What is qualitative research? Describes and analysis culture & behavior from the point of view of those being studied (emic perspective) Emphasis is on

What is qualitative research? Describes and analysis culture & behavior from the point of view of those being studied (emic perspective) Emphasis is on providing a holistic understanding of the social setting in which research is conducted Relies on a research strategy which is flexible and iterative

What is qualitative research Systematic exploration of illness requires in-depth interviewing & probing Rapport building essential for eliciting sensitive information Useful method of discovering local language usage by which people communicate

What are its uses? QR especially useful for: Exploring a health problem Identifying local perceptions Identifying relevant interventions Investigating feasibility, acceptability & appropriateness of health programs

What are its uses? Developing suitable information, education & communication Identifying problems in on going interventions & suggesting solutions Complementing quantitative data by helping to interpret it Designing more valid survey instruments

Qualitative Research Techniques Wide range available: Individual in-depth interviews Semi-structured interviews Focus group discussions Participant Observation Systematic Interviewing Techniques

In-Depth Interview Most widely used method of data collection in cultural anthropology Researcher has some idea of topics to be covered May use some sort of a topic list or guide But, minimal control over order in which topics are covered & over respondents responses Neither specific questions nor range and type of possible answers pre-defined

In-depth Interviewing It is informal and conversational Aim is to get informants to open up Express themselves in their own terms Key to a successful interview is effective probing Stimulate respondent to produce more information without introducing own words, ideas

Key Elements of Process Introduction Introduce project Interview Express cultural ignorance Express interest Use local expressions Closing Thank Informant

Qualitative Guides Purpose: To identify and provide preliminary exploration of relevant topics with selected informants Introduction: Purpose of study, consent Questions: Open-ended; exploratory, identify local terms Using the Guide: As a starting point; a set of cues Not to be followed precisely like a structured survey Yet, we do want to cover topics outlined

Guidelines for Formulating Questions Avoid yes/no questions eg. Are you currently ill? Avoid leading questions eg. Do you think allopathic medicines are the best means of treatment for illnesses? Use describe tell me about Learn how to rephrase questions

Main Techniques Be very familiar with the field guide Develop rapport---informal, conversational style, listen, watch and read non-verbal expressions, react as appropriate Probe, probe, probe..

Probing Techniques Silence uh-huh (nodding) O.K. What else? Repetition Tell me more about

Tape recording The Interviews Asking permission Benefits Risks Minimizing risks Always take written notes as well Monitor the recording as you go along

Follow-Up Interview Goal: To probe deeper, more sensitive, personal topics Read first interview and develop, adjust questions accordingly Last time we spoke, you mentioned Tell me more about.

Ethical Issues Respect the participant All information is voluntary All information is anonymous Everyone informed of study risks and benefits before they give permission Protecting participants from harm Providing information/referrals

Interview Boundaries Interview versus Education/Counseling Your role as interviewer: listen, provide information or referral at end of interview, or stop interview if needed

In-Depth Interviews Key Informant Interviews A KI is one from whom we receive extensive information KIs include, experts & those in positions of authority & also ordinary people Expertness is based on knowledge of local cultural beliefs & practices

Characteristics of A KI KI should be a person: With whom we have developed a special relationship & have more than one contact Who provides us with expert information Who are good observers, who like to talk Who are able to synthesize, analyze, give thoughtful explanations

Types of KIs Administrators, leaders, other authorities eg, government officers, NGO personnel Community based out-reach workers: eg ANMs, Community health workers Members of the study population: eg marries & pregnant women, adolescent girls, men etc.

Semi-Structured Interviews Effective means of collecting data suitable for systematic comparisons & testing hypotheses Ensures that a range of selected items are covered systematically Structure of interview should create a context that enables rather than impedes respondents

Semi-Structured Interviews Can also include open-ended questions These may be followed by more specific probes Interview may include skip outs Must recognize field conditions importance of privacy

Type of information Provides both quantifiable numeric, coded, as well as qualitative prose data What kind of healers have you used for skin problems? have you consulted a health worker for a skin problem? Provision for comments of interviewer about interview, useful

Strengths of Semi-Structured Interviews Enables coverage of wider range of topics systematically May also facilitate comparisons of qualitative data that are keyed directly to coded variables Provides opportunities to explain meaning of quantitative findings

Limitations of Semi-Structured Interviews Demands fund of knowledge about community & research questions to be studied Relies on substantial experience specially in research settings where cultural differences exist

When to Use Semi-Structured Interviews 1. When single subject responses are required-unit of analysis is the individual 2. When measurement is required on certain topics 3. When measurement of variation in views among study population is required

Case Studies Also in-depth interviews, but focused on individuals own actions & explanations Individual illness episode very useful type of case study, wherein ask: 1. Subject to tell about entire illness episode 2. Use a checklist of items to fill in entire sequence of treatment seeking

3. Get subject to tell about actual encounter with health provider, use probes 4. Ask for explanations on cause of illness, reasons for worsening/improvements 5. Re-visit subject for more details

Focus group Discussion A carefully planned discussion designed to obtain perceptions on a defined area of interest in a non- threatening environment

Focus group Discussion (Contd) Conducted with 7-8 people by a skilled interviewer who helps guide the discussion Group should be homogenous with members being unfamiliar to each other Group members influence each other by responding to ideas & comments Ideally discussions should be recorded after obtaining the permission of the group

Focus Group Discussions Conducted by a moderator, assisted by a note-taker & an organizer Give ample time for identifying & recruiting group members Over-include to guard against potential drop-outs Group proceedings can be recorded after obtaining consent Notes on body language, socio-gram on group dynamic important

Uses of A Focus Group Discussion 1. Generate information on a questionnaire 2. Needs assessment 3. Develop/Test new programs/interventions 4. To gain an understanding of local beliefs, cultural practices, perceptions, attitudes

Participant Observation An approach where investigator becomes active functioning member of culture under study Participates in activities, observes what others do, attempts to see through eyes of member of the culture Is a general approach to data collection involving unstructured interviews and observations Seeks a holistic view of people and behaviors being observed

Strengths of Participant Observation Methods help to reduce reactivity Helps to formulate appropriate & relevant questions in native language Provides an intuitive understanding of whats happening in a culture Helps in understanding meaning of data collected Maximizes ability to make valid statements

Useful when context is new or not well known Particularly useful at the beginning of research when problems is not well understood Useful when situation of interest is obscured or hidden Especially appropriate for understanding processes, events, norms, values, context of a social situation

Weaknesses of Participant Observation Can be time consuming Researcher must speak the local language Be skilled at observing details Have good memory Be skilled at writing detailed notes about what was observed Sometimes increased familiarity with culture under study makes it difficult to notice things

Structured Interviewing Techniques Involves exposing every informant in a sample to the same stimuli These data collection methods produce data that is quantifiable Aims to describe & analyze culture & behavior of respondents from their own point of view Help to isolate & define cultural domains eg: ways to cure a headache; kinds of cars

Free Listing Free lists help to isolate & define relevant domains Simply asks respondents to list as many items as they can think of in a particular domain Example: Please tell me all the illnesses that children here get? What are all the different kinds of drugs that people in your school use?

Strengths & Weaknesses Useful first step in research involving definition of new domains Best way to ensure that concepts & domains are culturally relevant Informants can usually do the task easily Need to be familiar with culture & language of informants to identify appropriate domain names to start listing

Pile Sorting Aims to study relations among items within a domain Useful for discovering perceptions on similarities & differences among items Helps to look at intra-cultural variations in how informants define domains Informants asked to sort cards with names of items written into piles or groups according to their own criteria

Pile Sort Informants asked to make as many or as few piles as they wish Once pile sort completed, informant asked to explain the different piles Example: What do all the items in this pile have in common? Technique of successive pile sort used to construct taxonomies which illustrates relations among items

Taxonomy Based On A Pile Sort Kinds of pets Goldfish Turtle Rabbit Mouse Parrot Horse Cat Dog Goldfish Turtle Parrot Mouse Rabbit Dog Cat Horse Goldfish Turtle Parrot

Strengths & Weaknesses of Pile Sort Can be done using large number of items Is easy to administer Cannot be used with non-literate samples unless items are pictures or actual stimuli Simple hand analysis possible Computerized analysis faster but requires knowledge of appropriate software

Sampling Techniques Selection of respondents based on information they can provide Types of sampling strategies: Purposive Snowball Convenience Quota Extreme Cases Sample size: Sample to informational redundancy or sample to saturation

Qualitative Data Analysis Taped interviews transcribed verbatim Translated into English Codes assigned to segments to segments of text Coding framework developed Look for patterns & emerging themes

Triangulation Main research tool used are the researchers themselves Subjective nature of data can open it to criticism A method to enhance quality of data is through triangulation: Data, Researcher, Combining qualitative & quantitative methods

Sampling in Qualitative Studies Techniques used vastly different from quantitative research Logic behind the approach uniquely different from those of quantitative research Non-probability sampling techniques used

Non-Probability Sampling Reasons for using non-probability sampling: Pilot studies to test questions & scales may not require representative study Subjects chosen because of special attributes There may be difficulties in identifying a sampling frame Aim is not to generalize or extrapolate findings

Characteristics of Non-Probability Sampling Not specified or drawn in advance Sample selected in serial fashion and is purposive in nature Criteria for sampling may change as study progresses Sampling terminated when information becomes repetitive (informational redundancy)

Non-Probability Sampling Techniques (1) Extreme or deviant case sampling: Learn from highly unusual manifestations of the phenomenon of interest Maximum variation sampling: Selecting a wide range of variation on dimensions of interest to identify common patterns Homogenous Sampling: Selecting similar types to describe a particular group in-depth

Non-Probability Sampling Techniques (2) Typical Case Sampling: Selection of cases that illustrates what is typical or average Critical Case Sampling: Selecting cases who for some reason are specially important Snowball Sampling: Subjects recommend others they know & the snowball gets bigger as more information rich cases get included

Non-Probability Sampling Techniques (3) Opportunistic Sampling: On the spot decisions about sampling to take advantage of new opportunities during data collection Convenience Sampling: Selecting whoever is easiest, closest & most convenient to save time & money The last is least desirable

Sample Size Qualitative inquiry is rife with ambiguities There are purposeful strategies instead of methodological rules Seems to work best for people with a high tolerance for ambiguity

Sample Size (contd) No rules for sample size in qualitative inquiry Sample size depends on: What you want to know The purpose of the inquiry Whats at stake What will be useful What will have credibility What can be done with available resources

Sample Size (contd) Issue of sample size is a lot like the problem students have when assigned to write an essay Student: How long does the paper have to be? Teacher: Long enough to cover the assignment Student: But how many pages? Teacher: Enough pages to do justice to the subject no more no less

Sample Size (contd.) Validity, meaningfulness & insights generated from equal, inquiry have more to do with information-richness of cases selected & the observational/analytical capabilities of the researcher than with sample size.

Sample Size (contd) Sampling to the point of redundancy, an ideal More practical suggestion is to use judgment & negotiation Specify minimum sample size based on purpose of study & build a rationale for it Design should be understood to be flexible Exercise care not to over-generalize

Contrasting Qualitative and Quantitative Methods

Quantitative Research Philosophy Views social phenomena as objective & external to the individual These social facts are studied through the application of the scientific method

Quantitative Research Basic features are: Hypothesis specified Research questions formulated Relevant variables operationalized Data collected using structured questionnaire Data analyzed statistically Aim to achieve generalizability of results

Quantitative Research Emphasis placed upon multiple interacting realities that are studied as a whole Focus is on subjectivity Relationship between Inquirer and respondent viewed differently

Qualitative Research Research is concerned with the generation & not testing of hypotheses Aim is to see the world through the eyes of the subjects This requires that data collection are relatively open & unstructured

What are Its Uses? QR especially useful for: Exploring a health problem Identifying local perceptions Identifying relevant interventions Investigating feasibility, acceptability & appropriateness of health programs

What are it uses? (contd) Developing suitable information, education & communication Identifying problems in on going interventions & suggesting solutions Complementing quantitative data by helping to interpret it Designing more valid survey instruments

Combining Qualitative and Quantitative Methods Has been the subject of heated debate Purists in both camps have argued against this union In recent times, use of two methods in combination has gained popularity Different ways in which the two techniques can be combined

Qualitative Before Quantitative Qualitative techniques can be used to provide much needed information when venturing into new areas Use of qualitative methods to check assumptions and refine research questions is valuable across & within cultures Also useful during the development of measurement scales

Qualitative & Quantitative Together The two can be used together in the same study to extend & complement findings Both types of information together will provide a better basis for planning strategies for prevention

Quantitative Before Qualitative Interpretation of quantitative findings can draw upon qualitative methods for valuable insights and illustrations Quantitative studies can yield hard data whose meaning may be unclear Qualitative studies help to provide clarity to such data

Practical Issues Combination of methods demands access to a wide range of expertise and skills Necessitates need for a team approach Give careful consideration to design issues Use of multiple methods may result in data that confirm or contradict each other Despite potential problems & demanding decisions, can lead to creative & synergistic research

Qualitative Quantitative InductiveDeductive HolisticParticularistic SubjectiveObjective Process orientedOutcome oriented Relative lack of controlControl variables Goal : understand actors view Goal : find facts & causes Discovery orientedVerification oriented ExplanatoryConfirmatory Not generalizedCan be generalized

Qualitative Quantitative Deals with individuals Deals with populations Deals with words, textDeals with numbers Suggests hypothesistests hypothesis Recognizes individualityGeneralizes & Of responses/findingsextrapolates findings Methods include interviews Methods include cohort FGDs, participant Obscase-control, cross-sectional, RCTs

Trustable data Stronger data, collected later or after repeated contact Weaker data, collected early during entry Seen or reported first handHeard second hand Observed behaviors activitiesReports or statements

Trustable Data Trusted Field workerField workers not trusted Privacy maintained during interviewsNo privacy Reproducibility of data Triangulation of data

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What is qualitative research? Describes and analysis culture & behavior from the point of view of those being studied (emic perspective) Emphasis is on