Qualitative methods in public health
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Transcript of Qualitative methods in public health
METTE SAGBAKKEN
DEPARTMENT OF GENERAL PRACTICE AND COMMUNITY MEDICINE
INSTITUTE OF HEALTH AND SOCIETY
Qualitative methods in public health
"The cure of many diseases remains unknown to the physicians of Hellos (Greece) because they do not study the whole person." ~ Socrates, (470-399 BC)
"The control of many diseases remains difficult because health professionals and policy makers do not study the whole picture” ~ Sagbakken, (1966- AC)
Qualitative versus quantitative methods
Prior to establishment of disciplines as anthropology, epidemiology – health projects often combined methods
Panum: investigated measles outbreak in the Faroe Islands in 1846 – combined observations and syrveys
Virchow: investigated typhus epidemic in 1848 – clinical, pathological, epidemiological, anthropological findings
Documented concrete links between social conditions and diseases
Trostle J. (2005). Epidemiology and culture. Cambridge University Press.
Qualitative versus quantitative methods
After discovery of bacteria specific to infectious diseases (1870s-1880s) the germ theory of disease becomes dominant
Development of laboratory disciplines as bacteriology, virology – less focus on social, economic, and cultural factors in disease control
Growth of disciplines, growing emphasis on quantitative research and dominance of medical profession in public
health
Separation of approaches to disease prevention and control
Robert Koch (1843-1910)
Yach. D (1992). The use and value of qualitative methods in health research in developing countries. Soc Sci Med, 4:603-12
Qualitative versus quantitative methods
“Not everything that can be counted
counts, and not everything that counts can be counted.”
Albert Einstein (1879-1955)
What knowledge ”counts”?
Many tuberculosis (TB) patients do not complete treatment. How many? (quantitative) Why? (qualitative)
Many TB patients use several months to get the right diagnosis. How many (quantitative)? Why? (qualitative)
Predefined categories – a ”shot-gun” method? (Becker)
Strength of qualitative methods – show how a multitude of factors may act as causes
What knowledge ”counts”?
Different methods important – can play complementary roles
Ex: Qualitative methods help explain mortality rates (men, third class passengers) in Titanic by exploring social and cultural rules
Social rule about class implied higher status passengers saved at the expense of lower-status passengers
Cultural rule of lifeboat access caused more men to die (within economic status group)
Trostle J. (2005). Epidemiology and culture. Cambridge University Press.
Qualitative versus quantitative methods
Which research method? Depends on the question
Quantitative methods: Suitable for questions such as:
”How many…?”, ”How often ...?”, or ”Is X more efficient than Y in treating Z?”
Qualitative methods: Suitable for questions such as: ”How do people perceive…?”, ”What do people do?”,
or ”How do people experience ...?”
Qualitative methods
The aim of qualitative research is not to measure or predict, but to gain new knowledge/understanding of phenomena such as:
Human experience, beliefs, behaviour, interaction
Social practices, systems, cultural norms
Involves collection of data not easily reduced to numbers
Qualitative methods
Humans are contextual beings
Understand the wider context in which peoples’ preferences, beliefs and behavior derive
Understand processes and dynamics of social life
What causes changes in behavior?
Qualitative methods
Impoverishment
Daily clinic attendance –
new costs and burdens
Impoverishment
Exhaustion Hopelessness
New strategies
Treatment interruption
Becoming ill
Loss of job/incomeExpenses
Identify processes
Treatment interruption
Accumulated burdens/costs- tipping point
Qualitative methods..
Allow people to speak in their own voice, rather than conforming to categories and terms imposed by others
Categories often not predefined: the fieldwork informs you of relevant categories (inductive - abductive)
Qualitative methods
Through exploration of meaning new and unexpected categories of meaning and experience can be discovered –
….that did not fit the original puzzle
Qualitative methods
Structural factors
• Loss of income
• Distance to clinic
• Organization of treatment
Socio-cultural factors
• Stigma in community
• Cultural obligations
Individualfactors
• Different explanatory models
• Other obligations
Outcomes may have multiple causes
Important to get an overview over causes – and how they may interrelate
Qualitative methods
By identify processes and multiple causes – create time- and context sensitive approaches to disease prevention and control:
By identifying multiple causes – increase awareness of the need of linking multiple actors/sectors/projects (food programs, labour organizations)
Through a dialogue with those concerned : - discover processes and experiences people go through being ill - identify local barriers and enablers - identify existing or non-existent support structures - help identify mutiple and more sustainable solutions (beyond bio-
med)
Qualitative data collection methods
Data collection methods
Interviews
Individual interviews Semi-structured In-depth
Informal conversations
Group interviewsFocus groups
Data collection methods
Individual interviews – advantages Opportunity to probe; explore further Get close to people; establish trust; Beneficial for sensitive issues. Several interviews can be
done.
Individual interviews – challenges Do not discover discrepancy between what people say and
what they do Structured situation – statements decontextualized
Informal conversations – advantages Often takes place in context – talk about what you see/hear People are more relaxed, more spontaneous answers
Informal conversations – challenges Less structured; less focused. Recall bias
Data collection methods
Focus groups – advantages Study interaction patterns Identify issues to include in subsequent individual
interviews Validate findings from individual interviewsGenerate new meaning – several minds work togetherMore data in less time
Focus groups – challenges Learn what people say they do, not what they actually doSome may dominate – consensus reached on wrong
premises Less suitable for sensitive topics
Data collection methods
Observation Participant or non-participant
“Fieldwork”
Data collection methods
Observation – advantagesBehaviour/statements better
understood in light of contextMove beyond the selective perceptions of othersDiscover issues no one has
paid attention to (tacit knowledge)
Learn about issues people are reluctant to talk about
Insight into processes/ chronologies of events
Understand complex topics
Observation - challengesTo what extent, in what
way are you influencing the field?
Is what you ”see” what is really happening?
Should know the local language
Time consuming
Data collection in qualitative methods
Study of texts and documents
Documents, books, articles, reports, advertisements, newspapers, diaries
Adds important contextual information – understanding findings