offers potential value because it can help identify problematic areas in student understanding and guide the process of targeted teaching. Several research studies in pharmacy education have used the method of content analysis. 2-7 Two studies in particular offer noteworthy examples: Wallman and colleagues employed manifest content analysis to analyze semi-structured interviews in order to explore what students learn during experiential rotations, 7 while Moser and colleagues adopted latent content analysis to evaluate open-ended survey responses on student perceptions of learning communities. 6 To elaborate on these approaches further, we will describe the two types of qualitative content analysis, manifest and latent, and demonstrate the corresponding analytical processes using examples that illustrate their benefit.
Content analysis rests on the assumption that texts are a rich data source with great potential to reveal valuable information about particular phenomena. 8 It is the process of considering both the participant and context when sorting text into groups of related categories to identify similarities and differences, patterns, and associations, both on the surface and implied within. 9-11 The method is considered high-yield in educational research because it is versatile and can be applied in both qualitative and quantitative studies. 12 While it is important to note that content analysis has application in visual and auditory artifacts (eg, an image or song), for our purposes we will largely focus on the most common application, which is the analysis of textual or transcribed content (eg, open-ended survey responses, print media, interviews, recorded observations, etc). The terminology of content analysis can vary throughout quantitative and qualitative literature, which may lead to some confusion among both novice and experienced researchers. However, there are also several agreed-upon terms and phrases that span the literature, as found in Table 1 .
Terms and Definitions Used in Qualitative Content Analysis
There is more often disagreement on terminology in the methodological approaches to content analysis, though the most common differentiation is between the two types of content: manifest and latent. In much of the literature, manifest content analysis is defined as describing what is occurring on the surface, what is and literally present, and as “staying close to the text.” 8,13 Manifest content analysis is concerned with data that are easily observable both to researchers and the coders who assist in their analyses, without the need to discern intent or identify deeper meaning. It is content that can be recognized and counted with little training. Early applications of manifest analysis focused on identifying easily observable targets within text (eg, the number of instances a certain word appears in newspaper articles), film (eg, the occupation of a character), or interpersonal interactions (eg, tracking the number of times a participant blinks during an interview). 14 This application, in which frequency counts are used to understand a phenomenon, reflects a surface-level analysis and assumes there is objective truth in the data that can be revealed with very little interpretation. The number of times a target (ie, code) appears within the text is used as a way to understand its prevalence. Quantitative content analysis is always describing a positivist manifest content analysis, in that the nature of truth is believed to be objective, observable, and measurable. Qualitative research, which favors the researcher’s interpretation of an individual’s experience, may also be used to analyze manifest content. However, the intent of the application is to describe a dynamic reality that cannot be separated from the lived experiences of the researcher. Although qualitative content analysis can be conducted whether knowledge is thought to be innate, acquired, or socially constructed, the purpose of qualitative manifest content analysis is to transcend simple word counts and delve into a deeper examination of the language in order to organize large amounts of text into categories that reflect a shared meaning. 15,16 The practical distinction between quantitative and qualitative manifest content analysis is the intention behind the analysis. The quantitative method seeks to generate a numerical value to either cite prevalence or use in statistical analyses, while the qualitative method seeks to identify a construct or concept within the text using specific words or phrases for substantiation, or to provide a more organized structure to the text being described.
Latent content analysis is most often defined as interpreting what is hidden deep within the text. In this method, the role of the researcher is to discover the implied meaning in participants’ experiences. 8,13 For example, in a transcribed exchange in an office setting, a participant might say to a coworker, “Yeah, here we are…another Monday. So exciting!” The researcher would apply context in order to discover the emotion being conveyed (ie, the implied meaning). In this example, the comment could be interpreted as genuine, it could be interpreted as a sarcastic comment made in an attempt at humor in order to develop or sustain social bonds with the coworker, or the context might imply that the sarcasm was meant to convey displeasure and end the interaction.
Latent content analysis acknowledges that the researcher is intimately involved in the analytical process and that the their role is to actively use mental schema, theories, and lenses to interpret and understand the data. 10 Whereas manifest analyses are typically conducted in a way that the researcher is thought to maintain distance and separation from the objects of study, latent analyses underscore the importance of the researcher co-creating meaning with the text. 17 Adding nuance to this type of content, Potter and Levine‐Donnerstein argue that within latent content analysis, there are two distinct types: latent pattern and latent projective. 14 Latent pattern content analysis seeks to establish a pattern of characteristics in the text itself, while latent projective content analysis leverages the researcher’s own interpretations of the meaning of the text. While both approaches rely on codes that emerge from the content using the coder’s own perspectives and mental schema, the distinction between these two types of analyses are in their foci. 14 Though we do not agree, some researchers believe that all qualitative content analysis is latent content analysis. 11 These disagreements typically occur where there are differences in intent and where there are areas of overlap in the results. For example, both qualitative manifest and latent pattern content analyses may identify patterns as a result of their application. Though in their research design, the researcher would have approached the content with different methodological approaches, with a manifest approach seeking only to describe what is observed, and the latent pattern approach seeking to discover an unseen pattern. At this point, these distinctions may seem too philosophical to serve a practical purpose, so we will attempt to clarify these concepts by presenting three types of analyses for illustrative purposes, beginning with a description of how codes are created and used.
Codes are the currency of content analysis. Researchers use codes to organize and understand their data. Through the coding process, pharmacy educators can systematically and rigorously categorize and interpret vast amounts of text for use in their educational practice or in publication. Codes themselves are short, descriptive labels that symbolically assign a summative or salient attribute to more than one unit of meaning identified in the text. 18 To create codes, a researcher must first become immersed in the data, which typically occurs when a researcher transcribes recorded data or conducts several readings of the text. This process allows the researcher to become familiar with the scope of the data, which spurs nascent ideas about potential concepts or constructs that may exist within it. If studying a phenomenon that has already been described through an existing framework, codes can be created a priori using theoretical frameworks or concepts identified in the literature. If there is no existing framework to apply, codes can emerge during the analytical process. However, emergent codes can also be created as addenda to a priori codes that were identified before the analysis begins if the a priori codes do not sufficiently capture the researcher’s area of interest.
The process of detecting emergent codes begins with identification of units of meaning. While there is no one way to decide what qualifies as a meaning unit, researchers typically define units of meaning differently depending on what kind of analysis is being conducted. As a general rule, when dialogue is being analyzed, such as interviews or focus groups, meaning units are identified as conversational turns, though a code can be as short as one or two words. In written text, such as student reflections or course evaluation data, the researcher must decide if the text should be divided into phrases or sentences, or remain as paragraphs. This decision is usually made based on how many different units of meaning are expressed in a block of text. For example, in a paragraph, if there are several thoughts or concepts being expressed, it is best to break up the paragraph into sentences. If one sentence contains multiple ideas of interest, making it difficult to separate one important thought or behavior from another, then the sentence can be divided into smaller units, such as phrases or sentence fragments. These phrases or sentence fragments are then coded as separate meaning units. Conversely, longer or more complex units of meaning should be condensed into shorter representations that still retain the original meaning in order to reduce the cognitive burden of the analytical process. This could entail removing verbal ticks (eg, “well, uhm…”) from transcribed data or simplifying a compound sentence. Condensation does not ascribe interpretation or implied meaning to a unit, but only shortens a meaning unit as much as possible while preserving the original meaning identified. 18 After condensation, a researcher can proceed to the creation of codes.
Many researchers begin their analyses with several general codes in mind that help guide their focus as defined by their research question, even in instances where the researcher has no a priori model or theory. For example, if a group of instructors are interested in examining recorded videos of their lectures to identify moments of student engagement, they may begin with using generally agreed upon concepts of engagement as codes, such as students “raising their hands,” “taking notes,” and “speaking in class.” However, as the instructors continue to watch their videos, they may notice other behaviors which were not initially anticipated. Perhaps students were seen creating flow charts based on information presented in class. Alternatively, perhaps instructors wanted to include moments when students posed questions to their peers without being prompted. In this case, the instructors would allow the codes of “creating graphic organizers” and “questioning peers” to emerge as additional ways to identify the behavior of student engagement.
Once a researcher has identified condensed units of meaning and labeled them with codes, the codes are then sorted into categories which can help provide more structure to the data. In the above example of recorded lectures, perhaps the category of “verbal behaviors” could be used to group the codes of “speaking in class” and “questioning peers.” For complex analyses, subcategories can also be used to better organize a large amount of codes, but solely at the discretion of the researcher. Two or more categories of codes are then used to identify or support a broader underlying meaning which develops into themes. Themes are most often employed in latent analyses; however, they are appropriate in manifest analyses as well. Themes describe behaviors, experiences, or emotions that occur throughout several categories. 18 Figure 1 illustrates this process. Using the same videotaped lecture example, the instructors might identify two themes of student engagement, “active engagement” and “passive engagement,” where active engagement is supported by the category of “verbal behavior” and also a category that includes the code of “raising their hands” (perhaps something along the lines of “pursuing engagement”), and the theme of “passive engagement” is supported by a category used to organize the behaviors of “taking notes” and “creating graphic organizers.”
