The value of qualitative research in primary care study development: an example using the De-STRESS study.

Talk Code: 
H Birkinshaw
Birkinshaw H,1 Shivji N,2 Geraghty A,3 Johnson H,3 Little P,3 Minshull A,4 Moore M,3 Stuart B,3 Pincus T,1 Chew-Graham CA,2, 5
Author institutions: 
1 Royal Holloway, University of London, 2 Keele University, 3 University of Southampton, 4 University of Birmingham, 5 West Midlands Applied Research Collaboration


Qualitative research is imperative to understanding a person’s lived experience of their symptoms. The De-STRESS study aims to identify, understand, and reduce distress in people with chronic musculoskeletal pain. As pain-related distress is qualitatively different to clinical depression, it is pivotal that GPs are able to distinguish between these in clinical practice. The value of qualitative research in underpinning questionnaire development is described.

The approach

The De-STRESS study consists of three consecutive stages: 1) qualitative study 2) cross-sectional questionnaire, and 3) intervention development. Stage 2 includes multiple measures of mood in order for a validated small set of questions that identify pain-related distress to be developed. To inform this questionnaire, Stage 1 consisted of semi-structured interviews with people with chronic musculoskeletal pain and distress, and GPs. Data were analysed using Thematic Analysis with a focus on identifying questions for Stage 2.


So far fourteen interviews with people with chronic musculoskeletal pain and distress, and 13 interviews with GPs have been conducted. Analysis suggests that pain-related distress is a complex mixture of symptoms of anxiety and depression. Analysis identified several concepts associated with pain-related distress that are essential in its differentiation from clinical depression: optimism, anxiety, coping, and previous experience of depression. Optimism is a key concept; both participant groups identified the need for optimism outside pain, which people with distress demonstrated. In comparison, people with depression tended towards pessimistic views across many aspects of their life. Subsequently, both bespoke questions and existing measures of these concepts will be included in the De-STRESS pain Stage 2 questionnaire. 


Qualitative research is an important foundation for all types of research into chronic pain, as shown by the De-STRESS study. Without qualitative research, later stages of the study would have omitted crucial concepts, undermining the quality of the study.


Funding acknowledgement: 
This study is funded by Versus Arthritis, grant number 22454.