PHARMACOEPIDEMIOLOGY

Qualitative Research
Approach
Prih Sarnianto

If we knew what we were

doing, it wouldnt be called
research, would it?
Albert Einstein

Research Method, definition

Study design:
A study design is a specific plan or
protocol for conducting the study,
which allows the investigator to
translate the conceptual hypothesis
into an operational one.
>> Qualitative word, word, word
>> Quantitative number, number, number

Research Method, perspectives

Example:
The perception of being cured from leprosy.
>>
>>

From the leprosy specialist

>>> Treatment completed

>>> Treatment completed

What does the patient think?

Get the perspective of informants, more

information is needed for it to become intelligible
>>> My patch is still here!
>>> Im still disabled.

Research Method, essence

Essence [of qualitative research]:

>> Inquiry process of understanding

>> Based upon distinct methodological
tradition of inquiry that explore a social of
human problem
The qualitative researchers

>>> Build a complex, holistic picture

>>> Analyze words
>>> Report detailed views of informants
>>> Conduct the study in natural setting
>>>> Explain rather than just describing behavior

Qualitative Method, advantages

Qualitative method can be used to:
>> Identify health determinants
>>> Underlying behaviors
>>> Attitudes
>>> Perceptions

>> Explain social and programmatic impediment to

>>> Informed choices
>>> Use of services

>> Shed light on the success of interventions

>> Facilitate understanding of policy, social, and
legal context in which decisions are made

Qualitative Method, advantages

Qualitative method is:
>> Flexible
>> Encourage discoveries
>> Stimulate more investigation of the
unexpected
>>> May be important to quantitative
research but do not replace quantitative
method since:
It address different questions

Study Design, types

>> Qualitative disebut juga interpretative research
Biography life history, oral history
Phenomenology the lived experience
Grounded theory symbolic interactionism
Ethnography interpretation of cultural/social/system
Case study exploration of a bounded system or case
>>> Understanding central phenomenon: Y

>> Quantitative
Experimental with intervension
Observational no intervension
>>> Understanding relationship

Study Design, comparison

When to use what
Qualitative

> Subject matter is unfamiliar.

> Exploratory research, when
relevant concepts are
unknown of their
definitions unclear.
> When meaning rather than
frequencies are sought.
> When flexibility of approach
is needed to allow for
discovery of unexpected; indepth investigation.
> For studying related issues,
cases, or events in detail.

Quantitative

> Subject matter is clearly

defined
> When measurement problems
are minor and have been
resolved.
> When detailed numerical
description of a representative
sample is required.
> When repeatability of
measurement is important.
> When generalizability of
results and comparison across
population is needed.

Study Design, comparison

Basic assumptions
Qualitative

Based on the notion of

constructivism, which
assumes multiple
realities that are socially
constructed through
individual and collective
perceptions or views of
the same situation.

Quantitative

Based upon the idea of

logical positivism, that
is, there is a singular
reality with stable, social
facts that are separate
from the feelings and
beliefs of individuals.

Study Design, comparison

Basic objectives
Qualitative

Concern is with the

understanding of the
social phenomenon
from the participants
perspectives. This
requires, to some
degree, researcher
participation.

Quantitative

Seeks to establish
relationships and
explain causes of
changes in measured
variables. That is, the
goal of science is to
explain and predict.

Study Design, comparison

Method and Process
Qualitative

Use of emergent design

utilizing constant
comparison and
revision.

Quantitative

The scientific method,

also known as a priori or
pre-established design.

Study Design, comparison

Researchers roles
Qualitative

Immersion in situation
and the phenomenon
being studied.

Quantitative

Detachment from study

in order to avoid bias.

Context
Qualitative

Generalizations are
contextually-bound.

Quantitative

Context-free
generalizations

Study Design, comparison

Characteristics:
Qualitative
Help readers understand
the multiple perspectives of
the situation by the persons
studied. Subjectivity in data
analysis and interpretation
is acknowledged.
>>
>>
>>
>>

Neutrality
Uniformity
Objectivity
Replicability

Quantitative
Experimental or
correlational designs are
used to reduce error, bias
and the influence of
extraneous variables-control of bias is through
design.
>> Accuracy
>> Reliability
>> Freedom from bias

Study Design, comparison

Precision
Qualitative

Provided by detailed
description of
phenomenon.

Quantitative

Obtained through the

use of measurement
and statistics.

Verification
Qualitative

Extension of
understandings by
others.

Quantitative

Results replicated by
others.

Study Design, comparison

Explanation
Qualitative

Quantitative

Summary through
narrativeimportance is
placed on reducing
complex realities to
simple explanations.

Traditionally, parsimonious
explanations were sought,
but this may be changing
due to technology.

Study Design, comparison

Logical reasoning
Qualitative

Quantitative

INDUCTIVEanyone have
an example?

DEDUCTIVEWhats the
classic example?

Conditional conclusions
Qualitative

Quantitative

Tentative summary
interpretations.

Statements of statistical
probability.

Study Design, comparison

Therefore.
Qualitative

Quantitative

Understanding
Interview/observation
Discovering frameworks
Textual [words words
words]
Theory generating
Quality of informant is more
important than sample size
Subjective
Embedded knowledge
Models of analysis: Fidelity to
text or words of interviewees

Prediction
Survey/questionnaires
Existing frameworks
Numerical [numbers
numbers]
Theory testing [experimental]
Sample size is the core issue in
reliability of data
Objective
Public
Model of analysis: Parametric,
non-parametric

Study Design, Sampling

>> No probability sampling

Individual people
Program, group organization or community
Genders, ethnic groups, older and younger

>> Strategies
Purposeful or judgment sampling

Key informants
Maximum variations, homogenous, critical case,
theory based, confirming and de-confirming cases

Snowball

or chain

Extreme or defiant case, typical case, intensity, politically

important case s, random purposeful

Stratified

purposeful

Criterion, opportunistic, combination or mixed, convenience

Qualitative research, techniques

Direct or participant observation [field notes]
Interviews or focus group discussions [FGDs]
with key informants
Video or text and image analysis [documents,
media data]
Skills
Surveys
Observing
User testing
Conversing
Participating
Interpreting

Qualitative research, techniques

Participant observation >> overt, must not be covert
>>> Gains insight into understanding cultural
patterns to determine whats necessary and
needed in encouraging people to access
Puskesmas [complementary to interviews]

Interviews or FGDs with stakeholders

>>> Explores how people seek treatment for their

sick family members.
>>> Gains insight into the meaning of Puskesmas for
people for getting healthcare.

Qualitative research, techniques

Focus Group >> What and Why?

>> Facilitated small group discussion.

>> Experience and perspectives.
>> Exploring specific area of interest in detail;
particularly useful for sensitive topics.
>> Interactions among members is key.
>> Not for generalizing findings

Qualitative research, techniques

FGD versus Other Methods

> Individual interviews

+ Multiple perspectives
+ Observe interactions
+ Participants help each others clarify ideas
Difficult to manage
Reluctant to reveal in group setting
Social norms influence responses

Qualitative research, techniques

FGD versus Other Methods

> Observations
+ More efficient
+ Easier access
Relying on reports of behavior versus actual
observations of behavior
Not a natural setting

Qualitative research, techniques

Ethical considerations

> Informed consents

> Provide project description at start of the group
> Clarify confidentiality and anonymity [within
group as well]

Qualitative research, techniques

Data analysis

>>> Themes arising from data would provide insight

into current healthcare seeking issues and see
what is important to people in certain region.

Survey

>>> Useful for verifying

results on a larger scale.

Rigor in qualitative
research

>>> Useful for triangulating

results.

User testing

Dependability
Credibility
Transferability
Confirmability

Qualitative research, data

Collecting data

>>> Primary tools are observations and interviews,

but can also include personal and official
documents, photographs, recordings, drawings,
e-mails, and informal conversations
>>> Multiple data source are normative
>>> The researcher records descriptive as well as
reflective notes about what one has seen,
heard, experienced, and thought about a during
an observation session.

Qualitative research, data

Qualitative data is information that is difficult
to measure, count, or express in numerical
terms. This type of data is used in research
involved detailed, verbal descriptions of
characteristics, cases, and settings.
>> Data which can be categorized in some way but

which cannot be reduced to numerical

measurements.
>> Data that is not quantitative.

Qualitative research, data

Regarding field notes
>>
>>
>>
>>
>>
>>
>>
>>
.

Put aside assumptions, experience context first

See phenomena through participants perspective
Write up notes immediately following an observation
Detail is critical: include date, site, time, and topic on
every set of field notes; leave wide margins for
writing impressions; use only one side of a page of
paper; draw diagram of site [if necessary].
List key words first, then outline ones observations
Keep the descriptive and reflective sections separate
Use memos to record hunches, questions, and
insights after each observation
Number the lines or paragraphs for easy access

Qualitative research, data

Regarding interviews
>> The purpose is to explore and to probe the interviewees
responses in order to gather in-depth data
>> The interviewer inquires into the interviewees attitudes,
interests, feelings, concerns, and values as these relate to
the context being studied
>> Meaning is jointly constructed between the interviewer
and the interviewee; meaning is not just a construction
on the part of the interviewee
>> Be alert for openings in responses to probe more deeply,
starting with mundane questions and gradually easing
into more sensitive and more complex questions
>> Interview data collection techniques include taking notes
during the interview, writing notes after the interview, or
tape recording and transcribing the interview [the
transcript is a verbatim]
.

Qualitative research, data

Interview dos and donts
>> Do listen and talk less
>> Do follow up on what is not clear and probe more
deeply into what is revealed
>> Dont use leading questions; do use open-ended
questions [probes]
>> Dont interrupt; do wait
>> Do keep interviewee[s] focused
>> Do ask for concrete details
>> Do tolerate silence and space between interviewees
responses; do allow the interviewee time to think
>> Dont judgmental about or react to interviewees
opinions, views, or beliefs.
>> Dont engage in debate with an interviewee
>> Do record everything the interviewee says and note
impressions of interviewees nonverbal behavior.

Qualitative research, data criteria

Credibility or plausibility
>> To demonstrate that the study was conducted in
such a manner as to ensure that the subject was
accurately identified and described
Transferability
>> To demonstrate that the results of the study are
generalizable to others in the original research
context or to contexts beyond the original study
Including a method section
>> To provide an in-depth description of the
processes and methods used in the study

Qualitative research, data analysis

Constant comparison method
>> Compares new evidence to prior evidence to
identify similarities and differences between
observations
Negative case and discrepant data method
>> The search for contradictory, variant, or
disconfirming data within the body of data
collected that provides an alternative perspective
on an emerging category or pattern
Analytic induction
>> A process concerned with developing and testing
a theory in order to generalize a studys findings

Qualitative research, report

>> Provide a setting where the data were
collected
>> Identify characters who provide information
>> Describe the social action in which the
characters are engaged
>> Offers an interpretation of what the social
action means to the characters
>> Offers an interpretation of what the social
action means to the characters
>>> Do not forget to make the matrix for the
collected [interview and other written] data

Qualitative research, plus-minus

Focus on the whole of the human experience and
the meanings ascribed to them by participants
They provide the researcher with deep insights that
would not be possible using quantitative methods
The major strength of qualitative work is the
validity of the data it produces
Participants true reality is likely to be reflected
Major limitation is its perceived lack of objectivity
and generalizability
Researchers become the research tools and may
lack objectivity

Qualitative research, combination

Combining Qualitative and Quantitative Method
>> Illustrative example
Research problem
High rates of smoking among construction
laborers
Research aims
>>> Conduct formative research to assess
smoking patterns and factors associated
with smoking among laborers
>>> Develop and test a smoking cessation
intervention, using an RCT design

Qualitative research, example

Combining Qualitative and Quantitative Method
>> Illustrative example
Methods

>>> Direct observation of worksites [for project

staffs to learn about range of work tasks,
and understand where/when/with whom
workers smoke, what they eat at
breakfast/meals, sources of food]
>>> Group and individual interviews [two wave
of interviews]
>>> Formed a qualitative research working group
for project

Qualitative research, example

Combining Qualitative and Quantitative Method
>> Illustrative example
Sampling

>>> Observation:

Convenience sample; close by; no major

differences by region

>>> Group and individual interviews:

Stratified by region; include racial/ethnic, gender,

and age mix; current and former smokers

>>> Recruitment and gaining access:

Through international union; training sites [bias?]

Qualitative research, example

Combining Qualitative and Quantitative Method
>> Illustrative example
Topic guide development

>>> Based on theoretical model we developed

by mixing existing models [behavioral
theories and work environment policy
theory]
>>> Working group developed topic guide
>>> Pilot tested and refined guide
>>> Revised throughout data collection
[iterative]

Qualitative research, example

Combining Qualitative and Quantitative Method
>> Illustrative example
Data collection and analysis

>>> Trained staff to conduct interviews and code

data
>>> Collected data and almost immediately
began analysis:
Group

discussion
Coding [structural and thematic, multiple
codes]
Creation of themes document
Revision of focus group guides
Retrieving codes for thematic analysis

Qualitative research, example

Combining Qualitative and Quantitative Method
>> Illustrative example
Application of results to the intervention
>>>
>>>
>>>
>>>
>>>
>>>

Identify themes in qualitative data

Define intervention methods
Incorporate into intervention messages
Reflect in visual in materials
Used in staff training
Apply to quality assurance

Qualitative research, example

Combining Qualitative and Quantitative Method
>> Illustrative example
Examples within the laborers intervention
materials
>>> Value of being fit for work

Being a Laborer is a demanding job. You face hazards every

day, and being healthy and fit enough to meet challenges is
important Being healthy means youve got the strength
you need to get the job done and take care of other
responsibilities too.
[General Presidents introduction to the TFR]

Qualitative research, example

Combining Qualitative and Quantitative Method
>> Illustrative example
Examples within the laborers intervention
materials
>>> Value of family and friends

Tobacco use can be a problem for your family members

and your LIUNA brothers and sisters too. Thats because
secondhand smoke causes over 53,000 deaths a year among
people who dont even use tobacco spouses, co-workers,
buddies.

Qualitative research, example

Combining Qualitative and Quantitative Method
>> Illustrative example
Examples within the laborers intervention
materials
>>> Health concerns

[O]ne thing you can do is make good decisions about your

health. Sometimes that means talking to your steward if
youre worried about on-the-job exposures or hazards. Other
times, it means taking control of your personal health, and
doing what you can to make your body stronger and
healthier. This is where [the program counselor] can help.

Qualitative research, example

Qualitative research, summary

Application of Qualitative Methods in Intervention
Research
>> Understanding the social context of the
population
>> Survey development
>> Intervention design
>> Staff training
>> Understanding the process of observed changes

Qualitative research, summary

Focused groups size and number
>> Six to eight participants
>> Over-recruit slightly and reminder about group
day before
>> Three to five groups per topic of interest
>> Saturation: When stop hearing new info

Qualitative research, summary

Constructing a topic guide
>> Avoid a close-ended questions: Going for
experience and perspectives
>> Based on your research questions
>> Topic areas, then question each topic, list probes
>> Start with icebreakers and easy question

Qualitative research, summary

Data management and analysis
>> Transcript recordings and check
>> In-depth analysis
>> Analysis across groups by theme

Qualitative research, summary

Focused groups composition
>> Purposive
>> Sub-groups return to your research questions
>> Homogenous versus heterogeneous

Qualitative research, summary

Logistics
>> Eligibility screening
>> Conducted in primary language of group
>> Length: 1 to 2 hours, no more
>> Location: convenient
>> Tape record
>> Take notes [note-taker]
>> Incentives

Qualitative research, summary

Focused groups facilitation
>> Two people: Facilitator and note-taker
>> Show interest and respect
>> Introduce group members and yourself
>> Actively listen; follow leads but stay on topic
>> Encourage between-participant discussion; avoid
group interview dynamic
>> Eye contact tip

THANK YOU!
prih1488@gmail.com