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Qualitative Research Methods

• Monique Hennink - Emory University, USA
• Inge Hutter - Erasmus University Rotterdam, Netherlands
• Ajay Bailey - University of Utrecht, Netherlands
• Description

Practical and straightforward, this book is a multidisciplinary introduction to the process of planning, conducting and analysing qualitative research, from selecting appropriate methods to publishing your findings. Built around the authors’ Qualitative Research Cycle – consisting of the design, data collection and analytic cycles – this pragmatic guide clearly demonstrates the steps you need to take to ensure your research is rigorous and robust. Drawing on decades of experience teaching workshops, the book is packed with techniques and tools to help you turn theory and method into research practice. This second edition:

• Showcases the importance of linking research design to data analysis, helping you avoid potential pitfalls and get the most out of your data
• Highlights the relevance and wide application of qualitative methods with an array of international examples of real field research and interdisciplinary case studies
• Gives clear guidance on writing qualitative research, including how to respond to critiques of qualitative methods
• Has a renewed focus on evaluating quality in qualitative research, ensuring your work is valid, reflexive and ethical

Offering tried and tested research tools like interview guides that you can apply to your own projects and supported by online resources including checklists and reflective questions, this book is the perfect companion for anyone looking to complete a successful project using qualitative research methods.

Supplements

This introductory textbook presents a useful framework of three interconnected cycles – the design cycle, the data collection cycle and the analytic cycle – to guide students through the process of conducting qualitative research. Engaging examples illustrate each step from start to completion.

Hennink, Hutter and Bailey provide a highly practical overview of all stages in the qualitative research process, linking clearly the cycles of design, data collection and data analysis. Excellent case studies illustrate qualitative research in practice. The authors’ clarity and coherence throughout the text makes this book a valuable read for all qualitative researchers.

Written from a situated epistemological perspective, this handbook nicely blends theory with method and method with practical examples. A valuable guide for early career researchers in need of clear and simple answers to deal with complex phenomena and common critiques.

It might be valuable for any analysis done douring the class.

I have used it as the main textbook which offers an outstanding understanding of qualitative research with easy to follow and ample examples from the field.

This is essential for degree students who are focusing on a qualitative research project.

Excellent guide for students choosing to undertake qualitative research.

a useful and contemporary guide to qualitative research that will be appropriate to both undergraduate and postgraduate students.

It is always good to get an update to a book and this update is welcome ten years after the first edition.

I like to direct student to books that are readable and add value to their own learning, irrespective of their learning style. I think this book will appeal to a wide audience.

For me, take the time to also access the online resources, do not just use the book. Start at the glossary flash cards, a good place to help with some tricky terminology for people new to research.

Use book and online resources to get the most out of this publication

This is a very good resource

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Qualitative Research Methods

• Monique Hennink - Emory University, USA
• Inge Hutter - Erasmus University Rotterdam, Netherlands
• Ajay Bailey - University of Utrecht, Netherlands
• Description

Practical and straightforward, this book is a multidisciplinary introduction to the process of planning, conducting and analysing qualitative research, from selecting appropriate methods to publishing your findings. Built around the authors’ Qualitative Research Cycle – consisting of the design, data collection and analytic cycles – this pragmatic guide clearly demonstrates the steps you need to take to ensure your research is rigorous and robust. Drawing on decades of experience teaching workshops, the book is packed with techniques and tools to help you turn theory and method into research practice. This second edition:

• Showcases the importance of linking research design to data analysis, helping you avoid potential pitfalls and get the most out of your data
• Highlights the relevance and wide application of qualitative methods with an array of international examples of real field research and interdisciplinary case studies
• Gives clear guidance on writing qualitative research, including how to respond to critiques of qualitative methods
• Has a renewed focus on evaluating quality in qualitative research, ensuring your work is valid, reflexive and ethical

Offering tried and tested research tools like interview guides that you can apply to your own projects and supported by online resources including checklists and reflective questions, this book is the perfect companion for anyone looking to complete a successful project using qualitative research methods.

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Supplements

This introductory textbook presents a useful framework of three interconnected cycles – the design cycle, the data collection cycle and the analytic cycle – to guide students through the process of conducting qualitative research. Engaging examples illustrate each step from start to completion.

Hennink, Hutter and Bailey provide a highly practical overview of all stages in the qualitative research process, linking clearly the cycles of design, data collection and data analysis. Excellent case studies illustrate qualitative research in practice. The authors’ clarity and coherence throughout the text makes this book a valuable read for all qualitative researchers.

Written from a situated epistemological perspective, this handbook nicely blends theory with method and method with practical examples. A valuable guide for early career researchers in need of clear and simple answers to deal with complex phenomena and common critiques.

It might be valuable for any analysis done douring the class.

I have used it as the main textbook which offers an outstanding understanding of qualitative research with easy to follow and ample examples from the field.

This is essential for degree students who are focusing on a qualitative research project.

Excellent guide for students choosing to undertake qualitative research.

a useful and contemporary guide to qualitative research that will be appropriate to both undergraduate and postgraduate students.

It is always good to get an update to a book and this update is welcome ten years after the first edition.

I like to direct student to books that are readable and add value to their own learning, irrespective of their learning style. I think this book will appeal to a wide audience.

For me, take the time to also access the online resources, do not just use the book. Start at the glossary flash cards, a good place to help with some tricky terminology for people new to research.

Use book and online resources to get the most out of this publication

This is a very good resource

• A discussion of the theoretical principles as well as practical application of qualitative research is covered through case studies, field examples, and exercises.
• International field examples are provided and highlight the application of qualitative research in different cultural contexts.
• Research tools, such as interview guides, recruitment scripts, coded data segments, theoretical frameworks, are provided throughout the text.
• The chapters on research methods (in-depth interviews, focus group discussion and observation) include photographs of the method in practice to demonstrate specific elements of research practice (e.g. seating of interviewers, interview context, body language).
• Exercises are included at the end of each chapter to help the reader practice specific skills such as writing a qualitative research question, conducting a mock focus group discussion, an interview or an observation, transcribing an interview, developing codes from data, and presenting qualitative research.
• Annotated further readings are included in each chapter, one list of readings related to methodological concepts and a second list of readings for examples of empirical research.
• Each chapter includes a series of questions to assist the reader in evaluating the quality of their research.
• Each chapter concludes with a textbox summarizing the key points to reiterate important concepts to the student.

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• INTRODUCTION Introduction to the Book Who is This Book For? The Qualitative Research Cycle Structure of the Book Features of this Book The Nature of Qualitative Research What is Qualitative Research? When to Conduct Qualitative Research The Underlying Interpretive Paradigm Qualitative and Quantitative Research Verstehen and Understanding The Emic and Etic Perspective Subjectivity and The Need for Reflexivity Our Approach to Qualitative Research Evaluating quality PART ONE: THE DESIGN CYCLE The Design Cycle Introduction Formulating Qualitative Research Questions Incorporating Literature and Theory Developing a Conceptual Framework Selecting a Fieldwork Approach Evaluating Quality Ethical Issues in Qualitative Research Introduction What is Ethics? Ethics in Qualitative Research Ethical Issues in the Design Cycle Ethical Issues in the Ethnographic Cycle Ethical Issues in the Analytic Cycle Evaluating quality PART TWO: THE ETHNOGRAPHIC CYCLE Participant Recruitment What is Participant Recruitment? Defining and Refining the Study Population How Many to Recruit: The Principle of Saturation Recruitment Goals Strategies for Participant Recruitment Evaluating quality In-Depth Interviews What is an In-Depth Interview? When to Conduct an In-Depth Interview Purpose of an In-Depth Interview The Cyclical Nature of Data Collection Developing an Interview Guide Preparing for Data Collection Reflecting on Subjectivity and Positionality Conducting the Interview Strengths and Limitations Evaluating Quality Focus Group Discussions What is a Focus Group Discussion? When to Conduct Focus Group Discussions The Cyclical Nature of Data Collection Developing the Discussion Guide Preparing for Data Collection Conducting the Focus Group Discussion Post-Discussion Information Strengths and Limitations Evaluating quality Observation What is Observation? When to Conduct Observation What to Observe Types of Observation Preparing and Conduct of Observation Writing an Observation Strengths and Limitations Evaluating Quality PART THREE: THE ANALYTIC CYCLE Data Preparation and Developing Codes Introduction The Nature of Qualitative Data Analysis Our Approach to Analysis Foundations of Grounded Theory Data Preparation Developing Codes Making a Codebook Coding Data Evaluating Quality Textual Data Analysis Introduction Formulating a Project-Specific Plan of Analysis Searching Data The Cyclical Process of Analysis Thick Description Comparison Categorizing and Conceptualizing Theory Development Evaluating Quality Writing Qualitative Research Writing in Qualitative Research Who is the Audience? Structure of Writing Beginning to Write Writing a Methodology Presenting Qualitative Results Evaluating Quality.
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Qualitative Research Methods , by Monique Hennink, Inge Hutter, and Ajay Bailey, 2020, pp. 376, £ 36.99 (paperpack), ISBN: 9781473903913, London: SAGE Publications

• Published: 30 March 2023
• Volume 57 , pages 4935–4938, ( 2023 )

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• Muhammad Imran 1 &
• Norah Almusharraf 1  

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Imran, M., Almusharraf, N. Qualitative Research Methods , by Monique Hennink, Inge Hutter, and Ajay Bailey, 2020, pp. 376, £ 36.99 (paperpack), ISBN: 9781473903913, London: SAGE Publications. Qual Quant 57 , 4935–4938 (2023). https://doi.org/10.1007/s11135-023-01660-5

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Accepted : 24 March 2023

Published : 30 March 2023

Issue Date : October 2023

DOI : https://doi.org/10.1007/s11135-023-01660-5

Qualitative Research Methods

• International Institute of Social Studies

Research output : Book/Report/Inaugural speech/Farewell speech › Book › Academic

T1 - Qualitative Research Methods

AU - Hutter, Inge

AU - Hennink, M

AU - Bailey, A

SN - 9781412922265

BT - Qualitative Research Methods

CY - Onbekend

Monique   Hennink

Faculty, Global Health

Dr. Monique Hennink is Professor in the Hubert Department of Global Health in the Rollins School of Public Health and Associated Faculty in Sociology at Emory University. She is also Visiting Professor at University of Michigan, Department of Epidemiology, and Instructor at the University of Columbia's EPISUMMER program in Epidemiology. She earned her PhD in Demography in the United Kingdom.

Dr Hennink was indicted into Emory’s MilliPub Club in 2023 which honors faculty authors of a scientific publication with over 1,000 citations - considered high impact scholarship. She received the 2020 Provost’s Distinguished Teaching Award for Excellence in Graduate and Professional Education  at Emory University. She also received the 'Excellence in Research ' Award in 2019 and the ' Excellence in Teaching' Award in 2016 at the Rollins School of Public Health.

She has particular expertise in applying qualitative research to examine public health issues. She has 30 years’ experience in the design, conduct, analysis, and publication of qualitative health research. She has authored five textbooks on qualitative research, including: Qualitative Research Methods 2nd edition (2020);  Focus Group Discussions (2014), Qualitative Research Methods (2011) (also translated into Chinese) and International Focus Group Discussion s (2007). She teaches graduate-level courses in qualitative research at Emory University. She developed the ' QUAL-WORKS' ( http://tinyurl.com/rsph-qr ) training program for public health professionals. Her courses, workshops and books reflect the application of qualitative methods in globally diverse settings and provide guidance on how to balance methodological rigor with the practical realities of global research. She has also published on various methodological aspects of qualitative research, such as using interpreters and translators in qualitative research; the effect of using court reporters on data quality; estimating sample size in qualitative studies; and highlighting emerging methodological issues in focus group research. She is a board member for SAGE Publications on their ‘Cases in Methodology’ work, and is on the editorial board of the International Journal of Multiple Research Approaches. She co-chaired a three-year scientific panel for the International Union of the Scientific Study of Population (IUSSP), on ‘Qualitative Research in Population Studies’ which had a mandate to promote rigor in the use of qualitative methods in the discipline. She has led scientific sessions on qualitative research at key professional forums, such as: International Congress of Qualitative Inquiry; International Institute for Qualitative Methods; European Association of Population Studies; and the International Union for the Scientific Study of Population.

Her research focuses on understanding the social, cultural and contextual influences on behavior around public health issues in order to develop effective health interventions. She focuses primarily on sexual and reproductive health, sanitation behavior and chronic disease management. She has conducted studies to examine sexual risk taking amongst mobile populations; sex education and sexual behavior of adolescents in different cultural contexts; cultural norms surrounding contraceptive use; influences on sex trafficking; and the context of sexual risk taking after male circumcision. She has also conducted research on women’s empowerment, such as the contribution of microcredit to empowerment and health improvement; whether microcredit can be strengthened to enhance poverty reduction; and how empowerment influences maternal health. She is core faculty in the  Centre for Global Safe Water, Sanitation and Hygiene at Emory University and conducts collaborative research on behavioral influences on sanitation behavior in developing countries. For example, behavioral influences on latrine use; the influence of social networks on purchasing household water filters; gender and water management; and pathways of fecal contamination in urban slums. She is an affiliated faculty member of the Global Diabetes Research Centre and conducts collaborative studies on tailoring lifestyle interventions to population groups at heightened risk for diabetes in the US and internationally.

Contact Information

Rollins School of Public Health ,

Atlanta , GA 30322

1518 Clifton Road. Room 7031

Phone: 404.727.4882

Fax: 404.727.4590

Email: [email protected]

Areas of Interest

• Adolescent Health/Child Health
• Behavior and Health
• Community Based Research
• Global Health
• HIV/AIDS Prevention
• Sexual Health/Behavior
• B.A (Hons) 1987, Flinders University, South Australia
• Ph.D 1997, University of Southampton, United Kingdom

Courses Taught

• GH 522: Qual.Methods 2: Data Analysis

Affiliations & Activities

What students have to say:

“ Dr. Hennink is a great listener and wonderful advisor who makes time to meet with students.  Her generosity is displayed through a genuine concern and care for student interests, and her ability to dispense valuable advice complements her wide range of research experience in reproductive health and family planning .” – Stephanie Hess

" Dr. Hennink brings a wealth of wisdom, insight and experience to the Global Health Department. Her passion for improving reproductive health and qualitative research is inspiring! She always goes above and beyond for students, even while writing her latest book or journal article. She is an incredible resource for every GH student. I am extremely grateful for all her guidance and support !" - Karen Foster

 “ Dr. Hennink is a wonderful addition to the Department of Global Health. She has mentored me in numerous ways.  She immediately responds to my most pressing questions and concerns, and has been willing to assist me well outside of her office hours - I recall her graciously making an international phone call on my behalf! I am grateful for her guidance and her dedication to students. She provides a similar level of passion and commitment within the classroom as well.  Dr. Hennink has a wealth of experience with regards to her work in reproductive health, and she is more than willing to assist students in pursuing their own interests and dreams .” – Juno Lawrence

Publications

• Hennink, M. , 2023 , Teaching Qualitative Sample Size Estimation. , Chapter in Ruth, A., Wutich, A., and Russell, B (editors) The Handbook of Teaching Qualitative and Mixed Research Methods: A Step-by-Step Guide for Instructors. , ,
• Hennink, M., and Kaiser, B. , 2022 , Sample Sizes for Saturation in Qualitative Research: A Systematic Review of Empirical Tests. , Social Science and Medicine. , 292,
• Hennink, M., Hutter, I. and Bailey, A. , 2020 , Qualitative Research Methods. Second Edition. , Sage Publications , ,
• Hennink, M., Kaiser, B. and Marconi, V. , 2016 , Code Saturation vs. Meaning Saturation: How many interviews are enough? , Qualitative Health Research , 27, 591-608
• Hennink, M., Kaiser, B., Sekar, S. and Ali, M. , 2016 , How are Qualitative Methods used in Diabetes Research? A 30-Year Systematic Review. , Global Public Health , 11, DOI: 10.1080/17441692.2015.1120337
• Hennink, M., Kaiser, B., and Weber, MB. , 2016 , What Influences Saturation? Estimating Sample Sizes in Focus Group Research , Qualitative Health Research. , 29,
• Kulb, C., Hennink, M., Kiiti, N., and Mutinda, J , 2015 , How Does Microcredit Lead to Empowerment? A Case Study of the Vinya wa Aka Group in Kenya. , Journal of International Development , DOI:10.1002/jid.3130,
• Shiotani, R. and Hennink. M. , 2014 , Socio-Cultural Influences on Default of Directly Observed Therapy (DOT) for Tuberculosis in Rural India , Global Public Health , 16, 1-13
• Hennink, M. , 2014 , Understanding Qualitative Research: Focus Group Discussions , Oxford University Press, UK. , ,
• Hennink, M. and McFarland, D. , 2013 , Delicate Web: Household changes in health behaviour enabled by microcredit in Burkina Faso , Global Public Health , 8, 144-158
• Hennink, M., and Weber, M. , 2013 , Quality Issues of Court Reporters and Transcriptionists for Qualitative Research. , Qualitative Health Research , 23, 700-710
• Hennink, M., Kulb, C., and Kiiti, N. , 2013 , Vinya wa Aka: An Expanded Microcredit Model for Community Development. , Development in Practice , 23, 1034-1047
• Hennink, M., Pillinger, M., Kiiti, N, Jayakaran, R. , 2012 , Defining Empowerment: Perspectives from International Development Organizations. , Development in Practice , 22, 202-15
• Huffman, S., Veen, J., Hennink, M., and McFarland, D. , 2012 , Exploitation, Vulnerability to Tuberculosis, and Access to Treatment among Uzbek Labor Migrants in Kazakhstan. , Social Science & Medicine , 74, 864-72
• Grund, J. and Hennink, M. , 2011 , A qualitative study of sexual behavior change and risk compensation following adult male circumcision in urban Swaziland. , AIDS Care , 24, 245-51
• Holmes, K., Winskell, K., Hennink, M. and Chidiac, S. , 2011 , Microfinance and HIV Mitigation Among People Living with HIV in the Era of Anti-Retroviral Therapy: Emerging Lessons from Côte d’Ivoire , Global Public Health , 6, 447-61
• Hennink, M, Hutter, I, and Bailey, A. , 2011 , Qualitative Research Methods , SAGE Publications, London , ,
• Hennink, M. , 2008 , Language and Communication in Cross-Cultural Qualitative Research , Doing Cross Cultural Research: Ethical and Methodological Perspectives. Springer Publishers , ,
• Hennink, M. , 2007 , Emergent Issues in International Focus Group Discussions , Handbook of Emergent Methods in Social Research, Hesse-Biber, S., and Leavey, P. (eds) , ,
• Hennink, M. , 2007 , International Focus Group Research: A Handbook for the Health and Social Sciences , Cambridge University Press , ,
• Hennink M., Rana, I., and Iqbal R. , 2005 , Knowledge of Personal and Sexual Development amongst Young People in Pakistan. , Culture, Health and Sexuality. , 7, 319-332
• Mturi, A., and Hennink, M. , 2005 , Perceptions of Sex Education for Adolescents in Lesotho , Culture Health and Sexuality , 7, 129-143
• Hennink, M., and Clements, S. , 2005 , The Impact of Family Planning Clinics on the Urban Poor in Pakistan , Studies in Family Planning , 36, 33-44
• Hennink M., and Simkhada, P. , 2004 , Sex Trafficking in Nepal: Context and Process. , Asian and Pacific Migration Journal , 13, 305-338
• Hennink M., Diamond I., and Cooper P. , 1999 , Contraceptive Use Dynamics of Asian Women In Britain. , Journal of Biosocial Science , 31, 537-554
• Hennink M., Cooper P., and Diamond I. , 1999 , Safer Sex at Holiday Centers: Providing Contraceptive Services to Seasonal Workers , British Journal of Family Planning , 25, 45-54
• Hennink, M. and Diamond I. , 1999 , Using Focus Groups in Social Research , Handbook of the Psychology of Interviewing. Chapter 2.5, pp113-141. Memon. A., and Bull., R. (Eds) John Wiley & Sons. , ,
• Hennink M., Diamond I., and Cooper P. , 1999 , Young Asian Women and Relationships: Traditional or Transitional? , Ethnic and Racial Studies , 22, 867-891

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Qualitative Research Methods 1st Edition

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This comprehensive text takes a practical approach that mirrors the path that students follow in conducting a research project. The book is based on the authors′ highly successful multidisciplinary qualitative methods workshops, which have been conducted for over a decade. They introduce a ′qualitative research cycle′ that leads students through the selection of appropriate methods, the collection of data, and the transformation of findings into a finished project. The book provides a clear explanation of the nature of qualitative research and its key concepts.

• ISBN-10 1412922267
• ISBN-13 978-1412922265
• Edition 1st
• Publisher SAGE Publications Ltd
• Publication date December 8, 2010
• Language English
• Dimensions 7.25 x 0.75 x 9.25 inches
• Print length 328 pages
• See all details

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Editorial Reviews

Hennink, Hutter, and Bailey’s work is about actually ‘doing’ qualitative research. All the key topics are covered, and sensible ‘warnings’ offered to avoid some of the usual data collection and analysis traps of ethnographic work...the book is accessible, comprehensive and well illustrated both textually and graphically. More importantly and necessarily, it stresses the importance of the theoretical stance taken and its influence upon methodology Dr Ron Iphofen Social Research Association News

If there is a need for a spirited defence ofqualitative research then this book makes a strong, compelling and well-delivered case...The book is well structured with a concise style, and the authors make good use of case studies, tables and exercises...New and established researchers will benefit from this book, as well as students wanting an insight intoqualitative research. The passion that these authors feel about their subject comes through strongly in the writing Ian Birkinshaw Nursing Standard

Qualitative Research Methods by Hennink, Hutter and Bailey however, provide qualitative researchers with a modern grasp on qualitative research methods. Hennink et al. explain ‘how to do’ qualitative research using a cyclical process, divided into 3 interconnected phases or cycles... The authors’ innovative approach is in contrast to most qualitative research textbooks that focus on qualitative research using the familiar, linear research process. In addition, the presentation of this current book will help apprentice qualitative researchers to appreciate the different stages of the qualitative research cycle... Overall, the chapters are logical and focus on key elements of qualitative research. In an added attempt to support their readers the authors provide excellent examples of directed reading. The use of ‘exercises’ and ‘key points’ reiterates the main points gleaned from each chapter. Anita Duffy Nurse Education in Practice

I was very impressed both with the depth and the clarity of information presented by Hennink and her colleagues. This book has a clear and logical structure. It insightfully discusses both the theoretical and epistemological issues that arise at all stages of qualitative research, as well as the very practical application of these methods. The chapters contain detailed guidance, hints and tips on how to use the methods without the text feeling heavy or over-whelming. The ′Evaluating Quality′ section at the end of each chapter provides a useful summary and check-list, not only for designing one′s own research project, but also for critiquing the quality and validity of other published qualitative studies... This is an excellent new text book for budding qualitative researchers. Rebecca Langford Critical Public Health

About the Author

Dr. Monique Hennink is an associate professor of global health at Emory University. She has particular expertise in applying qualitative methods to public health research. She has authored five textbooks on qualitative research and developed the “QUAL-WORKS” training program for public health professionals. Her research focuses on behavioral aspects of public health issues by understanding the social, cultural, and contextual influences on behavior in order to develop effective health interventions. Her research focuses primarily on sexual and reproductive health, sanitation behavior, chronic disease management, women’s empowerment, and microcredit. She conducts research in multiple study contexts throughout Africa, Asia, UK, and USA.

Product details

• Publisher ‏ : ‎ SAGE Publications Ltd; 1st edition (December 8, 2010)
• Language ‏ : ‎ English
• Paperback ‏ : ‎ 328 pages
• ISBN-10 ‏ : ‎ 1412922267
• ISBN-13 ‏ : ‎ 978-1412922265
• Item Weight ‏ : ‎ 1.35 pounds
• Dimensions ‏ : ‎ 7.25 x 0.75 x 9.25 inches
• #1,291 in Social Sciences Research
• #7,744 in Core
• #10,854 in Social Sciences (Books)

About the authors

Ajay bailey.

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Inge Hutter

Monique M. Hennink

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Hennink, M., Hutter, I. and Bailey, A. (2011) Qualitative Research Methods. Sage Publications, London, Los Angeles, New Delhi, Singapore, Washington DC.

has been cited by the following article:

TITLE: Low utilization of skilled birth attendants in Ngorongoro Conservation Area, Tanzania: A complex reality requiring action

KEYWORDS: Collaboration; Maternal Health; Quality of Care; Maasai; Complexity

JOURNAL NAME: Health , Vol.5 No.7D , July 18, 2013

ABSTRACT: Limited integration of contextual factors in maternal care contributes to slow progress towards achieving MDG5 in sub-Sahara Africa. In Ngorongoro, rural Tanzania, the maternal mortality ratio is high with 642 maternal deaths/100,000 live births. Skilled birth attendants (SBAs) assist only 7% of deliveries. This study, undertaken from 2009 to 2011, used Participatory Action Research involving local stakeholders (Maasai women and men, traditional birth attendants (TBAs), hospital staff) to examine reasons for low utilization of SBAs and moreover to develop proposals how to integrate contextual factors and local needs in the health care system. Interviews, observations and literature study were also conducted. Thaddeus and Maine’s Three Delays model is used to structure the analysis. Delaying factors in decision making at home: negative perceptions by the community on availability and quality of care in the hospital; discontinuity of care by TBAs; food and financial insecurity; desired nearness to cattle and family; limited recognition of maternal deaths; limited male health education and suboptimal birth preparedness. Delaying factors in reaching the hospital: vehicle and road limitations. Delaying factors in receiving hospital care: limited (human) resources and limited knowledge sharing at the hospital. Community members and health workers proposed: increasing food/financial security; tailoring male health education; combining TBA/SBA care to provide continuous, culturally appropriate labour support; creating separate maternity wards; increasing the number and training of staff; ensuring continuous availability of Emergency Obstetric Care. Applying solutions to increase hospital utilization seems complex as collaborative actions by multiple actors and institutions are needed to create both a needs based and clinically sound continuum of maternal care. To follow-up this process of integrating local solutions into the maternal care system, we suggest to adapt the WHO Strategic Approach—a top-down framework for the implementation of innovations—to fit this bottom-up approach.

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