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

???????????

##########

%%%%%%%%%%

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