Qualitative Research and CEHP (Turell & Howson)

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 Healthwturell@platformq.com

Alexandra Howson MA, PhD, CCMEPOwnerThistle Editorial, LLCalexhowson@thistleeditorial.com

AgendaAgenda- The Qualitative Approach- Utilization in CEHP lifecycle- Data Collection- Questions and Interview Behavior- Analysis- Reporting

The qualitative The qualitative approachapproach

Qualitative ResearchQualitative Research

“Not everything that can be counted counts, and not everything that counts can be counted.”

- William Bruce Cameron

Search for objective, universal truths using standardized data gathering techniques

Naturalistic/interpretative approach

Focus on how people perceive their worlds and interpret experience

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.

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

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.”

 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

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

Data CollectionData Collection

Sample MethodologiesSample Methodologies

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

Optional Webcam-

enabled images

Text based chat &

audio capable

Online Methodologies

Virtual Interview Room

Types of QuestionsTypes of Questions

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

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

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

Coding and AnalysisCoding and Analysis

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.

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

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

• Rigor• Validity• Saturatio

n

Methodology

How can Software Assist?

GATHERORGANIZ

EANALYZE VISUALIZ

ERESULTS

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

ReportingReporting

ReportingReportingoReports = based on trends and

relationships found within the data

• Includes:oTrend Description oRespondent QuotesoVisualizations (themes, their

relationships, demographic elements)oInterpretation

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."

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.

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.’”

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."

Visualizing DataVisualizing Data

Visualizing DataVisualizing DataWord Clouds

Visualizing DataVisualizing Data

Questions?Questions?

Follow-up Questions?Follow-up Questions?Contact UsContact Us

Wendy Turell, DrPH, CCMEPDirectorCME Outcomes and AnalyticsPlatformQ Healthwturell@platformq.com

Alexandra Howson MA, PhD, CCMEPOwnerThistle Editorial, LLCalexhowson@thistleeditorial.com

AppendixAppendix

ResourcesResources

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

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

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.