ROBERTA E. GOLDMAN, PHD DEPARTMENT OF FAMILY MEDICINE ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY JULY 2012 Overview of Qualitative Research Methods for

ROBERTA E. GOLDMAN, PHDDEPARTMENT OF FAMILY MEDICINE

ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY

JULY 2012

Overview of Qualitative Research Methods for Primary Care

and Public Health

Qualitative Research Overview

Roberta Goldman, PH.D., Brown University and HSPH, 2012

Qualitative research provides data about meaning and context regarding the people and environments of study

Study populations are increasingly alert to how they are being approached by interventionists, and how they are represented in research

The Qualitative Perspective


“I want to understand the world from your point of view. I want to know what you know in the way you know it. I want to understand the meaning of your experience, to walk in your shoes, to feel things as you feel them, to explain things as you explain them. Will you become my teacher and help me understand?”

James P. Spradley (1979)

Nature of Qualitative Research


Attempts to “make sense of” the social world in terms of the meanings people bring to it

To uncover ideas, insights, or ways of thinking of and explaining phenomena about which little is known

To gain novel and fresh perspectives on things about which quite a bit is already known

Qualitative Research Approach


Differs in approach and results from surveys

Looking for range of phenomena in sample studied Rarely use statistical analysis Not representative of the total population

Purposive, stratified samplesGenerally not random samplesMulti-method (i.e. multiple qualitative

methods; mixed qualitative and quantitative methods)

How to Choose your Methods


The methods are in service to your research questions and goals.

The quantity of your interviews, focus groups, or observations is dependent on the participant characteristics you need to include, and the purpose of your research.

Uses of Qualitative Research in Primary Care and Public Health


Obtain data that are useful on their own Detailed, contextually-based data on subtle

meanings associated with attitudes, beliefs, and behaviors

What, how, and why people conceptualize issues differently in different contextual circumstances

Generate “indigenous” terms and categories Generate new avenues for study Process evaluation

Uses of Qualitative Research in Primary Care and Public Health


Obtain data that serve as building blocks or can be triangulated with other data: mixed qualitative/quantitative design

Information that enhances intervention design Information that informs survey design and

implementation Understand the range of relevant survey questions

and responses Test surveys and intervention elements

Cognitive interviewing and pilot testing Information that complements and/or explains

other results

Example:


Hablemos de Tí: Let’s Talk about You (PI: R. Goldman)

Focus groups of middle-aged and older Latinas about perspectives on social, cultural, physical elements of menopausal transition (n=9 groups)

“Reunion” groups (n=9 groups)Individual interviews (n=18 participants)Interactive internet intervention (n=81

participants)

The Qualitative Study Question


Ask an overall study question that has open-ended possibilities for answers: What are the emotional experiences of public

middle school children who change schools mid-year?

How do Portuguese older adults conceptualize the diabetic diet?

In what ways do culture and religion play a role in Hmong adults’ views of health care?

How do political ads on television influence adults’ perceptions of health care reform?

Entering the Community

Preparation for Research


Preparatory steps are essential for community-based qualitative research

Define your communityInvolve community representatives at all

stages from the very beginningGet involved in the community Stay involved in the communityDecide how to represent yourself



Learn what you can from previous studies and secondary data sources: Academic and popular media Public health and other disciplines Maps Demographic statistics Urban planning documents Etc.



Learn what you can from knowledgeable individuals: Community, civic, political, economic, health,

education, business, unions, social service, etc. Academics Other key informants Assess the quality of your key informants



Learn what you can through participant observation e.g. neighborhoods, organizations, resources,

businesses, housing, transportation, health sites, educational resources, financial structures, community events

Be able to recognize what people are talking about or alluding to

Recognize relevant social fields for inquiry

Selected Qualitative Research Methods


Participant observation Individual interviews Focus groups Media content analysis Visual (i.e. video or still image)

All in conjunction with broad literature review, including ethnographic literature The more you know before you start, the better your

research will be

Participant Observation – More than just hanging around

What is it? Etic view Observation Reflection Ranges from high to no participation Informal interviewing for emic explanation


Participant Observation

Why do it? See what’s really going on Counterbalance: Triangulate data from other methods

Understand and “test” what people say Know what to ask people about because

you’ve seen it already



How to really see: Know what you’re looking for, and Be open to seeing what you don’t expect Be cognizant of what you’re looking at Observe the details, variations, etc.

Take notes Reflect on observations and notes; question what you

saw Discuss observations and notes Go look again

and so on. . .



Spectrum of observation

Full participant

Passive Observer


Participant Observation - Fieldnotes

Document your observations Fieldnote journal – running record of observations

AND observer comments Structured observation note grid Brief notations while in the field Expand upon and organize notes as soon as possible –

thick description Truism in anthropology:

For every hour of observation you need 3 hours of writing fieldnotes


Types of Individual Qualitative Interviewing

Categories of Individual Qualitative Interviews

*Informal Conversations in the field

Unstructured Interview setting with no formal guide

**Semi-structured Interview setting with an interview guide;

probesStructured

Interview setting with a rigid question list


In-Depth Interviews

Various kinds and purposesOpen-ended questionsLooking for meaning and context and

information in respondents’ own wordsCombine structure with flexibilityInteractiveFollow new lines of inquiry as they ariseExplore a topic in-depth with follow-ups

and probes: whys, hows, examples, etc.


Key Informant Interviews

Insider/outsiderKnow something about your topic area, in a

way different from your way of knowingCan articulate their knowledgeChoose broadlyCan connect you with other KIs and

informationSemi-structured using flexible question guideMaybe informed consentUsually no monetary compensationExploratory; process evaluation; explanatory


Life History Interviews

In-depth exploration of a small number of illustrative individual cases

Useful for collecting detailed, contextual, diachronic data

Life history interview goes both backward and forward in time

Places the topic of interest within the context of interviewees’ daily lives, both past, present, and looking into the future


Conducting Individual Semi-Structured Interviews

Consider the setting – privacy, comfort, security, noise level, impact of others present, where you put the mic, etc.

Consider your appearance, dress, behavior, demeanor; be tranquil

Introduce yourself, project, sponsor



Informed consent and assurance of confidentiality

Explain process of the interviewAsk permission to record and take notesGain rapport – friendly AND professionalBe real, but stay professional and

appropriateBe empathic because you are a human

being, but you are not a counselorDevelop strategies to redirect



Always bring a question guide that you know well and have practiced in pilot interviews

Can use guide flexibly in terms of wording and question order

Stay alert for new avenues of inquiry that arise due to participant’s responses

Make quick notes on guide as reminders – started a topic; want to return to a topic

If returning to a question, note that it was discussed before


Conducting Individual Qualitative Interviews

Listen alertly; make quick decisions Do you need a follow-up question? Do you need a probe? Is it time to move on to the next question?

Don’t use leading phrasing or paraphrasingAsk for clarityBe sure you can explain to someone else what

the participant said in the interview; if not, you need clarity from the participant: PROBE

Use a variety of neutral probes


Writing Open-Ended Questions

Philosophy

Few questions with broad reachorMany specific questions orStart broad, get more narrow

Your design of the question guide depends on your goals for the research, your participants, your moderator’s skills, nature of the topics


Know why you’re asking questions

Be very familiar with your objectives: know what you want; know what you mean

Write questions to get at content, context and meaning – go for the why’s and when’s and how’s in addition to and maybe more than the what’s

Ask for explanations, feelings, understandings, personal interpretations

Use scripted and/or spontaneous probes


It’s an iterative process. . .

Relax, think broadly, then more narrowlyBlitz out your topicsReview, edit topicsTalk to colleagues about topics, editForm into open-ended questionsEdit and revise your questions – multiple times!



Critique questions for Quality (are they truly open-ended?) Impartiality (do they avoid leading phrasing?) Literacy (are most participants likely to understand

the words in the questions and the meaning of the questions?)

Clarity (does the wording of the questions adequately reflect what you intend the questions to ask?)

Assess appropriateness (given your topic and interview setting, will the questions upset your participants – unsettling personal questions, test-like questions, etc?)



Review, discuss, edit, refine questions Consider order and placement

Often start with easy to answer, ‘grand tour’ question Consider impact of earlier questions on later questions

Show questions to people who are familiar with your objectives and those who are not

Consider the usefulness of every question and delete Pilot the questions with people similar to your study

population – some form of Cognitive Interviewing Modify and finalize questions Be willing to revisit question script as study proceeds

Change wording or order; Add/delete questions


What to Include in your Question Script

Core questionsFollow-up questions: Specific

anticipated questions that follow core question

Probes: Anticipated general probes to ask why, why not, how, when, etc.


Here’s the hard part: What will NOT be in your question script

Directions for spontaneously re-ordering questions

Follow-up questions to: Seek clarification Seek explanation for unanticipated response Follow new lines of inquiry that arise due to a

previous response

This is where the real action lies!


Focus Groups

What is a Focus Group?

“A carefully planned series of discussions designed to obtain perceptions of a defined area of interest in a permissive, non-threatening environment.”

Krueger RA, Casey MA. 2000. Focus Groups: A Practical Guide for Applied Research. Thousand Oaks, CA: Sage


Why do Focus Groups?

Focus groups are about human interactionBenefit from social discourseResearch question lends itself to collecting

more superficial data from an interactive group of people

Discussion of ideas, opinions, beliefs, knowledge, preferences, etc.

Not looking for in-depth case histories


Other Qualitative Methods


Media content analysisVisual methods

Documents

ROBERTA E. GOLDMAN, PHD DEPARTMENT OF FAMILY MEDICINE ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY JULY 2012 Overview of Qualitative Research Methods for