W6-11 Exam Print Alht211 PDF

**Week 6 Quantitative cont.** 6.1 Quantitative -- but not an RCT   **Learning Objectives** By the end of this week you will be able to: - Determine NHRMRC Levels of Evidence for all quantitative study designs - Appraise the utility of small n research designs - Identify appropriate...

**Week 6 Quantitative cont.** 6.1 Quantitative -- but not an RCT   **Learning Objectives** By the end of this week you will be able to: - Determine NHRMRC Levels of Evidence for all quantitative study designs - Appraise the utility of small n research designs - Identify appropriate means of graphical representation of data - Demonstrate basic Excel skills in calculating and representing data     **NHMRC Levels of Evidence: Levels III and IV** - Pseudo-randomized controlled trial (III-1) - Comparative study with concurrent controls (III-2) - Comparative study without concurrent controls (III-3) - Case Series with pre-/post-test outcomes   Are they worth your appraisal? The answer is... YES!       **Level III & IV Evidence : NHMRC** Level III: What are Pseudo-Randomised Controlled and Comparative Studies?      **The Pseudo-Randomised Controlled Study Smith, Morrow & Ross (2015)**     Diagnosis: Test accuracy - Concurrent validity (when a standardised test is tested against another standardised test that we know works)   Alternate allocation (random ) Issues: Not blinded- for test accuracy , uneven grouping   N of 2 Communities: Matched pair and constrained randomisation (eg Public health)   **Allocation bias!** Multiple group case series Figure 8.3, Polgar and Thomas (2020)     - Trying to make sure community A and B are as similar as possible - Community A- didn't introduce program and community B was exposed to control program - Problems in allocation of group series   **What are Comparative Studies?** Time-Series Cohort - Calles quasi experimental designs\> especially interventions - Independent variable is the exposure of something to the group that either does or doesn't have a disease   Case Control - Time series cohort- starts at a period of time and moves forward, retrospective\> useful for groups that already have an impairment... e.g. we don't know who is and isn't going to get cancer - Look at the grouping- one group people who have the condition and other group people who don't have the condition - Look at other variables in society that could be linked to the condition - Case control- good for people who already have a problem or condition and is therefore useful for epidemiology and aetiology study   Historical control (III-3) - Reviewing a particular cohort and measure against controls that we already have information about at another time - Lower level of evidence than an RCT, however were looking at a group of people wth an intervention and comparing it to another intervention that is a gold standards - looking at types of outcomes... ensure new group of participants are very similar to the control group established in the other study    *Epidemiology* *Causal Relationships* - *Note: Both addressed in the graphic below* - *Vital in COMPARITIVE studies*     RCT: people who are or not exposed to particular factors- outcome overtime... start now and move forward in time Case CS: looking back at a case controlled study with factors that were present of absent for people who have or don't have the disease   Cross section sudied- study of people observed at a single point in time   **What to check for...** **Cohort and Case Control studies** - Are comparison groups well described/defined? - Were measures of exposure and outcomes collected in the same way (preferably blinded) for each cohort? - Were all possible confounds identified? - What was the follow-up period? - If you are using historical controls, what differences are there in possible confounds?   **Pseudorandomised**\> - Appraisal: allocation bias is likely   **Comparative studies**: failure to clearly define the comparison groups. Are the comparison groups well defined or described in similarity   **Measures of exposure or outcome:** are they collected in the same way and or blinded in the cohort study   - Possible confounds: if there are no confounds in the study than something is wrong... - Follow up periods: was there enough time of a follow up period in cohorts. What happens to them as time progresses in perspective of the independent variable. - Historical controls: possible confound of historical controls and the experimental groups of current date cohort.   6.2 Are 'lower level' studies useful? **What are the Cons?** - Small n → cannot be generalised to larger populations - Sampling Bias\> small sample, bigger application to larger samples - Maturation Bias\> small study... likely to be a similar type of people - Investigator/clinician blinding not possible, no control - Measurement/Observation Bias \> problem: small amount of people and investigators know who they are - Client blinding not possible - Hawthorne effect\> occurs when people are in a study because they know if they are in research... expecting something good to come out of it - Note: rates of satisfaction   - Smaller number= smaller power - Do authors address there is bias or are they trying to minimise boas - Small studies- no control= backbone that RCTs are based on       - Different research questions ask for different designs - Risk factors with cohorts, surveys- accuracy of symptoms, frequency or prevalence- emotions etc. RCT- does this intervention work for greater populations   **Why not RCT?** - Some variables unchangeable (eg age, cancer, gender) - Ethical reasons (eg withholding Tx) \> experimental arm and no-treatment control (seen as withholding therapy from someone- may drop out) - Expensive \> tools to analyse statistics, very big to have power to prove effectiveness in treatment - Different research questions need different designs - RCTs measure change -- they rarely explain change \> dony explain why it occurs - RCTs measure populations -- dont address individual differences - RCTs -- biomedical model, not psychosocial   \"Absence of a randomised trial is not absence of evidence\" (Rosenbek, 2016) - Need to collect evidence to try and account for those changes we have to make in clinics   [PCTs are not cased on a psychosocial models because in allied health we are more concerned with behaviours rather than treatments and cures ]   **Smaller n Studies and Survey Designs** Case Series Surveys Single Case Experimental Designs   **Case Series (Level IV, NHMRC, 2008)**   **What?** - AKA clinical experiment (intervention or independent variable) - One participant group ('cases'), no controls - Prospective, with protocol \> protocol in collecting the outcome (blind raters- people who are blind and rate outcomes). What have they done to minimise biases?   **Why**? - 'Hypothesis-generating' (Hoffman et al., 2024) \> good idea that a modification to treatment to try and reduce the confounds as much as possible - **Pilot study**\> smaller studies guide bigger studies - Useful in targeting specific populations/quality improvement - Useful for complex populations 'Understanding unusual patient conditions' (Portney & Watkins, 2015) e.g. population with high comorbidities   **Surveys** What**?** - Questionnaires \> questioning to address quality improvement - Interviews - Can include open ended questions to collect qualitative data  Why? - Quantifies attitudes, beliefs - Characteristics of populations \> what are common wants, needs, barriers - Demographic characteristics   **Single Subject Experimental Designs (SSEDs) or Single Case Experimental Designs (SCEDs)**    - Experimental designs of study - Powerful for studies that only have one person: what makes them different? - Rigorous structure that involves an AB multiple design - Baseline period- no treatment and then go into a baseline period (with drawl design)   **Single Subject Experimental Designs (SSEDs) or Single Case Experimental Designs (SCEDs)** Multiple SSEDs = Meta-analysis Focus on specific dependent variable \> only looking at a very narrow thing and use small element to make change Protocol minimises other confounds 'Experimental' means not a case study \> unbiases scheme of cause and effect Empirical research SCED guidelines: The Single-Case Reporting Guideline In Behavioural Interventions (SCRIBE)   **What is a Case Study? Is it OK?** - AKA 'Phase I' study - Detailed observations - Behaviours and outcomes measured quantitatively - Natural, real-life \> done in clinics and community - ++variables = causal effects unknown - Good for complex clients/rare conditions - Good to observe **treatment processes**   6.3 Creating Useful Graphics: Building Your Excel Skills **Important Concepts and Skills for ALHT211** - How to create basic graphs, tables and charts - How to consider the right visual for the data   - Quantitative (**descriptive** & inferential) - Qualitative Data (themes)         **Presenting data** - **Bar graphs** can show nominal data (variables with qualitative characteristic e.g., ethnic group, gender), categorical data, or percentages as shown in figure 1. - The length of the bars are proportional to the frequency or percentage of the category. - You should be able to see precise values for the bars on the axis.     **Presenting data** - Histograms typically display the differences in frequencies or percentages among categories of interval/ratio variables. - The width of the bars are proportional to the width of the category and height proportional to the frequency or percentage of that category. - The histogram can be used to display the relative frequencies. - It can also show the nature of the **distribution** of the data; i.e., whether the data are **normally distributed.**     **Presenting data** - Pie charts or pie graph stypically show the differences in frequencies or percentages among categories of nominal or ordinal variables. - The pie "slices" add up to 100% of the total frequencies      **Scatterplot** The scatterplot shows the distribution of two variables simultaneously. The relationship (or correlation) between two continuous variables is estimated.     **Presenting data** - **Boxplots** display two common measures of the variability or spread in a data set. Range: largest value minus smallest value, and IQR (interquartile range) : Q3 minus Q1. - The bottom whisker goes from Q1 to the smallest non-outlier in the data set, and the top whisker goes from Q3 to the largest non-outlier. - The body of the boxplot consists of a \"box\" (hence, the name), which goes from the lower quartile (Q1) to the upper quartile (Q3). - If the data set includes one or more outliers, they are plotted separately as points on the chart. - Within the box the line is the median of the data set. Two vertical lines, called whiskers, extend from the top and bottom of the box.      **Week 7 Introduction to qualitative research**   **Lecture objectives** - Differentiate between quantitative and qualitative study designs - Understand key theoretical underpinnings that inform qualitative research design - Describe the key characteristics and features of qualitative research design - Understand examples of qualitative research designs   Quantitative- distinct numbers Qualitative- finding about emotions and opinions related to themes/experiences    **What is qualitative research?** - Understand what a problem is or issue that needs to be explored - Assumptions inform the study of research problems - Involves the collection of data in a natural setting sensitive to the people and places under study\> usual environment - Establishes patterns and themes - The written report involves presentation of participant voices, reflexivity of the research and interpretation of the problem - All contributes to the literature or a call for change   - Addresses an individual or group of people\> helps us to understand that population sample - Main take away: Qualitative research understand a problem or issue that needs to be explored and understand assumptions/ opinions of the participants involved in the study   **Differences between qualitative and quantitative methods**      **Differences between qualitative and quantitative methods**   **Quantitative methods** - Provide mechanism in terms of which we can predict and control specific health variables: - Discovering the causes of disease or disabilities - Developing and validating assessment procedures - Evaluating the effectiveness of interventions   - predicting or controlling a variable   **Qualitative methods** - Provides evidence and theories that enable us to **understand** our participants as human beings \> client centred and holistic approach to client health - Examines **personal meanings of individuals experiences** and actions in the context of their social environment. - By 'qualitative' we mean that the data consists of language or pictures recorded by the researcher.   - Want to understand THEIR experiences and THEIR meaning - Tell a story   (Polgar & Thomas 2013)    **Differences between qualitative and quantitative methods**    **How does qualitative research inform practice?**   Think about your profession - Occupational Therapy or Speech Pathology   - Understand client experiences and perspectives - Facilitates a client-centred approach to clinical practice - One could make a good argument that healthcare professionals are informal qualitative methodologists when they interact with people in a setting everyday of their professional lives. - Need to be aware and understand the different qualitative methodologies and how the results can inform your practice.   (Creswell, 2013)   **Assumptions underpin qualitative research** - Ontological beliefs: - Multiple realities experienced by others that the researcher reports and staying separate to participants (e.g. particular client group might have unique and different experiences and perspectives). - Important that researcher reports and stays separate from participants - Gain multiple realities and beleifs   - Epistemological beliefs: - Getting closer to the lived experience of participants under study enhances the researchers understanding and capacity to report. (e.g. involves observation). - Observing participants - Immersion in the research   - Axiological beliefs: - Researcher discloses own bias and includes own values and perspective in interpretations - Researcher discloses their own opinions and values throughout the research   - Methodological beliefs: - The researcher follows a methodological structure, from the ground up to develop an understanding of the participants experience as analysis proceeds. - Uses a structures process to gain qualitative information and analyse data we have **Key Characteristics of Qualitative Research** - **Natural setting** - Researchers collect data on site where participants experience the problem - Gather up-close information   - **Researcher as a key instrument** - Research collects data themselves by examining documents, observing behaviour and interviewing participants   - **Multiple methods** - Typically gather multiple forms of data such as interviews, observations and documents   - **Complex reasoning: Inductive and/or deductive reasoning** - I**nductive reasoning:** "bottom-up" researcher working back and forth, collecting data to build patterns, categories and themes. Specific information to generalized information.   - **Deductive reasoning**: Build themes that are constantly checked against the data. - Generalised information \> specific information.   - **Participant meaning** - Focus is on learning the meaning that the participants hold about the problem or issue.   - **Emergent design** - The initial plan is not tightly prescribed- phases may change depending on the data collected. - Allow data to gradually guide the research program   - **Reflexivity** - Researchers position themselves and acknowledge how their background can inform the interpretation of the data. This involves self-reflection.   - **Holistic account** - About understanding the complex picture of the problem or issue under study. - Not able a cause and effect relationship-rather the complex interaction of factors in any situation.   **In health sciences 4 main type of qualitative research exist:**    - Type of research is influenced by different philosophical assumptions and interpretive frameworks. - Each stage of qualitative research can look similar or different for different types.  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Phenomenology\> UNDERSTAND LIVED EXPERIENCE**  **Learning Objectives** Students will: - Describe the nature of phenomenological research - Differentiate phenomenological research from other qualitative research methods   **Outline** - Purpose and Principles - Research questions - Data collection - Data analysis - Trustworthiness - Application to Allied Health (OT & SP)   **Purpose** - "...seeks to understand, describe and interpret human behaviour and the meaning individuals make of their experiences" (Liamputtong, 2017, p. 159) - Describe experiences from the perspective of (several) people who have the experience - (e.g., teenagers with disabilities, carers of people who have dementia) - Outcome: to improve policies and practices \> change deliverance of client services   **Types of phenomenology** - **Descriptive** -- Compile a composite description; find commonalities, describe features or essence of experiences   - **Interpretive or hermeneutic** -- derive and interpret meaning of the experience, consider individual components in relation to the whole   **Nature, principles** - Concept of 'lived experience': **only** those who have lived the experience are fully knowledgeable. - **Multiple realities** -- different perspectives from different people. Derive meaning from the same phenomenon in different ways - Explore perceptions -- seeing, hearing, feeling etc - Explore meaning -- thinking, reasoning, believing, valuing etc   **Research questions** What is the experience of...? - High school students who stutter with respect to friendships and bullying? - Older adults experiencing a fall? - Speech pathologists working in palliative care? - Occupational therapist in completing NDIS application forms?   **Data collection** - Collect multiple sources of data about a phenomena - In-depth interviews with participants - Surveys & questionnaires   - Usually 5 to 25 people who have experienced the phenomenon - Focus of questions: - What have you experienced? - What contexts or situations have influenced or affected your experiences?   **Data analysis** - Draw out statements or quotes that epitomise the experience - Determine theme or clusters of meaning - Describe the experience, conditions, situations or context - Describe the 'essence' of the experience **Narrative Research/ Inquiry \> PEOPLES EXPERIENCE FROM THEIR PERSPECTIVES**   Learning Objectives Students will - Describe the key features of narrative research - Differentiate narrative research from other qualitative research methods   **Outline** - Purpose and principles - Types of research questions - Data collection - Analysis - Application to speech pathology and occupational therapy   **What is narrative research?** - Study of - A spoken discourse or written text that provides an account of an event or series of events - The stories told by individuals, usually of experiences and the their personal meaning of those experiences. - Reveals - **People's experience, from their perspective** - What is important to people - The context that shapes their experience   **Types of narratives** - **Biographical** -- - experiences of another person's life   - **Autobiography** -- - described by the person who is the subject of the study   - **Ethnographical** -- - set within a (cultural) context - Understand series of events\> about a particular cultural context   - **Life history** -- - an account of a person's whole life   - **Oral history** -- - personal reflection of events and causes   **Types of research questions** - (what's the story here?) - What is the client experience of generalising voice changes into everyday contexts following therapy? - What is the experience of recovery from TBI in the teenage years? - How do parents approach and manage home practice for their child with a speech/language disorder? - How were new role-emerging placements for students in aged care settings developed?   **Participants** - People "who are rich in information and able to express their experiences or recall events in depth" (Liamputtong, 2013, p. 75) - **Purposive sampling** - Select small numbers; ensure participants have the desired qualities or abilities by setting inclusion and exclusion criteria - **Snowball sampling** - Ask participants to identify others with similar experience, often by forwarding information **Data collection** Conversations with participants In-depth interviews; variable structure & prompting \> MOST POPULAR Self-recording Journals, diaries and letters -- collect & review Methods of recording Make notes Audio record Audiovisual record Emails Graphic representations -- photos, drawings\> paediatrics not as experienced as expressing their feelings/emotions **Data Analysis** - The process of searching for the 'story' inherent in the telling of experience - Take a systematic approach to sifting through the data; impose a structure on the telling of a story - **Create a 'storied account'** and share with participant -- **narrative analysis** - Derive **themes** from the stories -- **analysis of narratives**   **Data Analysis** - **Preparation** - Listen to the interview - Transcribe data ourselves - Set in a table with space for analysis on the RHS - **Meaning** - **Thematic**: Identify common themes, often across several narratives - **Content**: Identification of key elements in the story - **Structure or Plot** - Organisation of the story - Abstract, Orientation, Complication, Result, Evaluation, Coda (Labov, 1972)   **Conclusion/summary** - Narrative research tells an account of events/actions chronologically connected - Different types and purposes **Ethnography\> explore culture or human behaviour** **Ethnographic Research Methods**   Learning Objectives Students will - Describe the key features of ethnographic research - Differentiate ethnographic research from other qualitative methods **Outline** - Purpose and Principles - Research questions - Data collection - Data analysis - Generalisability and critique - Application to speech pathology/occupational therapy   **Purpose and principles** - Understand the way of life or work for the group of people under study - Explore **culture and human behaviour** - Originally - travelled long distances to study isolated groups little known to the Western world; conducted over lengthy periods of time - (e.g., Margaret Mead -- Asia & Pacific). - Now - seek to understand people and events within local cultures (including roles, relationships, interactions, patterns of behaviour, rules,) - e.g. ethnic or social groups, neighbourhoods, workplaces, institutions, or groups in cyberspace.   **Research questions** - What are the key features of a typical work day for a hospital speech pathologist/occupational therapist? - What kinds of social environments are provided for residents of aged care facilities? - How does free play (e.g., recess, lunchtime) at school facilitate or inhibit communication for children with language disorders?   **Data collection** Fieldwork observation \> documenting them in a systematic way   1\. Observations about people, places, events and processes, 2\. Researcher's own actions and reactions, 3\. Theoretical insights, questions and reflections   Interviews and narratives Artefacts, photos, diaries, documents, clothing   **Data analysis** - Organise information\> organise it into a meaningful whole - **Interpret what the data means** - Other qualitative methodologies for analysis: **TRIANGULATION** - Content, Narrative, Comparative, Thematic - Comfortable with seeking an overall perspective of analysing the data from multiple different perspectives   - Four types of analysis: - **Domain** -- identify categories - **Taxonomic** -- how domains are organised - **Componential** -- attributes, contrasts, components - **Thematic** -- recurring principles, relationships among domains   **Generalisability of Findings** General relevance beyond the local circumstances in which it was produced when: - the case being studied represents only one part of the setting - the case being studied is typical of a larger collective Assess and present evidence about the validity of generalisations   **Critiquing Ethnography** - **Focus (wider topic)** -- its articulation (scope, boundaries), importance, relevance - **Case(s) studied** -- the limited aspect of the wider focus that is the actual subject of research - **Methods** -- including processes through which data are generated, relationships between ethnographers and participants, analytic techniques - **Claims about the case** -- different kinds of claims and the different kinds of evidence that would warrant them - **Conclusions drawn** --saying something about the wider focus, moving beyond the specific case(s) via e.g. theoretical inference, generalisations     - Overall reflecting on the process you have used which involves the critiquing of the process used   **In summary....** - Ethnography is a **form of research that has a specific interest in describing culture and in cultural interpretation** and analysis - Ethnography usually has most of the following features - People, words and actions are studied in everyday contexts: in other words research takes place in the field - Data are gathered from a range of **sources** but participant observation and interviews are usually the main ones - Data is for the most part relatively **unstructured** - The focus is usually on a single or a few cases: this is to facilitate in-depth study **\> small participant numbers are okay** - The categories for interpreting what people say or do are generated out of the process of data analysis **Grounded Theory\> GENERATE OR DISCOVER A THEORY** Overview - Design definition - Pertinent research questions - Participants - Ethical Issues - Data Collection - Data Analysis   **What is Grounded Theory?** "Grounded theory methods consist of systematic, yet flexible, guidelines for collecting and analysing qualitative data to construct theories 'grounded' in the data themselves." (Charmaz, 2006, p. 2)   - Inductive, bottom up approach - Look at participants, what their saying, explain their experiences, developing a theory that accounts for their experiences   **The principles** - Grounded theorists collect data **in order to develop a theory** - The purpose is to understand what happens in particular research settings and in the lives of research participants - The focus is on how people explain their experiences and what they mean - During analysis the researcher attempt to make sense of the statements and actions of participants by exploring connections between different 'codes', 'categories' and 'themes     - Grounded theorists start with an area of interest or a research problem BUT they do not start with a hypothesis that they aim to 'test' - Explore research problem, allow insight and issue to emerge from close examination of the problem   - Rather, insights and issues 'emerge' from close examination of the data and from researcher interpretation, and are built from the ground up - Data is simultaneously collected and analysed using a process called **'constant comparison'**   - **Quantitative: there is a set theory or hypothesis to test in relation to a problem. Qualitative: emergence of the data allows us to build a theory that represents the data appropriately**   **The proponents** - Grounded theory originally developed by Barney Glaser and Anselm Strauss, sociologists (Glaser & Strauss, 1967; Glaser, 1978) - Since then the authors have 'split' and evolved the grounded theory method in different ways - There are now three (3) main interpretations of this method used in research contexts   **Interpretations of Grounded Theory** **The process** There are different 'interpretations' of grounded theory methods, but almost all share the following steps in the process:    **START FROM \'BOTTOM UP\'**   **Pertinent research questions** - Grounded Theory is a helpful method to use when there is very little known or understood about a topic - It can help generate specific research questions to which quantitative methods can be applied - As a method it is highly suited to the exploration of 'complex phenomena' - As a method it is **highly suited to exploration of questions related to social constructs** -- i.e. how people interact with the world, each other and themselves   **Example research questions** - How do people experience chronic illness? (Charmaz, 1990) - How do adults with cerebral palsy and complex communication needs experience loss and grief? (Dark, Balandin, & Clemson, 2011) - How do Occupational Therapists understand and use intuition in mental health settings? (Chaffey, Unsworth, & Fossey, 2010) - How do community dwelling adults with diminishing autonomy define spirituality and its contribution to meaningful occupation? (Griffith, Caron, Desrosiers, & Thibeault, 2007)   **Participants** - The goal of recruitment for grounded theory studiesis to source a group of participants who have 'lived experience' of the topic in question - Small sample numbers are appropriate in grounded theory studies - In grounded theory, participants can be 'purposefully recruited' at late stages of a project to advance conceptual and theoretical development and ensure saturation of concepts   **Ethical issues** Informed consent Good communication ability (alternative and augmentative modes of communication are appropriate) Insight into own experiences Communication support Participant verification of emerging data   **Data Collection** - "All is data" (Glaser, 2002) - The aim of data collection is 'rich data' and 'rich description' - Therefore, data may take the form of: - Interviews - Focus groups - Written documents - Reports - Artefacts - Field notes and observations   **The Interview Conversation** - Intensive interviewing / In‐depth interviewing - An interview is a 'directed conversation' (Lofland & Lofland, 1984; 1995) - The purpose is to elicit a participant's interpretation of their own experience - -- The participant will be asked to: **reflect, describe, narrate, illustrate, explain** - A good interview schedule will be based on focused but **open ended questions**; an interviewer will be flexible and will follow the lead of the interviewee   **Data Analysis** - **In grounded theory methods, data is collected and analysed concurrently** - The analytic tool used in grounded theory is called '**coding**' (Charmaz, 2006) "Qualitative coding, the process of defining what the data are about, is our first analytic step. Coding means naming segments of data with a label that simultaneously categorises, summarises and accounts for each piece of data" (Charmaz, 2006, p. 43)   - **Coding generates themes**   **Coding** - Coding is the process that takes the researcher from **raw, concrete data to the framework for interpreting meaning** - Grounded Theory coding involves at least 2 phases: - 1\. An initial phase which involves naming each word, line or segment of data (Initial coding) - 2\. Selection of the most frequent initial codes to sort, synthesize, integrate and organise large amounts of data (Focused coding)\> themes   **Interpretation of Results** - **Interpretation happens at the same time as data analysis** - As codes are applied to data, the underlying aim is to understand and explain the meaning of the participant's experiences i.e. interpret what is happening for that person - In grounded theory, quality interpretation depends on good quality data and good quality analysis   **Presentation of Results** - In Grounded Theory, results are ultimately presented as a coherent theory that explains the experience in question - Often theories are visually represented as models which show how the different concepts and categories are related to each other; they often capture the complexity of an experience       Summary and key messages Grounded theory is a qualitative research method which utilises inductive methods to generate theory that is grounded in data ** There are different 'schools' of Grounded Theory** Processes for coding, categorising and integrating data are clearly explicated     **Week 9 Essential components of rigorous qualitative studies** **Lecture objectives** - Understand the processes involved in qualitative research - Understand trustworthiness and why is it important in qualitative research. - Understand the criteria is used to ensure trustworthiness in qualitative research. - Understand some strategies that support trustworthiness in qualitative research     **Qualitative Research Process**   **1. Research question/aim** **Examples below:** - How do speech pathologists use the Australian Aphasia Rehabilitation Pathway to inform practice? - To explore participants\' perceptions of their own experience of moments of stuttering. - To explore the experiences of young adults with developmental disabilities about their sexuality, their perceptions about how their sexuality was viewed by the community, and about the sexual education that is required and how it should be delivered. - To identify what children and adolescents with cerebral palsy suggest are effective ways for researchers to involve them as partners in research   **2. Choose qualitative research design** - Narrative - Phenomenology - Ethnography - Grounded theory - Interpretive description - Phenomenography - The type of qualitative approach may offer different ways of collecting, analysing and presenting data    - What we want to ensure is if we decide on a method of qualitataive data gathering we maintain the same process throughout   **Participant recruitment** Sampling Determined by the nature of your research question Need to include informed participants who have knowledge that is of interest to researchers **Purposive and convenience** sampling often used No requirement for a particular sample size Saturation point--- until no new data is emerging   - We want participants with an informed knowledge of what we want to explore - Lived experience or in depth knowledge     **Data Gathering strategies**   1. **Participation in the setting**   - Research can have involvement in the social group being studied - **Collecting what is seen and heard to analyse** - Different for different approaches - **Ethnography and narrative**: May involve participating in the setting (e.g. participating in a child classes and school events). - **Narrative**: May involve attending activities of participant and talking with people related to participant (e.g. school of child, family dinner).   - Researcher documents personal reflections and documents if and how the researchers' presence may be influencing the study participants' behaviour\> REFFLEXIVITY- understand we have/don't have an effect on the study and need to acknowledge it   **2. Observation** - Field notes that record a detailed, non-judgemental concrete description of what was observed - Researcher is not required to be actively involved - The meaning of what is observed can only be inferred, so qualitative studies often involve both observation and participation      **3. In-depth interviews** -- Face-to-face (or via zoom or telephone) -- Individual (or a focus group) Goal is to deeply explore an individual\'s ideas about a specific event or issue Interviews may be unstructured, semi structured or structured     **Example of a semi-structured interview questions**    **4. Analysis of documents and objects** - Known as secondary data - Secondary data source: Diaries, personal journals, historical documents, minutes of meetings, annual reports, newspapers, magazines, speeches. - Cultural artefacts and inanimate objects. - Different for different types of qualitative approaches and research question. - **Ethnography** may use artifacts, newspapers etc. - **Narrative** inquiry may use journals and diaries.     **Data analysis in qualitative research**   - Varies depending on the chosen research design (e.g. ethnography, phenomenology, grounded theory etc). - For example, thematic analysis is commonly used in phenomenology and grounded theory can use qualitative coding or constant comparison - General qualitative data analysis involves:   - Organising the data (NVIVO) - Reading and memoing - Describing the data into codes and themes - Classifying the data into codes and themes - Interpreting the data - Representing and visualizing the data    **Thematic analysis** Qualitative approaches are incredibly diverse complex and nuanced Thematic analysis can be seen as a foundational method for qualitative analysis Braun and Clarke (2006) and (2019) have an established thematic analysis phases   Phase 1. Familiarising yourself with the data \> reading through transcripts Phase 2. Generating initial codes Phase 3. Searching for themes Phase 4. Reviewing themes Phase 5. Defining and naming themes Phase 6. Producing the report \> summary of themes   **Thematic analysis** **1. Familiarising yourself with the data** - Transcribing the data \> rewriting out the transcripts - Reading and re-reading the data - Nothing down initial ideas or casual notes - Being thoughtful and curious about what you are reading \> reflective of participant responses - Not about attaching labels- comes later - Process of becoming immersed in the data and connecting with it - It is about "knowing" your data   **2. Generating initial codes**: - Coding interesting features of the data in a systematic fashion across the entire data set, collating data relevant to each code - Organising the data into meaningful groups - Giving data clear labels to help organise data around meaning-patterns        **Thematic analysis** **3. Searching for themes** Collecting codes into potential themes, gathering data relevant to each potential theme   **4. Reviewing themes** Checking that themes work in relation to all codes. Might involve making a mind map.   **5. Defining and naming themes** Ongoing analysis to refine specifics of each theme, clear definition of each theme   - Do these individually and then come together with other researchers   **Thematic analysis- codes and themes**     **Reflexive Thematic Analysis** - Reflexive put simply- is about reflection - The role of the researchers and reflexivity must be considered through the research process - Reflecting on the research and the research process, and the impact you have has researchers on the research process, can lead to new insights and new discoveries      **Reflexive Thematic Analysis**   - Braun and Clark (2019) emphasise the importance of being **reflexive** while engaging in thematic analysis by remembering: - Not a baking recipe that needs to be followed precisely to ensure an effective outcome - Reflection and transparency should be recorded - Themes - Not summaries of the data- they are meaning - Not waiting in the data to emerge - Creative and interpretive stories about the data - Collaborative between all researches     **Presenting qualitative research** - Presenting themes - Quotes and fieldnotes - Tables - Diagrams - Figures - Different for different approaches - Grounded theory aims to present a theory - Narrative enquiry aims to present a story   **Presenting qualitative research** Can present as a diagram      **5-step process for client--centred EBP (5 A's)** 1\. **Ask**: Translate uncertainty into an answerable question   2\. **Acquire**: Systematic retrieval of best available evidence   3\. **Appraise**: Critical appraisal of evidence for validity, relevance and applicability   4\. **Apply**: Application of results in practice   5\. **Assess**: Evaluation of performance   **TRUSWORTHINESS** **What is trust worthiness in qualitative research?**   - The **quality and rigor** in qualitative enquiry - Findings are authentic enough to allow practitioners to act upon them with confidence - Ensures quality of the findings increases the reader's confidence in the findings - Requires logical connections among ALL STEPS of the research process - To consider from start to finish (e.g. research question, data collection, data analysis and data interpretation)         **Ensuring trustworthiness of the research** A number of strategies can be implemented to ensure the trustworthiness of the research by looking at the transparency of: -- Methods& processes used to collect data. -- How data is compressed. -- How data is analysed.    **Triangulation** Triangulation of data contributes to the trustworthiness of the findings that are generated The aim is to enhance validity by using more than one:   -- Theory -- Data sources (participants from different settings) -- Data collection method (interviews, focus groups, observation)    - Ensure the us of multiple methods of data resources in qualitative research- develop a comprehensive understanding of a phenomenon - More than 1 theory, data sources, data collection method     **Role of the researcher and reflexivity** - The researcher in any qualitative study brings with them potential influences and biases to the study - The role of the researcher and reflexivity must be considered through the research process - Reflective stance can be engaged in that involves exploring the researcher/s/ experiences and how these may have influenced aspects of the project - Consider the rapport developed with participants and how this could impact stages of data collection and analysis.   **Audit trail and reflective commentary** - Important to track ones reflections (journal) and data analysis processes   - **Reflective commentary:** - **Bracketing**: This involves recognising and recording in a document ones understanding and ideas you have about the topic before starting the project (Thorne, 2016). - **"Reflective commentary**" involves recording impressions of interviews and reflections regarding patterns emerging in the data prior to and throughout data collection and data analysis process (Shenton, 2004). - **Audit trail:** - The research processes, including data collection and data analysis process, can be recorded as an audit trail in a word document.     **Member Checks** - Respondent validation can be sought once initial themes are generated. - Participants can be asked if themes represented their experiences and if they wanted to add any other perspectives.   **Peer debriefing and review** - Through discussion, the vision of the investigator may be widened as others bring to bear their experiences and perceptions - Collaborative sessions can be used by the researcher to discuss alternative approaches - One than one researcher involved in analysis/coding - Opportunities for scrutiny of the project by colleagues, peers and academics should be welcomed (e.g. conferences and presentations)     ** Week 10 Mixed methods** ** ** Learning outcomes - Describe the key features of Mixed Methods research - Explain the main ways of constructing mixed methodological research projects - Justify when mixed methodology is preferable to another design in research projects - Discuss mixed methodology in relation to research design   **Mixed methods designs**   - **Mixed methods research designs involve [both qualitative and quantitative data. ]** - Mixed methods research is a research design recognises that reality is complex and can be best understood through multiple perspectives.   **Central premis**e**- a combination of methods provides a better understanding of the research problem**.   **Core Characteristics of MM** **The researcher**: 1\. Collects and rigorously analyses both qualitative and quantitative data (at least one strand of each)   2.Mixes (integrates/links) the two forms of data **either:** **Concurrently**- by combining them (or merging them) **Sequentially**-- by having one build on the other **Embedding** -- one within the other   3\. Gives priority to one or both forms of the data (depending on the research emphasis)   4\. Uses these procedures in a **[single study]** or in **[multiple phases]** of a program of study.     Mixed Methods Example 1: - **Study Focus**: Patient perspectives of rehab gaming technology. - **Qualitative strand (primary)**: Patient interviews - **Quantitative strand (secondary)**: System Usability Scale - **Embedded concurrent design**        **When to use MMs (mixed methods)**   The researcher must **[justify]** why a mixed methods design is required: - One data source may be insufficient - Results need to be explained - Exploratory findings need to be generalised- reflect the wider population - A second method is needed to enhance a primary method (embed) - An overall research objective can be best addressed with multiple phases or projects     **Theoretical underpinnings of MM** - Pragmatism is the theory underpinning MM - Pragmatism is the connection between knowledge and the methods by which the knowledge is gained. - Pragmatism seeks the middle ground between the objective (quantitative = positivism) and subjective (qualitative = constructivism) positions. - In a pragmatic approach the **[focus becomes the research question]** that requires answers by whatever mix of approaches appears to be most useful.   Break   **Choosing an appropriate mixed methods design** Four key decisions: 1. The level of interaction between the strands 2. The relative priority of the strands 3. The **timing** of the strand 4. The procedures for **mixing** the strands   Mixed Methods Example 1: - **Study Focus**: Patient perspectives of rehab gaming technology. - **Qualitative strand (primary)**: Patient interviews - **Quantitative strand (secondary)**: System Usability Scale - **Embedded concurrent design**     **The level of interaction between the strands** The extent to which the strands are kept separate or interact with each other   Two general options:   A. An **independent** level of interaction: the research questions, the data collection and data analysis are kept separate -- only brought together when the researcher is drawing conclusions during overall interpretation.   B. An **interactive** level of interaction -- direct interaction of the two strands the methods are brought together BEFORE the final interpretation. This can occur in many different ways   **The relative priority of the strands** Priority: the relative importance or weighting of the quantitative or qualitative methods for answering the studies questions.   The three possible weightings: 1\. An **equal priority** -- both equally address the research problem 2\. A **quantitative priority** -- with the qualitative strand having a secondary role 3\. A **qualitative priority** -- with the quantitative methods have a secondary role     **Timing of the two strands** ** "Timing" refers when qualitative and quantitative elements are conducted**   Three ways: 1\. **Concurrent** -- implements both strands during a single phase of the study. 2\. **Sequential** -- strand simplemented in two different phases- collection and analysis of one after the collection and analysis of the other. Either method can be first (depending on design) 3\. **Multiphase combination** -- multiple phases of sequential or concurrent timing over a program of study   **Mixing the strands** Refers to how the researcher brings together/integrates the two strands of data. **The point of interface** -- the point at which the two strands are mixed.   **Four potential points:** 1\. At the interpretation stage 2\. At the analysis stage 3\. At the data collection stage 4\. At the design stage   1\. During interpretation -- when the two strands are mixed during the final step of research process- after both sets of data have been collected and analysed. What has been learned from combining the results.   2\. During data analysis -- analyses each separately then merges the two sets of results for a combined analysis- relates the results of one to the other   3\. During data collection -- mixing the strands when the second set of data is being collected. Uses strategy of connecting one strand builds on the result of the other -- the results of the first strand used to shape the collection of data in the second   4\. At the level of design -- embedding or using theoretical framework -- embed one within the study that is of the other type.   Break     **The convergent parallel design** - Concurrent (same) timing for implementing both strands during the same phase of the process - Equal priority - Strands independent during analysis - Mixes the results during overall interpretation     **The Explanatory sequential design** Two distinct interactive phases: First: [collection and analysis] of quantitative data This phase has the priority for addressing the studies questions Second phase: is the qualitative phase. It follows from the results of the first phase   Interpret how the qualitative results help explain the initial quantitative results   **The exploratory sequential design** First phase - begins with and prioritises the collection and the analysis of the qualitative -- to explore Second phase - built on first to test or generalise the initial results.- quantitative The researcher interprets how the quantitative results build on the initial qualitative results.                  **The embedded design** - Researcher collects and analyses both quantitative and qualitative within either a traditional qualitative or quantitative design - Adds a strand of one within the other -- to enhance the design in some way.     **Transformative design** - A mixed methods design the researcher shapes within a transformative theoretical framework - All decisions about timing, priority etc. are made within the context of the transformative framework. - The dark box is the theoretical framework that determines the study   - When a study is shaped by a theoretical framework      **The multiphase design** - Combines both concurrent and sequential designs over time within a program of study addressing an overall program objective. - Often used for the development, adaptation and evaluation of specific programs.   - Combine and compare multiple studies and their benefits/ weaknesses   Mixed Methods Example 2: ** Study Focus**: Implementation of robotics. ** Qualitative strand:** Therapist focus groups pre/post implementation ** Quantitative strand**: Audits & Observation studies ** Multi-phase design**     **How to describe the mixed method design being used** 1. Report the aim of the study 2. Identify the type of mixed methods design being used -- use the full name 3. Give the defining characteristics of the design -- level of interaction, timing, priority and mixing decisions 4. State the [overall purpose or rationale for using this design] -- by providing a statement for the purpose of the quantitative and the qualitative design (in order appropriate to the design). 5. Provide rationale for why both strands are needed.     **Week 11 Evidence--informed Practice for Aboriginal and Torres Strait Islander Peoples** **Learning Objectives** HCF 8.2 Analyse the contemporary role of Aboriginal and Torres Strait Islander **health professionals, organisations and communities** in delivering culturally safe health care to Aboriginal and Torres Strait Islander clients - Recognise the impact of bias in developing clinical expertise and culturally safe service contexts - Utilise evidence-informed grey literature (organisations) - Demonstrate understanding of community, and Aboriginal and Torres Strait Islander Allied Health professionals as experts in guiding culturally safe, evidence-informed interprofessional health care and research      - Aiming for the spot in the middle of the evidence based practice framework         **[CULTURAL SAFETY & CRITICAL REFLEXIVITY]**   **Cultural safety** - Cultural safety is unique as a first nations led approach - Facilitates change in organisations/ communities/ businesses - How we analyse power ratios - It\'s a life long journey and ongoing   **Cultural responsiveness** - Training - Doesn\'t examine power/ right/ white privileged - Process and practice to achieve cultural safety BUT NOT cultural safety itself   **Cultural awareness** - Focus on Aboriginal people themselves including their practices rather than non\--indigenous people examining their own cultures - Identify your own culture and be aware of the biases or affects   **Cultural respect and security** - Only use in NT and WA   **Cultural competence- problematic term** - Was used in terms of the diversity in languages and cultural linguistics - NOT first nations people specifically - Framework is problematic- comes across as \"you can become competent in diversity of culture\" NOT USED ANYMORE (cannot be culturally competent in all of the country\'s of first nations people)       **Community Needs and Service Context** "Chapter 13: Interdisciplinary Care to Enhance Mental Health and Social and Emotional Wellbeing" (Schultz, et al, 2014)   - "Bio-psycho-socio-cultural-spiritual framework" (p.226) \> biological/ psychosocial/socioeconomic/ cultural factors   - Cultural, socio-economic, biological, cultural, spiritual factors - ALL these factors should support the people/ family/ carers/ communities involved - **Family, carers, community & interprofessional team**   - EBP framework- community needs and preferences are at the forefront of our approach/ service - Service context and clinical expertise are guided by community needs and preferences     **Community Needs and Service Context** **Service type** Is it a local Aboriginal led organisation? Is there access to community-led cultural safety training? Are there Aboriginal and Torres Strait Islander Health professionals employees? **Location** Is there an Aboriginal Community Controlled Health Organisation (ACCHO) or Affiliate nearby? Rural/remote/urban?   Creating a culturally safe space involves a high level of **critical reflexivity**   Importantly, c**ultural safety** is not something that the practitioner, system, organisation or program can claim to provide... it is something that is **experienced by the consumer/client**"   Cultural safety **requires us to ask the client or service** recipient whether they felt they were treated with respect, and had their **culture, values and preferences taken into account** - whether they felt **safe** Walker, Schultz & Sonn 2014, p.201   **Community Needs and Clinical Expertise** - **Cultural Safety** - Life-long learning - Listening to people and learning from people in community, on country - **Diverse**: No one body of information - An understanding of your worldview and reflective practice on hidden bias - Recognition and understanding of white privilege in society - Historical and systemic bias - Requires **Critical Reflexivity**   **Community Needs and Clinical Expertise PRACTICE** - Community-led cultural safety training Contacting the local/regional Aboriginal community controlled health organisations (ACCHOs) - Contacting Aboriginal liaison officers /interpreters - The source of referral is important -- is it family and community? Or other? - Engagement in community, beyond the individual to genuinely understand community values, needs & protocols - Develop resources from Aboriginal & Torres Strait Islander organisations   (Armstrong et al., 2019; Mohamed et al., 2024)        **KEY: MAKE THE PROCESS COMMUNITY LED**   **[EXTERNAL EVIDENCE: RESOURCES & GREY LITERATURE]**   **The Lowitja Institute** - Health and wellbeing of Aboriginal and Torres Strait Islander people - Quality Research - Knowledge exchange - Supporting Aboriginal and Torres Strait Islander researchers and the health care workforce Lowitja Insititute (2024)            **External Evidence -- Grey Literature** Non-Indigenous Organisations   Examples: ✓NHMRC Guidelines ✓OTA, OTC & SPA Ethics and Guidelines ✓AHPRA **[Aboriginal and Torres Strait Islander Health Strategy ]** ✓Government reports & policy documents ✓Census disease registries   Other Published AND Unpublished examples: ✓Theses and essays ✓Newspaper articles ✓Newsletters & bulletins **✓Cultural knowledge** **✓Traditional or community knowledge** **✓Oral histories**     **[ABORIGINAL & TORRES STRAIT ISLANDER RESEARCH & METHODOLOGIES]**      **External Evidence -- Research & Critical Appraisal** Ethical Research: Five key principles   **1.Net Benefits for Aboriginal people and communities** - Who are the communities and the people? - How will the outcome of the paper benefit the individual participants and the communities in which they come from? - Who decides/gives feedback on whether the benefit is real, or perceived by the investigators? - What will happen to this information next?   - How was the paper evaluated by people in the community? - Research SHOULD involve first nations people! As investigators!     **2. Aboriginal community control of research** - Is the research led by Aboriginal and/or Torres Strait Islander researchers? - Are the authors from the communities within the project? - If not, how has community been involved in the research? - Is community control evident in every section of the paper? (e.g. from background, recruitment, method, data collection member checking etc)   - MUST find our more from the local communities and associated population -       **3. Cultural sensitivity** - Have elements been addressed in relation to cultural practices and beliefs at a local context (eg kinship, reciprocity) (Department of Health, 2014) - Has the impact of history, colonisation and oppression been addressed? (Eg in the method of data collection: see Gibson et al. 2018) - Are all resources culturally appropriate? How do you know? - Do the measures/methods reflect the community needs?   4\. Reimbursement of costs *There must not be any imposition upon Aboriginal people and communities to be involved in the research project*: Has the cost of travel and time been considered?   5\. Enhancing Aboriginal skills and knowledge Are Aboriginal Community Organisations, Reference Groups, participants and/or researchers a part of the team?   **Aboriginal and Torres Strait Islander Research Methodologies** - Incorporate Aboriginal and Torres Strait Islander ways of knowing, being and doing (Riley, 2021) - Consider '8 ways' (Yunkaporta, 2009) - Processes take time (Riley, 2021) - Dadirri (Deep listening) (Miriam-Rose Foundation, 1988) - Use of Grey Literature (Laycock et al, 2011) - Indigenous Standpoint Theory (Nakata, 2007)      - These processes take time and embrace the slow journey to health - Literature has been lost into a white- centralised academic population - Consider how we share knowledge   **Yarning** Atkinson et al (2021): - Knowing -- Epistemology - qualitative research - Being -- Ontology - Doing -- Axiology   QUALITATIVE METHODS   Kennedy et al (2022) Culturally safe Privileges knowledge systems - Used yarning as a data collection method - Included it\'s a culturally safe strategy of data collection - Improves the knowledge system of those and where tha data is coming form - Consider: HOW was the yarning conducted? And WHERE did the data stem form?    BUT: critical review of processes is necessary!     **Aboriginal and Torres Strait Islander Research Methodologies** **For Qualitative AND Quantitative studies (and culturally safe practice)**   - Yarning to inform data design and data analysis (Gibson et al, 2020) - Use appropriate outcome measures eg Australian Therapy Outcome Measure for Indigenous Clients \[ATOMIC\] (Hill et al., 2020) - Validity of adapted/modified outcome measures - Most standardised tools inappropriate, do not fit world view of communities - Risk to cultural safety in communication disorders (Armstrong et al., 2024) - Knowledge translation to inform communities and policy: ensure benefit