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Qualitative Research Design

Mental Health Epidemiological and Research Methods

Mental Health Program

Learning objectives

By the end of this session, the participant will be able to:

• Contemplate the history and main concept in qualitative research

• Identify the different qualitative research designs
• Understand the Features Of Qualitative Research Design
• Describe the Sampling and Data Analysis in Qualitative Research
Session Topics

• Topic 1: Introduction To Qualitative Research History and Concepts

• Topic 2 : Qualitative Research Design
• Topic 3: Features Of Qualitative Research Design
• Topic 4: Sampling and Data Analysis in Qualitative Research
Introduction To Qualitative
History and Concepts

There is a rich tradition of using qualitative methods in mental health services

research, most notably represented in the ethnographies of populations with
mental health problems , and the institutions that serve them. Nevertheless,
as in other areas of scientific research , qualitative methods in mental health
services research have long been regarded as being “unscientific”, largely due
to a lack of understanding of and experience with such methods.
This perspective began to change in the last two decades with calls for more
of an interdisciplinary perspective and a recognition that qualitative methods
could offer more in terms of an understanding of the need for and delivery of
health services in general and mental health services in particular than was
available from the use of quantitative methods alone.
Since that time, qualitative methods have increasingly been used in mental
health services research, both as the primary or exclusive method of data
collection and analysis, and increasingly when combined with quantitative
methods in mixed method designs.
• In both instances, there have been concerted efforts to demonstrate the
rigor applied to the collection and analysis of qualitative data as well as the
scientific basis for qualitative methods, characteristics that are also valued
in the use of quantitative methods. In addition, the unique value of
qualitative methods to scientific inquiry and understanding of mental health
services has become more evident
Rationale for using qualitative methods

1- Qualitative methods represent an approach to understanding that does not require, or does
not lend itself to, enumeration .They can be viewed as both an art and a science.
2- Qualitative methods have often been used in mental health services research to:
a- provide a depth of understanding to complement the breadth of understanding afforded
by quantitative methods,
b- aiding in the interpretation of results obtained from quantitative methods, and
c- contextualizing phenomena of interest.
3- Qualitative methods are ideal for eliciting the perspectives of those being studied. It “allow
people to speak in their own voice, rather than conforming to categories and terms imposed on
them by others” .
4- Qualitative methods serve to enhance the validity of data being collected because it enables
the investigator to compare their own perception of reality with the perception of those who are
being studied.
5- Qualitative methods are often found to be especially useful during initial
stages of research .it enable investigators to acquire some understanding of
issues, to obtain “pilot data”, or when there is too little previous research or
absence of theory to allow for identification of hypotheses to be tested.
When to Use Qualitative Methods?

Qualitative methods has been much used in psychiatry, in the reporting of clinical
observations from practice, often by means of : a case study or series qualitative
1-Qualitative research methods are particularly suited to answering the question
“How does this come to happen?”.
2- In the exploratory stages of a research project, qualitative methodology is used to :
a- To clarify or set the research question,
b- To aid conceptualization and
c- To generate a hypothesis.
3- it can also be useful following quantitative work to interpret, qualify or illuminate
Characteristics of Qualitative Methods

1- Qualitative and quantitative methods are similar in that they both adhere to
certain principles of scientific inquiry and rigor.
2- The principles of validity, reliability, generalizability and objectivity that govern
sound quantitative research have their counterparts in the principles of credibility,
dependability, transferability, and reflexivity that govern sound qualitative research.
3- One of the techniques used to insure validity in qualitative methods is the concept
of “saturation, the point at which no additional data collection in needed, no new
codes are developed, and themes and subthemes have been fully fleshed out”.
4- Saturation refers to completeness or fullness necessary to insure that everything
related to the phenomenon of inquiry that can be collected and analyzed has been
done so within the limits of the forms of collection and analysis chosen.
Principles of
Quantitative research VS. Qualitative research

Quantitative research Qualitative research

Validity Credibility
Reliability Dependability
Generalizability Transferability
Objectivity Reflexivity
Reliability or dependability of qualitative
data analysis

A- Reliability or dependability of qualitative data analysis is usually achieved by establishing a

specified level of agreement in identification of topics or themes through both qualitative and
quantitative means.
B- The inductive approach typically includes a process of “coding by consensus”, which
includes one or both of two activities:
1) regular meetings among coders to discuss procedures for assigning codes to segments
of data and resolve differences in coding procedures, and
2) comparison of codes assigned on selected transcripts to calculate a percent
agreement or kappa measure of inter-rater reliability.
Most studies in the mental health services literature report the first method , while others
report measures of inter-rater reliability of coding of qualitative transcripts appear to have
used both methods to insure the reliability of coding assigned; however, they also
acknowledge that they relied primarily on a priori codes rather than identify new or
emergent codes.
Characteristic of Qualitative
1- Qualitative methods acknowledge the importance of generalizability, often
referred to in the literature as the transferability of findings from one context
or population to another. Sometimes it is described as a limitation.
2- Some studies may have the explicit reflexivity employed by investigators as
a means of identifying and addressing potential biases in the collection and
interpretation of data.
3- The potential biases may be associated with the investigator's
preconceived beliefs, assumptions and theoretical orientations; demographic
characteristics; experience with the methods used and familiarity with the
phenomenon under investigation.
4- the use of triangulation to enhance rigor of analysis of viewpoints by
purposefully interviewing people in various roles within an organization, peer
debriefing and support meetings among research team members, and
providing a detailed audit trail during analysis.
Qualitative Research
Qualitative methods
Qualitative Research design

1- Methodologies associated with qualitative research can be categorized

under three main headings: observations, interviews and the study of written
2- Qualitative methods are often used in combination: such as interviews and
observation, or interviews and examination of written records. This is called
‘triangulation of sources’ and it enhances the completeness of the data (after
all, what people say they do in an interview setting and what they actually do
as revealed by observation can be quite different).
Methods Of Qualitative
Qualitative Usage
Observation Unstructured or structured Observer’s role: participant
or complete
Interviews In-depth, semi-structured or structured Interviewees:
individual or group
Study of written 1- Informal documents (e.g. diaries, letters) or
2- Formal documents (e.g. case notes)
1- Observation Method

Observation can be either:

1- Unstructured, where the relevance of actions and particular events
emerges gradually over time; it attempts to record behavior with as few pre-
conceived ideas as to what is happening as possible, gradually making sense
of what is going on from the experience of being in the setting.
2- Structured, using pre established observational schedules that determine
when and what is observed and recorded. It use existing theories as a
framework to guide observational recording; this saves time, but runs the risk
that assumptions are made.
Observation Method

The role of the researcher while conducting an observation is important to the type of
data collected. Observers can participate to a greater or lesser extent in the activities
they are observing and record observations (field notes) at varying intervals. This form
of observation means that interactions are part of the process, which blurs the
distinction here between observations and interviews. Types of observations:
1- It can be covert, where the researcher hides his or her true purpose and identity
from the subjects, there are ethical problems with covert observation, particularly in
health service settings
2- it can be overt, where the researcher does not hide his or her true purpose and
identity from the subjects
3-Complete observation means that the researcher makes no attempt to interact with
events other than to record them.
2- Interviews Method

As with observations, interviews can be classified according to their degree of

predetermined structure:
1- Structured interviewing: consists of administering questionnaires; the
researcher may have been trained to ask the questions in a standardized
manner and responses to questions may have to be from a fixed selection.
2- Semi-structured interviews: have various fixed schedules of questions,
but also allow the interviewer some choice in selecting the lines of
questioning to take. Responses are open-ended and can be explored in detail;
they can be recorded during the interview either by written note-taking or on
audio- or videotape.
Interviews Method

In-depth or ‘long’ interviews may have a preset theme, but the interviewer
and subject are free to respond and explore whatever issues they identify as
relevant. Interviews are recorded on video- or audiotape and later
3- Focus groups

1- Interviews can also be conducted in group format.

2- It is useful to have some predetermined structure for such groups in order to provide a
focus for discussion (hence the term ‘focus groups’; Kitzinger, 1995).
3- Focus groups contain a small number of members selected to give a range of views on
the chosen topic; they conduct a semi-structured discussion guided by key points or
questions and facilitated by two or more recorders.
4- Sessions can be audio- or videotaped. It is important when using audiotape to make
careful records of who is speaking at all times.
5- Other aspects of the group’s behavior can also be observed and form part of the data.
6- Focus groups are particularly valuable in gathering user views on service provision
(Powel et al, 1996).
4- Written records

Documentary analysis is not solely the realm of the medical historian. It can
be undertaken on either:
1- formal records such as case notes and death certificates, or
2- informal records such as diaries and letters.
In a qualitative study, a combination of documentary analysis, interviews and
observation is often used. Barret’s (1996) ethnography of a psychiatric unit is
a good example of such a study.
Features Of Qualitative
Research Design
Features Of Qualitative
Research Design
• Qualitative research design observed in mental health services research
emphasis on naturalistic inquiry, “a ‘discovery-oriented’ approach that
minimizes investigator manipulation of the study setting and places no prior
constraints on what the outcomes of the research will be .
• Qualitative designs are, for the most part, observational in nature. Data are
collected in situ, usually as events happen.
Features Of Qualitative
Research Design
• a new trend in qualitative research is the emergent and iterative nature of
qualitative research in mental health services
• The emergent design is based on the principle that circumstances often
dictate changes in focus or means of data collection and that the researcher
should be prepared to accommodate to those changes rather than adhere
to a plan to use potentially inappropriate or inadequate methods .
• Qualitative mental health services research are often iterative in nature in
which there is a constant back and forth between data collection and
analysis .
Data Collection and Fieldwork Strategies

There exist several different forms of data collection strategies in qualitative

studies of mental health services. The most common strategies are :
1- Extended interviews
2- Focus groups, followed by
3- Ethnographic fieldwork,
4- Structured approaches that involve both qualitative and quantitative
Data Collection Approaches

1- The extended interview: [is the most frequently used method for data
collection in mental health services research and is intended to elicit
information on the participant's experience, opinions, and perceptions of
mental health services. This form of data collection can range from brief
responses to open-ended questions on more structured interviews or surveys
to a series of extended interviews with “key informants,” individuals
especially knowledgeable about the topic under examination.
A particular form of extended interviewing is the structured narrative, in
which the participant describes the experience of having an illness and
seeking services for that illness.
Data Collection Approaches
2- Focus group. Focus groups are interviews that are designed to use group
interaction to generate data and insights less accessible in individual
interviews . Although this cannot always be achieved in service settings, the
ideal composition of a focus group is between 6 and 10 “homogeneous
strangers,” individuals who are similar by virtue of their experience with or
familiarity with the topic but who otherwise are not closely linked to one
3- Ethnographic fieldwork often consists of several different modes of data
collections, but perhaps the most distinctive feature is the technique of
participant observation. Participant observation consists of spending time
and talking with people in their own settings.
4-Finally, some qualitative mental health services studies have relied upon
more quasi-statistical techniques for data collection. These techniques often
represent the iterative nature of qualitative methods in that the investigators
alternate between qualitative data collection, transformation of qualitative
data into quantitative data, and validation or elaboration using another round
of qualitative data collection
Issues Related to Design

While adhering to the same scientific standards, qualitative methods are

nevertheless distinguished from quantitative methods by certain other
characteristics, including design strategies, data collection and analysis
1- One of the most obvious distinctions in the design of qualitative studies is
the reliance upon generally smaller samples for investigation.
Note: there are qualitative mental health services studies involving large
samples, they generally do not require them since their aim is to achieve a
depth of understanding rather than a breadth (generalizability) of
Issues Related to Design Cont.

2- The number of participants is often based on availability of participants

and feasibility of data collection rather than quantitative power calculations.
In addition, there are certain rules in identifying how many participants to
include in a qualitative study, including precedent and saturation.
3- The use of purposeful sampling to identify and recruit study participants.
The “purposeful sampling” designed to maximize the information gained
from what is typically a much smaller group of participants than found in
most quantitative studies.
Sampling and Data
Analysis in Qualitative

1- Sampling in qualitative research is described as non-probabilistic or purposive, as

subjects can be chosen deliberately in order to test a particular theoretical premise.
2- The purpose of sampling here is not to identify a random subgroup of the general
population from which statistically significant results can be extrapolated, but to identify
cases that possess relevant characteristics for the question being considered.
3- This process should nevertheless be systematic and not based on convenience.
4- Theoretical sampling is a type of non-probabilistic sampling where the objective of
developing a theory guides the process of sampling and data collection.
5- A case is selected because it is expected to exemplify or test some identified theoretical
6- The resulting data lead to refinement of that theory and guide further data collection;
the relation between sampling and explanation is thus iterative and theory led.
Sampling Cont.

Among the most common forms of purposeful sampling are:

1- Sampling extreme or deviant cases is designed to reduce variation and
highlight the most prominent features of a phenomenon under investigation.
2- Criterion sampling is also intended to reduce the range of variation and
limit the possibility of collecting information not directly related to the
phenomenon of interest.
3-maximum variation sampling is intended to expand the range of variation
and thereby select participants who are representative of a larger population
and can maximize the opportunity for a comprehensive view of the
phenomenon of interest
Data Analysis Strategies

For the most part, qualitative studies rely on a variety of methods for
inductive analysis and creative synthesis.
The analysis of qualitative data appears to be very different from quantitative
analysis. Instead of testing hypotheses in a sequential manner using a series
of statistics, analysis of qualitative data runs concurrently with data
The purpose of data collection is accurate representation of the phenomena
under study using detailed or ‘thick’ description (Geertz, 1993). As an
account emerges, categories and themes become apparent, and it is this
generation of theory from the data, rather than the testing of a prior
hypothesis, that is the purpose of qualitative analysis.
Data Analysis Strategies

1- Many of the coding strategies employed for analyzing qualitative data in

mental health services research fall under the general rubric of “content” or
“thematic” analysis. Such analysis often involves a rigorous process of
reviewing transcripts and other documents line by line and assigning codes
based on a priori and/or emergent topics or themes, and the construction of
2- Coding also occurs in stages in which initial preliminary codes are followed
by secondary or focused coding , or in which open codes are followed by axial
codes ..
Grounded theory

Grounded theory is a term often used loosely to describe qualitative analysis, as

the categories and codes generated are ‘grounded’ in the collected data.
However, it also refers to a precisely structured method consisting of set
techniques (Glaser & Strauss, 1967).
Constant comparison of the data in four stages is designed to systematically
generate coding categories until nothing new is revealed, i.e. the point of
theoretical saturation is reached.
These categories are then tested by theoretical sampling, that is, collection of
further data on the basis of concepts shown in the earlier stages to be relevant.
It is insufficient for a research paper merely to state that “data were analyzed
using grounded theory”: researchers must be explicit as to what is meant by this.
Observational data analysis

In observational studies, data are recorded in the form of field notes made by
the observer at the time of the study.
These field notes are then reviewed when the researcher is no longer in the
‘field’ (the observational situation) and written up as an ethnography.
This combines a description of the setting with a theoretical framework for
understanding events through the personal experience of the researcher.
Documentary data analysis

Content analysis can be used for documents in much the same way as it is for
interview transcripts, although again an interpretative analysis that takes into
account meaning and context is preferable to the quantitative word-count
A third method of content analysis commonly applied to documents is
discourse analysis. Influenced by the critical theorists such as Foucault, the
emphasis is on the use of official documents by different social groups in
order to regulate the actions of another (Lupton & Chapman, 1995).
Interview data analysis

Interviews, both individual and group, are transcribed to produce texts that can be
used to generate coding categories and to test theories.
This process is often described as content analysis, and can involve enumerating
procedures such as counting word frequencies, sometimes aided by computer
The transcripts can be a simple record of the words spoken or more complex
documents including annotations for pauses, intonation and other non-verbal
Conversation analysis involves the combined use of both audio and visual recordings to
study interactional practices in particular settings (Atkinson & Heritage, 1984).
Narrative analysis centers on personal accounts of experience or events, either via an
oral history or written autobiographical documents.
• Thus, individual documents are interpreted in the light of their historical
context and the pre-existing social relationships at that time.
Data management

1- Qualitative studies produce large amounts of data the data are being
constantly reviewed and rearranged or recoded.
2- Computer packages are available to assist with data handling, but it may
take considerable time to input data from its raw field-note form.
3- Coding programs within such packages can be useful, especially in
facilitating team working on multi-site projects, but they may lead to an
overemphasis on text-based analysis (Weaver & Atkinson, 1994).
4- Problems include reliance on quantitative content analysis such as
counting word frequencies in texts, which pays no attention to the context or
meaning of words and can lead to false assumptions.

• This presentation was adapted from “Title of Presentation or Source”,

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Thank you