Qualitative research methods

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Qualitative research methods

• Epi 611
• November 2006

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Objectives

• To define and distinguish qualitative (from
  quantitative) methods
• To provide examples of the use of qualitative
  data in epidemiological research
• To understand the unique contribution of
  qualitative data
• To introduce methods for collecting and analyzing
  qualitative data
• To understand some of the complexities in using
  qualitative data

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1. Definitions and characteristics

• More than methods, a new paradigm in social
  research
• The more precisely the position is determined,
  the less precisely the momentum is known in this
  instant, and vice versa. (Heisenberg, 1927)
• What we observe is not Nature itself, but
  Nature exposed to our method of questioning
  (Heisenberg, 1958)
• " O body swayed to music, O brightening glance,
  How can we know the dancer from the dance ?
  (W.B. Yeats, 1928)

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1. Definitions and characteristics

• Origins in the  Chicago School  in the
  1920s-30s
• Rejection of the positivist paradigm and the
  notion of an objective observer and an
  unequivocal underlying truth
• Attempting to represent reality as it is seen
  from different perspectives

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1. Definitions and characteristics

• Antirealist position
• Rejection of the idea of an unequivocal
  underlying truth
• Vs
• Subtle realism position
• Attempts to represent reality as it is seen from
  different perspectives
• Mays Pope 2005

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1. Definitions and characteristics

• Implications for epidemiological researchers
• You may be part of, in fact may be constructing,
  the phenomena you are measuring

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1. Definitions and characteristics

• Qualitative research is
•  A situated activity that locates the observer
  in the world 
• Qualitative researchers
•  Study things in their natural settings,
  attempting to make sense of, or to interpret,
  phenomena in terms of the meaning people bring to
  them 
• Denzin Lincoln, 2000

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1. Definitions and characteristics

• Qualitative methods
• Attempt to represent complex phenomena with
  multiple variables operating simultaneously
• Rather than isolating the independent effects of
  single variables
• Study phenomena as they occur naturally
• without trying to hold factors constant or
  control confounding factors

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1. Definitions and characteristics

• Sub-paradigms of qualitative research
• Constructivist aims for understanding,
  reconstruction of actors perspective
• Examples grounded theory, ethnography, social
  constructivism, interpretive anthropology
• Critical aims are social transformation,
  restitution, emancipation
• Examples feminist, neomarxist, critical race
  theory, queer theory, postcolonial theory

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1. Definitions and characteristics

• The critical paradigm is finding a place in
  public health/epidemiology

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Critical Public Health, Volume 14, Number 3 /
September 2004

• 'We've been trained to put up with it' real
  women and the menopauseMargaret E. Morris A1
  and Anthea Symonds
• Abstract
• This paper, based on qualitative research among
  a group of women in South Wales, looks at the
  meanings they give to the menopause, its effects
  on their working and family lives and the support
  currently offered by medicine and health
  promotion. This study is set against a wider
  discussion of the medicalization of the
  menopause, and the organization of work within
  which the current generation of women are
  situated. It also argues for a new public health
  approach including the adoption of more
  qualitative research techniques that would
  address the concerns and beliefs of people rather
  than following the traditional 'objective'
  epidemiological model. The paper concludes that
  the present generation of women do not share a
  negative view of the menopause but are struggling
  against mixed messages from their own cultural
  background, from promotion of medicalized
  'solutions' and from contemporary pressures of
  work.

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Qualitative paradigms contrasted
Based on Guba Lincoln, 1994.
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Qualitative and quantitative paradigms contrasted
Based on Green, 1988.
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2. Uses of qualitative methods

• Two main approaches in health research to date
• Enhancement model
• Sees qualitative methods to be complementary
  (subsidiary to?)
• Difference model
• Qualitative research contributes to evidence
  bases in its own right

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Uses of qualitative methods

• Qualitative methods are used for
• Assisting understanding of why interventions do
  or do not work
• Improving the accuracy and relevance of standard
  quantitative approaches
• i.e., getting inside the black box
• PRE MEASURE POST
  MEASURE
• PRE MEASURE POST
  MEASURE

PROGRAM
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• E.g.
• POP Santé
• Healthy alcohol consumption intervention
  evaluation

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• Developing quantitative measures that fully
  capture the phenomena of interest
• e.g. study of teens qualitative experience of
  nicotine dependence
• Finding unanticipated effects
• Unstated objectives and issues
• Generating hypotheses to be tested quantitatively

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When and when not to usequalitative approaches

• When
• rich contextualized description is needed
• variations in intervention implementation or
  process are to be assessed
• new or refined program theory is needed
• When not
• causal attribution of intervention effects is
  required
• incremental effects are to be isolated
• resource expenditures are to be assessed

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3. Qualitative methods

• Data collection methods that are
• Open-ended - do not pre-define
• Response choices
• Samples
• Inclusive of all possible variables

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Qualitative vs quantitative data gathering

• Qualitative and quantitative data gathering are
  distinguished by several basic features
• Quantitative
• relatively large number of cases
• highly structured and uniform
• minimum of coding
• captures only a limited number of variables of
  interest
• Qualitative
• less structured
• significant variation among elements
• smaller number of respondents
• captures the entire field, not only a few
  isolated variables
• requires coding

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3. Qualitative methods

• 1. Unstructured or semistructured interviews
• List of questions, based on research questions
• Interview flows like a conversation
• Question wording and order may vary
• (But standardization helps interviewers reduce
  bias)
• Interviews are transcribed or summarized

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3. Qualitative methods

• 2. Group interviews focus groups
• Semi-structured interviews with 6-10 people
• Using
• Interview guide
• Facilitation techniques
• Group is unit of analysis
• Sessions are transcribed or summarized
• Other group techniques nominal, delphi

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3. Qualitative methods

• 3. Observation
• Using a semi-structured template
• Participant observation
• Observer becomes part of the scene
• 4. Others
• Photovoice
• E.g. CAPC evaluaiton
• Journaling
• POP Santé
• Stories, life histories, narratives
• Montréal-North

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• 5. Case studies
• Structured cross-case comparisons
• E.g. Major Collaborative Research Initiatives
  program evaluation SSHRC
• http//www.sshrc.ca/web/about/publications/mcri_pe
  rformance_e.pdf

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3. Qualitative methods

• Qualitative sampling
• Purposive intended to deliberately include
  meaningful cases
• Including disconfirming cases
• Progressive
• Can be defined as the study progresses
• Open
• Stops when saturation is reached

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3. Qualitative methods

• Quantitative vs qualitative data
• Qualitative data is usually some form of text,
  words
• Transcription
• Interview notes
• Observation notes
• Can also be visual data
• Drawings
• Photos
• Film/video

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Quantitative vs qualitative data

• Must be organized, analyzed and interpreted to
  derive (induce) their meaning
• Unlike quantitative data, where meaning is
  predetermined
• Quantitative data as convenient (?) summaries of
  qualities eg. age

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4. Qualitative data analyses

• Involves inductive identification of categories
  of meaning and relationships among the categories

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4. Qualitative data analyses

• Main types
• Constructivist identification of emergent
  themes based on patterns of responses
• E.g. ABC organization evaluation

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4. Qualitative data analyses

• Qualitative data analysis software
• NVIVO (NU-Dist)
• Atlas
• Example street girls focus groups (Haley et al)
• Positive association between contraception use
  and pregnancy

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4. Qualitative data analyses

• Matrix
• Classsification of content into cells of a matrix
  defined by analysis dimensions
• Identification of patterns in across rows and
  columns
• E.g. Motor vehicle deaths

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4. Qualitative data analyses

• Content analysis
• formal counts of word frequency that can be
  treated quantitatively

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4. Qualitative data analyses

• What does the word  epidemiology  evoke for
  you?
• Write down the first three words that come to
  your mind.

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Santropol Roulants analysis
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5. Advantages and disadvantages of qualitative
methods

• Pros
• Much deeper appreciation of phenomena under study
• Many relate more easily to it than quantitative
  approaches
• Cons
• Often seen as soft, no substitute for controlled
  studies
• Data collection and analysis is more costly and
  time consuming

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5. Advantages and disadvantages data collection
and analysis
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6. Mixing qualitative and quantitative methods

• Many studies and evaluations in public health now
  combine qualitative and quantitative methods
• Aiming for triangulation cross-validating
  results by comparing findings on the same
  question from multiple sources, methods
• convergent results provide reassurance about the
  credibility and trustworthiness of the results
• divergent results must be explained

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Examples

• Evaluation of a diabetes prevention program for
  primary schools (Heart and Stroke Foundation of
  Québec)
• Quantitative pre-post design with control group
  measuring teacher-rated impacts on childrens
  knowledge and behaviour
• Qualitative semi-structured interviews with
  principal, focus groups with teachers and
  students observation of teacher training

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7. Quality in qualitative research

• Questions to ask regarding the quality of
  qualitative measurement and analysis
• Sampling
• Did the sample include the full range of possible
  cases or settings so that conceptual rather than
  statistical generalizations could be made (that
  is, more than convenience sampling?)
• If appropriate, were efforts made to obtain data
  that might contradict the or modify the analysis
  by extending the sample (for example, to a
  different type of area)?.

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7. Quality in qualitative research

• Data collection and analysis
• Were the data collection and analysis procedures
  systematic?
• Was an audit trail provided such that someone
  else could repeat each stage, including the
  analysis?
• How well did the analysis succeed in
  incorporating all the observations?
• To what extent did the analysis develop concepts
  and categories capable of explaining key
  processes or respondents accounts or
  observations?
• Was it possible to follow the iteration between
  data and the explanations for the data?
• Did the researcher search for disconfirming cases?

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7. Quality in qualitative research

• Reflexivity of the account
• Did the researcher self-consciously assess the
  likely impact of the methods used on the data
  obtained?
• Were sufficient data included in the reports of
  the study to provide sufficient evidence for
  readers to assess whether analytical criteria had
  been met?

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7. Quality in qualitative research

• Correspondences between paradigms
• Reliability reproducibility
• Validity credibility, trustworthiness
• Generalizability not relevant

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• Recommended reading
• Patton MQ (2002) Qualitative research and
  evaluation methods (3rd ed.). Thousand Oakes,
  CASage Publications, Inc. 
• Miles M., and Huberman, M. (1994). Qualitative
  Data Analysis An Expanded Sourcebook. Thousand
  Oaks, CA Sage