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Use of Qualitative Methods in Health Research

Use of Qualitative Methods in Health Research . Presenter: Dr Himani Shemar Moderator: Dr Abhishek V Raut. Qualitative Research. Qualitative research is a type of scientific research. In general terms, scientific research consists of an investigation that:

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Use of Qualitative Methods in Health Research

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  1. Use of Qualitative Methods in Health Research Presenter: Dr Himani Shemar Moderator: Dr Abhishek V Raut

  2. Qualitative Research Qualitative research is a type of scientific research. In general terms, scientific research consists of an investigation that: • seeks answers to a question • systematically uses a predefined set of procedures to answer the question • collects evidence • produces findings that were not determined in advance • produces findings that are applicable beyond the immediate boundaries of the study

  3. Need for Qualitative Research • Need to understand about target population • Guide additional data collection • Clarify, explain and elaborate findings from quantitative data • Generation of hypotheses replaces testing of hypotheses • Need explanation instead of measurement • Need understanding instead of generalisability

  4. Qualitative Research Approaches • Grounded Theory • Phenomenology • Ethnography

  5. Grounded Theory • Focus: develop a theory to explain underlying social processes of a cultural group • Useful in areas where little is known or when a new perspective is needed • Used for exploratory, descriptive studies • Because the theory emerges from the data, it is said to be grounded in the data • Foundation in Symbolic Interactionism

  6. Phenomenology • Focus: reveal the meaning of the lived experience from the perspective of participants • Describe the essences of lived experience • Essences: elements related to the true meaning of something that gives common understanding to the phenomenon under study • Conveyed with descriptive language • Drawn from Philosophy; used across disciplines

  7. Ethnography • Focus: study human behaviour in the cultural context in which it is embedded • Ethnography is the work of describing a culture – the way of life of a cultural group • Associated with Cultural Anthropology

  8. Type of Qualitative methods • Participatory Research (PR) techniques: Social Mapping, Pair wise ranking, Seasonal Calender, Cobweb diagram, trend analysis, Venn diagram, Transect Walk • In-depth techniques: Focus Group Discussions, key informant interviews, In-depth Interview • Systematic Techniques: Free listing, Pile sorting

  9. Uses of Qualitative Research

  10. Exploratory studies • Conducted when there are few or no earlier studies to which references can be made for information • Aim is to look for patterns, ideas or hypotheses

  11. Advantage of qualitative methods in Exploratory Research • Use of open ended questions and probing gives participants an opportunity to respond in their own words • Open ended questions have ability to evoke responses that are: • Meaningful and culturally salient to participant • Unanticipated by researcher • Rich and explanatory in nature

  12. Example: If we are trying to get more men to undergo vasectomy we might start by having participants identify all of the percieved barriers and facilitators to having the procedure.

  13. Questionnaire construction and adaptation Qualitative methods can be used to determine respondents’ idea regarding content of questionnaire, language used, question and response format.

  14. Example: Food Frequency Questionnaire • Help decide what the main nutritional/dietary issues are in a particular setting; • Select appropriate tools for estimation of portion size. • Help decide who will be the best proxy reporters for the diets of individuals who cannot provide their own report (e.g., small children); • Select foods for inclusion on food frequencies and infant diet histories; • Select appropriate wording (labels) for foods on a food frequency;

  15. Decide on appropriate probing questions for 24-hour recalls; • Design additional survey questions which assess impact of a nutrition intervention programme on cognitive and behavioural factors; • Develop questions for structured surveys; • Aid in the interpretation of quantitative findings.

  16. Enhance findings of quantitative Research • It serve a source of hypotheses for quantitative study • Identify appropriate variables to be measured. • Help to improve the accuracy & relevance of quantitative studies by increasing our understanding of creation of quantitative data • Providing explanations for unexpected or unexplained findings in quantitative studies

  17. Systematic Review

  18. Program Development

  19. Program Evaluation When do we employ Qualitative methods? • When we have established effectiveness, but we are interested in replication, we ask “how” a program is implemented • When we are interested in conducting process evaluation and want to know the reasons a program is not yielding the expected results.

  20. Use of Qualitative methods in Evaluation • Identify implementation and intermediate outcomes • Verify and complement quantitative measures • Eliminate threats to internal validity • Identify unintended outcomes • Develop better quantitative measures

  21. Stages of evaluation • Determining the focus of evaluation • Evaluating the implementation or process of a program • Determining improvements and changes to a program

  22. Key questions in conducting Qualitative Evaluation Assessment • Who are the clients for evaluation? • What are the questions & issues driving the evaluation? • What resources are available to do evaluation? • What has been done previously? • What is the program al about?

  23. Key questions cont… • What kind of environment does program operate in and how does that affect the comparisons available to an evaluator? • Which research design alternatives are desirable and appropriate? • What information sources are available, program structure and environment in which program operates? • Should program evaluation be undertaken

  24. Which approach to use in qualitative methods • Qualitative methods used alone • Qualitative methods used after Quantitative approach • Qualitative methods used before Quantitative methods

  25. Process Evaluation Example: media campaign designed to increase voluntary use of helmets • Have the campaign products (posters, billboard, radio and television spots) been pre-tested? • How often were the campaign advertisements run? • How many people saw them? • Was the target group being reached?

  26. Process Evaluation cont… • Are high-quality helmets available and affordable in local shops? • If the intervention involves enforcement of helmet legislation: • Is there noticeable enforcement by police? • Are the police supportive of the campaign? • Is the penalty sufficient to change behaviour?

  27. Verbal Autopsy Example: Identifying factors associated with Maternal deaths in Jharkhand, India: A Verbal Autopsy Study.

  28. Limitations of Qualitative study • Proper analysis of text is time consuming • Ability to claim a representative sample is often diminished • Inability to measure variation of responses in any meaningful way • Not an ideal choice for reliably comparing groups

  29. References • Family Heath International. Mack N, Woodsong C, Macqueen KM, Guest G, Namey E. Qualitative Research methods: A data collector’s Field Guide. USAID. 2005 • Dongre AR, Deshmukh PR, Kalaiselvan G, Upadhyaya S. Application of Qualitative Methods in Health Research: An Overview. Online J Health Allied Scs.2009;8(4):3 • Heary CM, Hennessy E. The Use of Focus Group Interviews in Pediatric Health Care Research. Journal of Pediatric Psychology. 2002;27(1):47-57. • Qualitative Research. http://www.sagepub.in/upm-data/48453_ch_1.pdf accessed on 14/12/2013. • Garbarino S, Holland J. Quantitative and Qualitative Methods in Impact Evaluation and measuring results. Governance and Social Development Resource Centre. 2009.

  30. References 6. Noyes J, Popay J, Pearson A, Hames K, Booth A. Qualitative Research and Cochrane reviews. Cochrane Book Series. 2008. 7. Bam K, Thapa R, Newman MS, Bhatt LP, Bhatta SK. Sexual Behaviour and Condom Use among seasonal dalit migrant laborers to India from far West: Nepal: A Qualitative Study. PLOS ONE. September 2013;8(9):1-10. 8. Khan N. Pradhan MR. Identifying factors associated with maternal deaths in Jharkhand, India: A Verbal Autopsy Study. J Health PopulNutr. June 2013;31 (2):262-71. 9. Black N. Why we need qualitative research. Journal of Epidemiology and Community Health. 1994;48:425-26. 10. HearyCM. The use of Focus group Interviews in Pediatric Health Care Research. Journal of Pediatric Psychology.2002;27(1):47-57.

  31. References • SofaerS. Qualitative methods: What are they and why use them? Health Services Research. December 1999;34(5). 12.Hudelson PM. Qualitative Research for Health Programmes. World Health Organization.1994. 13.Murphy E, Dingwall R, Greatbatch D, Parker S, Watson P. Qualitative research methods in health technology assessment: a review of the literature. Health Technol Assessment.1998;2(16). 14.USAID. CORE. Training in Qualitative Research Methods: Building Capacity of PVO, NGO, and MOH partners.

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