Qualitative Studies In Community Health: A Systematic Review In The Elderly Population


The increased recognition of the qualitative methodology in the health field is a way of enhancement and highlights topics that would remain hidden if the option was the quantitative research. The purpose of this systematic review paper is to reflect about the importance of the qualitative methodology in the study of community health with the elderly. It seeks to identify areas of existing research, describe findings and analyse implications emerged for socio-educational intervention to inform practice and further research. The relevant literature was identified through two electronic databases: MEDLINE and PubMed (2010-2015). Inclusion criteria were: published qualitative or mixed-method studies, about elders, in community health. Relevant data including findings and practice recommendations were extracted and compared in tabular format and were included 48 articles of the 226 initially identified. The majority (20) came from Europe and 11 from North America, but we found studies in all Continents. Study repliers included health professionals, informal carers, patients, community members and relatives. Most (13) were focused on health care network, six on end-of-life care and six on quality of life and successful aging. The others referred to multiples themes. Qualitative research in elderly community health can help researchers to gain a more complete understanding or interpret the results of quantitative data more completely, as well as show us local specificities, that support a differentiated socio-educational intervention.

Keywords: Qualitative researchelderlycommunity healthsocio-educational intervention


Quantitative research come from the positivist paradigm, dominated studies in the scientific

community for decades and says that research must use the methods and procedures of the physical-

natural sciences, such as physics, chemistry, biology and others, including the medical sciences. With the

development of the social and human sciences, research has assumed that the nature of the social world is

not the same as that of the natural world, often finding multiple realities considering the meanings that

individuals attribute to phenomena. Hence, a second paradigm of a constructivist nature has emerged in

the scientific community, specifically from the 60's of last century (Coutinho, 2011). Paulilo (1999, cit. in

Araújo, Martins, Fernandes, Mendes, & Magalhães, 2016) discusses that this phenomenological research

permits deeping facts and specific processes of individuals, including values, attitudes and

representations. In fact, the intention is to obtain an in-depth knowledge of people's life experiences

through their representations of it and not of events per se or by measuring behaviors and quantitatively

correlating them, as defended in the positivist paradigm also called empirical-analytic (Bogdan & Biklen,


Qualitative and quantitative research are complementary and the choice of one or another way of

investigating will always depend on the questions that are the basis of the researcher's study. Despite their

relevance in different areas, including in medicine and health in general, as we will see below, papers

using the qualitative methodology were for a long time scarce and even considered of less value and non-

scientific (Britten, 2005). In the past, if the researcher wanted, by instance, to explain the phenomenon of

drug abuse the study might be carried out by psychiatrists, epidemiologists or researchers in the field of

clinical pharmacology, whereas if the aim was to understand their implications for the patient's life, the

study would be easily attributed to "qualitative researchers" in the field of psychology, sociology or

education (Turato, 2005). However, according to the author, it is essential that health professionals also

become interested in qualitative methods, since they have the advantage of linking a clinical attitude (as

result of their practice) with an existential one, which will allow to bring important contributions for the

advancement of scientific knowledge.

Nevertheless, the methodological option for qualitative research has been only recently (especially

in the last decade) valued in several areas, including in health. Nowadays, health professionals have been

choosing for a scientific model, complementary to the positivist, helping them to understand the human

being in his relationship with the environment, namely the way he/she lives in society (Santos, Azevedo,

Costa, & Medeiros, 2011). In fact, taking care of health, besides knowledge and technique, also integrates

emotion and creativity and has a relational, existential and contextual nature (Barbosa, Motta, & Resck,

2015). Using the qualitative methodology in the health area allows us to understand the feelings, ideas

and behaviors of the patients and their families, as well as of the health professionals themselves,

improving the quality of the professional-patient relationship and the treatment and preventive measures

compliance (Turato, 2005).

Public health, as a fundamentally interventional area, is an organized and concerted effort in the

conditions of life that create, maintain and protect the health of individuals. Community health represents

an evolution of this concept, by the emphasis placed on responsibility and community participation in this

process. The attention given to community health emerges from the development of science in medicine

and its care of the population. In this context, the present paper will be focus on health support to a

rapidly growing age group in the most developed countries: the elderly. Data from the World Health

Organization (WHO), in 2011, show that the process of population aging, which is intended to be active,

is occurring on a planetary scale and is associated with a decrease in mortality and an increase in life

expectancy both resulting from improvements in medical care and living conditions, at home and in

permanent and partial elderly support services. Understanding living conditions and health care needs of

elderly people is becoming increasingly need considering the demographic data above.

According to WHO (2011), currently the non-communicable diseases, such as heart problems,

cancer and diabetes, affect most of the elderly people, reflect changes in lifestyle and diet. Hence, WHO

(2011) recommend that it is fundamental to guarantee appropriate care and to implement preventive

measures to live longer, with quality, letting the elderly people to remain active and autonomous, which

will reduce health costs for the family and society. However, this international organization underlinethat

families and societies have been decreasing their support to the elderlypopulation, requiring an

investment in the collection of data and intervention tools to ensure the well-being of this group that has

been living more and more alone.

In this sense, to understand how to support this population can start from studies of a qualitative

nature that gives information to complement the results that we already have stemming from the

quantitative studies that have dominated the panorama of research for centuries. By understanding local

and individual specificities, will be possible to design well-founded socio-educational intervention

guidelines, that will be implemented by social workers, as well as by nurses, physicians, psychologists

and other health technicians traditionally included in these intervention programs in public health.

This systematic review aims to understand the relevance of the qualitative methodology in the

field of community health with the elderly, namely the existing publications and their results, with

implications for the emergence of guidelines for socio-educational intervention.

Problem Statement

According to WHO (2011) maintain independence and active life, strengthen health prevention

and promotion policies for elderly people, and maintain and/or improve the quality of life in aging, are the

main challenges for public health.

Therefore, it is an area of intervention with a strong component of epidemiology, but with the

participation of multiple areas of knowledge (medicine, statistics, law, social sciences ...) in intervention

planning. The social work intervention in health, particularly socio-educational intervention, constitutes a

privileged field of action, in empowering individuals for social life, fostering autonomy, responsibility,

understanding and involvement/participation in the surrounding environment, as well as the change of

behaviours, in order to improve their living conditions (Carvalho & Baptista, 2004). Community health

research with the elderly population has become increasingly important (Lima-Costa & Veras, 2003),

reinforced by the fact that population aging is considered one of the greatest challenges of contemporary

public health (WHO, 2011). In this context, quantitative and qualitative studies increase, highlighting the

latter by the possibility of identifying specific and contextual needs that become fundamental for local

intervention, enhancing results. Hence, it’s important to know the contributes of the qualitative research

in this field in order to improve the socio-educational intervention.

Research Questions

Given the problem statement, we formulated the following research questions: what’s the

relevance of qualitative methodology in the community health with elderly population? What are the

main themes and the main socio-educational practice implications in this field?

Purpose of the Study

The purpose of this systematic review paper is to identify and appraise the importance of the

qualitative methodology in the study of elderly in community health. It seeks to identify areas of existing

research, describe findings and analyse implications emerged for socio-educational intervention to inform

practice and further research.

Research Methods

This is a systematic review and the relevant literature was identified through two electronic

databases: MEDLINE and PubMed (2010-2015). The search terms were qualitative research AND

community health AND elderly and the inclusion criteria were: published qualitative or mixed-method if

the qualitative methods could be considered as a separate section of the study; with elderly samples (≥65

years); and studies in community health. Following we excluded duplicates and 226 citations were

retrieved for possible inclusion in the present review. With full text available (free access) we found only

119 articles. The study selection criteria were applied by one author in consultation with at least one

other, by reading titles and abstracts, and if the source was suitable for inclusion, the full article was read.

Each study was rated for seven quality using pre-defined assessment criteria (Table 1 ), by two of the

authors independently.

Table 1 -
See Full Size >


The final result of agreement between encoders was 94%, and discrepancies were discussed as a

panel with a third author to reach consensus. In the quality assessment were awarded grades ranging from

one (very poor) to four (good), providing a maximum score of 28, and only were accepted studies with

≥21 score. Finally, there were 48 articles included in the study, whose information extracted was

tabulated. Figure 1 details the study selection process and the number of papers retrieved and excluded at

Figure 1: Figure 01. Flow diagram of study selection process
Figure 01. Flow diagram of study selection process
See Full Size >


The majority (20) of analysed studies came from Europe and 11 from North America, especially

from EUA, but we found studies in all Continents (Asia 7, Australia 5, South America 4 and Sub-Saharan

Africa 1). Study respondents were health professionals, informal carers, patients, community members

and relatives. According to the techniques of collecting dates, predominate semi structured interviews

(34) and focus group (16). Questionnaires, observation, workshops, inventories and document analysis,

all of them, only appear eleven times.

According to the themes, most (13) of the articles are focused on health care network, six on end-

of-life care and six on quality of life and successful aging. The others refer to multiples themes (Table 2 ),

each of them with a frequency between one (7 references) and three (two references).

Table 2 -
See Full Size >

1.Legend: Courtney et al. (2010); 2. Heravi-Karimooi, Anoosheh, Foroughan, Sheykhi, & Hajizadeh (2010); 3. Mullen, Nicolson, & Cotton (2010); 4. Chan & Pang (2011); 5. Gysels, Pell, Straus, & Pool (2011); 6. Hansen, Bi, Nitschke, Pisaniello, Newbury, & Kitson (2011); 7. Kennedy, Harbison, Mahoney, Jarvis, & Veitch (2011); 8. Klymko, Artinian, Price, Abele, & Washington (2011); 9. Medbo, Melbye, & Rudebeck (2011); 10. Motta, Aguiar, & Caldas (2011); 11. Stewart, Goddard, Schiff, & Hall (2011); 12. Uchoa, Firmo, Lima-Costa, & Corin (2011); 13. van Uffelen, Heesch, Hill, & Brown (2011); 14. Yamada, Vass, Hvas, Igarashi, Hendriksen, & Avlund (2011); 15. Antonsson, Korjonen, & Rosengren (2012); 16. Huong, Hai Ha le, Quynh Chi, Hill, & Walton (2012); 17. Tsai, Wong, Ku, & Liu (2012); 18. Tynkkynen, Lehto, & Miettinen (2012); 19. Aase, Laugaland, Dyrstad, & Storm (2013); 20. Breitholtz, Snellman, & Fagerberg (2013); 21. Garcia, Espinoza, Lichtenstein, & Hazuda (2013); 22. Horder, Frandin, & Larsson (2013); 23. Muller-Mundt, Bleidorn, Geiger, Klindtworth, Pleschberger, Hummers-Pradier, & Schneider (2013); 24. Romo, Wallhagen, Yourman, Yeung, Eng, Micco, . . . Smith (2013); 25. Thai, Walter, Eng, & Smith (2013); 26. Turjamaa, Hartikainen, & Pietila (2013); 27. Zayas, Wisniewski, & Kennedy (2013); 28. Au, Wong, McMillan, Bridges, & McGrath (2014); 29. Cheung, Geisler, & Sunneberg (2014); 30. Corvol, Balard, Moutel, & Somme (2014); 31. Countouris, Gilmore, & Yonas (2014); 32. Ferretti, Gris, Mattiello, Paz Arruda Teo, & De Sa. (2014); 33. Gilmartin, Marriott, & Hussainy (2014); 34. Goth & Smaland (2014); 35. Heppenstall, Keeling, Hanger, & Wilkinson (2014); 36. Resnick, Michael, Griffith, Klinedinst, & Galik (2014); 37. Riva, Monti, Iannello, Pravettoni, Schulz, & Antonietti (2014); 38. Wiig, Guise, Anderson, Storm, Lunde Husebo, Testad, . . . Moltu (2014); 39. Andreasen, Lund, Aadahl, Gobbens, & Sorensen (2015); 40. Bindels, Cox, Abma, van Schayck, & Widdershoven (2015); 41. Geisler & Cheung (2015); 42. Holloway, Toye, McConigley, Tieman, Currow, & Hegarty (2015); 43. Karki, Bhatta, & Aryal (2015); 44. Ligthart, van den Eerenbeemt, Pols, van Bussel, Richard, & Moll van Charante (2015); 45. McCloskey, Jarrett, & Stewart (2015); 46. Pereira, Giacomin, & Firmo (2015); 47. Philippi, Luderer, & Altenhoner (2015); 48. van Erning, Janssen-Heijnen, Creemers, Pruijt, Maas, & Lemmens (2015)

About the healthcare network for the elderly, the main conclusions are: a) elderly-related health

and social policies and national guidelines related on what is best for the local people rather than related

to the benefits of the governmental or municipality, contrary to what is most frequent; this has a potential

to compromise the affordability of the services and undermining the principles of the welfare state; b) the

needs of hierarchically organized services and levels of care that provide support for the healthcare teams'

work; d) a good relationship between participating organizations and professionals is required for

successful by identifying barriers concerning institutional collaboration.

We also found that: e) structural funding and the need of education programs for teams, that

facilitate the development of professional and personal skills, including project leadership are also key

elements; f) the psychological and social resources should be valued as well as the economical resource;

g) It is fundamental to identify needs, including instrumental activities of daily living, from the elderly,

families and caregivers, to support programs and services that emphasize person-centered approach; h)

community involvement to promote supportive social networks including the participation of the elderly.

Concerning the end-of-life care planning, stands out: a) the identification of decision-making

processes for the elderly and caregivers, and the development of strategies to involve them (self-

determination), adopting a person-centered approach; b) understanding sociocultural specificity in

choices; c) find methods of overcoming the barriers\ perceived by the elderly; d) adjust care throughout

the aging process in terms of clinical, psychosocial and information needs. Promote quality of life (QoL)

and successful aging, it is important, according to the elaborated synthesis: a) to measure QoL as a

support for the intervention; b) respect the elderly (interests and values); c) understand the elderly's

perception about successful enrichment, to improve communication with the technicians and the

intervention; d) involve the elderly in volunteering activities with peers; e) stop and prevent resignation of

the elderly. Different conclusions, given the diversity of themes, can be drawn from the remaining

articles. However, all refer the possibility of using the results in terms of developing socio-educational

actions. Indeed, in general, all results point out changeable behavioral aspects, as well as providing,

identifying and respecting individual and collective specificities in the intervention to promote successful



Qualitative research in elderly community health can help researchers to gain a more complete

understanding or interpret the results of quantitative data more completely, as well as show local

specificities. Europe and North America stand out with the greatest focus (33 out of 48 studies) in the

review. Generally, there is an investment in the network of care, end-of-life care planning and quality of

life and active aging.

In terms of conclusions, emphasis is placed on the need to value the interests and needs of the

elderly and caregivers, focusing on less economic approaches, favoring psychological, personal and social

aspects, as well as people-centered interventions. It is also noted the concern to capture the perceptions of

all involved in the aging process: health professionals, informal carers, patients, community members and


We observed an increase in the qualitative studies, in multiple themes, that support a socio-

educational intervention respecting the individual, local and regional specificities, in order to value and

imply the individual in the modification of behaviors that promote an aging with quality. Professionals in

this area can and should collaborate intensively in multidisciplinary teams that also involve health

professionals. We emphasize a limitation due to the inclusion of free access texts, hence the need to revise all the

texts resulting from the research and the inclusion criteria referring to the nature and characteristics of the

works. We believe that the search for research in other electronic databases and other time periods is

relevant. It is important to use these and other results of similar work as support for programs and socio-

educational practices.


To the Centre for Studies in Education, Technologies and Health (CI&DETS) at the Polytechnic

Institute of Viseu, Portugal.


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Psychology, clinical psychology, psychotherapy, abnormal psychology

Cite this article as:

Martins, E., Fernandes, R., Mendes, F., & Magalhães, C. (2017). Qualitative Studies In Community Health: A Systematic Review In The Elderly Population. In Z. Bekirogullari, M. Y. Minas, & R. X. Thambusamy (Eds.), Clinical & Counselling Psychology - CPSYC 2017, vol 22. European Proceedings of Social and Behavioural Sciences (pp. 66-75). Future Academy. https://doi.org/10.15405/epsbs.2017.05.9