Critique of a Qualitative Research Study: Perinatal Distress During the COVID-19 Pandemic (Example Using IMRaD)

What makes a good qualitative research critique?

A research critique is not a summary. It is a systematic, balanced appraisal of a study’s strengths and weaknesses, used to judge whether its findings are trustworthy and useful for practice. Qualitative research explores meanings, experiences and perspectives rather than measuring variables, so it is judged by different standards than quantitative research. Instead of validity and reliability, qualitative studies are judged on trustworthiness: credibility, dependability, confirmability and transferability (Lincoln & Guba, 1985).

A strong qualitative critique evaluates each of the following elements (Polit & Beck, 2021):

The IMRaD structure

Most research articles follow the IMRaD format, and a good critique follows it too:

• I – Introduction: the research problem, background literature, gap in knowledge and study aims.
• M – Methods: research design, philosophical stance, setting, sampling, ethics, data collection and analysis.
• R – Results: the participants and the themes or categories that emerged, supported by quotations.
• a – and
• D – Discussion: interpretation of findings against existing literature, strengths, limitations, and implications for practice and research.

The critique below applies this framework to Jones et al.’s (2022) study of perinatal distress during the COVID-19 pandemic.

Introduction

Research problem and population of interest

The research problem is clearly stated and highly relevant. Perinatal mental health difficulties increased worldwide during the COVID-19 pandemic. UK estimates suggested that more than half of perinatal women experienced anxiety and depression symptoms during the first national lockdown. Most of this evidence came from quantitative screening surveys, which measure how many women are distressed but not what distress feels like or what causes it. The authors identify this gap well. Without women’s own descriptions, services risk designing interventions that do not match women’s real experiences.

The population of interest is clearly defined: perinatal women, meaning those who were pregnant or up to 12 months postpartum, living in the United Kingdom during the first COVID-19 lockdown. The problem is significant for nursing and midwifery, because perinatal mental illness affects maternal wellbeing, bonding and infant development.

Critique: The introduction is concise and logically builds a case for the study. One weakness is that it says little about what earlier qualitative work had already found about perinatal distress before the pandemic. That context would make it easier to separate pandemic-specific experiences from long-standing ones.

Research questions / study aims

The study had two aims:

1. to qualitatively explore the feelings and psychological symptoms women associated with perinatal distress during the pandemic; and
2. to identify the sources (stressors) of that distress, to inform preventive interventions.

Critique: The aims are clear, focused and well suited to qualitative inquiry, because they ask “what” and “how” questions about lived experience. They are written as aims rather than formal research questions, which is acceptable in descriptive qualitative research. The aims also link directly to practical goals, which strengthens the study’s relevance.

Methods

Research tradition / qualitative approach

The authors used a qualitative descriptive design. They analyzed free-text survey responses using content analysis followed by inductive thematic analysis, based on Braun and Clarke’s (2006) approach, from a realist stance. A realist position assumes that participants’ words reflect their experiences fairly directly, which fits the practical aim of describing symptoms and stressors.

Critique: Stating the philosophical stance is a strength, since many qualitative studies leave it unstated. The study does not follow a “classic” tradition such as phenomenology or grounded theory, so it describes experiences rather than interpreting deep meaning or building theory. Combining content analysis, which counts how often categories appear, with thematic analysis is pragmatic. However, reporting frequencies makes the findings partly quantitative. Readers should treat those percentages as descriptive, not as estimates of how common an experience is in the wider population.

Ethical aspects of the study

Ethical approval was obtained from the authors’ university Human Research Ethics Committee. The study followed the British Psychological Society’s Code of Human Research Ethics and its guidance for internet-mediated research. Participants gave informed consent online, and the survey was anonymous. Information about perinatal mental health support was shown at the start and end of the survey, and participants who scored highly on the depression or anxiety measures received an automated message encouraging them to seek help.

Critique: The ethical safeguards are a clear strength. Asking distressed perinatal women to recall a recent upsetting experience could cause emotional harm, and the signposting and automated safety message show responsible protection of a vulnerable group. One limitation of anonymity is that the researchers could not follow up with participants who disclosed severe distress or risk. This trade-off should be acknowledged in online research.

Sampling and participants

The study used convenience and volunteer (self-selected) sampling. Participants were recruited in May 2020 through social media, online parenting forums, organizations and the Prolific research platform, with a prize draw as an incentive. Inclusion criteria were being pregnant or within 12 months postpartum, aged 18 or over, living in the UK and fluent in English. In total, 424 women answered the open-ended question: 190 pregnant and 234 postnatal.

The sample was not diverse. About 92% were White, most were married or cohabiting, and most were university-educated. Around half scored above clinical cut-offs for depression on the Edinburgh Postnatal Depression Scale (EPDS ≥13) and for anxiety on the Perinatal Anxiety Screening Scale (PASS ≥26).

Critique: The sample is very large for qualitative research and covers both pregnancy and the postnatal period, which allows a useful comparison. However, it was self-selected and demographically homogeneous. The experiences of Black, Asian and minority ethnic women, single mothers, and women with low income or limited English, who were among those most affected by the pandemic, are therefore underrepresented. This limits transferability. Purposive sampling for diversity would have strengthened the study.

Data collection

Data came from an anonymous online survey that included the EPDS, the PASS, demographic questions and one open-ended question. The question asked women to think about the last time they felt especially distressed or upset, and to briefly describe what happened, why they were distressed and what they did.

Critique: Online qualitative surveys were practical and ethical during lockdown. They reached many women quickly and safely, and anonymity may have encouraged honest disclosure of stigmatized feelings. The main weakness is depth. A single written question cannot produce the rich, detailed accounts that semi-structured interviews do, and the researchers could not probe or clarify. Some responses were brief, and not all women described both their feelings and the cause of their distress. The question also asked about a single episode, which may not reflect women’s ongoing experience.

Data analysis approach

Analysis took place in two stages. Content analysis was used to categorize the feelings and symptoms women described, and inductive thematic analysis was used to identify the sources of distress. Following Braun and Clarke’s (2006) phases, the authors coded the responses, grouped codes into themes, reviewed and refined them through thematic mapping, and discussed them as a team to reach agreement. The authors report trying to bracket their own professional and personal assumptions.

Critique: The analysis is described clearly enough to follow, and having several researchers discuss the codes and themes increases dependability. The inductive approach let themes come from the data rather than from predefined categories, which suits the exploratory aims. Weaknesses include limited detail about each researcher’s background and how it may have shaped interpretation (reflexivity), no mention of qualitative software or an audit trail, and no member checking. Member checking would have been difficult with anonymous data, but the authors could have discussed alternatives. Braun and Clarke (2021) also caution that “bracketing” fits poorly with reflexive thematic analysis, in which the researcher’s subjectivity is treated as a resource rather than something to remove.

Results

Results and themes

Feelings and symptoms. The content analysis produced 12 categories of feelings and symptoms. The most common was feeling upset and tearful, followed by worry and overthinking. Other categories included fear, guilt and inadequacy, anxiety, stress, frustration, panic, feeling overwhelmed, sadness, anger and irritability, and nightmares or intrusive thoughts. A key finding was that, although many women screened positive for depression, their descriptions pointed more to anxiety and general distress than to classic depressive symptoms such as low mood or loss of interest.

Sources of distress. Thematic analysis identified five themes:

Pregnant women more often described fears about pregnancy and birth and restrictions on antenatal care. Postnatal women more often described infant crying, sleep deprivation and fear for the baby’s wellbeing.

Critique: The results are well organized, and each category and theme is supported by direct participant quotations, which increases credibility and lets readers judge the interpretations for themselves. Comparing pregnant and postnatal women adds valuable detail. Because many responses were short, some themes are descriptive “topic summaries” rather than richly interpreted patterns of meaning. The frequency percentages also reflect what women chose to write in one answer, not how common each stressor actually was.

Meaning and credibility of findings

The findings are meaningful in three ways. First, they show that perinatal distress during the pandemic was experienced mainly as anxiety, worry and overwhelm, which challenges the usual focus on postnatal depression in screening and services. Second, they show that distress came from a mix of pandemic-specific stressors (restrictions, fear of infection, isolation) and ordinary stressors of motherhood (crying, sleep loss, unmet expectations, relationship strain). Third, they put women’s own voices behind the high rates of distress reported in quantitative studies.

Applying Lincoln and Guba’s (1985) trustworthiness criteria:

• Credibility: supported by multiple researchers, team discussion and extensive quotations. It is limited by the absence of member checking and by brief responses.
• Dependability: supported by a clearly described analytic process that follows recognized guidelines. Fuller documentation of the audit trail would strengthen it.
• Confirmability: partly supported by the authors’ attempts at bracketing. A more detailed reflexive statement is needed.
• Transferability: moderate. The setting and timing are clearly described, but the homogeneous, mostly White and educated sample limits application to more diverse populations.

Discussion

Strengths and limitations

The authors acknowledge most of these limitations themselves, which is a strength of the report.

Clinical practice and future research

Implications for clinical practice. The findings support several practical changes for nurses, midwives and health visitors:

• Broaden screening beyond depression to include anxiety, worry, intrusive thoughts and general distress, for example by using tools such as the PASS alongside the EPDS.
• Offer transdiagnostic interventions that target worry, overwhelm and stress rather than only depression.
• Strengthen social support through peer support groups, virtual antenatal classes and contact with health visitors, especially when face-to-face services are limited.
• Include partners in scans, appointments and birth as essential co-parents, not as “visitors.”
• Prepare women realistically for pregnancy and early motherhood, including infant crying and sleep loss, to reduce the gap between expectations and reality.
• Use trauma-informed care and ask about previous traumatic or complicated births.

Future research. Studies should use in-depth interviews to explore these themes more deeply, use purposive sampling to include ethnically and socioeconomically diverse women, partners and non-English speakers, and follow women longitudinally to see how distress changed as restrictions eased. Evaluating interventions designed around these themes, such as peer support or expectation-focused antenatal education, would also be valuable.

Overall quality of the study

Using the Critical Appraisal Skills Programme (CASP, 2018) qualitative checklist as a guide, the study can be rated as good quality with moderate limitations:

Jones et al. (2022) provide a timely and ethically sound account of how perinatal women experienced distress during the COVID-19 pandemic. Its main contribution is showing that this distress was largely anxiety-based and arose from both pandemic restrictions and the everyday challenges of motherhood. Its findings should be applied with caution because of the brief, survey-based data and the lack of sample diversity. Even so, the study offers useful, evidence-based direction for nurses and midwives to improve perinatal mental health screening, support and care.

References

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Braun, V., & Clarke, V. (2021). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 18(3), 328–352. https://doi.org/10.1080/14780887.2020.1769238

Critical Appraisal Skills Programme. (2018). CASP qualitative checklist. https://casp-uk.net

Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150(6), 782–786.

Jones, K., Harrison, V., Moulds, M. L., & Lazard, L. (2022). A qualitative analysis of feelings and experiences associated with perinatal distress during the COVID-19 pandemic. BMC Pregnancy and Childbirth, 22, Article 572. https://doi.org/10.1186/s12884-022-04876-9

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage.

Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.

Somerville, S., Dedman, K., Hagan, R., Oxnam, E., Wettinger, M., Byrne, S., Coo, S., Doherty, D., & Page, A. C. (2014). The Perinatal Anxiety Screening Scale: Development and preliminary validation. Archives of Women’s Mental Health, 17(5), 443–454.