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Roberta E. Goldman, PhD


Overview of Qualitative Research Methods for Primary Care and Public Health ROBERTA E. GOLDMAN, PHD DEPARTMENT OF FAMILY MEDICINE ALPERT MEDICAL SCHOOL – PowerPoint PPT presentation

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Title: Roberta E. Goldman, PhD

Overview of Qualitative Research Methods for
Primary Care and Public Health
  • Roberta E. Goldman, PhD
  • Department of Family Medicine
  • Alpert Medical School
  • of Brown University
  • July 2012

Qualitative Research Overview
  • Qualitative research provides data about meaning
    and context regarding the people and environments
    of study
  • Study populations are increasingly alert to how
    they are being approached by interventionists,
    and how they are represented in research

The Qualitative Perspective
  • I want to understand the world from your point
    of view. I want to know what you know in the way
    you know it. I want to understand the meaning of
    your experience, to walk in your shoes, to feel
    things as you feel them, to explain things as you
    explain them. Will you become my teacher and
    help me understand?
  • James P. Spradley (1979)

Nature of Qualitative Research
  • Attempts to make sense of the social world in
    terms of the meanings people bring to it
  • To uncover ideas, insights, or ways of thinking
    of and explaining phenomena about which little is
  • To gain novel and fresh perspectives on things
    about which quite a bit is already known

Qualitative Research Approach
  • Differs in approach and results from surveys
  • Looking for range of phenomena in sample studied
  • Rarely use statistical analysis
  • Not representative of the total population
  • Purposive, stratified samples
  • Generally not random samples
  • Multi-method (i.e. multiple qualitative methods
    mixed qualitative and quantitative methods)

How to Choose your Methods
  • The methods are in service to your research
    questions and goals.
  • The quantity of your interviews, focus groups, or
    observations is dependent on the participant
    characteristics you need to include, and the
    purpose of your research.

Uses of Qualitative Research in Primary Care and
Public Health
  • Obtain data that are useful on their own
  • Detailed, contextually-based data on subtle
    meanings associated with attitudes, beliefs, and
  • What, how, and why people conceptualize issues
    differently in different contextual circumstances
  • Generate indigenous terms and categories
  • Generate new avenues for study
  • Process evaluation

Uses of Qualitative Research in Primary Care and
Public Health
  • Obtain data that serve as building blocks or can
    be triangulated with other data mixed
    qualitative/quantitative design
  • Information that enhances intervention design
  • Information that informs survey design and
  • Understand the range of relevant survey questions
    and responses
  • Test surveys and intervention elements
  • Cognitive interviewing and pilot testing
  • Information that complements and/or explains
    other results

  • Hablemos de Tí Lets Talk about You (PI R.
  • Focus groups of middle-aged and older Latinas
    about perspectives on social, cultural, physical
    elements of menopausal transition (n9 groups)
  • Reunion groups (n9 groups)
  • Individual interviews (n18 participants)
  • Interactive internet intervention (n81

The Qualitative Study Question
  • Ask an overall study question that has open-ended
    possibilities for answers
  • What are the emotional experiences of public
    middle school children who change schools
  • How do Portuguese older adults conceptualize the
    diabetic diet?
  • In what ways do culture and religion play a role
    in Hmong adults views of health care?
  • How do political ads on television influence
    adults perceptions of health care reform?

Entering the Community
Preparation for Research
  • Preparatory steps are essential for
    community-based qualitative research
  • Define your community
  • Involve community representatives at all stages
    from the very beginning
  • Get involved in the community
  • Stay involved in the community
  • Decide how to represent yourself

Entering the Community
  • Learn what you can from previous studies and
    secondary data sources
  • Academic and popular media
  • Public health and other disciplines
  • Maps
  • Demographic statistics
  • Urban planning documents
  • Etc.

Entering the Community
  • Learn what you can from knowledgeable
  • Community, civic, political, economic, health,
    education, business, unions, social service, etc.
  • Academics
  • Other key informants
  • Assess the quality of your key informants

Entering the Community
  • Learn what you can through participant
  • e.g. neighborhoods, organizations, resources,
    businesses, housing, transportation, health
    sites, educational resources, financial
    structures, community events
  • Be able to recognize what people are talking
    about or alluding to
  • Recognize relevant social fields for inquiry

Selected Qualitative Research Methods
  • Participant observation
  • Individual interviews
  • Focus groups
  • Media content analysis
  • Visual (i.e. video or still image)
  • All in conjunction with broad literature review,
    including ethnographic literature
  • The more you know before you start, the better
    your research will be

Participant Observation More than just hanging
  • What is it?
  • Etic view
  • Observation
  • Reflection
  • Ranges from high to no participation
  • Informal interviewing for emic explanation

Participant Observation
  • Why do it?
  • See whats really going on
  • Counterbalance Triangulate data from other
  • Understand and test what people say
  • Know what to ask people about because youve seen
    it already

Participant Observation
  • How to really see
  • Know what youre looking for, and
  • Be open to seeing what you dont expect
  • Be cognizant of what youre looking at
  • Observe the details, variations, etc.
  • Take notes
  • Reflect on observations and notes question what
    you saw
  • Discuss observations and notes
  • Go look again
  • and so on. . .

Participant Observation
  • Spectrum of observation
  • Full participant
  • Passive Observer

Participant Observation - Fieldnotes
  • Document your observations
  • Fieldnote journal running record of
    observations AND observer comments
  • Structured observation note grid
  • Brief notations while in the field
  • Expand upon and organize notes as soon as
    possible thick description
  • Truism in anthropology
  • For every hour of observation you need 3 hours of
    writing fieldnotes

Types of Individual Qualitative Interviewing
Categories of Individual Qualitative Interviews
  • Informal
  • Conversations in the field
  • Unstructured
  • Interview setting with no formal guide
  • Semi-structured
  • Interview setting with an interview guide probes
  • Structured
  • Interview setting with a rigid question list

In-Depth Interviews
  • Various kinds and purposes
  • Open-ended questions
  • Looking for meaning and context and information
    in respondents own words
  • Combine structure with flexibility
  • Interactive
  • Follow new lines of inquiry as they arise
  • Explore a topic in-depth with follow-ups and
    probes whys, hows, examples, etc.

Key Informant Interviews
  • Insider/outsider
  • Know something about your topic area, in a way
    different from your way of knowing
  • Can articulate their knowledge
  • Choose broadly
  • Can connect you with other KIs and information
  • Semi-structured using flexible question guide
  • Maybe informed consent
  • Usually no monetary compensation
  • Exploratory process evaluation explanatory

Life History Interviews
  • In-depth exploration of a small number of
    illustrative individual cases
  • Useful for collecting detailed, contextual,
    diachronic data
  • Life history interview goes both backward and
    forward in time
  • Places the topic of interest within the context
    of interviewees daily lives, both past, present,
    and looking into the future

Conducting Individual Semi-Structured Interviews
  • Consider the setting privacy, comfort,
    security, noise level, impact of others present,
    where you put the mic, etc.
  • Consider your appearance, dress, behavior,
    demeanor be tranquil
  • Introduce yourself, project, sponsor

Conducting Individual Semi-Structured Interviews
  • Informed consent and assurance of confidentiality
  • Explain process of the interview
  • Ask permission to record and take notes
  • Gain rapport friendly AND professional
  • Be real, but stay professional and appropriate
  • Be empathic because you are a human being, but
    you are not a counselor
  • Develop strategies to redirect

Conducting Individual Semi-Structured Interviews
  • Always bring a question guide that you know well
    and have practiced in pilot interviews
  • Can use guide flexibly in terms of wording and
    question order
  • Stay alert for new avenues of inquiry that arise
    due to participants responses
  • Make quick notes on guide as reminders started
    a topic want to return to a topic
  • If returning to a question, note that it was
    discussed before

Conducting Individual Qualitative Interviews
  • Listen alertly make quick decisions
  • Do you need a follow-up question?
  • Do you need a probe?
  • Is it time to move on to the next question?
  • Dont use leading phrasing or paraphrasing
  • Ask for clarity
  • Be sure you can explain to someone else what the
    participant said in the interview if not, you
    need clarity from the participant PROBE
  • Use a variety of neutral probes

Writing Open-Ended Questions
  • Few questions with broad reach
  • or
  • Many specific questions
  • or
  • Start broad, get more narrow
  • Your design of the question guide depends on your
    goals for the research, your participants, your
    moderators skills, nature of the topics

Know why youre asking questions
  • Be very familiar with your objectives know what
    you want know what you mean
  • Write questions to get at content, context and
    meaning go for the whys and whens and hows
    in addition to and maybe more than the whats
  • Ask for explanations, feelings, understandings,
    personal interpretations
  • Use scripted and/or spontaneous probes

Its an iterative process. . .
  • Relax, think broadly, then more narrowly
  • Blitz out your topics
  • Review, edit topics
  • Talk to colleagues about topics, edit
  • Form into open-ended questions
  • Edit and revise your questions multiple times!

Its an iterative process. . .
  • Critique questions for
  • Quality (are they truly open-ended?)
  • Impartiality (do they avoid leading phrasing?)
  • Literacy (are most participants likely to
    understand the words in the questions and the
    meaning of the questions?)
  • Clarity (does the wording of the questions
    adequately reflect what you intend the questions
    to ask?)
  • Assess appropriateness (given your topic and
    interview setting, will the questions upset your
    participants unsettling personal questions,
    test-like questions, etc?)

Its an iterative process. . .
  • Review, discuss, edit, refine questions
  • Consider order and placement
  • Often start with easy to answer, grand tour
  • Consider impact of earlier questions on later
  • Show questions to people who are familiar with
    your objectives and those who are not
  • Consider the usefulness of every question and
  • Pilot the questions with people similar to your
    study population some form of Cognitive
  • Modify and finalize questions
  • Be willing to revisit question script as study
  • Change wording or order Add/delete questions

What to Include in your Question Script
  • Core questions
  • Follow-up questions Specific anticipated
    questions that follow core question
  • Probes Anticipated general probes to ask why,
    why not, how, when, etc.

Heres the hard part What will NOT be in your
question script
  • Directions for spontaneously re-ordering
  • Follow-up questions to
  • Seek clarification
  • Seek explanation for unanticipated response
  • Follow new lines of inquiry that arise due to a
    previous response
  • This is where the real action lies!

Focus Groups
What is a Focus Group?
  • A carefully planned series of discussions
    designed to obtain perceptions of a defined area
    of interest in a permissive, non-threatening
  • Krueger RA, Casey MA. 2000. Focus Groups A
    Practical Guide for Applied Research. Thousand
    Oaks, CA Sage

Why do Focus Groups?
  • Focus groups are about human interaction
  • Benefit from social discourse
  • Research question lends itself to collecting more
    superficial data from an interactive group of
  • Discussion of ideas, opinions, beliefs,
    knowledge, preferences, etc.
  • Not looking for in-depth case histories

Other Qualitative Methods
  • Media content analysis
  • Visual methods