Problems with multinational qualitative research projects: findings and solutions

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Problems with multinational qualitative research
projects findings and solutions

• Prof. Paul Van Royen, MD, PhD
• Hilde Bastiaens MD, Etienne Vermeire MD, PhD
• University of Antwerp
• Department of General practice

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Problem

• Qualitative research methods increasingly used in
  primary health care research
• Also in multinational collaborative projects,
  growing need to use these methodologies

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Collaborative projects

• Home visits study
• Van Royen P. De Lepeleire J. Svab I. Miranda JA.
  Home visits in European general practice- A
  qualitative study. EGPRW workshop Bergen.
• Van Royen P, De Lepeleire J, Maes R. Home visits
  in general practice an exploration by focus
  groups. Arch Public Health 2002 60 371-384
• Improve
• Wetzels R. Geest TA. Wensing M. Ferreira PL.
  Grol R. Baker R. GPs' views on involvement of
  older patients an European qualitative study.
  Patient Education Counseling. 2004 53(2)183-8
• Eurobstacle
• Vermeire E, Van Royen P, Coenen S, Wens J,
  Denekens J. The adherence of type 2 diabetes
  patients to their therapeutic regimens a
  qualitative study from the patients perspective.
  Pract Diab Int 200320(6)209-214
• Vermeire E et al. ( submitted to Soc Sc Med)

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Difficulties and problems identified

• Ensuring consistency of
• Methods
• Sampling
• Analysis

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Results problems identified

• Long time to get approval from one, or even more,
  ethical committee(s)
• Some qualitative methodologies hard to apply in a
  specific local context
• Lack of experience with qualitative research
  time to find or train skilled moderators and
  interviewers

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Variation in research ethics

• In some countries, approval to a research ethics
  committee obligatory considerable time and
  effort
• Application/ formal enquiry required to check if
  approval is required
• In other countries no approval required and/or no
  applications made
• Is interview/ focus group research a hazardous
  intervention, which needs ethical approval ?

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Sampling

• No gold rules for sampling also depending on
  obtaining saturation of data
• Can be different in different countries no
  uniform protocol with a fixed sample size for
  each participating partner

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Sampling example - IMPROVE

• Recruitment through GPs reflecting the national
  situation with respect to age, sex, practice
• Maximal variety of elderly, according to sex,
  age, region and recent health status

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Problems with languages

• Multilingual character difficulty to send texts
  to the main researchers to ask for help in
  analysing the transcribed texts
• Loss of depth or real meanings of words, codes
  or themes, when texts are translated in one
  language (mostly English)

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Problems with languages- examples IMPROVE

• 11 countries and 10 languages
• translating two complete interviews per country
  coded by two researchers
• Codes were compared with the national codes
• Defining an international coding scheme

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Problems with languages- examples IMPROVE

• Sometimes other meanings of codes f.i.
  importance of advocates as a facilitator for
  patient involvement
• Different according to the social context and
  practice organisation relatives, nurses,
  receptionist,

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Financing

• Mostly with very low budget
• Difficulty to find all necessary people
• Logistic support frequently insufficient

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Financing Home visits study

• no supporting budget -
• In Portugal only one researcher and almost no
  experience with QHR
• No possibility to translate texts
• Only the reserach parts of Slovenia and Belgium
  were published

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Discussion solutions

• Necessity to promote consistency between
  countries through careful training of
  interviewers or moderators? research training
• Use of a structured schedule or grid to perform
  research

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Discussion solutions (2)

• Protocols should include some flexibility to
  methods used and sample size
• Samples of transcripts should be translated to
  test and to review the application of codes in
  each country

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Discussion solutions (3)

• Need for a process of refining, rephrasing and
  translating codes and themes, according to
  local and international context

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International collaborative projects

• Including qualitative research may only succeed
  through regular meetings for all participating
  researchers
• Paying attention to all mentioned solutions