Transcript Slide 1

AN OVERVIEW OF
QUALITATIVE RESEARCH
September 5, 2014
Elyse R. Park, Ph.D., M.P.H
Associate Professor in Psychiatry
Massachusetts General Hospital/Harvard
Medical School
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Send us an email!
[email protected]
QUALITATIVE PAPERS IN PubMed
Year
PubMed
Pubs
1990
1994
1998
2000
2004
2008
2010
399,836
423,431
461,188
521,038
622,978
817,189
930,796
Qualitative research
Pubs
38
86
150
217
922
1920
2676
Ratio
(per 1,000 articles)
0.10
0.20
0.33
0.42
1.48
2.35
2.87
Considerations when using Qualitative
Methods
• Developing a research question
• Selecting data collection modality
• Recruitment & sampling
• Developing the interview guide
• Piloting the interview guide
• Qualitative analysis
• Determining quality of research
What is Qualitative Research?
Features of Qualitative Research
 Researcher’s role
 Main task is to determine how
people understand & behave
 Little standardized instrumentation
 Most analysis is done with words
Types of Qualitative Research
Questions
• Descriptive
– What happened?
• Interpretative
– What’s the meaning?
• Theoretical
– Why did things happen?
Anticipating Clinical Integration of
Genetically-Tailored Tobacco Treatment:
Perspectives of PCPs
OBJECTIVES
• Explore physicians’ attitudes toward treatment
strategies that matched patients according to
genotype
• Understand patient-based & physician-based
barriers
• Identify concerns about external factors that
would need to be addressed prior to clinical
integration of a genetic test to tailor smoking
cessation treatment.
Park et al., Nicotine & Tobacco Research, 2007
Cultural Attitudes About Breast Health
Study Purpose
• To explore minority women’s cultural
attitudes toward screening that might
influence their return for screening
– Communication
– Barriers
– Health Beliefs
– Improving mammography rates in
community
Moy, Park et al, Psychooncology, 2006
Considerations when using Qualitative
Methods
• Developing a research question
• Selecting data collection modality
• Recruitment & sampling
• Developing the interview guide
• Piloting the interview guide
• Qualitative analysis
• Determining quality of research
What Type of Question Is It?
Question
What (exploratory)
What (how many, how
much)
Who & Where
Why & How (explanatory)
Strategy
Qualitative
Quantitative
Quantitative
Qualitative
Qualitative vs. Quantitative
Qualitative
Quantitative
Subject matter is unfamiliar
Subject matter clearly defined
When relevant concepts are unknown When measurements are known
or unclear
When meaning rather than
frequencies are sought
When flexibility of approach is
needed
When detailed numerical description
of a representative sample is required
For studying selected issues,
cases or events in detail
When generalizability of results &
comparison across populations is
needed
When repeatability of
measurements is important
Mixed Methods
• Collecting quantitative data
• Collecting qualitative data
• Using both sets of data to draw conclusions
Mixed Methods
1. Interactive or independent
– Interactive: mixing of study questions, data
collection and/or analysis
– Independent: mixing during interpretation
2. Priority of each study
3. Timing of each study
– Concurrent
– Sequential
– Multiphase/combined
–
Creswell & Clark, 2011
Exploring The Role of Mood on
Postpartum Relapse to Smoking
• Purpose: To examine how anxiety & depression
impact postpartum relapse to smoking
• Design: Pilot study (n=65)
– Smokers who quit during pregnancy
– Repeated surveys during 6 months
postpartum
– In-depth interviews for participants 1) who
relapse or 2) report symptoms of
anxiety/depression
(Park et al., Nicotine & Tobacco Research, 2009;
Park et al, Addictive Behaviors, 20009)
Racial Disparities in Coping with Lung
Cancer
•
•
Use CanCORS dataset to 1) compare
rates of depression in non-Hispanic Black
(NHB) and White (NHW) lung cancer
patients and 2) identify rates of mental
healthcare utilization) Trager & Park, JCO 2014
Conduct in-depth interviews with patients
recruited from the Dana-Farber Harvard
Cancer Center to characterize Phase 1
findings (n=20)
Developing A Qualitative Research
Question
Dangers
– Too Diffuse
– Too Focused
– Contains unexamined assumptions
– Reflects research questions, not interview
questions
Research Questions & Hypotheses
Research Questions
• Quantitative: HYPOTHESES
• Qualitative: PROPOSITIONS
Uses for Qualitative Methods
Purposes of Qualitative Research
• Stand alone
• To inform survey development
• To elucidate survey findings
• To inform program development
(curriculum, interventions)
Linking Qualitative Data With Surveys
Qualitative data…
Contribute to the creation of survey items by:
1) Capturing survey domains
2) Determining dimensions
3) Item wordings (cultural idioms)
• Augment testing of an instrument
• Help generate hypotheses
• Explain aspects of findings that are puzzling
Black and White adults' perspectives
on the genetics of nicotine
addiction susceptibility
• To explore attitudes and beliefs of black
and white participants regarding the role
of genetics in addiction to nicotine
• To explore attitudes of black and white
participants about use of genetic testing to
be matched to optimal smoking cessation
treatment
Park et al., Addictive Behaviors, 2011
Using Qualitative Data to Inform Survey
Development
SURVEY GOAL: To develop a national survey
to assess residents’ attitudes about crosscultural care:
1) Perceptions of preparedness to deliver care
to diverse populations
2) Educational experiences
3) Educational climate
Weissman et al., JAMA, 2005
QUALITATIVE STUDY GOAL:
To elucidate the 3 survey domains
Park et al., Academic Medicine, 2005
Mixed Methods Design
1) Convergent: separate quantitative and
qualitative data collection, separate
analyses & comparison of the two
2) Explanatory: quantitative data collected
first; qualitative data collection is
subsequent
3) Exploratory: qualitative data collection
explores a topic and analysis results are
used to build a quantitative data collection
procedure
Considerations when using Qualitative
Methods
• Developing a research question
• Selecting data collection modality
• Recruitment & sampling
• Developing the interview guide
• Piloting the interview guide
• Qualitative analysis
• Determining quality of research
Qualitative Data Collection
 Individual in depth interviews
 Narratives
 Focus group interviews
 Consensus methods
 Participant observation
 Case studies
 Document analysis
Patient and Physician’s Attitudes
Regarding the Disclosure of Medical Errors.
Design: 13 focus groups. Physician-only, patientonly, & physician/patient groups.
Patient questions: defining patient safety & medical
errors
Physician questions: what they would disclose to
patients
Themes of results:
• What errors to disclose
• Disclose near misses?
• Role of apology
Gallagher T et al., JAMA, 2003
Focus Groups versus Individual
Interviews
FOCUS GROUPS
• Observe interaction/captures interpersonal
dynamics
• Allows for spontaneity
• Secure environment if participants feel
empowered to speak among peers
INDIVIDUAL INTERVIEWS
• Interviewer control
• More information per informant
• Useful for evoking personal experiences/
perspectives
Considerations when using Qualitative
Methods
• Developing a research question
• Selecting data collection modality
• Recruitment & sampling
• Developing the interview guide
• Piloting the interview guide
• Qualitative analysis
• Determining quality of research
Qualitative Sampling
Purposeful/purposive sampling
Particular settings, persons, or events are
deliberately selected according to 1) research
purpose and 2) theoretical development
Stratification: deliberate selection of participants
based on certain criteria
(Patton, 1990; Miles &
Huberman, 1994)
Purposive Sampling
Particular settings, persons, or events are
deliberately selected based on a characteristic.
ΔHomogeneous
Δ Stratified Purposeful
Δ Snowball
Δ Criterion
Δ Random Purposeful
Patton MQ, 1990
Saturation
• Saturation occurs when no new information
(redundancy) is obtained (Lincoln & Guba, 1985; Patton,
1990)
• Through the constant comparison of data (Glaser &
Strauss, 1967, Cutcliffe & McKenna, 2002) - researcher
states s/he has saturation based on comparison
of data analyzed to additional data
• Recurrent patterns and themes are seen
Considerations when using Qualitative
Methods
• Developing a research question
• Selecting data collection modality
• Recruitment & sampling
• Developing the interview guide
• Piloting the interview guide
• Qualitative analysis
• Determining quality of research
Determining the Structure of Interviews
• 3 Levels: Un—Semi—Highly
• Structure determines the:
– Content
– The number of questions
– Sequencing
Developing The Interview Guide
Unstructured
• 1-2 broad topics
Structured
• 4-5 distinct topics or questions
• distinct probes for each topic
• specific order
• order from general to specific
• begin with most important questions
• builds in transitions among topics
Considerations when using Qualitative
Methods in Cross Cultural Research
• Developing a research question
• Selecting data collection modality
• Recruitment & sampling
• Developing the interview guide
• Piloting the interview guide
• Qualitative analysis
• Determining quality of research
Pilot Testing The Guide
• Are the questions phrased in a way that will elicit
the information that you’re seeking?
• Are the questions clear?
• Are the questions biased?
• Are any of them closed ended?
• Do any need expansion?
• DID YOU use ANY double negatives?
Considerations when using Qualitative
Methods
• Developing a research question
• Selecting data collection modality
• Recruitment & sampling
• Developing the interview guide
• Piloting the interview guide
• Qualitative analysis
• Determining quality of research
Data analysis
Inductive: categories and themes
emerge (grounded theory)
Deductive: processes of “fitting”
the data into categories and
themes (framework analysis)
Steps to Analysis
1) Familiarization
2) Transcribing
3) Organizing
4) Coding
Reducing data
Displaying data
• Helps organize data
• See areas where analysis is complete
• See patterns & themes
• See how data “fits” theory
5) Drawing & Verifying Conclusions
Components of Data Analysis:
Interactive Model
Data
Collection
Data
Reduction
Data
Display
Conclusions:
Drawing/Verifying
Miles and Huberman, 1994
Analyzing chunks of text
Identifying themes
Building codebooks
Marking texts
Constructing models
Characteristics of Qualitative
Data Analysis
• Systematic and verifiable
• Theory driven
• Iterative process
• Flexible to alternate views
• Includes a system to handle incongruencies
between coders
Audit Trail
Auditability: clear account of the research
process so that that reader can judge the
dependability of the study (aka decision trail)
Lincoln & Guba, 1985
Keeping Track Of The Analysis Process
• Theories that influenced the data analysis
• How data were organized
• Multiple coder strategy
• How you conducted data reduction
• How conclusions were drawn & verified
What Are You Coding?
• The Word
• Internal Consistency
• Frequency
• Extensiveness
• Intensity
• What Was Not Said
Initial Coding Framework
COVERAGE CHARACTERISTICS AND SATISFACTION
• Access satisfaction
– Satisfied
– Not satisfied
• Problems with access
– Physician not in network
– Plan accepted by a limited number of physicians
– Distance to providers
DIFFICULTIES AND GAPS IN COVERAGE
• Ever had a period that was not covered?
– Yes
• Reason for gap
– Affordability
– Change in job/job status
– Change in dependent status
– Other
POSSIBLE ATTRIBUTES
• Insured (Y/N)
• Gender
• Cancer Recurrence (Y/N)
To Compute Or Not
Advantages of Computing
• Reducing time needed for manual handling tasks
• Increased flexibility in handling large amounts of data
• More rigorous analysis of data
• More visible data analysis audit trail
St John & Johnson, 2000
Disadvantages of Computing
• Focus on quantity vs. meaning
• Data can become too reduced/too much focus on
coding & retrieval
• Time spent learning use
• Pressures to use/commercialism
St John & Johnson, 2000
Robert Wood Johnson Qualitative
Research Guidelines Project
http://www.qualres.org/index.html
Experimentalistics try to control it.
Statisticians count it.
Interviewers ask questions about it.
Observers watch it.
Participant observers do it.
Qualitative inquirers find meaning in it.
-From Halcolm’s Laws of Inquiry
Interactive Exercise
1) Write down an idea for a study that you may want
to conduct qualitatively.
2) Explain your idea/question and discuss what you
bring to the study: your background, beliefs,
clinical training, & patient population.
3) Discuss the answers to the following questions:
a. I want to ask this question because…
b. One thing I’m sure about what’s going on is…
c. I would be really surprised if I learned…
Disclosure: Quantitative
Physicians’ intentions to disclose findings of a somatic alteration were
influenced by both the availability of an FDA-approved medication
and by the prognosis conferred. The majority of participants (n=xx;
xx%) responded that they would “definitely disclose” this finding if
there were an agent that was currently being studied in a Phase II
trial that was accessible to patients. More than half of physicians
(n=xx, xx%) would “definitely disclose” if the alteration conferred a
favorable prognosis or if the alteration was in a pathway for which a
FDA-approved agent was available for a different cancer. However,
only xx% (n=xx) would “definitely disclose” an alteration found that
conferred an unfavorable prognosis
Disclosure: Qualitative
The decision to disclose was predicated upon the belief that is the
patient’s right to know, as well as a strong sense of expressed
identity and obligation in enrolling patients in clinical trials (“This is
what we do.”). Physicians expressed intentions to disclose to enable
exploration of different treatment options, with the clarification that
disclosing doesn’t necessarily mean treating. Physicians’ willingness
to disclose would also be influenced by a patient’s perceived
treatment access (e.g. insurance coverage), potential trial candidate
status (e.g., eligibility, performance status, preclinical data), toxicity of
the medications, and a patient’s ability to benefit from the treatment.
However, if a patient is not deemed a good trial candidate, there was
still a sentiment expressed that the patient had a right to know about
the findings; there was expressed tension about what to do when a
patient was not a viable candidate yet had right to know.
Qualitative Validity Threats
• Description
• Interpretation
• Theory
• Researcher Bias
• Reactivity
Ways To Enhance Validity
• Respondent validation
• Triangulation: Using multiple investigators, theories, data,
or methods to gather data, within a single study, to provide
confirmation and completeness of data
• Attending to cases that deviate from theory
• Supervision and peer review of analysis
Consistency & Dependability
Assuring that information collected is accurate &
consistent.
• Pretesting & standardizing instruments
• Team interviewing
• Tape recording
• Debriefing
• Participant feedback
• Multiple coders/establishing inter-rater reliability
• Coding with content analysis
• Keeping an audit trail
Questions? Comments?
Send us an email!
• [email protected]
Consistency & Dependability