Transcript Introduction to the appraisal of qualitative research

Qualitative Research
What, why and how
(...and should I even go there?)
Alexander M Clark, PhD BA(Hons) RN
Associate Professor,
University of Alberta
AHFMR Population Health Investigator
CIHR New Investigator
[email protected]
What is qualitative research?
• Research based on non-numerical data
• Variety of different:
– Philosophical bases
– Methods
– Data collection techniques
• So be wary of oversimplifying diversity…
What qualitative research is not…
• Not:
– ‘Quality of life’ research
– Research into quality
– Survey with open ended questions
– Count the number of particular words
Characteristics of qualitative research
• Insider’s perspective
– Personal involvement
– Openness to ‘the other’
• Holistic
– Context
– Complexity
– Depth
• Inductive
– Responsiveness
– Moving beyond the specific
• (Morse 1992; Powers and Knapp 1995)
Data generation techniques
• Research using non-numerical data
– Transcribed speech
• Focus groups
• Interviews
– Observational notes
• Field observers
– Historical documents
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Official records
Letters
Emails!
Web pages
Qualitative Research: An evolution
• 1980s
– Low awareness
– Difficult to attain funding
– Absent from government
policy
– Marginal presence in
medicine journals
– Greater presence in
social science and
nursing journals
• 2000s
– Moderate awareness
– Attractive to funding
bodies
– Informs government
policy
– Permeation into most
(though not all)
mainstream health /
medical journals
The origin of qualitative research
• Understanding the ‘other’
– Imperialist Ethnography
– ‘Objective, colonizing accounts of field
experiences…(of that which was) alien, foreign
and strange’
– Prominent ethnographies:
• Native Americans
• African tribes
Mary Kingsley (1862-1930)
‘Travels in West Africa’ (1897)
‘West African Studies’ (1899)
• ‘…a new reason for polygamy…it enabled a man to get enough
to eat.
This sounds sinister from a notoriously cannibal tribe; but the
explanation is that the Fans are an exceedingly hungry tribe,
and require a great deal of providing for.
It is their custom to eat about ten times a day when in village,
and the men spend most of their time in the palaver- houses
at each end of the street, the women bringing them bowls of
food of one kind or another all day long.
When the men are away in the forest rubber or elephanthunting, and have to cook their own food, they cannot get
quite so much; but when I have come across them on these
expeditions, they halted pretty regularly every two hours and
had a substantial snack, and the gorge they all go in for after a
successful elephant hunt is a thing to see--once.’
• Gradual movement to less imperialist, more
culturally and socially sensitive approaches
Summary point 1: What
• Qualitative Research now established set of
techniques
• Uses a variety of techniques to collect non-
numerical data
• Moved from outsiders’ to insiders’
perspective
• Seeks to provide a holistic account based on
inductive reasoning
Why?: Types of questions
• What is the society like?
– Social norms
– Cultural practices
• Why do certain behaviours occur?
– Processes
– Patterns
– Paradoxical
– Surprising
• What is this experience like?
– Nuances
– Depth
Explaining patterns in data
• Increasingly large volume and sophistication in
quantitative data collection
– Large cohorts
– Numerous fields
– Automated data linkage and storage
• Patterns are increasingly described…but not
explained
Examples…
• Delay in seeking help during heart attack
– 90 minute window for clot busting therapy
– Average 4 hour delay time to help seeking
• Availability of services to reduce risk after
heart attack
– Evidence of mortality benefit
– 30% participation rate
– Rates lowest in those in most need
What is missing?
• All that is useful cannot be quantified
– Complexity
– Unknown factors
– Process
– Defies quantification
• Values
• Aspirations
• Human decision-making
Example 2: Knowledge utilization
• Evidence-based practices rates around 30%
• Poor insights into:…
– Why guidelines are poorly utilized?
– What factors influence implementation of
evidence?
– What can be done to improve rates…
Low compliance
• Greater impact on health if existing therapies
are used than from new therapies (WHO
2004)
• Around 50% ‘compliance’ rates in those with
chronic disease
• Increasingly strained health care infrastructure
to provide professional support
Systematic review of qualitative
research
• Synthesizing findings from a number of studies in a
common topic
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Meta-synthesis / Meta-ethnography
Search strategy
Selection criteria
Synthesis of bodies of studies
Why? Summary Point 2
• Qualitative research can address questions
– What is the society like?
– Why do certain behaviours occur?
– What is this experience like?
– Individual studies or reviews
How?: Philosophical bases
• Constructivism
– Relativism
• Realism
– Critical realism
– Postpositivism
• Positivism
– Objectivism
Methods
• Grounded theory
– Theory around social processes
• Phenomenology / Hermeneutics
– Experience and meaning
• Ethnography
– Culture
• Document / Historical
• Generic
A brief overview
• Phenomenology
Complex lived experience
• Grounded theory
Theories of the social
• Ethnography
Culture
• Case Study
Deep understanding of cases
• Generic / Interpretive
Descriptive
Experiences or perspectives
Phenomenology
• Focus:
• Domain:
• Background:
The study of phenomena
Being, lived experiences,
essences
Philosophy
• Names:
Husserl, Heidegger, Gadamer
• Data collection: One to one interviews
Use of phenomenology in health research
• Meaning
– Experiences
• Living
– Illnesses / Health
• Perspectives
– Beliefs, decision-making,
judgments…
• Understanding
• Beck (1992) PPD
– DSMIV
– Personal experience
• Bowman (1991) Chronic
back pain
– Pain scores
– Effect on independence,
living and health
Where is meaning in a text?
• Writer
– What is intended?
• Text
– What is inherent?
• Reader
– What I interpret?
What will a phenomenological study
look like?
• Justification for examining the human
experience
• Sample size usually 5-30 people
• Insiders’ account
• Deep analysis of dimensions of phenomena
under study
Interpretive descriptive / G eneric
• Focus:
Descriptive study of themes
• Domain:
Subjective experience,
perspectives, beliefs,
knowledge….
• Background:
Applied sciences
• Names:
Many…
• Data collection:
Semi-structured interviews
What will an interpretive descriptive
study look like?
• Has no specific methodological label
– ‘Thematic analysis’ ‘Interpretive analysis’
– ‘Qualitative research’
• Sample size usually 5-30 people
• Insiders’ account
Use of ID in health research
• Health and Illness
experience
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Myocardial infarction
Breat cancer survivor
Perspectives
Beliefs, knowledge
decision-making,
judgments…
• Goal: Understanding
• Accessing support
services
– Tod et al (2002)
• Learning needs of
patients
– Wehby and Brenner
(1992)
• Explanatory models for
symptoms
– Russell et al (1998)
Ethnography
• Focus:
The study of cultures
• Domain:
Macro and micro cultures
• Background: Cultural anthropology
• Names:
Mead, Atkinson, Hammersley
• Data collection: Observation, group-work,
interviews
‘Ethnography is appropriate if the needs are to
describe how a cultural group works and to
explore beliefs, language, behaviours and
issues such as power, resistance and
dominance.’
– Creswell (2007, page 70)
Use of ethnography in health research
Culture
Places
Settings
Populations
Macro
Town
Vulnerable population
Micro
Families
Student group on a course
• Porter and Ryan (1996)
– Racist behaviour in
clinical settings
• Preston (1997)
– Families of people with
CHD
What will an ethnographic study look
like?
• Clear specification of a group under study and
justification for this
• Perhaps some mention of a key informant
• Would engage in field work
– Observational data collection
– Oral data collection
– Cultural artifacts
• Build up a research cultural portrait / account
Grounded Theory
• ‘…to move beyond description…to generate or
discover a theory, an abstract analytical
schema of a process (or action or interaction).’
Cresswell (2007, pg 63)
• Theory is grounded in the data
Grounded theory
• Focus:
• Domain:
• Background:
Developing theory grounded in
data
Social processes and interactions
Applied
• Names:
Glaser, Strauss
• Data collection: One to one interviews
Use of grounded theory in health research
Social
Processes
Interactions
Actions
Paterson (2001)
Empowerment in
chronic illness
Jillings (2007)
Self care processes
during heart failure
Johnson (1990)
Adjustment after
myocardial infarction
Case study
• ‘…study of an issue explored through one of
more cases in a bounded system
– Cresswell (2007, pg 73)
Case study
• Focus:
• Domain:
• Background:
A case related to an issue
Many…as long as it helps
illustration
Social science, health, psychology
• Names:
Stake
• Data collection: Multiple (paper, verbal, visual)
Use of case study in health research
Cases that are particularly
Typical
Atypical
Noteworthy
Interesting
Illustrative
• Power and
powerlessness in homecare
– Efraimsson et al
• Program for prevention
of heart disease
Bradley et al (1999)
Could be: Individual(s),
groups, programs,
activities….
How? Data collection techniques
• Interview
– Unstructured
– Semi-structured
– Structured
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Focus group
Observational
Video
Internet
Document extraction
Judging quality in qualitative research
• Trustworthiness
– Do we understand?
– Do we agree?
• Credibility
– Can we follow?
• Typicality
– Site
– Sample
Quality Screening
• Contentious issues
– For what purpose?
• Inclusion / Exclusion
• Commentary
– How expressed?
• Measured?
• Narrative
Is a qualitative methodology
appropriate?
• How well justified?
– Nature of the research question
– Existing knowledge of topic area
• Does it seem logical / sensible?
• Any evidence of alternatives being considered
or appropriate?
– Survey
What design appropriate to question ?
• Decision-making clear and appropriate?
– Convincing
• What is the design called?
– What is the design irrespective of what it is called?
Was the recruitment strategy
appropriate?
• Participants
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How selected?
Most appropriate
Typicality
Size of sample
Addressing the research issue
• Setting
– Justified
– Typical v Atypical
• Data collection
– Method clear
– Justification appropriate
• Size
– Sample size
– Depth of analysis
Ethics
• Issues of:
– Confidentiality
– Consent / Process nature of consent
– Approval from ethics commitee
Rigor of analysis
• Is analysis process described?
• Is it clear how themes emerged from the
data?
• Are the findings supported by the data?
• Was ‘contradictory’ data examined?
Clear statement of findings?
• Are findings clear / explicit?
• Are issues of credibility addressed?
• Does the study refer back to the research
questions?
Value of the research
• What contribution to knowledge does the
study make?
– How far can they transfer findings to different
populations / settings /countries?
• What is the significance of this?
– Insight
– New knowledge
How?: Summary Point 3
• Qualitative research is very diverse
– Various methods
• But there can be underlying / transcending
principles of methodological quality
• We can draw on these to appraise qualitative
studies
Useful references
• Murphy E, Dingwall R, Greatbatch D, Parker S,
Watson P. Qualitative research methods in
health technology assessment: a review of the
literature. Health Technol Assess 1998; 2(16).
• http://www.refer.nhs.uk/ViewRecord.asp?id=
87
• [email protected]