17. AMB4 Qualitative Methods 2015
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QUALITATIVE METHODS
MDSC3200Affette McCaw-Binns, Community Health Section
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Objectives
Distinguish between qualitative and quantitative methods of data collection
Describe three qualitative methods applicable for use in the health sciences
Compare and contrast uses of qualitative and quantitative data
Examine the scope and limitations of qualitative research in the health sciences
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Quantitative vs Qualitative Research Quantitative methods – document amount of the
problem Study based on measures of quantity or frequency Findings described in numbers, not words
How big is X, and how many are there? Qualitative methods – classify phenomena
What, how, when, where – the nature of the problem as people perceive it Concepts, definitions, characteristics, symbols, descriptors
Why groups differ What social or behavioural problems influence disease
and how How and why does X vary in different
circumstances?22/04/23
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McCaw-Binns
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What is qualitative research?
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Disciplined enquiry into the personal meanings of individuals’ experiences, perceptions, attitudes and actions in the context of their social experiences The meanings people attach to their experiences How they make sense of their social world
Aim: in-depth understanding of specific individuals & small groups, rather than general characteristics of large population of individuals e.g. what explains disconnect between quantitative
knowledge of how STIs are transmitted and prevented, and the behavioural failure to apply this knowledge to individual actions i.e. regular condom use, avoiding multiple sexual partners
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Uses in health science
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Investigates complex human behaviour that impact health Why knowledge ~= behavioural decisions
Access unquantifiable facts about people such as: How people give meaning to their lives and make sense
of things People’s perceptions about how their bodies work versus what
doctors think they know Experiment: Ask some adolescents how babies get made?
Evaluate views re health service provision from the perspective of: Patients vs. health professionals vs. managers
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Uses of qualitative research Qualitative research enables investigators to:
Observe social life in its natural habitat What people do at home versus what they report in the clinic ?
examples Go where the action is
Observe persons in their usual interactions, negotiations Watch – Unobtrusive research observing behaviour
e.g. how doctors interact with patients, conduct examinations Can produce a richer understanding of many social
phenomena once the researcher observes in a deliberate, well planned, unbiased and active way Requires special skills, which needs to be learned and
honed22/04/23McCaw-Binns
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Uses of qualitative research
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Quantitative/qualitative approaches complement each other
Preliminary phase – quantitative study helps to understand key phenomena to be studied What questions to ask before trying to quantify behaviour Identify terms commonly used to describe actions in the
community Clarify open ended questions Develop hypotheses
Interpretive phase (after) to validate and explain phenomena observed Have participants explain unusual observations, e.g.
Why the information received was not what was expected Give their interpretation of findings as your ideas may differ from
theirs
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Approaches to Qualitative Research
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8 Direct observations
Behaviours and events e.g. How doctors deliver health education messages?
Nature of interaction How people talk to each other (at, with) and interact
Do we talk to patients or at them? Do they understand us? Dental skills labs is a qualitative approach to teaching
Interviews Individual (key informant) Group (focus groups)
Analyse the text, recorded speech, video tapes Focus: talk and actions rather than numbers
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Approaches to Qualitative Research
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Process of ‘watching’ can entail: Direct observation (passive/unobtrusive) Joining in (participant observation) Talking to people (interviewing) Reading/interpreting what persons have
written/drawn Often used in psychiatry
Several qualitative research techniques, will discuss: In-depth interview Focus groups discussions and Consensus methods – Delphi and nominal group
techniques
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Iterative process
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Interviews Structured (usual approach for quantitative
studies) Structured Questionnaire Questions with fixed choice of answers administered in a
standardized manner Semi-structured
Open ended questions defining areas to be covered Interviewer/interviewee may diverge to pursue an idea or
response in more detail Depth
Less structured: One or two issues to be covered in depth Follow-up questions are based on what interviewee says
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Qualitative InterviewsTypes of questions
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Good questions should be open-ended, neutral, sensitive and clear to the interviewee
Types of questions: Behaviour or experience Opinion or belief Feelings Knowledge Sensory perceptions Background or demographic details (for context)
Start easy → Difficult/sensitive issues
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1. Depth interviews
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13 Two persons discuss issue(s) with the understanding that there
will be complete honesty, openness, mutual trust, confidentiality
Less structured, with follow-on questions based on responses Supplementary questions intended to clarify issues and probe for
details Patient history taking = qualitative depth interview
Requires experienced interviewer who understand the concept area to effectively probe issues Good medical history taker – difference between consultant and
intern! Requirement:
Absence of other participants, why? Uses:
Case studies Life history assessments Research on sensitive issues
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Sampling and Sample Size Non-probabalistic sampling most
often used e.g. of types?
Representativeness not an issue Focus: eliciting issues of interest from
persons selected
Smaller numbers Assess in more detail Sampling (and data collection) ends when
no new information is elicited22/04/23McCaw-Binns
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The Instrument The interviewer or observer is the main
instrument Must be neutral or directive as needed Take cues or signals from participants Tries not to inject personal opinions or
views or to be distracted during the process
Issue: Hawthorne Effect – presence of observer
may influence behaviour 22/04/23McCaw-Binns
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2. Focus group discussion
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Group processes used to explore and clarify views that would be less accessible in a one-on-one interview Capitalizes on communication between participants Capitalizes on group interaction
People encouraged to talk to one another Ask questions/Exchange anecdotes Comment on each others experiences/points of view
Quick, convenient way to collect data from several people simultaneously Typically no more than 12-15 people; more than one
group
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Advantages of focus groups
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17 Doesn’t discriminate against persons who
cannot read or write Facilitator can encourage participation of
persons reluctant to be interviewed e.g. Intimidated by formality Shy when isolated in a one-to-one interview Can encourage people who have ‘nothing to say’
but engage in discussion generated by group members
High validity to depth of enquiry Bonus: group dynamics may unearth aspects
of the topic not anticipated by the researcher, e.g. side conversations, body language
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Disadvantage of focus groups Less control over the research process than
individual interviews Data difficult to analyse Differences between groups can be troublesome Reliability may be an issue – ?observer bias Moderators require special skills
Remain neutral Control ‘bullies’ Follow leads, including being sensitive to ‘body
language’
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3. Consensus methods: Introduction
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Many key decisions in health care have to be made without adequate objective information, e.g. How best to treat patients What services to provide How best to organize and deliver services What research should be prioritized
Decision making in the face of uncertainty is a common challenge for clinicians, managers and policy makers
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Consensus methods II
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Consensus method can formalize decision making in ways that: Are transparent Eliminate negative aspects of decision making Provide scientific credibility to the process
Consensus methods can be used to: Assess extent of agreement (consensus
measurement) Resolve disagreement (consensus development) Allow for qualitative assessment of evidence
e.g. jury trial, expert panel
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Uses of Consensus methods
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Develop clinical and organizational guidelines Assemble evidence Adapt international best practice to local
reality
Determine priorities Which services to provide What topics to research Which outcomes to measure
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Features of consensus methods
Feature CharacteristicsAnonymity To avoid individual dominance;
questionnaire used in Delphi and private ranking in nominal group
Iteration Processes occur in "rounds," allowing individuals to change their opinions (based on new information)
Controlled feedback
Shows the distribution of the group's response (indicating to each individual their own previous response in Delphi)
Statistical group response
Expressing judgment using summary measures of the full group response giving more information than just a consensus statement
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Nominal group technique:Expert panel
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Informed panel considers a problem Consensus methods structured to prevent
the dominance by one individual or vested interest group
Group’s view derived from aggregation of individual members’ views rather than the group arriving at a communal view
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Nominal group meeting
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24 Highly structured meeting to gather
information from relevant experts Usually 8-12 members
Fewer: reliability in jeopardy More: discussion unmanageable
Process: Literature review provided to participants ahead of
meeting Facilitator = expert or credible non-expert Two (or more) rounds in which panelists
Rate problem/issue Discuss Re-rate
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Nominal Group Technique
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STAGE 1: Formulation of nominal group question STAGE 2: Group members independently and
privately record ideas and opinions relating to the question or problem of interest
STAGE 3: Ideas or rankings recorded, often in a round-robin feedback session
STAGE 4: Discussion to clarify and categorise different ideas to obtain a list of options
STAGE 5: Group members independently rank/re-rank the different options. The group decision in based on consensus achieved during this ranking process
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Delphi Method
The Delphi process takes its name from the Delphic oracle's skills of interpretation and foresight
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Delphi Method Round 1: Individuals invited to provide
opinions on a specific matter, based on their knowledge, experience
Round 2: Participants rank their agreement with each statement in the questionnaire
Round 3: Participants re-rank their agreement with each statement in the questionnaire, can change their score in view of the group's response until reach consensus 22/04/23McCaw-Binns
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28 22/04/23McCaw-Binns
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Delphi Technique
Participants do not meet in one place (mail, e-mail)
Relatively inexpensive Allows involvement of
participants from distant geographical areas
Encourages minority views
Allows period of ‘considered’ thought
Does not allow individuals to dominate
Reaching consensus can be time consuming
Difficult to maintain high response rate (often decreases as rounds progress)
Important issues may be missed in centralising opinion
Representativeness of group (experts vs multidisciplinary)
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McCaw-Binns
Strengths Limitations
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Issues: Qualitative methods
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Internal and external validity Can findings from a select group be
replicated? Can they be generalized to the population?
Social phenomena may be profoundly affected by the participants Did one or a few persons sway group opinion? What is true in one setting may not hold in
another How well do the conclusions explain why
people behave in the way they do?
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Triangulation - validation
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Each method a researcher employs provides a slightly different facet of the same reality
By combining several lines of sight, one obtains a better, more substantive picture of reality TRIANGULATION
Multiple data collection technologies used to test hypotheses; measure a single concept or construct
Combine quantitative and qualitative methods to gain greater depth of understanding Quantitative survey Observation Focus group
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Quantitative and qualitative methods working together
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Used jointly = powerful tools Preliminary studies
Can form essential preliminary to quantitative research, e.g. Identify colloquial terms, questions to ask, options for closed ended
questions Discover behavioral issues to be measured later
Post hoc studies Supplement quantitative work by validating data collected
Explain unusual quantitative findings, e.g. Divergence between knowledge and practice
Explore complex phenomena or areas not amenable to quantitative research, e.g. Interactions between social norms and observed behaviour
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Summary
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Qualitative methods provide: Opportunity to collect preliminary or
supplementary information to support, explain quantitative data
Useful for scientifically arriving at consensus
Opportunity to better understand human behaviour
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Lesson exercise: Qualitative methods
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List three questions which a qualitative approach would be better suited at providing an appropriate answer
List two problems which a combined qualitative and quantitative methods would address
What is the distinction between a qualitative variable and a qualitative method of data collection?