1. Qualitative Research Process Nursing 302 Spring -2008

2. What is Qualitative Research? A holistic approach to questions--a recognition that human realities are complex. Broad questions. The focus is on human experience The research strategies used generally feature sustained contact with people in settings where those people normally spend their time. Contexts of Human Behavior.

3. What is Qualitative Research? There is typically a high level of researcher involvement with subjects; strategies of participant observation and in-depth, unstructured interviews are often used. The data produced provide a description, usually narrative, of people living through events in situations.

4. What is Qualitative Research? Research that derives data from observation, interviews, or verbal interactions and focuses on the meanings and interpretations of the participants (From Holloway and Wheeler, "Ethical issues in qualitative nursing research," Nursing Ethics, 1995 Sep; 2(3): 223-232). Year introduced: 2003”

5. Learning Objective 1 Differentiate between qualitative and quantitative research

6. Qualitative and Quantitative Approaches Qualitative ( Usually) Non-probability based sample Non-generalizable Answers Why? How? Formative, earlier phases Data are “rich” and time- consuming to analyze Design may emerge as study unfolds Researcher IS the instrument. Used inductive approach Attepmt to obtain rich, deep and valid data Quantitative Typically a probability-based sample Generalizable Answers How many? When? Where? Tests hypotheses, latter phases Data are more efficient, but may miss contextual detail Design decided in advance Various tools, instruments employed. Used deductive approach. Attempt to obtain hard replicable, and reliable data.]

7. Qualitative and Quantitative Approaches Quantitative Objective data Explanation Parts are equal to the whole One truth Large sample Researcher separate from the study Results presented as statistics Qualitative Subjective data Discovery Whole is greater than parts Multiple truths Small sample size Researcher part of the study Results presented as narrative data

8. Learning Objective 2 Recall the types of qualitative research

9. Streubert and Carpenter (2002) Qualitative Approaches Phenomenology Grounded theory Ethnography Historical Action research

10. Burns and Grove (2005) Qualitative Approaches Phenomenology Grounded theory Ethnography

11. Burns and Grove (2005) Qualitative Approaches Historical Philosophical inquiry Critical social theory

12. Polit and Beck (2004) Qualitative Approaches Phenomenology Grounded theory Ethnography Historical analysis

13. Polit and Beck (2004) Qualitative Approaches Ethnoscience Hermeneutics Ethology Ecological psychology

14. Polit and Beck (2004) Qualitative Approaches Ethnomethodology Symbolic interaction Discourse analysis

15. Qualitative Approaches Used by All Phenomenology Grounded theory Ethnography Historical

16. Types of qualitative 1. Phenomenology 2. Grounded theory 3. Ethnography 4. Case Study 5. Historical 6. Action research

17. Cohort, Period, and Aging Effects A Qualitative Study of Older Women ’ s Reasons for Remaining in Abusive Relationships To understand women’s reasons for continuing long-term abusive relationships, inter-views were conducted with 36 women who were over the age of 55. These women matured during times of sweeping social changes with the feminist, battered women’s, and elder abuse movements. Reasons for remaining were organized into three categories: cohort, period, and aging effects. Cohort effects included reasons similar to those of younger women such as lacking education or job skills. Period effects related to efforts to seek help early in the abusive relationship and receiving little assistance from society’s social institutions. Finally, aging effects dealt with how the health challenges of physical age limited options.

18. Interventions for Violence Against Women Scientific Review C. Nadine Wathen, MA; Harriet L. MacMillan, MD, MSc JAMA. 2003;289:589-600 Context Intimate partner violence is prevalent and is associated with significant impairment, yet it remains unclear which interventions, if any, reduce rates of abuse and reabuse. Objective To systematically review, from the perspective of primary health care, the available evidence on interventions aimed at preventing abuse or reabuse of women. Data Sources MEDLINE, PsycINFO, CINAHL, HealthStar, and Sociological Abstracts were searched from the database start dates to March 2001 using database-specific key words such as domestic violence, spouse abuse, partner abuse, shelters, and battered women. References of key articles were hand searched. The search was updated in December 2002. Study Selection Both authors reviewed all titles and abstracts using established inclusion/exclusion criteria. Twenty-two articles met the inclusion criteria for critical appraisal. Data Extraction Following the evidence-based methods of the Canadian Task Force on Preventive Health Care, both authors independently reviewed the 22 included studies using an established hierarchy of study designs and criteria for rating internal validity. Quality ratings of individual studies—good, fair, or poor—were determined based on a set of operational parameters specific to each design category developed with the US Preventive Services Task Force. Data Synthesis Screening instruments exist that can identify women who are experiencing intimate partner violence. No study has examined, in a comparative design, the effectiveness of screening when the end point is improved outcomes for women (as opposed to identification of abuse). No high-quality evidence exists to evaluate the effectiveness of shelter stays to reduce violence. Among women who have spent at least 1 night in a shelter, there is fair evidence that those who received a specific program of advocacy and counseling services reported a decreased rate of reabuse and an improved quality of life. The benefits of several other intervention strategies in treating both women and men are unclear, primarily because of a lack of suitably designed research measuring appropriate outcomes. In most cases, the potential harms of interventions are not assessed within the studies reviewed.

19. Phenomenology Moustakas, 1994, p. 13: “to determine what an experience means for the persons who have had the experience and are able to provide a comprehensive description of it. From the individual descriptions, general or universal meanings are derived, in other words, the essences of structures of the experience.”

20. Phenomenology Describes the meaning of the lived experience about a concept or a phenomenon for several individuals. Examine human experiences through the descriptions that are provided by the people involved. There is no preconceived notions, expectations, or frameworks present to guide the researcher.

21. Phenomenology The researcher must identify what he expects to discover and then deliberately put aside his idea (bracketing). Foundational questions : “What is the meaning, structure, and essence of the lived experience of this phenomenon for this person or group of people” e.g. what is it like for a mother to live with a teenage child who is dying with cancer.

22. Ethnography A description and interpretation of a cultural or social group or system. The researcher examines the group’s observable and learned patterns of behavior, customs, and ways of life. Involves prolonged observation of the group, typically through participant observation. Foundational question “what is the culture of this group of people?”

23. Ethnography Data collection include participant observations, interviews and life histories. Data collection and analysis occur simultaneously The end purpose of ethnography is the development of cultural theories. Researcher interview people who are most knowledgeable about the culture.

24. Grounded Theory The intent of grounded theory is to generate or discover a theory that relates to a particular situation. If little is known about a topic, grounded theory is especially useful. Use both inductive and deductive approach

25. Grounded Theory Foundational question “what theory emerges from systematic comparative analysis and is grounded in fieldwork so as to explain what has been and is observed”

26. Grounded Theory Data collected and analyzed and then a theory is developed that is grounded in the data Purposeful sampling is used …the researcher looks for certain subjects who will be able to shed light on the phenomenon that is being studied. Is more concerned with the theory generation rather than testing of hypotheses.

27. Historical studies Concern the identification, location, evaluation, and synthesis of data from the past. seeks not only the discover of event from the past but to relate these past happening to the present and to the future. The sources are frequently referred as primary and secondary sources.

28. Historical studies Evaluation of Historical research involve External criticism: concerned with the authenticity or genuiness of data …seek to determine if a letter was actually written by the person whose signature was contained on the letter. Internal criticism: examine the accuracy of the data.

29. Case Studies A case study is an exploration of a “bounded system” or a case (or multiple cases) over time through detailed, in-depth data collection involving multiple sources of information rich in context. The context of the case involves situating the case within its setting. which may be physical, social, historical and/or economic.

30. Case Studies e.g. The purpose of this study was to gain an understanding of every day decisions within the context of the previous and present life experiences of cognitively intact residents in assisted living facilities. Research questions …. what is the context that shapes the every day decisions?

31. Learning Objective 3 List the overall steps in qualitative research

32. Overall Steps in the Qualitative Process Identify the phenomenon to study Select the research design Review the literature Select the sample Gain entry to the research site Protect the rights of participants Collect the data Analyze the data Communicate the study results

33. Learning Objective 4 Discuss each step in qualitative research

34. The Steps The first step—Identify the problem General to more focused Broad statements Purpose statement

35. Select the Design Phenomenological approach Grounded theory Action research

36. Review the Literature Debate on when to do May bias the study results Preferred at the end of the study Tells how results fit with the body of knowledge

37. Select the Sample Smaller in size (10–12) No set rules Saturation is more important

38. Gain Entry to Research Site Research in field IRB approval is important Key informants may be used

39. Protecting the Participants Anonymity vs. Confidentiality Demographic information Ethical considerations

40. Learning Objective 5 Identify two of the most common data collection methods used in qualitative research

41. Qualitative Data Collection Rather than developing an instrument to use, the qualitative researcher is the instrument. Recording data: Field notes, tape recorders, video and photographic data Interviews must be transcribed.

42. Qualitative Data Collection 1.Interviews 2.Observations 3.Documents

43. Qualitative Data Collection Semi-structured interviews and participants observations are two of the most common types…..It allows for flexibility open-ended questionnaires, lifer histories, diaries, personal collection of letters and photographs and official documents.

44. Qualitative Data Collection Data collection continues until the data are saturated …data becoming redundant. Generally the number of subjects interviewed in qualitative research is small.

45. The Interview Process used most Semistructured in nature “A shared journey”

46. Participant Observation Direct observation and recording of data Research directly involved with participants

47. Participant Observation Other methods are o Open-ended questionnaires o Life histories o Diaries o Personal collections o Official documents

48. Focus Groups Small groups Moderator Criteria o Purpose o Planned environment o Well-trained personnel

49. Learning Objective 6 Recognize reliability and validity issues in qualitative research

50. Reliability and validity Reliability reflects repeatability of scientific observations and sources that could influence the stability and consistency of those observations. Validity reflects reality and the meaning of the data and if the data is accurately interpreted.

51. Reliability and validity One of the ways that the rigor of a qualitative study is considered is through the long period of time spent collecting data. Both the large amount of data collected and the length of time spent collecting data helps to increase the reliability and the validity of qualitative study.

52. Reliability and validity Need to evaluate validity and reliability in terms of the concepts of trustworthiness and credibility. Credibility = ensuring that the theoretical framework generated is understood and is based on the data from the study Trustworthiness = extent to which one can believe in the research findings

53. Analysis of qualitative When does analysis begin? During data collection. Thick description is the foundation for qualitative analysis and reporting. Organize the data. Read all the data and get a sense of the whole. Coding for recurring themes and categories

54. Learning Objective 7 Discuss the complexity of analyzing qualitative data

55. Data Analysis Begins with data collection Is more complex to analyze Not a distinct but a continual process

56. No Universal Rules Uses words not numbers Massive amount of information May take months to interpret

57. Analysis of qualitative Content analysis involve creating categories, coding data into these categories. Words are the unit of analysis, music, pictures, programs…etc

58. Content Analysis Procedures Categories of data Variations based on research design Coding—the basic analysis tool Themes developed from coded data The “storyteller” concept

59. Software Programs Many are now available Field notes and verbatim audiotapes Technology is changing the “look and feel” of research A help or a hindrance

60. Learning Objective 8 Identify sources for the presentation of qualitative research studies

61. Communication of the Results All research needs to be reported Massive amount of data does present problems The title tells the story

62. Formats for Communication Similar to quantitative reporting Journals Conferences Posters Personal stories Space issues

63. Learning Objective 9 Determine the benefits of combining quantitative and qualitative research methods

64. Mixed Method Studies Some studies use mixed methods to collect and analyze data…both quantitative and qualitative. For example, a person might do a quantitative survey and follow it up with qualitative interviews or focus groups. Again, the question dictates the method.

65. Quantitative and Qualitative Methods Combining the two strengthens studies Ruling out rival explanations for results Valuing both methods by the researcher Mixing the methods may cause concerns

66. Critiquing Qualitative Design Does the phenomenon lend itself to study by qualitative methods or would a quantitative approach have been more appropriate. Does the study focus on the subjective nature of human experiences. Will the study findings have significance to nursing Does the researcher clearly describe how subject were selected.

67. Critiquing Qualitative Design Is the data collection and recording process fully presented. Is it clear how researcher bias in data collection was avoided. Is the data analysis method consistent with the purpose of the study. Have the research questions been answered Are recommendations made for future research.

68. Summary Qualitative research seeks to understand and interpret personal experiences, behaviours, interactions, and social contexts to explain the phenomena of interest. Qualitative represents various research methodologies including ethnography, phenomenology, grounded theory, case studies and historical analysis.