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Adapting Research Methods for Diverse Ethnic Groups


Electronic media in Spanish. Emphasis on family and collective orientation of culture ... Typical U.S. Approach in Studies of English Speaking Diverse Groups ... – PowerPoint PPT presentation

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Title: Adapting Research Methods for Diverse Ethnic Groups

Adapting Research Methods for Diverse Ethnic
  • Eliseo J. Perez-Stable, M.D.
  • Anita Stewart, Ph.D.
  • Anna Nápoles-Springer, Ph.D.
  • University of California, San Francisco
  • Clinical Research with Diverse Communities
  • EPI 222, Spring 2002

  • Integrating qualitative and quantitative methods
  • Using focus groups to develop questionnaires and
    community interventions
  • Using cognitive interviewing to develop

What are Qualitative Methods?
  • Data consist of words, not numbers
  • Richly descriptive, open-ended
  • Focus on inductive analytic approaches
  • Many types ethnography, participant-observation,
    direct observation, interviews, focus groups

When are Qualitative Methods Useful?
  • Open-ended interviews typically used in
    quantitative research in new areas of study
  • Especially critical in cross-cultural studies due
    to lack of information
  • Useful when need in-depth knowledge about issues
    especially with less studied cultural groups

When are Qualitative Methods Useful?
  • To understand the meaning of participants
    events, situations, and actions
  • To understand contextual influences on
    participants actions
  • To identify unanticipated phenomena and
    influences (e.g., exploratory studies to design
    questionnaires and identify variables for study)
  • To understand the processes underlying observed
    relationships between variables

Combining Qualitative and Quantitative Methods
  • Qualitative Methods to Develop Quantitative Tools
  • Qualitative Methods to Explain Quantitative

Combining Qualitative and Quantitative Methods
  • Quantitative Methods to Expand on Qualitative
  • Quantitative and Qualitative Methods Equal

(Tasjakkori A. Sage Publications, Inc. 1998)
Sampling In Qualitative Research
  • Quantitative research-2 types of sampling
  • Probability
  • Convenience
  • Qualitative research-3rd type of sampling
  • Purposeful
  • Deliberately select settings, persons or events
    to best answer research questions

Goals of Purposeful Sampling
  • Achieve representative, typical settings,
    individuals, or activities
  • Adequately capture heterogeneity, sample for
    broadest range of variation rather than typical
  • Examine extreme cases that test theory
  • Set up contrasts to examine differences between
    settings or individuals
  • (Maxwell JA. Sage Publications, Inc., 1996)

Qualitative Methods to Develop Quantitative Tools
  • Focus Group-
  • Open-ended guided group discussion with probing
    of responses
  • Cognitive Interviewing
  • Individual interviews using open-ended probes to
    assess how items are interpreted and adequacy of
    response choices

Open-ended Interviews to Develop Structured
  • Example Constructing attitudinal scales
  • Use open-ended interviews (individual or group)
    to obtain statements on topic of interest
  • Organize statements into item pool
  • Pretest closed-ended items
  • Modify items based on pretest and administer in
    structured interview

  • Integrating qualitative and quantitative methods
  • Using focus groups to develop questionnaires and
    community interventions
  • Cognitive interviewing to develop questionnaires

Focus Groups
  • Group discussion led by experienced moderator
    usually 1.5 - 2 hours
  • Purposeful sampling of 6-10 homogenous
    participants per group
  • Use open-ended questions with follow-up probes
    for clarification, usually covering 10-12 topics
  • Participants stimulate comments of others
  • Audio-record and transcribe discussion

Focus Groups-Logistics
  • Moderator skills listening, communication,
    negotiation, cultural similarity to participants
  • Costs of group 600 - 1000 per group
    (incentives, audio-taping, transcription,
    translation, food)
  • Convenient and hospitable community setting
  • In-person recruitment with telephone and mail

Latino Smoking Attitudes - From Focus Groups to
Community Intervention
  • Family concerns - 2nd hand smoke
  • Heightened health issues
  • Importance of appearance and interpersonal
    relations - Simpatía
  • Habitual use less important
  • Addiction less of a concern

The Subjective Culture of Smoking Focus Groups
  • Examine similarities and differences in
    attitudes, beliefs and behaviors (Triandis)
  • Sampling stratified by comparison groups
  • Probability vs. purposeful sampling
  • Antecedents and consequences
  • Use information to design intervention

The Subjective Culture of Smoking - Structured
  • 17 antecedents to smoking (habitual activities,
    social activities, emotional states)
  • 15 reasons to quit (family, appearance, health)
  • 3 reasons to keep smoking (weight, nervousness,

Reasons for Trying to Quit Smoking Latinos and
Anglos, 1990
  • Latinos Anglos Difference
    95 CI diff
  • Effect on others 62.8 51.7 11.1
    (18.9, 3.3)
  • Smell 51.6 33.7 17.9 (25.6, 10.2)
  • Cost 50.6 48.6 2.0 (9.9, 5.9)
  • Wrinkles 49.0 33.9 15.1 (22.8, 7.4)
  • Criticized by family 43.9 24.0 19.9
    (27.3, 12.5)
  • Family pressure 40.7 23.4 17.3
    (24.6, 9.9)
  • Burn clothes 40.1 25.1 15.0 (22.4,

Reasons for Continuing to Smoke Latinos and
Anglos, 1990
  • Latinos Anglos Difference 95 CI diff
  • Not to gain weight 19.9 26.1 6.2
    (0.5, 12.8)
  • Feel less nervous 49.4 36.8 12.6
    (20.4, 4.8)
  • Helps concentration 28.8 29.7 0.9
    (6.3, 8.1)

Multivariate Model for Latinos Reasons to Quit or
  • OR 95 CI
  • Criticized by family 1.93 (1.26, 2.98)
  • Burn clothes 1.57 (1.02, 2.42)
  • Children's' health 1.67 (1.08, 2.57)
  • Bad breath 2.07 (1.40, 3.06)
  • Family pressure 1.69 (1.10, 2.60)
  • Good example 1.83 (1.21, 2.76)
  • Not to gain weight 0.38 (0.24, 0.59)

Community Intervention Programa Latino Para
Dejar de Fumar
  • Guia Para dejar de Fumar--self-help guide
  • Electronic media in Spanish
  • Emphasis on family and collective orientation of
  • Immediate effects of smoking
  • Health effects in different context
  • Physicians role

  • Integrating qualitative and quantitative methods
  • Using focus groups to develop questionnaires and
    community interventions
  • Cognitive interviewing to develop questionnaires

Distinction Between International and U.S.
Studies - Why Pretest?
  • International studies assume conceptual
    non-equivalence to begin with
  • Different nations, languages
  • Usually dealing with translated measures
  • During translation, items can be added or
    modified to improve conceptual and semantic
  • Product is an adapted instrument

Typical International Approach
Assess Conceptual Equivalence (Qualitative)
Begin here (assumes conceptual differences across
  • If new domains or definitions are found, can
    revise and add items
  • Translated adapted version is the goal
  • Assures conceptual adequacy prior to testing
    psychometric adequacy

Assess Psychometric Equivalence (Quantitative)
Typical U.S. Approach in Studies of English
Speaking Diverse Groups
  • Select existing well-tested measures (developed
    in mainstream) and assume they will work
  • Assumes perspectives of diverse group are similar
    to mainstream
  • Cultural hegemony (Guyatt)
  • Middle-class ethnocentrism (Rogler)

Typical U.S. Subgroup Approach When No
Translation is Done
Assess Conceptual Equivalence (Qualitative)
No Guidelines! If refine items based on
qualitative studies, no longer have comparable
If problems
Most studies begin here (assumes universality
of constructs)
Proceed with analysis. May miss important
domains and definitions
Assess Psychometric Equivalence (Quantitative)
If equiv.
Special Script for Recruiting People for
Cognitive Interviewing
  • Often do not understand their role
  • Explain how their help fits into the larger
    study, goal of main study, process of creating
  • Explain their role clearly
  • help us learn how to ask better questions
  • help us make questions clearer for others

Cognitive Interviewing Purposes of Probing
  • To learn ..
  • .. if respondents understand the words and
    phrases the way you intended (meaning)?
  • .. about the process of answering the
  • .. about usefulness of response choices
  • -Whether response choices are adequate
  • -How they use the response choices
  • .. whether item might be hard or unacceptable
  • Results can be used to revise items

Cognitive Interviewing Example of Probing
  • Meaning of words/phrases and questions
  • What does the word _______ mean to you?
  • What does the phrase ________ mean to you?
  • I asked you ______. What did you think of when I
    said ______?

Sample Result Probing the Meaning of a Phrase
  • Im going to ask you questions about how the
    office staff treated you personally . What does
    the phrase office staff mean to you?
  • the receptionist and the nurses
  • nurses and appointment people
  • the person who takes your blood pressure
    and the clerk in the front office
  • (We intended receptionist and appointment

Sample Result Probing the Meaning of a Phrase
  • I asked you how often doctors ask you about
    your health beliefs. What does the term health
    beliefs mean to you?
  • .. I dont want medicine
  • .. How I feel, if I was exercising
  • .. Like religion? --not believing in
    going to doctors?
  • We changed the question to personal beliefs
    about your health

Sample Result Probing the Meaning of a Phrase
(Pasick et al. 2000)
  • During the last 12 months, how many times have
    you visited a doctor or other health professional
    just for a checkup (physical examination) - even
    when you were feeling well.
  • Chinese women why would you go to a doctor if
    you were not sick?
  • Latina women could not rephrase the question
  • African American women hypertension so
    prevalent, could not distinguish monitoring
    from general checkup

Probe on Difficulty in General
  • Can ask respondents whether they think others
    would have difficulty answering a question or
    would answer the question honestly

Example of Probe on Difficulty CES-D Item
  • During the past week, how often have you felt
    that you could not shake off the blues, even with
    help from family and friends
  • Probe Do you feel this is a question that people
    would or would not have difficulty understanding?
  • Latinos more likely to report people would have
    difficulty than other groups

TP Johnson, Health Survey Research Methods, 1996
Example Probing the Process of Answering
  • I asked you _____ and you answered____.
  • Why did you pick this answer?
  • What were you thinking of when you picked this
  • Can you tell me what you were thinking when you
    answered this way?
  • Can you give me some examples?
  • What came to mind when I asked you _____?

Sample Result Probing the Process of Answering
  • When I asked you how often doctors gave you a
    chance to say what you thought was important, you
    answered rarely - what were you thinking of
    when you picked your answer?
  • Sometimes I would be slow thinking, by the time
    I ask something, they are gone.... my doctor
    knows how to exit that door.

Example Use of Response Scale
  • Do diverse groups use the response scale in
    similar ways?
  • Sample Result on questions about cultural
    competence of providers .. interviewers
    reported that Asian respondents who were
    completely satisfied did not like to use the
    highest score on the rating scale

CPEHN Report, 2001
Sample Result Use of Response Scale
  • In an exercise class of Samoans, instructor asked
    them to rate the difficulty of the exercise he
    just did on a 1-10 scale
  • They did not understand what a 1-10 scale was

Sample Result Learning about Acceptability
  • Comments during interview to question How
    often did doctors ignore your feelings?
  • What do you mean ignore my feelings? Does
    that mean Im bawling in front of him?
  • What type of feelings? ..when they ask
    how are you feeling? Other kinds of
  • This type of question would only be asked
    in extreme cases. This question is too

Other Cues to Problems in Face-to- Face Pretests
  • When administering the survey
  • Be aware of behavioral cues related to specific
    items or to questions in general
  • Long pauses in answering
  • Discomfort
  • Yawning
  • Looking at their watch

Interviewers Role
  • Be flexible during interview
  • probe on items that appear to be problematic
  • If a long pause in answering..
  • I noticed you pausing - what were you thinking
    about answering that question?

Approaches to Adapting Standard Measures
  • Add parenthetical phrases where words are hard
    for target group to understand
  • Substitute more culturally appropriate examples
  • e.g., limitations in moderate activities such as
    playing tennis - substitute soccer
  • If items need substantial adaptation,
  • Administer new and standard items
  • Can analyze measurement properties of standard
    measure and adapted measure

Tradeoffs of Using Adapted Measures
  • If adapted measure works better
  • You improved internal validity - able to answer
    your question with this measure
  • You lost external validity - cant compare your
    scores to other studies
  • If adapted measure does not work
  • Can still use original measure
  • It may not work either

What to do if Measures Are Not Adequate or
Equivalent in a Specific Study
  • Need guidelines for how to handle data when
    substantial non-comparability is found in a study
  • Drop bad or biased items from scores
  • Compare results with and without biased items
  • Analyze study by stratifying diverse groups
  • The current challenge for measurement

ConclusionsIntegrating Quantitative and
Qualitative Methods
  • In diverse populations, qualitative work is
    necessary in addition to more traditional
    quantitative studies
  • Prior to quantitative to develop concepts, items
    appropriate to culture
  • After quantitative
  • to help identify reasons for items not performing
    well quantitatively
  • to explore possible explanations for unexpected