Qualitative Research Qualitative Research MethodsMethods

Dr. S. K. Mishra, Director (Operations) Dr. S. K. Mishra, Director (Operations) Head, Center for Health Services Research, Administration & PolicyHead, Center for Health Services Research, Administration & Policy

Asian Institute of Public Health, Bhubaneswar-751015, INDIA Asian Institute of Public Health, Bhubaneswar-751015, INDIA Tel:+91-674-6574656, Tel/Fax:+91-674-2557656Tel:+91-674-6574656, Tel/Fax:+91-674-2557656

Cell : +91-98310-87621 / 94323-47182/92383-56139 Cell : +91-98310-87621 / 94323-47182/92383-56139 www.aiph.ac.in

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Definitions Health (WHO -1948):

"a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity“

Public Health the science and art of preventing disease,

prolonging life and promoting health through the organised efforts and informed choices of society, organizations, public and private, communities and individuals.“ (J.Last 2000)

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Public Health “Public health is the science and art of preventing

disease, prolonging life and promoting physical health and efficacy through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of social machinery which will ensure every individual in the community a standard of living adequate for the maintenance of health; so organizing these benefits in such a fashion as to enable every citizen to realize his birthright and longevity.” (Winslow, 1920)

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Public Health Research -Public Health Research -Challenges For FutureChallenges For Future

Changing the audiences/targets Changing channels of communication Changing Behavioral Sciences theory &

resources Changing values & mandates Changing institutional / organizational

structures / funds Changing political environment &

resources

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Assessment of Individual/Institutional/ Organizational capabilities & capacities

Competence Commitment Clout Coverage Continuity

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Theories & Models:

I- Step/Stage Theories: Theory-1-Diffusion of Innovations

Theory B.Ryan & N.Gross (1943), 1950) E.M.Rogers (1962),1983) T.W.Valente (1995)

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Theories & Models (contd.) Theory-2-The Input / Output

Persuasion Model/Theory W.J.McGuire (1969) (1989)

Theory-3- Social/ Behavioral Change Theories

J.O.Prochaska & Others- (1992)

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Theories & Models (contd.) II-Cognitive Theories

Theory- 4- Theory of Reasoned Action F.Fishbein & I Ajzen (1975)

Theory- 5 – Social & Cognitive (learning) Theories

A.Bandura –(1977), (1986)

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Theories & Models (contd.) III- Social Process Theories

Theory-6-Social Influence, Social Comparison & Convergence Theories

L.Festinger (1954) D.L.Kincaid (1979),(1987),(1988) B.Latane(1981) S.Moscovici(1976) E.M.Rogers & D.L.Kincaid (1981) J.M.Suls(1977)

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Theories & Models (contd.) IV-Emotional Response Theories

Theory-7- Theory of Emotional Responses

M.S.Clark (1992) R.B.Zajonc (1984) R.B.Zajonc, S.T.Murph, M.Inglehart &

Others (1989)

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Theories & Models (contd.) V-Mass Communication Theories

Theory-8-Mass media Theory George Gerbner (1973), (1977) George Gerbner & Others (1980)

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Behavioral Change / Social Change can occur:

Awareness------Knowledge Acceptance-----Approval Intention--------Attitude Action------------Practice Networking------Advocacy

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Health seeking Behavior Inter-personal Crisis Social Interference Pressure of Sanctioning Perceived Threat Nature & Quality of Symptoms

B.Zola (1964)

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SCIENTIFIC RESEARCH “Research is a systematic

investigation and study of materials and sources in order to establish facts and reach new conclusions.” (WHO)

Steps of Research:1. Concrete Experience2. Reflective Observation3. Abstract Conceptualization4. Active Experimentation

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Scientific Research It may be described as a systematic pursuit

of new knowledge The aim of scientific research is to gain

knowledge, and knowledge is inherently a social commodity to be shared and used

The objective of scientific research is to use observation as a basis for answering questions of interest

It has got two operational levels Level of observation Level of abstraction

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Operational Stages of scientific Study/Research Random Observation Systematic Exploration Testing of well defined isolated hypothesis Experiment directed by systematic theory

Formulation of Hypothesis Observation & Collection of necessary data Analysis of Data Generalisation of collections

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Generalisation Logical Method

Method of Agreement Method of Difference Joint Method Residue Method Concomitant Variation Method

Statistical Method Inductive Deductive

Cause & Effect Relationship

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Scientific Tool “By a scientific tool, we mean a

physical or conceptual instrument that is used in scientific enquiry”

Mathematical symbols and tables of random numbers are, therefore, tools, according to this definition

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Scientific Technique “By a scientific technique, we refer

to a way of accomplishing a scientific objective, a scientific course of action. Techniques, therefore, are ways of using scientific tools.

Stratified random sampling is thus a technique, it employs the random numbers tools.

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Scientific Method By a scientific method, we refer to the way

techniques are selected in science, i.e. to the evaluation of alternative course of scientific action.Methods are rules of choice, techniques are the choices themselves.”

Thus the choice between simple random sampling, stratification and other sampling designs is a matter of scientific method

The chief characteristics include: Objectivity Verifiability Predictability Generality

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Scientific Methodology “The study of scientific methods

frequently referred to as methodology. The objective of methodology is the improvement of procedures and criteria employed in the conduct of scientific research”

An example: Concept- Family financial Resources Variable- Per capita Family income Indicator- Total family income divided by family size Category- Low/ Medium/ High.

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Reliability & Validity The reliability of a particular method refers to its

repeatability, whether it will reliably produce the same answer or measurement when used by a different people at different times or in different situations.

The validity of a method is the extent to which it measures what it purports to measure at any given situation at that point of time.

Qualitative: High Validity + Low Reliability Quantitative: High Reliability + Low Validity

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Statistical Methods Sample Survey Quantitative Data Processing

Collection Organization Presentation Analysis Interpretation

Statistical Fallacies & Limitation

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Epidemiological Methods

Descriptive Epidemiological method Analytic Epidemiological method

Observational Case-control Study Cohort Study

Intervention /Experimental

Association method Artifactual Indirect Causal

Epidemiological Surveillance Active Passive Sentinel

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Behavioural Sciences Methods Questionnaire/ Schedule Interview Observation Projective Methods Socio-metric Methods PLA / PRA /RRA Johari Window Transactional Analysis Focus Group Discussion

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Management Science Methods

Organisational Analysis Environmental Analysis Portfolio Analysis and Display matrices Force Field Analysis Performance Appraisal Management By Objectives (MBO) Decision making Techniques Case Study/ Management Work Study Operations Research (OR)(Strategy of Tactics) Systems Analysis (SA) (Strategy of Choice) Log Frame Analysis

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Economic Methods Strategic decision-making Operational decision-making

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Survey vs. Research1. Specific problems & situations2. Fulfill immediate needs & use

available knowledge at a given time

3. Purpose is to improve the lot of the community- Utilitarian in nature

4. Results in social reforms, administrative changes, remedial measures

5. Forms the basis of hypothesis6. Hypothesis is not required to

get it operational 7. It is for professional reasons to

develop or refine skills- Training.

1. General & abstract problems2. Long-term and broader

perspective in order to develop more accurate procedures and theories

3. Purpose is to increase the general knowledge –Purely scientific in nature

4. Results in formulation of new concepts/theories/ techniques

5. Develops the hypothesis and evolves a theory

6. A hypothesis is a must for it to be testified

7. Personal and discipline specific to gain new knowledge- Teaching.

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Research Design is a plan, which enables Research Design is a plan, which enables one to reason from observed facts and one to reason from observed facts and events to logically sound conclusions.events to logically sound conclusions.

Purpose: To provide a conclusive answer to the

problem posed by the researcher To control the potentially relevant

variables i.e. those which may also influence the research outcome, but ion which the researcher is not interested at the moment

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Research Designs:

I. Simple Designs:1. One-shot single group 2. One group before /after test 3. Two groups simulated before & after test

II. Experimental Designs:1. Before / after random group2. Three groups before / after 3. Four groups before/ after (The Solomon

Design,1949) 4. Post-test only control group

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Research Designs:

III- Mixed Designs1. One-way analysis of variation2. Factorial

IV- Quasi-experimental Designs1. Time-series2. Equivalent time sample3. Non-equivalent control group4. Time-series two-groups

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Behavioral research is inclined to Behavioral research is inclined to apply to those aspects of behavior apply to those aspects of behavior that are directly or objectively that are directly or objectively observable.observable.

Limitations: Dynamic, unstable, intangible Unique but difficult to replicate Researcher-Respondent bias

Context & Content Relationships- Doctor & Patient Healthcare Manager & Health Workers

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QUALITATIVE VS.QUANTITATIVE Confers depth of

understanding Answers the question

‘’ why’’ Identify motivations Subjective report Exploratory /discovery Gains insights,

intuitive Interpretive

Know level of occurrence

How many? How often

Actions Objective Definitive /proof Measures events Descriptive, analytic

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QUALITATIVE VS.QUANTITATIVEStrength: Cost-effective Addresses health belief,

perceptions and behaviour of illness Gives meaning to symptoms and

their treatment Looks at religion, world views as

explanation of misfortunes Aetiological explanation of illness Health needs of the community Relationship between human

behaviour and certain forms of illness / sickness

The context of illness / sickness including economic, social, cultural, power and gender relationships

Organisation of medical institutions Compare different healing systems Doctor-patient relationship

Strength: Objectively verifiable Scientifically respected Can quantify precisely defined

data and analyse them ( Good for immunological, physiological and epidemiological studies)

Universal approach Expensive for large scale

studies

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QUALITATIVE VS.QUANTITATIVEWeakness: Labour intensive Training of researchers Population sample not

random and difficult Small group studies /

difficult for generalisation because lack of replication

Observer error disagreement i.e. low reliability

Unsuitable for large scale studies or for measuring physiological phenomena etc.

Weakness: Exclude levels of

phenomena other than the physical such as context

Can not measure meaning Abstracts from human to

cellular, biological level and low context

Proceeds from the idea to data i.e. deductive

It is itself culture-bound, expresses certain assumptions which are not acknowledged always

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Methods of Qualitative Research1. Observation – Participant & non-participant2. Individual Interviews – Key Informant & In-depth3. Group Interviews4. Focus Group Discussions5. Narratives- Structured & Unstructured6. Case Studies7. Pile-sorting / Q-sort8. Delphi Technique9. Rapid Assessment Procedure (RAP)10. Social/ Behavioral Investigation

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Sampling Techniques for Qualitative Research methods

1. Extreme or Deviant case 2. Maximum variation3. Homogeneous4. Typical case5. Critical case6. Criterion7. Confirmatory or Dis-confirmatory case8. Political case9. Snow-ball or chain10. Convenience11. Opportunity

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Content analysis is defined as any Content analysis is defined as any technique for making inferences by technique for making inferences by systematically and objectively identifying systematically and objectively identifying specified characteristics of messages.specified characteristics of messages.

Categories: Appearance Frequency Ranking Rating

Units: Words Themes Characters Items Numbers

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Factors affecting group dynamics that can affect the quality of qualitative data collection

Demographic characters Value system Social / Economic stratification Inter-personal relationships Power structure Institutional/ Organizational structure Researcher-Respondent biases

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Ethical Principles for Research

The principle of non-malafide intentions

The principle of benefits The principle of autonomy The principle of justice

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Ethical Guidelines of Health Research

1. Essentiality2. Maximization of public interest & of social justice3. Knowledge, ability and commitment to do research4. Respect and protection of autonomy, rights and

dignity of participants5. Privacy, anonymity & confidentiality6. Precaution & Risk minimization7. Non-exploitation8. Public domain9. Accountability & transparency10. Totality of responsibility

Wishing you all the best,

THANQTHANQ42