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QUALITATIVE METHODS MDSC3200 Affette McCaw-Binns, Community Health Section
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Page 1: 17. AMB4 Qualitative Methods 2015

QUALITATIVE METHODS

MDSC3200Affette McCaw-Binns, Community Health Section

Page 2: 17. AMB4 Qualitative Methods 2015

Objectives

Distinguish between qualitative and quantitative methods of data collection

Describe three qualitative methods applicable for use in the health sciences

Compare and contrast uses of qualitative and quantitative data

Examine the scope and limitations of qualitative research in the health sciences

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Quantitative vs Qualitative Research Quantitative methods – document amount of the

problem Study based on measures of quantity or frequency Findings described in numbers, not words

How big is X, and how many are there? Qualitative methods – classify phenomena

What, how, when, where – the nature of the problem as people perceive it Concepts, definitions, characteristics, symbols, descriptors

Why groups differ What social or behavioural problems influence disease

and how How and why does X vary in different

circumstances?22/04/23

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McCaw-Binns

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What is qualitative research?

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Disciplined enquiry into the personal meanings of individuals’ experiences, perceptions, attitudes and actions in the context of their social experiences The meanings people attach to their experiences How they make sense of their social world

Aim: in-depth understanding of specific individuals & small groups, rather than general characteristics of large population of individuals e.g. what explains disconnect between quantitative

knowledge of how STIs are transmitted and prevented, and the behavioural failure to apply this knowledge to individual actions i.e. regular condom use, avoiding multiple sexual partners

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Uses in health science

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Investigates complex human behaviour that impact health Why knowledge ~= behavioural decisions

Access unquantifiable facts about people such as: How people give meaning to their lives and make sense

of things People’s perceptions about how their bodies work versus what

doctors think they know Experiment: Ask some adolescents how babies get made?

Evaluate views re health service provision from the perspective of: Patients vs. health professionals vs. managers

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Uses of qualitative research Qualitative research enables investigators to:

Observe social life in its natural habitat What people do at home versus what they report in the clinic ?

examples Go where the action is

Observe persons in their usual interactions, negotiations Watch – Unobtrusive research observing behaviour

e.g. how doctors interact with patients, conduct examinations Can produce a richer understanding of many social

phenomena once the researcher observes in a deliberate, well planned, unbiased and active way Requires special skills, which needs to be learned and

honed22/04/23McCaw-Binns

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Uses of qualitative research

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Quantitative/qualitative approaches complement each other

Preliminary phase – quantitative study helps to understand key phenomena to be studied What questions to ask before trying to quantify behaviour Identify terms commonly used to describe actions in the

community Clarify open ended questions Develop hypotheses

Interpretive phase (after) to validate and explain phenomena observed Have participants explain unusual observations, e.g.

Why the information received was not what was expected Give their interpretation of findings as your ideas may differ from

theirs

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Approaches to Qualitative Research

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8 Direct observations

Behaviours and events e.g. How doctors deliver health education messages?

Nature of interaction How people talk to each other (at, with) and interact

Do we talk to patients or at them? Do they understand us? Dental skills labs is a qualitative approach to teaching

Interviews Individual (key informant) Group (focus groups)

Analyse the text, recorded speech, video tapes Focus: talk and actions rather than numbers

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Approaches to Qualitative Research

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Process of ‘watching’ can entail: Direct observation (passive/unobtrusive) Joining in (participant observation) Talking to people (interviewing) Reading/interpreting what persons have

written/drawn Often used in psychiatry

Several qualitative research techniques, will discuss: In-depth interview Focus groups discussions and Consensus methods – Delphi and nominal group

techniques

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Iterative process

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Interviews Structured (usual approach for quantitative

studies) Structured Questionnaire Questions with fixed choice of answers administered in a

standardized manner Semi-structured

Open ended questions defining areas to be covered Interviewer/interviewee may diverge to pursue an idea or

response in more detail Depth

Less structured: One or two issues to be covered in depth Follow-up questions are based on what interviewee says

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Qualitative InterviewsTypes of questions

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Good questions should be open-ended, neutral, sensitive and clear to the interviewee

Types of questions: Behaviour or experience Opinion or belief Feelings Knowledge Sensory perceptions Background or demographic details (for context)

Start easy → Difficult/sensitive issues

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1. Depth interviews

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will be complete honesty, openness, mutual trust, confidentiality

Less structured, with follow-on questions based on responses Supplementary questions intended to clarify issues and probe for

details Patient history taking = qualitative depth interview

Requires experienced interviewer who understand the concept area to effectively probe issues Good medical history taker – difference between consultant and

intern! Requirement:

Absence of other participants, why? Uses:

Case studies Life history assessments Research on sensitive issues

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Sampling and Sample Size Non-probabalistic sampling most

often used e.g. of types?

Representativeness not an issue Focus: eliciting issues of interest from

persons selected

Smaller numbers Assess in more detail Sampling (and data collection) ends when

no new information is elicited22/04/23McCaw-Binns

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The Instrument The interviewer or observer is the main

instrument Must be neutral or directive as needed Take cues or signals from participants Tries not to inject personal opinions or

views or to be distracted during the process

Issue: Hawthorne Effect – presence of observer

may influence behaviour 22/04/23McCaw-Binns

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2. Focus group discussion

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Group processes used to explore and clarify views that would be less accessible in a one-on-one interview Capitalizes on communication between participants Capitalizes on group interaction

People encouraged to talk to one another Ask questions/Exchange anecdotes Comment on each others experiences/points of view

Quick, convenient way to collect data from several people simultaneously Typically no more than 12-15 people; more than one

group

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Advantages of focus groups

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cannot read or write Facilitator can encourage participation of

persons reluctant to be interviewed e.g. Intimidated by formality Shy when isolated in a one-to-one interview Can encourage people who have ‘nothing to say’

but engage in discussion generated by group members

High validity to depth of enquiry Bonus: group dynamics may unearth aspects

of the topic not anticipated by the researcher, e.g. side conversations, body language

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Disadvantage of focus groups Less control over the research process than

individual interviews Data difficult to analyse Differences between groups can be troublesome Reliability may be an issue – ?observer bias Moderators require special skills

Remain neutral Control ‘bullies’ Follow leads, including being sensitive to ‘body

language’

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3. Consensus methods: Introduction

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Many key decisions in health care have to be made without adequate objective information, e.g. How best to treat patients What services to provide How best to organize and deliver services What research should be prioritized

Decision making in the face of uncertainty is a common challenge for clinicians, managers and policy makers

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Consensus methods II

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Consensus method can formalize decision making in ways that: Are transparent Eliminate negative aspects of decision making Provide scientific credibility to the process

Consensus methods can be used to: Assess extent of agreement (consensus

measurement) Resolve disagreement (consensus development) Allow for qualitative assessment of evidence

e.g. jury trial, expert panel

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Uses of Consensus methods

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Develop clinical and organizational guidelines Assemble evidence Adapt international best practice to local

reality

Determine priorities Which services to provide What topics to research Which outcomes to measure

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Features of consensus methods

Feature CharacteristicsAnonymity To avoid individual dominance;

questionnaire used in Delphi and private ranking in nominal group

Iteration Processes occur in "rounds," allowing individuals to change their opinions (based on new information)

Controlled feedback

Shows the distribution of the group's response (indicating to each individual their own previous response in Delphi)

Statistical group response

Expressing judgment using summary measures of the full group response giving more information than just a consensus statement

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Nominal group technique:Expert panel

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Informed panel considers a problem Consensus methods structured to prevent

the dominance by one individual or vested interest group

Group’s view derived from aggregation of individual members’ views rather than the group arriving at a communal view

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Nominal group meeting

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information from relevant experts Usually 8-12 members

Fewer: reliability in jeopardy More: discussion unmanageable

Process: Literature review provided to participants ahead of

meeting Facilitator = expert or credible non-expert Two (or more) rounds in which panelists

Rate problem/issue Discuss Re-rate

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Nominal Group Technique

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STAGE 1: Formulation of nominal group question STAGE 2: Group members independently and

privately record ideas and opinions relating to the question or problem of interest

STAGE 3: Ideas or rankings recorded, often in a round-robin feedback session

STAGE 4: Discussion to clarify and categorise different ideas to obtain a list of options

STAGE 5: Group members independently rank/re-rank the different options. The group decision in based on consensus achieved during this ranking process

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Delphi Method

The Delphi process takes its name from the Delphic oracle's skills of interpretation and foresight

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Delphi Method Round 1: Individuals invited to provide

opinions on a specific matter, based on their knowledge, experience

Round 2: Participants rank their agreement with each statement in the questionnaire

Round 3: Participants re-rank their agreement with each statement in the questionnaire, can change their score in view of the group's response until reach consensus 22/04/23McCaw-Binns

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Delphi Technique

Participants do not meet in one place (mail, e-mail)

Relatively inexpensive Allows involvement of

participants from distant geographical areas

Encourages minority views

Allows period of ‘considered’ thought

Does not allow individuals to dominate

Reaching consensus can be time consuming

Difficult to maintain high response rate (often decreases as rounds progress)

Important issues may be missed in centralising opinion

Representativeness of group (experts vs multidisciplinary)

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McCaw-Binns

Strengths Limitations

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Issues: Qualitative methods

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Internal and external validity Can findings from a select group be

replicated? Can they be generalized to the population?

Social phenomena may be profoundly affected by the participants Did one or a few persons sway group opinion? What is true in one setting may not hold in

another How well do the conclusions explain why

people behave in the way they do?

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Triangulation - validation

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Each method a researcher employs provides a slightly different facet of the same reality

By combining several lines of sight, one obtains a better, more substantive picture of reality TRIANGULATION

Multiple data collection technologies used to test hypotheses; measure a single concept or construct

Combine quantitative and qualitative methods to gain greater depth of understanding Quantitative survey Observation Focus group

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Quantitative and qualitative methods working together

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Used jointly = powerful tools Preliminary studies

Can form essential preliminary to quantitative research, e.g. Identify colloquial terms, questions to ask, options for closed ended

questions Discover behavioral issues to be measured later

Post hoc studies Supplement quantitative work by validating data collected

Explain unusual quantitative findings, e.g. Divergence between knowledge and practice

Explore complex phenomena or areas not amenable to quantitative research, e.g. Interactions between social norms and observed behaviour

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Summary

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Qualitative methods provide: Opportunity to collect preliminary or

supplementary information to support, explain quantitative data

Useful for scientifically arriving at consensus

Opportunity to better understand human behaviour

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Lesson exercise: Qualitative methods

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List three questions which a qualitative approach would be better suited at providing an appropriate answer

List two problems which a combined qualitative and quantitative methods would address

What is the distinction between a qualitative variable and a qualitative method of data collection?