Qualitative Research Methods PDF

QUALITATIVE RESEARCH METHODS Lecturer: Prof Ghufran Jassim  Learning outcomes Students will be able to:  Describe the comparative roles of qualitative and quantitative research  Define the types of research questions that can be addressed using qualitative research methods  Explain the...

QUALITATIVE RESEARCH METHODS Lecturer: Prof Ghufran Jassim  Learning outcomes Students will be able to:  Describe the comparative roles of qualitative and quantitative research  Define the types of research questions that can be addressed using qualitative research methods  Explain the principal methods used in qualitative research  Describe the main methods of analysis in qualitative and mixed methods research What is qualitative research? “Development of concepts which help us to understand social phenomena in natural (rather than experimental) settings, giving due emphasis to the meanings, experiences and views of participants.” (Pope & Mays,1995)  Research approaches Epistemology – what can we know? Realism Pragmatism Interpretivism/constructionism Methodology – how can we find out? Quantitative Mixed methods Qualitative Methods – what tools to use? Experiments, surveys Interviews, focus groups Differences between qualitative & quantitative Characteristic Quantitative Qualitative Goal Verification Understanding Concept development Questions asked What? How much? Why? How do? How often? How come? Setting Experiments Natural Researcher position Distant Involved Tools Structured Interactive interview guide Analysis Statistical Interpretive Results Generalisable Give meaning, experience and views Source: (and more differences in) Huston, P. and Rowan, M. (1998)  “Listen to the patient. He is telling you the diagnosis” (William Osler)  When do we use qualitative research? ▪ Many important questions not easily answered by quantitative methods ✓ Perceptions, beliefs, experiences, behaviour ✓ Understanding events/issues within context ✓ Generating and refining theory ▪ When you want to study ‘real life’ situations ▪ When situations are complex and dynamic ▪ When the research problems or questions are not clear – a messy situation  Scenario The A&E Dept treats 70,000 new cases a year, and staff feel that the majority of these patients do not need hospitals to provide their treatment. These patients attend with minor illness/injuries whose need could sometimes be met in local primary care facilities. However, junior doctors tend to investigate and treat patients with minor problems intensively and the Dept overspent last year. Waits for treatment are very long, resulting in an often hostile environment in the waiting room. Nurse turnover is high and it has been difficult to recruit good staff. The management team meets tomorrow to discuss whether there is any research that could usefully address these problems.  POLLS: Are these questions suited to qualitative or quantitative research? 1. Which patients can be safely be treated at the primary care level? 2. How many of the patients are attending inappropriately? 3. What are the sources of patient dissatisfaction with current hospital care and primary care? 4. Why do junior doctors treat patients with minor problems ‘intensively’, rather than treating more appropriately or referring back to primary care? 5. How could the primary care level cope with the influx of new patients?  Qualitative Research Designs Story telling experience Essence of generation One case observe Themes Creswell (2007) Qualitative Inquiry & Research Design  Ethnography Geographical Religious Social group Lifestyle Tribal  Focused Ethnography ▪ Intense data collection Hinder & Greenhalgh (2012) ▪ Less time spent in the field "This does my head in". ▪ Examine experiences within Ethnographic study of self- a culture/sub-culture management by people with diabetes ▪ Explores certain problems https://bmchealthservres.biomedcentral. com/articles/10.1186/1472-6963-12-83 within sub-groups  Narrative research – narrative medicine ▪ Narrative medicine: the use of narrative as a tool to collect and interpret information on the patient’s experience of illness ▪ Expressive writing interventions (EWI) - Zhou et al., (2015) EWI had a significant impact on reducing negative somatic symptoms in a 1-3 month follow-up (breast cancer) - Houston et al., (2011) EWI produced significant improvements in blood pressure for patients with baseline uncontrolled hypertension Fioretti et al (2016) https://www.ncbi.nlm.nih.gov/pubmed/27417197  Phenomenology ▪ Meaning of an illness for individuals, through lived experience ▪ Essence of an experience What are the effects What is it like to live on people’s lives? with back pain? Snellgrove et al., (2009) An interpretative phenomenological analysis of living with chronic low back pain https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1348/135910709X402612 Grounded theory  Case study research “A case study can be defined as an intensive study about a person, a group of people or a unit, which is aimed to generalise over several units” (Gustafsson, 2017) Heale et al (2016) A multiple-case study in nurse practitioner- led clinics: an exploration of the quality of care for patients with multimorbidity. https://pubmed.ncbi.nlm.nih.gov/28032834/ ✓ Document review ✓ Interviews with nurse practitioners ✓ Chart audits: to determine the extent to which evidence-based guidelines were followed for patients with diabetes  Sampling in qualitative research Purposive Selected based on characteristics of a population and the objective of the study Convenience Easily accessible, convenient to researchers Snowball Participants with whom contact has already been made use their networks to refer researcher to other potential participants Quota Number of people with certain characteristics ▪ Non-probability sampling: not all members of the population have an equal chance of participating in the study POLL: Which type of sampling strategy was used? A study was planned to explore the perspectives and preferences of stroke survivors to inform the design of a cognitive rehabilitation intervention. The researchers sampled a mix of male/female participants who reported experiencing cognitive impairment as a consequence of stroke, who were over 18 years of age, and in a range of community healthcare areas. Eligible participants also had to be living within a community setting and not in residential care.  Data saturation ▪ The point in data collection when new data no longer bring additional insights to the research question. ▪ “the gold standard by which purposive sample sizes are determined” (Guest et al., 2006) ▪ ‘Informational redundancy’ (Sandelowski, 2008) ▪ When researcher begins to hear the same comments again and again  Qualitative Data Collection Methods Interviews Unstructured: Semi-structured: ✓ freedom to tell stories as they ✓ standard questions, but additional wish: often life histories ✓ questions and probing ✓ additional themes that have not ✓ understanding of people’s life been considered by researcher experiences ✓ questions asked in any order ✓ researcher helps to keep the narrative moving forward ✓ may require personal disclosure Tasks involved in interviewing At any one time the researcher needs to… Be alert to contradictions with what has been said Listen to what is being Assess how it relates to earlier said and understand it… the research questions “At any one time the researcher needs to listen to what is being said and understand it; assess how it relates to the research questions; be alert to contradictions with what Decide has been said earlier; decide what to follow-up or what to follow- explore in more detail now and up or what explore into return to later; decide how to Decide more phrase the how to phrase next question; pick up on nuances, detail now andhesitation, what to emotion, and non-verbalthesignals; next question pace the interview; keep an return eye toon laterrecording equipment, and deal with any Pace the distractions or interruptions that arise.” interview Mason in Ritchie and Lewis, 2007 Pick up on nuances, hesitation, emotion, and non-verbal signals Keep an eye on Deal with any recording equipment distractions or interruptions that arise Ritchie and Lewis, 2007  Focus Group Discussions ▪ 5-8 people “The focus group presents a more natural environment ▪ Homogenous group than that of the individual interview because participants are influencing ▪ Individual/group data and group and influenced by others – just as they are in real life.” interaction (Kreuger & Casey, 2009) ▪ Representation of diverse opinions and ideas X Sensitive information ▪ May be less inhibiting than 1:1 X settings with large power interviews differentials  Observation Image attribution: SIA Acc. 90-105 [SIA2008-5981] "What people say, what people do, and what they say they do are entirely different things) Margaret Mead (1901-1978) ▪Participant: researcher as participant in setting being observed ▪Non-participant: researcher does not participate in setting  Data analysis COLLECTION ANALYSIS QUANTITATIVE COLLECTION ANALYSIS QUALITATIVE Qualitative is iterative  Qualitative data analysis Content – thematic Common themes/ideas and issues across and framework the data Grounded theory Using coding and categorising to generate theory Narrative Writing data collected in the format of a story Conversational & Patterns of language Discourse analysis Data analysis example Noble & Smith (2014) Noble & Smith (2014) https://ebn.bmj.com/content/17/1/2.long Data analysis example: Noble & Smith (2014) Data analysis example: Noble & Smith (2014)  Quality in qualitative analysis Quality in qualitative analysis Comprehensiveness Analysis should be systematic. Thoroughness Account for variation within data and complexity. Done through: a. Comparison: between cases and within cases. Why are things the same or different? b. Being critical: look for deviant cases: examples that differ from the rest of the data. Transparency Give practical details/examples of coding decisions, and main themes. Keep an audit trail of decision making Reliability Rigorous research practice Triangulation: use different tools Use a team of researchers Report multiple perspectives Source: Durand & Chantler eds. (2014) Reporting Qualitative Research: COREQ checklist https://academic.oup.com/intqhc/article/19/6/349/1791966 Mixed Methods Research “The whole is greater than the sum of its parts”  Mixed methods research “Mixed methods research is a methodology for conducting research that involves collecting, analysing, and integrating (or mixing) quantitative and qualitative research (and data) in a single study or a longitudinal program of inquiry. The purpose of this form of research is that both qualitative and quantitative research, in combination, provide a better understanding of a research problem or issue than either research approach alone.” Creswell, J & Plano-Clark, VL. (2011). Typologies of mixed methods designs The explanatory Convergent parallel sequential design design The exploratory sequential design The embedded design  1. Convergent parallel design Quantitative Data Collection and Analysis Compare Interpretation or Relate Qualitative Data Collection and Analysis 2. The explanatory sequential design Quantitative Follow Qualitative Data Collection and Up Data Collection and Interpretation Analysis With Analysis 3. The exploratory sequential design Qualitative build Quantitative Data Collection and to Data Collection and Interpretation Analysis Analysis  4. The embedded design Quantitative (or Qualitative) Design Quantitative or Qualitative Data Collection & Interpretation Analysis Quantitative or Qualitative Data Collection & Analysis (Before, During or After) Maternal, newborn & child health in Malawi Research aim: To identify community systems obstacles and enabling factors underpinning MNCH service utilisation in Malawi within the first 1000 days of life, to generate strategies for strengthening community systems Mixed methods: in-depth interviews, Focus groups, and service utilisation data  POLL: what type of mixed methods design? Objective: This study aimed to describe women's opinions on the use of medications and "natural" products during breastfeeding, pharmacovigilance and phytosurveillance, and the management of breastfeeding. Methods: This was a mixed-methods study. In the first qualitative phase, we conducted focus groups and in-depth interviews with 25 mothers attending community services. Coding and content analysis were carried out using NVivo9. We identified 4 main categories, and on this basis, we built a questionnaire administered to 248 pregnant women and new mothers attending 2 third-level hospitals. We conducted a descriptive and bivariate analysis (P ≤.05) using Epi-Info v.7. POLL: what type of mixed methods design? Objective To explore the experiences of patients at risk for cardiovascular disease in primary care with the Activate intervention in relation to their success in increasing their physical activity. Methods A mixed methods study was conducted, parallel to a cluster-randomised controlled trial in primary care, using a questionnaire and semi-structured interviews. Questionnaires from 67 patients were analysed, and semi- structured interviews of 22 patients were thematically analysed. Experiences of patients who had objectively increased their physical activity (responders) were compared to those who had not (non-responders). Objective success was analysed in relation to self-perceived success  Reading Kuper A, Levinson W An introduction to reading and appraising qualitative research, BMJ BMJ 2008;337:a288 https://www.bmj.com/content/337/bmj.a288.full  Which of the following research questions suit a qualitative design? A. What is the effect of social skill groups intervention among autistic children? B. How do the mothers of special needs describe the process of adjustment to having a child with disability? C. What are the factors affecting the developmental delay in children with special needs? D. What is the difference between special needs and normal children in terms of cognitive abilities? E. What is the relationship between MMR vaccine and autism?  You intend to study quality of life of women with breast cancer using a qualitative design. You recruited women and interviewed them using a set of 5 questions. What is this method of data collection called? A. Focus group B. Structured interview C. Unstructured interview D. Observation E. Survey You intend to conduct a qualitative study to describe the beliefs and ways of life of a religious group in North America (Amish group). What type of qualitative designs most suit this research objective? A. Ethnography B. Narrative research C. Phenomenology D. Grounded theory E. Case study  While collecting data for your qualitative study on describing the experiences of medical students with COVID-19 in the clinical area, you collected data until there was no new themes emerging. What is this concept of sample size determination referred to? A. Electronic Sample size calculation B. Data saturation C. Data interpretation D. Theme generation