I wrote in December about the Covid-related attitudes I’ve been seeing recently as a researcher. Thanks for all your responses.  I’ve also written two posts recently about civility and have received lots of interesting feedback about them. I don’t think it’s a coincidence that we’re on edge because of Covid and that it has become difficult to have civil conversations nowadays.

In conducting qualitative research recently and following current events around the world, I’ve come to see that it’s getting harder to discuss things we used to be able to talk about. This is an urgent issue for qualitative researchers, as conversation is our stock in trade. In fact, it’s urgent for everybody. What’s changed? We’re in an age of what I’ve started calling ‘hyper-morality’ – when we carry moral considerations to an extreme.

For instance, liberty is a fundamental moral value. It’s the bedrock of the Declaration of Independence and the US Constitution and is what makes these documents so remarkable. However, liberty must be balanced with responsibility—our rights to pursue our own interests sometimes must be subordinated to the needs of others, and sometimes group needs must take a back seat to individual needs. If you look at the most intractable issues in the world today, you’ll see extreme views about liberty and responsibility on both sides of the argument.

Here’s another example. Loyalty is a virtue, whether it be to family, social group, political tribe or what have you. However, it’s possible to place such emphasis on loyalty that we end up endorsing actions or opinions inconsistent with our own values. That’s what happens when a legitimate moral concern gets elevated to an unreasonable level.

Conflicting moral views are at the heart of most difficult issues, and that’s what makes them tricky – think vaccinations, taxes, guns, or plant-based diets. Intelligent, empathetic adults should be able to work through these challenges and have productive conversations. But when morality gets ‘turned up to eleven,’ all bets are off. There’s probably no way to have a productive conversation when hyper-morality is present.

To be functioning humans, we must find a way to balance moral considerations. For instance, while you might place a high value on your own freedoms, it’s necessary to balance that against your responsibility not to harm others. And, while you might give great weight to loyalty, it’s important to remember that you also have a responsibility to think for yourself. This all sounds reasonable, right? The problem is that, in a hyper-moralized world, balance goes out the window.

How did we get here? I’m blaming cable news, talk radio and social media for this—the most extreme, controversial, even offensive positions are the ones that get the most attention. There’s no room for thoughtful, respectful dialogue, let alone empathy. We’ve been marinating in this toxic environment for several years now, and it’s affected how we see and talk about things. When influential figures are modeling hyper-morality, it’s challenging for the rest of us to act like adults.

So now what? Hell, if I know. My only suggestion is to think globally and act locally—the world’s a big place, and there’s a limit to how much you can change it, but you can influence your own community. None of us has much ability to influence how prominent figures conduct themselves, but we can set an example of rational behavior for others. In order to do this, it might be necessary for each of us to look inward to see if we are hyper-moralizing ourselves.

And, if you’re a qualitative researcher, how do you negotiate these treacherous waters?

First, resist the natural inclination to judge others for holding opinions contrary to yours.

Secondly, do whatever you can to avoid sensitive topics – if that’s feasible. There’s nothing wrong with overtly cutting off a discussion that you think might get acrimonious.

If you think sensitive topics are likely to come up, and you’re worried this might compromise the quality of conversation, consider conducting one-on-one interviews instead of focus groups. That way, the only person your participant can argue with is you.

If you must do groups, it might be a good idea to avoid putting participants who have divergent opinions on sensitive issues in the same session.

It makes me sad that I felt it necessary to write about this topic. However, in adversity lies opportunity. Hopefully, this fraught time will enable us to develop more empathy and strengthen our conversation skills.

I’ve had many conversations with research participants over the past two years about how the pandemic is affecting their outlook. Here’s what I’ve been hearing recently.

I hear a lot about uncertainty and a reluctance to make plans. People see the world as being in a constant state of flux. The metaphors I hear most involve the ‘ground shifting beneath one’s feet’ and ‘feeling suspended in midair.’

People feel insecure and unsafe, helpless, and not in control of their lives and destinies. Closely related, they feel poorly served— even betrayed— by institutions. This crosses the political spectrum and all socioeconomic strata. The media, the medical establishment and government at all levels are seen with increasing suspicion. They don’t know where to go to get accurate information, and don’t know whom to trust.

Many seem to perceive our society as unraveling, and feel helpless to stop it. They grieve for life in the ‘before times,’ particularly in-person, spontaneous, carefree interactions, making new friends, and interacting comfortably with strangers.

Perhaps the most poignant comments have been about an acute sense of mortality. The pandemic has brought us face-to-face with death and serious illness, and that’s changed how we see the world and our place in it. As a result, people say they are reevaluating their priorities and work lives—they’re less willing to ‘go through the motions,’ and want work that is fulfilling, ‘that benefits people beyond just me.’

This is what I’ve been hearing. How about you? I’d love to know. And, remember all that talk at the beginning of 2020 about ‘the new normal?’ I’m pretty sure this is it. How long it’s going to last is anybody’s guess—this mindset could stick around for years, and brings with it some significant implications:

If you’re a qualitative researcher, it’s probably a good idea to allow participants space early in the discussion to get this topic off their chests. It will put the rest of the conversation into valuable context. I generally avoid bringing this subject up myself—rather, I prefer to let participants broach the topic on their own time and in their own way.

If you’re a marketer, it’s particularly important to conduct research to understand – in as much detail as possible – how the pandemic is affecting perceptions and decision-making. It’s also important to remember that these attitudes need to be tracked over time, as they are going to evolve.

All of us are subject to these feelings—we all face challenges and difficulties. As the incomparable Elaine Stritch used to say, “everybody’s got a sack of rocks.” As we move into the holiday season, we should all try to remember how fortunate we are, despite our worries. Even with feelings of disaffection and uncertainty, we can all find stability and joy in our relationships with the people we love. This is the perfect time of year to do that.

If you know me, you know that ‘awesome’ is a word I rarely use.

It’s trite and usually undeserved. But, when you’re talking about nurses, it’s the word to use. Nurses are fantastic. They work so hard and care so much. And they do it under very challenging conditions. Burnout rates among nurses are high, and there’s a longstanding global nurse shortage, creating extremely difficult circumstances at the point of care.

Evolutionary psychology tells us that our high regard of nurses is hardwired into us—we naturally revere those who provide care and nurturance. But there’s more to it than just that. Nurses are skilled, knowledgeable professionals.

I’ve been doing a lot of healthcare research over the past few years, and have interviewed many nurses. Of all the types of people I talk to as a researcher, they may be my favorite. They’re also underutilized as research participants. However, if you’re going to get the most out of qualitative research among nurses, there are few things to keep in mind.

Before we get into that, allow me to do a bit more gushing about nurses.

They’re knowledgeable. Nurses regularly impress me with their command of their therapeutic areas. Whether it’s understanding the side effects of dozens of medications, or knowing the ins-and-outs of all the equipment and devices needed for patient care, nurses are walking encyclopedias. Those not directly involved in patient care often don’t realize this, and thus don’t understand the value of including nurses in healthcare research.

They’re pragmatic. Nurses are among the most practical people you’ll ever meet, and are problem solvers by nature. They like to keep things simple, not looking to overcomplicate things. They don’t go for increased capability if there’s no clear benefit. This pragmatism is a major strength, but it does have implications for qualitative research. More about this below.

They’re great explainers. Nurses often have primary responsibility for patient education, so they know how to explain therapies and conditions to patients (in a way that’s understandable and not scary) better than just about anybody.

They focus on the patient. While other HCPs focus on procedures, treatments, devices and processes in addition to the patient, nurses focus primarily on patients and their welfare.

They’re gutsy.  I’ve interviewed military nurses who’ve been deployed to very dangerous places, to nurses who’ve cared for Ebola and Covid patients, and to nurses who work in trauma centers in areas with high rates of violent crime. And they do it, because that’s what they do and because it must be done.

Okay. So, let’s get into what you need to know when conducting qualitative among nurses.

If you’re looking to understand patient experiences and attitudes, don’t just talk to patients. Nurses, because they work with so many patients, and because they’re so focused on patient care, sometimes can tell you things about patients’ feelings or experiences that the patients themselves can’t. They can also provide insights into the decision-making processes of patients and their families.

Remember how I pointed out how great nurses are at explaining things? This makes them a tremendous asset for marketers and researchers. If you’re testing any sort of communication materials (package inserts, brochures, websites, advertising, etc.), nurses can be your secret weapon. They know more about how to make things understandable and accessible to patients and HCPs than anybody else.

Remember that pragmatism I mentioned earlier? That’s something to keep in mind when designing research. Nurses focus on the reality of a situation, and don’t spend a lot of time thinking about why things are the way they are or how they could be better. It’s just not in their nature. So, if you’re looking to get insight about the future or the hypothetical, nurses may not be your best bet.

Similarly, nurses are not great at telling you what’s suboptimal about a situation, because they’re such strong problem solvers. Nurses will make the best of whatever circumstances they face—they’ll bend over backwards to find a way to make things work. So, instead of discussing what’s wrong with a specific situation or how it could be improved, focus discussion on the workarounds and hacks they’ve devised. And a related point—most nurses REALLY appreciate it if you get right to the point in market research interactions.

Unlike most research participants (including doctors), nurses rarely flake on you, and they’re almost always on time. So be careful not to overly over-recruit.

So, next time you’re designing an upcoming healthcare or life sciences study, consider including nurses in your research. You’ll be glad you did.

My thanks to my colleagues Caroline Volpe and Colleen Welsh-Allen for their input to this post.

I’ve had some interesting conversations with many of you about civility in response to my recent post. One idea that came up a lot was that moral considerations may be the single greatest barrier we face to civil discourse. This is an important matter for qualitative researchers who strive for insightful conversations.

It’s hard to have a civil, respectful dialogue with another person about something on which you completely disagree, particularly if the source of disagreement is a different moral worldview. Understanding someone else’s mindset is hard if it differs significantly from yours, but it gets doubly so when it comes to morality. Morality is our sense of right and wrong. It’s easy for right vs. wrong to morph into good vs. evil. If we disagree, that might suggest that I’m for good and you’re for evil— at which point it’s impossible for us to have a conversation.

Think about some current fraught issues: abortion, guns, covid vaccines. In all these cases, morality is driving opinions and disagreement. And that sorely tests our ability to be civil.

Morality is how we balance the needs of the individual against the needs of the group. Different moral worldviews achieve that balance differently. For instance, while your worldview around one issue might emphasize personal freedom, your views on another might prioritize responsibilities to others.

Another thing that stresses civility is that we often lack the analytical tools and vocabulary to understand fully where another person is coming from. It’s helpful if you can identify the moral framework that informs someone’s POV, and be well versed in the basis of that model, its history, its strengths, and flaws. For more on this, see my post on moral mindsets from about a year ago; it remains one of my most viewed.

Developing a full understanding of a moral mindset that differs profoundly from your own is an act of will and courage. Doing something that might force you to reconsider your own opinion goes against human nature and is emotionally risky. But that’s all in a day’s work for a good qualitative researcher.

Ci·vil·i·ty – formal politeness and courtesy in behavior or speech.

Back in May, I attended a virtual conference held by The Urgency of Civility, an organization dedicated to fostering civility within our world. It was a fascinating and refreshing two days, full of content that was both intellectually stimulating and relevant to these troubled times.

Civility has become a serious matter. We live in a world that is increasingly fraught – both socially and politically. Just having conversations can be nerve-wracking. This has acute implications for qualitative researchers, as conversation is how we make our living. I recently conducted shop-along interviews on a seemingly benign topic: disposable cups and plates. However, when the concept of recyclability came up, some of the conversations became awkward, as both the participant and I were nervous about sharing our views. Recyclability and sustainability have become highly politicized and polarized issues. I worked through this challenge, but things could have gone badly, and tiptoeing around this issue cost valuable time and dampened the mood.

One idea that has become clear to me is that civility is a skill—one that can be gained and built, and one that can wither and be lost. We can learn to be civil, we can get better at it over time, and, in so doing, can teach others to do so as well. Doing so requires acquiring a few habits and tools:

Resisting the desire to judge and moralize—moral posturing is conversational poison. We tend to look for moral explanations for our differences. This is simplistic and unproductive.

Courage—A Vietnam veteran I once knew used to say, “war is easy; peace is hard.” Having a civil conversation when you’d prefer either confrontation or avoidance isn’t easy. It requires you to be both vulnerable and open to new ideas. Remember: civility doesn’t mean misrepresenting your views in order to avoid conflict.

Resisting competitive instincts— human beings often tend to be reflexively contentious. This is an evolved trait that, unfortunately, is unlikely to foster civility. Resist allowing a conversation to devolve into a competition that must be won.

Introspection—civility often requires us to ask ourselves what’s preventing us from engaging in civil discourse on a specific topic or with a specific individual. This isn’t always easy, but it is essential to having a civil, productive conversation.

Compassion and empathy— one key to civility is understanding where incivility might be coming from. Deliberate incivility may be a result of feelings of powerlessness or fear, or of a sense of being disregarded or disrespected.

Understanding opposing viewpoints— John Stuart Mill once wrote, “He who knows only his own side of the case knows little of that. His reasons may be good, and no one may have been able to refute them. But if he is equally unable to refute the reasons on the opposite side, if he does not so much as know what they are, he has no ground for preferring either opinion.” Taking a genuine interest in how others have come to see things the way they do is a habit very much worth developing, as it can lead to some fascinating conversations. It also unequivocally demonstrates respect, which goes a long way.

Commitment—it’s essential to be dedicated to fostering civility, and to be willing to set an example. This isn’t always easy. Not only does civility seem to be on the wane, but aggressive incivility seems to be increasingly common. Sadly, making a point of being civil may open you to ridicule.

It’s also good to have some conversational tools and techniques in your back pocket. Having a civil exchange can be much easier if you have a set of questions at the ready when things get dicey. Here are a few I use regularly:

“How did you come to have that point of view?

“What are some experiences you’ve had that have informed your opinion?”

“What are some things that people who disagree with you don’t understand?”

This list is certainly not exhaustive.  I’d love to know your thoughts on civility and how to be civil.

As qualitative researchers, we have a unique opportunity to set an example for others. We spend so much of our time engaged in conversation with all kinds of people, and our profession demands that we create an environment for the free exchange of ideas and opinions. In doing so, we should view ourselves as modeling key principles of civil discourse.