Stage 1 – Research Methods Research Methods

Qualitative health research (S6)

Qualitative Research:
 “Seeks to describe and analyse the culture and behaviour of humans and their groups from the point of view of those being
studied” -- (Bryman)
 “Blanket designation for all forms of social inquiry that rely primarily on qualitative data … understanding the meaning of
human action.” (Schwandt)
What are some examples of qualitative data?
 Qualitative health research is not:
o Survey research**
o Anecdotal - does generate empirical data
o Airy fairy - follows a systematic, scientific process
Choose Wisely “Providers and patients must share responsibility for understanding individual patients’ goals and preferences
and for making decisions about treatments.”
Paradigm
 Inductivist: Theory is derived from research (not tested by research)
 Constructivist: Meaning is built by the interaction between the researcher and participants
 Intrepretivist: understanding the world through they way participants interpret it

Quantitative Qualitative

• To quantify relationships among variables • To describe, understand, explore a central

phenomenon
• To explore and/or test hypotheses based on • To explore phenomena and generate hypotheses
predicted associations among variables
• To quantify relationships among variables, i.e. • To describe and explain associations e.g.
measure the strength of associations and the contextual or social reasons
probability that the association exists in the larger
population

Why use qualitative research - A qualitative approach would be used when you want to:
 Know about “how” not “how many”
 Gain a deep understanding
 Generate new theories or hypotheses
 Explain a behaviour or observation (not to describe the action/choice)
 Give people a voice  attitudes, beliefs, values, concerns, aspirations, culture, goals
Research
 Initial design: generate hypothesis, needs assessment, describe context or potential barriers for a new intervention, inform
development of an intervention, define outcomes of importance, inform survey design.
 Process evaluation: assess participation in research, barriers and facilitators of uptake/implementation, responses to the
intervention
 Outcome evaluations: identify reasons for patterns and trends in the results, explain differences in effectiveness, generate
further hypothesis
Practice
 Shared decision-making: decision aids and doctor-patient communication to discuss treatment options and clarify values
and preferences
 Patient educational resources: information about disease, treatment options, access to services that are important and
relevant to patients
 Clinical quality measures: define and measure quality indicators that concord with patient preferences
 Policy
 Funding priorities: inclusion of stakeholder priorities
 Practice guidelines: underpin recommendations for patient-centered care
 Clinical quality measures: define and measure quality indicators that concord with patient preferences
Limitations
 Does not assess frequency (e.g. of opinion)
 Cannot produce “generalisable” results (can be transferable)
 Difficult to replicate
 Lack of transparency
 Inevitably subjective
 Respondent dependent
Methodology: A way of thinking about and studying social reality (underlying theory or framework that guides the choice of
methods and research process)
Methods: A set of procedures and techniques for data collection and analysis
Common methodologies used in health research:
Grounded theory: Systematic and iterative data collection and constant comparative analysis to develop conceptual frameworks
or theories about social processes.
Phenomenology: Philosophy based on reflective inquiry and description of the “lived experience” in a given context – explanations
for actions.
Ethnography: Process of describing and interpreting the behaviours and actions of social groups or cultures usually through
interviews and observations – defined population, detailed fieldwork
Qualitative study - Study design
Where do I start?
 Identify the problem/phenomenon that you want to understand (based on observations, experience)
 Literature review (ideally systematic review [ENTREQ]): gain familiarity, avoid duplication, identify knowledge gaps

Focus of the study | What do you want to know about?

Individuals
 Perspectives, attitudes, experiences of individuals
 Example: Impact of disease on personal identity and relationships
Groups
 Cultures, communities, ethnic groups
 Example: Perspectives of Aboriginal people on access to healthcare
Structure
 Government, social networks, hospitals
 Example: How organisational structures impact guideline implementation
Concepts
 Theories, ideas, notions (e.g. hope)
 Example: Hope in advance care planning
Processes
 Processes or action (e.g. recovery, childbirth)
 Example: How first-time mothers experience antenatal care
Scope of study
 Research Question
 Sites
 Participants
o Participant selection strategies
o Why do we need to select?
 Usually not feasible to select the whole population of interest
 Time limited
 Access
 Key informants: who can best provide an answer to your
research questions?
 Sample for meaning (not frequency)
 Resources (time, Funding, personnel)

Quantitative Qualitative

• Larger sample size (to reduce sampling error, • Smaller sample size (select information-rich
provide adequate power, and achieve statistical participants to gain in-depth insight)
representativeness)

• Random • Purposive

• Pre-determined • Depends on progress of analysis

• Statistical results • Seek “saturation” of concepts

Purposive - To intentionally recruit a sample who can provide diverse, comprehensive, and relevant information.
Theoretical - Usually used in grounded theory where participants are selected to test theory emerging in concurrent analysis, or to
provide further information on specific concepts.
Snowball - To identify subsequent respondents by asking participants to identify individuals who can give important and relevant
insights on the research topic.
Convenience - To select participants who are easily accessible and are willing to participate.
Purposive - Sample size
 Ranges from n = 1 to 200 (can be more)
o Interview studies should have at least 25 participants
 Depends on the scope of the research question
 Feasibility (time, funding, personnel)
 Publishability
Theoretical/data saturation
 When little or no new data (issues/points) are being raised in subsequent data collection
 Gained a deep and comprehensive understanding
 Within subgroups or across all participants?
Observation - Study events and actions within a particular social or historical context
 “Systematic method of data collection that relies on the researcher’s ability to gather data through their senses within real-
world contexts” (O’Leary)
 Used with other methods
Advantages
  See how people act (which can be different to they way they think they act)
 See practices and interactions in context (quality improvement)
 Flexible
 Suitable for addressing organisational questions
 Include material and non-human components
Disadvantages
 Time consuming and costly
 Barriers to access
Document analysis
Identify, organise, evaluate, synthesise documentary data
Types of documents
 Public: newspapers, magazines, social media (tweets, blogs, websites, youtube), speech transcripts, published policies
 Personal: letters, emails, journals, portfolios
 Practical: manuals, flow charts, protocols
 Files: meeting minutes, memos
Interviews
 Elicit an individual’s perspectives
o “A specific form of conversation where knowledge is produced through the interaction between an interviewer and
interviewee.” (Kvale 2007)
o Partnership  meaning-making
o Non-structured (flexible – change questions/order) (Example – shortened)
o In-depth information and understanding i.e. a D&M with an EXPERIENCES OF ELDERLY KIDNEY TRANSPLANT RECIPIENTS
agenda
o Usually one-to-one Decision-making regarding current transplant
 Why interview? • Could you tell me about how you came to decide to have
o Interested in an individual’s knowledge, perspectives, values, a kidney transplant?
goals, interactions Experience of kidney transplantation
o Personal topics e.g. treatment decision-making other topics?
 Where should interviews be conducted? • How has your life changed since the transplant?
o Comfort, privacy, quiet, convenient Self-management
o Home vs. clinical setting • What do you do to maintain your health – why?
 In-person vs phone/skype • What challenges do you face and how do you cope with
 Types of interviews it?
o Structured interviews  (quantitative) Health outlook (prognosis)
o Semi-structured interviews (more common)
o In-depth / unstructured interviews (narratives, life stories) • Have you thought of what might happen with your health
 Interview guide in the next year, 5 years, 10 years – could you tell me
o Starting point / living document what goes through your mind?
o Evolves over subsequent interviews Support
o Need to adapt questions to paint the full picture
Designing the interview guide
• What sorts of things could you suggest that might help to
improve the experiences of elderly kidney transplant
 Start from the research topic/research questions
recipients?
 Literature/peer input
 Break down into subtopics/domains
 Generate broad questions and prompts for each
 Structure and flow (natural; easy  complex)
Interview guide
 Introduction: who you are, purpose of research, interest in participant, confidentiality, recording
 Opening questions: get participants orientated to the topic, sets the context, easy questions
What is the first word that comes to mind when I say cancer?
 Broad questions: opens the subject, widen perspectives
 Prompts: detailed explanations, elaboration, ask for reasons
 Closing questions: gives opportunities to express additional perspectives
o Is there something else that you think might be important to mention?
o Open ended +++
o Flexible
o Map
Ways of asking
 Thematic/content
 Dynamic
 Probes – details & clarification
o Introductory and opening
o E.g. elaboration, continuation, clarification, attention
o Open-ended
o Silence can be important (reflection, fatigue)
Probes – description and examples
 Elaboration: to ask for more detail e.g. “Can you tell me a little more about that?” “What did she say to you?” “Can you
give me an example?”
 Continuation: to encourage the participant to keep talking e.g. “Go on”, body language, ‘silence’
 Clarification: to resolve ambiguities or confusion about meaning e.g. “Do you mean that you feel guilty because you are
tired?”
 Attention: to indicate that the interview is paying attention e.g. “I see, that’s really interesting.”
 Completion: to encourage the participant to finish a particular line of thought e.g. “You said that you told your doctor,
what happened then?”
 Extend: to explore confirmatory, different or additional views on a concept raised by previous participants e.g. “A few
people have mentioned [x], what do you think about that?”
 Rating scales: e.g. “On a scale from 0 (being completely dependent) to 10 (being completely independent/self-reliant),
how would you rate yourself and why?
 Ideal world: “If you could talk to your younger self about staying healthy, what advice would you give?” “If you were given
a million dollars…” “If there was one thing you could change…”
Focus groups - In-depth discussion that capitalises on group interaction
“… encourage interaction between research participants as much as possible. When group dynamics work well the co-participants
act as co-researchers taking the research into new and often unexpected directions and engaging in interaction that is both
complementary and argumentative (questioning, challenging, and disagreeing with each other).” – Kitzinger 1994
 Facilitated
 Allows exploration and clarification of views
 Participants usually share a social or cultural experience
 1.5 – 2 hours
 It is NOT:
o a group interview
o a support group
o used to achieve consensus
o used to quantify opinions
Why run focus groups?
 To research “sensitive” populations e.g. those who feel more relaxed about talking with others who have a shared experience
(ethnic minority groups, refugees)
 Brainstorm (e.g. develop an intervention)
 Explore the processes of reasoning and debating
Embedding activities
 Prioritisation e.g. nominal group technique, rating, ranking
 Hypothetical scenarios
 Elicit reactions to data
Participants
 Homogenous versus heterogeneous
 Shared experiences – participants feel others in the group can relate and understand them better
 Known vs. unknown to each other (inhibit responses?)
 6-8 participants per group
 3-5 sessions are recommended for each “variable” of investigation
 Interact well enough to generate meaningful discussions
Run sheet and Question guide
1. Ice-breaker questions: connect
2. Introductory questions: being topic discussion
3. Transition questions
4. Key questions: develop insights into central issues
5. Closing
Quantitative Qualitative

• Descriptive statistical analysis, variance of • Reading of the data, making memos,

responses, determine general trends conceptualising the data, grouping concepts
into themes, identifying patterns and
relationships among themes

• Inferential analysis and refined analysis • Coding and identifying concepts, grouping into
using the appropriate statistical tests themes

• Software used to conduct statistical analysis • Software used to store, label, retrieve data
(facilitates but does not do analysis)

• Quantified estimates of effect or • Narrative and rich description

associations, statistics

• Frequency • Breadth and depth

• Emphasis on generalisability (involves • Emphasis on transferability of concepts and

statistical analysis to determine the extent
to which the findings can be extrapolated to
another population)
Recording and transcription
 Recording the interview/focus groups
theories (the reader determines whether the
findings “fit” or resonate in their own context or
experience)
 o Allows maximum interaction and engagement
o Consider volume and background noise
 Transcribing the interview/focus group
o Transforms audio recording into text
o Verbatim: word for word, questions and answers
o Level of transcription (content/linguistics)
Data Analysis
Aims of analysis
 Condensing copious amounts of data
 Capture the breadth and depth of the data
 Comprehensible, insightful, trustworthy, compelling, original
 Answer the research question
 Describe phenomena
 Develop a theory or explanation
Principles
 Aligns with the topic and scope of the research question
 Consider audience: Done concurrently with data collection
 Generally inductive
 The researcher is an active participant
o Methodology  output
o Qualitative study
o Grounded theory ([sociology] generate theory, uncover social processes, explain behaviour)
o Ethnography ([anthropology] study of culture)
o Phenomenology (understandings and interpretations of their “lived experience” to explain behaviours)
Coding
Codes are tags or labels for assigning units of meaning to the descriptive or inferential information compiled during a study. Codes
usually are attached to “chunks” of varying size – words, phrases, sentences or whole paragraphs, connected or unconnected to a
specific setting” (Miles and Huberman 1994)

 Starting point for most forms of qualitative data analysis

 “Process of defining what the data are about” (Charmaz 2006)
 Coding is highlighting relevant segments of words and involves
o Classifying relevant words
o Conceptualising the data
o Raising questions
o Seeking explanations
o Noticing relationships
Analysis
 Thematic analysis
 Content analysis
 Grounded theory analysis
Thematic analysis
 Usually inductive – derived from the data
 Constant comparisons within and across sources
 Output  themes (full of meaning)
Content analysis
 Deductive: code data into codes identified and defined apriori
 Used when a meaningful denominator exists for reporting proportions
 Inter-rater reliability
Grounded theory analysis
 Open coding: generating preliminary initial concepts from the data
 Axial coding: reviewing, developing, linking, grouping codes/concepts
 Selective coding: organising and formalising relationships, developing theoretical frameworks
 Memoing
Theory
“An organised, coherent, systematic articulation of a set of [ideas or concepts] that are communicated as a meaningful whole.”
(Reeves 2008)
 Provides a framework for thinking about a problem
 Guides study design (e.g. what to focus on)
 Guides data analysis (e.g. tools for interpretation  not to be a restrictive lens)
Developing theory
 Individual insights  understanding the wider relevance (conceptual transferability)
Reporting and rigour
“A concise, coherent, logical, non-repetitive, and interesting account of the story the data tell – within and across themes.”
“Convince the reader of the merit and validity of your analysis.” (Braun & Clarke 2006)
 Credibility
 Dependability– is the process logical and auditable?
o Dependability Interpretation is intrinsic, not feasible to produce identical findings
o Coherent link  Methodology, methods, data, findings
o Clarity about how data were collected and analyzed to demonstrate rigorous and systematic approach
 Transferability
 Confirmability
 Credibility – can the findings be trusted?
o Multiple realities exist (not measuring an objective reality)
o Offers well-rounded, reliable, and sensible explanations based on evidence
 Appropriate question guide
 Purposive sampling
 Thick description – context and findings described in detail
 Reflexivity – researchers identify and address own biases that may have influenced decisions made during the study
 Triangulation – methodological, theoretical, data/sources, researcher, interdisciplinary
Recording of data
 Transcription – verbatim
o Computer software
 Transferability – are the findings relevant to other settings?
o Concepts and theories are relevant and have implications elsewhere
o Comparison with other studies
 Thick description – study setting and participant characteristics are described in detail
 Confirmability – are the findings and interpretations linked to the data?
o I.e. not a product of the researcher’s imagination
o “Accurately” reflects participant perspectives
 Investigator checking – multiple investigators to ensure that analysis captures full breadth and depth of data
 Member checking – participants provide feedback on preliminary findings; integrated
 Raw data – e.g. quotations
Projects
Opportunities
 What topics/research questions are you interested in?
 Can you embed a qualitative component in your studies? E.g. evaluation

Quantitative Qualitative

• Objective reality to be • Reality is socially constructed

observed and discovered by an individual, which cannot
be measured but it can be
interpreted; contextual

• Reliability: stability of findings • Reliability: consistency and

trustworthiness of findings
(Kvale)

• Validity: truthfulness of • Validity: whether a method

findings i.e. measurement investigates what it purports to
investigate (Kvale)