Qualitative & Mixed Methods

1. Qualitative & Mixed Methods Module 14

2. Overview Qualitative Research • Broad view of features • Many traditions • Contrasts with quantitative research • Qualtitative method roadmap • Data collection methods • Standards of evaluation Mixed Methods • Approaches to mixing • Examples

3. Research Methods In the social sciences, there are 3 generic types of research methods • Quantitative methods • Qualitative methods • ‘Mixed methods’ blending quantitative and qualitative

4. Qualitative Research Focus on making sense of or interpreting social or human phenomena: experiences, behaviors, organizational functioning, social movements, interactional relationships, descriptions of culture Phenomena are studied in their natural settings Investigators interpret phenomena in terms of the meanings people bring to them Denzin and Lincoln, 2000.

5. Qualitative work: Common features The researcher is the primary instrument for data collection and analysis Involves fieldwork Attends to low inference descriptive data

6. Qualitative Methods - Traditions

7. Qualitative Research Attends to description of how vs. how many Is an inductive and open process: the investigator builds concepts, hypotheses, and theories from analysis of the data. The data collection and analysis process is iterative. The investigator returns to the data with new questions and ideas to explore until there is a very deep understanding of the phenomenon / issue.

8. Qualitative Quantitative Assumptions Social facts have an objective reality Primacy of method *Variables are measured with existing tools Relationships between variables can be assessed using standard statistics Assumptions Reality is socially constructed Primacy of subject *Variables are complex, interwoven and difficult to measure Relationships between variables are generally described as observed patterns or cases

9. Qualitative Quantitative Purpose Generalizable findings Prediction Causal explanations Researcher’s Role Detachment and impartiality Objective portrayal Design a priori and inflexible Purpose Contextualization Interpretation Understanding peoples’ perspectives Researcher’s Role Personal involvement and partiality Emphatic understanding Design Flexible and emergent

10. Qualitative Quantitative Purpose Generalizable findings Prediction Causal explanations Researcher’s Role Detachment and impartiality Objective portrayal Design a priori and inflexible Purpose Contextualization Interpretation Understanding peoples’ perspectives Researcher’s Role Personal involvement and partiality Emphatic understanding Design Flexible and emergent

11. Qualitative Quantitative Approach Begins with hypotheses and theories Manipulation and control Experimentation Deductive Component analysis Seeks consensus, the norm Reduces all data to numerical indices Precise technical language, numerical presentation Approach End with hypotheses and grounded theory Emergence and portrayal Naturalistic Inductive Searches for patterns Seeks pluralism, complexity Minor use of numerical indices Thick description through writing

12. Questions?

13. The Circle of Inquiry Identify Knowledge Gap Search for Existing Information Disseminate & Implement Focus the Study Question Analyze & Interpret Results Collect Data Design the Study Adapted from: Nutting, PA, Stange, KC. Practice-based research: The opportunity to create a learning discipline. In: The Textbook of Family Practice, 6th Edition. Rakel RE (ed.), W. B. Saunders Company, 2001.

14. Qualitative Data Collection Methods • In-depth interviews • Narratives, detailed responses to probing questions • Direct observation • Field notes containing descriptions of activities, behaviors, actions, interactions, and processes • Document analysis • Written documents: records, memoranda, correspondence, reports, diaries

15. Qualitative Methods Road Map Connecting Corroborating / Legitimating Crabtree & Miller, Doing Qualitative Research 1999 2nd Ed. Sampling / Data collection Describing Organizing

16. Qualitative Methods Road Map Representingtheaccount Connecting Corroborating / Legitimating Sampling / Data collection Describing Organizing

17. Qualitative Methods Road Map Actively reflecting, Specifically how what is happening is influencing & shaping the interpretive process. Determining next steps. Representingtheaccount Connecting Corroborating / Legitimating Sampling / Data collection Describing Organizing

18. Qualitative Methods Road Map 3 general strategies: - Template - Editing - Immersion /Crystalization Connecting Corroborating / Legitimating Sampling / Data collection Describing Organizing

19. Qualitative Methods Road Map Representingtheaccount Connecting Corroborating / Legitimating Sampling / Data collection Describing Organizing

20. Qualitative Methods Road Map Gathering Process Representingtheaccount Connecting Corroborating / Legitimating Sampling / Data collection Describing Organizing

21. Qualitative Methods Road Map Representing theaccount Connecting Corroborating / Legitimating Analysis Process Sampling / Data collection Describing Organizing

22. Qualitative Methods Road Map Interpretive Process Representing theaccount Connecting Corroborating / Legitimating Sampling / Data collection Describing Organizing

23. Qualitative Methods Road Map Reflexivity Representingtheaccount Connecting Corroborating / Legitimating Sampling / Data collection Describing Organizing

24. Questions?

25. Standards of Qualitative Research God is in the details. R. Preston, 1994, p. 298 The devil is in the details. Popular adage. Frankel, Standards of Qualitative Research. In Doing Qualitative Research, 2nd Ed.

26. Standards for Evaluation Quantitative Internal Validity External Validity Reliability Objectivity Qualitative Credibility / Trustworthiness (Transferability) Confirmability, dependability Engagement, reflexivity

27. Trustworthiness • Ways to achieve trustworthiness: • Member checks: recycling interpretation back to the key informants • Searching for disconfirming evidence • Triangulation: multiple data sources and multiple methods • Thick description: a thorough description of the context of the study

28. Confirmability • Ways to address confirmability: • Collection of data in ways that allow for audits • Audio recordings • Full transcripts of interviews • Collection of low inference observational data • Engaging a team approach • Independent auditors

29. Reflexivity • Ways to address reflexivity: • Document beliefs, framework, theories underlying approach to the problem before beginning the data collection. • Actively journal reflections, possible biases/ limitations to ‘lens’ or ‘gaze’. Document how to overcome limitations to more fully examine phenomena. • Engage other perspectives in team analysis. • Report reflexivity in final product

30. Summary: What’s Involved in Qualitative Inquiry Source: Creswell JW. 1998. Qualitative inquiry and research design: choosing among five traditions. Thousand Oaks, CA: Sage. Spend time in the field gathering data Engage in data analysis to reduce raw data to themes or categories; complex & time-consuming Write extensively to show multiple perspectives in order to substantiate findings Participate in a form of research that does not have firm guidelines or specific procedures, and is evolving and constantly changing

31. Qualitative/Quantitative • Both approaches are highly respected • When done well, both contribute equally to the knowledge base • When possible, researchers should blend the methods • enriches the data to enable deeper understanding • validates the conclusions from more than one perspective

32. Summary of Quantitative and Qualitative features

33. Mixed Methods General consensus that no longer a quantitative vs. qualitative methods – both are necessary.

34. Mixed Methods Attack the research problem with an arsenal of methods that have non-overlapping weaknesses in addition to complementary strengths. J Brewer & A Hunter Foundations of multimethod research: Synthesizing styles. Sage 2006. page 4.

35. Mixed Methods Scope of mixing methods – within study – within line of inquiry – within broad topic area

36. Approaches to mixing methods Sequential studies Quantitative Qualitative Qualitative Quantitative

37. Approaches to mixing methods Mixing methods in the same study • Dominant/ Less Dominant Secondary method plays a small role • Triangulation Equal weight, both Quantitative and Qualitative data collected & analyzed in a complementary manner.

38. Examples of mixing Data transformation – convert data of one type to the other can be analyzed together. Typology development – one type of data used to develop a typology that is used to drive analysis with other type of data. Extreme case analysis – pursue data collection or analysis of data of the other type with the intent of refining the initial explanation for the extreme case.

39. Example line of inquiry

40. Direct Observation of Primary Care To accurately measure, using direct observation, the level of preventive services delivered to eligible patients, and to document the context of the competing demands of the primary care medical encounter To determine the optimal non-observational method… To use a multimethod approach to identify and explore which characteristics of the medical encounter, physicians, patients and the office environment are associated with delivery of preventive services to eligible patients

41. Direct Observation of Primary Care • Cross-sectional observation of 84 family practices & 4454 patient visits to 138 physicians in Ohio • Direct Observation Davis Observation Code Checklists • Medical Record Reviews • Patient Exit questionnaire • Billing Data • Practice Environment Checklist • Ethnographic Fieldnotes

42. Prevention & Competing Demands PI – Crabtree Aim: Understand primary care practice from the ground up through intensive direct observation of the practice environment and patient care to better understand how these factors affect preventive service delivery

43. Prevention & Competing Demands • In-depth multimethod comparative case study of 18 family practices & 1,600 visits to 56 clinicians in Nebraska • Longer direct observation of practice environment recorded in checklists and field notes (4-8 weeks of observation) • Direct observation of 30 encounters/clinician recorded in checklists and field notes • Chart audits of patients who were observed • Interviews of all clinicians, most staff, some community members

44. Study To Enhance Prevention by Understanding Practice (STEP-UP) • Randomized clinical trial of 80 family practices in Ohio • Multimethod assessment (MAP) of values, structures, and processes • Patient survey and medical record review to assess preventive service delivery at 6 month intervals • Practice-individualized intervention

45. Doctor-patient communication study Specifically this study aims to: 1. Characterize the way a ‘teachable moment’ arises and is constructed within the patient-physician interaction. 2. Identify factors that enhance or impede the use of illness visits to provide health behavior advice. 3. Determine the effectiveness of a ‘teachable moment’ for increasing: patient recall of advice, motivation to modify behavior, and change in health behavior.

46. Doctor-patient communication studyGraphic representation of mixing

47. Doctor-patient communication studyOutputs Primary paper #1 Discovery of the teachable moment communication process. Primary paper #2 Quantitative testing the association of TM vs. other kinds of advice with outcomes

48. Doctor-patient communication studyEmbedded example National Heart Lung & Blood guideline for assessment and treatment of obesity. - coding template of key guideline elements - audio recordings, apply template - findings from quantitative prompted qualitative examination. (Unplanned)

49. Mixing methods Expertise/training in methods you want to mix - team members - consultants - cross training - learning by doing*

50. Summary