AN OVERVIEW OF QUALITATIVE RESEARCH September 5, 2014

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

2. Questions during talk? Comments? Send us an email! u54.ssmc@gmail.com

3. QUALITATIVE PAPERS IN PubMed • Year PubMed Qualitative research Ratio • Pubs Pubs (per 1,000 articles) • 399,836 38 0.10 • 1994 423,431 86 0.20 • 1998 461,188 150 0.33 • 2000 521,038 217 0.42 • 2004 622,978 922 1.48 • 2008 817,189 1920 2.35 • 2010 930,796 2676 2.87

4. 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

5. What is Qualitative Research?

6. 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

7. Types of Qualitative Research Questions • Descriptive • What happened? • Interpretative • What’s the meaning? • Theoretical • Why did things happen?

8. 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

9. 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

10. 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

11. What Type of Question Is It? Question Strategy

12. Qualitative vs. Quantitative Qualitative Quantitative Subject matter is unfamiliar Subject matter clearly defined When relevant concepts are unknown or unclear When measurements are known When meaning rather than frequencies are sought When detailed numerical description of a representative sample is required When flexibility of approach is needed When repeatability of measurements is important For studying selected issues, cases or events in detail When generalizability of results & comparison across populations is needed

13. Mixed Methods Collecting quantitative data Collecting qualitative data Using both sets of data to draw conclusions

14. Mixed Methods Interactive or independent Interactive: mixing of study questions, data collection and/or analysis Independent: mixing during interpretation Priority of each study Timing of each study Concurrent Sequential Multiphase/combined Creswell & Clark, 2011

15. 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)

16. 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)

17. Developing A Qualitative Research Question Dangers • Too Diffuse • Too Focused • Contains unexamined assumptions • Reflects research questions, not interview questions

18. Research Questions & Hypotheses Research Questions • Quantitative: HYPOTHESES • Qualitative: PROPOSITIONS

19. Uses for Qualitative Methods

20. Purposes of Qualitative Research Stand alone To inform survey development To elucidate survey findings To inform program development (curriculum, interventions)

21. 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

22. 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

23. Using Qualitative Data to Inform Survey Development • SURVEY GOAL: To develop a national survey to assess residents’ attitudes about cross-cultural care: • Perceptions of preparedness to deliver care to diverse populations • Educational experiences • Educational climate Weissman et al., JAMA, 2005 QUALITATIVE STUDY GOAL: • To elucidate the 3 survey domains • Park et al., Academic Medicine, 2005

24. Mixed Methods Design • Convergent: separate quantitative and qualitative data collection, separate analyses & comparison of the two • 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

25. 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

26. Qualitative Data Collection Individual in depth interviews Narratives Focus group interviews  Consensus methods Participant observation Case studies Document analysis

27. Patient and Physician’s Attitudes Regarding the Disclosure of Medical Errors. Design: 13 focus groups. Physician-only, patient-only, & 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

28. 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

29. 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

30. 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)

31. 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

32. 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

33. 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

34. Determining the Structure of Interviews 3 Levels: Un—Semi—Highly Structure determines the: Content The number of questions Sequencing

35. 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

36. 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

37. 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?

38. 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

39. Data analysis Inductive: categories and themes emerge (grounded theory) Deductive: processes of “fitting” the data into categories and themes (framework analysis)

40. Steps to Analysis • Familiarization • 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

41. Components of Data Analysis: Interactive Model Data Collection Data Display Data Reduction Conclusions: Drawing/Verifying Miles and Huberman, 1994

42. Analyzing chunks of text Identifying themes Building codebooks Marking texts Constructing models

43. Characteristics of Qualitative Data Analysis Systematic and verifiable Theory driven Iterative process Flexible to alternate views Includes a system to handle incongruencies between coders

44. 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

45. 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

47. What Are You Coding? • The Word • Internal Consistency • Frequency • Extensiveness • Intensity • What Was Not Said

48. 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)