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

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


1
Qualitative Research What, why and how
(...and should I even go there?)
Alexander M Clark, PhD BA(Hons) RN Associate
Professor, University of Alberta AHFMR Population
Health Investigator CIHR New Investigator Alex.Cl
ark_at_ualberta.ca
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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

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What qualitative research is not
  • Not
  • Quality of life research
  • Research into quality
  • Survey with open ended questions
  • Count the number of particular words

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Characteristics of qualitative research
  • Insiders perspective
  • Personal involvement
  • Openness to the other
  • Holistic
  • Context
  • Complexity
  • Depth
  • Inductive
  • Responsiveness
  • Moving beyond the specific
  • (Morse 1992 Powers and Knapp 1995)

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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  • Historical documents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

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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

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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

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Mary Kingsley (1862-1930) Travels in West
Africa (1897) West African Studies (1899)

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  • a new reason for polygamyit 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.

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

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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

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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

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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 describedbut not
    explained

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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

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What is missing?
  • All that is useful cannot be quantified
  • Complexity
  • Unknown factors
  • Process
  • Defies quantification
  • Values
  • Aspirations
  • Human decision-making

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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

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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

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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

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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

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How? Philosophical bases
  • Constructivism
  • Relativism
  • Realism
  • Critical realism
  • Postpositivism
  • Positivism
  • Objectivism

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Methods
  • Grounded theory
  • Theory around social processes
  • Phenomenology / Hermeneutics
  • Experience and meaning
  • Ethnography
  • Culture
  • Document / Historical
  • Generic

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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

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Phenomenology
  • Focus The study of phenomena
  • Domain Being, lived experiences, essences
  • Background Philosophy
  • Names Husserl, Heidegger, Gadamer
  • Data collection One to one interviews

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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

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Where is meaning in a text?
  • Writer
  • What is intended?
  • Text
  • What is inherent?
  • Reader
  • What I interpret?

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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

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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

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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

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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)

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Ethnography
  • Focus The study of cultures
  • Domain Macro and micro cultures
  • Background Cultural anthropology
  • Names Mead, Atkinson, Hammersley
  • Data collection Observation, group-work,
    interviews

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  • 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)

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Use of ethnography in health research
  • Culture
  • Places
  • Settings
  • Populations
  • Macro
  • Town
  • Vulnerable population
  • Micro
  • Families
  • Student group on a course
  • Porter and Ryan (1996)
  • Racist behaviour in clinical settings
  • Preston (1997)
  • Families of people with CHD

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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

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Grounded Theory
  • to move beyond descriptionto 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

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Grounded theory
  • Focus Developing theory grounded in data
  • Domain Social processes and interactions
  • Background Applied
  • Names Glaser, Strauss
  • Data collection One to one interviews

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Use of grounded theory in health research
  • Social
  • Processes
  • Interactions
  • Actions
  • Paterson (2001) Empowerment in chronic illness
  • Jillings (2007)
  • Self care processes during heart failure
  • Johnson (1990)
  • Adjustment after myocardial infarction

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

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Case study
  • Focus A case related to an issue
  • Domain Manyas long as it helps
    illustration
  • Background Social science, health, psychology
  • Names Stake
  • Data collection Multiple (paper, verbal, visual)

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Use of case study in health research
  • Cases that are particularly
  • Typical
  • Atypical
  • Noteworthy
  • Interesting
  • Illustrative
  • 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)

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How? Data collection techniques
  • Interview
  • Unstructured
  • Semi-structured
  • Structured
  • Focus group
  • Observational
  • Video
  • Internet
  • Document extraction

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Judging quality in qualitative research
  • Trustworthiness
  • Do we understand?
  • Do we agree?
  • Credibility
  • Can we follow?
  • Typicality
  • Site
  • Sample

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Quality Screening
  • Contentious issues
  • For what purpose?
  • Inclusion / Exclusion
  • Commentary
  • How expressed?
  • Measured?
  • Narrative

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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

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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?

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Was the recruitment strategy appropriate?
  • Participants
  • How selected?
  • Most appropriate
  • Typicality
  • Size of sample

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Addressing the research issue
  • Setting
  • Justified
  • Typical v Atypical
  • Data collection
  • Method clear
  • Justification appropriate
  • Size
  • Sample size
  • Depth of analysis

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

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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?

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

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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

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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

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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?id87
  • Alex.Clark_at_ualberta.ca
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