Making Quilts: Making Quilts: The Art and Science of The Art and Science of

Qualitative ResearchQualitative Research

Andrew Sussman, PhD, MCRPFamily and Community Medicine1.25.14

OverviewOverview

Qualitative Research: what, why, howQualitative Research: what, why, how

Mixed Method ResearchMixed Method Research

See one, do oneSee one, do one

““Life is not a problem to be solved, but a reality to be Life is not a problem to be solved, but a reality to be experienced.experienced.””

——Soren KierkegaardSoren Kierkegaard

Making QuiltsMaking Quilts

BricoleurBricoleur——

"make creative and "make creative and resourceful use of resourceful use of whatever whatever materials are at materials are at handhand””

Situating Qualitative ResearchSituating Qualitative Research Qualitative/quantitative research are not just different ways

of doing research, but different ways of knowing

Paradigm: a pattern or model (Thomas Kuhn): methods often highlighted but are downstream

(Post) Positivism Interpretivism

Science as “cultural filter”

““What we observe is not nature itself, but nature What we observe is not nature itself, but nature exposed to our method of questioning.exposed to our method of questioning.““

——Werner HeisenbergWerner Heisenberg

What is qualitative research?What is qualitative research?

Quantitative ResearchQuantitative Research

(Positivism)(Positivism)Measurement--numbersMeasurement--numbers““Top downTop down””GeneralizingGeneralizingObjectiveObjectiveSeparating and reducingSeparating and reducing

Qualitative ResearchQualitative Research

(Interpretivism)(Interpretivism)Context, values, Context, values, experiencesexperiences““bottom upbottom up””SubjectivitySubjectivitySeeing the whole Seeing the whole picturepictureParticularParticular

What is qualitative researchWhat is qualitative research

Layers of meaning--Layers of meaning--““like peeling onionslike peeling onions”” Richness, depth key termsRichness, depth key terms

Context MattersContext Matters

Most sciences attempt Most sciences attempt to understand to understand phenomena by phenomena by isolating them from isolating them from their context. their context.

Humanities and social Humanities and social sciences often attempt sciences often attempt to understand the to understand the meaning of meaning of phenomenaphenomena

Meaning can only be Meaning can only be understood in context. understood in context.

Observation Observation Exercise:Exercise:

How do you How do you ‘read’ this ‘read’ this image?image?

Insider Meanings (Emic)

Outsider Meanings (Etic)

A Call for IntegrationA Call for Integration

Limitations of positivismLimitations of positivism

Social world is not like billiards:Social world is not like billiards:undergoing constant non-linearundergoing constant non-linearchangechange

““Simplicity and predictability do not make Simplicity and predictability do not make positivism wrong; they merely limit it.positivism wrong; they merely limit it.””

——Paul ThomasPaul Thomas

Common Common (Inherent) (Inherent) Criticisms of Criticisms of Qualitative ResearchQualitative Research

Biased False

Anecdotal False

Lacks External Validity False

Lacks rigor False

Not systematic False

Tolerance for ambiguity True

Not numerically representative True

Involves little division of labor True

Small scale, time consuming True

Needs close supervision to learn True

The Qualitative ToolboxThe Qualitative Toolbox

MethodsMethods Not one way for doing qualitative research Not one way for doing qualitative research Need for flexibility—data collection and analysis Need for flexibility—data collection and analysis

happening together happening together

1. Participant-Observation2. Ethnography3. Photography4. Ethnomethodology5. Interviewing/Focus Groups

6. Unobtrusive Measures (audio/video tape)

7. Natural Experiment8. Case Study9. Social Network Analysis10. Content Analysis11. Historiography12. Secondary Analysis of

Data

Most Used ToolsMost Used Tools

InterviewingInterviewing: : individual, focus groups, case studyindividual, focus groups, case study unstructured to structuredunstructured to structured

ObservationsObservations:: participant observation, field notes, participant observation, field notes,

audio/video taping (degree of obtrusiveness)audio/video taping (degree of obtrusiveness) Collecting Texts and ArtifactsCollecting Texts and Artifacts

documents in public sphere, mediadocuments in public sphere, media

Qualitative Research: How toQualitative Research: How to’’ss Clear connection between research questions and Clear connection between research questions and

methodsmethods—methods determined by needs —methods determined by needs

Who to involve? Who to involve? —sample must be —sample must be appropriateappropriate and and purposefulpurposeful—not random; people who best represent or —not random; people who best represent or have knowledge of topic; have knowledge of topic;

dynamic relationship between sampling, data dynamic relationship between sampling, data collection and analysiscollection and analysis—data collection and analysis —data collection and analysis are concurrent are concurrent

Survey—usually the same for every subjectSurvey—usually the same for every subject Interview—(could be) slightly different for every subjectInterview—(could be) slightly different for every subject

Morse JM, Barrett M, Mayan M, Olson K, Spiers J. Verification strategies for establishing reliability and validity in qualitative research. International Journal of Qualitative Methods 2002.

How to make sense of it: Data How to make sense of it: Data Analysis/CodingAnalysis/Coding

LoopsLoops:: Do data collectionDo data collection Review the dataReview the data Come together to Come together to

discuss themes discuss themes Modify interview Modify interview

guideguide Do data collection…Do data collection…

Rinse, lather, repeatRinse, lather, repeat......

CodingCoding

Coding: a word or short phrase that serves Coding: a word or short phrase that serves to organize or categorize your data to organize or categorize your data (community; equitable coverage; (community; equitable coverage; stereotyping)stereotyping)

Themes: clusters or patterns of codes that Themes: clusters or patterns of codes that thematically thematically ‘‘hang togetherhang together’’

Data Analysis—Coding Data Analysis—Coding

http://ssrcdepaul.wordpress.com/http://ssrcdepaul.wordpress.com/2011/10/07/constant-comparison-with-2011/10/07/constant-comparison-with-jellybeans/jellybeans/

Coding with JellybeansCoding with Jellybeans

Start slowly with small amounts of dataStart slowly with small amounts of data WonWon’’t all fit together at the start and lots of t all fit together at the start and lots of

differencesdifferences Gets more clear as you progressGets more clear as you progress Forms a Forms a ““quiltquilt””—patchwork —patchwork

Coding problemCoding problem: takes things apart while : takes things apart while wewe’’re trying to put it all togetherre trying to put it all together

““Data SaturationData Saturation””—when do we stop?—when do we stop?

The

mes

New Data

stop data collection

Qualitative Sampling Qualitative Sampling ““EvidenceEvidence””

Guest G et al. Field Methods, Vol. 18, No. 1, February 2006 59–82

Qualitative Research ConsiderationsQualitative Research Considerations

Qualitative Data Analysis software: To use or not to Qualitative Data Analysis software: To use or not to use? Does not give you answers…use? Does not give you answers…

Validity and reliability—need to assess using Validity and reliability—need to assess using different standardsdifferent standards

Context matters—each study unique: not about Context matters—each study unique: not about engineering the perfect data collection instrument engineering the perfect data collection instrument (although we try)(although we try)

Low Division of Labor—all hands on deck; can seem Low Division of Labor—all hands on deck; can seem deceptively easy; takes timedeceptively easy; takes time

Mixed Method ResearchMixed Method Research Increasingly recognized in health, education, Increasingly recognized in health, education,

psychology; different types of researchpsychology; different types of research

INTEGRATES one or more qualitative and quantitative INTEGRATES one or more qualitative and quantitative techniques for data collection and analysistechniques for data collection and analysis

MORE than simply the presence of both techniques: MORE than simply the presence of both techniques: process to integrate, relate and synthesize process to integrate, relate and synthesize

Outcome TRANSCENDS individual Outcome TRANSCENDS individual method and/or disciplinesmethod and/or disciplines

Deep in the Trenches of the Deep in the Trenches of the Paradigm WarsParadigm Wars

DEFINITION: When one type of research DEFINITION: When one type of research (qualitative or quantitative) is not enough to (qualitative or quantitative) is not enough to address the research problem or answer the address the research problem or answer the research questions. research questions.

““Incompatibility ThesisIncompatibility Thesis””“accommodation between paradigms is

impossible . . . we are led to vastly diverse, disparate, and totally antithetical ends” –E. Guba, 1990

Some considerationsSome considerations

TimingTiming Which one is emphasized?Which one is emphasized? How to put data togetherHow to put data together

Example of Mixed Method Example of Mixed Method DesignDesign

QUALITATIVEQUALITATIVE

(preliminary analysis)(preliminary analysis)

QUANTITATIVEQUANTITATIVE

(preliminary analysis)(preliminary analysis)

PUT IT ALL PUT IT ALL TOGETHERTOGETHER

QUALQUAL QUANQUAN

(conduct at same time)(conduct at same time)

PUT IT ALL PUT IT ALL TOGETHERTOGETHER

Why isnWhy isn’’t everyone doing it? t everyone doing it? Practical ChallengesPractical Challenges

Getting fundedGetting funded Planning aheadPlanning ahead ““Multi-lingual teamMulti-lingual team”” ItIt’’s more difficults more difficult PublicationPublication

Window of Opportunity in Health Window of Opportunity in Health ResearchResearch

Science of the Social: Science of the Social: qualitative methods; mixed method qualitative methods; mixed method

research; Complexity science; social research; Complexity science; social network analysisnetwork analysis

Why: advances in basic knowledge Why: advances in basic knowledge have not always led to advances in have not always led to advances in things we care about things we care about

• Social problems, health and well beingSocial problems, health and well being

Ethical Issues in Qualitative Ethical Issues in Qualitative ResearchResearch

Is the recorder always on? Is the recorder always on? Reflection leading to (in)action—unintended Reflection leading to (in)action—unintended

consequencesconsequences Challenges to maintain confidentiality (focus Challenges to maintain confidentiality (focus

groups; reporting misconduct?)groups; reporting misconduct?) Focus on reducing individual harms not Focus on reducing individual harms not

sufficient—other potential harms (entire sufficient—other potential harms (entire community)community)

Questions?

SEE ONE, DO ONE:SEE ONE, DO ONE:THREE TOPICSTHREE TOPICS

First Topic: First Topic:

1. Problem of Substance use1. Problem of Substance use: : New Mexico leads the country in deaths by New Mexico leads the country in deaths by

prescription pain medication overdoseprescription pain medication overdose Health care clinics often donHealth care clinics often don’’t identify people t identify people

who have these problems even though there who have these problems even though there are some effective treatments to help themare some effective treatments to help them

WhatWhat’’s going on? How can we figure out s going on? How can we figure out ways to help people?ways to help people?

Second Topic Second Topic

2. Lung Cancer Screening by CT Scan2. Lung Cancer Screening by CT Scan Lung cancer is still a leading cause of death. Lung cancer is still a leading cause of death.

A new way to screen for lung cancer has just A new way to screen for lung cancer has just been approved. BUT…we donbeen approved. BUT…we don’’t know if t know if health care providers and patients will want to health care providers and patients will want to do this screening.do this screening.

How do we find out?How do we find out?

Third TopicThird Topic

3. Complementary and Alternative Medicine3. Complementary and Alternative MedicineMany people in New Mexico use CAM Many people in New Mexico use CAM approaches to take care of themselves but they approaches to take care of themselves but they dondon’’t often feel comfortable telling their doctors t often feel comfortable telling their doctors about this use. Not doing so can cause about this use. Not doing so can cause problems with other treatments.problems with other treatments.

How do we help figure out ways to have better How do we help figure out ways to have better communication between patients and doctors?communication between patients and doctors?

Your Job:Your Job:

Design a qualitative projectDesign a qualitative project WhatWhat’’s the s the main goalmain goal for the project? for the project? Methods: How will you do the research? Methods: How will you do the research?

• Who will you talk to? Interviews or focus groups?Who will you talk to? Interviews or focus groups?• How many people?How many people?• List 4 questions you would askList 4 questions you would ask

Achieving your goal: is the problem solved? Achieving your goal: is the problem solved? What would you do next?What would you do next?