Donor deferral: a qualitative approach. Arjuna Ponnampalam Transfusion Medicine Fellow December 20 th, 2011

Objectives Introduction to Qualitative research methodology Understanding the meaning of permanent deferral for blood donors – Whittaker et al. Critical appraisal of literature

Quantitative Which? How much? Quantitative Which? How much? Qualitative What? Why? How? Qualitative What? Why? How?

“How many parents would consult their GP when their child has a mild temperature?” “Why do parents worry so much about their children’s temperature?” “What proportion of smokers have tried to give up?” “What stops people giving up smoking?”

Qualitative – Multiple versions of reality – Exploratory, explanatory – Inductive – Naturalistic – Subjective – Holistic Quantitative – One reality that can be measured – Confirmatory – Deductive – Experimental – Objective – Particularistic

Fundamental principles: Perspective of participants Interpretive and inductive Naturalistic setting

methodology Phenomenology Grounded theory Case study Ethnography

methods Interviews and focus groups Document review Participant observation

sample Data collection Analysis Saturation: a) Data b) Theoretical Saturation: a) Data b) Theoretical

Critical appraisal: Is a structured check list universally applicable? Encourage mechanistic and protocol-driven approach. – How to read a paper, 4 th edition, Trisha Greenhalgh – JAMA – Users’ guide to the medical literature, Giacomini – Qualitative research in transfusion medicine, Arnold

Critical appraisal: Hallmarks of a rigorous qualitative study: – Appropriate research design – Systematic data collection – Thorough and thoughtful analysis – Good knowledge translation

Critical appraisal: Did the paper describe an important clinical problem addressed via a clearly formulated question?

what is the question? What is the experience of blood donors who receive postdonation notification of permanent deferral? What are the important issues to consider when developing an effective process for notifying donors? What is the best practice for notifying donors of permanent deferral?

Critical appraisal: Was a qualitative approach appropriate?

methodology Grounded theory

Critical appraisal: How were the setting and the subjects selected? Were participants relevant to the research question and was their selection well reasoned?

Critical appraisal: What methods did the researcher use for collecting data – and are these described in enough detail? Was there an adequate paper trail? Was the data collection comprehensive enough to support rich and robust descriptions of the observed events?

Data collection Constant comparison method Telephone interviews Semi structured interview guide Open ended questions (30-45 mins) Audiotaped and fully transcribed Imported into quality data management software program

Critical appraisal: What was the researcher’s perspective and has this been taken into account? Was a multidisciplinary approach undertaken?

Critical appraisal: What methods did the researcher use to analyze the data – and what quality control measures were implemented? Did they employ triangulation? Was there validation by participants?

Data analysis Team analysis approach Inductive and iterative process feedback Open -> Axial -> Selective coding Key findings validated via triangulation method – Multidisciplinary team consensus – Audit trial, multiple data sources – Member checking – Comparison of study findings with published lit.

Critical appraisal: Are the results credible, and if so, are they clinically important? Were deviant occurrences described and discussed?

Results 28 agreed to participate 2.5 mos. between notification and interview No difference between first time and repeat donors Data analyzed in two groups: – A) positive, B) negative/indeterminate Motivation for donation – Altruism – Awareness of need for blood

Critical appraisal: What conclusions were drawn, and are they justified by the results?

Author conclusions: Holistic understanding Majority of donors are extremely distressed Confusion 35% contact CBS, 75% contact family physician Family physician education CBS acknowledgement Retesting/re-entry process Majority not reconciled at 3 months

Critical appraisal: Are the findings of the study transferable to other settings?

my critique: Clearly defined rationale Thoughtfully framed questions Appropriate methodology and methods to answer posed questions Developed a sensible theoretical model Exhaustive inquiry which translates into transferable themes to other populations

Questions?