Qualitative Research What, why and how (...and should I even go there?)

Qualitative ResearchWhat, why and how

(...and should I even go there?)

What is qualitative research?

• Research based on non-numerical data• Variety of different:

– Philosophical bases– Methods– Data collection techniques

• So be wary of oversimplifying diversity…

What qualitative research is not…

• Not:– ‘Quality of life’ research– Research into quality– Survey with open ended questions– Count the number of particular words

Characteristics of qualitative research

• Insider’s perspective – Personal involvement– Openness to ‘the other’

• Holistic– Context– Complexity – Depth

• Inductive– Responsiveness– Moving beyond the specific

• (Morse 1992; Powers and Knapp 1995)

Data generation techniques

• Research using non-numerical data– Transcribed speech

• Focus groups • Interviews

– Observational notes• Field observers

– Historical documents• Official records• Letters• Emails!• Web pages

Qualitative Research: An evolution

• 1980s– Low awareness– Difficult to attain funding– Absent from

government policy– Marginal presence in

medicine journals– Greater presence in

social science and nursing journals

• 2000s– Moderate awareness– Attractive to funding

bodies– Informs government

policy– Permeation into most

(though not all) mainstream health / medical journals

The origin of qualitative research

• Understanding the ‘other’ – Imperialist Ethnography– ‘Objective, colonizing accounts of field

experiences…(of that which was) alien, foreign and strange’

– Prominent ethnographies:• Native Americans• African tribes

Mary Kingsley (1862-1930)

‘Travels in West Africa’ (1897)

‘West African Studies’ (1899)

• ‘…a new reason for polygamy…it enabled a man to get enough to eat.

This sounds sinister from a notoriously cannibal tribe; but the explanation is that the Fans are an exceedingly hungry tribe, and require a great deal of providing for.

It is their custom to eat about ten times a day when in village, and the men spend most of their time in the palaver- houses at each end of the street, the women bringing them bowls of food of one kind or another all day long.

When the men are away in the forest rubber or elephant-hunting, and have to cook their own food, they cannot get quite so much; but when I have come across them on these expeditions, they halted pretty regularly every two hours and had a substantial snack, and the gorge they all go in for after a successful elephant hunt is a thing to see--once.’

• Gradual movement to less imperialist, more culturally and socially sensitive approaches

Summary point 1: What

• Qualitative Research now established set of techniques

• Uses a variety of techniques to collect non-numerical data

• Moved from outsiders’ to insiders’ perspective

• Seeks to provide a holistic account based on inductive reasoning

Why?: Types of questions• What is the society like?

– Social norms– Cultural practices

• Why do certain behaviours occur?– Processes– Patterns– Paradoxical– Surprising

• What is this experience like?– Nuances– Depth

Explaining patterns in data

• Increasingly large volume and sophistication in quantitative data collection– Large cohorts– Numerous fields– Automated data linkage and storage

• Patterns are increasingly described…but not explained

Examples…

• Delay in seeking help during heart attack– 90 minute window for clot busting therapy– Average 4 hour delay time to help seeking

• Availability of services to reduce risk after heart attack– Evidence of mortality benefit– 30% participation rate– Rates lowest in those in most need

What is missing?

• All that is useful cannot be quantified– Complexity – Unknown factors– Process– Defies quantification

• Values• Aspirations• Human decision-making

Example 2: Knowledge utilization

• Evidence-based practices rates around 30%• Poor insights into:…

– Why guidelines are poorly utilized?– What factors influence implementation of

evidence?– What can be done to improve rates…

Low compliance

• Greater impact on health if existing therapies are used than from new therapies (WHO 2004)

• Around 50% ‘compliance’ rates in those with chronic disease

• Increasingly strained health care infrastructure to provide professional support

Systematic review of qualitative research

• Synthesizing findings from a number of studies in a common topic– Meta-synthesis / Meta-ethnography– Search strategy– Selection criteria– Synthesis of bodies of studies

Why? Summary Point 2

• Qualitative research can address questions– What is the society like?– Why do certain behaviours occur?– What is this experience like?

– Individual studies or reviews

How?: Philosophical bases

• Constructivism– Relativism

• Realism– Critical realism– Postpositivism

• Positivism– Objectivism

Methods

• Grounded theory– Theory around social processes

• Phenomenology / Hermeneutics– Experience and meaning

• Ethnography– Culture

• Document / Historical• Generic

A brief overview• Phenomenology

• Grounded theory

• Ethnography

• Case Study

• Generic / Interpretive Descriptive

Complex lived experience

Theories of the social

Culture

Deep understanding of cases

Experiences or perspectives

Phenomenology

• Focus: The study of phenomena• Domain: Being, lived experiences,

essences• Background: Philosophy

• Names: Husserl, Heidegger, Gadamer

• Data collection: One to one interviews

Use of phenomenology in health research

• Meaning– Experiences

• Living– Illnesses / Health

• Perspectives– Beliefs, decision-making,

judgments…

• Understanding

• Beck (1992) PPD– DSMIV – Personal experience

• Bowman (1991) Chronic back pain– Pain scores– Effect on independence,

living and health

Where is meaning in a text?

• Writer– What is intended?

• Text– What is inherent?

• Reader– What I interpret?

What will a phenomenological study look like?

• Justification for examining the human experience

• Sample size usually 5-30 people• Insiders’ account• Deep analysis of dimensions of phenomena

under study

Interpretive descriptive / G eneric• Focus: Descriptive study of themes

• Domain: Subjective experience, perspectives, beliefs, knowledge….

• Background: Applied sciences

• Names: Many…

• Data collection: Semi-structured interviews

What will an interpretive descriptive study look like?

• Has no specific methodological label– ‘Thematic analysis’ ‘Interpretive analysis’– ‘Qualitative research’

• Sample size usually 5-30 people• Insiders’ account

Use of ID in health research

• Health and Illness experience– Myocardial infarction– Breat cancer survivor– Perspectives– Beliefs, knowledge

decision-making, judgments…

• Goal: Understanding

• Accessing support services– Tod et al (2002)

• Learning needs of patients– Wehby and Brenner

(1992)

• Explanatory models for symptoms – Russell et al (1998)

Ethnography

• Focus: The study of cultures• Domain: Macro and micro cultures• Background: Cultural anthropology

• Names: Mead, Atkinson, Hammersley

• Data collection: Observation, group-work, interviews

‘Ethnography is appropriate if the needs are to describe how a cultural group works and to explore beliefs, language, behaviours and issues such as power, resistance and dominance.’– Creswell (2007, page 70)

Use of ethnography in health research

CulturePlacesSettingsPopulations

MacroTownVulnerable population

MicroFamiliesStudent group on a course

• Porter and Ryan (1996)– Racist behaviour in

clinical settings

• Preston (1997)– Families of people with

CHD

What will an ethnographic study look like?

• Clear specification of a group under study and justification for this

• Perhaps some mention of a key informant• Would engage in field work

– Observational data collection– Oral data collection– Cultural artifacts

• Build up a research cultural portrait / account

Grounded Theory

• ‘…to move beyond description…to generate or discover a theory, an abstract analytical schema of a process (or action or interaction).’

Cresswell (2007, pg 63)

• Theory is grounded in the data

Grounded theory

• Focus: Developing theory grounded in data

• Domain: Social processes and interactions• Background: Applied

• Names: Glaser, Strauss

• Data collection: One to one interviews

Use of grounded theory in health research

SocialProcessesInteractionsActions

Paterson (2001) Empowerment in chronic illness

Jillings (2007)Self care processes during heart failure

Johnson (1990)Adjustment after myocardial infarction

Case study

• ‘…study of an issue explored through one of more cases in a bounded system– Cresswell (2007, pg 73)

Case study

• Focus: A case related to an issue• Domain: Many…as long as it helps

illustration• Background: Social science, health,

psychology

• Names: Stake

• Data collection: Multiple (paper, verbal, visual)

Use of case study in health research

Cases that are particularlyTypicalAtypical

NoteworthyInterestingIllustrative

Could be: Individual(s), groups, programs, activities….

• Power and powerlessness in home-care– Efraimsson et al

• Program for prevention of heart disease

Bradley et al (1999)

How? Data collection techniques

• Interview– Unstructured– Semi-structured– Structured

• Focus group• Observational• Video • Internet• Document extraction

Judging quality in qualitative research

• Trustworthiness– Do we understand?– Do we agree?

• Credibility– Can we follow?

• Typicality– Site– Sample

Quality Screening

• Contentious issues– For what purpose?

• Inclusion / Exclusion• Commentary

– How expressed?• Measured?• Narrative

Is a qualitative methodology appropriate?

• How well justified?– Nature of the research question– Existing knowledge of topic area

• Does it seem logical / sensible?• Any evidence of alternatives being considered

or appropriate?– Survey

What design appropriate to question ?

• Decision-making clear and appropriate?– Convincing

• What is the design called?– What is the design irrespective of what it is called?

Was the recruitment strategy appropriate?

• Participants• How selected?• Most appropriate• Typicality• Size of sample

Addressing the research issue

• Setting– Justified– Typical v Atypical

• Data collection– Method clear– Justification appropriate

• Size– Sample size– Depth of analysis

Ethics

• Issues of:– Confidentiality– Consent / Process nature of consent– Approval from ethics commitee

Rigor of analysis

• Is analysis process described?• Is it clear how themes emerged from the

data?• Are the findings supported by the data?• Was ‘contradictory’ data examined?

Clear statement of findings?

• Are findings clear / explicit?• Are issues of credibility addressed?• Does the study refer back to the research

questions?

Value of the research

• What contribution to knowledge does the study make?– How far can they transfer findings to different

populations / settings /countries?

• What is the significance of this?– Insight– New knowledge

How?: Summary Point 3

• Qualitative research is very diverse– Various methods

• But there can be underlying / transcending principles of methodological quality

• We can draw on these to appraise qualitative studies

Useful references

• Murphy E, Dingwall R, Greatbatch D, Parker S, Watson P. Qualitative research methods in health technology assessment: a review of the literature. Health Technol Assess 1998; 2(16).

• http://www.refer.nhs.uk/ViewRecord.asp?id=87

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