Qualitative Research Approaches/Designs HCO 628/728

1. Qualitative ResearchApproaches/DesignsHCO 628/728 Nataliya V. Ivankova, PhD UAB School of Health Professions and School of Nursing Email: nivankov@uab.edu

2. Qualitative Research and Methods Qualitative research is a means for exploring and understanding the meaning individuals or groups ascribe to a social or human problem. The process of research involves emerging questions and procedures; collecting data in the participants’ setting; analyzing the data inductively, building from particulars to general themes; and making interpretations of the meaning of the data. The final written report has a flexible writing structure. Qualitative methods – techniques associated with the gathering, analysis, interpretation, and presentation of narrative information. Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods approaches. Thousand Oaks, CA:Sage Publications.

3. Key Characteristics • Focus on understanding the central phenomenon vs. relationships among the variables • Emerging research design • Inductive • Researcher is the primary instrument of data collection and analysis • Interest is in both the process and outcomes • Data collection is in the field – natural setting • Data collection and analysis is simultaneous: zigzag process • Constant comparative analytical method • Research literature plays a minor role in guiding the study

4. Quantitative Explaining or predicting variables Qualitative Understanding or exploring a central phenomenon Y In-depth understanding of Y; external forces shape and are shaped by Y Explaining or predicting variables versus exploring or understanding a central phenomenon X Y The independent variable (X) influences a dependent variable (Y)

5. When Designing a Qualitative Study • Focus on process as well as outcomes • Let the design emerge • Study the phenomenon in the natural settings • Look for shared patterns of • experience • behavior • culture • Use inductive reasoning • Develop a complex and in-depth understanding of the central phenomenon • study many ideas with few participants and sites • Discuss the context of the phenomenon • Follow the “scientific method”

6. Major Qualitative Approaches/Designs

7. Major Qualitative Research Approaches/Designs • Narrative research • Phenomenology • Ethnography • Grounded theory • Case study

8. Major Qualitative Research Approaches/Designs • Narrative research • Key questions: “What are the experiences in the individual’s life? How do they shape this individual’s life?” • Phenomenology • Key questions: “What does this experience mean to individuals? What meaning do individuals assign to this experience?” • Ethnography • Key questions: “What is the culture like for this group? How does it shape peoples’ beliefs, behavior, and experiences?”

9. Major Qualitative Research Approaches/Designs • Grounded theory • Key questions: “How does the process work? What theory can explain the process of individuals’ experiencing the phenomenon?” • Case study • Key questions: “ What has happened? How do individuals describe the phenomenon and their experiences with the phenomenon?”

10. Differences Among Major Approaches/Designs • Discipline origin (single vs. multiple) • Types of research problems addressed • Study focus • Sampling strategies • Data collection strategies • Data analysis procedures • Nature of findings • Narrative/reporting approaches

12. Criteria for Choosing a Qualitative Approach/Design • Intent or focus • Study purpose and research question • Researcher’s philosophical assumptions or worldviews • Researcher’s training • Discipline orientation • Audience • Study feasibility and resources

13. Phenomenology • The purpose is to describe the meaning of lived experiences for several individuals; what the participants have in common as they experience a phenomenon • common, everyday human experiences (e.g., love, grief, stigma, sickness) • experiences with typical sociological and psychological phenomena (e.g., having AIDS, experiencing caregiver elder abuse) • experiences with common transitions or processes (e.g., caring for terminally ill relatives, coping with cancer)

14. Design Characteristics • Focus is on understanding the essence or structure of a phenomenon as described by participants • Grounded in philosophy of existentialism • stresses the individual's unique position as a self-determining agent responsible for the authenticity of his or her choices • Developing a composite description of the essence of the experience that consists of “what” is experienced (textural description) and “how” it is experienced (structural description)

15. Design Characteristics • Criterion sampling – having experience with the phenomenon • Heterogeneous group of participants (5-15 persons) • Multiple interviews, observations, artifacts (e.g., art, poetry, music) • Asking two broad general questions: • What have you experienced in terms of the phenomenon? • What contexts or situations have typically influenced or affected your experiences about the phenomenon? • Bracketing personal experiences (epoche) • researcher puts aside, or “brackets” his or her own ideas, feelings, perceptions, prior experiences

19. Phenomenology Example Amy Morgan (2007) – PhD Dissertation “MIRROR, MIRROR: A PHENOMENOLOGICAL STUDY OF THE ROLE OF REFLECTION IN TEACHING IN ELEMENTARY SCHOOL” Purpose: “The purpose of this phenomenological study was to explore the reflective experiences of 12 currently practicing elementary school teachers working in a southeastern, suburban school district in order to illuminate, from the perspective of teachers, the meaning of reflection in teaching.”

20. Research Questions • Central question: • What is the meaning of reflection in teaching? • Sub-questions: • In what ways do teachers experience reflection in the context of the classroom? • In what ways do teachers experience reflection in contexts outside the classroom? • What role does a teacher’s reflection play in the experience of teaching? • What role does experience play in a teacher’s reflection? • What role does the school environment play in teachers’ reflective practices?

21. The Essence of Reflection “Reflection is part of the rhythm of teaching. It is so much a part of being a teacher that, often, teachers cannot verbalize their experience with it. Much of the reflecting that teachers do is a type of thinking on one’s feet, allowing the response from students to inform their instruction, and make adjustments on the spot. Along with reflecting upon student learning, teachers also use reflective practices to monitor their own teaching. Effective teachers will reflect on their practice in any setting, but a caring, nurturing, trusting environment is the most conducive to the effective reflection that helps teachers solve problems, adjust to changes, and become lifelong learners.”

22. Grounded Theory • The purpose is to develop a theory for an action, a process, or interaction that is “grounded” in the views of the participants • Substantive theories about everyday experiences • Systematic grounded theory originated in 1967 with Glaser and Strauss as a contrast to the a priori theoretical orientations in sociology

23. Design Characteristics • Theoretical sampling to help form the theory • 25-30 participants • Questions focus on the steps in the process • Saturation in data collection • 3-step data analysis coding, and development of logic paradigm or visual picture of the theory • open, axial, selective • Constant comparative method • Theory is presented at the end of the study in a narrative statement, visual model, or a series of hypotheses or propositions.

24. Grounded Theory Coding Process Open Coding: “What is this about? “What patterns exist?” Axial Coding: “What is the Relationship that explains How the process works? Selective Coding: What implications does it have? Constant Comparative Theory

25. Grounded Theory Example Elizabeth Barstow (2012) – PhD Dissertation How Older Adults with Age-Related Macular Degeneration Living in a Southeastern Metropolitan Area Develop Physical Activity Self-Efficacy: A Grounded Theory Study Research Question: How do older adults with AMD living in a southeastern metropolitan area develop Physical Activity Self-Efficacy? Focus on: knowledge and beliefs about PA, determinants of PA participation, strategies to develop PASE, understanding of the process of PASE development.

27. Facilitatory Strategies to Enhance participation Vision & Non-vision Related Inhibitory Self-Perceived Benefits Intrinsic-Improved Mental and Physical Health, Increased Independence, Activity Enjoyment, Feeling Extrinsic-Exposure to Environment and Others Self-management behaviors ????? Diet, Medication & Appointment Adherence, Abstains from Chemicals Physical Activity Self-Efficacy Physical Activity Participation & Characteristics E. Barstow Conceptual Model of PA Self-Efficacy Development in Older Adults with AMD

28. Case Study • The purpose is to study an issue through one or more cases in a setting or context (a bounded system) • explores event, process or one or more individuals in depth • is bounded by time and activity • a case is studied within a real-life, contemporary context or setting • Single vs. multiple case study

29. Case Study “The case could be a child. It could be a classroom of children or a particular mobilization of professionals to study a childhood condition. The case is one among others…. An innovative program may be a case. All the schools in Sweden can be a case. But a relationship among schools, the reasons for innovative teaching, or the policies of school reform are less commonly considered a case. These topics are generalities rather than specifics. The case is a specific, complex, functioning thing” (p. 2). Stake, R. (1995). The art of case study research. Thousand Oaks, CA:Sage Publications.

31. Design Characteristics • Focus is on in-depth understanding of the case to present its substantive description • Purposeful sampling • Questions focus on understanding the context of the case and the issue • Multiple sources of information • interviews, observations, document analysis, artifacts, audio-visual materials • Within-case and across-case analysis • Case description and case themes • Report consists of a rich description of the case or cases

32. Case Study Example • Rucks, A., Mulvihill, B., Wingate, M., Ivankova, N., Jeong, S.J., Xie, P. • “Collaboration Among Tribal and State Maternal and Child Health (MCH) Organizations: CATSO Project” • Funded by grant from the RobertWood Johnson Foundation Public Health Service Systems (ID: 67623) • Webinar: http://media.soph.uab.edu/mchwebinar-20120827/collaborationamongtribalandstatematernal.swf

33. Study Design • Mixed methods, two phase sequential • 34 states with federally recognized tribes in 2010 • Participants • State HRSA Title V Maternal and Child Health(MCH) and Children with Special Health Care Needs (CSHCN) directors in the study area • Personnel working in American Indian/Alaska Native (AI/AN) organizations serving the MCH population in the study area

34. Phase II - Multiple Case Study • 5 states with respondents from both Title V and AI/AN organization/agency (“pairs”) - working on MCH issues in the same geographic area • To understand different points of view • Interviews • Document analysis

35. Integrating QUAN and QUAL Results The quantitative survey findings suggest collaborative relationship were limited to the discussion and exchange of ideas and information among Title V and AI/AN MDH entities and were low in density and average in intensity. Case study revealed that collaborative relationships existed in a variety of forms ranging from formal to informal, depended on multiple institutional, contextual, and personal factors, and were aimed at overcoming barriers and achieving common goals.

36. Narrative • The purpose is to study an individual and his/her experiences as told to the researcher or found in documents and archival materials. • Providing first-person account of experiences that are in a story format having a beginning, middle, and end. • chronology of the experiences (life course stages) • Forms of narrative research: • biography, autobiography, life histories, personal experience story

37. Design Characteristics Focus is on the experiences of individuals that are expressed in lived and told stories Purposeful sampling - one or a few individuals are selected Questions focus on the processes in the individual’s life Data collection – participants’ stories or narratives and information about the context of the stories Narratives are analyzed for key elements (time, place, plot, and scene) Stories are “re-storied” into a general framework Epiphanies - turning points in which the story line changes direction dramatically

38. Ethnography • The purpose is to describe and interpret the culture of a group • shared and learned patterns of values, behaviors, beliefs and language of a culture-sharing group • Selecting cultural themes to study about the group (e.g., enculturation, socialization, learning, domination) • Realist ethnography – traditional approach used by cultural anthropologists • Criticalethnography – advocating for the emancipation of groups marginalized in society

39. Design Characteristics • Focus is on developing a complex, complete description of the culture of a group • Purposeful sampling – identifying an intact culture-sharing group • Looking for patterns in culture-sharing group • Data collection – extensive fieldwork • extended participant observations of the group; interviews, artifacts • Gatekeepers; key informants • Data is analyzed and interpreted from a cultural perspective – cultural themes • Final product is a holistic cultural portrait of the group

40. Key Readings in Five Qualitative Research Designs Clandinin, D. J., & Connelly, F. M. (2000). Narrative inquiry: Experience and story in qualitative research. San Francisco, CA: Jossey-Bass. Thousand Oaks, CA: SAGE. Creswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Thousand Oaks, CA: Sage. Fetterman, D. (1998). Ethnography: Step by step. Thousand Oaks, CA: SAGE. Moustakas, C. (1994). Phenomenological research methods. Thousand Oaks, CA: SAGE. Stake, R. (1995). The art of case study research. Thousand Oaks, CA: SAGE. Strauss, A. & Corbin, J. (2007). Basics of qualitative research: Techniquesand procedures for developing grounded theory (3d ed.)

41. Questions?