document review in qualitative research

Document Analysis

First Online: 02 January 2023

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Benjamin Kutsyuruba 4

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This chapter describes the document analysis approach. As a qualitative method, document analysis entails a systematic procedure for reviewing and evaluating documents through finding, selecting, appraising (making sense of), and synthesizing data contained within them. This chapter outlines the brief history, method and use of document analysis, provides an outline of its process, strengths and limitations, and application, and offers further readings, resources, and suggestions for student engagement activities.

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Qualitative Text Analysis: A Systematic Approach

Systematic Reviews and Meta-Analysis: A Guide for Beginners

Qualitative Content Analysis: Theoretical Background and Procedures

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Additional Reading

Kutsyuruba, B. (2017). Examining education reforms through document analysis methodology. In I. Silova, A. Korzh, S. Kovalchuk, & N. Sobe (Eds.), Reimagining Utopias: Theory and method for educational research in post-socialist contexts (pp. 199–214). Sense.

Kutsyuruba, B., Christou, T., Heggie, L., Murray, J., & Deluca, C. (2015). Teacher collaborative inquiry in Ontario: An analysis of provincial and school board policies and support documents. Canadian Journal of Educational Administration and Policy, 172 , 1–38.

Kutsyuruba, B., Godden, L., & Tregunna, L. (2014). Curbing the early-career attrition: A pan-Canadian document analysis of teacher induction and mentorship programs. Canadian Journal of Educational Administration and Policy, 161 , 1–42.

Segeren, A., & Kutsyuruba, B. (2012). Twenty years and counting: An examination of the development of equity and inclusive education policy in Ontario (1990–2010). Canadian Journal of Educational Administration and Policy, 136 , 1–38.

Online Resources

Document Analysis: A How To Guide (12:27 min) https://www.youtube.com/watch?v=vOsE9saR_ck

Document Analysis with Philip Adu (1:16:40 min) https://youtu.be/bLKBffW5JPU

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Kutsyuruba, B. (2023). Document Analysis. In: Okoko, J.M., Tunison, S., Walker, K.D. (eds) Varieties of Qualitative Research Methods. Springer Texts in Education. Springer, Cham. https://doi.org/10.1007/978-3-031-04394-9_23

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Qualitative Research Journal

ISSN : 1443-9883

Article publication date: 3 August 2009

This article examines the function of documents as a data source in qualitative research and discusses document analysis procedure in the context of actual research experiences. Targeted to research novices, the article takes a nuts‐and‐bolts approach to document analysis. It describes the nature and forms of documents, outlines the advantages and limitations of document analysis, and offers specific examples of the use of documents in the research process. The application of document analysis to a grounded theory study is illustrated.

Content analysis
Grounded theory
Thematic analysis
Triangulation

Bowen, G.A. (2009), "Document Analysis as a Qualitative Research Method", Qualitative Research Journal , Vol. 9 No. 2, pp. 27-40. https://doi.org/10.3316/QRJ0902027

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Health Policy Plan
v.35(10); 2020 Dec

Document analysis in health policy research: the READ approach

Sarah l dalglish.

1 Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA

2 Institute for Global Health, University College London, Institute for Global Health 3rd floor, 30 Guilford Street, London WC1N 1EH, UK

Hina Khalid

3 School of Humanities and Social Sciences, Information Technology University, Arfa Software Technology Park, Ferozepur Road, Lahore 54000, Pakistan

Shannon A McMahon

4 Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Im Neuenheimer Feld 130/3, 69120 Heidelberg, Germany

Associated Data

Document analysis is one of the most commonly used and powerful methods in health policy research. While existing qualitative research manuals offer direction for conducting document analysis, there has been little specific discussion about how to use this method to understand and analyse health policy. Drawing on guidance from other disciplines and our own research experience, we present a systematic approach for document analysis in health policy research called the READ approach: (1) ready your materials, (2) extract data, (3) analyse data and (4) distil your findings. We provide practical advice on each step, with consideration of epistemological and theoretical issues such as the socially constructed nature of documents and their role in modern bureaucracies. We provide examples of document analysis from two case studies from our work in Pakistan and Niger in which documents provided critical insight and advanced empirical and theoretical understanding of a health policy issue. Coding tools for each case study are included as Supplementary Files to inspire and guide future research. These case studies illustrate the value of rigorous document analysis to understand policy content and processes and discourse around policy, in ways that are either not possible using other methods, or greatly enrich other methods such as in-depth interviews and observation. Given the central nature of documents to health policy research and importance of reading them critically, the READ approach provides practical guidance on gaining the most out of documents and ensuring rigour in document analysis.

Key Messages

Rigour in qualitative research is judged partly by the use of deliberate, systematic procedures; however, little specific guidance is available for analysing documents, a nonetheless common method in health policy research.
Document analysis is useful for understanding policy content across time and geographies, documenting processes, triangulating with interviews and other sources of data, understanding how information and ideas are presented formally, and understanding issue framing, among other purposes.
The READ (Ready materials, Extract data, Analyse data, Distil) approach provides a step-by-step guide to conducting document analysis for qualitative policy research.
The READ approach can be adapted to different purposes and types of research, two examples of which are presented in this article, with sample tools in the Supplementary Materials .

Introduction

Document analysis (also called document review) is one of the most commonly used methods in health policy research; it is nearly impossible to conduct policy research without it. Writing in early 20th century, Weber (2015) identified the importance of formal, written documents as a key characteristic of the bureaucracies by which modern societies function, including in public health. Accordingly, critical social research has a long tradition of documentary review: Marx analysed official reports, laws, statues, census reports and newspapers and periodicals over a nearly 50-year period to come to his world-altering conclusions ( Harvey, 1990 ). Yet in much of social science research, ‘documents are placed at the margins of consideration,’ with privilege given to the spoken word via methods such as interviews, possibly due to the fact that many qualitative methods were developed in the anthropological tradition to study mainly pre-literate societies ( Prior, 2003 ). To date, little specific guidance is available to help health policy researchers make the most of these wells of information.

The term ‘documents’ is defined here broadly, following Prior, as physical or virtual artefacts designed by creators, for users, to function within a particular setting ( Prior, 2003 ). Documents exist not as standalone objects of study but must be understood in the social web of meaning within which they are produced and consumed. For example, some analysts distinguish between public documents (produced in the context of public sector activities), private documents (from business and civil society) and personal documents (created by or for individuals, and generally not meant for public consumption) ( Mogalakwe, 2009 ). Documents can be used in a number of ways throughout the research process ( Bowen, 2009 ). In the planning or study design phase, they can be used to gather background information and help refine the research question. Documents can also be used to spark ideas for disseminating research once it is complete, by observing the ways those who will use the research speak to and communicate ideas with one another.

Documents can also be used during data collection and analysis to help answer research questions. Recent health policy research shows that this can be done in at least four ways. Frequently, policy documents are reviewed to describe the content or categorize the approaches to specific health problems in existing policies, as in reviews of the composition of drowning prevention resources in the United States or policy responses to foetal alcohol spectrum disorder in South Africa ( Katchmarchi et al. , 2018 ; Adebiyi et al. , 2019 ). In other cases, non-policy documents are used to examine the implementation of health policies in real-world settings, as in a review of web sources and newspapers analysing the functioning of community health councils in New Zealand ( Gurung et al. , 2020 ). Perhaps less frequently, document analysis is used to analyse policy processes, as in an assessment of multi-sectoral planning process for nutrition in Burkina Faso ( Ouedraogo et al. , 2020 ). Finally, and most broadly, document analysis can be used to inform new policies, as in one study that assessed cigarette sticks as communication and branding ‘documents,’ to suggest avenues for further regulation and tobacco control activities ( Smith et al. , 2017 ).

This practice paper provides an overarching method for conducting document analysis, which can be adapted to a multitude of research questions and topics. Document analysis is used in most or all policy studies; the aim of this article is to provide a systematized method that will enhance procedural rigour. We provide an overview of document analysis, drawing on guidance from disciplines adjacent to public health, introduce the ‘READ’ approach to document analysis and provide two short case studies demonstrating how document analysis can be applied.

What is document analysis?

Document analysis is a systematic procedure for reviewing or evaluating documents, which can be used to provide context, generate questions, supplement other types of research data, track change over time and corroborate other sources ( Bowen, 2009 ). In one commonly cited approach in social research, Bowen recommends first skimming the documents to get an overview, then reading to identify relevant categories of analysis for the overall set of documents and finally interpreting the body of documents ( Bowen, 2009 ). Document analysis can include both quantitative and qualitative components: the approach presented here can be used with either set of methods, but we emphasize qualitative ones, which are more adapted to the socially constructed meaning-making inherent to collaborative exercises such as policymaking.

The study of documents as a research method is common to a number of social science disciplines—yet in many of these fields, including sociology ( Mogalakwe, 2009 ), anthropology ( Prior, 2003 ) and political science ( Wesley, 2010 ), document-based research is described as ill-considered and underutilized. Unsurprisingly, textual analysis is perhaps most developed in fields such as media studies, cultural studies and literary theory, all disciplines that recognize documents as ‘social facts’ that are created, consumed, shared and utilized in socially organized ways ( Atkinson and Coffey, 1997 ). Documents exist within social ‘fields of action,’ a term used to designate the environments within which individuals and groups interact. Documents are therefore not mere records of social life, but integral parts of it—and indeed can become agents in their own right ( Prior, 2003 ). Powerful entities also manipulate the nature and content of knowledge; therefore, gaps in available information must be understood as reflecting and potentially reinforcing societal power relations ( Bryman and Burgess, 1994 ).

Document analysis, like any research method, can be subject to concerns regarding validity, reliability, authenticity, motivated authorship, lack of representativity and so on. However, these can be mitigated or avoided using standard techniques to enhance qualitative rigour, such as triangulation (within documents and across methods and theoretical perspectives), ensuring adequate sample size or ‘engagement’ with the documents, member checking, peer debriefing and so on ( Maxwell, 2005 ).

Document analysis can be used as a standalone method, e.g. to analyse the contents of specific types of policy as they evolve over time and differ across geographies, but document analysis can also be powerfully combined with other types of methods to cross-validate (i.e. triangulate) and deepen the value of concurrent methods. As one guide to public policy research puts it, ‘almost all likely sources of information, data, and ideas fall into two general types: documents and people’ ( Bardach and Patashnik, 2015 ). Thus, researchers can ask interviewees to address questions that arise from policy documents and point the way to useful new documents. Bardach and Patashnik suggest alternating between documents and interviews as sources as information, as one tends to lead to the other, such as by scanning interviewees’ bookshelves and papers for titles and author names ( Bardach and Patashnik, 2015 ). Depending on your research questions, document analysis can be used in combination with different types of interviews ( Berner-Rodoreda et al. , 2018 ), observation ( Harvey, 2018 ), and quantitative analyses, among other common methods in policy research.

The READ approach

The READ approach to document analysis is a systematic procedure for collecting documents and gaining information from them in the context of health policy studies at any level (global, national, local, etc.). The steps consist of: (1) ready your materials, (2) extract data, (3) analyse data and (4) distil your findings. We describe each of these steps in turn.

Step 1. Ready your materials

At the outset, researchers must set parameters in terms of the nature and number (approximately) of documents they plan to analyse, based on the research question. How much time will you allocate to the document analysis, and what is the scope of your research question? Depending on the answers to these questions, criteria should be established around (1) the topic (a particular policy, programme, or health issue, narrowly defined according to the research question); (2) dates of inclusion (whether taking the long view of several decades, or zooming in on a specific event or period in time); and (3) an indicative list of places to search for documents (possibilities include databases such as Ministry archives; LexisNexis or other databases; online searches; and particularly interview subjects). For difficult-to-obtain working documents or otherwise non-public items, bringing a flash drive to interviews is one of the best ways to gain access to valuable documents.

For research focusing on a single policy or programme, you may review only a handful of documents. However, if you are looking at multiple policies, health issues, or contexts, or reviewing shorter documents (such as newspaper articles), you may look at hundreds, or even thousands of documents. When considering the number of documents you will analyse, you should make notes on the type of information you plan to extract from documents—i.e. what it is you hope to learn, and how this will help answer your research question(s). The initial criteria—and the data you seek to extract from documents—will likely evolve over the course of the research, as it becomes clear whether they will yield too few documents and information (a rare outcome), far too many documents and too much information (a much more common outcome) or documents that fail to address the research question; however, it is important to have a starting point to guide the search. If you find that the documents you need are unavailable, you may need to reassess your research questions or consider other methods of inquiry. If you have too many documents, you can either analyse a subset of these ( Panel 1 ) or adopt more stringent inclusion criteria.

Exploring the framing of diseases in Pakistani media

Health policies must account for how societies perceive and understand a given disease’s origins and causes, and media sources play an important role in framing health issues ( ; ). Document analysis was employed to understand the frames used in print media (newspapers) in Pakistan when discussing Human Immunodeficiency Virus (HIV) and viral hepatitis, two diseases that are spread using similar modes of transmission but have varying levels of stigma in the country. Alongside document analysis, key informant interviews were used for triangulation and to flesh out what stigma for HIV meant in the country. A sample of newspaper articles was drawn from the electronic database LexisNexis (January 2006-September 2016) based on readership, electronic availability in LexisNexis and geographic diversity, to capture cultural differences across provinces over time ( ). Broad search terms were used for HIV and viral hepatitis, resulting in 3415 articles for hepatitis and1580 articles for HIV. A random sample comprising 10% of the total HIV articles ( = 156) and 5% of the total hepatitis articles ( = 176) was selected and coded using a fixed coding guide. The coding guide was developed using an inductive approach ( ; ), which involved reading a sample of articles line by line to identify media frames for HIV and viral hepatitis ( ; , 2012). Two rounds of pre-testing were carried out before the final sample of articles was coded. However, the use of LexisNexis as the primary data source excluded newspapers published in the local language (opening up the possibility of omitting some media frames). Therefore, interviews were important for triangulation of findings. Data from document analysis were collated in an Excel sheet and analysed in STATA 14. The findings of the document analysis highlighted that while both diseases were transmitted predominantly through injecting drug use in the country, hepatitis was only discussed using frames such as ‘medical’ (discussing transmission, prevention, and treatment methods), ‘resources’ (resources available to fight the disease), ‘magnitude’ (gives the scope of the problem or disease prevalence) and ‘need for awareness’–there was no ‘stigma and discrimination’ frame attached to the disease [Figure, HIV and viral hepatitis articles by main frames (%)]. In contrast, the ‘stigma and discrimination’ frame and the ‘social causes of disease’ frame (discussing non-medical causes for the spread of disease) were used exclusively in articles on HIV, notably including suggestions that acquiring the disease was linked to socially immoral and un-Islamic behaviour. Key informant interviews helped to probe further the traits associated with someone who had HIV. Taken together, document analysis and key informant interviews helped build a richer narrative of HIV stigma in the country. Given the difference in how these diseases were understood, these findings suggested that there was a need for explicit policy to reframe HIV as a disease. Countries such as Iran, Indonesia and Malaysia have successfully garnered government and policy attention to HIV and reduced stigma by reframing it as a disease spread through injecting drug use ( ).

In Table 1 , we present a non-exhaustive list of the types of documents that can be included in document analyses of health policy issues. In most cases, this will mean written sources (policies, reports, articles). The types of documents to be analysed will vary by study and according to the research question, although in many cases, it will be useful to consult a mix of formal documents (such as official policies, laws or strategies), ‘gray literature’ (organizational materials such as reports, evaluations and white papers produced outside formal publication channels) and, whenever possible, informal or working documents (such as meeting notes, PowerPoint presentations and memoranda). These latter in particular can provide rich veins of insight into how policy actors are thinking through the issues under study, particularly for the lucky researcher who obtains working documents with ‘Track Changes.’ How you prioritize documents will depend on your research question: you may prioritize official policy documents if you are studying policy content, or you may prioritize informal documents if you are studying policy process.

Types of documents that can be consulted in studies of health policy

Category	Examples
Official documents
Implementation documents
Legal documents
Working documents
Scholarly work
Media and communications
Other

During this initial preparatory phase, we also recommend devising a file-naming system for your documents (e.g. Author.Date.Topic.Institution.PDF), so that documents can be easily retrieved throughout the research process. After extracting data and processing your documents the first time around, you will likely have additional ‘questions’ to ask your documents and need to consult them again. For this reason, it is important to clearly name source files and link filenames to the data that you are extracting (see sample naming conventions in the Supplementary Materials ).

Step 2. Extract data

Data can be extracted in a number of ways, and the method you select for doing so will depend on your research question and the nature of your documents. One simple way is to use an Excel spreadsheet where each row is a document and each column is a category of information you are seeking to extract, from more basic data such as the document title, author and date, to theoretical or conceptual categories deriving from your research question, operating theory or analytical framework (Panel 2). Documents can also be imported into thematic coding software such as Atlas.ti or NVivo, and data extracted that way. Alternatively, if the research question focuses on process, documents can be used to compile a timeline of events, to trace processes across time. Ask yourself, how can I organize these data in the most coherent manner? What are my priority categories? We have included two different examples of data extraction tools in the Supplementary Materials to this article to spark ideas.

Case study Documents tell part of the story in Niger

In a multi-country policy analysis of integrated Community Case Management of childhood illness (iCCM), Niger was among the few countries that scaled up the policy at national level ( ). Alongside key stakeholder interviews and non-participant observation, document analysis was used to reconstruct the policy process leading to this outcome. In total, 103 documents were obtained from policy actors in Niger, researchers working on similar topics, or collected on the Internet ( ). Documents included official policies and strategies, field reports, legal regulations, program evaluations, funding proposals, newsletters and newspaper articles, among other sources. Document acquisition was greatly facilitated by asking for documents during stakeholder interviews, although some documents were not available due to a fire that destroyed World Health Organization (WHO) servers in the years preceding the study. Data from the documents was extracted into a Microsoft Excel file, recording information about specific aspects of child health policy and programs, framing of issues, use of research evidence, and mention of international recommendations, among other topics. Documents were also used to compile a timeline of events in the policy process. Policy processes were elucidated by creating a timeline of events, which documented how specific decrees, workshops, meetings, and other events occurred over time. The timeline was overlaid with measures of implementation (number of health posts built, number of health workers trained) to understand how decision-making processes propelled real-world outcomes, and served as proxies for financial data that were rarely included in policy documents ( ). Additionally, document analysis revealed a partial account of what was driving these events. Many documents showed a concern for reaching the Millennium Development Goal on child mortality (Figure, Representations of progress toward Millennium Development Goal 4 in Nigerien policy documents). Graphs mapping country progress toward Millennium Development Goal (MDG)-4 appeared in nearly all documentation on iCCM, and progress was regularly reported on by the Nigerien National Institute of Statistics, suggesting that these were a significant motivating factor in policy and resource allocation decisions. Yet older historical documents showed a long-standing recognition of the problem of children's access to life-saving healthcare (well before the MDGs), with policy remedies going back to least 1965 in the form of rural first-aid workers ( ). Triangulation with interviews and observation also showed that national policymakers’ practical knowledge and ethical imperative to save children's lives was at least as important as the MDGs in motivating policy action ( ). Taken together, the document and non-document data showed that, as in other contexts, the MDGs were useful mainly to direct international fundraising and satisfy donor norms in expectation of funding increases ( ).

Document analyses are first and foremost exercises in close reading: documents should be read thoroughly, from start to finish, including annexes, which may seem tedious but which sometimes produce golden nuggets of information. Read for overall meaning as you extract specific data related to your research question. As you go along, you will begin to have ideas or build working theories about what you are learning and observing in the data. We suggest capturing these emerging theories in extended notes or ‘memos,’ as used in Grounded Theory methodology ( Charmaz, 2006 ); these can be useful analytical units in themselves and can also provide a basis for later report and article writing.

As you read more documents, you may find that your data extraction tool needs to be modified to capture all the relevant information (or to avoid wasting time capturing irrelevant information). This may require you to go back and seek information in documents you have already read and processed, which will be greatly facilitated by a coherent file-naming system. It is also useful to keep notes on other documents that are mentioned that should be tracked down (sometimes you can write the author for help). As a general rule, we suggest being parsimonious when selecting initial categories to extract from data. Simply reading the documents takes significant time in and of itself—make sure you think about how, exactly, the specific data you are extracting will be used and how it goes towards answering your research questions.

Step 3. Analyse data

As in all types of qualitative research, data collection and analysis are iterative and characterized by emergent design, meaning that developing findings continually inform whether and how to obtain and interpret data ( Creswell, 2013 ). In practice, this means that during the data extraction phase, the researcher is already analysing data and forming initial theories—as well as potentially modifying document selection criteria. However, only when data extraction is complete can one see the full picture. For example, are there any documents that you would have expected to find, but did not? Why do you think they might be missing? Are there temporal trends (i.e. similarities, differences or evolutions that stand out when documents are ordered chronologically)? What else do you notice? We provide a list of overarching questions you should think about when viewing your body of document as a whole ( Table 2 ).

Questions to ask your overall body of documents

An external file that holds a picture, illustration, etc.
Object name is czaa064f1.jpg

HIV and viral hepatitis articles by main frames (%). Note: The percentage of articles is calculated by dividing the number of articles appearing in each frame for viral hepatitis and HIV by the respectivenumber of sampled articles for each disease (N = 137 for HIV; N = 117 for hepatitis). Time frame: 1 January 2006 to 30 September 2016

An external file that holds a picture, illustration, etc.
Object name is czaa064f2.jpg

Representations of progress toward Millennium Development Goal 4 in Nigerien policy documents. Sources: clockwise from upper left: ( WHO 2006 ); ( Institut National de la Statistique 2010 ); ( Ministè re de la Santé Publique 2010 ); ( Unicef 2010 )

In addition to the meaning-making processes you are already engaged in during the data extraction process, in most cases, it will be useful to apply specific analysis methodologies to the overall corpus of your documents, such as policy analysis ( Buse et al. , 2005 ). An array of analysis methodologies can be used, both quantitative and qualitative, including case study methodology, thematic content analysis, discourse analysis, framework analysis and process tracing, which may require differing levels of familiarity and skills to apply (we highlight a few of these in the case studies below). Analysis can also be structured according to theoretical approaches. When it comes to analysing policies, process tracing can be particularly useful to combine multiple sources of information, establish a chronicle of events and reveal political and social processes, so as to create a narrative of the policy cycle ( Yin, 1994 ; Shiffman et al. , 2004 ). Practically, you will also want to take a holistic view of the documents’ ‘answers’ to the questions or analysis categories you applied during the data extraction phase. Overall, what did the documents ‘say’ about these thematic categories? What variation did you find within and between documents, and along which axes? Answers to these questions are best recorded by developing notes or memos, which again will come in handy as you write up your results.

As with all qualitative research, you will want to consider your own positionality towards the documents (and their sources and authors); it may be helpful to keep a ‘reflexivity’ memo documenting how your personal characteristics or pre-standing views might influence your analysis ( Watt, 2007 ).

Step 4. Distil your findings

You will know when you have completed your document review when one of the three things happens: (1) completeness (you feel satisfied you have obtained every document fitting your criteria—this is rare), (2) out of time (this means you should have used more specific criteria), and (3) saturation (you fully or sufficiently understand the phenomenon you are studying). In all cases, you should strive to make the third situation the reason for ending your document review, though this will not always mean you will have read and analysed every document fitting your criteria—just enough documents to feel confident you have found good answers to your research questions.

Now it is time to refine your findings. During the extraction phase, you did the equivalent of walking along the beach, noticing the beautiful shells, driftwood and sea glass, and picking them up along the way. During the analysis phase, you started sorting these items into different buckets (your analysis categories) and building increasingly detailed collections. Now you have returned home from the beach, and it is time to clean your objects, rinse them of sand and preserve only the best specimens for presentation. To do this, you can return to your memos, refine them, illustrate them with graphics and quotes and fill in any incomplete areas. It can also be illuminating to look across different strands of work: e.g. how did the content, style, authorship, or tone of arguments evolve over time? Can you illustrate which words, concepts or phrases were used by authors or author groups?

Results will often first be grouped by theoretical or analytic category, or presented as a policy narrative, interweaving strands from other methods you may have used (interviews, observation, etc.). It can also be helpful to create conceptual charts and graphs, especially as this corresponds to your analytical framework (Panels 1 and 2). If you have been keeping a timeline of events, you can seek out any missing information from other sources. Finally, ask yourself how the validity of your findings checks against what you have learned using other methods. The final products of the distillation process will vary by research study, but they will invariably allow you to state your findings relative to your research questions and to draw policy-relevant conclusions.

Document analysis is an essential component of health policy research—it is also relatively convenient and can be low cost. Using an organized system of analysis enhances the document analysis’s procedural rigour, allows for a fuller understanding of policy process and content and enhances the effectiveness of other methods such as interviews and non-participant observation. We propose the READ approach as a systematic method for interrogating documents and extracting study-relevant data that is flexible enough to accommodate many types of research questions. We hope that this article encourages discussion about how to make best use of data from documents when researching health policy questions.

Supplementary Data

Supplementary data are available at Health Policy and Planning online.

Supplementary Material

Czaa064_supplementary_data, acknowledgements.

The data extraction tool in the Supplementary Materials for the iCCM case study (Panel 2) was conceived of by the research team for the multi-country study ‘Policy Analysis of Community Case Management for Childhood and Newborn Illnesses’. The authors thank Sara Bennett and Daniela Rodriguez for granting permission to publish this tool. S.M. was supported by The Olympia-Morata-Programme of Heidelberg University. The funders had no role in the decision to publish, or preparation of the manuscript. The content is the responsibility of the authors and does not necessarily represent the views of any funder.

Conflict of interest statement . None declared.

Ethical approval. No ethical approval was required for this study.

Abdelmutti N, Hoffman-Goetz L. 2009. Risk messages about HPV, cervical cancer, and the HPV vaccine Gardasil: a content analysis of Canadian and U.S. national newspaper articles . Women & Health 49 : 422–40. [ PubMed ] [ Google Scholar ]
Adebiyi BO, Mukumbang FC, Beytell A-M. 2019. To what extent is fetal alcohol spectrum disorder considered in policy-related documents in South Africa? A document review . Health Research Policy and Systems 17 : [ PMC free article ] [ PubMed ] [ Google Scholar ]
Atkinson PA, Coffey A. 1997. Analysing documentary realities In: Silverman D (ed). Qualitative Research: Theory, Method and Practice . London: SAGE. [ Google Scholar ]
Bardach E, Patashnik EM. 2015. Practical Guide for Policy Analysis: The Eightfold Path to More Effective Problem Solving . Los Angeles: SAGE. [ Google Scholar ]
Bennett S, Dalglish SL, Juma PA, Rodríguez DC. 2015. Altogether now… understanding the role of international organizations in iCCM policy transfer . Health Policy and Planning 30 : ii26–35. [ PubMed ] [ Google Scholar ]
Berner-Rodoreda A, Bärnighausen T, Kennedy C et al. 2018. From doxastic to epistemic: a typology and critique of qualitative interview styles . Qualitative Inquiry 26 : 291–305. 1077800418810724. [ PMC free article ] [ PubMed ] [ Google Scholar ]
Bowen GA. 2009. Document analysis as a qualitative research method . Qualitative Research Journal 9 : 27–40. [ Google Scholar ]
Bryman A. 1994. Analyzing Qualitative Data .
Buse K, Mays N, Walt G. 2005. Making Health Policy . New York: Open University Press. [ Google Scholar ]
Charmaz K. 2006. Constructing Grounded Theory: A Practical Guide through Qualitative Analysis . London: SAGE. [ Google Scholar ]
Claassen L, Smid T, Woudenberg F, Timmermans DRM. 2012. Media coverage on electromagnetic fields and health: content analysis of Dutch newspaper articles and websites . Health, Risk & Society 14 : 681–96. [ Google Scholar ]
Creswell JW. 2013. Qualitative Inquiry and Research Design . Thousand Oaks, CA: SAGE. [ Google Scholar ]
Dalglish SL, Rodríguez DC, Harouna A, Surkan PJ. 2017. Knowledge and power in policy-making for child survival in Niger . Social Science & Medicine 177 : 150–7. [ PubMed ] [ Google Scholar ]
Dalglish SL, Surkan PJ, Diarra A, Harouna A, Bennett S. 2015. Power and pro-poor policies: the case of iCCM in Niger . Health Policy and Planning 30 : ii84–94. [ PubMed ] [ Google Scholar ]
Entman RM. 1993. Framing: toward clarification of a fractured paradigm . Journal of Communication 43 : 51–8. [ Google Scholar ]
Fournier G, Djermakoye IA. 1975. Village health teams in Niger (Maradi Department) In: Newell KW (ed). Health by the People . Geneva: WHO. [ Google Scholar ]
Gurung G, Derrett S, Gauld R. 2020. The role and functions of community health councils in New Zealand’s health system: a document analysis . The New Zealand Medical Journal 133 : 70–82. [ PubMed ] [ Google Scholar ]
Harvey L. 1990. Critical Social Research . London: Unwin Hyman. [ Google Scholar ]
Harvey SA. 2018. Observe before you leap: why observation provides critical insights for formative research and intervention design that you’ll never get from focus groups, interviews, or KAP surveys . Global Health: Science and Practice 6 : 299–316. [ PMC free article ] [ PubMed ] [ Google Scholar ]
Institut National de la Statistique. 2010. Rapport National sur les Progrès vers l'atteinte des Objectifs du Millénaire pour le Développement. Niamey, Niger: INS. [ Google Scholar ]
Kamarulzaman A. 2013. Fighting the HIV epidemic in the Islamic world . Lancet 381 : 2058–60. [ PubMed ] [ Google Scholar ]
Katchmarchi AB, Taliaferro AR, Kipfer HJ. 2018. A document analysis of drowning prevention education resources in the United States . International Journal of Injury Control and Safety Promotion 25 : 78–84. [ PubMed ] [ Google Scholar ]
Krippendorff K. 2004. Content Analysis: An Introduction to Its Methodology . SAGE. [ Google Scholar ]
Marten R. 2019. How states exerted power to create the Millennium Development Goals and how this shaped the global health agenda: lessons for the sustainable development goals and the future of global health . Global Public Health 14 : 584–99. [ PubMed ] [ Google Scholar ]
Maxwell JA. 2005. Qualitative Research Design: An Interactive Approach , 2 nd edn. Thousand Oaks, CA: Sage Publications. [ Google Scholar ]
Mayring P. 2004. Qualitative Content Analysis . In: Flick U, von Kardorff E, Steinke I (eds). A Companion to Qualitative Research SAGE. [ Google Scholar ]
Ministère de la Santé Publique. 2010. Enquête nationale sur la survie des enfants de 0 à 59 mois et la mortalité au Niger 2010. Niamey, Niger: MSP. [ Google Scholar ]
Mogalakwe M. 2009. The documentary research method—using documentary sources in social research . Eastern Africa Social Science Research Review 25 : 43–58. [ Google Scholar ]
Nelkin D. 1991. AIDS and the news media . The Milbank Quarterly 69 : 293–307. [ PubMed ] [ Google Scholar ]
Ouedraogo O, Doudou MH, Drabo KM et al. 2020. Policy overview of the multisectoral nutrition planning process: the progress, challenges, and lessons learned from Burkina Faso . The International Journal of Health Planning and Management 35 : 120–39. [ PubMed ] [ Google Scholar ]
Prior L. 2003. Using Documents in Social Research . London: SAGE. [ Google Scholar ]
Shiffman J, Stanton C, Salazar AP. 2004. The emergence of political priority for safe motherhood in Honduras . Health Policy and Planning 19 : 380–90. [ PubMed ] [ Google Scholar ]
Smith KC, Washington C, Welding K et al. 2017. Cigarette stick as valuable communicative real estate: a content analysis of cigarettes from 14 low-income and middle-income countries . Tobacco Control 26 : 604–7. [ PMC free article ] [ PubMed ] [ Google Scholar ]
Strömbäck J, Dimitrova DV. 2011. Mediatization and media interventionism: a comparative analysis of Sweden and the United States . The International Journal of Press/Politics 16 : 30–49. [ Google Scholar ]
UNICEF. 2010. Maternal, Newborn & Child Surival Profile. Niamey, Niger: UNICEF . [ Google Scholar ]
Watt D. 2007. On becoming a qualitative researcher: the value of reflexivity . Qualitative Report 12 : 82–101. [ Google Scholar ]
Weber M. 2015. Bureaucracy In: Waters T, Waters D (eds). Rationalism and Modern Society: New Translations on Politics, Bureaucracy, and Social Stratification . London: Palgrave MacMillan. [ Google Scholar ]
Wesley JJ. 2010. Qualitative Document Analysis in Political Science.
World Health Organization. 2006. Country Health System Fact Sheet 2006: Niger. Niamey, Niger: WHO.
Yin R. 1994. Case Study Research: Design and Methods . Thousand Oaks, CA: Sage. [ Google Scholar ]

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Article Contents

Introduction, what is document analysis, the read approach, supplementary data, acknowledgements.

< Previous

Document analysis in health policy research: the READ approach

Article contents
Figures & tables

Sarah L Dalglish, Hina Khalid, Shannon A McMahon, Document analysis in health policy research: the READ approach, Health Policy and Planning , Volume 35, Issue 10, December 2020, Pages 1424–1431, https://doi.org/10.1093/heapol/czaa064

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Rigour in qualitative research is judged partly by the use of deliberate, systematic procedures; however, little specific guidance is available for analysing documents, a nonetheless common method in health policy research.

Document analysis is useful for understanding policy content across time and geographies, documenting processes, triangulating with interviews and other sources of data, understanding how information and ideas are presented formally, and understanding issue framing, among other purposes.

The READ (Ready materials, Extract data, Analyse data, Distil) approach provides a step-by-step guide to conducting document analysis for qualitative policy research.

The READ approach can be adapted to different purposes and types of research, two examples of which are presented in this article, with sample tools in the Supplementary Materials .

Step 1. Ready your materials

Exploring the framing of diseases in Pakistani media

Types of documents that can be consulted in studies of health policy

Category .	Examples .
Official documents
Implementation documents
Legal documents
Working documents
Scholarly work
Media and communications
Other

Category .	Examples .
Official documents
Implementation documents
Legal documents
Working documents
Scholarly work
Media and communications
Other

Step 2. Extract data

Case study Documents tell part of the story in Niger

Step 3. Analyse data

Questions to ask your overall body of documents

HIV and viral hepatitis articles by main frames (%). Note: The percentage of articles is calculated by dividing the number of articles appearing in each frame for viral hepatitis and HIV by the respectivenumber of sampled articles for each disease (N = 137 for HIV; N = 117 for hepatitis). Time frame: 1 January 2006 to 30 September 2016

Representations of progress toward Millennium Development Goal 4 in Nigerien policy documents. Sources: clockwise from upper left: (WHO 2006); (Institut National de la Statistique 2010); (Ministè re de la Santé Publique 2010); (Unicef 2010)

Step 4. Distil your findings

Supplementary data are available at Health Policy and Planning online.

Conflict of interest statement . None declared.

Ethical approval. No ethical approval was required for this study.

Abdelmutti N , Hoffman-Goetz L. 2009 . Risk messages about HPV, cervical cancer, and the HPV vaccine Gardasil: a content analysis of Canadian and U.S. national newspaper articles . Women & Health 49 : 422 – 40 .

Google Scholar

Adebiyi BO , Mukumbang FC , Beytell A-M. 2019 . To what extent is fetal alcohol spectrum disorder considered in policy-related documents in South Africa? A document review . Health Research Policy and Systems 17 :

Atkinson PA , Coffey A. 1997 . Analysing documentary realities. In: Silverman D (ed). Qualitative Research: Theory, Method and Practice . London : SAGE .

Google Preview

Bardach E , Patashnik EM. 2015 . Practical Guide for Policy Analysis: The Eightfold Path to More Effective Problem Solving . Los Angeles : SAGE .

Bennett S , Dalglish SL , Juma PA , Rodríguez DC. 2015 . Altogether now… understanding the role of international organizations in iCCM policy transfer . Health Policy and Planning 30 : ii26 – 35 .

Berner-Rodoreda A , Bärnighausen T , Kennedy C et al. 2018 . From doxastic to epistemic: a typology and critique of qualitative interview styles . Qualitative Inquiry 26 : 291 – 305 . 1077800418810724.

Bowen GA. 2009 . Document analysis as a qualitative research method . Qualitative Research Journal 9 : 27 – 40 .

Bryman A. 1994 . Analyzing Qualitative Data .

Buse K , Mays N , Walt G. 2005 . Making Health Policy . New York : Open University Press .

Charmaz K. 2006 . Constructing Grounded Theory: A Practical Guide through Qualitative Analysis . London : SAGE .

Claassen L , Smid T , Woudenberg F , Timmermans DRM. 2012 . Media coverage on electromagnetic fields and health: content analysis of Dutch newspaper articles and websites . Health, Risk & Society 14 : 681 – 96 .

Creswell JW. 2013 . Qualitative Inquiry and Research Design . Thousand Oaks, CA : SAGE .

Dalglish SL , Rodríguez DC , Harouna A , Surkan PJ. 2017 . Knowledge and power in policy-making for child survival in Niger . Social Science & Medicine 177 : 150 – 7 .

Dalglish SL , Surkan PJ , Diarra A , Harouna A , Bennett S. 2015 . Power and pro-poor policies: the case of iCCM in Niger . Health Policy and Planning 30 : ii84 – 94 .

Entman RM. 1993 . Framing: toward clarification of a fractured paradigm . Journal of Communication 43 : 51 – 8 .

Fournier G , Djermakoye IA. 1975 . Village health teams in Niger (Maradi Department). In: Newell KW (ed). Health by the People . Geneva : WHO .

Gurung G , Derrett S , Gauld R. 2020 . The role and functions of community health councils in New Zealand’s health system: a document analysis . The New Zealand Medical Journal 133 : 70 – 82 .

Harvey L. 1990 . Critical Social Research . London : Unwin Hyman .

Harvey SA. 2018 . Observe before you leap: why observation provides critical insights for formative research and intervention design that you’ll never get from focus groups, interviews, or KAP surveys . Global Health: Science and Practice 6 : 299 – 316 .

Institut National de la Statistique. 2010. Rapport National sur les Progrès vers l'atteinte des Objectifs du Millénaire pour le Développement. Niamey, Niger: INS.

Kamarulzaman A. 2013 . Fighting the HIV epidemic in the Islamic world . Lancet 381 : 2058 – 60 .

Katchmarchi AB , Taliaferro AR , Kipfer HJ. 2018 . A document analysis of drowning prevention education resources in the United States . International Journal of Injury Control and Safety Promotion 25 : 78 – 84 .

Krippendorff K. 2004 . Content Analysis: An Introduction to Its Methodology . SAGE .

Marten R. 2019 . How states exerted power to create the Millennium Development Goals and how this shaped the global health agenda: lessons for the sustainable development goals and the future of global health . Global Public Health 14 : 584 – 99 .

Maxwell JA. 2005 . Qualitative Research Design: An Interactive Approach , 2 nd edn. Thousand Oaks, CA : Sage Publications .

Mayring P. 2004 . Qualitative Content Analysis . In: Flick U, von Kardorff E, Steinke I (eds). A Companion to Qualitative Research . SAGE .

Ministère de la Santé Publique. 2010. Enquête nationale sur la survie des enfants de 0 à 59 mois et la mortalité au Niger 2010. Niamey, Niger: MSP.

Mogalakwe M. 2009 . The documentary research method—using documentary sources in social research . Eastern Africa Social Science Research Review 25 : 43 – 58 .

Nelkin D. 1991 . AIDS and the news media . The Milbank Quarterly 69 : 293 – 307 .

Ouedraogo O , Doudou MH , Drabo KM et al. 2020 . Policy overview of the multisectoral nutrition planning process: the progress, challenges, and lessons learned from Burkina Faso . The International Journal of Health Planning and Management 35 : 120 – 39 .

Prior L. 2003 . Using Documents in Social Research . London: SAGE .

Shiffman J , Stanton C , Salazar AP. 2004 . The emergence of political priority for safe motherhood in Honduras . Health Policy and Planning 19 : 380 – 90 .

Smith KC , Washington C , Welding K et al. 2017 . Cigarette stick as valuable communicative real estate: a content analysis of cigarettes from 14 low-income and middle-income countries . Tobacco Control 26 : 604 – 7 .

Strömbäck J , Dimitrova DV. 2011 . Mediatization and media interventionism: a comparative analysis of Sweden and the United States . The International Journal of Press/Politics 16 : 30 – 49 .

UNICEF. 2010. Maternal, Newborn & Child Surival Profile. Niamey, Niger: UNICEF

Watt D. 2007 . On becoming a qualitative researcher: the value of reflexivity . Qualitative Report 12 : 82 – 101 .

Weber M. 2015 . Bureaucracy. In: Waters T , Waters D (eds). Rationalism and Modern Society: New Translations on Politics, Bureaucracy, and Social Stratification . London : Palgrave MacMillan .

Wesley JJ. 2010 . Qualitative Document Analysis in Political Science.

World Health Organization. 2006. Country Health System Fact Sheet 2006: Niger. Niamey, Niger: WHO.

Yin R. 1994 . Case Study Research: Design and Methods . Thousand Oaks, CA : Sage .

Supplementary data

Month:	Total Views:
November 2020	1,237
December 2020	341
January 2021	634
February 2021	1,157
March 2021	1,230
April 2021	1,120
May 2021	1,157
June 2021	1,274
July 2021	1,238
August 2021	1,293
September 2021	1,175
October 2021	1,271
November 2021	1,230
December 2021	1,164
January 2022	1,034
February 2022	1,278
March 2022	1,535
April 2022	1,491
May 2022	1,675
June 2022	1,288
July 2022	1,160
August 2022	1,168
September 2022	1,267
October 2022	1,368
November 2022	1,269
December 2022	1,077
January 2023	1,327
February 2023	1,548
March 2023	1,937
April 2023	1,743
May 2023	1,784
June 2023	1,569
July 2023	1,587
August 2023	1,477
September 2023	1,643
October 2023	1,766
November 2023	1,570
December 2023	1,165
January 2024	1,533
February 2024	1,463
March 2024	1,870
April 2024	2,194
May 2024	1,976
June 2024	1,566
July 2024	1,746
August 2024	1,291

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Home » Documentary Analysis – Methods, Applications and Examples

Documentary Analysis – Methods, Applications and Examples

Table of Contents

Documentary Analysis

Definition:

Documentary analysis, also referred to as document analysis , is a systematic procedure for reviewing or evaluating documents. This method involves a detailed review of the documents to extract themes or patterns relevant to the research topic .

Documents used in this type of analysis can include a wide variety of materials such as text (words) and images that have been recorded without a researcher’s intervention. The domain of document analysis, therefore, includes all kinds of texts – books, newspapers, letters, study reports, diaries, and more, as well as images like maps, photographs, and films.

Documentary analysis provides valuable insight and a unique perspective on the past, contextualizing the present and providing a baseline for future studies. It is also an essential tool in case studies and when direct observation or participant observation is not possible.

The process usually involves several steps:

Sourcing : This involves identifying the document or source, its origin, and the context in which it was created.
Contextualizing : This involves understanding the social, economic, political, and cultural circumstances during the time the document was created.
Interrogating : This involves asking a series of questions to help understand the document better. For example, who is the author? What is the purpose of the document? Who is the intended audience?
Making inferences : This involves understanding what the document says (either directly or indirectly) about the topic under study.
Checking for reliability and validity : Just like other research methods, documentary analysis also involves checking for the validity and reliability of the documents being analyzed.

Documentary Analysis Methods

Documentary analysis as a qualitative research method involves a systematic process. Here are the main steps you would generally follow:

Defining the Research Question

Before you start any research , you need a clear and focused research question . This will guide your decision on what documents you need to analyze and what you’re looking for within them.

Selecting the Documents

Once you know what you’re looking for, you can start to select the relevant documents. These can be a wide range of materials – books, newspapers, letters, official reports, diaries, transcripts of speeches, archival materials, websites, social media posts, and more. They can be primary sources (directly from the time/place/person you are studying) or secondary sources (analyses created by others).

Reading and Interpreting the Documents

You need to closely read the selected documents to identify the themes and patterns that relate to your research question. This might involve content analysis (looking at what is explicitly stated) and discourse analysis (looking at what is implicitly stated or implied). You need to understand the context in which the document was created, the author’s purpose, and the audience’s perspective.

Coding and Categorizing the Data

After the initial reading, the data (text) can be broken down into smaller parts or “codes.” These codes can then be categorized based on their similarities and differences. This process of coding helps in organizing the data and identifying patterns or themes.

Analyzing the Data

Once the data is organized, it can be analyzed to make sense of it. This can involve comparing the data with existing theories, examining relationships between categories, or explaining the data in relation to the research question.

Validating the Findings

The researcher needs to ensure that the findings are accurate and credible. This might involve triangulating the data (comparing it with other sources or types of data), considering alternative explanations, or seeking feedback from others.

Reporting the Findings

The final step is to report the findings in a clear, structured way. This should include a description of the methods used, the findings, and the researcher’s interpretations and conclusions.

Applications of Documentary Analysis

Documentary analysis is widely used across a variety of fields and disciplines due to its flexible and comprehensive nature. Here are some specific applications:

Historical Research

Documentary analysis is a fundamental method in historical research. Historians use documents to reconstruct past events, understand historical contexts, and interpret the motivations and actions of historical figures. Documents analyzed may include personal letters, diaries, official records, newspaper articles, photographs, and more.

Social Science Research

Sociologists, anthropologists, and political scientists use documentary analysis to understand social phenomena, cultural practices, political events, and more. This might involve analyzing government policies, organizational records, media reports, social media posts, and other documents.

Legal Research

In law, documentary analysis is used in case analysis and statutory interpretation. Legal practitioners and scholars analyze court decisions, statutes, regulations, and other legal documents.

Business and Market Research

Companies often analyze documents to gather business intelligence, understand market trends, and make strategic decisions. This might involve analyzing competitor reports, industry news, market research studies, and more.

Media and Communication Studies

Scholars in these fields might analyze media content (e.g., news reports, advertisements, social media posts) to understand media narratives, public opinion, and communication practices.

Literary and Film Studies

In these fields, the “documents” might be novels, poems, films, or scripts. Scholars analyze these texts to interpret their meaning, understand their cultural context, and critique their form and content.

Educational Research

Educational researchers may analyze curricula, textbooks, lesson plans, and other educational documents to understand educational practices and policies.

Health Research

Health researchers may analyze medical records, health policies, clinical guidelines, and other documents to study health behaviors, healthcare delivery, and health outcomes.

Examples of Documentary Analysis

Some Examples of Documentary Analysis might be:

Example 1 : A historian studying the causes of World War I might analyze diplomatic correspondence, government records, newspaper articles, and personal diaries from the period leading up to the war.
Example 2 : A policy analyst trying to understand the impact of a new public health policy might analyze the policy document itself, as well as related government reports, statements from public health officials, and news media coverage of the policy.
Example 3 : A market researcher studying consumer trends might analyze social media posts, customer reviews, industry reports, and news articles related to the market they’re studying.
Example 4 : An education researcher might analyze curriculum documents, textbooks, and lesson plans to understand how a particular subject is being taught in schools. They might also analyze policy documents to understand the broader educational policy context.
Example 5 : A criminologist studying hate crimes might analyze police reports, court records, news reports, and social media posts to understand patterns in hate crimes, as well as societal and institutional responses to them.
Example 6 : A journalist writing a feature article on homelessness might analyze government reports on homelessness, policy documents related to housing and social services, news articles on homelessness, and social media posts from people experiencing homelessness.
Example 7 : A literary critic studying a particular author might analyze their novels, letters, interviews, and reviews of their work to gain insight into their themes, writing style, influences, and reception.

When to use Documentary Analysis

Documentary analysis can be used in a variety of research contexts, including but not limited to:

When direct access to research subjects is limited : If you are unable to conduct interviews or observations due to geographical, logistical, or ethical constraints, documentary analysis can provide an alternative source of data.
When studying the past : Documents can provide a valuable window into historical events, cultures, and perspectives. This is particularly useful when the people involved in these events are no longer available for interviews or when physical evidence is lacking.
When corroborating other sources of data : If you have collected data through interviews, surveys, or observations, analyzing documents can provide additional evidence to support or challenge your findings. This process of triangulation can enhance the validity of your research.
When seeking to understand the context : Documents can provide background information that helps situate your research within a broader social, cultural, historical, or institutional context. This can be important for interpreting your other data and for making your research relevant to a wider audience.
When the documents are the focus of the research : In some cases, the documents themselves might be the subject of your research. For example, you might be studying how a particular topic is represented in the media, how an author’s work has evolved over time, or how a government policy was developed.
When resources are limited : Compared to methods like experiments or large-scale surveys, documentary analysis can often be conducted with relatively limited resources. It can be a particularly useful method for students, independent researchers, and others who are working with tight budgets.
When providing an audit trail for future researchers : Documents provide a record of events, decisions, or conditions at specific points in time. They can serve as an audit trail for future researchers who want to understand the circumstances surrounding a particular event or period.

Purpose of Documentary Analysis

The purpose of documentary analysis in research can be multifold. Here are some key reasons why a researcher might choose to use this method:

Understanding Context : Documents can provide rich contextual information about the period, environment, or culture under investigation. This can be especially useful for historical research, where the context is often key to understanding the events or trends being studied.
Direct Source of Data : Documents can serve as primary sources of data. For instance, a letter from a historical figure can give unique insights into their thoughts, feelings, and motivations. A company’s annual report can offer firsthand information about its performance and strategy.
Corroboration and Verification : Documentary analysis can be used to validate and cross-verify findings derived from other research methods. For example, if interviews suggest a particular outcome, relevant documents can be reviewed to confirm the accuracy of this finding.
Substituting for Other Methods : When access to the field or subjects is not possible due to various constraints (geographical, logistical, or ethical), documentary analysis can serve as an alternative to methods like observation or interviews.
Unobtrusive Method : Unlike some other research methods, documentary analysis doesn’t require interaction with subjects, and therefore doesn’t risk altering the behavior of those subjects.
Longitudinal Analysis : Documents can be used to study change over time. For example, a researcher might analyze census data from multiple decades to study demographic changes.
Providing Rich, Qualitative Data : Documents often provide qualitative data that can help researchers understand complex issues in depth. For example, a policy document might reveal not just the details of the policy, but also the underlying beliefs and attitudes that shaped it.

Advantages of Documentary Analysis

Documentary analysis offers several advantages as a research method:

Unobtrusive : As a non-reactive method, documentary analysis does not require direct interaction with human subjects, which means that the research doesn’t affect or influence the subjects’ behavior.
Rich Historical and Contextual Data : Documents can provide a wealth of historical and contextual information. They allow researchers to examine events and perspectives from the past, even from periods long before modern research methods were established.
Efficiency and Accessibility : Many documents are readily accessible, especially with the proliferation of digital archives and databases. This accessibility can often make documentary analysis a more efficient method than others that require data collection from human subjects.
Cost-Effective : Compared to other methods, documentary analysis can be relatively inexpensive. It generally requires fewer resources than conducting experiments, surveys, or fieldwork.
Permanent Record : Documents provide a permanent record that can be reviewed multiple times. This allows for repeated analysis and verification of the data.
Versatility : A wide variety of documents can be analyzed, from historical texts to contemporary digital content, providing flexibility and applicability to a broad range of research questions and fields.
Ability to Cross-Verify (Triangulate) Data : Documentary analysis can be used alongside other methods as a means of triangulating data, thus adding validity and reliability to the research.

Limitations of Documentary Analysis

While documentary analysis offers several benefits as a research method, it also has its limitations. It’s important to keep these in mind when deciding to use documentary analysis and when interpreting your findings:

Authenticity : Not all documents are genuine, and sometimes it can be challenging to verify the authenticity of a document, particularly for historical research.
Bias and Subjectivity : All documents are products of their time and their authors. They may reflect personal, cultural, political, or institutional biases, and these biases can affect the information they contain and how it is presented.
Incomplete or Missing Information : Documents may not provide all the information you need for your research. There may be gaps in the record, or crucial information may have been omitted, intentionally or unintentionally.
Access and Availability : Not all documents are readily available for analysis. Some may be restricted due to privacy, confidentiality, or security considerations. Others may be difficult to locate or access, particularly historical documents that haven’t been digitized.
Interpretation : Interpreting documents, particularly historical ones, can be challenging. You need to understand the context in which the document was created, including the social, cultural, political, and personal factors that might have influenced its content.
Time-Consuming : While documentary analysis can be cost-effective, it can also be time-consuming, especially if you have a large number of documents to analyze or if the documents are lengthy or complex.
Lack of Control Over Data : Unlike methods where the researcher collects the data themselves (e.g., through experiments or surveys), with documentary analysis, you have no control over what data is available. You are reliant on what others have chosen to record and preserve.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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The Monitoring and Evaluation Toolkit

Document analysis.

A useful tool for data checking, often combined with analysis of project records and interviewing, is document analysis.

This technique can also be used in theory-based evaluations. By analysing key documentation and reports relating to your project and the problem it is tackling, you can get a better understanding of the context and the factors that are causing the problem. You can also triangulate your findings and check your assumptions by asking whether they are borne out in the documentation.

Illustration

So, your survey of a local village has shown that men have attended family planning courses along with their wives and that they are now regularly using contraceptives. Yet your analysis of local reports (e.g. hospital records) show that there is an increase in unplanned births, teenage pregnancies and the spread of infectious diseases. The documentation appears to contradict your survey and you may need to ask some discreet questions of villagers in order to get to the bottom of this.

What counts as document analysis?

The points raised below draw heavily on the work of Glenn A. Bowen (‘Document Analysis as a Qualitative Research Method’)

Document analysis is a systematic procedure for reviewing or evaluating documents—both printed and electronic (computer-based and Internet-transmitted) material

Documents that may be used for systematic evaluation as part of a study take a variety of forms including:

advertisements; agendas, attendance registers, and minutes of meetings; manuals; background papers; books and brochures; diaries and journals; event programs (i.e.,printed outlines); internal correspondence; letters and memoranda; maps and charts; newspapers (clippings/ articles); press releases; program proposals, application forms, and summaries; radio and television program scripts; organisational or institutional reports; survey data; and various public records.

Scrapbooks and photo albums can also furnish documentary material for research purposes. These types of documents are found in libraries, newspaper archives, historical society offices, and organisational or institutional files.

Why use this technique?

Document analysis helps you to triangulate the claims about your project because it allows you to refer to multiple sources and to combine this document review with, for example, interviews.

So, documentary evidence drawn from school brochures and school websites in Namibia may tell you that the overriding priroty of schools in Winhoek is on pupil safety.

Yet police records may reveal that there is a high incidence of rape of young school girls, including by secondary school teachers. Interviews may be required to tease out why the documentary evidence is contradictory.

Documents serve various purposes. They provide context and historical background, point to possible interview questions, offer a means of tracking developments and monitoring progress over the course of a project, and provide a means of verifying (or questioning) that progress or indeed other claims.

Advantages & Disadvantages

Document analysis helps you focus on the questions you might ask in interviews and also helps you understand what to look out for with participant observation.
It is particularly useful when you want to drill down and focus on a particular case study, be it a particular patient, school pupil, village, sub-sector or workshop.
It is relatively cost-effective and rapid where data is readily available (e.g. via the internet).
Documents offer specific and stable data, which is unaffected by the presence of researchers (with participant observation by contrast, project participants may behave differently when they know they are being observed).

Disadvantages

Documents may not be complete or written in an objective fashion so you will have to adopt a critical stance and not assume that the information contained within them is precise or unbiased.
The number of documents involved can lead to information overload. Which parts of which document are most relevant to your question? Which is largely about the progress of your project and the factors that have helped or hindered that progress?
Documents may need to be anonymised and scrutinised against other documents. Is the one document that you end up using most representative or is it stating something very different to all the other documents? If so, why is this? Is the source or research design or the purpose of the document different?
Note that artifact analysis can be an alternative or complement to document analysis. It involves interpreting different artifacts such as tools, sculptures, weapons or even pieces of equipment. For ways of analysing such artifacts, see for example the National Archives website .

Data collection methods for evaluation: Document review

Resource link.

Data collection methods for evaluation - document review (PDF, 162KB)

This resource from the Centers for Disease Control and Prevention (CDC) provides a brief guide to using document review as a data collection method for evaluation.

This guide provides an overview of when to use document review, how to plan and conduct it, and its advantages and disadvantages. It is noted that document review is helpful for gathering background information, determining if program implementation reflects program plans, and developing other data collection tools for evaluation.

Document review has several advantages, including being relatively inexpensive, providing a behind-the-scenes look at a program that may not be directly observable, and bringing up issues not noted by other means. However, there are also potential disadvantages, such as information being incomplete or inaccurate, biased due to selective survival of information, and time-consuming to collect, review, and analyze many documents.

Centers for Disease Control and Prevention (CDC), (2018). Data collection methods for evaluation: Document review (No. 18). U.S. Dept. of Health and Human Services. https://www.cdc.gov/healthyyouth/evaluation/pdf/brief18.pdf

'Data collection methods for evaluation: Document review' is referenced in:

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Best of AEA365: Approaching document review in a systematic way

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INNOVATIONS in pharmacy

Vol. 15 No. 3 (2024)

Pharmacy Practice & Practice-Based Research

Original Research

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License .

Development, Pilot, and Evaluation of a Qualitative Documentation Tool for Pharmacists to Share High Impact Patient Intervention Stories

Alex William Middendorf

South Dakota State University College of Pharmacy and Allied Health Professions

Alexa Vanden Hull

Deidra Van Gilder

Erin Miller

Sharrel Pinto

Belmont University College of Pharmacy and Health Sciences

DOI: https://doi.org/10.24926/iip.v15i3.5772

Keywords: documentation, patient stories, community pharmacy

Background: Community pharmacists are often the most accessible member of the healthcare team to many patients and play a key role in managing their chronic conditions, such as diabetes or heart disease, through expanded pharmacy services like Medication Therapy Management. Despite their accessibility, pharmacy services are often underutilized due, in part, to a lack of adequate reimbursement models for pharmacy services. There is a need for qualitative data to be collected to indicate the full impact of those services and why they are so important in a patient’s healthcare journey.

Methods: An online Patient Stories Reporting Tool (PRST) was developed to allow outpatient pharmacists to document their perspectives of select direct patient care encounters that they felt showcased their value. In a pilot test, the PSRT was distributed to pharmacists from a partnering pharmacy organization. Qualitative data was collected, assessed by project team members, and organized by intervention types. For select stories, the otherwise undocumented nuances of delivered services and their impact were considered.

Results: Forty-seven stories were reported by 17 pharmacists across 13 practice sites from August 2021 to March 2023. Three types of key interventions delivered were identified including General Patient Education (7 stories), Medication Optimization (20 stories), and Cost Reduction (20 stories). Given the nature and scope of this initial pilot, one story for each of the three most prevalent intervention types was identified as exemplifying the types of stories the tool can collect.

Conclusions: The three selected stories help to characterize the services pharmacists provide, the important nuances of pharmacist-patient interactions, and the value of sharing these stories through tools like the PSRT. Through these stories, the PSRT also begins to record the nuances of pharmacist interventions and the impact they can make in a patient’s healthcare journey. Potential applications of the tool are multivarious including leading to improvements in the perception of pharmacists’ roles on the healthcare team and justifying reimbursement models.

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Open access
Published: 19 August 2024

Physical activity policies in Saudi Arabia and Oman: a qualitative study using stakeholder interviews

Ali Ahmed Alzahrani 1 ,
Peter Gelius 2 ,
Adrian E. Bauman 3 &
Klaus Gebel ORCID: orcid.org/0000-0003-0330-7756 1

Health Research Policy and Systems volume 22 , Article number: 111 ( 2024 ) Cite this article

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Countries in the Middle East have some of the lowest rates of physical activity and some of the highest rates of obesity in the world. Policies can influence population levels of physical activity. However, there is a dearth of research on physical activity policies in the Gulf region. This qualitative study analyses cross-sectoral barriers and facilitators for the development, implementation and evaluation of physical activity policies in Saudi Arabia and Oman, two of the largest countries in the region.

Semi-structured interviews were conducted with 19 senior policymakers from the Ministries of Health, Education, and Sport in Saudi Arabia and Oman, and were examined using thematic analysis.

We identified seven themes related to physical activity policies in Saudi Arabia and Oman: leadership; existing policies; physical activity programs related to policies; private sector policies; challenges; data/monitoring; and future opportunities. Both countries have a central document that guides policy-makers in promoting physical activity, and the available policies in both countries are implemented via multiple programs and initiatives to increase physical activity. Compared with Oman, in Saudi Arabia, programs from the non-profit sector, represented by community groups, play a more significant role in promoting physical activity outside the government framework. The private sector has contributed to promoting physical activity in both countries, but interviewees stated that more financial support is required. Policy limitations differ between Saudi Arabia and Oman: intersectoral collaboration in Oman is limited and mainly based on individuals’ own initiative, while the health transformation in Saudi Arabia tends to slow down policy implementation in relevant areas. Physical education in Saudi Arabia and Oman is similar; however, increased support and collaboration between government agencies and the private sector for out-of-school sports academies are needed.

Conclusions

This study addresses key gaps in analysing physical activity policies in Gulf Cooperation Council countries. Our study highlights the importance of increasing financial support, improving collaboration between governmental agencies and between them and the private sector and consolidating efforts to back physical activity policies and dismantle cross-sectoral barriers in Saudi Arabia and Oman. Educational institutions in Saudi Arabia and Oman play a crucial role in promoting physical activity from early childhood to young adults. Our insights assist policy-makers, public health officials and stakeholders in shaping effective physical activity-promoting policies, programs and interventions to prevent non-communicable diseases. Challenges identified in Saudi Arabia and Oman's policies will inform their future development.

Peer Review reports

Despite the health benefits of physical activity [ 1 , 2 , 3 ], in most countries, large proportions of the population remain insufficiently active [ 4 , 5 ]. In line with social–ecological models of health [ 6 ], the need for policies to increase population levels of physical activity has been highlighted [ 7 , 8 ]. Physical activity policy is defined as any formal or informal legislative or regulatory action or organized guidance provided by governments and organizations [ 9 , 10 , 11 , 12 ]. Policies can be cross-sectoral and encompass access to various forms of physical activity, including walking and cycling, regulate and promote programs and initiatives, and provide a comprehensive framework for the design, funding and implementation of diverse physical activity interventions [ 9 , 13 , 14 ].

Countries in the Middle East have amongst the lowest levels of physical activity and some of the highest rates of overweight and obesity in the world [ 4 , 15 ]. In Saudi Arabia and Oman, only 29.7% and 25.6% of the adult population, respectively, meet the physical activity recommendations. For the Middle East and North Africa (MENA) region the rate is 38.5% and the global average is 31.3% [ 4 ]. Moreover, in 2020 in Oman, Qatar, Bahrain, Kuwait and the United Arab Emirates, more than 80% of teenagers and 55% of adults (45% of men and 65% of women) were not sufficiently active [ 16 ]. In Saudi Arabia and Oman, dietary patterns are shifting due to increased consumption of processed foods, leading to higher rates of obesity, diabetes and cardiovascular diseases. Traditional diets rich in fruits, vegetables and lean meats are being replaced by fast food and sugary drinks. Moreover, reduced physical activity and increasingly sedentary lifestyles are major determinants of the obesity epidemic [ 17 , 18 ]. Therefore, there is an urgent need in this region for action on physical activity, including policy development, implementation and evaluation.

The 2014 report from the WHO Regional Office for the Eastern Mediterranean on promoting physical activity in the region included a policy mapping exercise on national policy and action on physical activity in all 22 member states [ 19 ]. National physical activity policies were reported for most countries, including all members of the Gulf Cooperation Council (GCC), a political and economic alliance of six Middle Eastern countries [Saudi Arabia, Kuwait, the United Arab Emirates (UAE), Qatar, Bahrain and Oman] that share a similar cultural, social and economic background. According to WHO’s recent Global Status Report on Physical Activity [ 16 ], only 11 of the 22 countries in the Eastern Mediterranean Region had a national physical activity strategy, while all GCC countries had one. The report also identified some partnerships to promote physical activity between various ministries in the Gulf states, particularly across the health, sports and education sectors.

In a systematic scoping review, Klepac Pogrmilovic et al. examined the academic literature on physical activity policy and identified 163 papers, covering 168 countries, including all 6 GCC members [ 20 ]. Few papers on physical activity policy across the Eastern Mediterranean region were identified, thus, the findings for the region were largely based on the 2014 report of the WHO Regional Office [ 20 ]. In another study by Klepac Pogrmilovic and colleagues, a survey on national physical activity policies was completed by representatives of 76 countries. However, this only included three of the 22 countries from the Eastern Mediterranean Region. The authors also emphasized that although national policies and strategies exist in all GCC countries, implementation is lacking. The authors recommended that further research be undertaken into physical activity and sedentary behaviour policy in the region [ 8 ]. It is essential to contextualize these findings with regard to physical activity policies in the Gulf region, including disparities and challenges in their implementation.

Recently, Albujulaya et al. analysed physical activity policy initiatives in Saudi Arabia by conducting semi-structured interviews with three policy-makers from the Ministries of Education and Sports and with six Saudi academics working in this field [ 21 ]. Surprisingly, they did not interview anyone from the Ministry of Health. They concluded that while physical activity amongst Saudis overall has increased, levels among women are still low. While Albujulaya et al. analysed aspects of physical activity policy development, implementation and evaluation in Saudi Arabia, they did not address potential cross-sectoral barriers and facilitators for these processes.

The primary objective of the present study was to analyse cross-sectoral barriers and facilitators for physical activity policy development, implementation and evaluation in GCC countries. The best research paradigm for this study is qualitative research. We chose interpretivist research to describe complex social realities, explore new or under-researched subjects and generate hypotheses for future quantitative research. This approach allows for a detailed examination of phenomena, which is difficult with quantitative methods. Practically, we also lacked a large, easily accessible sample to survey quantitatively. Therefore, interpretivism is particularly effective for understanding stakeholder perspectives on physical activity policies in unique cultural settings, such as those in Saudi Arabia and Oman, providing deep insights into subjective experiences and nuanced views. To achieve this, we interviewed policy-makers from the Ministries of Health, Sport and Education in Saudi Arabia and Oman, the two largest countries in the GCC. We picked these three ministries as previous research highlights that they are chiefly responsible for promoting physical activity and implementing related policies in the Gulf region [ 22 , 23 , 24 ].

Study design

This is a qualitative study using the interpretivist research paradigm [ 25 ], comprising semi-structured interviews with key stakeholders in physical activity policy-making in Saudi Arabia and Oman. We utilized the COREQ checklist to ensure the rigour and transparency of our qualitative methods (Appendix 1).

Sampling and recruitment

We defined stakeholders as those that are directly involved in the development, implementation and evaluation of physical activity policies. We initially sought to conduct interviews with stakeholders in all six GCC countries. We attempted to reach a contact in the Ministry of Health (MoH) in each GCC country by writing to the official email address of the ministries to introduce the study and request the contact details of relevant stakeholders. Despite following up with non-responders, we did not receive any replies from Qatar, Bahrain, Kuwait and the United Arab Emirates. Therefore, we narrowed the scope to Saudi Arabia and Oman, the two largest countries of the six, with 36.4 million and 4.6 million inhabitants, respectively, accounting for 70% of the GCC’s population [ 26 ]. After obtaining contact details of key stakeholders from the ministries, the participants were contacted directly via email or telephone. To recruit additional participants, we used snowball sampling by asking interviewees to provide contact details of other relevant stakeholders in their organization. Because of the documented previous involvement of the sports and education sectors in promoting physical activity in the Gulf States [ 19 ], we also asked participants to identify relevant stakeholders in the Ministries of Sports and Education in Saudi Arabia and Oman. Our study focussed on the Ministries of Sports, Health and Education as they are significantly involved in promoting physical activity within Gulf Cooperation Council countries [ 22 , 23 , 24 ]. Attempts to contact the ministers directly were unsuccessful. However, we managed to reach senior staff in the ministries and in university sports federations which belong to the Ministries of Education. Additionally, we employed different strategies to engage participants from the non-governmental sector in both countries, including networking through professional contacts of the first author, utilizing online platforms such as Twitter and Facebook and forums and capitalizing on established partnerships with both non-governmental organizations (NGOs) and governmental sectors.

Participants were provided with information on the study, and all gave written consent to participate. Additionally, participants were informed at the beginning of the interview that they could withdraw from the study at any time if they chose not to continue participating. An interview guide, based on a review of previous literature [ 22 , 24 ] and collaborative input from the authors, was developed (Appendix 2). In the interviews, we explored stakeholders’ perspectives and opinions regarding existing physical activity policy documents from the Ministries of Health, Education and Sport in their country, as well as facilitators and barriers to physical activity policy development, implementation and evaluation, with field notes made during the interviews. A.A. conducted the interviews via Zoom due to the coronavirus disease 2019 (COVID-19) pandemic between December 2021 and February 2022. Interviews were conducted in Arabic, were audio-recorded with permission obtained from the participants and transcribed verbatim, and lasted between 10 min and 45 min. Repeat interviews were not carried out. The following personal information was collected from each participant: name, organization, position, age, gender and previous work experience. The participants were provided with an opportunity to review the Arabic transcripts for accuracy, and the final transcripts were translated to English. Monitoring of data saturation, an ongoing process based on the notion of informational redundancy [ 27 ], was conducted to ensure that comprehensive insights were obtained. The determination of the number of samples needed to reach data saturation was done separately in each country.

Data analysis

Authors A.A., A.B. and P.G. reviewed the transcripts to familiarize themselves with the content, after which thematic analysis was jointly undertaken by A.A., A.B. and P.G. to code each transcript. Themes were subsequently developed through a partially deductive approach: Main categories in Table 1 were derived from existing frameworks of the policy process, such as the HARDWIRED framework [ 28 ] (covering aspects such as development process, partnerships, resources, communication, evaluation and evidence-base) and CAPPA criteria [ 29 ] (including sectors/institutions involved, implementation, legal status, target groups, goals and targets, timeframe, budget and evaluation/surveillance). Subsequently, sub-categories were added via an inductive process conducted by A.A. during the thematic exploration stage, involving a comprehensive review of all codes within the combined dataset encompassing both Saudi Arabia and Oman. A.A., A.B. and P.G. discussed the coding and the preliminary interpretations to cross-validate the findings. These themes were informed by a comprehensive analysis of the extant literature and relevant findings from previous studies [ 22 , 24 ]. As a medical doctor at King Faisal Medical City in the southern region of Saudi Arabia, the lead author’s professional background informed his approach to data analysis in this qualitative study.

Ethical approval

The study was approved by the Human Research Ethics Committee of the University of Technology Sydney (UTS HREC ref. no. ETH21-6428).

Interviews were conducted with 19 high-level stakeholders in physical activity policy; 12 from Saudi Arabia and 7 from Oman. A total of four of the participants (two from each country) were women. In Saudi Arabia, four participants were from the Ministry of Health (MoH, including one from an NGO that is supervised by the MoH), five were from the Ministry of Education (MoE) and three represented the Ministry of Sport (MoS). In Oman, one participant represented the Ministry of Health, three were from the Ministry of Education and three were from the Ministry of Sport.

We generated six themes regarding physical activity policies in Saudi Arabia and Oman: leadership; existing policy documents; implementation of physical activity policies; challenges; data/monitoring for physical activity policies; and future opportunities. The theme non-profit sector/community groups was generated only for Saudi Arabia. Table 1 provides an overview of the derived main themes and findings.

Saudi Arabia

Participants from the Saudi MoH and MoS stated that the leadership in the legislation, regulation, and evaluation of physical activity policies is divided between the two ministries. They also collaborate with other government agencies, including the MoE and the Ministry of Municipal and Rural Affairs, to increase physical activity opportunities in schools, workplaces and communities. Two participants from the MoE mentioned that the University Affairs Council and the Supreme Economic Council also work in the promotion of physical activity by regulating the implementation of programs in their sectors according to policy documents from the MoH and MoE.

According to the participant from the NGO supervised by the MoH, the non-profit sector is instrumental in promoting physical activity through walking groups. These have been established throughout the country to provide opportunities for people to engage in physical activity and to socialize, and which are co-organized by various stakeholders, including local businesses, schools, healthcare providers and government agencies: “I firmly believe that the non-profit sector plays a pivotal role in advocating for physical activity in Saudi Arabia” (NGO participant).

Participants from the Saudi MoH underlined that Health in All Policies is one of the main objectives in the new health care transformation in the kingdom. Most participants from the three ministries identified a certain level of cooperation between different stakeholders, particularly between the Ministries of Health, Sport and Education.

The Omani MoH leads the policies and programs to promote physical activity. Participant 1 from the MoH said that their non-communicable disease (NCD) and Health Committees are crucial for leading policy-making and promoting physical activity related to the National Policy for Prevention and Control of NCDs document [ 30 ].

Regarding Health in All Policies, all participants from Oman stated that there is cooperation between the different ministries, but that it is limited and based on individual agencies’ own initiatives rather than combined efforts or a policy imprimatur: “Partnerships exist, but they are limited and based on individual initiatives” (participant 2 from the MoS).

Relevant existing policies

Most of the participants from all three ministries in Saudi Arabia referred to the Quality of Life document [ 31 ], an economic and social reform blueprint that is part of the government’s overarching Saudi Vision 2030 development program [ 32 ]. The Quality of Life document includes the most important physical activity policies implemented by the three ministries: “There is no doubt that the 2030 Vision is our basic guidance” (participant 3 from the MoH). “Before 2017 there were no clear policies. Everyone works on vision files, and everyone has to achieve the [Vision 2030] target to increase the quality of life of the Saudi community” (participant 2 from the MoE). The Quality of Life document emphasizes the need to enhance public health and healthcare services, promote healthy behaviours, and provide opportunities for physical activity and sports participation.

Interviewees from the MoE highlighted that the University Sports Federation strategy promotes physical activity and sport in tertiary education [ 33 ]. Some important miscellaneous policy documents were identified by staff of the three ministries, such as the National Strategy for Healthy Food and Physical Activity 2015–2025 [ 34 ], the Physical Activity Guidelines for Health Practitioners [ 35 ], the 24-Hour Movement Guidelines [ 36 ] (all by the MoH) and the annual report of the Sport for All Federation by the MoS [ 37 ].

Almost all participants across all three ministries stated that the government of Oman’s overarching Vision 2040 [ 38 ] is currently the most important policy document. Participants from the MoE reported that the Vision 2040 guides the promotion of student physical activity, with support from related documents such as the student learning calendar, education document, standards document and the school sports curriculum. These policy documents aim to promote physical activity among students by better integrating physical education (PE) classes into the overall curriculum to encourage regular physical activity and healthy habits. According to participant 1 from the MoH, the Education Document is a comprehensive strategy, including PE and promotion of physical activity in schools and universities. The document outlines various initiatives, policies and guidelines to ensure that education includes a focus on physical health and fitness [ 39 ]. Three participants from the three different Omani ministries referred to the National Policy for Prevention and Control of NCDs [ 30 ], published by the MoH, as the central policy document for physical activity promotion in Oman. Three study participants from the MoS suggested that the Omani Sports Strategy [ 40 ] is important for guiding the promotion of physical activity for different segments of society.

Implementation of physical activity policies

(a) physical activity programs.

The MoH and MoE collaborate on a range of health-related issues (obesity, diabetes, mental health and visual acuity) to improve the overall health of school students and to detect problems at an early stage [ 41 ]. This led to the development of the Rashaka initiative, a large-scale multi-component school-based obesity prevention program, which started in 2016 and involved nearly 1000 schools across the country. In 2020, Rashaka was replaced by an annual program composed of screening of students for early signs of chronic diseases and lectures highlighting the significance of physical activity and a healthy diet.

Participants 3 and 4 of the Saudi MoH mentioned the Walk 30 Minutes initiative, which was implemented in 2021 and intends to increase physical activity through mass media and social media, and forms part of the National Strategy for Healthy Food and Physical Activity 2015–2025 of the MoH. An initiative by the University Sports Federation [ 33 ] (related to policies from the MoS), aiming to support sports facilities and clubs for girls and women, was mentioned by three participants from the MoS, and one participant highlighted the MoS’s Talent Support Program to identify and develop talented athletes in different sports.

Participant 3 of the Saudi MoH and participant 5 of the MoE mentioned the Healthy Mall Campaign and the Healthy Campus Project to promote physical activity in air-conditioned malls and universities. These initiatives are related to policies of the National Strategy for Healthy Food and Physical Activity (MoH and MoE). Despite challenges, the study participants considered the Saudi physical activity programs to be effective.

Participants 1 and 2 of the MoE identified programs related to PE policies from the Education Document, which include increasing the number of PE classes per week and organizing tournaments in different sports. According to participants from the three different ministries, a range of physical activity programs took place during the COVID-19 pandemic, including campaigns calling for physical activity at home using apps with exercise videos. These initiatives, as reported by the participants, align with and are supported by the physical activity policy documents from the Ministries of Health, Sport and Education, that is, the National Policy for Prevention and Control of NCDs [ 30 ] and the Oman Sport Strategy [ 40 ].

According to multiple participants, several community-based initiatives were underway in Oman, such as Active Community, Healthy Cities and Healthy Villages and The Green Playgrounds Project. These initiatives had been set up in all Omani cities to make the built environment more activity friendly, for example, by improving neighbourhood walkability, which is also based on the National Policy for Prevention and Control of NCDs [ 30 ].

(B) Private sector

According to most of the participants, the private sector makes important contributions to physical activity promotion in Saudi Arabia by being directly involved in the policy development process. The Tatweer Educational Company, a private holding dedicated to implementing the government's education reform initiative, has developed programs to promote physical activity in schools, aligning with its commitment to a holistic education system. In line with the conceptualization of active travel as physical activity, the Red Sea Company drives the development of Saudi Arabia’s west coast and aims to improve neighbourhood walkability. Participants from the MoE were unanimous in the view that private universities make significant contributions to the promotion of physical activity among staff and students on the basis of financial support from their funders. International and local investors in the education sector are urging private universities to promote physical activity to enhance the universities’ reputation and to be more attractive for prospective students.

According to participant 1 from the Ministry of Health, walking and hiking groups supported by the Health Promotion Center [ 42 ] (a non-profit charitable organization under the umbrella of the Saudi Ministry of Labor and Social Affairs) play an important role in promoting physical activity in Saudi Arabia. This is despite a lack of governmental support, with influencers and celebrities utilizing social media platforms for the promotion of physical activity. This organization has internal policies for the promotion of physical activity through different programs: “The fact is that community groups working to spread this culture of walking have no ceilings, no limits, and no bureaucracy” (participant 1 from the MoH).

In contrast to Saudi Arabia, participants in Oman stated that more support from the private sector is needed to promote physical activity in the country. However, participant 3 from the MoE mentioned an agreement between the MoE and Muscat Pharmacy & Stores limited liability company (LLC) to hold a football tournament for elementary school students. Nevertheless, it is important to highlight that there is a prevailing perception that physical activity cannot be easily monetized. This contributes to the private sector’s limited interest in supporting such initiatives in the Gulf countries, as it is not perceived to yield immediate profits. Overall, the participants from both Saudi Arabia and Oman stated that, unlike in government-supported programs, in the private sector there are no performance indicators to track the progress of physical activity programs.

Data/monitoring

Two participants from the Saudi MoH and MoE mentioned challenges in relation to physical activity monitoring, as each of the three involved ministries independently conducts surveys on physical activity with different methodologies and tools, which may yield conflicting results in monitoring the effects or end-product of physical activity policies. Furthermore, participants from all three ministries confirmed the existence of national surveys for physical activity and emphasized their importance in assessing activity levels. They also shared insights about how they monitor the implementation of physical activity policies and evaluate the effectiveness of various initiatives in their respective sectors: “We follow and evaluate health through periodic national surveys, but each ministry has its own survey with different results. It is not clear how widely these data are utilized in different sectors, such as education, and sports, to inform policies and interventions” (participant 2 from the MoH).

Participants from the MoH and MoS stated that participation rates, policy compliance, budget allocation and health outcomes are being tracked to assess the effectiveness and progress of physical activity policies, with a specific focus on regular reports and data analysis. Furthermore, one participant from the MoE said that there is no monitoring happening for their education-specific policies.

Participant 4 from the MoH suggested that limited policy implementation is likely until the health transformation process is completed by 2030. The health transformation in Saudi Arabia is a recent, prominent project that aims to restructure the health sector to make it more comprehensive, effective and integrated. The transformation is mainly focussed on the prevention of chronic diseases and the promotion of a healthy lifestyle through physical activity and a nutritious diet. On the ground, this transformation entails significant changes in healthcare infrastructure, delivery and accessibility, as well as increased awareness campaigns and the implementation of various programs aimed at improving public health and wellbeing [ 43 ]. To expedite the health transformation in Saudi Arabia, the respondent considered it essential to implement the policies from the Quality of Life document, which is part of the Kingdom’s Vision 2030. This particularly involves promoting physical activity and healthy lifestyles. By fostering these habits, the country could achieve significant improvements in public health and wellbeing. Participant 3 suggested that bureaucracy is a limitation, as new policies and regulations take a long time to implement under different administrations. Moreover, participants from the MoH and MoE declared that a lack of sustainability of physical activity programs and funding were major limitations due to changes in administrations over short periods. Most participants representing the three Saudi ministries stated that a lack of collaboration and cooperation between government departments was a major challenge. For instance, some policies from the MoH need to be implemented by the MoE, such as the screening program of school students [ 41 ]. The hot climate and the desert environment in the Gulf region also present challenges when it comes to implementing physical activity policies.

According to most participants, a lack of funding for the promotion of physical activity was a common challenge in Saudi Arabia because health budgets are mostly allocated to hospitals and curative services rather than to NCD prevention, including physical activity promotion. A lack of facilities (e.g. sports fields, recreation centres, indoor and outdoor courts and multi-use sporting hubs) is a further challenge according to most Saudi respondents. Moreover, negative societal attitudes towards physical activity were highlighted by one participant, citing challenges such as the prevalence of social norms that prioritize sedentary pastimes and leisure activities, thereby reinforcing a culture that tends to discourage physical activity [ 44 ].

According to most participants, insufficient collaboration between different stakeholders, as well as a lack of government funding and support from the private sector, were the most important barriers to physical activity promotion. Like in Saudi Arabia, participants from Oman said that the hot climate and desert environment in the Gulf region, a lack of facilities and/or a lack of access to them and negative attitudes in the population towards physical activity (social norms that prioritize sedentary pastimes and leisure activities) all pose obstacles to physical activity. Some participants from the MoE stated that a lack of support for PE facilities in schools has been a major obstacle to increasing students’ physical activity. Like in Saudi Arabia, respondents from Oman felt that the country should rapidly implement the provisions of the Vision 2040, specifically those related to the prevention of chronic diseases through the promotion of a healthy lifestyle and physical activity. Furthermore, an increase in government funding dedicated to promoting physical activity would be desirable.

Future opportunities

Participant 3 from the Saudi MoH stated that future policies might include investment in technology, such as developing smartphone apps for the promotion of physical activity during pandemics, and these could contribute to future physical activity programs. However, this requires direct support from the government, both financially and technically, by providing technical expertise, developing and implementing technology-based solutions and ensuring privacy and security. Furthermore, participant 1 from the MoS and participant 3 of the MoE claimed that programs, such as out-of- school academies for talented young athletes, could further encourage physical activity and foster athletic talent. Three participants from the MoE pointed out that unifying efforts between different stakeholders would be important. Moreover, more support in terms of funding, infrastructure, a skilled workforce, and research are considered promising opportunities by most participants from the three ministries.

Participants from the three ministries stated that community participation, such as activating schools as centres for physical activity promotion in the community, would be a great opportunity in the future if cooperation between different ministries is enhanced. Three participants from the Omani MoS and MoE said that improvements to facilities and the skills of the workforce (e.g. PE teachers, coaches, gym instructors, etc.) are required to increase activity levels. Despite the existence of the national plan for physical activity promotion in Oman [ 45 ], all participants emphasized that the lack of partnerships between the government and other relevant parties, such as schools, sports clubs and community organizations, is a common and significant obstacle. Furthermore, participant 1 from the MoS and participant 3 from the MoE said that more support for out-of-school sport academies, including improved collaboration between governmental agencies and the private sector, and supporting physical education as a part of the Omani education strategy, would be great opportunities.

Participants from the Ministries of Education of Saudi Arabia and Oman highlighted that physical education is crucial for the future in both countries, fostering healthy habits essential for a productive workforce. Integrating physical education into the curriculum promotes wellness and prevents lifestyle-related diseases, contributing to various sectors [ 39 ]. As both nations progress, emphasizing physical education will enhance individual health and serve as a strategic investment in a robust, dynamic workforce.

This study examined cross-sectoral barriers and facilitators for physical activity policy development, implementation and evaluation in Saudi Arabia and Oman by interviewing high-level stakeholders from their Ministries of Health, Sports and Education. Oman established a national policy framework for physical activity in 2014 [ 18 ] under the umbrella of the Oman Vision 2040 [ 38 ], 3 years before Saudi Arabia introduced its Quality of Life Program [ 46 ] under the umbrella of the Saudi Vision 2030 [ 31 ]. Many programs and initiatives to enhance physical activity in both countries were identified, particularly sports initiatives. However, it is worth noting that these efforts often lack comprehensiveness, encompassing a broad range of activities and demographics, and face challenges in effective implementation – observations that are in line with findings from a survey on national physical activity policies by Klepac Pogrmilovic et al. [ 8 ]. The programs and initiatives are predominantly focussed on urban areas and may neglect rural communities [ 44 , 47 ]. Interest in promoting gender equity in physical activity in Oman was prominent, with several programs for female participants [ 24 ]; there was less focus on gender equity in Saudi Arabia, although a positive development was the introduction of PE classes for female students in primary and secondary education in 2018. Policies for promoting physical activity should also support individuals with special needs, patients and the elderly by implementing community programs targeted at these groups, such as walking groups and fitness classes for older adults, and programs targeting people with chronic conditions. Additionally, it is important to focus on policies and programs that support gender equality in physical activity and health.

Our finding regarding insufficient backing of policy interventions to create environments supportive of physical activity in both countries aligns with a study by Allender et al., who interviewed stakeholders in local government in Victoria, Australia, to analyse physical activity policies and initiatives. Similar to our findings from Saudi Arabia and Oman, they identified a lack of relevance and competing priorities (i.e. promoting healthy eating environments was not considered a priority above food safety) as reasons for the lack of support towards creating supportive environments for physical activity and healthy eating [ 48 ].

Health in All Policies has been embraced in Saudi Arabia by integrating the promotion of physical activity into policy development across various areas such as education, sports and the private sector. However, while this integration is mentioned in the respective documents, challenges in implementation may have arisen due to limited cooperation between sectors. Many partnerships have been established with multiple parties in the Kingdom (MoH, MoS, MoE, and the Ministry of Municipal and Rural Affairs) to further develop physical activity policies in each sector and to remove obstacles to the implementation of physical activity programs. According to a WHO report from 2017, promoting Health in All Policies in Saudi Arabia has been identified as a national priority, monitored by the Ministry of Health [ 49 ]. Intersectoral collaboration in Oman is apparently less developed than in Saudi Arabia, hindering the integration of physical activity policies across sectors. Unlike Saudi Arabia’s comprehensive approach of Health in All Policies, Oman relies more on individual agency initiatives. However, there is potential for improvement in Oman to strengthen intersectoral collaboration and enhance the integration of physical activity policies by establishing a comprehensive policy framework and promoting coordinated efforts among sectors. For instance, the Omani government could create an intersectoral task force or committee dedicated to fostering collaboration.

In Saudi Arabia, the non-profit sector, represented by community groups, plays a significant role in promoting physical activity outside of the government framework, aided by the promotion of physical activity by influencers and celebrities through social media platforms [ 42 ]. By contrast, our study participants did not mention any significant involvement of the non-profit sector in physical activity promotion in Oman, either because these types of organizations do not play a role or because their role is not valued by the government stakeholders who we interviewed. The private sector contributes to promoting physical activity in both countries, with particularly strong partnerships with the governmental sector in Saudi Arabia. This may be because tax benefits exist for companies that encourage and promote physical activity in Saudi Arabia [ 31 ]. There are previous examples of these types of partnerships in Oman, such as a collaboration between the education and private sector aiming to create a healthier environment and lifestyle in schools. These partnerships have been achieved through the provision of financial support and sponsorships, specifically targeting sports equipment, facilities and physical activity programs in schools [ 50 ]. However, insufficient budget allocation in this area was considered a challenge, which is consistent with our study, with most participants from the sultanate expressing the need for greater financial support from the private sector.

Policy limitations differ between both countries, mainly due to the health transformation in Saudi Arabia, specifically with the Kingdom’s Vision 2030 [ 51 ]. The slow pace of transformation in various Saudi public health, infrastructure, urban planning, sports and recreation policies may impact their likelihood of being fully implemented by 2030, potentially falling short of WHO’s target for increased physical activity by that year set in their Global Action Plan on Physical Activity [ 52 ]. One of the objectives of the health sector transformation and the Quality of Life Program is to decrease the proportion of the Saudi population who are not sufficiently physically active below (67%) by 2030 [ 51 ]. The government has taken proactive measures to promote physical activity, investing in initiatives that raise awareness about its importance and the associated health benefits. This includes campaigns, public awareness programs and the establishment of recreational facilities to facilitate physical activity. In Oman, more collaboration between political parties is essential to improve the implementation of physical activity policies. According to participant 1 from the Omani MoH, several meetings were recently held with all parties to create plans to better implement physical activity policies. These meetings have led to increased monitoring and stricter enforcement by the Omani government regarding the implementation of physical activity policies in all relevant ministries. Effective health system policies significantly depend on inter-institutional collaboration. While primary health institutions play a central role, the impact of related entities is equally crucial. Educational bodies, sports organizations and community health centres contribute significantly to decision-making processes. Their closer involvement would ensure a more comprehensive approach to promoting physical activity, enhancing wellness and preventing lifestyle-related diseases [ 53 ].

According to previous studies, insufficient funding for promoting physical activity, and more broadly for NCD prevention, is a challenge in both Saudi Arabia and Oman [ 23 , 24 ]. Similarly, in a US study, state public health practitioners were interviewed about the National Physical Activity Plan, who also identified implementation costs and the complexity of physical activity policies as significant challenges [ 54 ]. Financial incentives and private sector involvement, while valuable, do not ensure adequate funding for all aspects of public health initiatives. The private sector’s contribution is often focussed on areas aligned with their business interests or corporate social responsibility. Nevertheless, in Saudi Arabia, certain private sector companies run national programs, such as the Tatweer Educational Company, a private holding dedicated to implementing the government's education reform initiative [ 55 , 56 ]. Enhancing funding for the implementation of physical activity policies in the Gulf region holds great promise in advancing infrastructure, cultivating a proficient workforce, and fostering research initiatives. On the basis of the Saudi Quality of Life document 2030 [ 46 ], the budget of the Ministries of Health, Sport and Education for promoting physical activity will likely increase until 2030.

The monitoring and evaluation of policy implementation across ministries in both countries is challenging due to the absence of comprehensive and precise data on physical activity prevalence in key sectors such as health, sport and education. Therefore, there is an urgent need to address data quality issues, such as inconsistent measurement methods employed across different sectors, which make it difficult to compare and consolidate data, and the lack of standardized protocols which undermines the accuracy and reliability of prevalence estimates. To efficiently monitor policy implementation, the responsibility could, for instance, be entrusted to the MoH for coordination with all pertinent sectors, while the General Statistics Authority should be designated to collect data on physical activity.

Responsibility for ensuring data quality rests with various stakeholders involved in the data collection, including researchers, survey administrators, data analysts and policy-makers. These stakeholders must work collectively to implement robust data collection methodologies, appropriate sampling techniques, rigorous quality control measures and transparent reporting practices. Monitoring of the impact of policies on population levels of physical activity in Saudi Arabia and Oman has improved, but more work is needed, particularly in the education sector in Oman, which requires evaluation of the progress and impact of policies.

To create and implement comprehensive policies, programs and supporting environments, a variety of sectors must collaborate in both countries. This may include transport, urban planning, media, social work, religious and cultural affairs [ 23 ]. In Saudi Arabia, one of the most effective health-promoting practices is physician-recommended physical activity [ 57 ], which is recognized as one of the eight best investments for physical activity by the International Society for Physical Activity and Health [ 58 ]. Therefore, the primary healthcare system in the Gulf region has a critical role in the promotion of physical activity, and further policy development in this area would be promising [ 57 ]. In addition, physical education policies in schools play an integral part in the Gulf states [ 59 ]. Educational institutions in Saudi Arabia and Oman are crucial in promoting physical activity among various age groups. From childhood through adolescence to young adulthood, schools offer structured physical education programs, health education and gender-inclusive activities. Universities support these efforts by providing sports facilities and activities as well as by conducting research on active lifestyles. Coordinated national policies amplify the effectiveness of these initiatives [ 22 , 39 , 60 ]. Furthermore, active transport and urban design policies have not yet been developed sufficiently to become potential contributors to population levels of physical activity in these countries due to cultural, environmental and climatic differences [ 23 ].

Strengths and limitations

Strengths of this study include a sample of high-level stakeholders who are directly involved in the formulation of physical activity policies from three ministries in Saudi Arabia and Oman, the two largest countries in the GCC. Additionally, we recruited one prominent participant from an NGO that is supervised by the Saudi Ministry of Health. We were not able to reach participants from the non-governmental sector in Oman. The original research plan was targeted at all six member countries of the Gulf Cooperation Council, but we were not able to recruit participants from the other GCC states due to political sensitivities surrounding the subject and a lack of responsiveness from relevant authorities. This may limit the generalizability of our findings beyond these specific contexts. However, we managed to recruit senior participants from the two largest GCC countries, which account for 70% of the GCC population. As in many countries, governmental representatives may have been constrained in what they reported in these interviews. Regarding the limitation of interview responses, some participants spoke about the existence of physical activity policies but did not want to provide further information on how they are being implemented, and this kind of information is not easy to obtain from other sources either. Thus, these gaps constitute a need for future research. To ensure research quality based on Lincoln and Guba’s criteria [ 61 ], we implemented several strategies. For credibility, we used investigator triangulation (involving multiple researchers) and theoretical triangulation (utilizing multiple policy frameworks). We did not use methodological triangulation, as we only conducted interviews, nor data triangulation, relying solely on audio transcripts. To ensure dependability, we kept detailed records of data collection and assessed coding accuracy and reliability among our team. For transferability, we addressed inherent challenges by collecting data from two countries, Saudi Arabia and Oman, enhancing the applicability of our findings to similar contexts. Although achieving confirmability was challenging due to our focus on individual perceptions, we aimed for transparency and objectivity in documenting our procedures and decisions.

This study fills important gaps in the analysis of physical activity policies in the Gulf region. Understanding the unique challenges, barriers and successes in promoting physical activity in the GCC countries is essential for developing relevant policies and strategies in the future. Our study highlights the importance of increasing financial support, improving collaboration between governmental agencies and between them and the private sector, and consolidating efforts to back physical activity policies and dismantle cross-sectoral barriers in Saudi Arabia and Oman. Educational institutions in Saudi Arabia and Oman play a crucial role in promoting physical activity from early childhood to young adults. Schools offer structured physical education, health education and gender-inclusive activities, while universities provide sport facilities and conduct research on active lifestyles. Coordinated national policies enhance the effectiveness of these efforts.

Specifically, we recommend allocating dedicated funds, establishing a centralized task force for coordinated policy implementation, creating incentives for private sector investment, developing a national strategy with measurable targets and conducting comprehensive policy reviews to remove bureaucratic obstacles. These steps will facilitate sustained progress and broader engagement in physical activity initiatives.

Our findings provide valuable insights and evidence for policy-makers, public health officials and other stakeholders in the region to develop targeted policies, programs and interventions that promote physical activity and prevent non-communicable diseases. The identified challenges and limitations of physical activity policies in Saudi Arabia and Oman will guide their future development.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available to maintain participants’ confidentiality. However, they can be obtained from the corresponding author upon reasonable request.

Abbreviations

Coronavirus disease 2019

Gulf Cooperation Council

Health in all policies

Limited liability company

Ministry of Education

Ministry of Health

Ministry of Sport

Non-communicable disease

Non-governmental organization

Physical activity

Physical education

United Arab Emirates

United States

World Health Organization

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Acknowledgements

We would like to express our sincere thanks to the policy-makers in the Kingdom of Saudi Arabia and Oman for their participation in this research.

This project is kindly supported through a PhD scholarship from King Faisal Medical City in Saudi Arabia and PhD funding from the Faculty of Health of the University of Technology Sydney.

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A.A. recruited participants and conducted interviews with policy-makers. A.A., A.B. and P.G. collectively analysed the transcripts. K.G., A.B. and P.G. made significant contributions to the thorough review and editing of the manuscript.

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Alzahrani, A.A., Gelius, P., Bauman, A.E. et al. Physical activity policies in Saudi Arabia and Oman: a qualitative study using stakeholder interviews. Health Res Policy Sys 22 , 111 (2024). https://doi.org/10.1186/s12961-024-01192-w

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