Codes,conceptsandcategories,ohmy!Buildingyourskillsin

qualitativedataanalysisASSOCIATIONOFPEDIATRIC PROGRAMDIRECTORS

ANAHEIM2017

Welcome!AlyssaBogetz,MSW(StanfordUniversity)

ErikaAbramson,MD,MS(WeillCornellMedicalCollege)

HilaryHaftel,MD,MHPE(UniversityofMichigan,AnnArbor)

MelissaKlein,MD,MEd(CincinnatiChildren’s)

Su-TingLi,MD,MPH(UniversityofCalifornia,Davis)

KateMichelson,MD,MMSc (BostonMedicalCenter)

ArabellaSimpkin,MD,MA(HarvardMedicalSchool)

DisclosuresTheauthorshavenofinancialrelationshipsorconflictsofinteresttodisclose

Objectives1. Defineanddifferentiate3commonqualitativeanalytical

approaches

2. Recognizewhichanalyticalapproachisappropriateforagivenresearchquestionandgoal

3. Analyzequalitativedatathroughthedevelopmentofyourowncodingschemeandthemes

Agenda1. Briefintroductiontoqualitativeresearch 3:15-3:25pm2.Discuss theconceptandprocessofcoding,categoryandthemecreation

3:25-3:35

3.Activity1:Codeatranscript 3:35-4:004.Activity2:Create categoriesandthemes 4:00-4:205. Discusshowtoselectananalyticalapproach 4:20-4:306.Q&A,summary andworkshopevaluation 4:30-4:45

WhatisQualitativeResearch?ANDWHENSHOULDYOUUSEIT

QualitativeResearch•Designedtounderstandtheperspectivesandexperiencesofindividualsorgroups

•Subjective• Emphasizesmeaning,interpretation

•Inductive• Goalistogeneratehypotheses,developtheories

•Reflective• Acknowledgesresearcher’sroleandbiases

Whenshouldyouusequalitativemethods?•Explore aproblemorissueindepth

•Understandvariablesthataredifficulttomeasurequantitatively• Informsurveydesign

•Empowerindividualstosharetheirstories,giveavoice

•Explain howideaslinktogetherinexistingtheoriesormodels

•Generatenewtheories

QualitativeResearchRequiresRigorQuantitativeCriteria

QualitativeCounterpart

Definition

InternalValidity Credibility Truthvalue

ExternalValidity Transferability Applicability

Reliability Dependability Consistency

Objectivity Confirmability Neutrality

QualitativeResearchRequiresRigorQuantitativeCriteria

QualitativeCounterpart

Definition

InternalValidity Credibility Truthvalue

ExternalValidity Transferability Applicability

Reliability Dependability Consistency

Objectivity Confirmability Neutrality

QualitativeResearchRequiresRigorQuantitativeCriteria

QualitativeCounterpart

Definition

InternalValidity Credibility Truthvalue

ExternalValidity Transferability Applicability

Reliability Dependability Consistency

Objectivity Confirmability Neutrality

AnalyzingDataCODING,CATEGORYANDTHEMECREATION

AnalysisConsiderations•Whowillbepartofyouranalysisteam?

•Howwillyoudividethework?• Everyonecodesalltranscripts• EveryonecodesfirstXtranscripts,agreesoncodingschemaandthendividesuptheremainingtranscripts

•Whatwillyouusetohelporganizeyouranalysis?• Qualitativeanalysissoftware(Atlas.ti,Dedoose,Hyperresearch,Nvivo,etc.)• Excel• Notecards

DataAnalysisSteps•Readthroughdata•Developpreliminarycodelist• Code– word/phrase(oftentakenverbatimfromtext)whichrepresentsasingleidea• Singlewords,phrases,sentences,orparagraphscanbecoded•Discusscodelistwithcolleaguestofinalizelistandcreatecodebook(iterativeprocess)•Coderemainingtranscriptsusingcodebook•Organizecodesintolargercategories•Organizecategoriesintolarger,overarchingthemes(thematicanalysis)

Code→Category→Theme

Theme

Category Category CategoryCategory

Theme

Code – word/phrasewhichrepresentsasingleidea

Category – word/phrasetodescribeagroupofcodes

Theme – word/phrasetodescribebroader,overarchingidea

Code Code Code Code Code Code Code

Topic:Self-DirectedLife-LongLearninginMedicineQuotesThereseemstonotbeenoughtimeintheday.SometimesIfindI’mjusttootiredtofocusonreading.Morepressingissues ofday-to-dayworkandpatientcareTimeconstraints withworkTimeWhenI’mhomeIwanttodootherthingsBeingtiredHavingtoomanyotherpressingmatters toattendtoBeingconstantly tiredTimeBalancing workandfamily

LiST,etal.SuccessfulSelf-DirectedLife-LongLearninginMedicine:AConceptualModelDerivedfromQualitativeAnalysisofaNationalSurveyofPediatricResidents.AcademicMedicine.2010;85(7):1229-1236.

Self-DirectedLife-LongLearninginMedicineQuotes CodeListThereseemstonotbeenoughtimeintheday.SometimesIfindI’mjusttootired tofocusonreading.

Time

Morepressingissues ofday-to-dayworkandpatientcareTimeconstraints withworkTimeWhenI’mhomeIwanttodootherthingsBeingtiredHavingtoomanyotherpressingmatters toattendtoBeingconstantly tiredTimeBalancingworkandfamily

Self-DirectedLife-LongLearninginMedicineQuotes CodeListThereseemstonotbeenoughtimeintheday.SometimesIfindI’mjusttootired tofocusonreading.

Time

Morepressingissues ofday-to-dayworkandpatientcare

Tired

Timeconstraints withworkTimeWhenI’mhomeIwanttodootherthingsBeingtiredHavingtoomanyotherpressingmatters toattendtoBeingconstantly tiredTimeBalancingworkandfamily

Self-DirectedLife-LongLearninginMedicineQuotes CodeListThereseemstonotbeenoughtimeintheday.SometimesIfindI’mjusttootired tofocusonreading.

Time

Morepressingissues ofday-to-dayworkandpatientcare

Tired

Timeconstraints withwork Patient care/learnerbalance

TimeWhenI’mhomeIwanttodootherthingsBeingtiredHavingtoomanyotherpressingmatters toattendtoBeingconstantly tiredTimeBalancingworkandfamily

Self-DirectedLife-LongLearninginMedicineQuotes CodeListThereseemstonotbeenoughtimeintheday.SometimesIfindI’mjusttootired tofocusonreading.

Time

Morepressingissues ofday-to-dayworkandpatientcare

Tired

Timeconstraints withwork Patient care/learnerbalance

Time BalancinglifeandworkWhenI’mhomeIwanttodootherthingsBeingtiredHavingtoomanyotherpressingmatters toattendtoBeingconstantly tiredTimeBalancingworkandfamily

FromCodestoCategories

Codes Categories• Time pressures• Tired

??

• Balancing pt.care/learning

• Balancinglife/work

??

FromCodestoCategories

Codes Categories• Time pressures• Tired

Environmental Strain

• Balancing pt.care/learning

• Balancinglife/work

CompetingDemands

Code→Category→Theme

Theme

Category EnvironmentalStrain

CompetingDemandsCategory

???

Code – word/phrasewhichrepresentsasingleidea

Category – word/phrasetodescribeagroupofcodes

Theme – word/phrasetodescribebroader,overarchingidea

Code Code Code Time Tired Pt-care Life-work

Code→Category→Theme

Theme

Category EnvironmentalStrain

CompetingDemandsCategory

BarrierstoAchievingLearningGoals

Code – word/phrasewhichrepresentsasingleidea

Category – word/phrasetodescribeagroupofcodes

Theme – word/phrasetodescribebroader,overarchingidea

Code Code Code Time Tired Pt-care Life-work

Theme:BarrierstoAchievingLearningGoalsQuotes Code Category

• Thereseemstonotbeenoughtimeintheday

• Time• Timeconstraints withwork

Timepressures

Environmental Strain

• SometimesIfindI’mjusttootired tofocusonreading

• Beingtired• Beingconstantly tired

Tired

• Havingtoomanyotherpressingmatters toattendto

• Morepressingissues ofday-to-dayworkandpatientcare

Patientcare-learnerbalance

CompetingDemands

• Balancingworkandfamily• WhenI’mhomeIwanttodo

otherthings

Life-workbalance

Howmanycodes?•Dependsonresearchquestion•Startwithlargenumber,thenrefineovertimethroughadditionalanalysis(iterative)anddiscussion(peerdebriefing)

•Endresult=25-30codes->4-5themes

•Singletranscript=10-15codes

SmallGroupActivity1:PracticeCoding1. Independentlyreadthetranscriptanddevelopa

preliminarylistofcodesusingtheworksheetprovided

2. Insmallgroupsof3-4,discussyourcodelistsanddevelop1agreed-uponlist

3. Reapplyagreeduponcodelisttoyourowntranscripts

25min

SmallGroupActivity2:CreateCategoriesandThemes1. Inyoursmallgroupsof3-4,reviewyourcoded

transcriptsanddecidehowtoorganizeyourcodesintocategories

2. Fromyourcategories,develop2-4themesthatrepresentthedataandhowideasarerelated

3. Bepreparedtoshareyourthemeswithyourtable

20min

3ApproachestoAnalysisCONTENT,THEMATICANDGROUNDEDTHEORY

SelectingAnApproach1. Researchgoal

2.Datathatyouhave

Research Goal Type ofData

Content • Describedataasis• Quantifycodesorcategories• Comparefrequencyof

categoriesbetweengroups(residentsv.fellows)

• Open-endedsurveyquestions

• Structuredinterviewsorfocusgroups

• Essays/narratives

Thematic • Develop themes• Interpret”bigpicture”

meaningofdata

• Structured orsemi-structuredinterviewsorfocusgroups

• Essays/narrativesGroundedTheory

• Generateatheoryorconceptualmodelabout aprocess/socialphenomenon

• Semi-structured interviewsorfocusgroups

• Essays/narratives

ResearchQuestions

Howdoresidentsandfellowsdifferinthestrategiestheyusetocultivatetheirownwellnessduringtraining?

Whatfactorsfacilitateresidentwellnessduringresidencytraining?

Whatfactorsfacilitateresidentwellnessand whatistherelationshipbetweenthese?

ContentAnalysis

ThematicAnalysis

GroundedTheory

Descriptive ⇢ Transformative

Code Code Code

ContentAnalysisThematicAnalysis

GroundedTheory

Developcategories

Countfrequencyofcategories

Developcategories

Combinecategoriesintothemes

Developcategories

Combinecategoriesintothemes

Generatetheory/modelforhowthemesrelate

Whatdoesitmeantobe“well”duringresidency?CONTENT,THEMATICANDGROUNDEDTHEORYANALYSIS

ContentAnalysisCodes Categories

• Finding moments• Notagoal

Wellness isaprocess

• Effort• Practice• Dailyoccurrence

Requiresdeliberatepractice

• Mindfulness• Deepbreathing• Attention/awareness• Gratitude

Involvesconnectingto oneself

• Meaningful connectionwithpatients, co-residents,significant others/friends

Involves connectingtoothers

• Peace• Joy• Grounding

Outcomes ofwellness

ThematicAnalysisCodes Categories Themes• Finding moments• Notagoal

Wellness isaprocess

EffortEveryDay• Effort• Practice• Dailyoccurrence

Requiresdeliberatepractice

• Mindfulness• Deepbreathing• Attention/awareness• Gratitude

Involvesconnectingtooneself

Connection

• Meaningful connectionwithpatients, co-residents, significantothers/friends

Involves connectingtoothers

• Peace• Joy• Grounding

Outcomes ofwellness BeingWell

ThematicAnalysisEffortEveryDay◦ Wellnessisaprocess,notanendpoint,andrequiresintentional,dailyeffort.

Connection◦ Wellnessinvolvesseekingandcultivatingasenseofconnection:tooneselfthroughmindfulnessandattention;topatientsandcolleaguesthroughmeaningfulrelationships;andtoone’sworkandworkplacethroughengagement.

BeingWell◦ Whenpracticed,wellnessleadstoasenseofgrounding,joyandpeace.

Beingwell(Peace,joy,gratitude,grounding)

Connection(Withoneselfandothers)

EffortEveryDay(Deliberateeffortandpracticeovertime)

GroundedTheory

Descriptive ⇢ Transformative

Code Code Code

ContentAnalysisThematicAnalysis

GroundedTheory

Developcategories

Countfrequencyofcategories

Developcategories

Combinecategoriesintothemes

Developcategories

Combinecategoriesintothemes

Generatetheory/modelforhowthemesrelate

Conclusions•Codingisthebuildingblockofallqualitativeanalysis•Approachyouselectdependson:• Researchgoal• Typeofdata•Analyticalapproachshouldbedeterminedearly:• Researchquestionandstudydesign•Embracetheprocess,consultwithqualitativeresearcherifpublicationisgoal

Thankyou!

Whatquestionscanweanswerforyou?

Resourcepacket

Pleasecompletethebrief(1-2minute)evaluationsowecanimprovethisworkshopfor

futureyears!