QUALITATIVE

METHODS

MDSC3200
Affette McCaw-Binns, Community Health

Objectives
2

Distinguish between qualitative and

quantitative methods of data collection
Describe three qualitative methods
applicable for use in the health
sciences
Compare and contrast uses of
qualitative and quantitative data
Examine the scope and limitations of
qualitative research in the health
sciences
McCaw-Binns

08/27/15

Quantitative vs Qualitative
Research

Quantitative methods document amount of the

problem

Study based on measures of quantity or frequency

Findings described in numbers, not words
How big is X, and how many are there?

Qualitative methods classify phenomena

What, how, when, where the nature of the problem

as people perceive it

Concepts, definitions, characteristics, symbols, descriptors

Why groups differ

What social or behavioural problems influence disease
and how
How and why does X vary in different circumstances?
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What is qualitative research?

4

Disciplined enquiry into the personal meanings of

individuals experiences, perceptions, attitudes and
actions in the context of their social experiences

The meanings people attach to their experiences

How they make sense of their social world

Aim: in-depth understanding of specific individuals &

small groups, rather than general characteristics of
large population of individuals

e.g. what explains disconnect between quantitative

knowledge of how STIs are transmitted and prevented, and
the behavioural failure to apply this knowledge to individual
actions

i.e. regular condom use, avoiding multiple sexual partners

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Uses in health science

5

Investigates complex human behaviour that

impact health

Why knowledge ~= behavioural decisions

Access unquantifiable facts about people such as:

How people give meaning to their lives and make sense

of things
Peoples perceptions about how their bodies work versus what
doctors think they know
Experiment: Ask some adolescents how babies get made?

Evaluate views re health service provision from the

perspective of:
Patients vs. health professionals vs. managers
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Uses of qualitative research

6

Qualitative research enables investigators to:

Observe social life in its natural habitat

Go where the action is

Observe persons in their usual interactions, negotiations

Watch Unobtrusive research observing behaviour

What people do at home versus what they report in the clinic ?

examples

e.g. how doctors interact with patients, conduct examinations

Can produce a richer understanding of many social

phenomena once the researcher observes in a
deliberate, well planned, unbiased and active way

Requires special skills, which needs to be learned and

honed
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Uses of qualitative research

7

Quantitative/qualitative approaches complement each

other
Preliminary phase quantitative study helps to
understand key phenomena to be studied

What questions to ask before trying to quantify behaviour

Identify terms commonly used to describe actions in the community
Clarify open ended questions
Develop hypotheses

Interpretive phase (after) to validate and explain

phenomena observed

Have participants explain unusual observations, e.g.

Why the information received was not what was expected
Give their interpretation of findings as your ideas may differ from
theirs

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Approaches to Qualitative
Research
Direct observations
Behaviours and events

e.g.

How doctors deliver health education messages?

How

people talk to each other (at, with) and interact

Nature of interaction

Do we talk to patients or at them? Do they understand us?

Dental

skills labs is a qualitative approach to teaching

Interviews
Individual

(key informant)
Group (focus groups)

Analyse the text, recorded speech, video tapes

Focus: talk and actions rather than numbers
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Approaches to Qualitative
Research

Process of watching can entail:

Direct observation (passive/unobtrusive)
Joining in (participant observation)
Talking to people (interviewing)
Reading/interpreting what persons have
written/drawn

Often used in psychiatry

Several qualitative research techniques, will discuss:

In-depth interview
Focus groups discussions and
Consensus methods Delphi and nominal group
techniques
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Iterative process
10

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Interviews
11

Structured (usual approach for quantitative

studies)

Semi-structured

Structured Questionnaire
Questions with fixed choice of answers administered in a
standardized manner
Open ended questions defining areas to be covered
Interviewer/interviewee may diverge to pursue an idea or
response in more detail

Depth

Less structured: One or two issues to be covered in depth

Follow-up questions are based on what interviewee says
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Qualitative Interviews
Types of questions

12

Good questions should be open-ended,

neutral, sensitive and clear to the
interviewee

Types of questions:

Behaviour or experience
Opinion or belief
Feelings
Knowledge
Sensory perceptions
Background or demographic details (for context)

Start easy Difficult/sensitive issues

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1. Depth interviews
13

Two persons discuss issue(s) with the understanding that there

will be complete honesty, openness, mutual trust,
confidentiality
Less structured, with follow-on questions based on responses

Requires experienced interviewer who understand the concept

area to effectively probe issues

Supplementary questions intended to clarify issues and probe for

details
Patient history taking = qualitative depth interview

Good medical history taker difference between consultant and

intern!

Requirement:
Absence of other participants, why?
Uses:
Case studies
Life history assessments
Research on sensitive issues McCaw-Binns

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Sampling and Sample Size

14

Non-probabalistic sampling most often

used

Representativeness not an issue

e.g. of types?
Focus: eliciting issues of interest from
persons selected

Smaller numbers

Assess in more detail

Sampling (and data collection) ends when no
new information is elicited
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The Instrument
15

The interviewer or observer is the main

instrument
Must be neutral or directive as needed
Take cues or signals from participants
Tries not to inject personal opinions or
views or to be distracted during the
process

Issue:

Hawthorne Effect presence of observer

may influence behaviour
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2. Focus group discussion

16

Group processes used to explore and clarify

views that would be less accessible in a one-onone interview

People encouraged to talk to one another

Capitalizes on communication between participants

Capitalizes on group interaction
Ask questions/Exchange anecdotes
Comment on each others experiences/points of view

Quick, convenient way to collect data from

several people simultaneously

Typically no more than 12-15 people; more than one

group
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Advantages of focus groups

17

Doesnt discriminate against persons who

cannot read or write
Facilitator can encourage participation of
persons reluctant to be interviewed e.g.
Intimidated by formality
Shy when isolated in a one-to-one interview

Can encourage people who have nothing to say

but engage in discussion generated by group
members

High validity to depth of enquiry

Bonus: group dynamics may unearth aspects
of the topic not anticipated by the researcher,

e.g. side conversations, body language

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18

Disadvantage of focus
groups

Less control over the research process than

individual interviews
Data difficult to analyse
Differences between groups can be troublesome
Reliability may be an issue ?observer bias
Moderators require special skills

Remain neutral
Control bullies
Follow leads, including being sensitive to body
language
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3. Consensus methods:
Introduction

Many key decisions in health care have to

be made without adequate objective
information, e.g.

How best to treat patients

What services to provide
How best to organize and deliver services
What research should be prioritized

Decision making in the face of uncertainty

is a common challenge for clinicians,
managers and policy makers
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Consensus methods
II

20

Consensus method can formalize decision

making in ways that:

Are transparent
Eliminate negative aspects of decision making
Provide scientific credibility to the process

Consensus methods can be used to:

Assess extent of agreement (consensus

measurement)
Resolve disagreement (consensus development)
Allow for qualitative assessment of evidence

e.g. jury trial, expert panelMcCaw-Binns

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Uses of Consensus methods

21

Develop clinical and organizational

guidelines

Assemble evidence
Adapt international best practice to local
reality

Determine priorities

Which services to provide

What topics to research
Which outcomes to measure
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Features of consensus
methods

Feature

Anonymity

Characteristics
To avoid individual dominance;
questionnaire used in Delphi and private
ranking in nominal group

Iteration

Processes occur in "rounds," allowing

individuals to change their opinions
(based on new information)

Controlled
feedback

Shows the distribution of the group's

response (indicating to each individual
their own previous response in Delphi)

Statistical
group
response

Expressing judgment using summary

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measures of theMcCaw-Binns
full group
response

Nominal group technique:

Expert panel

23

Informed panel considers a problem

Consensus methods structured to prevent
the dominance by one individual or
vested interest group
Groups view derived from aggregation of
individual members views rather than
the group arriving at a communal view
HE21A: McCaw-Binns

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Nominal group meeting

24

Highly structured meeting to gather

information from relevant experts
Usually 8-12 members

Fewer: reliability in jeopardy

More: discussion unmanageable

Process:

Literature review provided to participants ahead of

meeting
Facilitator = expert or credible non-expert
Two (or more) rounds in which panelists
Rate problem/issue
Discuss
Re-rate
HE21A: McCaw-Binns 08/27/15

Nominal Group Technique

25

STAGE 1: Formulation of nominal group question

STAGE 2: Group members independently and
privately record ideas and opinions relating to
the question or problem of interest
STAGE 3: Ideas or rankings recorded, often in a
round-robin feedback session
STAGE 4: Discussion to clarify and categorise
different ideas to obtain a list of options
STAGE 5: Group members independently
rank/re-rank the different options. The group
decision in based on consensus achieved during
this ranking process
HE21A: McCaw-Binns

08/27/15

Delphi Method
26

The Delphi
process takes its
name from the
Delphic oracle's
skills of
interpretation
and foresight
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Delphi Method
27

Round 1: Individuals invited to provide

opinions on a specific matter, based on their
knowledge, experience

Round 2: Participants rank their agreement

with each statement in the questionnaire

Round 3: Participants re-rank their

agreement with each statement in the
questionnaire, can change their score in
view of the group's response until reach
consensus
McCaw-Binns 08/27/15

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McCaw-Binns

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Delphi Technique
29

Limitations

Strengths

Participants do not meet

in one place (mail, e-mail)
Relatively inexpensive
Allows involvement of
participants from distant
geographical areas
Encourages minority
views
Allows period of
considered thought
Does not allow individuals
to dominate

Reaching consensus can be

time consuming
Difficult to maintain high
response rate (often
decreases as rounds
progress)
Important issues may be
missed in centralising
opinion
Representativeness of group
(experts vs multidisciplinary)

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Issues: Qualitative methods

30

Internal and external validity

Social phenomena may be profoundly

affected by the participants

Can findings from a select group be replicated?

Can they be generalized to the population?

Did one or a few persons sway group opinion?

What is true in one setting may not hold in
another

How well do the conclusions explain why

people behave in the way they do?
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31

Triangulation Each
method a researcher employs provides a
validation

slightly different facet of the same reality

By combining several lines of sight, one obtains
a better, more substantive picture of reality

TRIANGULATION

Multiple data collection technologies used to

test hypotheses; measure a single concept or
construct
Combine quantitative and qualitative methods
to gain greater depth of understanding

Quantitative survey
Observation
Focus group

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Quantitative and qualitative

methods working together

32

Used jointly = powerful tools

Preliminary studies

Can form essential preliminary to quantitative research , e.g.

Post hoc studies

Supplement quantitative work by validating data collected

Identify colloquial terms, questions to ask, options for closed ended

questions
Discover behavioral issues to be measured later

Explain unusual quantitative findings, e.g.

Divergence between knowledge and practice

Explore complex phenomena or areas not amenable to

quantitative research, e.g.

Interactions between social norms and observed behaviour

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Summary
33

Qualitative methods provide:

Opportunity to collect preliminary or

supplementary information to support,
explain quantitative data
Useful for scientifically arriving at
consensus
Opportunity to better understand
human behaviour
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Lesson exercise: Qualitative

methods

34

List three questions which a qualitative

approach would be better suited at
providing an appropriate answer
List two problems which a combined
qualitative and quantitative methods
would address
What is the distinction between a
qualitative variable and a qualitative
method of data collection?
McCaw-Binns

08/27/15