Qualitative research Workshop on: Nurse-led Research NZ Assoc Clinical Research Conference

1. Qualitative researchWorkshop on: Nurse-led ResearchNZ Assoc Clinical Research Conference David R. Thomas Emeritus Professor, University of Auckland ResearchWorks NZ Ltd dr.thomas@auckland.ac.nz August 2011

2. Rationale for qualitative research • Allows gathering of information directly relevant to a research topic • Can adapt or revise data-gathering (e.g. interview topics) as data collection proceeds • Suitable for small-scale projects BUT – qualitative data analysis requires specific skills

3. What is qualitative research? • Collects and analyses data in the form of words or language • Short interview and questionnaire responses (< one page) • Long text interview responses (> one page) • Observations of settings and events (e.g., researcher’s notes) • May involve numbers, but not statistical analyses

4. Multiple varieties of qualitative research: Some common labels • Phenomenology • Ethnography • Discourse analysis • Grounded theory • General inductive approach • Stories & narratives • Case studies • Biography

5. Case Study: Evaluation of EDS form for diabetes service Investigators: Theresa Busler & Judith Dee, Diabetes Nurse Specialists Whitiora Diabetes Service, Middlemore Hospital Research questions were: 1. Is the electronic discharge summary (EDS) an effective tool to communicate clinical information to general practitioners (GPs) and diabetes nurse specialists (DNS)? 2. To what extent is the information contained in the EDS understood by people with diabetes? 3. Can changes be made to the EDS to create a more user friendly method of communication the hospital stay, based on the findings of the study?

6. Evaluation of EDS form – Data collection • Phone interviews with 26 patients, 8 GPs, 4 nurses (DNS) face-to-face. • Patient interview questions: • How do you find out information about your health – where do you get this information from? • You were given a discharge summary when you left hospital. Did you read it? (If they had not read it – tell me why you did not read it? • Tell me what you understood from the information that was in that discharge summary. • Some of your diabetes medications were changed in hospital. Tell me what you understood about that change? • Were you aware of any side effects of the medication you were taking for your diabetes? Tell me about that? • What do you think needs to be in the discharge summary? what is important to you?

7. Evaluation of EDS form – Example 1 patient interview data Researcher: Did you get a letter about your discharge and did you read that. Patient: Yes I did, maybe my daughter already read it. Researcher: So you didn’t read it. Patient: No I didn’t. Researcher: Why do you think you didn’t read it. Patient: No I was busy.

8. Evaluation of EDS form – Example 2 patient interview data Researcher: When you were recently in hospital did anyone give you anything in terms of information. Patient: No Researcher: Did you see any leaflets or were you given anything when you left hospital such as papers, were you given any letters. Patient: What a discharge paper? Researcher: Oh you were. Obviously you know what that is. Did you have a look at that. Patient: Yes. Some of it I understood some of it I didn’t. Researcher: That is quite useful to know, so that the stuff you did understand did you find that useful. Patient: Yes and the stuff I don’t understand I am asking the doctor about it tomorrow.

9. Evaluation of EDS form - Categories from inductive analysis

10. Evaluation of EDS form – uses of the EDS • I would say that having both are easier for me, having the information spoken to me and then being able to refer to the letter later on because it’s hard to remember when you get to my age. • The letter was confusing so I gave it to the doctor and the pharmacist and they were ok • I thought it was really great it gave me a better understanding of what had happened with mum and her time in hospital and it explained the medication she was being sent home with. I thought it was really good, I took it with me to the pharmacy on the way home after her discharge, they read through it as well.

11. Reasons for using qualitative research • Cost-effective for small-scale nurse-led studies • Can address specific research questions effectively (e.g. about service delivery) • Does not require hypothesis testing • Provides context and understanding for programmes and services

12. Research designs with qualitative research • Standalone qualitative • Mixed method: Both qualitative and quantitative • Sequential Development: Qualitative then quantitative • Followup: Quantitative then qualitative

13. Requirements for effective qualitative research • Overall strategy: Adequate familiarity with strategy or approach to be used • Data collection: Need to collect rich or elaborate text data • Analysis: Competency needed in qualitative analysis procedure used • Reporting: Need to report findings in an appropriate style

14. Selected references: Qualitative research • Creswell, J. W. (2006). Qualitative inquiry and research design: Choosing among five approaches (2nd ed.) Sage. • Ezzy, D. (2002). Qualitative analysis: Practice and innovation. Crows Nest, NSW: Allen & Unwin. • Silverman, D. (2001). Interpreting qualitative data: methods for analysing talk, text and interaction (2nd ed.). London: Sage. • Strauss, A. & Corbin, J. (1990). Basics of Qualitative Research. Newbury Park: Sage. • Thomas, D. R. (2006). A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation, 27(2), 237-246.