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Qualitative Methods and How to Dovetail With Quantitative Methods

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Title: Qualitative Methods and How to Dovetail With Quantitative Methods


1
Qualitative Methods and How to Dovetail With
Quantitative Methods
  • Melanie Percy, RN,PhD,CPNP
  • The University of Texas at Austin
  • School of Nursing
  • Dawn Nixon, MA
  • Young Wings
  • Red Cliff Birth to Six Mental Health Program
  • Red Cliff Ojibwe Reservation
  • Wisconsin

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What is Young Wings?
  • Initial Definition
  • A pediatric mental health program, based upon
    Dr. T. Berry Brazelton Touchpoints model, located
    within a tribal early childhood center. It will
    provide early identification of, and intervention
    for, signs of developmental derailment in
    children aged birth to 6.
  • (Goals 4.1, 5.3, 5.4)

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Initial Plan for Services
  • Developmental screening.
  • Identification of children with early signs of
    difficulty.
  • Interventions
  • Psychological assessment.
  • Parent education.
  • Individual play therapy.
  • Referral to community partners (e.g. Evenstart
    Literacy program).

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Barriers to Receipt of Mental Health Services
Addressed
  • Lack of pediatric mental health availability.
  • 60 mile round-trip.
  • 3-6 month wait.
  • Lack of reliable transportation.
  • Lack of cultural competency
  • Limited understanding of hx., Native American
    values, range of acculturalization and
    significance of spirituality and ritual.
  • Stigma for receipt of mental health services.
  • (Goals 1.1, 3.1, 3.2)

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Initial Evaluation Plan
  • Pre- and post- administration of the Parenting
    Stress Index.
  • Client satisfaction survey.
  • Child/family identification rate.
  • Longitudinal statistical analysis of county child
    abuse and neglect statistics.
  • Analysis of community utilization rates.

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What is Young Wings?
  • All that was in the initial plan, plus
  • A valued member of the ECC management team who
    effects and writes policy from a mental health
    perspective.
  • An advocate for parents with the local school
    district. Liaison between ECC, school district,
    and community.
  • A resource for the ECC and community during times
    of stress.
  • And more

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Questions..
  • How would the families/staff/community define
    Young Wings? How is it perceived?
  • How has Young Wings been accepted by
    families/staff/community?
  • What factors make Young Wings successful and
    accessible?

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Core Principles of Qualitative Evaluation
  • Each person/community is unique.
  • Each person/community deserves respect.
  • People and communities should be understood in
    context and holistically.
  • The process (how things are done) is as important
    as the outcomes (what is achieved).
  • Information should be openly shared and honestly
    communicated. Patton, 1990

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Why Qualitative?
  • The personal nature of qualitative inquiry
    derives from its openness, the evaluators close
    contact with the program, and the procedures of
    observation and in-depth interviewing,
    particularly the latter, which communicate
    respect to respondents by making their ideas and
    opinions (stated in their own terms) the
    important data source for the evaluation.
  • Patton, 1990 pg.124

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Cornerstones of Evaluation
  • Why?
  • To validate your program goals.
  • To guide future program development.
  • To maintain or increase funding.

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Basic questions to consider
  • What are your goals?
  • Who is your population?
  • Who are the stakeholders?
  • Where does your funding come from and what will
    you have to do to continue it?

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Quantitative vs Qualitative
  • Quantitative - statistical analysis of an
    objective number. That number is usually created
    by counting the number of clients served, or
    statistical analysis of data received.
  • Qualitative - using written or spoken interviews
    to determine impact of program on families. Then
    analyzed for themes and reported as a narrative.

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Why quantitative?
  • Use standardized measures that fit diverse
    opinions and experiences into predetermined
    categories.
  • Statistically significant findings.
  • Broad, generalizable set of findings.

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Why Qualitative ?
  • Can study selected issues in depth.
  • Provides detailed data
  • Direct quotation, careful descriptions are used
    in an open- ended narrative.
  • No quantitative tools may exist for variables of
    interest.

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Comparing qualitative and quantitative data
  • Please rate your satisfaction with the
    healthcare you child has received in this clinic.
  • a. very satisfied
  • b. somewhat satisfied
  • c. satisfied
  • d. not satisfied
  • e. very dissatisfied

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Please tell me about your experience of
receiving healthcare for your child in this
clinic.
  • Kay Gibbons is wonderful! Very kind, thoughtful.
    I hope that this clinic is not taken away because
    we need it badly, and its helped us a lot
    already. I am happy because they speak Spanish.

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Philosophy behind qualitative evaluation
  • What is reality? What is knowable?
  • What is the nature of human experience?
  • Value seeing the world as understood by the
    client.
  • Desire to capture accurately and thoroughly the
    experiences, and perspectives of the staff,
    administration, and participants of the program
    being evaluated.

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Key Elements
  • Observing
  • Participant observation of program
  • Observing during interviews (nonverbal behavior,
    relationship with interviewee)
  • Interviewing
  • Formal interviews
  • Informal, naturally occurring conversations.

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Doing Interviews
  • Qualitative evaluation means the evaluator must
    quickly attempt to develop an insiders view of
    what is happening
  • While maintaining an outsiders ability to
    describe the experience.

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Gaining entry
  • One of most difficult parts of qualitative
    evaluation is knowing whom to interview or
    observe.
  • Need key informants. People who have insight
    and respect in the community.
  • Key informants can explain and interpret what the
    evaluator is experiencing.

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Doing Qualitative Evaluation
  • Consider
  • what was said?
  • what was happening?
  • what was the context?
  • what is the history of the program?
  • the larger community?

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Inductive Analysis
  • Audiotapes will be transcribed and transcripts of
    tapes will be analyzed.
  • Attempt to make sense of program without imposing
    pre-existing expectations on the program setting.
  • Begin with specific observations and builds
    towards generalized patterns

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Analyzing Data
  • Multiple computer programs have been developed to
    analyze qualitative data
  • Ethnograph, Hyperesearch, Nudist, Hermann, etc
  • Transcripts are entered into program and
  • themes are developed

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  • Statements are placed on cards and sorted
    according to their theme.
  • Themes are collapsed and reorganized as major
    patterns are seen and categorized.
  • Then rival or competing themes and explanations
    should be examined and rejected or explained.

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Presenting Data
  • Detailed descriptions and in-depth quotations are
    the data that are reported to validate the
    categories decided upon.
  • Presenting qualitative data can be very lengthy
    and time-consuming, but also interesting and
    insightful.

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Objectivity and Truth vs. Reliability and Validity
  • Important that the evaluator is neutral - has no
    theory to prove, and no predetermined results to
    support.
  • Finally results need to be brought back to the
    program and discussed to determine the goodness
    of the data.
  • Does it fit the program? Does it seem factual and
    confirmable?

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Summary
  • Qualitative evaluation can be a useful tool for
    understanding the impact you are having on a
    community.
  • Conducting a qualitative evaluation can be
    difficult and time-consuming but ultimately
    rewarding as you gain new understandings about
    your program and the people you serve.

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Now its your turn
  • In groups of 3-4 write an evaluation question
    from your clinic as a qualitative question and as
    a quantitative question.
  • Discuss in your groups what kind of information
    would you expect from each question. Be prepared
    to have a spokesperson to present this to the
    larger group.

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Group Discussion
  • A spokesperson from each group will present the
    two questions from the group.
  • For group discussion
  • What makes one qualitative, and one quantitaive?
  • How will the information be different based on
    these questions?
  • How is each question valuable to the evaluation?

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Mock Interviews
  • Who would your key informant be? Why did you
    choose that person?
  • Let the group become a focus group, pick one
    person to be the interviewer. Ask one of your
    questions, and see what kind of information you
    receive.
  • Report to group.

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Analysis
  • Next, take tapes to the data transcriber, or
    transcribe them yourself.
  • Once tapes have returned, go ahead and start
    analyzing - look for similar subject lines.

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What does it mean?
  • Collapse categories
  • What does it all mean?
  • May want to go back to your key informants, to
    discuss what you think the interviews meant.

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  • 4. Have you ever brought your child to the school
    based health center?
  • 5. What was that experience like?
  • 6. Is there anything else that you would like to
    tell us about your or your childs experience
    with healthcare?

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How to present this to stakeholders
  • Numbers (statistics) and then talk about themes
    discovered in qualitative method.
  • Then present theme, quotes that support that
    theme, and then the final analysis of what it all
    means.

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Example
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Qualitative Evaluation of School Based Health
Centers
  • City of Austin asked to have an evaluation of
    their school-based health centers.
  • After meeting with city officials, health
    department administrators, school officials, and
    school-based health center personnel it was
    determined to conduct several focus groups with
    parents of children seen at the center.

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Interviews
  • PTA and community leaders were asked to identify
    people who would like to participate in the focus
    group.
  • Also a notice went out in the school newsletter
    asking people to participate.
  • Participants were given a 20 grocery store
    coupon to thank them for their time food and
    child care were provided.

46
Focus groups
  • Focus groups were formed with 6-8 people each.
  • English language and Spanish language focus
    groups were conducted separately.
  • Focus groups were audiotaped and note takers
    (undergraduate students) took notes as people
    talked.

47
Questions
  • Questions began as very generalized and became
    more specific.
  • 1. Tell me about a time when your child was
    sick and you took your child to a health care
    provider.
  • 2. Tell me about a good experience with a
    healthcare provider.
  • 3. Tell me about a bad experience with a
    healthcare provider.

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Themes
  • Mother's descriptions of their experiences with
    the health care system were organized into the
    following thematic categories
  • "doing what I have to",
  • "caring for my child",
  • "no respect".

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Doing what I have to do
  • They wont see her if she doesnt have a fever,
    so I always say she has a fever when I go to take
    her in.
  • Its a long way to the health dept clinic. Before
    the SBHC was here, I would take three buses to
    get to the clinic. Sometimes it would be pouring
    rain, and Im standing out at the bus stop
    waiting with my three small children, and one of
    them is already sick. But you have to take them
    in when they get sick.

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Caring for my child
  • When my child is sick, I or my husband stay home
    from work. We wont get no pay that day but
    thats what you have to do. Ive gotten fired
    before.
  • The medicine is so expensive, sometimes it takes
    all the money we have for the week.

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No Respect
  • I go to the clinic and it takes all morning. They
    dont care that you are just sitting and sitting
    there. You can see the nurses and doctors just
    drinking coffee, and here we are just waiting.
  • Even the doctors and nurses talk down to you.
    They act like you dont know nothing. Im a good
    mother n I love my kids. Im taking care of them
    the best way I know how.

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  • Mothers described feeling angry and frustrated
    when they were forced to wait for long periods of
    time with sick children.
  • The attitudes of professional and
    non-professional staff strongly influenced their
    satisfaction with the health care experience.
  • Mothers were most satisfied when their child was
    seen quickly by someone who was caring and
    attentive to their needs.

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Conclusions
  • This study emphasizes the importance of valuing
    and respecting the knowledge that mother's bring
    to the health care environment and clearly
    demonstrating that respect throughout the health
    care setting.

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  • Questions? Further discussions?
  • Resources
  • Patton, M. (1996). Utilization Focused
    Evaluation The New Century Text. Sage
  • Patton, M. (2001). Qualitative Research and
    Evaluation Methods. Sage.
  • Patton, M. (1995). How to Use Qualitative Methods
    in Evaluation, Vol. 4. Sage.

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  • Shaw, I. (1999). Qualitative evaluation. Sage
  • Denzin, N., Lincoln, Y., (1998). Collecting
    Interpreting Qualitative Materials. Sage
  • Babiss, F. (2004). An Ethnographic Study of
    Mental Health Treatment Outcomes Doing What
    Works. Haworth Press.

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