qualitative research and cehp (turell & howson)
DESCRIPTION
CMEpaloozaTRANSCRIPT
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Qualitative Research and Qualitative Research and CEHPCEHP
CMEpalooza
Presented March 20, 2014View archived presentation on
youtube: http://tinyurl.com/kg9kl9t
Wendy Turell, DrPH, CCMEPDirectorCME Outcomes and AnalyticsPlatformQ [email protected]
Alexandra Howson MA, PhD, CCMEPOwnerThistle Editorial, [email protected]
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AgendaAgenda- The Qualitative Approach- Utilization in CEHP lifecycle- Data Collection- Questions and Interview Behavior- Analysis- Reporting
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The qualitative The qualitative approachapproach
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Qualitative ResearchQualitative Research
“Not everything that can be counted counts, and not everything that counts can be counted.”
- William Bruce Cameron
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Search for objective, universal truths using standardized data gathering techniques
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Naturalistic/interpretative approach
Focus on how people perceive their worlds and interpret experience
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ExplorationExploration• Unearth a complete and detailed description of
the how and why behind physician, allied healthcare provider, and patient behavior.
• Produce deep answers to research questions that give voice and layered explanation to the answers you seek.
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Why Qualitative?Why Qualitative?• Patient care is complex• Semi-structured, open ended approach to inquiry • Less limiting - explores beyond pre-selected
answer choices • Interaction - researchers probe and react to
study subject comments
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Data: What vs WhyData: What vs WhyQuantitative Data:A 37% drop-off was observed in adherence to post surgery medication regimens
Qualitative Data“After their bypass surgery, when they have seen God and all that, they listen, but after they are out of the hospital and they are going through rehab and they are fine, that period of after the bypass, they are invincible.”
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Qualitative Research
Quantitative Research
Type of Questions
Probing “below the surface”; immediate follow up & adjustment
Limited probing; pre-determined questions NOT adjusted
Sample Size SmallAny size including large
Information per respondent
MuchVaries; Limited to answer choices
AdministrationRequires skilled researcher
Fewer specialist skills required
Type of Analysis
Follows structured steps; subjective and interpretative
Statistical; objective
Type of ResearchExploratory, descriptive
Descriptive or Causal
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Applications in CEHPApplications in CEHP
Across research phases
With different research participants
Alone or mixed methods
Needs assessment
Intervention development
Formative evaluation
Outcomes evaluation
Survey development
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Data CollectionData Collection
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Sample MethodologiesSample Methodologies
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Online MethodologiesOnline Methodologies• Research methodologies = evolving with
communication styles• Widely-used, often preferred options for
researchers and respondents• Benefits
o Cost Savings o Ease for wide geographical representationo Ease for scheduling (no need for travel, sessions tailored to their
availability)o Anonymity = less inhibition / more honesty
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Optional Webcam-
enabled images
Text based chat &
audio capable
Online Methodologies
Virtual Interview Room
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Types of QuestionsTypes of Questions
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Question TypesQuestion Types• Open ended, neutral, sensitive, clear to
respondent
Patton, MQ. How to use qualitative methods in evaluation. London: Sage, 1987.
1. Main questions2. Probes3. Follow ups4. Specifying5. Interpreting
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More about QuestionsMore about Questions• Use vocabulary of respondent• Appropriate tone• What open ended q looks like• Language that may invoke defensiveness• Q writing, q order
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Interviewer BehaviorInterviewer Behavior• Active Listening – Be ‘in the moment’• Encourage respondent
o Give appropriate verbal and non-verbal feedback
• Stay neutralo Avoid presenting your perspective (bias interview)o Avoid counseling, teaching
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Coding and AnalysisCoding and Analysis
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CodingCoding• Breaking down data into units which are then
grouped according to characteristics• Proceeds linking diverse observations• Helps with understanding• It’s practical! • Organization = quick access when you need it for analysis/description.
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CodingCoding• 1st phase: review data:
o What’s happening? o What’s important? o What patterns are emerging?
• 2nd stage: repeat, refine, expand/reject categories
• Text can be tagged with >1 code
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Grounded TheoryGrounded Theory• Glaser & Straus (1967) – emphasis on developing
theory/explanation from data versus gathering data to test a theory/hypothesis.
• The theory is grounded in reality as represented in the data
• Benefits:o Theory is derived from what speakers do, vs. what is believed
they should doo Ensures the researchers maintain an open mind towards
inquiry vs. imposing existing beliefs on data
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• Rigor• Validity• Saturatio
n
Methodology
How can Software Assist?
GATHERORGANIZ
EANALYZE VISUALIZ
ERESULTS
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How can Software Assist?
Source: Nvivo (QSR)
Coding Memoing
Visuals Queries
-Review-Merge-Refine
-Models-Matrices-Charts
-Key Ideas-Reflect-Link
-Text Search-Word Frequency-Matrix-Coding Comparison
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ReportingReporting
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ReportingReportingoReports = based on trends and
relationships found within the data
• Includes:oTrend Description oRespondent QuotesoVisualizations (themes, their
relationships, demographic elements)oInterpretation
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Reporting: DescriptiveReporting: DescriptivePatient Concern about high blood pressure:
The overwhelming response to the question "Should a person be concerned about having high blood pressure?" was "yes." Most people believed that being unconcerned could result in serious health problems, specifically heart disease or even death. "A person can die if they have high blood pressure because it can cause a stroke or it can cause heart problems."
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Reporting: TrendsReporting: TrendsPatients’ opinions on how well providers explain a medication varies from “satisfied” to “very well” For some patients, the nurse practitioner provides more detail, as does the pharmacist and the information that accompanies the medication.Between the nurse practitioner and the physician, respondents tend to trust the physician more. In many cases, it appears that patients with a strong, long, and trusting relationship with their providers perceive them as explaining the medication better than those withoutan established relationship or who distrust their providers.
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Reporting: Giving Reporting: Giving VoiceVoice
Provider: “After their bypass surgery, when they have seen God and all that, they listen, but after they are out of the hospital and they are going through rehab and they are fine, that period of after the bypass, they are invincible.”
Patient: “I took [the prescription] to the pharmacy and ……they were only going to give me four pills because it is so expensive, and I am saying to myself, ‘why did they give me this, I am going to die because I will not be able to afford it?’In my head, I said ‘Oh Lord; please make this work without any side effects so I can take it.’”
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Reporting: Quote Reporting: Quote IntegrationIntegration
Having a normal blood pressure level:Living a calm life, feeling relaxed, and avoiding or solving problems were seen as very effective ways to keep blood pressure normal. "Be calm in everything. Do not get angry over something small."
"I try not to have problems with anyone at home, in the street, or anywhere else. If I were to have a problem with anyone here, my blood pressure would go up immediately. A person can burst."
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Visualizing DataVisualizing Data
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Visualizing DataVisualizing DataWord Clouds
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Visualizing DataVisualizing Data
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Questions?Questions?
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Follow-up Questions?Follow-up Questions?Contact UsContact Us
Wendy Turell, DrPH, CCMEPDirectorCME Outcomes and AnalyticsPlatformQ [email protected]
Alexandra Howson MA, PhD, CCMEPOwnerThistle Editorial, [email protected]
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AppendixAppendix
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ResourcesResources
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Software Resources: Software Resources: Coding & OrganizationCoding & Organization• Free (QDA Miner Lite)
o http://provalisresearch.com/products/qualitative-data-analysis-software/freeware/
• Low Cost: dedoose o http://www.dedoose.com/
• Bells and Whistles software: Nvivo or Atlas Tio http://www.qsrinternational.com/products_nvivo.aspxo http://www.atlasti.com/index.html
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Resources Cont.Resources Cont.• Hopkins Open Coursework: http://ocw.jhsph.edu/• Qualitative course materials:
o http://ocw.jhsph.edu/index.cfm/go/viewCourse/course/qualitativedataanalysis/coursePage/index/
• Online Qual. Textbook: http://onlineqda.hud.ac.uk/Introduction/index.php
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Resources Cont.Resources Cont.• Cater JK. SKYPE: a cost-effective method for
qualitative research. Rehab, Counselors + Educators Journal. 20011;4:
• Cohen DJ, Crabtree BF. Evaluative criteria for qualitative research in health care: controversies and recommendations. Ann Fam Med. 2008;6:331-339.
• Curry L, Nembhard IM, Bradley EH. Qualitative and
mixed methods provide unique contributions to outcomes research. Circulation. 2009. 119:1442-1452.