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Critical Appraisal: QualitativeSian Aynsley
Information Skills Trainer
South London Healthcare NHS Trust
Queen Elizabeth, Woolwich
Outline of session
Qualitative research: what, why, how?
◦ Presentation
◦ “Qualitytative Street” exercise
◦ Appraisal of article
Questions and follow up
Objectives of session
Understand the difference between
quantitative and qualitative research
Become familiar with major features and
terminology of qualitative research
Apply critical appraisal to a qualitative
paper using the CASP checklist
Research methods
Quantitative
◦ Uses numbers to
describe and analyse
◦ Useful for finding
precise answers to
defined questions
◦ Objective
◦ Deductive reasoning
◦ Statistical sampling
Qualitative
◦ Uses words to
describe and analyse
◦ Useful for finding
detailed information
about people‟s
perceptions and
attitudes
◦ Subjective
◦ Inductive reasoning
◦ Theoretical sampling
Quan or qual?
How many parents would consult
their GP if their child had a mild
temperature?
Why do so many parents worry
so much about their child‟s
temperature?
What proportion of smokers
have attempted to give up
smoking?
What stops people giving up
smoking?
Qualitative
Qualitative
Quantitative
Quantitative
Quan or qual?
“a frequent criticism is that qualitative
data...amounts to little more than anecdotes,
personal impressions or conjecture” (Mays and Pope, 2000)
“Doctors have traditionally placed high value on
number based data, which may in reality be
misleading, reductionist and irrelevant to the
real issues” (Greenhalgh, 2010)
Quan or qual?
“Both methods are valid if applied to
appropriate research questions, and they
should complement each other” (Bowling, 2010)
“The view that the two approaches are
mutually exclusive has itself become
„unscientific‟” (Greenhalgh, 2010)
Qualitative research: why?
Different people have different ways of making
sense of the world
“Allows for the generation of rich data and the
exploration of “real life” behaviour, enabling
research participants to speak for themselves” (Kuper et al, 2008)
Results can explore issues that are poorly
understood or extend / modify existing
theories
Qualitative research: how?
Research questions have an open focus
A variety of methods and approaches can be
used which are rigorous and systematic
“A method of naturalistic enquiry which is
usually less obtrusive than quantitative
investigations and does not manipulate a
research setting” (Bowling, 2002)
◦ Natural settings are used
Results may be transferred to similar situation
but are usually not totally replicable
Components of qualitative
research: IMRAD
Introduction
◦ Why?
Methods
◦ How?
Results
◦ What?
Discussion
◦ Meaning
Types of question
What? How? Why?
“What is it like to be the mother of an
unborn baby?”
“How do smokers feel about the various
smoking cessation options available?”
“Why do people not take the medicine
prescribed to them?”
Theoretical frameworks
“Qualitative researchers pay attention to the
theoretical bases of their methodological
approaches, so their choices of what theory
and which methodology to use are related” (Kuper et al, 2008)
Qualitative methodologies
Discourse analysis
◦ Analyses language and its role in the social
world
Ethnography
◦ Studies a group‟s cultural beliefs and values
◦ Originates from anthropology
Grounded theory
◦ Generating a theory based on data collected
Qualitative research methods
Different research methodologies may
employ the same method
Most common methods:
◦ Observation
◦ Interviews
◦ Focus groups
◦ Questionnaires
Observation
Used most frequently by ethnographers
Participant observation: researcher
takes an active role in group interaction
Non-participant observation:
researcher takes unobtrusive role to
minimise bias
Interviews
Widely used research method, used in all
methodologies
Pre-set questions, broad list of topics or
mix of both
◦ Structured
◦ Semi-structured
◦ Unstructured
Focus groups
Group interview
Capitalises on communication between
research participants to generate data
Requires expertise to manage
Questionnaires
Can vary in structure
◦ Structured (Lickert scale)
◦ Unstructured (Market survey)
Content of question differentiates a
qualitative questionnaire from a
quantitative – more than yes / no
Free text questions
Sampling
Tends to be small
“Biased”: randomisation not an issue
Study must clearly define:
◦ Sample individuals - characteristics
◦ Study inclusion / exclusion criteria
◦ Recruitment
◦ Sampling strategies
Sampling strategies
Convenience sampling
◦ Subjects easy to recruit, likely to respond etc.
Purposive sampling
◦ Based on purpose of study
Snowballing
◦ Building a network of respondents
Theoretical sampling
◦ Based on emerging findings
Setting
Venue should be clearly described
Appropriate setting lessens chance of
performance bias
Familiar environment best
Data analysis
Interpretations made by researcher(s)
from descriptions / observations of
participants – inductive approach
Data should be analysed individually, then
compared with other data to identify
recurring elements
Content analysis: counting words, coding
data
Data saturation: themes start recurring
Data analysis
Any use of computer software for data
analysis should be stated (ex: NVivo)
Analysis should be repeated by more than
one researcher
Themes synthesised from raw data should
be described (thematic analysis)
Large amounts of data are usually
generated
Triangulation
Comparison of results from:
◦ Two or more different methods of data
collection (e.g. interview and observation)
◦ Two or more data sources (e.g. interviews
with members of different interest groups)
◦ Two or more theoretical approaches
Researcher bias / Reflexivity
To address performance bias, researchers
should:
◦ Keep a reflective component in their field
notes
◦ Engage in dialogue with the subjects to clarify
their views
◦ Consider what the biases could have been
Ethics
Ethical standards, approval, issues should
be discussed
◦ Anonymity (if possible)
◦ Confidentiality (always)
◦ Informed consent (always)
Follow up interview to check whether
findings are recognisable by the subject
◦ Respondent validation
Transferability
Can I apply these results to my own
practice?
◦ Participants‟ socio-cultural origin
◦ Age range
◦ How the researchers had access to this
group
◦ The researcher‟s relationship with the
subjects
Can be difficult to transfer results
exactly
Summary
Researchers should consider:
◦ How a sample is recruited
◦ Whether the setting for data collection is
appropriate
◦ How the data is analysed
◦ Whether the findings make sense to the
subjects
29
The “Qualitytative Street”
exercise*
Focus group study
Participants must have some experience
of eating Quality Street chocolates and
know which one is their favourite
Do you want to participate?
Is there anyone who does not wish to
participate?* Source: Jenny Tancock, former Clinical Librarian at University Hospitals of
Morecambe Bay NHS Trust
The “Qualitytative Street”
exercise: appraisal
How was the group “recruited”?
◦ Did anyone ask what the study was about
before agreeing to participate?
Non-participants: why did you choose not
to take part?
◦ What are some of the reasons participants
might choose to opt out?
The “Qualitytative Street”
exercise: appraisal
How were the data “collected”?
◦ Observation
◦ Interview
◦ Focus group
◦ Questionnaire
Sweet choice / Sweet preference
How did we know when to stop
collecting data?
The “Qualitytative Street”
exercise: appraisal
How were the data “analysed”?
◦ Content analysis
◦ Thematic analysis
◦ Use of computer software
How might the two methods of data
collection be compared?
◦ Triangulation
The “Qualitytative Street”
exercise: appraisal
Reflexivity
◦ How did you feel about participating in a
study without knowing the objectives?
What aspects of the study might have
affected how you participated?
◦ Setting
◦ Group
◦ Role of researcher
The “Qualitytative Street”
exercise: appraisal
How could the study have been
improved?
If this was a real study, what would be
good practice?
A final thought...
“Qualitative methods really come into
their own when researching uncharted
territory – that is, where the variables of
greatest concern are poorly understood,
ill-defined and cannot be controlled” (Greenhalgh, 2010)
References and further reading
Ajetunmobi, O (2001) Making sense of critical appraisal
Arnold, London
Bowling, A (2010) Research methods in health (2nd ed)
Open University Press, Buckingham
Crombie, I K (1996) The pocket guide to critical appraisal
BMJ Books, London
Dawes, M (2005) „Introduction to critical appraisal‟ in
Dawes, M et al Evidence-based practice (2nd ed)
Elsevier, Edinburgh
Greenhalgh, T (2010) How to read a paper: the basics of
evidence-based medicine (4th ed) BMJ Books, London
References and further reading
Kuper, A (2008) An introduction to reading and appraising
qualitative research, BMJ vol 337(7666) p404-9
Patton, MQ (2002) Qualitative research and evaluation
methods (3rd ed) Sage Publications, London
Mays, N and Pope, C (2006) Qualitative research in health
care (3rd ed) Blackwell, Oxford
Trochim, W (2006) Research methods knowledge base
[Online] Web Centre for Social Research Methods
http://www.socialresearchmethods.net/kb/index.php#about
[Accessed 24 Nov 2010]