Qualitative and Quantitative

Primary Care Research: An Primary Care Research: An Introduction (To Some Really Introduction (To Some Really

Important Concepts)Important Concepts)

John B. Schorling, M.D., M.P.H.John B. Schorling, M.D., M.P.H.Professor of Medicine and Public Heath SciencesProfessor of Medicine and Public Heath Sciences

James R. Martindale, Ph.D.James R. Martindale, Ph.D.Assistant Professor of Research and Public Assistant Professor of Research and Public Health SciencesHealth Sciences

Objectives:Objectives:

Be able to better formulate a research Be able to better formulate a research questionquestion

Feel more comfortable with the clinical Feel more comfortable with the clinical research process research process

Understand the ideas of constructs and Understand the ideas of constructs and operationalizationoperationalization

Understand the major differences between Understand the major differences between quantitative and qualitative approaches to quantitative and qualitative approaches to doing educational researchdoing educational research

““If we knew what we were If we knew what we were doing, it wouldn’t be called doing, it wouldn’t be called research, would it?”research, would it?”

Albert EinsteinAlbert Einstein

Developing Your QuestionDeveloping Your Question

Start with a clear purposeStart with a clear purpose Know your literatureKnow your literature Be iterative in your approachBe iterative in your approach Try to specify the who, what, where and when Try to specify the who, what, where and when

of your purposeof your purpose Ask yourself “What would the answer to this Ask yourself “What would the answer to this

question add to the literature?” and…question add to the literature?” and…

Developing Your QuestionDeveloping Your Question

Don’t let methodology drive the question!Don’t let methodology drive the question!

The Research ProcessThe Research Process

1.1. Identification of general problem/questionIdentification of general problem/question

2.2. Literature reviewLiterature review

3.3. Specify questions/hypothesesSpecify questions/hypotheses

4.4. Determination of design/methodologyDetermination of design/methodology

5.5. Data collectionData collection

6.6. Data analysis/presentationData analysis/presentation

7.7. Interpretation of findingsInterpretation of findings

The Right and the LeftThe Right and the Left

Quantitative research - numbers, Quantitative research - numbers, numbers, numbersnumbers, numbers

Qualitative research - words, words, Qualitative research - words, words, wordswords

Quantitative vs. Qualitative: Quantitative vs. Qualitative: Assumptions about the WorldAssumptions about the World

Based upon the idea Based upon the idea of “logical of “logical positivism”, that is, positivism”, that is, there is a singular there is a singular reality with stable, reality with stable, social facts that are social facts that are separate from the separate from the feelings and beliefs feelings and beliefs of individuals.of individuals.

Based on the notion Based on the notion of “constructivism”, of “constructivism”, which assumes which assumes multiple realities that multiple realities that are socially are socially constructed through constructed through individual and individual and collective collective perceptions or views perceptions or views of the same of the same situation.situation.

Quantitative vs. Qualitative: Quantitative vs. Qualitative: Research PurposeResearch Purpose

Seeks to establish Seeks to establish relationships and relationships and explain causes of explain causes of changes in changes in measured variables. measured variables. That is, the goal of That is, the goal of science is to explain science is to explain and predict.and predict.

Concern is with the Concern is with the understanding of the understanding of the social phenomenon social phenomenon from the from the participants’ participants’ perspectives. This perspectives. This requires, to some requires, to some degree, researcher degree, researcher participation.participation.

Quantitative vs. Qualitative: Quantitative vs. Qualitative: Methods and ProcessMethods and Process

The scientific The scientific method, also known method, also known as a priori or pre-as a priori or pre-established design.established design.

Use of emergent Use of emergent design utilizing design utilizing constant constant comparison and comparison and revision.revision.

Quantitative vs. Qualitative: Quantitative vs. Qualitative: Prototypical StudiesPrototypical Studies

Experimental or Experimental or correlational designs correlational designs are used to reduce are used to reduce error, bias and the error, bias and the influence of influence of extraneous extraneous variables--control of variables--control of bias is through bias is through design.design.

Use of ethnography, Use of ethnography, which helps readers which helps readers understand the understand the multiple perspectives multiple perspectives of the situation by of the situation by the persons studied. the persons studied. Subjectivity in data Subjectivity in data analysis and analysis and interpretation is interpretation is acknowledged.acknowledged.

Quantitative vs. Qualitative: Quantitative vs. Qualitative: Researcher RoleResearcher Role

Detachment from Detachment from study in order to study in order to avoid bias.avoid bias.

Immersion inImmersion in situation and the situation and the phenomenon being phenomenon being studied.studied.

Quantitative vs. Qualitative: Quantitative vs. Qualitative: ContextContext

Context-free Context-free generalizationsgeneralizations

Generalizations are Generalizations are contextually-bound.contextually-bound.

Quantitative vs. Qualitative: Quantitative vs. Qualitative: PrecisionPrecision

Obtained through Obtained through the use of the use of measurement and measurement and statisticsstatistics

Provided by detailed Provided by detailed description of description of phenomenonphenomenon

Quantitative vs. Qualitative: Quantitative vs. Qualitative: VerificationVerification

Results replicated Results replicated by others.by others.

Extension of Extension of understandings by understandings by others.others.

Quantitative vs. Qualitative: Quantitative vs. Qualitative: ExplanationExplanation

Traditionally, Traditionally, parsimonious parsimonious explanations were explanations were sought, but this may sought, but this may be changing due to be changing due to technology.technology.

Summary through Summary through narrative--narrative--importance is placed importance is placed on reducing on reducing complex realities to complex realities to simple explanations.simple explanations.

Quantitative vs. Qualitative: Quantitative vs. Qualitative: Logical ReasoningLogical Reasoning

DEDUCTIVE--DEDUCTIVE--What’s the classic What’s the classic example?example?

INDUCTIVE--INDUCTIVE--anyone have an anyone have an example?example?

Quantitative vs. Qualitative: Quantitative vs. Qualitative: Conditional ConclusionsConditional Conclusions

Statements of Statements of statistical statistical probability.probability.

Tentative summary Tentative summary interpretations.interpretations.

Types of Quantitative StudiesTypes of Quantitative Studies

DescriptiveDescriptive True experimentalTrue experimental Quasi-experimentalQuasi-experimental CorrelationalCorrelational PredictivePredictive

Research Using Primary DataResearch Using Primary Data

Cross-sectionalCross-sectional

Case ControlCase Control

CohortCohort

Randomized controlled trialRandomized controlled trial

Cross-sectional StudyCross-sectional Study

Data gathered at one point in timeData gathered at one point in time

Often used for surveysOften used for surveys

Can not make inferences about Can not make inferences about causalitycausality

Robert Johnston’s Project

Interested in PTSD Reviewed literature on PTSD in primary care

settings for his POM1 presentation Decided to do a survey to determine prevalence

and associated conditions Reviewed existing instruments Survey includes 2 PTSD questionnaires,

AUDIT, SF-12 and PHQ-9 Obtained IRB approval June, 2010 Goal is to survey 100 patients at UMA

Case Control StudyCase Control Study

Start with the outcome- identify a Start with the outcome- identify a sample with the condition of interestsample with the condition of interest

Identify a similar control groupIdentify a similar control group Look back to determine exposureLook back to determine exposure Calculate the risk in the cases and Calculate the risk in the cases and

controls- odds ratio used controls- odds ratio used Can not use to establish prevalenceCan not use to establish prevalence

Cohort StudyCohort Study

Start with an identified groupStart with an identified group Determine exposure in everyone at the Determine exposure in everyone at the

same timesame time Follow the group to determine who Follow the group to determine who

develops the outcome of interestdevelops the outcome of interest Can be used to determine prevalenceCan be used to determine prevalence Association measured as relative risk Association measured as relative risk

(rate ratios)(rate ratios)

Randomized Controlled TrialRandomized Controlled Trial

Gold standard for determining Gold standard for determining associationsassociations

Identify a groupIdentify a group Randomly assign individuals to Randomly assign individuals to

exposureexposure Only reliable way to control for Only reliable way to control for

confoundingconfounding

Research Using Secondary DataResearch Using Secondary Data

Literature reviewLiterature review

Systematic reviewSystematic review

MetanalysisMetanalysis

Analysis of existing data collected for Analysis of existing data collected for another purposeanother purpose

Literature ReviewLiterature Review

Gather articles on a topic of interestGather articles on a topic of interest

Summarize the findingsSummarize the findings

Systematic ReviewSystematic Review

Gather articles using a pre-defined Gather articles using a pre-defined search strategy- may include search strategy- may include unpublished studiesunpublished studies

Develop a-priori objective criteria to Develop a-priori objective criteria to evaluate the quality of the studiesevaluate the quality of the studies

Summarize the quality of the data and Summarize the quality of the data and the resultsthe results

MetanalysisMetanalysis

Do a systematic reviewDo a systematic review

Obtain the primary data if possibleObtain the primary data if possible

Summarize the data quantitativelySummarize the data quantitatively

Analysis of Existing DataAnalysis of Existing Data

Use administrative data for researchUse administrative data for research Insurance claims data- MedicareInsurance claims data- Medicare Central Data Repository (CDR) at UVaCentral Data Repository (CDR) at UVa

Use regularly collected survey dataUse regularly collected survey data National Center for Health Statistics National Center for Health Statistics

performs multiple surveys periodically- performs multiple surveys periodically- NAMCS, NHIS, NMCES, NHANESNAMCS, NHIS, NMCES, NHANES

Use data collected for another studyUse data collected for another study

Timeline for GSP Research ProjectTimeline for GSP Research Project

Fall 2010- develop a research ideaFall 2010- develop a research idea Spring 2011Spring 2011

Work with mentor on developing your ideaWork with mentor on developing your idea Put together a protocol for IRB approvalPut together a protocol for IRB approval

Summer 2011- MSSRP, collect dataSummer 2011- MSSRP, collect data Fall 2011- medical student research dayFall 2011- medical student research day Fall 2013- research elective to finish Fall 2013- research elective to finish

project project Spring 2013- GSP thesis + presentationSpring 2013- GSP thesis + presentation

THANK YOU!THANK YOU!

Contact: jrm7e@virginia.eduContact: jrm7e@virginia.edu