HSERV 526 Qualitative Research in Public Health Stephen Bezruchka TA: Anthony Sok-Heng Tessandori.
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Transcript of HSERV 526 Qualitative Research in Public Health Stephen Bezruchka TA: Anthony Sok-Heng Tessandori.
HSERV 526
Qualitative Research in Public Health
Stephen Bezruchka
TA: Anthony Sok-Heng Tessandori
Understanding a culture by getting to know it personally, rather than counting/measuring aspects of it
Leads to hypotheses that can be investigated by quantitative techniques
Rigor and validity in qualitative research
Cultural familiarity respect for adherents adherents respecting you
Qualitative Research in Public Health
Qualitative Research: soft science?
DRAFTQualitative Methods CompetenciesMarch 1, 2005
1. Be able to use qualitative methods for practical applications in publichealth, including document review, qualitative research, instrumentdevelopment, direct observation, informant interviews, focus groups, andother formal group methods.
2. S tudent s shou ld be ab le to de scribe the comp lementa ry featu res and app ropriateinteg rat ion of qua lita tive and qua ntitat ive app roa ches to resea rch rega rding hea lthproblems of a popu la tion
3. S ituate qua lita tive resea rch in an ep istemologica l frame work as a too lbox to ga indep th in viewing socia l phenomena tha t produce s insight into mean ings and a ctions .
4. Basic terms and concep ts of qua lita tive app roa ches includ ing sub jectivity, reflexivity,e thnog raphy , ep istemiology, de cons truction, pos ition an d voice
5. Be ab le to clas sify the type s of find ings produ ced by differen t leve ls of data synthe sisand inte rpre tat ion (e.g ., No find ings , Top ica l survey, Thema tic su rvey,Concep tua l/thema tic des cription , Inte rpre tive explanat ion)
6. Articula te how the resea rche r’s sociocultura l pos ition affec ts the ques tions as ked, theme thod s of inqu iry, data collection , inte rpreta tion and d isse minat ion and the role ofposition and voice in situa ting the resea rcher in the resea rch
7. Ident ify ways to increa se trus tworthines s of the qualita tive proce s s and find ings (e.g .,multiple code rs , me mos /aud it tra il to docu ment evo lution of thinking,exercises /me mos in re flexivity, pa rticipant che cks , theo re tica l sa tura tion, negat ivecase s , et c.)
8. Be ab le to write a method s s ec tion for a propo sa l using qua litat ive method s thatwould de scribe (1) why th is method s is suited to the resea rch ques tion/da ta; (2) whatprocedu res a re en ta iled in data collection; (3) how the s tuden t will organ ize the da taonce collec ted; (4) de scribe the ana lytic proce dures ; (5) as sure trus tworthines s ofthe proces s ; and (6) give a s ense of how th e da ta will be repo rted (i.e ., the mes ,theo ry deve lopment , conte xtua l factors , etc.) (This las t one kind o f en compa sse s a llthe abo ve so may jus t be a res ta temen t of e verything e lse .)
9. De scribe d ifferen t qua litat ive method s includ ing :• content analysis• thematic description• grounded theory• Phenomenology• Hermeneutics• Discourse analysis• Narrativ e analysis• Ethnography
Health ServicesDepartmentSocial and Behavioral Sciences trackCOMPETENCIES
Qualitative Competenciesdocument review, qualitative research,
instrument development, direct observation, informant interviews, focus groups, formal methods
describe complementary features and appropriate integration of qualitative and quantitative approaches to research regarding health problems of a population
epistemological toolbox to view social phenomena & gain insight into meanings and actions
subjectivity, reflexivity, ethnography, epistemology, deconstruction, position and voice
classify the types of findings produced by different levels of data synthesis and interpretation
bias: how the researcher’s sociocultural position affects the questions asked, methods of data collection, interpretation and dissemination
ways to increase trustworthiness of the qualitative process and findings
write a methods section for a proposalmethods:
• content analysis• thematic description• grounded theory• Phenomenology• Hermeneutics• Discourse analysis• Narrative analysis• Ethnography
Other Qualitative Research CoursesSeminar in Advanced Qualitative Methods
James Pfeiffer, Autumn 2006, Hserv 590– Theoretical foundations, in-depth analysis and use of
computers (ATLAS ti)
Interpretive methods (phenomenology, narrative analysis, and grounded theory)Helene Starks, Winter 2006, Medical History Ethics
MHE 497
Learning Objectives for this session
review syllabus
describe the terms emic and etic
list methods of qualitative investigations
discuss possible research questions and choosing teams
recount the attributes of a cultural domain
Examples of qualitative research and relationship to quantitative work
Handouts• Course schedule with exercise due dates
• Syllabus with readings
• Exercises
SIGN THE SHEET BEING HANDED OUT– Those taking course for credit only
WORK of course
Overview of many methods
Attending lecturesRapid pace, INTERRUPT
Exercises in class
Group project
Individual exercises
Group presentation and report
Extra session needed as a group
Grading• Exercises (12 each)
• Project report (20)
• Project Presentation (20)
Lecture noteshttp://courses.washington.edu/hserv526/
Course readings
Course PacketRams Copy Center 4144 Univ Way NE
Recording of lectures
TextbooksRequired:
-Bernard Research methods in Anthropology (2006) or 2002 Third Edition
– Ulin, P. R., E. T. Robinson, et al. (2005). Qualitative Methods: A field guide for applied research. San Francisco, Jossey-Bass.
Recommended– Krueger, Focus Groups– LeCompte Ethnographer's Toolkit– Morse Qual. Res Methods for Health Prof.– Scrimshaw RAP– Spradley Ethnographic Interview
TODAY’S READING
Body Ritual Among the Nacirema
In course packet
Past Students suggest• Focus on techniques in exercises, not research
question
• Coding is important
• Much of material is "common sense"
• Why do it? See flaws in outsiders programs
• when you listen to what someone says or watch what they do, you learn much about that setting that you won’t see from counting how many people came to the health center
PROJECTS• PAST YEAR'S Titles in today' syllabus
• PAST YEAR'S Reports on reserve in library
• Guidelines: no sensitive topics, receptive population, everyone mentally competent, adult, easily accessible, 5 minute rule, focused topic
• Groups with non-native English speakers to have one native English speaker
Past ProjectsUW Cultures student groups:
smokers, Muslims, international, activists
specific settings:
computer labs, instructional center, WAC, IMA, museums
specific employee groups:
IMA, copy workers, food service workers, janitors, bus drivers
OthersNear UW cultures:
Agua Verde workers, Ave street people, tanners, Greenlake walkers, movie goers, bus riders
Stress-related:pool players, computer lab noise, relationships, knitting
Health relatedSeattle groups:p-patch
gardening
Project suggestions (my interests)
• Perceptions of progress? US relative health decline
• Beliefs about dominant ideology (if you work hard, you will succeed, so America's system in which there is a big gap is necessary for our society to function best
• Student beliefs about equality and equity
• Faculty beliefs about distributive justice
• Beliefs about whether rich people's health is worse off with more inequality?
NEXT SESSION (THURSDAY)Think of questions/topics for study TODAY
FILL OUT THE FORM including TIMES
TALK TO OTHERS ABOUT FORMING A GROUP
Your email to Anthony by WEDS NOON should include the contents of the six columns
NO LATE SUBMISSIONS
Anthony will collate them all and email them to everyone by Wednesday10 PM to help you decide
THURSDAY we will form groups
Specific TopicEXAMPLE Discrimination of wheelchair users in Health Sciences Center or in community
YOUR TOPIC
Population to study EXAMPLE Users of wheelchairs
YOUR POPULATIONSpecific place to access population EXAMPLE University Hospital 3rd floor entry
YOUR PLACE TO ACCESS
Specific site for direct observation EXAMPLE Wheelchair users as they arrive at the hospital
YOUR OBSERVATION SITE
Informant Interview focus EXAMPLE What is it like as you go from home to the hospital?
YOUR INTERVIEW FOCUS
Participant Observation Activity EXAMPLE Spend an hour in a wheelchair in the University Hospital complex
YOUR PARTIPANT ACTIVITYNAME______, PHONE NUMBER _________
EMAIL TO BE SENT TO Anthony see syllabusPLUS MEETING TIMES
CRUCIAL STEP BEFORE THURSDAY (AFTER SENDING
YOUR EMAILED EXERCISE PROBLEM
• Study the email Anthony sends with the projects people have thought of, serial numbered to identify them (Wednesday 10 pm)
• Rank the ones you are interested in working in, and bring the top three to Thursday's class– Look at the times for possible meeting on that project,
and don't rank them if the meeting time suggested is not possible for you.
Qualitative Research
-
try to understand how communities perceive a concept
that is a part of their culture
INHERENTLY POLITICAL
QUALITATIVE RESEARCH• OBSERVATION,
• INFORMANT INTERVIEWS,
• formal methods (free list, pile sort)
• FOCUS GROUPS
• PARTICIPATORY METHODS
• RAP (similar to fast food)
• CODING, ANALYSIS
Qualitative Research
• Iterative
• Cyclical
• Refinement of focus
• Flexible
• Triangulation
COMPARING QUALITATIVE AND QUANTITATIVE RESEARCH METHODS
QUALITATIVE QUANTITATIVE
GENERAL Perspective
insider's (emic) outsider's (etic)
exploratory confirmatory
Hypothesis generating testing
METHODS words numbersStructured
less (a continuum) more
Why questions fewer more
Dynamic more less
SAMPLING number small large
depth more less
type purposeful or 'random' random
CONTEXT(style or Richness more lessmanner of data collection) multiple methods single method
WHY STUDY HOW TO LEARN ABOUT A CULTURE?
• Many problems today stem from not respecting OTHER cultural values
• need to get an emic perspective of a culture (population)
• tools to do that are taught in this course• in the process of learning about that culture, you
begin to respect it• then holders of the culture begin to respect you• you can begin to work together to make positive
changes
CULTURE• “knowledge that people learn as part of a group
that is used to interpret experience and generate social behavior”
• elements include– shared, collective
– systematic, organized
– both explicit and implicit elements
– variability across population
"Culture is a way of life shared by the members of one group but not necessarily with the members or other groups of the same species. It covers knowledge, habits, and skills, including underlying tendencies and preferences, derived from exposure to and learning from others. Whenever systematic variation in knowledge, habits, and skills between groups cannot be attributed to genetic or ecological factors, it is probably cultural. The way individuals learn from each other is secondary, but that they learn from each other is a requirement. Thus, the "culture" label does not apply to knowledge, habits or skills that individuals readily acquire on their own." Frans de Waal The Ape and the Sushi Master
Cultural attributes• “cultural consensus”, shared among people in the
same group• holistic, interconnected, usually studied by long
intensive field studies, seeing how things relate in broad patterns
• aspects are overt or covert – people within the culture may not want to tell you, or
can’t generate the answer– differences in way behavior is organized and
characterized
Cultural differences
• Man in hospital with ventricular tachycardia
• Baby massaged with ghee in cold after delivery
• bikas
emic etic
Insider’s perspective
CULTURE• Hard to describe one's culture
• Understanding another culture is difficult
• How do you learn about cultures?
CULTURAL DOMAINS• defined as category of cultural meaning that
includes other cultural categories, (from an emic perspective), – domain can be related to a place/location (e.g. school or
clinic), a concept (diarrhea, food flexibility), material things (medicines, cars), or people (shamans, gypsies, nuns)
• Cognitive Anthropology (semantic distinctions)
• Componential analysis (building blocks of meaning in semantics)
Domain attributes• cover term (that indicates a category of
cultural knowledge) words used in plural– tree– illnesses that women get in a village in Nepal
• included terms (at least 2, that are the elements that comprise a domain) – oak, yew, pine, maple – mutu khane
Domain attributes
• semantic relationship where all included terms are related to cover term in same way – pine and maple are “kinds of trees” – mutu khane is an illness that women get in
Nepal
• DOMAINS ARE NOT THEMES– (Spradley reading on themes in packet) – comes out in Analysis later
Domain attributes
• boundaries: certain things are not part of that domain – a tulip is not within the domain of a tree – e.g. sunburn is not an illness that women in a
village get in Nepal
• OFTEN/USUALLY, domains are not found in many qualitative studies
Research Topic
Cultural Domain
included terms
Student Eating Habits on Campus
Healthy Foods
Unhealthy Foods
Convenience Foods
Domain analysis• Read interview texts• Look for names of things (esp. plural)• See if one of names could be cover term
– Name used for more than one thing– Name could be used as “kind of”– Others become included terms
• Semantic relationships
• Boundary
Class exercise• Take notes on interview of TA by instructor
• Look for included terms– Cover term– Semantic relationship– Boundary
People who Scuba Dive
Cultural Domain
included terms
Scuba Diving
???????????
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EXAMPLES: Qualitative studies
STD’s in minority women prevention trial
(reading packet)– Behavioral intervention based on knowledge of cultural
beliefs produced large decline in re-infection rate
• 18 months of qual. research• Create culture- and sex-
specific small-group interventions– Af Am & Mex Am fe.
• 2 groups randomized• 1 group standard
counseling• 1 group culture specific
counseling
05
1015202530
%
6 months 12 months Overall
TIme after enrolment
2nd Aquisition STD
control intervention
34% 49% 38%
AIDS Risk reduction model
Pre-tested with 13 groups (85) women
05
1015202530
%
6 months 12 months Overall
TIme after enrolment
2nd Aquisition STD
control intervention
34% 49% 38%
Summary of session• Qualitative and quantitative methods are
complementary
• Cultural domains are a useful way to understand how groups organize words