Qualitative Research in Health & Leisure

Qualitative Research in Health & Leisure Focus Groups and Interviews Eimear Foley, BSc., MSc. 19th January 2006

Overview • What is qualitative research? • Why use qualitative research? • Interviewing • Focus Groups • Analysis • Reporting • Examples

What is Qualitative Research? • Qualitative research designs are those that are associated with interpretative approaches, from the participants point of view, rather than measuring discrete, observable behaviour. • Qualitative methodologies are strong in those areas that have been identified as potential weaknesses within the quantitative approach

Qualitative research … • Allows the researcher to explore the cognitive and affective aspects of the research question in greater detail • Encourages participants to introduce concepts of importance to the issues rather than adhering to pre-determined subject area • Approaches ‘which seek to uncover the thoughts, perceptions and feelings experienced by informants’ (Minichiello et al., 1995:10)

Interviewing • Structured – usually with a structured questionnaire • Semi-structured Interviews- Guided Conversations • Allow for focused, conversational, two-way conversation • Depth of information, time consuming • Provide reasons for answers • Less intrusive – sensitive issues • In Depth – 1/2 issues covered in great detail, questions are based on what the interviewee says

Qualitative interviewers should try to be interactive and sensitive to the language and concepts used by the interviewee and also try to keep the agenda flexible • Good questions in qualitative interviews should be open ended, neutral, sensitive, and clear to the interviewee (Patton, 1987)

Types of questions for qualitative interview (Patton, 1987) • Behaviour or experience • Opinion or belief • Feelings • Knowledge • Sensory • Background or demographic

Tips for interviewing… • Use questions carefully, but informally • Ask questions exactly as written • Follow the order given • Ask every question • Don't finish sentences

Obtaining Adequate Responses - The Probe • Silent probe Pause and wait • Overt encouragement “Uh-huh”, “OK” • Elaboration “Is there anything else you would like to add?” • Ask for clarification "A minute ago you were talking about the experience you had in primary school. Could you tell me more about that?" • Repetition "What I'm hearing you say is that you found that experience very enjoyable." Followed by a pause

Focus Groups • “a group of individuals selected and assembled by researchers to discuss and comment on, from personal experience, the topic that is the subject of the researcher” (Powell et. al., 1996: 499) • Focus groups rely on interaction within the group based on topics that are supplied by the researcher

Why use focus groups? • Draw upon participants attitudes, feelings, beliefs, experiences and reactions – not feasible using other methods e.g. observation, one-to-one interviews, surveys • Attitudes etc. more likely to be revealed in social group setting • Large amount of info – short amount of time • Useful when interested in everyday use of language and culture of particular groups • Also to explore degree of consensus

Benefits • Interaction • Information about why issue is salient • Involvement in decision making process – Empowerment • Forum for change • Limitations • Researcher has less control over data produced • Social Desirability • Difficult to assemble • Not fully confidential or anonymous

Organisation of Focus Group • No. of participants = 6 - 10 people • Duration = 1 – 2 hours • Location = Neutral • Same group meeting several times • One meeting, several groups

Participants: • Heterogeneous vs. Homogeneous • People need to feel comfortable • Possess similar characteristics or levels of understanding about topic • Locating participants • Time consuming • Specific interests – word of mouth through key participants e.g. swimmers, parents • Advertising or poster campaign • Existing social networks e.g. ARG, ICA, Musical Society

Role of moderator • Clear explanation of purpose • Help people feel at ease • Promote debate by asking open ended questions • Tease out diverse range of meanings • Probe for detail/Steer conversation back on course • Facilitate interaction • Avoid showing approval or giving personal opinion • One moderator facilitates and other takes notes, checks equipment and give feedback

Designing Questions • Open-ended questions: allows respondents to give answers in their own way • Useful to get unanticipated answers • Responses are open ended i.e. not yes or no answers • Example: What can you tell me about diet? What are your thoughts on yoga?

Interpretational Analysis • There is no one correct way of analysing qualitative data • Essential to describe the planned method and decision criteria • Transcript – written version of the interview • Make notes when transcribing tape – provoke memories and thoughts • First transcript will be messy and unedited • Research question must be clearly defined in advance

Data Organisation: Step 1 – Creating Tags • Creating Tags – aims to produce a set of concepts which adequately represent the information included in interview transcript • Separates relevant meaningful portions of data from their context • Each unit is tagged with a provisional name describing the topic • E.g. Barriers to physical activity

Data Organisation Step 2 – Creating categories • List and compare the tags already derived in step 1 • Group similar tags and give a label that captures the essence of the topic (Miles & Huberman, 1984) • Set of categories serves as preliminary organising system • Segments must remain flexible • Higher order categories

Codes • You may decide to use a set of already existing codes with your data. These are called a priori codes. • A priori codes are codes that are developed before examining the current data. • Many qualitative researchers like to develop the codes as they code the data. These codes are called inductive code. • Inductive codes are codes that are developed by the researcher by directly examining the data.

Writing the report • In-depth analysis of higher order categories • Intensity & Frequency of responses • Identify group consensus (agreement) • Organise report by issue (instead of by group) • Discuss similarities and differences by groups and by individuals • Restate and answer the research question(s) • Quotes and comments should be used to support findings

Analysing Focus Groups • Distinct feature of working with focus group data is the need to indicate the impact of the group dynamic and analyse the interaction between research participants • When coding, use special categories such as • Jokes and anecdotes • Questions • Deferring to the opinion of others • Changes of mind • A focus group research report that is true to its data should also usually include at least some illustrations of the talk between participants, rather than simply presenting isolated quotations taken out of context. (Kitzinger, 1995)

Example: Dying from cancer in developed and developing countries: lessons from two qualitative interview studies of patients and their carers (Murray et al., 2003) • Objective: To describe the experiences of illness and needs and use of services in two groups of patients with incurable cancer, one in a developed country and the other in a developing country. • A qualitative approach was used so that accounts could be obtained sensitively without upsetting participants with advanced illnesses • Participants: Scotland: 20 patients with inoperable lung cancer and their carers. Kenya: 24 patients with common advanced cancers and their main informal carers. • Methodology: • Scotland - conducted and tape recorded in-depth interviews at three monthly intervals for up to a year with patients and their main informal carer in the patient's home. • Kenya - guided by staff at the hospital and affiliated nurse training school, a semi-structured interview schedule was developed. A local nurse conducted single interviews with patients and carers in the local language.

Data Analysis • Results were analysed throughout the fieldwork to allow emergent themes to be fed back into the data collection. • These themes and the research questions formed the basis of the coding strategies. • QSR NVivo • At both sites transcripts and field notes were checked and coded by two experienced researchers

Living with cancer in ScotlandPatients and their carers in Scotland were predominantly concerned about the prospect of death. "The doctor told me that you're actually on borrowed time with cancer . . . They're hoping to shrink this cancer in the right lung, but you're more or less a time bomb" (patient 1). "You're wondering if you're going to see tomorrow. When I first was told, that was the first thing that went through my head, How long? When?" . . . it's been like going to hell and back" (patient 2).

Example: Fruits, vegetables, and football: Findings from focus groups with alternative high school students regarding eating and physical activity (Kubik et al., 2005) • Purpose: To increase our understanding of factors that may influence the dietary and physical activity practices of adolescents attending an alternative high school (AHS) • Methodology: 7 schools (4 urban, 3 suburban); 76 students (36 f, 34 m); 45-60 min focus groups; incentive – healthy snack & $20 gift voucher • Trained moderator & co-moderator, audiotaped • Questions developed by investigators & piloted with convenience sample • Introductory Q’s – last time you exercised, everything you had to eat or drink yesterday • Key Q’s – factors that influence food choice; circumstances that make it easier or harder to be active; ideas for a school health promotion programme • Semi-structured questioning to ensure consistency but allow flexibility

Data Analysis • Audiotapes were transcribed verbatim to ensure systematic analysis of focus-group discussions. • Data then were analyzed using a 3-step process (Miles & Huberman, 1994) with the student as the unit of analysis. • Interviewers reviewed and edited transcripts and abstracted meaningful data. • Data were organized into categories representing emerging themes such as eating options at school and factors that influence being active. • Reviewers created a matrix that allowed for the tabulation of themes by school and a comparison of themes across schools. Results then were compared, contrasted, and rank ordered to create a textual summary of findings. • To control for possible bias, all transcripts were reviewed independently by 2 other investigators. The selection of categories and themes also was verified by independent review. • There was a high level of concordance between reviewers

Students reported an interest in “fun” activities. Team sports, particularly football, were considered fun by both girls and boys. Social support and role modeling behavior of friends and adults also were identified as factors that helped one be active. Others liked the way it made them feel “good about yourself” and “lighter and stronger.” Having a goal, “something to work for,” was a motivator for both girls and boys. Boys liked the “adrenaline rush.” “Now I feel like I have a lot more energy and a lot happier when I’m more active and just better able to deal with the world” (male student at an urban school).

Points to note • Be aware of any biases you may have towards the topic • First, make a list of your characteristics e.g. age, gender, religion, interests. • It is likely that these characteristics will be the root of the bias • List ways in which your characteristics might bias you in your efforts at research interviewing. • Then write how you might counteract these biases. • And then write how these efforts to counteract your biases might themselves lead to other biases!

Ethical Issues • Same for all methods of social research • Full information must be given to participants about the purpose and uses of the contributions • Need to clarify that participants contributions will be shared by group and moderator • Do not pressurise people to respond • Encourage participants to keep confidential what they hear • Anonymise data e.g. (Male, aged 46)

References • Cote, J., Salmela, J., Baria, A., (1993) Organizing and Interpreting Unstructured Qualitative Data. The Sport Psychologist, 7, 127-137 • Flick, U. (2002) An Introduction to Qualitative Research (2nd ed.) Sage publications; London • Grbich, C. (1999) Qualitative Research in Health: An Introduction, New South Wales: Sage • Kubik, M., Lytle, L., Fulkerson, J. Fruits, vegetables, and football: Findings from focus groups with alternative high school students regarding eating and physical activity Journal of Adolescent Health 2005 (36) 494-500 • Miles MB, Huberman AM. Qualitative Data Analysis, 2nd ed. London:Sage, 1994. • Minichiello, V., Aroni, R., Timewell, E. and Alexander, L. (1995) In-depth Interviewing: Principles, Techniques, Analysis, 2nd edition. Melbourne: Longman • Murray, SA., Grant, E., Grant, A., Kendall, M. (2003) Dying from cancer in developed and developing countries: lessons from two qualitative interview studies of patients and their carers. BMJ, Feb 2003;326:368 • Patton MQ. (1987) How to use qualitative methods in evaluation, 108-43 London: Sage • Powell R.A. and Single H.M. (1996) ‘Focus groups’, International Journal of Quality in Health Care 8 (5): 499-504.

Qualitative Research in Health & Leisure