Issues and Challenges around Appraising Qualitative Research ESQUIRE Sheffield 4 September 2014 11:50-12:30 Ruth Garside Senior Lecturer in Evidence Synthesis

Talk structure Quality appraisal: Should we do it? How can we do it? What are the challenges? Next steps?

Should we? Do we need to distinguish between high quality research and poor? Standards for systematic reviews generally. Precedent?

Review of published reviews of qualitative research Of 42 studies: 21 did not describe appraisal of studies 6 explicitely mentioned not conducting formal appraisal of studies 5 papers did a critical appraisal, but did not use a formal checklist 7 described modifying existing instruments 1 used an existing instrument without modification Dixon-Woods M, et al. Synthesizing qualitative research: a review of published reports. Qual Res 2007; 7:375

How? Break out groups What makes qualitative research “good quality”?

Not a new issues for qualitative researchers!

Suggested Validity Criteria Altheide & Johnson 1994 Author Suggested Validity Criteria Altheide & Johnson 1994 Plausibility, relevance, credibility, importance of topic. Eisenhart & Howe 1992 Completeness, appropriateness, comprehensiveness, credibility, significance. Leininger 1994 Credibility, confirmability, meaning in context, recurrent patterning, saturation, transferability. Lincoln 1995 Positionality, community as arbiter, voice, critical subjectivity, reciprocity, sacredness, sharing perquisites of privilege. Lincoln & Guba 1985; ‘89 Truth value, applicability, consistency, neutrality. Marshall 1990 Goodness, canons of evidence. Maxwell 1992; ‘96 Descriptive validity, interpretive validity, theoretical validity, evaluative validity, generalizability. Sandelowski 1986, ‘93 Credibility, fittingness, auditability, confirmability, creativity, artfulness. Smith 1990 Moral and ethical component. Thorne 1997 Methodological integrity, representative credibility, analytic logic, interpretive authority. Whittemore et al Validity in Qualitative Research. Qual Health Res. 2001; 11(4): 522-537

Example checklists

CASP Qualitative research checklist   Question Hint: Consider Y/N/CT 1 Was there a clear statement of the aims of the research? • What was the goal of the research? • Why it was thought important? • Its relevance. 2 Is a qualitative methodology appropriate? If the research seeks to interpret or illuminate the actions and/or subjective experiences of research participants. • Is qualitative research the right methodology for addressing the research goal? Is it worth continuing? Critical Appraisal Skills Programme http://media.wix.com/ugd/dded87_951541699e9edc71ce66c9bac4734c69.pdf

Question Hint: consider 3 Y/N/CT 3 Was the research design appropriate to address the aims of the research? If the researcher has justified the research design (e.g. have they discussed how they decided which method to use)? 4 Was the recruitment strategy appropriate to aims of the research? • If the researcher has explained how the participants were selected. • If they explained why the participants they selected were the most appropriate to provide access to the type of knowledge sought by the study. • If there are any discussions around recruitment (e.g. why some people chose not to take part). 5 Was the data collected in a way that addressed the research issue? • If the setting for data collection was justified. • If it is clear how data were collected (e.g. focus group, semi-structured interview etc.) • If the researcher has justified the methods chosen. • If the researcher has made the methods explicit (e.g. for interview method, is there an indication of how interviews were conducted, or did they use a topic guide)? • If methods were modified during the study. If so, has the researcher explained how and why? • If the form of data is clear (e.g. tape recordings, video material, notes etc). • If the researcher has discussed saturation of data. 6 Has the relationship between researcher and participants been adequately considered? • If the researcher critically examined their own role, potential bias and influence during. (a) Formulation of the research questions. (b) Data collection, including sample recruitment and choice of location. • How the researcher responded to events during the study and whether they considered the implications of any changes in the research design.

Question Hint: consider 7 Y/N/CT 7 Have ethical issues been taken into consideration? • If there are sufficient details of how the research was explained to participants for the reader to assess whether ethical standards were maintained. • If the researcher has discussed issues raised by the study (e.g. issues around informed consent or confidentiality or how they have handled the effects of the study on the participants during and after the study). • If approval has been sought from the ethics committee. 8 Was the data analysis sufficiently rigorous? • If there is an in-depth description of the analysis process. • If thematic analysis is used. If so, is it clear how the categories/themes were derived from the data? • Whether the researcher explains how the data presented were selected from the original sample to demonstrate the analysis process. • If sufficient data are presented to support the findings. • To what extent contradictory data are taken into account. • Whether the researcher critically examined their own role, potential bias and influence during analysis and selection of data for presentation. 9 Is there a clear statement of findings? • If the findings are explicit. • If there is adequate discussion of the evidence both for and against the researchers arguments. • If the researcher has discussed the credibility of their findings (e.g. triangulation, respondent validation, more than one analyst). • If the findings are discussed in relation to the original research question. 10 How valuable is the research? • If the researcher discusses the contribution the study makes to existing knowledge or understanding e.g. do they consider the findings in relation to current practice or policy? or relevant research-based literature? • If they identify new areas where research is necessary. • If the researchers have discussed whether or how the findings can be transferred to other populations or considered other ways the research may be used.

In small groups discuss: Are there any challenges to using these criteria? Do they assess “quality” Why? / Why not?

Example checklists Wallace A, et al . Meeting the challenge: developing systematic reviewing in social policy. Policy and Politics 2004; 32(4):455-470.

Challenges 1). Research community agreement Standards for qualitative research have variously emphasized literary and scientific criteria, methodological rigor and conformity, the real-world significance of the questions asked, the practical value of the findings, and the extent of involvement with, and personal benefit to, research participants. Sandelowski, M., and J. Barroso. 2007. Handbook for synthesizing Qualitative Research. New York: Springer Few items have been universally accepted as important across methods and disciplines Mose has suggested doifferent criteria for ecah of these doiferences.

Challenges 2). Lack of fit between systematic review and qualitative researcher priorities Epistemological. History! Marginalised. Technical vs creative and theoretical Practical vs theory driven Judging versus collaborative/ supportive

Challenges 3). What are we actually appraising? Lack of distinction between reporting standards and conduct. Applying one standard to a discipline with different standards. Different purposes – theory generation vs pragmatic questions Many checklists give multiple sample “guidance” for each question but dichotomous scores One persons IPA another’s thematic. Traditions of reporting between disciplines

Challenges 4). Interpretation required Comparing 3 checklists: Agreement in categorizing papers was slight….Structured approaches did not appear to yield higher agreement than unprompted judgement. Dixon-woods et al. 2007. J Health Serv Res. 12(1): 42-47 Took up to 100 mins to apply

Challenges 5). What do we do with “poor quality” studies? Variously: Exclude “Weight” Test through contribution to the synthesis

A proposal: Technical aspects Trustworthiness Theoretical considerations Practical considerations Garside. Should we appraise the quality of qualitative research reports for systematic reviews and if so, how?. Innovation: the European Journal of Social Science Research. 2014; 27(1): 67-79

1. Technical aspects: 1. Is the research question(s) clear? Y/P/N Comments 1. Is the research question(s) clear? 2. Is the research question(s) suited to qual. enquiry? Are the following clearly described? 3. Context 4. Sampling 5. Data collection 6. Analysis Adapted from: Dixon-Woods et al. The problem of appraising qualitative research. Qual Saf Health Care 2004; 13:233-225 & Popay J, Using Qualitative Research to Inform Policy and Practice. ONS, Cardiff: April 2008.

2. Trustworthiness For example: Are the design and execution appropriate to the research question? What evidence of reflexivity is there? Do the voices of the participants come through? Are alternative interpretations, theories etc explored? How well supported by the data are any conclusions? Are ethical considerations given appropriate thought? etc.

3. Theoretical considerations For example: Does the report connect to a wider body of knowledge or existing theoretical framework; and, if so Is this appropriate (e.g. not uncritical verification); Does the paper develop explanatory concepts for the findings etc.

4. Practical considerations Not “is this research valid?” but rather “what is this research valid for?” For example Does this study usefully contribute to the policy question? Does this study provide evidence relevant to the policy setting? Does this study usefully contribute to the review? Adapted from: Aguinaldo JP. Rethinking Validity in Qualitative Research from a Social Constructionist Perspective: From "Is this valid research?" to "What is this research valid for?". The Qualitative Report 2004; 9(1):127-136.

Thank you! R.Garside@ex.ac.uk www.ecehh.org