Public Health Workforce: Where Is the Qualitative Research?
The lack of qualitative public health workforce research is of concern, especially given that the personal experiences and needs of public health workers have changed substantially since the onset of the COVID-19 pandemic.
What is qualitative research?
Qualitative research explores and provides deeper insights into real-world problems through gathering participants’ experiences, perceptions, and behaviors – it answers the how and why questions rather than how many or how much. Debates about the rigor of qualitative research are not new and may relate to perspectives about ‘lower quality’ represented in the Evidence Pyramid, which dates back to the Canadian Task Force on the Periodic Health Examination in 1979. Though more contemporary researchers have begun to understand the importance of qualitative research and its strengths, most research within many fields, such as public health workforce, continue to focus predominately on quantitative methods.
While quantitative research provides highly valuable insights, these methods often cannot provide explanations for the findings. For example, numerous studies of public health accreditation found that small, rural local health departments were less likely to apply for or obtain accreditation. However, some small, local health departments eventually received accreditation. Understanding the factors that supported their accreditation process required a qualitative approach. Findings from that work provided information that could be used to support other small local health departments in the accreditation process.
Qualitative Public Health Workforce Research
The limited amount of qualitative public health workforce research is seen using a simple MeSH term search in PubMed. A search of qualitative research, workforce, and environment and public health found that the number of public health workforce qualitative research articles grew steadily from 5 articles in 2002 to 106 articles in 2012. Since then, the number has dropped from 79 in 2018 to only 22 in 2019 and again only 16 in 2022. A search of workforce and environment and public health MeSH terms yields a similar trend between 2002 to 2023 (though all public health workforce research dates back to 1945 with the first visible increase in articles observed in 1967). However, when comparing the percent of qualitative research to all public health workforce research, it ranged from as low as 0.8% in 2002 to 11.7% in 2018. This trend has been found in other areas of public health as well, such as systems approaches.
Figure 1: PubMed search bar chart of qualitative public health workforce research results from 2002 to 2023.
The lack of qualitative public health workforce research is of concern, especially given that the personal experiences and needs of public health workers have changed substantially since the onset of the COVID-19 pandemic. For example, Scales et al. (2021) found in their qualitative assessment of the COVID-19 response experiences of public health workers in the United States that numerous factors affect mental health among public the public health workforce including: teamwork and workplace camaraderie, potential for growth in the field of public health, considerations for adaptive work environments, politicization of response, and constrained hiring capacity and burnout. Although these findings may be specific to participants, they provide a basis for other organizations and researchers to understand what their employees may be experiencing. Qualitative research can also provide context to why or why not programs are successful, such as Blenner et al. (2021) who used participants’ responses to gain additional insights into their experiential Public Health Scholars Training Program. Similar to Scales et al. (2021), the qualitative findings may not be representative of every participant in the program but do provide some insight about why and how the program is or is not successful. Finally, there are numerous opportunities for qualitative data within already existing databases such as PH WINS. See for example the Yeager et al. (2023) study that explored governmental public health employee experiences during the COVID-19 pandemic using an existing open-ended question. This research was able to provide some generalizable experiences and could also be used to explore experiences of employees with specific characteristics – such as from a small versus large health department.
Ultimately, as public health workforce research continues to expand, qualitative methods need to be utilized alongside quantitative methods to provide additional depth and insight.
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Chelsey Kirkland, PhD (c), MPH, CHW (she/her) is a researcher within the Center for Public Health Systems at University of Minnesota, School of Public. During her time there, she has collaborated on numerous nation-wide, mixed-methods research projects working to support and build-up the public health workforce. Her background is in a variety of public health issues including health equity, health disparities, social determinants of health, community health workers, and physical activity. When not working, she enjoys being outside with her family and two dogs. Her favorite activities include running, water-skiing, and playing violin.
Valerie Yeager, DrPH, MPhil is a Professor at the Indiana University Richard M. Fairbanks School of Public Health in Indianapolis. As a researcher focused on public health services and systems (PHSSR), Dr. Yeager studies the recruitment and retention of the public health workforce and organizational strategies for system improvement.
