Qualitative analysis boot camp final presentation slides

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Do you have responses to open-ended questions or want to use qualitative data to evaluate CE/QI interventions? Qualitative Analysis Boot Camp at the ACEHP 2013 meeting in San Francisco on 1 February has tools to get you started.

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  • Generating theory/explanation, building hypotheses
  • Acknowledges importance of immediate, practice context
  • Many, diverse, interacting elements in healthcare, plus distinct organizational cultures, patterns of communication, tacit knowledge etc2. Best way to understand in-depth motivations and feelings of providers and patients3. Unrestrained sharing of information, experience, and viewpoint4. Gain clarity, depth, and a “fuller picture”of understanding - Can improve effectiveness of quantitative research, e.g. use qualitative data to focus quantitative measures5. Provides a blend of statistical quantifying and layered qualitative understanding of motivation, behavior, change – helpful to triangulate data, methods, researchers6. Economical Option
  • Prior to gran/t/proposal or intervention development – identify + sensitizestakeholders to intervention, secure buy-in, build picture of organizational process, leadershipBaseline assessments e.g. readiness for changeCan identify organizational enablers and facilitators of learning Learner change progressionMay use qualitative data to developquantitative measuresAlso mixed approach to evaluate full impact of initiatives/interventions through blend of statistical quantifying and layered contextual understanding of changeCan help to get a clearer picture of contextual and experiential factors that influence change, learning and practice
  • Audio: can help increase response rates, maximizes efficient use of resources, reduces interviewer effects, detachment can improve quality of response (more disclosure), researcher can take detailed notes without making respondent feel uncomfortable, faster results [Knox 2009]ReferencesCater JK. SKYPE: a cost-effective method for qualitative research. Rehab, Counselors + Educators Journal. 20011;4: Gill P, Stewart, K.; Treasure, E.; Chadwick, B. Methods of data collection in qualitative research: interview and focus groups. British Dental Journal. 2008;204: 291-295. Hayman B, Wilkes L, Jackson D, Halcomb E. Story-sharing as a method of data collection in qualitative research. Journal of Clinical Nursing. 2012, Vol. 21 Issue1/2:285-287.Meho LI. E-mail interviewing in qualitative research: a methodological discussion. J AmerSoc Info Sci Tech. 2006; 57(10):1284–1295. Musselwhite K, Cuff L, McGregor L, King KM. The telephone interview is an effective method of data collection in clinical nursing research: a discussion paper. Int J Nurs Stud. 2007 Aug;44(6):1064-70. Epub 2006 Jul 17.Novick G. Is there a bias against telephone interviews in qualitative research? Res Nurs Health. 2008;31:391-398.Reeves S, Kuper A, Hodges BD. Qualitative research methodologies: ethnography. BMJ. 2008;337:a1020.
  • Online adds deeper level of interactivity to the interviews
  • Online adds deeper level of interactivity to the interviews
  • A filing system
  • Interpretation tied closely to data
  • GATHER- existing research, current information, data sourcesORGANIZE – data sources, coding structure, demograhics, lit reviewANALYZE- coding, queries, memos, valuesVISUALIZERESULTS reports, presentations
  • GATHER- existing research, current information, data sourcesORGANIZE – data sources, coding structure, demograhics, lit reviewANALYZE- coding, queries, memos, valuesVISUALIZERESULTS reports, presentations
  • http://www.pbs.org/wgbh/americanexperience/films/lobotomist/The Lobotomist, transcript
  • Audit trail
  • Give voice to perspectives of providers and patients (adherence example)- humanizes data you get from a survey
  • Qualitative analysis boot camp final presentation slides

    1. 1. Qualitative Analysis Boot CampSession F48Friday, 2/1/13 - 4:30 - 5:30 pm PSTYerba Buena 3-4/Lower B238th ACEHP Annual ConferencePresenters:Wendy Turell, DrPH, CCMEPContextive Research LLCAlexandra Howson, MA(Hons) PhD, CCMEPThistle Editorial LLC
    2. 2. Today! Qualitative Research Introduction Data Collection Coding and Analysis Reporting Resources Coding Practice! Questions/Discussion
    3. 3. Qualitative Research“Not everything that can be counted counts, andnot everything that counts can be counted.”- William Bruce Cameron
    4. 4. Exploration 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.
    5. 5. Qualitative vs. Quantitative Qualitative Research Quantitative Research Probing; allowing Limited probing; pre-Type of Questions immediate interactive determined questions follow up & adjustmentSample Size Small Any size including largeInformation per Varies; Limited to answer Muchrespondent choices Fewer specialist skillsAdministration Requires skilled researcher required Follows structured steps;Type of Analysis subjective and Statistical; objective interpretativeType of Research Exploratory, descriptive Descriptive or Causal
    6. 6. 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 Mixed methods
    7. 7. Applications in CEHP Research Phases  Research Subjects  Needs Assessment  Physicians  Intervention Development  Allied Healthcare Providers  Formative Evaluation  Healthcare Staff  Post Intervention Assessment  Patients/Caregivers (“Outcomes”)  Instrument Development Methodological Focus  Help inform development of  Pure Qualitative quantitative tools  Mixed Methods
    8. 8. Data Collection
    9. 9. Sample Methodologies/Tools• Interviews (in person, virtual/online, telephonic)• Focus Groups (in person, virtual/online facilities)• Message Boards/Social Media Analysis• Observation• Document Analysis• Mixed-Methods (Qualitative and Quantitative combination)
    10. 10. Online Methodologies Research methodologies = evolving with communication styles Widely-used, often preferred options for researchers and respondents Benefits Cost Savings Ease for wide geographical representation Ease for scheduling (no need for travel, sessions tailored to their availability) Anonymity = less inhibition / more honesty
    11. 11. One-on-One In-Depth Interviews Webcam- enabled images.Text based chat & audio capable
    12. 12. One-on-One In-Depth InterviewsWhiteboard mayalso be filledwith text, video,images, orinteractive ranking,posting, or writingactivities. Theinterviewee canmove objectsonscreen, as in thiscard-sortingexercise.
    13. 13. Online Research Community
    14. 14. Coding and Analysis
    15. 15. Coding 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.
    16. 16. Coding 1st phase: review data:  What’s happening?  What’s important?  What patterns are emerging? 2nd stage: repeat, refine, expand/reject categories Text can be tagged with >1 code
    17. 17. Grounded 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:  Theory is derived from what speakers do, vs. what is believed they should do  Ensures the researchers maintain an open mind towards inquiry vs. imposing existing beliefs on data
    18. 18. How can Software Assist? Methodology GATHER ORGANIZE ANALYZE VISUALIZE RESULTS• Rigor• Validity• Saturation
    19. 19. How can Software Assist? -Review -Key Ideas -Merge -Reflect -Refine -Link Coding Memoing Visuals Queries -Models -Text Search -Matrices -Word Frequency -Charts -Matrix -Coding ComparisonSource: Nvivo (QSR)
    20. 20. Visualizing Data
    21. 21. Visualizing Data Word Clouds
    22. 22. Visualizing Data
    23. 23. “Many who had once supported lobotomy beganto disavow it. "It is inconceivable," reported theAmerican Medical Association, "that anyprocedure that effectively destroys the brain couldpossibly restore the patient to a normal state."Lobotomy, one former supporter declared, wasreally no more subtle than a gunshot to the head.Especially vehement were Freudianpsychoanalysts, who condemned lobotomy as abrutal assault on the brain. But Walter Freemanhad little patience for his critics.”
    24. 24. Analysis: Coding with Software
    25. 25. Reporting
    26. 26. Reporting  Reports = based on trends and relationships found within the data Includes:  Trend Description  Respondent Quotes  Visualizations (themes, their relationships, demographic elements)  Interpretation
    27. 27. Reporting: DescriptivePatient Concern about high blood pressure:The overwhelming response to the question "Should aperson be concerned about having high bloodpressure?" was "yes." Most people believed thatbeing unconcerned could result in serious healthproblems, specifically heart disease or even death."A person can die if they have high blood pressurebecause it can cause a stroke or it can cause heartproblems."
    28. 28. Reporting: TrendsPatients‟ opinions on how well providers explain amedication varies from “satisfied” to “very well”For some patients, the nurse practitioner provides moredetail, as does the pharmacist and the information thataccompanies the medication.Between the nurse practitioner and the physician,respondents tend to trust the physician more. In manycases, it appears that patients with a strong, long, andtrusting relationship with their providers perceive them asexplaining the medication better than those withoutan established relationship or who distrust their providers.
    29. 29. Reporting: Giving VoiceProvider: “After their bypass surgery, when they have seenGod and all that, they listen, but after they are out of thehospital and they are going through rehab and they arefine, 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 isso expensive, and I am saying to myself, „why did they giveme this, I am going to die because I will not be able toafford it?‟In my head, I said „Oh Lord; please make this work withoutany side effects so I can take it.‟”
    30. 30. Reporting: Quote IntegrationHaving a normal blood pressure level:Living a calm life, feeling relaxed, and avoiding or solvingproblems were seen as very effective ways to keep bloodpressure normal. "Be calm in everything. Do not get angry oversomething small.""I try not to have problems with anyone at home, in the street, oranywhere else. If I were to have a problem with anyone here, myblood pressure would go up immediately. A person can burst."
    31. 31. Resources
    32. 32. Software Resources: Coding &Organization Free (QDA Miner Lite)  http://provalisresearch.com/products/qualitative-data- analysis-software/freeware/ Low Cost: dedoose ($10 per month)  http://www.dedoose.com/ Bells and Whistles software: Nvivo or Atlas Ti  http://www.qsrinternational.com/products_nvivo.aspx  http://www.atlasti.com/index.html
    33. 33. Resources Cont. Hopkins Open Coursework: http://ocw.jhsph.edu/ Qualitative course materials:  http://ocw.jhsph.edu/index.cfm/go/viewCourse/course /qualitativedataanalysis/coursePage/index/ Online Qual. Textbook: http://onlineqda.hud.ac.uk/Introduction/index.php
    34. 34. 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.
    35. 35. Coding Exercise What’s happening? What’s important? What patterns are emerging?
    36. 36. For Additional Information or Questions: wendy@contextiveresearch.com alexhowson@thistleeditorial.com

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