Introduction to Qualitative Research Concepts and Methods

1. Introduction to Qualitative ResearchConcepts and Methods Joshua E. Richardson, PhD, MLIS, MS Assistant Professor Center for Healthcare Informatics and Policy Department of Public Health, Weill Cornell Medical College

2. “Not everything that can be counted counts. Not everything that counts can be counted.”

3. “Not everything that can be counted counts. Not everything that counts can be counted.” -William Bruce Cameron “Informal Sociology: A Casual Introduction to Sociological Thinking”

4. Learning Objectives By the end of this session, fellows will be able to: • Identify when qualitative methodology is appropriate for answering a research question • Understand qualitative research principles for data collection, analysis and dissemination • Understand the challenges associated with collecting and managing qualitative data

5. Overview • Concepts that underlie qualitative research • What is it? • How and why is it useful? • What’s its relationship to quantitative methods? • Qualitative methods • Study design • Data gathering • Analysis & dissemination

6. What is qualitative research? • The study of things in their natural setting, qualitative researchers attempt to make sense of or interpret phenomena in terms of the meanings people bring to them. • Denzin and Lincoln (1994)

7. Qualitative research is a natural fit for clinicians

8. Why qualitative research? • To understand participants’ perspectives and the meanings they construct • How participants “make sense of things” • To develop a “profound grasp of the obvious.” • To examine reasons • To discover what variables might be important, generate hypotheses or theory (Hurley RE.Qualitative research and the profound grasp of the obvious. Health Services Research,1999;34:1119-1136)

9. Qualitative and Quantitative Research: Different ways of seeking the truth Qualitative • Constructivist • Inductive Generate hypothesis • Subjective Emphasizes meaning/ interpretation • Contextual “thicker data” on relatively few cases Quantitative • Positivist • Deductive Test hypothesis • Objective Emphasize measurement • Generalized “thinner data” on a large number of cases

10. Qualitative and quantitative data provide complementary insights Mixed Qualitative Quantitative • Address different research questions • Provide different perspectives about the same question

11. Advantages and Disadvantages of Qualitative Research Limitations Strengths Provides deep insight Understand alternate viewpoints through subjective data Exploratory research and hypothesis generation Not reliant on pre-defined variables Generalizability Time consuming Methods not as well-known as quantitative study designs Expense

12. Methods

13. Qualitative research requires rigor • Asking appropriate research questions • Developing appropriate study designs • Conducting data acquisition activities that are justifiable, innovative, and ethical • Employing analyses that are trustworthy • Producing evidence that is relevant and useful

14. Qualitative research is iterative Crabtree and Miller, Doing Qualitative Research

15. Defining a research question • What problem in the universe are you trying to understand? • What are the gaps in the literature? • How will your study contribute to the literature by addressing identified gaps?

16. Case Example • Problem in the universe • Many parents are refusing to vaccinate their children • Gaps in the literature • Existing research is quantitative and/or relies on hypothetical (not real-time) decision-making • How will your qualitative study contribute? • “…(it will) describe the full range of mothers' attitudes about vaccinating their children and the promoters and inhibitors of mothers' acceptance of vaccinations during the time when mothers are actively deciding whether to vaccinate their infants.”

17. Identifying the researcher(s) • Will there be one researcher or a research team? • What skills and perspectives are available? • Consider consulting external researchers

18. Sampling Strategies • Sampling strategies • Typical cases (average) • Extreme cases (outliers) • Maximum variation sampling (range) • Snowball (chain) sampling • Iterative • Move back and forth between sampling and analyzing data • Thematic saturation • No more emergent patterns in the data

19. Gaining IRB approval • Be explicit and specific about what qualitative research is, how and why it is appropriate • Describe the researcher(s) and their experience with qualitative inquiry • Protect subjects and their data • Protect non-subjects you encounter • Note strategies to mitigate any harm to participants

20. Qualitative research is iterative Crabtree and Miller, Doing Qualitative Research

21. Complementary approaches

22. Data Collection Techniques 1-on-1 Interviewing Focus groups Observing Video-taping Studying documents Administering questionnaires (with questions that generate descriptions) Eliciting narrative writing Gathering diaries Collecting drawings

23. Observation preparatory work • Have a clear purpose of the observation • Make explicit any model or interpretive framework • Identify examples of what to include and what to exclude • Reflexivity: know your biases • Formatting: consider an observation guide

24. Structured observation guide

25. Open-ended observation notes http://josephmcgee.wordpress.com/tag/ethnographic/

26. 1-on-1 Interviews • One-on-one interviews represent a conversational partnership • Purpose: to obtain information about the participant’s feelings, thoughts, beliefs and experiences • Ask what, how and why questions • Consider: variable interview formats Highly structured Informal, open-ended

28. Focus Groups • Interviewing small groups of people • Relatively quick and inexpensive way to obtain a lot of data • Purpose: to foster a dialogue that clarifies or expands the participants’ views on the topic of interest • Consider: impact of group dynamics

29. Data collection: Observation • Purpose: describe and understand social action • Ethnography: studying a culture • Close, prolonged observation • Observation shifts between breadth to depth • Focused Observation: • Brief periods of observation that focus on a particular event or activity • Observation check list Focused Observation Ethnography

30. Qualitative research is iterative Crabtree and Miller, Doing Qualitative Research

31. Data Analysis • Grounded theory • Iterative “coding” • Identify emerging concepts and themes • Generate hypotheses • Content Analysis to analyze documents • Using word counts to describe material • Can be quantitative and/or qualitative

32. Organize data into codes then themes • Codes are meant to label pertinent data • In vivo codes use participant terms • “Sociological constructs” use researcher terms • Organize codes into categories • Build categories into themes, lessons learned, takeaways • This is a process of inductive reasoning

34. Example coding map Theme Selective Coding Selective Coding Concept A Concept B Axial Coding Open Coding Open Coding Indicator Indicator Indicator Indicator

35. Example: Vaccine refusal Trust Selective Coding Selective Coding Environmental Inhibitors Knowledge Axial Coding Open Coding Open Coding Bad experience with past vaccination Skepticism of others around them Doesn’t know effects of disease Believes disease is not around

36. Qualitative analysis software helps organize data and facilitate analysis http://alternativeto.net/software/dedoose/about

37. Qualitative research is iterative Crabtree and Miller, Doing Qualitative Research

38. Trustworthiness • Triangulation • Methods • Observer • Participants • Peer debriefing • Member checking • Audits • Detailed evidence

39. Demonstrating rigor in qualitative results • Credibility - confidence in the 'truth' of the findings • Transferability - showing that the findings have applicability in other contexts • Dependability - showing that the findings are consistent and could be repeated • Confirmability - a degree of neutrality or the extent to which the findings of a study are shaped by the respondents and not researcher bias, motivation, or interest.

40. Dissemination

41. Dissemination • Make the research question clear • Describe the sampling strategy • Describe the researcher(s)

42. Dissemination • Show the data • Use quotes wisely • Be brief • Demonstrate rigor to build trustworthiness • Note the limitations to your study • Conclude with how the findings add to the body of knowledge

43. Journals to be aware of • Qualitative Health Research • Sociology of Health & Illness • Anthropology & Medicine • Social Science & Medicine • Studies in Medical Anthropology

44. A parting thought “Research is to see what everybody else has seen, and to think what nobody else has thought.” -Albert Szent-Gyorgyi 1937 Nobel Prize for Medicine

45. Acknowledgements • Erika Abramson, MD, MS • Some slides were adapted from qualitative workshops given at COMSEP and PAS by: • Janice L. Hanson, U of Colorado School of Medicine • Virginia F. Randall, Uniformed Services University of the Health Sciences • Su-Ting Li, University of California, Davis • Dorene Balmer, Baylor College of Medicine

46. Thank YouJosh Richardsonjor2032@med.cornell.edu