Health Promotion International, 2024, 39, daae049

https://doi.org/10.1093/heapro/daae049
Perspective

Perspective
A critical review of the reporting of reflexive

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thematic analysis in Health Promotion International
Virginia Braun1, and Victoria Clarke2,*,
1
School of Psychology, The University of Auckland, Private Bag 92019, Auckland Mail Centre 1142, New Zealand
2
School of Social Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK
Corresponding author. E-mail: Victoria.clarke@uwe.ac.uk
*

Abstract
Using the concept of methodological congruence—where the different elements of a study ‘fit’ together—we explore both prob-
lematic and good practice in (reflexive) thematic analysis (TA) as reported in Health Promotion International (HPI). Aligning with
the importance we place on ‘owning your perspectives’ we situate this exploration in relation to our understanding of the varia-
tion in approaches to TA and qualitative research more broadly. This contextualization is necessary for highlighting why we judge
practices to be in/congruent, and to facilitate more knowing congruence in future research. We critically reviewed a ‘sample’ of
31 papers published in HPI between 2010 and 2023 citing Braun and Clarke as reference for TA. We overview a range of problem-
atic and good features of the use of TA in HPI, before focusing on two domains that seemed to present key challenges: theory
and themes. Methodological incongruence can occur when postpositivist values and practices unwittingly creep into ostensibly
non-positivist TA; we encourage thoughtfully and what we term ‘knowing’ consideration of theory, and quality practices and
criteria. Methodological incongruence can also occur through mismatched conceptualizations of themes—notably, the use of
‘topic summaries’ as themes for reflexive TA (and fragmented thematic structures with ‘thin’ themes). We provide examples from
the reviewed papers to demonstrate good practice in researcher reflexivity, articulation of theoretical and methodological frame-
works and congruent themes. However, mindful of power dynamics, we only discuss problematic practice in general terms, to
protect author anonymity. To facilitate thoughtful, quality TA—of all kinds—we provide eight pointers for researchers (and review-
ers) to guide quality practice, and facilitate the use of concepts, procedures and criteria that promote knowing methodological
congruence.
Keywords: Big Q qualitative, coding, methodological congruence, saturation, small q qualitative, theme, topic summary

A CRITICAL REVIEW OF THE USE OF qualitative or non-positivist orientation to qualitative

REFLEXIVE THEMATIC ANALYSIS IN research. Not all approaches to TA (developed prior or
since) can be so characterized (Finlay, 2021). As such,
HEALTH PROMOTION INTERNATIONAL TA is best thought of as a family of methods, with
Thematic analysis (TA), including the reflexive TA shared characteristics, alongside important differences
approach we have outlined (e.g. Braun and Clarke, in underlying philosophy, concepts and procedures.
2006, 2022), is widely used in qualitative health pro- These divergences matter for research practice and for
motion research, including that published in Health quality, but—evidenced by our reviews of published
Promotion International (HPI). We first wrote about TA research (Braun and Clarke, 2021c), including in
TA for a psychology audience, but reflexive TA has health (Braun and Clarke, 2023a, 2023b, 2024)—it
become widely taken up beyond psychology. (In appears the methodological consequences of them are
March 2024, our initial 2006 paper had over 190,000 not well understood, and what we have referred to
Google Scholar citations.) Our aim was to develop elsewhere as ‘unknowing’ practice (Braun and Clarke,
an approach to TA which aligned with our fully 2023b) is common. Unknowing practice is the flip side

© The Author(s) 2024. Published by Oxford University Press.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/
licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly
cited.
2 V. Braun and V. Clarke

use of qualitative techniques for data generation and

Contribution to Health Promotion analysis; a values-based definition crucially refers to a
wider distinctly qualitative values framework, within
• This article aims to support researchers in which qualitative approaches to data generation and
improving the quality and coherence of analysis are used. The idea of research values offers
their thematic analysis (TA) research by a simplified catch-all for the philosophical meta-­
identifying both common problems and theoretical assumptions that ground and give validity
good practices. to research: paradigms (the broad world views, norms
• The article critically reviews 31 papers and assumptions underpinning research); ontologies
using TA published in Health Promotion

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(theories of being and reality); epistemologies (theories
International that cite Braun and Clarke. of knowledge and knowledge production) and so on.
• The review also aims to support manuscript To us, qualitative research has two key components: (i)
reviewers in identifying good and problem- research techniques, procedures and practices and (ii)
atic practice and providing researchers with the values that underpin those practices, and determine
constructive and coherent feedback on their things like what constitutes meaningful knowledge
TA research. and knowledge production, what data give research-
• We provide recommendations for good ers access to (e.g. contextually situated lived experi-
practice—including choosing an approach ence; discursive practices), and what constitutes good
to TA most appropriate to the purpose and research practice.
values of the research.
Big Q and small q qualitative
of what we consider to be good—knowing—practice: a An example of a proceduralist definition of qualitative
researcher who is deliberative, thoughtful and reflexive research is the use of ‘non-quantitative methods to con-
in their choices and articulation of their research. They tribute new knowledge and provide new perspectives
don’t uncritically accept directives for ‘good practice’ on healthcare’ (Tong et al., 2007, p. 350), provided
(including ours in this article!), but, drawing on meth- by the influential Consolidated Criteria for Reporting
odological literature, reason through whether particu- Qualitative Research (COREQ) checklist. Another
lar concepts and practices are congruent with their term for this version of qualitative research is small
research. A knowing researcher then is also oriented q qualitative (Kidder and Fine, 1987), where, in the
to methodological congruence—the conceptual align- absence of an explicitly articulated values framework,
ment or ‘fit’ between different elements of a research research tends to default to disciplinary dominant
project—as we discuss further below. norms—typically some variant of positivism and/or
In this Perspectives article, we briefly critically realism. Kidder and Fine’s term for values-based qual-
review a selection of papers published in HPI, in order itative research is Big Q qualitative. Although whether
to support: (i) quality practices for health promotion there is one unifying set of underlying Big Q research
researchers using TA; and (ii) quality, constructive values is debated, Big Q is often understood as non-
and congruent reviewing of manuscripts reporting (or anti-)positivist, theorizing knowledge production
TA. We first briefly demarcate the domains of qualita- as partial, situated and contextual, and acknowledg-
tive research and TA, to contextualize and ground the ing, and valuing, researcher subjectivity as a resource
problematic (and good) practices we identified through for research rather than a problem to be managed.
our review. Our review then homes in on two particu- These contrast with the post-positivist aspiration for
lar problematic aspects: the gnarly problem of theory objectivity, ensuring the accuracy and reliability of
and the lack of clarity and congruence in theme con- analysis and keeping researcher ‘bias’—understood
ceptualization. We finish with some key recommenda- as researcher subjectivity threatening and distorting
tions for quality practice. objectivity—in check.

Experiential and critical qualitative

QUALITATIVE RESEARCH AND THEMATIC In mapping the terrain of Big Q qualitative, we find
ANALYSIS: DEFINING AND MAPPING THE it useful to distinguish between ‘experiential’ and ‘crit-
ical’ orientations (Braun and Clarke, 2013, 2022)—
TERRAIN umbrella terms that designate different orientations for
The term fully qualitative (which we used above) and ‘tasks’ of research. Experiential—probably the vast
evokes a distinction between understanding qualita- majority of qualitative research, especially in health—
tive research in (i) proceduralist or (ii) values-based designates qualitative approaches that take a broadly
ways. A proceduralist definition equates it with the empathic interpretative orientation in exploring,
Reflexive thematic analysis in Health Promotion International 3

understanding and interpreting human experience, of themes conveys a fundamentally different

which is typically viewed as socially embedded and/ way of imagining themes: either things that can
or contextually located. Language becomes a tool for be ‘found’, that exist and that we seek to know,
accessing such experience. Critical approaches in con- or things that are produced, an outcome of the
trast interrogate the social construction of meaning analysis process, unknowable before the analytic
and treat language as shaping reality not just conveying work is done.
reality. In critical qualitative research, the focus moves • (3) Our final cluster of TA methods is those we
away from (socially embedded) individual experience term ‘codebook TA’. These tend to have a rela-
and sense-making to consider sense-making as a social tively structured coding approach (like small q/

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practice. This research could be described as theoret- coding reliability TA) but, being founded more in
ically/conceptually critical, as the term ‘critical quali- qualitative values (like Big Q/reflexive TA), they
tative’ is (confusingly) also used to describe research do not tend to treat ‘coding accuracy’ as key for
with an overt social justice agenda and an interest in quality assurance. The label ‘codebook TA’ is a
power and the social world—this latter version of crit- useful differentiating tool—but it is important to
ical qualitative is particularly common in the USA in note that such approaches typically have non-TA
our discipline of psychology (Levitt et al., 2021). That names, such as framework analysis—developed
quite different traditions use the same term highlights for applied policy research (Ritchie and Spencer,
the importance of researchers carefully theoretically 1994), and increasingly popular in health research
locating their approach to qualitative research in a (see Smith and Firth, 2011)—and template anal-
particular study, with descriptions grounded in the rel- ysis (King and Brookes, 2016)—developed in
evant literature. psychology, and influential in organizational
research.
Diversity within thematic analysis—coding
reliability, reflexive and codebook approaches
Approaches to TA range from small q to Big Q—our KNOWINGNESS AND
approach offers the latter (although we did not explain
METHODOLOGICAL CONGRUENCE FOR
it in those terms initially). As we have witnessed our
approach used in ways that do not align with its under- QUALITY THEMATIC ANALYSIS
pinning values, we have taken care to more clearly In reviewing published research, our intent is not to
differentiate the approach, and its values and prac- determine if ‘the rules’ have been followed, which
tices—hence the (newish) name reflexive TA, empha- would reflect a rather technical orientation to qual-
sizing the inherent and inescapable subjectivity of the itative research, with narrow and fixed ideas of per-
method (which is a good thing!), and the researcher’s fection (see Chamberlain, 2000). Instead, we seek to
active role in knowledge generation (Braun and Clarke, understand methods-as-used, to understand incon-
2019). We have also sought to clearly (from our per- gruency, and where ‘gaps’ in understanding appear
spective) map the terrain of TA, locating our and other to be, so that we can better advise researchers for
approaches in this landscape (see Braun and Clarke, quality scholarly practice. For us, quality in TA is not
2022)—we hope constructionist readers forgive us determined by adherence to any particular version,
for the realist metaphor. We now differentiate TA into or following ‘the recipe’ for TA, so much as practis-
three broad clusters (initially it was two; Finlay [2021] ing and reporting in a way that is knowing and meth-
similarly makes a bipartite differentiation): odologically congruent—or knowingly incongruent
(we have previously used the terms methodologically
• TA methods that offer a small q ‘coding reliability’ coherent and incoherent in our methodological schol-
approach (e.g. Boyatzis, 1998; Guest et al., 2012). arship but now prefer the less negative connotations
With a foothold in positivism, coding reliability of incongruent). As previously noted, a knowing
TA typically offers structured coding and proce- researcher is one who strives to be informed about
dures for theme identification oriented to ensuring the conceptual foundations of particular methods
and demonstrating the accuracy and reliability of and research practices, and the logics of their inquiry.
coding. It is someone who makes deliberative choices (start-
• Big Q ‘reflexive TA’ approaches, like ours. These ing from being aware there are choices to make, and
non-positivist approaches are characterized by recognizing how these matter) and is reflexive about
organic and open procedures for coding and their role in knowledge production. Knowingness
theme development that centre the researcher’s captures understanding of what you are doing, why
interpretative engagement with the data. The you are doing it, and how you are doing it makes
language of identification versus development (conceptual) sense.
4 V. Braun and V. Clarke

Methodological congruence as a key quality do qualitative research because they can’t do numbers,
marker and kept the 31!) This is because it can be difficult to
Knowing practice is crucial for methodological con- determine in published papers what, if any, approach
gruence. Research is methodologically congruent when has been used, because of a lack of or limited descrip-
different components ‘fit’ together—such components tion of the researcher’s analytic process (Braun and
include: research question(s); ontology; epistemology; Clarke, 2023a). The papers were published between
methodology; explanatory theory; methods; quality 2010 and 2023, with most (n = 27) published in the
standards and practices; conceptualization of language 5 years from 2019 to 2023. Being mindful of power
and researcher subjectivity; assumptions about what data dynamics, we follow Smith’s (2011) use of anonymity,

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access and so on. Congruence can be imagined via an describing in general terms the hallmarks of problem-
analogy of hosting an evening meal (dinner) for friends atic practice. However, as there is value in real-world
or family—within whatever cultural context, there will be examples, we provide some examples of good prac-
foods designated as ‘appropriate’ and ‘inappropriate’ for tice from the reviewed papers (it’s important to note,
dinner, and a congruent meal would include and exclude however, that few papers were consistently ‘good’;
on that basis. In a UK context, for instance, porridge or papers often contained both good and problematic
muesli would be incongruent if they appeared on the din- practice). Before focusing specifically on two domains
ner table, whereas pasta and salad would be congruous. (methodological incongruence and apparent theoreti-
Knowing practice involves presenting your guests with cal unknowingness; theme (mis)conceptualization), we
either appropriate foods, or offering an explanation of briefly summarize and evaluate the use of TA in HPI.
why an inappropriate food is there (which they may
judge to be justified, or not—a fancy porridge, such as
UK celebrity chef Heston Blumenthal’s infamous snail CHARACTERISTICS AND EVALUATION
porridge, may ‘work’ in some contexts). OF THEMATIC ANALYSIS RESEARCH IN
Across TA approaches, different research prac- HEALTH PROMOTION INTERNATIONAL
tices are congruent or incongruent, depending on the
Research design and research questions
particulars of the approach. Knowingness involves
understanding this, and considering in/congruence Most papers reported standalone qualitative stud-
around the practices used. Take data saturation, ies—some were part of wider studies including some
often presented as the ‘gold standard’ for determining mixed methods designs—and across the papers, a
‘sample size’ in qualitative research, and included in variety of research questions types were addressed.
reporting checklists like COREQ (Tong et al., 2007). Referencing a typology of ‘qualitative research ques-
Knowingness would involve a researcher reasoning tions’ we have developed (Braun and Clarke, 2013),
through the theoretical assumptions embedded in the TA was used to address questions centred on lived
concept of data saturation to determine whether it is experiences, participants’ perceptions of and perspec-
a good ‘fit’ for their research (e.g. Varpio et al., 2017; tives on particular phenomena, participants’ practices
Braun and Clarke, 2021c). Notions of congruence or behaviours in relation to particular phenomena,
(and Levitt et al., 2018 analogous concept of method- influencing factors (‘barriers and facilitators’—to the
ological integrity) often do not feature in quality and implementation of a particular policy, intervention or
reporting checklists and standards, which is one of the health behaviour—was a very common focus), and the
reasons we often find their usefulness is limited, espe- representation of particular phenomena in particular
cially in relation to Big Q/reflexive TA. contexts. Health promotion researchers are clearly
harnessing the potential that TA offers for addressing
a wide range of research questions (Braun and Clarke,
2022). The flexibility TA offers was also evident with
REVIEWING THEMATIC ANALYSIS regard to data generation methods and data sources
PAPERS IN HEALTH PROMOTION used, including interviews of various modalities, focus
INTERNATIONAL groups, secondary sources, qualitative surveys, obser-
vation, journal writing, photomethodology and stake-
We used the journal search function (on the default
holder reports. Multimethod designs were common,
relevance setting) to search for ‘thematic analysis’. We
with more studies than not having multiple (qualita-
selected the first 31 papers citing any of our TA writing;
tive or qualitative and quantitative) data sources.
papers did not have to report a reflexive TA or claim
to ‘follow’ the six-phase analytic process we have out-
lined. (We intended to review 30 papers—a nice round Thematic analysis approach used
number—but miscounted and ended up with 31. So Our evaluation of the TA research published in
we leant into the stereotype that qualitative researchers HPI was not radically different from that we have
Reflexive thematic analysis in Health Promotion International 5

reviewed in other journals (e.g. Braun and Clarke Clarke, 2006). Such decisions relate to different possi-
2023a, 2023b, 2024). All of the papers reported some ble orientations to and treatments of data, coding and
kind of TA or the results of a TA adjacent method; analysis. Only a minority of authors described a cod-
29 described the method used as TA and two papers ing orientation (reporting they coded data semantically
(published in 2022) as reflexive TA. The most com- or used a mix of semantic and latent coding). Those
monly cited source was our original paper (Braun and who noted an analytic orientation most frequently
Clarke, 2006)—often seemingly treated as a generic described an inductive approach; some described a
reference for any TA. In 22 papers, this was the combination of inductive and deductive. A deductive
sole (Braun and Clarke) source cited. In three other orientation was equated with practices aligned more

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papers, including the two describing using reflexive with coding reliability and codebook TA approaches
TA, more recent (Braun and Clarke) sources were (e.g. Boyatzis, 1998) than reflexive TA, such as: using
cited (e.g. Braun and Clarke, 2013, 2017, 2021a, existing theoretical constructs as themes, and organ-
2021b, 2021c, 2022; Clarke and Braun, 2017; also izing the data into these themes; developing a coding
Byrne, 2021). (The way we think about and articulate framework using an existing theory/theoretical model;
our approach has evolved, and will likely continue to developing codes from the research questions/aims of
do so, so reading more recent work is important if the study or using themes from existing literature to
using reflexive TA.) Some papers (also) cited other TA guide coding. In reflexive TA, a deductive coding ori-
approaches (e.g. Fereday and Muir-Cochrane, 2006; entation means that theory offers an interpretative lens
DeCuir-Gunby et al., 2010; Patton, 2015) or other for reading and making sense of data, so it shapes the
methodologies (e.g. grounded theory; Strauss and focus of analysis rather than evoking (implicitly) the
Corbin, 1990; Charmaz, 2006). (Although some still hypotheticodeductive model. For example, in a paper
advocate for ‘thematic coding’, where grounded the- exploring policymakers’ perspectives on school-based
ory coding procedures and other analytic techniques health initiatives in Victoria, Australia, Meiklejohn
are used to develop themes from qualitative data (e.g. et al. (2020, p. 1463) described how they used inter-
Flick, 2018), as there is now a plethora of method- pretive policy analysis as a lens for analysing their
ological literature for TA approaches, we think it data. This approach ‘explore[s] the multiple meanings
is important to justify the use of techniques from or perspectives of policies and how these meanings
another methodology over the use of methods specif- are communicated through the policies’. Defining the
ically developed for TA.) In a few examples, authors coding and inductive/deductive orientations we use is
appeared to have developed and used an idiosyncratic important both for ‘reflexive openness’ (Jacobs et al.,
TA approach by drawing on guidance on conducting 2021) and for centring considerations of methodolog-
TA or another approach written by several different ical congruence.
authors. Typically, any philosophical and procedural
differences across sources from different authors/
approaches were not acknowledged or discussed (and Methodological frameworks
a rationale for a combined or ‘new’ approach was In the reviewed papers, generally, there was little dis-
not provided). Indeed, there was considerable varia- cussion of a broader methodological framework,
tion and ‘messiness’ in both the described process of although some described using TA within a grounded
doing, and language of reporting, analysis—such as theory methodology, and some noted the use of a
ostensibly claiming to ‘follow’ our approach but then ‘descriptive’ or ‘generic’ qualitative approach. Some
describing something different; or reporting the use referenced TA as methodology—which we highlight,
of our method, but using the language and concepts because while language is slippery, to us, TA is more
of grounded theory, such as line by line coding (see method than methodology. We distinguish methods
Braun and Clarke, 2021a). The variation in practice as not predetermining or delimiting things like theo-
ascribed to Braun and Clarke (2006) was so great that retical frameworks (onto/epistemology), or offering
sometimes it seemed likely that some authors had not guidance (or directives) around ideal and appropriate
actually read the paper (see also Braun and Clarke, research questions, dataset/participant group con-
2023a). stitution and size, data generation methods and so
on—methods are not an ‘off-the-shelf’ package for a
The many questions of thematic analysis— whole research project. Some analytic approaches—
semantic and latent coding, inductive and like grounded theory, interpretative phenomenological
deductive analytic orientations analysis and discourse analysis—are more methodo-
There is a need to think about and make decisions in logical, with research elements from theory to research
using TA as an analytic method—we have described question delimited or determined (Chamberlain, 2012;
these as the ‘many questions of TA’ (see Braun and Braun and Clarke, 2021a). However, TA is not pure
6 V. Braun and V. Clarke

method, as different TA approaches are anchored own experiential account of the research, which is
by broad and different (qualitative) research values: contingent, provisional, partial, restricted and local
we like how Finlay’s (2021) distinction between sci- (Miller et al., 2008); I included wholeheartedly my
entifically descriptive and artfully interpretative TA own subjectivity in the research.
conveys this. With TA not being a methodology but
a method(ish) approach, the underpinning ontological Harrison et al. (2020, p. 1324) provided one of the
and epistemological assumptions, guiding theoreti- few other examples of explicit researcher reflexivity. In
cal frameworks and other specific elements like the a media framing analysis of the representation of cli-
approach to ‘sampling’ and data generation, need to mate change and health in two New Zealand media

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be specifically selected for the project. To continue the sites, they briefly acknowledged how their analysis was
dinner for friends or family analogy we used earlier, shaped by assumptions about the topic and the cover-
‘off-the-shelf’ methodologies can be thought of as akin age on one site:
to serving a premade lasagne, whereas a method(ish)
approach like TA is more like serving a lasagne you’ve Engaging in a process of reflexivity, we acknowl-
made yourself. In both instances, the basic components edge that our analysis is informed by our under-
of the dish (pasta, white sauce, tomato sauce, cheese) standing of what defines ‘health’, our belief in the
are the same, but when you make your own lasagne, importance of the natural environment for health
you select the different components (e.g. gluten-free or and well-being, and a pre-held hypothesis that
wheat pasta, dried or fresh, a meat- or vegetable-based the commercially owned [New Zealand Herald
tomato sauce with a glass of red wine added or not, Online] would lean towards sensationalized, de-­
cow’s milk or vegan cheese). And ideally, you select and contextualized framing.
combine them in a way that makes for a harmonious
and tasty dish! Reflexive openness most broadly in TA includes the
researcher ‘owning’ their theoretical underpinnings
Researcher reflexivity and knowingness and orientation, which we consider now.
Finally, we come to evident ‘knowingness’ in the
reviewed papers. In general, there was relatively little
evidence of researcher reflexivity, and/or researchers REFLEXIVE NON-OPENNESS AND THE
striving to ‘own their perspectives’ (Elliot et al., 1999) SEEMINGLY GNARLY PROBLEM OF
and positioning in the reviewed papers. (Publishing THEORY
norms and styles can actively work against the inclu-
There is no such thing as atheoretical qualitative
sion of such material in published work, although it
research—all research is anchored in assumptions and
can be conveyed more subtly through explicit discus-
theorizations about the nature of reality, what consti-
sion of, for instance, (meta)theory.) Freeman et al.
tutes meaningful knowledge and what data provide
(2017, p. 1051) offered a nice example of good prac-
access to. These broad or meta-theoretical consider-
tice in researcher reflexivity. In research exploring UK
ations need to be concurrent to any (additional) dis-
university students’ perceptions of walking through
cussion of explanatory theory or framing theoretical
and being with nature, the first author included reflec-
models that inform analysis—which included, in the
tion on their own walking and solo experience (WSE):
reviewed papers, interpretative policy analysis, media
framing, social cognition, psychosocial and ecological
Within the current research I acknowledge that
models.
my beliefs, experiences and interests influenced my
decision-making and actions and thus shaped the
research. My experiences of journeying in ‘wild’ Experiential and critical qualitative
landscapes, on my own and with groups, led me Considering the question of data, we categorized most
to conduct this research and influenced my ideas papers as broadly experiential—evident through ref-
about peoples’ behaviour in nature. These expe- erences to a ‘subjectivist epistemology’ or an interpre-
riences have provided me with the knowledge, tivist paradigm when philosophical meta-theory was
skill and confidence to create and lead my own mentioned—which conceives data as a way into par-
WSE which inevitably changes the dynamics of ticipant worlds and experiences. A critical orientation
the research process and relationship that can be (both social construction of meaning and social justice
formed with participants, e.g. sometimes my lead- versions) was evident in some papers. One referenced
ership role and previous outdoor experiences made constructionism and theorized language as perform-
it easier to build rapport and at other times it did ative and action-oriented—with data understood as
not. I acknowledge that research findings are my giving access to meaning-making not interior realities.
Reflexive thematic analysis in Health Promotion International 7

Some articles noted constructivism, constructionism recognized limitations of member checking, inter-
and relativism as ontologies/epistemologies—which rater reliability and universal criteria for enhanc-
starts to make theory more explicit. But review- ing trustworthiness (Smith and McGannon, 2018).
ing these as critical scholars, the descriptions and/or (p. 3)
enactment of claimed theory in the research was often
closer to contextualism/critical realism. And we noted McGrath et al. explained their use of the concept
the conflation of constructionism and constructivism, of information power to determine the number of
reflecting existing messiness (geographic and discipli- participants:
nary variation) and interchangeable use of these terms/

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frameworks (by some). This is an area where more in keeping with the principles and ethos of reflexive
explicit articulation of the consequences of theory for thematic analysis, the concept of ‘data saturation’
research is important (drilling down into the literature was viewed as inconsistent with the values and
suggests important differences between constructivism assumptions of reflexive thematic analysis and more
and constructionism, with the theorization of language consistent with a straightforward realist ontology
as active and performative a distinct characteristic of (Braun and Clarke, 2021c). Rather, assumptions of
constructionism; see Braun and Clarke, 2022). reflexive thematic analysis align with the view that
when research is situated as a reflexive practice of
The seemingly unknowing dominance of knowledge generation, there is always potential for
positivism and realism new insights or understanding (Braun and Clarke,
Although most papers included little or no deliberative 2021c). For this reason, the concept of information
discussion of philosophical meta-theory, theory and power was applied—where the larger information
its influence were present implicitly, and often in ways power the sample holds the less participants are
which worked to produce reflexive non-openness and needed (Malterud et al., 2016). (p. 4)
methodological incongruence. The persistently strong
tentacles of (versions of) positivism and realism on the They also explained why they had not sought to
(qualitative) social and health sciences were evident establish the reliability of their coding:
through the deployment of concepts and practices
widely advocated as, and perhaps (therefore) assumed This approach to coding is organic rather than reli-
to be, theoretically neutral/trans-theoretical. Reported ant on any particular coding framework, with the
practices or research concerns included: saturation; generation of themes being the final outcome of data
(researcher) bias; theme consensus/agreement; member coding and iterative theme development (Braun and
checking; concern for the accuracy and reliability of Clarke, 2021a). For this reason demonstrating cod-
data, coding or interpretation; intercoder reliability; ing reliability is illogical as researcher subjectivity
(lack of) representativeness, lack of (statistical) gen- is conceptualized as a resource for knowledge pro-
eralisability; triangulation and more. The theoretical duction (Braun and Clarke, 2021b). Rather, rigor
foundations (and therefore delimited applicability) of in terms of analysis was sought through a collabo-
these were typically only expressed by authors orient- rative research process, involving the research team
ing to or explaining why they hadn’t used concepts and and researcher to achieve richer interpretation of
practices like saturation or theme agreement (for criti- meaning rather than consensus of meaning (Byrne,
cal discussions of many of these, see Braun and Clarke, 2021). (p. 5)
2013, 2021c, 2022; Smith, 2017; Varpio et al., 2017,
2021; Smith and McGannon, 2018). For example, That authors deploying methodologically congruent
both Buckler et al. (2023) and McGrath et al. (2022) practices explain them around what they are not doing
described methodologically congruent choices/prac- suggests the broader context remains one in which pos-
tices and their rejection of methodologically incon- itivist/realist-founded practices remain normative and
gruent practices (which were commonly used in other expected (see Varpio et al., 2017, 2021). Reviewers
papers reviewed). Buckler et al. described the involve- and editors have an important role to play here, by not
ment of the co-authors as ‘critical friends’ to encourage expecting authors to explain their departure from pos-
reflexivity and quality practice: itivist/realist norms, and we encourage editorial inter-
vention to support authors in this, if reviewers have
Throughout data collection, analysis and writing asked for such explanation from authors.
of the manuscript, co-authors also acted as ‘critical In some papers, the stated theoretical position (e.g.
reviewers’ (Smith and Sparkes, 2016) to encourage constructionism; relativism) was (theoretically) incon-
deep exploration and alternative interpretations of gruent with reported research practices (data satura-
the data and as a step recommended to overcome tion; practices to ‘minimize bias’). Such practices are
8 V. Braun and V. Clarke

not incongruent with all forms of TA (though they are reflexive TA research. Reporting research exploring
incongruent for reflexive TA), highlighting the impor- COVID-19 vaccine decision-making during preg-
tance of reflexive openness and explicit and knowing nancy in Aotearoa/New Zealand, Jones and Neely
theoretical positioning as a crucial consideration for (2023) discussed the poststructuralist approach
quality TA, regardless of approach. In our experience, informing their study and their use of the story com-
some of this incongruence can be introduced through pletion method:
(unknowing or required) adherence to popular qual-
ity and reporting checklists—such as COREQ (Tong With a post-structuralist lens, story completion
et al., 2007), which a few cited. If used ‘unknowingly’, then becomes a method for examining the knowl-

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such quality and reporting tools can foster incongru- edge systems and discourse which inform partici-
ence through universalizing theoretically delimited pants’ thinking […] Story completion deliberately
constructs (e.g. member checking) and using positiv- aims to not uncover personal views or experiences
ist/realist and non-positivist concepts interchangeably of the study’s participants, rather, the participant
(e.g. researcher bias and reflexivity). is analysed as a complex and variable function
of discourse (Gravett, 2019). By adopting a post-­
Examples of good practice in discussing structuralist approach, we were able to examine
theoretical assumptions the stories through discourse, tropes, constructions
There were some good examples where the concep- or discursive repertories that inform participants’
tual underpinnings of the research were discussed. In understanding and decision-making (Gravett,
research exploring the gambling practices of younger 2019). (p. 4)
women in Australia, Thomas et al. (2022, p. 3)
described their critical qualitative approach as: Story completion, like many other data genera-
tion methods, can be theorized in different ways with
acknowledge[ing] the role of power, inequality, and regard to what the data give researchers access to—
injustice in health and social issues (Charmaz, 2017; in this instance, social discourses. For this reason, it
Jacobson and Mustafa, 2019). […] While traditional is important that researchers anchor their use of a
qualitative methodologies aim to interpret the world, method in a clearly demarcated theoretical framework.
critical qualitative inquiry aims to change the world Walsh et al. (2023), in a study exploring Irish young
(Denzin, 2017). For the present study, this meant people’s perspectives on school-based mental health
putting the voices of women at the centre of inquiry and suicide prevention using a participatory approach,
in order to reveal opportunities for social change, noted their ‘critical view’ (p. 2) on COREQ and their
activism and policy reform (Denzin, 2017). rejection of elements not coherent with reflexive TA.
They described the ‘critical paradigm’ informing their
And in their study of meaning-making around warn- research and their assumption that ‘individuals exist
ing labels on alcoholic beverage containers (also in within power-laden and inequitable environments,
Australia), May et al. (2022, p. 4) discussed their con- which means that power is always at play’ (p. 2)—an
ceptualization of language: assumption that they argued has important implica-
tions for researching young people’s perspectives on
Two key assumptions underpin our analysis. First, mental health in school settings which ‘contain sig-
that the cultural and social significance of alcohol nificant power imbalances between adults and young
is socially produced and reproduced through lan- people’ (p. 3). They also noted their contextualist and
guage (Harré and Van Langenhove, 1991); there- critical approaches to epistemology:
fore, shared social experiences are drawn upon to
re-construct (not just describe) social reality (Potter, we believe that reality is shaped by social, politi-
1996b; Andrews, 2012). Second, the meaning of cal, cultural, economic, ethnic and gender values.
language is context-specific and interpretations Research from a critical perspective strives to target
will vary depending on the nature of the discussion issues in social life, such as social justice and mar-
(Potter and Wetherell, 1987). ginalism while considering issues of power in the
research process. (p. 3)
These examples demonstrate the possibility of
cogently yet succinctly describing the theoretical These assumptions informed their use of a participa-
assumptions that underpin an analysis. More recently tory approach to inquiry, one that:
published papers in HPI—published after we selected
the ‘sample’ for our review—provide further exam- acknowledges power as a central research compo-
ples of good practice in engaging with theory in nent and offers a way to intervene with unavoidable
Reflexive thematic analysis in Health Promotion International 9

notions of power, by placing enhanced value on ‘made up things’ sense, but rather to convey the sense
young people’s authentic knowledge and perspec- of there being a key message each theme is trying to
tives on the world. (p. 3) convey.) Rather than capturing entities within the
data, identified by the researcher, themes offer ‘takes’
Their ontological and epistemological assumptions on the data. Shared meaning themes should be rich
also informed their choice and use of reflexive TA, and and multi-faceted, encompassing multiple observa-
their understanding of power and its centrality informed tions about the central concept (uniting meaning)
the refinement and finalization of themes. Walsh et al.’s of the theme. We have found a dandelion seed head
account provides a particularly compelling example of offers a useful visual analogy (Braun and Clarke,

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researchers ‘owning’ their theoretical perspectives and 2022): it has a calyx (central concept) and numerous
assumptions, and articulating how these shaped their pappus (facets of the central concepts) all connected
design choices and research practices. to the central calyx. Although it can be difficult to
avoid writing about themes or meaning as if they exist
in data, we encourage researchers reporting reflexive
INCONGRUENCE IN THEME TA to use more subjective and productive language
CONCEPTUALIZATION to evoke this creative process (Finlay, 2021)—themes
Incongruence in the conceptualization of themes was are developed, produced, crafted, created, constructed
common across the articles. Different approaches to rather than identified, found or discovered, or emerg-
TA conceptualize themes differently, in ways that mat- ing from data, like Venus arising from the sea fully
ter for quality. grown in Botticelli’s famous painting ‘The birth of
Venus’.
Topic summary and meaning-based themes
We have differentiated two common approaches as Examples of good practice in theme
topic summaries (or categories) and meaning-based conceptualization and development in
themes. Topic summary themes draw together material reflexive thematic analysis
related to a particular data topic, domain or category Given that theme mismatching is common in TA
(e.g. barriers to implementing policy X) and summarize research, we provide two examples of good reflexive
data content relevant to that topic. Topic summaries TA themes from the articles reviewed. The themes from
often map closely to research/data collection ques- McGrath et al.’s (2022) research exploring the experi-
tions/areas, making such ‘themes’ appear to pre-exist ences of participants in the health and wellbeing ini-
in the analysis. Analysis becomes a process centred tiative Sheds for Life (SFL) in Men’s Sheds settings in
on allocating data to (pre-known) themes, and deter- Ireland, told a story of three key elements of change:
mining the nature of these through exploring and/or
summarizing what participants said in relation to these • creating the right environment highlighted the
themes (often drawing together disparate observations importance of creating a supportive environment
related to the topic). Such themes often evoke a realist/ to facilitate men engaging optimally with SFL;
positivist model of research, with the themes treated • normalizing meaningful conversations, a legacy
as real entities, located within data, for the researcher for talking health conveyed the impact of SFL
to (accurately) ‘extract’. Topic summary themes were in encouraging meaningful conversations about
prevalent in the articles—even those described as using health and wellbeing. Key aspects were conveyed
reflexive TA, where topic summaries are conceptually with two subthemes: creating safety and trust
incongruent (yet quite common in published research; (how SFL built on the safety and intimacy within
Braun and Clarke, 2021b, 2023a, 2023b). the Shed context); strengthening bonds (how
In reflexive TA, themes are conceptualized as SFL deepened the sense of connection within the
meaning-rather than topic-centred, and, importantly, Sheds);
developed from and through data coding, and only • transforming perceptions of how men do health
after considerable analytic engagement. They have explored how SFL was gender transformative,
no ontological existence separate from the analytic with participants reframing what it meant for
process. This means when doing reflexive TA, it is them as men to be healthy. Subthemes reaping the
not possible to ‘code for themes’ or to use coding to benefits of engaging with health, and reframing
‘allocate data to themes’ because themes cannot be attitudes towards health conveyed core elements
pre-identified. Themes are interpretative stories about of this transformation.
data, stemming from the researcher’s subjectivity, and
crafted through their rigorous but positioned read- In their research, information relevant to health
ing of the data. (We use stories here not to evoke the promotion, such as ‘barriers’ and ‘facilitators’ (as
10 V. Braun and V. Clarke

mentioned, a common focus in the reviewed papers), with subthemes nested within themes, and perhaps
was discussed within and across the themes. However, themes nested within overarching themes, is under-
these did not structure the analysis—they were not stood as a way to capture the complexity of the data
used as either themes or subthemes. The barrier of being analysed. In reflexive TA, a highly differentiated
cost was briefly noted in creating the right environ- thematic structure can work against complexity and
ment, and that theme effectively focused on a ‘facilita- the development of unifying concepts and meanings.
tor’—the right environment. But the theme centred the Complexity in reflexive TA is evident in the presenta-
story, rather than the category. We note this to show tion of rich and multifaceted themes, with subthemes
that within reflexive TA, it is possible to address such used judiciously to highlight a dimension of the central

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core considerations for health promotion, without concept of the theme (subthemes aren’t a necessary fea-
structuring the analysis around them (by presenting ture of a reflexive TA). The difference in thematic struc-
a summary of information related to each). This is a ture and what it means across different TA approaches
key way the ‘output’ of reflexive TA typically differs again highlights the importance of understanding and
from something like framework analysis—highlight- knowingness for quality and congruent TA reporting.
ing that understanding your research output ‘needs’ is
important for determining which version of TA suits Qualitative data analysis software
your project. In several of the reviewed papers, an
Qualitative data analysis software (QDAS) was used
approach like framework analysis (Smith and Firth,
in many reviewed papers, and such tech may have
2011) seemed like it would have offered a better fit:
facilitated some papers reporting high numbers of
an approach designed for research with predetermined
themes, with highly differentiated thematic structures.
information needs, reporting topic summary themes,
No coding technology—whether QDAS or paper and
often known in advance, and a hierarchal thematic
pencil—is neutral—they all shape how research-
structure used to parse out the different experiences
ers engage with and analyse data (e.g. QDAS may
and viewpoints expressed within the data.
facilitate over-­
coding; hand coding under-coding).
Freeman et al. (2017) reported four meaning-based
If doing reflexive TA specifically, where themes are
themes to capture core aspects of what participants
meaning-based stories and subthemes convey impor-
reported gaining from outdoor/rural walking and solo
tant parts of the story, knowingness around the pro-
experience exercises:
cess, and the purpose of coding, is really important
(1) gaining a sense of freedom and escape; to avoid incongruence and an elaborate, fragmented,
(2) gaining a sense of awareness and sensitivity to topic summary output.
one’s environment and its influence;
(3) gaining confidence in being able to cope and
take action; RECOMMENDATIONS FOR DOING AND
(4) gaining a sense of perspective on and an appre- REPORTING METHODOLOGICALLY
ciation for life. CONGRUENT THEMATIC ANALYSIS
We simply report the theme names to highlight how RESEARCH
informative these can be in conveying the central con- We end with eight recommendations to enhance
cept of the theme—and to signal how a strong story methodological congruence. Although addressed to
theme (name) can entice the reader in, piquing curiosity. researchers seeking to conduct and publish high-­
The relatively small number of reported themes for quality TA research, we encourage reviewers assessing
both studies allowed for depth and complexity, and manuscripts submitted to HPI to consider these when
multifaceted themes. In contrast, some of the reviewed TA has been used.
papers reported a large number of ‘themes’ and sub-
themes (e.g. 20–30 in some papers), and/or elaborate 1. Read methodological literature—do not cite
and often fragmented thematic structures, with multiple without reading.
theme levels (including themes, categories, subthemes 2. Develop a sound (good enough) understanding
and/or codes). Such themes were often categories/topic of the diversity within TA. If ‘mixing’ from dif-
summaries; subthemes were often s­ ingle-faceted, more ferent approaches, ensure these are compatible,
akin to codes in reflexive TA. Given word count con- and explain why; if developing your own idio-
straints, there is a practical limit to the amount of depth syncratic TA approach, explain why this was
and detail that can be provided when reporting such necessary, and what it allowed you to do that
a large number of themes. In some coding reliability other approaches didn’t.
and codebook approaches, including framework anal- 3. Reflect on your research values and the goals and
ysis, as noted above, a differentiated thematic structure purpose of your research (e.g. more open and
Reflexive thematic analysis in Health Promotion International 11

exploratory [reflexive TA] versus more deline- CONFLICT OF INTEREST STATEMENT

ated and predetermined [codebook or coding
The authors have no conflicts of interest to declare.
reliability]). Select an appropriate TA approach,
and justify your use of this approach.
4. Own your perspectives. Discuss the theoretical
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