How to make the best of qualitative

phases of mixed method researchProfessor Kim Usher

Centre for Chronic Disease Prevention

Mixed Methods in Prevention and Health Services Research

Mixed Methods Research

• Types

• Principles

• Importance of stand-alone phases

• Integration

Integration

Sequential Exploratory MixedMethods Design

Mixed Methods ExplanatoryDesign

What do we mean by quantitative and

qualitative research?Usual distinctions

Quantitative Qualitative

Type of reasoning

Deductive Inductive

objectivity Subjectivity

Causation Meaning

Type of question

Pre-specified Open-ended

Outcome-oriented Process-oriented

Type of analyses

Numerical estimation Narrative description

Statistical inference Constant comparison

Chronic illnesses

Prime examples of conditions that by their very nature need to be studied from many perspectives.

Hierarchies for evaluating evidence

• Most based on criteria for rigor developed for quantitative research designs

• Design ranked according to extent the study is internally valid or free from bias

• RCTs best evidence

Qualitative research is evidence too!• Just because excluded from

hierarchies does not mean it is less valuable

• Implementation of interventions in real world requires knowledge about patients’ values and experiences

Why have qualitative phases?

• Evaluate the effects of interventions on health outcomes

• Examine views of participants

• Distinguish between components of interventions

• Understand a non-significant outcome

Why have qualitative phases?

• To develop measures

• To identify relevant phenomena

• To interpret/explain quantitative data

• Investigate complex phenomena

• Study special populations

Designing intervention studies with

qualitative componentsBefore a trial

•To ‘trial’ the trial

•To develop the intervention

•To test tools

Designing intervention studies with

qualitative componentsDuring a trial

•To describe and explain within and between subject variation discerned from instruments

•To understand whether intervention delivered as planned

•Patient reaction to intervention

Designing intervention studies with

qualitative componentsAfter a trial

•To select individuals for more intensive study based on scores

•Interview or observe to validate outcomes

•To help explain non-significant findings

Qualitative approaches

Phenomenology

•How one or more individuals experience a phenomenon

Ethnography

•Learning the culture of a group and what it is like to be a member of that group from the perspective of the members

Qualitative approaches

Case study

•A detailed account of one or more cases-focus on each case a a whole unit as it exists in the world

Grounded theory

•An inductive approach for generating theories or explanations

Future directions

• Qualitative studies enhance the meaningfulness of interventions

• Situate them in the real world of patients and their caregivers

• Shed light on facilitators and barriers to the uptake of promising interventions

• Illuminate aspects of the patient experience

Future directions

• Can identify barriers to implementing and sustaining community-based prevention programs

• Ensure patient safety, including reduction of misuse of medical therapies and oversights of clinical care

Conclusion

Not everything that can be counted counts, and not

everything that counts can be counted.

Albert Einstein