The sharpest look of qualitative research

For decades, qualitative research was viewed with distrust by the scientific community, remaining in the background because it was considered excessively subjective. In the last decade, however, these approaches have undergone a process of methodological refinement, becoming important tools for seeking answers to complex questions. A new frontier in this process is mixed methods, increasingly sophisticated, that seek to integrate qualitative and quantitative approaches. This model has proven useful for researchers investigating issues as diverse as the subjective experience of schizophrenia patients during long-term treatment, the reduction of childhood vaccination linked to misinformation, the socio-environmental transitions produced by sustainable development initiatives in the Amazon, or the various factors associated with the mental health of university students. Qualitative research methods, which involve approaches such as in-depth interviews or focus groups (that is, monitoring conversations about a topic that occur among members of a small group of people), seek to investigate aspects that are not easy to transform into numbers. They help to understand people's subjective perceptions and the meanings they attribute to phenomena. The advancement of this approach is particularly evident in the health field. In recent decades, its use has grown in publications in biomedical, public health, and various clinical professions journals. On the PubMed platform, the number of articles increased from just over 2,000 in 1980 to more than 26 thousand in 2000. In 2020, there were already more than 230 thousand, and the number almost doubled from there to now, reaching 425 thousand in 2026. For psychiatrist Egberto Ribeiro Turato, a professor at the Faculty of Medical Sciences at the State University of Campinas (Unicamp), this explosion is associated with the growing interest in the humanization of clinical activities, which began to demand an understanding of emotional and social dimensions. “In the health field, quantitative methods have always been highly valued because statistical results explain the causal links between the phenomena of illness and care. But more and more, the scientific community felt the need for methods capable of answering how patients, families, and the clinical professionals themselves experience human phenomena,” states Turato. The clinical-qualitative method (MCQ) applies resources from the human sciences to health, seeking to understand the meanings, feelings, and values involved in health and illness processes. Humanities in health Known as the creator of the clinical-qualitative method, disseminated in postgraduate courses throughout the country over the last 30 years, Turato defines qualitative research in health as “the investigation of the human or symbolic sciences applied to the areas of clinical and collective health.” According to him, instead of cause-and-effect relationships, the approach seeks symbolic links, driven by psychoanalytic, anthropological, and philosophical school references. “When a doctor or nurse researches why the patient does not use medication correctly, the quantitative approach would be able to show the percentage who forget to take it. But the reason that leads them to forget is of a subjective nature and requires another type of evaluation. Qualitative research changes the emotional and cultural relationship of the health professional with the patient,” explains Turato. In one of his most recent researches, he supervised a study on the experience of patients with schizophrenia in the specialized psychiatry outpatient clinic of FCM-Unicamp. They participate in a treatment protocol with clozapine (a highly effective antipsychoic for schizophrenia resistant to other drugs). But the medication has among its side effects the alteration in blood production in the bone marrow, with a decrease in white and red blood cells, which demands a strict protocol. “Blood must be collected for a blood count weekly, for 14 weeks. Our objective was not to know if the treatment was working, but what the patient feels when coming to Unicamp so frequently, as this could generate negative impressions, perhaps harming the treatment. In-depth open interviews were conducted, explored with a clinical-qualitative content analysis method,” explains Turato. Ariel Severino/FAPESP Journal The conclusion was that the treatment did not lead to negative symbolizations—the weekly visits made patients feel more welcomed. “We concluded that the protocol promotes a sense of security and favors adherence to treatment, in addition to mitigating patient isolation,” he summarizes. The work generated an article published in the journal Brain and Behavior, with support from FAPESP in the forms of Scientific Initiation Grant and Article Publications. In his doctoral thesis, completed in 1988, with FAPESP grant, Turato conducted an entirely quantitative research. “We did not use this term because the use of statistics was simply obvious,” he recalls. In the 1990s, the professor integrated the discipline of medical psychology at Unicamp, a field inaugurated in the 1950s by the Hungarian Michael Balint, author of “The Physician, His Patient, and the Disease.” “I taught the discipline and began to intuitively use interviews with patients,” he recounts. In 1993, he supervised the first article published using the qualitative clinical-psychological method at Unicamp. From there, Turato delved deeper into the approach and came into contact with the author of the first research work in health in Brazil, “The Challenge of Knowledge: Qualitative Research in Health,” by Cecília Minayo, from Fiocruz. In 2003, he published “Treatise on the Methodology of Clinical-Qualitative Research,” which also became a reference in Brazil. In 2016, resolution no. 510 of the National Health Council established the ethical rules for research in the human and social sciences, and today the most demanding scientific journals have already established checklists to guarantee methodological quality and avoid superficial data analysis. But the professor argues that to maintain the necessary rigor, mixed approaches can bring conceptual and epistemological confusions. “The definitions of qualitative and quantitative methods are rigorous, and there is a great difference between their constituent elements, such as sampling, collection instruments, and analyses. Therefore, I think that to do ‘quali-quanti’ research, one needs double the methodological knowledge, but also double the time, money, and mental energy.” 425 thousand qualitative articles published in 2026—were just over 2 thousand in 1980 TOPICS IN QUALITATIVE RESEARCH TODAY • Mental health of university students • Misinformation about vaccines • Socio-environmental transition in the Amazon • Treatment adherence in schizophrenia Another view of mental health Mixed methods, however, are widely used in other types of research. An example is the work of psychoanalyst Kelly Cristina Brandão da Silva, also from FCM-Unicamp. Unlike Turato, her scientific career was based on qualitative studies, but she decided to add a quantitative stage to her research project on the mental health and psychic suffering of students at the university. Initiated in July 2024, with support from FAPESP in the Research Aid – Regular modality, the project was born with a qualitative approach, based on focus groups. “The qualitative approach predominates among psychoanalysts, but we increasingly understand that the raw data from a quantitative stage help improve our questions. The approaches illuminate each other,” she says. The researcher explains that the inclusion of the quantitative stage required more human resources—and for this, seven grants were obtained within the scope of FAPESP aid. This phase included an online questionnaire with 118 questions, covering various sociodemographic data, with information about student retention, racism, gender, harassment at the university, and expectations about the professional future. “The data showed that the university has changed a lot. Unicamp introduced quotas for transgender and disabled people very recently, and the student profile is very different. The vast majority have a family income between 1 and 3 minimum wages. Student demands have also transformed. There has been an inflation of psychiatric diagnoses, and the demand for mental health assistance has increased,” she states. According to her, this data refined the questions from the qualitative stage. The results pointed out that, despite the broadening of ways to enter the university, there is a perception that retention policies are insufficient. “The focus groups also detected a conflict of belonging: Black, Brown, and Indigenous students begin to demand a change in bibliographies, disconnected from their knowledge and worldviews. There is a specific suffering for this new university population, with a highlight on refugees.” Between 2019 and 2021, anti-vaccine narratives on Telegram increased 689 times based on 80 million posts analyzed in 1,785 groups on Telegram. In the same scenario, childhood vaccination in Brazil fell from more than 90% to less than 68% of children up to 12 months vaccinated (2013–2020). The theme of the study was born in 2021, during the Covid-19 pandemic, when the researcher verified an increase in suicidal ideation among students in the speech therapy course she teaches. The research was included in a multicenter study, which already resulted in the publication of five articles, a book chapter, and the “Guide for Well-being at the University: Psychoanalysis, Mental Health, and Care Policies,” released in 2025. The objective of the research was to make a “clinical-political diagnosis” of the psychic suffering of students, which could help Unicamp improve its policies. The clinical-political perspective takes into account that mental suffering is not purely an individual or biological problem, but a product of institutional dynamics in the context of neoliberalism. The mixed methodology allowed to identify, for example, the suffering produced by the idea that everyone needs to be an entrepreneur, or by the difficulties of reconciling domestic work, motherhood, and university. The inclusion of a quantitative approach was an innovation for psychoanalysts at Unicamp, but in other fields of knowledge, such as the environmental area, there is a tendency towards methodological pluralism, and the mixed approach is predominant. This is the case of the Duramaz 3 Project, which seeks to understand how changes produced at the local level by sustainable development projects can drive large-scale socio-environmental transformations in the Amazon. Part of an international program initiated in 2007, involving various universities in Brazil and France, the project is entering its third phase. “The initiative examines socio-environmental transitions in 15 regions of the Amazon. The idea is to understand why some territories adopt a path of sustainable development and others one of degradation,” explains Carla Morsello, professor at the School of Arts, Sciences and Humanities at the University of São Paulo (EACH-USP). The third phase of the project, started in March, had support from FAPESP in the Research Aid – Thematic modality, with Morsello as the responsible researcher. “In the first two phases, data were collected for the production of indicators from different areas. In the third, the objective is to include more qualitative indicators, while simultaneously refining and synthesizing our set of indicators so that they are relevant mainly for local populations,” she explains. The qualitative method employed foresees the development of “serious games” (which have a playful component, but without entertainment purpose) that will serve as tools for participatory processes in defining scenarios. The creation of the game will be the central part of the Brazilian team’s work on the project. “The idea is for it to be played with local communities and public managers. The indicators will be used in the game so that participants understand the results of their decisions,” details Morsello. “When we study this process, it would be possible to do a direct observation study and discover that decisions were made. But it is not enough to understand the reasons behind the choices. Games help us with that,” explains the environmental scientist. Furthermore, qualitative methods are important in studies that seek to investigate traditional knowledge. According to Mário Aquino Alves, professor of the Public Management Department at FGV who has dedicated himself to qualitative studies in the last three decades, there is still prejudice against this type of approach due to a supposed excess of subjectivity. “What has changed in many ways is the ever-increasing sophistication of research designs, the formalization of procedures, and data interpretation. We have much more specific protocols for all phases of the research.” Every scientific work has a degree of subjectivity, according to him, as it involves choices: what questions to ask, which model to use, how to set up the database. In qualitative research, however, this is more visible because there is a need to interpret the evidence. “But interpreting does not mean there is arbitrariness. There is rigor in making the process transparent,” he explains. Ariel Severino/FAPESP Journal Webs of misinformation An example of this rigor is the study currently conducted by Alves on the association between misinformation about vaccines and the reduction in vaccination coverage in recent years in Brazil. Part of a study done by the Laboratory for Studies on Informational Disorder and Public Policies at FGV, with support from CNPq, the project also had support from FAPESP in the form of Research Aid – International Visiting Researcher modality, to ensure the participation of the social psychologist Lupicínio Iniguez Reda, from the Autonomous University of Barcelona, who is an expert in discourse analysis. “We set up the project to try to understand how these anti-vaccine discourses emerge in conspiracy theory groups, with data obtained from Telegram. This application has an interesting feature: the presence of open public groups, totally traceable,” says the researcher. The group developed a mechanism capable of tracking communities and identifying anti-vaccine content. “A quantitative analysis can show what kind of discourse is growing, but the qualitative one helps us understand why these narratives become convincing,” explains Alves. The use of AI also facilitates qualitative research by allowing work with larger volumes of texts, videos, and audio. The Covid-19 pandemic was accompanied by a drastic drop in childhood vaccination, which only began to be reversed from 2024. But even before the pandemic, between 2013 and 2020, the percentage of Brazilian babies under 12 months vaccinated fell from more than 90% to less than 68%. This phenomenon was also accompanied by an increase in misinformation. Only between 2019 and 2021, anti-vaccine posts increased 689 times, according to the studies of the FGV researchers who analyzed more than 80 million posts made in 1,785 groups on Telegram. The current study also seeks to understand the effect of these narratives on vulnerable people. For this, two control groups were set up: one in Guapiruvu, a rural neighborhood in the municipality of São Paulo, in the Ribeira Valley, and the other in a vulnerable community in the South Zone of the city of São Paulo. “In the Guapiruvu group, everyone has a cell phone, but they do not have access to the internet because there is no coverage. The South Zone group has total connectivity,” says Alves. With the help of the professor from the University of Barcelona, the researchers use discourse analysis to qualitatively interpret the circulating content. “What has changed in many ways is the ever-increasing sophistication of research designs, the formalization of procedures, and data interpretation” – Mário Aquino Alves, professor of the Public Management Department at Fundação Getulio Vargas (FGV)