Use of Qualitative Methods in Health Research

Presenter: Dr Himani ShemarModerator: Dr Abhishek V Raut

Qualitative Research

Qualitative research is a type of scientific research. In general terms, scientific research consists of an investigation that:

• seeks answers to a question • systematically uses a predefined set of procedures to

answer the question • collects evidence • produces findings that were not determined in advance • produces findings that are applicable beyond the

immediate boundaries of the study

Need for Qualitative Research Need to understand about target population

Guide additional data collection

Clarify, explain and elaborate findings from quantitative data

Generation of hypotheses replaces testing of hypotheses

Need explanation instead of measurement

Need understanding instead of generalisability

Qualitative Research Approaches

• Grounded Theory

• Phenomenology

• Ethnography

Grounded Theory• Focus: develop a theory to explain underlying social

processes of a cultural group

• Useful in areas where little is known or when a new perspective is needed– Used for exploratory, descriptive studies

• Because the theory emerges from the data, it is said to be grounded in the data– Foundation in Symbolic Interactionism

Phenomenology• Focus: reveal the meaning of the lived experience

from the perspective of participants

• Describe the essences of lived experience– Essences: elements related to the true meaning of

something that gives common understanding to the phenomenon under study

– Conveyed with descriptive language – Drawn from Philosophy; used across disciplines

Ethnography

• Focus: study human behaviour in the cultural context in which it is embedded

• Ethnography is the work of describing a culture – the way of life of a cultural group– Associated with Cultural Anthropology

Type of Qualitative methods

• Participatory Research (PR) techniques: Social Mapping, Pair wise ranking, Seasonal Calender, Cobweb diagram, trend analysis, Venn diagram, Transect Walk

• In-depth techniques: Focus Group Discussions, key informant interviews, In-depth Interview

• Systematic Techniques: Free listing, Pile sorting

Uses of Qualitative Research

Exploratory studies

Conducted when there are few or no earlier studies to which references can be made for information

Aim is to look for patterns, ideas or hypotheses

Advantage of qualitative methods in Exploratory Research

Use of open ended questions and probing gives participants an opportunity to respond in their own words

Open ended questions have ability to evoke responses that are:

Meaningful and culturally salient to participant Unanticipated by researcher Rich and explanatory in nature

Example:

If we are trying to get more men to undergo vasectomy we might start by having participants identify all of the percieved barriers and facilitators to having the procedure.

Sexual Behaviour and Condom Use among seasonal Dalit Migrant Laborers to India from Far west, Nepal: A

Qualitative Study

Objective: to assess sexual behaviours, lifestyle choices, and perceptions of HIV/AIDS among Dalits who migrate

to india from Far-West Region, Nepal

Study was a two stage process1st FGDs of Dalit male Migrant labourers

2nd : In-depth Interviews based on discussions of FGDs

Questionnaire construction and adaptation

Qualitative methods can be used to determine respondents’ idea regarding content of questionnaire, language used, question and response format.

Example: Food Frequency Questionnaire

• Help decide what the main nutritional/dietary issues are in a particular setting;

• Select appropriate tools for estimation of portion size.

• Help decide who will be the best proxy reporters for the diets of individuals who cannot provide their own report (e.g., small children);

• Select foods for inclusion on food frequencies and infant diet histories;

• Select appropriate wording (labels) for foods on a food frequency;

• Decide on appropriate probing questions for 24-hour recalls;

• Design additional survey questions which assess impact of a nutrition intervention programme on cognitive and behavioural factors;

• Develop questions for structured surveys;

• Aid in the interpretation of quantitative findings.

Enhance findings of quantitative Research

• It serve a source of hypotheses for quantitative study

• Identify appropriate variables to be measured.

• Help to improve the accuracy & relevance of quantitative studies by increasing our understanding of creation of quantitative data

• Providing explanations for unexpected or unexplained findings in quantitative studies

Systematic Review

Define and Refine question

Enhancing Review

Extending Review

Supplementing Review

Program DevelopmentPhase

Pre Project

Identify local perceptions of health and development prioritiesIdentifying local perceptions of health

Identifying relevant interventions and target populations

Project design

Developing appropriate IEC activities and materials

Designing more valid survey instruments by identifying topics for which survey research is most appropriate and identifying relevant questions and their approprite wording

Implementation

Investigating the feasibility, acceptibility & appropriatness of new health programComplementing quantitaive data collected in routine monitoring studies

Phase Task Example

Pre project phase

Assess problems of most concern to target population within a specific sector or issue; ranking of issue within that sector; relationship to general problems of concern to community

Free listing interviews of ‘most serious illness’ affecting children with 10 individuals in each of three areas of the project identified measles, pertussis, and diarrhea with vomiting as most serious. Dysentry, malaria and pneumonia were not considered among most serious illness by many people.

Phase Task ExampleProject design phase

Assess beliefs and attitudes and values underlying community behaviours that a project has selected for change

Key informant interviews and focus groups with caretakers identified that caretakers do not seek medical treatment for children with dysentery because they do not consider dysentery very seriously and because the local health centre usually does not have drugs

Phase Task Example

Monitoring and evaluation phase

Monitor stakeholder reactions to project activities, levels of participation in program

Group discussions with mother discover that some mothers are reluctant to use project services because the mothers feel they are treated rudely by project workers and ‘looked down upon’

Program Evaluation

When do we employ Qualitative methods?When we have established effectiveness, but we are

interested in replication, we ask “how” a program is implemented

When we are interested in conducting process evaluation and want to know the reasons a program is not yielding the expected results.

Use of Qualitative methods in Evaluation

Identify implementation and intermediate outcomes

Verify and complement quantitative measures

Eliminate threats to internal validity

Identify unintended outcomes

Develop better quantitative measures

Stages of evaluation

• Determining the focus of evaluation

• Evaluating the implementation or process of a program

• Determining improvements and changes to a program

Key questions in conducting Qualitative Evaluation Assessment

• Who are the clients for evaluation?

• What are the questions & issues driving the evaluation?

• What resources are available to do evaluation?

• What has been done previously?

• What is the program al about?

Key questions cont…

• What kind of environment does program operate in and how does that affect the comparisons available to an evaluator?

• Which research design alternatives are desirable and appropriate?

• What information sources are available, program structure and environment in which program operates?

• Should program evaluation be undertaken

Which approach to use in qualitative methods

• Qualitative methods used alone

• Qualitative methods used after Quantitative approach

• Qualitative methods used before Quantitative methods

Process Evaluation

Example: media campaign designed to increase voluntary use of helmets

Have the campaign products (posters, billboard, radio and television spots) been pre-tested?

How often were the campaign advertisements run?

How many people saw them?

Was the target group being reached?

Process Evaluation cont…

Are high-quality helmets available and affordable in local shops?

If the intervention involves enforcement of helmet legislation:

Is there noticeable enforcement by police?Are the police supportive of the campaign? Is the penalty sufficient to change behaviour?

Verbal Autopsy

Example: Identifying factors associated with Maternal deaths in

Jharkhand, India: A Verbal Autopsy Study.

Limitations of Qualitative study• Proper analysis of text is time consuming

• Ability to claim a representative sample is often diminished

• Inability to measure variation of responses in any meaningful way

• Not an ideal choice for reliably comparing groups

References1. Family Heath International. Mack N, Woodsong C, Macqueen KM, Guest

G, Namey E. Qualitative Research methods: A data collector’s Field Guide. USAID. 2005

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3. Heary CM, Hennessy E. The Use of Focus Group Interviews in Pediatric Health Care Research. Journal of Pediatric Psychology. 2002;27(1):47-57.

4. Qualitative Research. http://www.sagepub.in/upm-data/48453_ch_1.pdf accessed on 14/12/2013.

5. Garbarino S, Holland J. Quantitative and Qualitative Methods in Impact Evaluation and measuring results. Governance and Social Development Resource Centre. 2009.

References6. Noyes J, Popay J, Pearson A, Hames K, Booth A. Qualitative Research

and Cochrane reviews. Cochrane Book Series. 2008.

7. Bam K, Thapa R, Newman MS, Bhatt LP, Bhatta SK. Sexual Behaviour and Condom Use among seasonal dalit migrant laborers to India from far West: Nepal: A Qualitative Study. PLOS ONE. September 2013;8(9):1-10.

8. Khan N. Pradhan MR. Identifying factors associated with maternal deaths in Jharkhand, India: A Verbal Autopsy Study. J Health Popul Nutr. June 2013;31 (2):262-71.

9. Black N. Why we need qualitative research. Journal of Epidemiology and Community Health. 1994;48:425-26.

10. Heary CM. The use of Focus group Interviews in Pediatric Health Care Research. Journal of Pediatric Psychology.2002;27(1):47-57.

References

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12.Hudelson PM. Qualitative Research for Health Programmes. World Health Organization.1994.

13.Murphy E, Dingwall R, Greatbatch D, Parker S, Watson P. Qualitative research methods in health technology assessment: a review of the literature. Health Technol Assessment.1998;2(16).

14.USAID. CORE. Training in Qualitative Research Methods: Building Capacity of PVO, NGO, and MOH partners.