Search strategy

A systematic search was performed in Scopus on October 15, 2025, using the following search strategy to identify qualitative health studies authored by researchers affiliated with institutions in Peru and published between 2022 and 2025: AFFILCOUNTRY (peru) AND TITLE-ABS (qualitative) AND ((SUBJAREA (MEDI OR NURS OR DENT OR HEAL) OR SUBJAREA (PSYC))) AND PUBYEAR>2021 AND PUBYEAR < 2026

Study eligibility

We included original articles authored by researchers affiliated with institutions in Peru, that were published in scientific journals between 2022 and 2025 and presented findings from qualitative studies. This timeframe was chosen to reflect the current state of the field. Only studies in which at least 25% of participants were based in Peru were considered to ensure meaningful representation of the Peruvian population while allowing the inclusion of international studies. Publications related to health disciplines, including medicine, nursing, dentistry, psychology, and other health professions, were included. Mixed-methods studies were excluded due to the need for specific assessment tools. No language restrictions were applied.

Studies selection

Records were uploaded to the “Rayyan” software (Qatar Computing Research Institute, Doha, Qatar; https://www.rayyan.ai/). Six authors in pairs independently screened the records applying the selection criteria. Disagreements between the reviewers were resolved through discussion among the reviewers or with the collaboration of other authors.

Data extraction

To ensure consistency, a pilot data extraction was conducted prior to the main process. Subsequently, six authors worked in pairs to independently extract data from each study, recording all information in a predesigned Excel spreadsheet. The research team consisted of professionals in Medicine and Psychology with experience in conducting health research.

For each included study, we collected information on its general and methodological characteristics, including: language of the study (English, Spanish, or both English and Spanish), whether the study was published in a Peruvian journal (yes or no), number of authors (divided in tertiles), country of the first author’s institutional affiliation, international collaboration, defined as the inclusion of at least one co-author with an institutional affiliation in a country other than Peru (yes or no), study population, sample size, study setting (community settings, health facilities or educational centers), Peruvian region where the study was conducted, multicountry study, defined as a study that included research sites in countries other than Peru (only Peru or Peru and others countries), ethics committee approval (whether the article reported approval from at least one ethics committee), and ethics approval code reported (whether the article, supplementary material, or appendix included the ethics approval code).

Additionally, we assessed the quality of reporting using the SRQR checklist. The data extraction matrix included two components for the SRQR score: one for the assigned score and another to document the rationale, including verbatim excerpts from the reviewed articles to justify each rating. Each pair of investigators independently extracted study characteristics and SRQR items, and then met to compare each cell and reach consensus, resulting in a final extraction. Discrepancies that could not be resolved were discussed during weekly team meetings until agreement was achieved.

Quality of reporting

We used the SRQR 21-item checklist [6], which provides guidance on transparency and completeness in qualitative research reporting. Each of the 21 items was assessed to determine whether it was ‘reported’ (score = 2 points), ‘partially reported’ (score = 1 point), or ‘not reported’ (score = 0 points).

The total SRQR score ranged from 0 to 42 points. An item was considered ‘reported’ when the authors presented the required information in accordance with the SRQR guidelines, ‘partially reported’ when the authors provided some, but not all, of the required information, and ‘not reported’ when the authors failed to provide any of the required information according to the SRQR reporting standard [9]. Also, we created the variable “adequate SRQR reporting,” defined as belonging to the highest tertile (≥ 37 points) of the SRQR score. Given the absence of established or validated cut-off points for SRQR scores, this data-driven approach was used to identify studies with comparatively better reporting quality.

This SRQR checklist assessed the following items:

S1. Title. Concise description of the nature and topic of the study. Identifying the study as qualitative/mixed or indicating the approach (e.g., ethnography, grounded theory) or data collection methods (e.g., interview, focus group) is recommended.

S2. Abstract. Summary of key elements of the study using the abstract format of the intended publication; typically includes background, purpose, methods, results, and conclusions.

S3. Introduction 1. Description and significance of the problem/phenomenon studied; review of relevant theory and empirical work problem statement.

S4. Introduction 2. Purpose of the study and specific objectives or questions.

S5. Methods 1. Qualitative approach (e.g., ethnography, grounded theory, case study, phenomenology, narrative research) and guiding theory if appropriate; identifying the research paradigm (e.g., postpositivist, constructivist/ interpretivist) is also recommended; rationale.

S6. Methods 2. Researchers’ characteristics that may influence the research, including personal attributes, qualifications/experience, relationship with participants, assumptions, and/or presuppositions; potential or actual interaction between researchers’ characteristics and the research questions, approach, methods, results, and/or transferability.

S7. Methods 3. Context. Setting/site and salient contextual factors; rationale.

S8. Methods 4. Sampling strategy. How and why research participants, documents, or events were selected; criteria for deciding when no further sampling was necessary (e.g., sampling saturation); rationale.

S9. Methods 5. Documentation of approval by an appropriate ethics review board and participant consent, or explanation for lack thereof; other confidentiality and data security issues.

S10. Methods 6. Types of data collected; details of data collection procedures including (as appropriate) start and stop dates of data collection and analysis, iterative process, triangulation of sources/methods, and modification of procedures in response to evolving study findings; rationale.

S11. Methods 7. Description of instruments (e.g., interview guides, questionnaires) and devices (e.g., audio recorders) used for data collection; if/how the instrument(s) changed over the course of the study.

S12. Methods (or results) 8. Number and relevant characteristics of participants, documents, or events included in the study; level of participation (could be reported in results).

S13. Methods 9. Methods for processing data prior to and during analysis, including transcription, data entry, data management and security, verification of data integrity, data coding, and anonymization/deidentification of excerpts.

S14. Methods 10. Process by which inferences, themes, etc., were identified and developed, including the researchers involved in data analysis; usually references a specific paradigm or approach; rationale.

S15. Methods 11. Techniques to enhance trustworthiness and credibility of data analysis (e.g., member checking, audit trail, triangulation); rationale.

S16. Results 1. Main findings (e.g., interpretations, inferences, and themes); might include development of a theory or model, or integration with prior research or theory.

S17. Results 2. Evidence (e.g., quotes, field notes, text excerpts, photographs) to substantiate analytic findings.

S18. Discussion 1. Short summary of main findings; explanation of how findings and conclusions connect to, support, elaborate on, or challenge conclusions of earlier research; discussion of scope of application/generalizability; identification of unique contribution(s) to the field.

S19. Discussion 2. Trustworthiness and limitations of findings.

S20. Conflicts of interest. Potential sources of influence or perceived influence on study conduct and conclusions; how these were managed.

S21. Funding. Sources of funding and other support; role of funders in data collection, interpretation, and reporting.

Data analysis

Data were entered into Microsoft Excel, and all statistical analyses were performed using Stata software, version 19.0 (StataCorp, College Station, TX, USA; https://www.stata.com/). Descriptive analyses included absolute and relative frequencies for categorical variables and medians with interquartile ranges for quantitative variables. Additionally, an exploratory analysis of factors associated with adequate SRQR reporting was conducted. For this purpose, crude prevalence ratios (PR) with 95% confidence intervals (CI) were estimated using Poisson regression with robust variance.

Spatial data processing and visualization were performed in R (version 4.2.2; R Foundation for Statistical Computing, Vienna, Austria). Administrative boundary data for Peru were obtained from the “mapsPERU” package (version 2.0.0), which provides publicly available vector-based geospatial data. Spatial data were managed using the “sf” package (version 1.0.16). Data manipulation was conducted using “dplyr” package (version 1.1.4) and “ggplot2” package (version 3.5.1). No proprietary basemaps were used.

Ethical statement

Ethics committee approval was not required because this study involved only a review of previously published literature and did not include human participants.

Main results

A total of 147 qualitative studies were included. Most were published in English, had a median of five authors, and were conducted primarily in the capital city and in community settings. First authors were most commonly affiliated with Peruvian institutions, and the majority of studies were conducted exclusively by Peruvian authors. Ethics committee approval was not reported in nearly one quarter of the studies, and almost half did not provide an ethics approval code. The SRQR items with the highest adherence were the abstract (S2), the statement of study purpose (S4), and the presentation of main findings (S16), whereas title elements (S1), the qualitative approach or guiding paradigm (S5), and researchers’ characteristics and reflexivity (S6) were less frequently reported. Adequate SRQR reporting was associated with publication in English, a higher number of authors, non-Peruvian first-author affiliation, and international collaboration, with no significant associations observed for the study population or publication in Peruvian journals.

Characteristics of the studies

Approximately half of the included studies were conducted in Lima, indicating a pronounced geographical concentration of qualitative research in Peru, consistent with prior evidence of higher scientific output in Lima, the capital of Peru [18,19]. This finding suggests that qualitative research follows the pattern of centralized scientific activity in Peru. Barriers to research production in other regions may be driven by structural inequities, such as limited access to research training and funding, as well as the concentration of institutions with greater research capacity in Lima [18]. Strengthening interregional collaboration, revising funding allocation mechanisms, and prioritizing equitable research capacity development may contribute to a more balanced national research landscape [20].

Nearly one quarter of the studies did not report ethical procedures, and over two fifths failed to include an ethics approval code. This finding may reflect two non-mutually exclusive explanations. On the one hand, some studies may not have been reviewed by an ethics committee, which is particularly concerning given that qualitative research typically involves close engagement with participants and may address sensitive topics, thereby requiring ethical oversight to safeguard participant welfare, informed consent, and confidentiality. On the other hand, these results may indicate shortcomings in reporting practices rather than deficiencies in ethical conduct, whereby ethical approval was obtained but not explicitly documented in the published reports.

Well-established ethical and regulatory frameworks, including the Declaration of Helsinki and the International Ethical Guidelines for Health-related Research Involving Humans issued by CIOMS, as well as current Peruvian regulations [21], stipulate that all research involving human participants must undergo prior review and approval by a research ethics committee. These provisions aim to safeguard participants’ rights, safety, and well-being, and to ensure adherence to fundamental ethical principles such as autonomy, confidentiality, and justice.

Although the first author’s primary institutional affiliation was predominantly Peruvian (71.4%), a substantial proportion of the studies involved international collaboration (41.5%). This pattern suggests that, despite local leadership in qualitative research production, international collaboration could play a meaningful role in the development of these studies. Such collaborations may reflect efforts to strengthen methodological rigor, access complementary expertise, and enhance the visibility of research conducted in Peru.

Results of the SRQR checklist

The items most consistently reported included the presence of an abstract containing the key elements of the study (S2), the specification of the study objective in the introduction (S4), and the reporting of results, particularly the description of the main findings and the evidence supporting them (S16 and S17). In contrast, the least frequently addressed elements were the use of techniques to ensure the credibility of the findings (S15), the qualitative approach and research paradigm (S5), the characteristics of the researchers (S6), and the formulation of a title that accurately reflects the nature and focus of the study (S1).

Our findings align with a previous study of qualitative research in pediatric urology, where the abstract and the study objective were also among the most consistently reported items [10]. Moreover, our results are consistent with a previous research on qualitative studies of malaria in Colombia, which identified credibility techniques and the description of the methodological paradigm as among the least reported elements [12]. Another study examining qualitative research in community pharmacies likewise documented poor reporting of the title, researcher characteristics, and the nature of the study [9]. However, unlike those studies, which focused on specific populations or thematic areas, our analysis encompasses the qualitative scientific output of an entire region. This convergence suggests that there is a persistent tendency to report items that are commonly required in scientific manuscripts, irrespective of study design (e.g., abstract key aspects, objective, main findings), reflecting adherence to general reporting conventions rather than specific compliance with qualitative reporting guidelines. By contrast, several items that are fundamental to the rigor and transparency of qualitative research were among the least frequently reported.

This pattern indicates that while general reporting standards are largely met, less emphasis is placed on elements that are distinctive to qualitative inquiry and essential for the appraisal of methodological rigor. In this context, strengthening training in qualitative research reporting, encouraging the adoption of reporting guidelines such as SRQR by journals, and ensuring specialized peer review processes are essential to improve reporting quality.

Factors associated with adequate SRQR reporting

Regarding associated factors, articles published in Spanish were associated with lower reporting quality scores. This may be explained by the tendency of non-English-speaking authors to prioritize publication in English due to its greater international visibility [22] and citation potential [23]. As a result, manuscripts with stronger methodological rigor and better adherence to reporting standards may be more likely to be submitted to, and accepted by, English-language journals. Additionally, studies published in English may more frequently involve international collaborations, which can contribute additional methodological expertise and promote stricter adherence to reporting standards.

Additionally, lower reporting quality was observed in studies whose first author was affiliated with a Peruvian institution, whereas higher reporting quality was found in studies with a larger number of authors and at least one internationally affiliated author. These findings may reflect the potential contribution of international collaboration to improving reporting standards in qualitative research involving Peruvian populations. Previous evidence suggests that international collaboration has a positive impact on research quality [24,25], particularly in less well-established research systems [26], such as Peru.

Limitations and strengths

This study has some limitations. First, mixed-methods studies were not included, as their methodological quality is assessed using specific appraisal tools, such as the Mixed Methods Appraisal Tool (MMAT), which fall outside the scope of the present evaluation [27]. Second, the search was restricted to Scopus, excluding regional databases such as SciELO or LILACS due to their limitation in filtering results by affiliation in these repositories. Although Scopus allows the identification of studies with affiliation with Peruvian institutions, this restriction may have omitted qualitative research published in journals with a local scope. Third, the analysis was limited to the 2022–2025 period, to focus on recent studies and reduce potential bias related to the accelerated publication processes during the COVID-19 pandemic [28]. While this timeframe may have limited the inclusion of relevant scientific production, this scope allows for an evaluation of the current state of qualitative research in Peru. Fourth, although the SRQR provides a structured framework for evaluating reporting quality, the interpretation of some items may involve a degree of reviewer subjectivity. Also, because the SRQR evaluates reporting quality rather than intrinsic methodological rigor, some studies may have received higher or lower scores based on reporting completeness rather than the strength of their design. Finally, the regression analysis estimated crude associations; therefore, the observed relationships should be interpreted cautiously and should not be interpreted as evidence of causal relationships.

On the other hand, this study also has some strengths. First, flexibility was applied in the interpretation of certain SRQR items to avoid ratings being influenced by editorial decisions rather than the absence of relevant content. For instance, some articles did not present a structured abstract (assessed under item 2) yet contained all expected elements and were therefore awarded full points. Similarly, statements regarding reflexivity and ethical considerations located outside the methods section were accepted as valid. Second, study selection, data extraction, and analysis were conducted independently by pairs of reviewers, with discrepancies resolved by a third or even fourth evaluator, thereby reducing the risk of individual bias and strengthening the reliability of the assessment process. Third, for data extraction, each item was assigned a score, and this score was accompanied by a justification, which allowed for greater discussion among the authors and increased rigor in the assignment of the scores. Finally, a widely recognized instrument such as the SRQR was used, whose structure allows for the assessment of items applicable across multiple methodological approaches within qualitative research [29].