1. Qualitative Methods in Evaluation and Policy Analyis Aleksandar Štulhofer PhD University of Zagreb Workshop on Implementation Science in HIV Programming Cavtat, Croatia, 17-21June 2013

2. Qualitative Research Methodology What is qualitative research? Why do we use it? Is it rigorous? Can it be rigorous? The role of qual research in public health policy making and HIV programming

3. The Roots A history of anti-positivism (since the early 1900s) Ethnographical tradition (cultural anthropology) Verstehende Soziology (M. Weber) Phenomenological philosophy & symbolic interactionism Poststructuralism & Postmodernism

4. Why do we use it? To describe a social phenomenon in detail by providing insight into the meanings actors attach to it (“thick description”, C. Geertz) To understand a social phenomenon – explain ideas and behaviors in their embeddedness in a specific sociocultural context To make sense of qualitative data...

5. What about Methodological Rigor? Qual research is often criticized as “story telling” The importance of methodological rigor is still sometimes ignored or rejected as a “relict of positivism” Trustworthiness vs. validity  Triangulation  Member verification/validation  Negative cases  Transparency of the researcher’s position Elements of methodological rigor: quality sampling; validity-enhancing data collection strategy; systematic, transparent, and comparable coding (reliability); high ethical standards in the field...

6. The Art of Qualitative Data Collection Observation and participant observation (ethnographic approach) Text analysis Interview  In-depth  Semi-structured Focus groups Researcher as an instrument (the role of experience and sensitivity)

7. Theoretical Perspectives and Methodological Approaches A wide range of perspectives and approaches:  Grounded theory (inductive theory- generating approach; Glaser and Strauss)  Discourse analysis (sociolinguistics as the starting point in analyzing text or conversation)  Thematic analysis (a user-friendly coding strategy; Braun & Clarke, 2006) ...

8. Analytical Strategy & Coding Coding = stepwise data reduction strategy; tagging meaningful pieces of data An example of thematic analysis: Theme = a patterned response or specific meaning related to the research questions found in the data  Step 1: Transcribing the material  Step 2: Getting familiar with the data  Step 3: Open coding for themes  Step 4: Reviewing, revising, and comparing codes  Step 5: Axial coding for organizational themes  Step 6: Reviewing, revising, and comparing codes  Step 7: Generating the main theme

9. An Example The topic: Religious leaders who oppose public promotion of condoms in HIV campaigns  Sampling  Data collection  Data coding and analysis  Writing a report

10. Sampling and Sample Size Is representativeness a relevant issue? Sample diversity Purposeful sampling (information-rich cases)  Extreme cases  Typical cases  Maximum variation  Stratified purposeful sampling  Politically relevant cases  Theoretical sampling The question of sample size (is there a rule of thumb?); according to Dworkin n = 25-30 (Dworkin, 2012); redundancy criterion (Lincoln & Guba, 1985) Internet sampling (and interviewing) as a new strategy?

11. Qualitative Research and HIV- Related Health Policy The role of qualitative research in combating HIV and HIV-related health policies:  Understanding the meaning of risk taking behaviors  Understanding the obstacles to safer sex  Understanding obstacles to HIV treatment adherence  Describing sexual cultures (e.g., gift giving and sex in Uganda)  Understanding collective actors’ positions  Understanding the impact of a preventive campaign  Needs assessment analysis ...

12. Prospective Health Policy Analysis Inherently political nature of health policy Analysis of political dimensions of a health policy process  Agenda setting  Policy formulation  Implementation Combined qual methods: Real-time analysis of documentation, context (norms, values, and dominant perceptions) discourses, and political processes Engaging advocacy groups in research Methodological, practical & ethical challenges (Buse, 2008)

13. An Example The topic: School-Based Health education in Croatia  Study design  Data sources Texts Actors Social processes (social context, mobilization, information dissemination, power/political resources, economic resources, tactics and strategies...)  Data analysis  Combining different types of qualitative analysis

14. Thank you...