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Qualitative Research Methodology

Qualitative Research Methodology






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    Qualitative Research Methodology Qualitative Research Methodology Presentation Transcript

    • A Guide to UsingQualitative Research Methodology© 2002 Michael Quinn Patton and Michael CochranReproduced with kind permission of Michael Quinn Patton
    • Executive SummaryThis guide to using qualitative researchmethodology is designed to help you thinkabout all the steps you need to take toensure that you produce a good qualitypiece of work.The guide starts by telling you whatqualitative methodology is and when touse it in the field (understand people’sbelief system, perspectives, experiences). Italso flags the most important ethicalissues that you will encounter (consentand confidentiality).The second part of the guide tackles howyou can concretely develop qualitativeresearch designs; starting from clearlydefining your research question (one of themost important steps in your research!),to how to develop a research protocol;and finally giving you tips on the samplingmethods which are available and how touse them.The third part details how you can actuallyobtain the data - what methods can youuse to get the information you want? Thethree main methods (individual interviews,group interviews and observationalmethods) are explained, and the steps tobuild these different methods are outlined(How to do a topic guide? How to askquestions? How to develop interview skillsand manage expectations? How to rungroup discussions? etc)Finally, the fourth chapter looks into how,once you have collected all the data, youcan manage it and analyse it. For themanagement of data, a few practical issuesare addressed, such as confidentiality andsecurity, translation and recording. Theanalysis section will give you clues as tohow to use thematic or narrative analysis,what validation strategies you need tothink of, what good practice guidelinesyou should follow, and whether or not touse a computer software.Case studies will be developed throughoutthe year and put on the open repository.
    • A Guide to using Qualitative Research MethodologyContents1. What is qualitative research? Aims, usesand ethical issues a) What is qualitative research? 2 b) When to use qualitative methods 3 c) Ethical issues 52. How to develop qualitative research designs a) The research question 7 b) The research protocol 8 c) A word on sampling 93. How to generate data(i) Individual interviews a) Interviews- what are they? 11 b) Topic guides 12 c) Asking questions 13 d) Interviewing skills 14 e) Managing expectations 15(ii) Group interviews a) What is a group interview? 16 b) Advantages of group interviews 16 c) Practical issues 17(iii) Contextual data a) Observations 20 b) Reports and other written data 21 c) Oral data 214. Data management and analysis(i) Practical issues Confidentiality and security issues 22 Translation 22 Recording/transcribing interviews 22(ii) Analysis Thematic analysis of data 23 Narrative analysis 25 The use of computer software 28
    • 1. What is qualitative research? Aims, uses and ethical issues(a) What is qualitative research?Qualitative research is characterised by itsaims, which relate to understandingsome aspect of social life, and its methodswhich (in general) generate words, ratherthan numbers, as data for analysis.For researchers more familiar with quan-titative methods, which aim to measuresomething (such as the percentage ofpeople with a particular disease in acommunity, or the number of householdsowning a bed net), the aims and methodsof qualitative research can seem imprecise.Common criticisms include:samples are small and not necessarilyrepresentative of the broaderpopulation, so it is difficult to knowhow far we can generalise the results;the findings lack rigour;it is difficult to tell how far the findingsare biased by the researcher’s ownopinions.However, for many research projects, thereare different sorts of questions that needanswering, some requiring quantitativemethods, and some requiring qualitativemethods. If the question is a qualitativeone, then the most appropriate andrigorous way of answering it is to usequalitative methods. For instance, if youwant to lobby for better access to healthcare in an area where user fees have beenintroduced, you might first undertake across-sectional survey which will tell youthat 16.5% of your population does nothave access to care. This is essentialinformation, but you might also have anumber of other questions that the surveycan’t answer very well, such as:what are people’s experiences of userfees?what other barriers exist to accessinghealth care?These can be addressed throughqualitative methods such as interviews orfocus groups. If the final report is to beused for lobbying, the quantitative dataand qualitative data together are verypowerful. The survey identifies the extentof the problem, and the interviews canbe used to give some of the detail, andthe ‘story’ of how user fees have affectedpeople.In situations where little is known, it isoften better to start with qualitativemethods (interviews, focus groups, etc). Itcan help you with generating hypothesesthat can then be tested by quantitativemethods. For instance, in an area wherewe had no idea what kinds of issue wereacting as barriers to health care, it wouldbe difficult to design a survey to cover themain factors. Once these have beenidentified, then a quantitative approach(such as a survey) can be used if you need“Not everything that can be counted counts,and not everything that counts can be counted “ (Albert Einstein)2
    • to measure to what extent these issues aretypical for the whole population.The first step in research is, then, toidentify whether the specific researchquestion you want to answer is bestanswered by a quantitative or a qualitativeapproach. Often, there are severalquestions that we need to answer, such as‘How many people are affected?’, or ‘Howdoes this affect them?’. We’d then need touse both types of method.In this guide, we suggest some waysof making the qualitative parts of yourresearch more rigorous, so that users canhave more faith in your findings. The firststep, though, is to clarify some of thesituations in which qualitative methodsmight be chosen.Case Study: What are the barriers to accessing surgery for cataracts?1Although affordable surgery for cataracts is provided by an Eye Care Programme in a rural part of KwaZulu-Natal, researchers foundthat uptake was low, and that two-thirds of those who were blind or sight impaired from cataracts had not had surgery.Alan Rotchford and colleagues wanted to understand why elderly people in this area might not take up surgery. They interviewed 20people who had been invited for surgery, but did not attend, asking them about the impact of poor vision on their lives, their beliefsabout blindness and its treatment, and views of surgery.The interviews revealed a number of fears about surgery: that it would make vision worse, or might kill them. Many thought blind-ness was an inevitable risk of getting older. Most significantly, however, the interviewees did not share the researchers’ perspectivesof blindness as a disability. Living in secure and predictable environments with extended families, they did not in general see theirblindness as a ‘burden’. The impact of sight disability was not as debilitating as it might be in other environments.This study illustrates the value of qualitative methods. It identified some beliefs about surgery that were different from those ofprofessionals, and also some more fundamental reasons why surgery might not be a priority: i.e. poor eyesight was not as devastatinga disability as assumed by the researchers.(b) When to use qualitative methods?What, how, and why?Qualitative methods generally aim tounderstand the experiences and attitudesof patients, the community or health careworker. These methods aim to answerquestions about the ‘what’, ‘how’ or‘why’ of a phenomenon rather than ‘howmany’ or ‘how much’, which areanswered by quantitative methods. If the1Rotchford, A.P., Rotchford, K.M., Mthethwa, L.P. and Johnson, G.J. (2002) ‘Reasons for poor cataract surgery uptake – a qualitative study in rural SouthAfrica’, Tropical Medicine and International Health, 7(3): 288-2923
    • aim is to understand how a community orindividuals within it perceive a particularissue, then qualitative methods are oftenappropriate.Examples of topics that qualitativemethodologies can address include:People’s experiences of healthneeds, health care, accessing careand keeping healthy.Understanding differentperspectives, such as those ofprofessionals and patients.How experiences, attitudes and lifecircumstances affect health needsand behaviours.Scenarios where qualitativeresearch could helpAn NGO has distributed bed nets tovillagers, but it appears that they arenot being used. Household interviewsmight help the NGO understand howbeliefs about efficacy, familycircumstances or household prioritiesimpact on usage patterns.You are planning a health promotioncampaign about hand washing, toreduce diarrhoeal disease in a refugeecamp. Before designing the campaign,it would be useful to interviewresidents to find out their current beliefsand practices around hand washing,so your information ‘makes sense’within their understanding.Few women have attended a newservice of Voluntary Testing andCounselling for HIV in your clinic. In-depth interviews with healthprofessionals and local women wouldhelp understand the barriers to use.You want to know what your nationalstaff think about MSF; whether they feelincluded in the decision-makingprocess, what their perception is of theorganisation for which they work. Semistructured interviews and focus groupdiscussions could be organised to gettheir views.Douglas Adams, The Hitch-Hiker’s Guide to theGalaxy (London: Pan Macmillan, 1979), pp. 134-6Numbers are not always meaningful‘Er... Good morning, O Deep Thought,’ saidLoonquawl nervously, ‘do you have... er,that is...’‘An answer for you?’ interrupted DeepThought majestically, ‘Yes, I have.’‘Though I don’t think,’ added DeepThought, ‘that you’re going to like it.’‘Doesn’t matter!’ said Phouchg. ‘We mustknow it! Now!’... ‘Alright,’ said Deep Thought. ‘Theanswer to the Great Question...’‘Yes!...!’‘Is...’ said Deep Thought, and paused.‘Yes...!’‘Is...’‘Yes...!!!...?’‘Forty-two,’ said Deep Thought, withinfinite majesty and calm....‘Forty-two!’ yelled Loonquawl. ‘Is that allyou’ve got to show for seven and a halfmillion years’ work?’‘I checked it thoroughly,’ said the computer,‘and that quite definitely is the answer. Ithink the problem, to be quite honest withyou, is that you’ve never actually knownwhat the question is.’4
    • You want to ‘witness’ the plight ofvictims of violent trauma: you couldcollect experiences suffered through in-depth interviews and/or focus groups.(c) Ethical issuesAs a researcher, you have responsibilities toyour research participants, but also to yourcolleagues, MSF, and the people to whomyou will present your findings. Onestarting point in considering ethicalconcerns is the four principles of TomBeauchamp and Jim Childress (1983):Autonomy; respect the rights of theindividualBeneficience; doing goodNon-maleficience; not doing harmJustice; particularly equityConsider carefully the context in whichyou will be working, the aim of yourresearch and how sensitive the topic mightbe. Might the questions that you will beasking be traumatising or might they makeyour respondent(s) uncomfortable/fearfulof consequences?Remember that asking a person to talkabout experiences that were frightening,humiliating and painful can cause or increaseanxiety. It may not only create distressduring an interview, but may also emergeafter2. It is therefore very important thatyou take care in how you ask a questionand where you choose to ask questions.Two key ethical issues that should beconsidered in any project are consent andconfidentiality.(i) ConsentEveryone who participates in your studyshould have freely consented toparticipation, without being coerced orunfairly pressurised. This means theyshould be well-informed about whatparticipation entails, and reassured thatdeclining will not affect any services theyreceive. While written consent may insome situations frighten the individualsyou are talking to, you should at the veryleast obtain verbal consent.(ii) Confidentiality3It is not always easy or even possible tomeasure the dangers of a certain contextto a given population, let alone toindividuals. It is therefore essential toprotect the identity of the person fromwhom you gather information. If collected,the identity of the participants must beprotected at all times and not be leftlying around in notebooks or un-protectedcomputer files.2WHO Ethical and Safety Recommendations forInter-viewing Trafficked Women, 2003. WorldHealth Organization, London School of Hygieneand Tropical Medicine and Daphne Programme ofthe European Commission.3Rocha S (2004) ‘Has anyone said “ethics”?“Safety” of beneficiaries? Some considerationsabout info gathering in the field’, Analysis andAdvocacy Unit, MSF B.5
    • Formal ethical reviewIn some situations, you will need formalethical review of your intendedproject before starting to collect data.Such situations include: researchsponsored by many publicly fundedorganisations such as the UK’s DepartmentMSF Ethical Review BoardMSF as an organisation has the obligationto endorse with confidence any researchproposed to take place under its respon-sibility. It is for this reason that it wasdecided in 1999 to organise an ethicalreview board (ERB) specifically for MSF.The MSF ERB will sometimes provide themajor review of a proposal (if MSFproposes research independently) orsometimes a preliminary review of aproposal (in cases where there is acollaboration with another institutionwith its own ERB/IRB). The overall ethicalreview should always include a reviewby a locally constituted review board inthe country where the research will takeplace.ObjectiveTo ensure that all research carried out byMSF is ethically sound, thus safeguardingthe dignity, rights, safety and well-beingof all actual or potential researchparticipants. This is achieved through thereview of all proposals of research to becarried out by or in cooperation with anMSF mission by an independent andcompetent ethical review board.How to contact the ERB?Send an e-mail with your proposal to:doris.schopper@geneva.msf.orgfor International Development; researchcarried out by individuals registered asstudents at many institutions, if done aspart of their studies; research intendedfor publication in many journals. All peerreviewed journals require ethical reviewbefore acceptance. Even if formal reviewis not needed, it is good practice to giveyour protocol (see next section) to yourmanager and perhaps colleagues for themto give you feedback on potential ethicalissues.6Typical ethical frameworkThe ERB has a typical ethical framework.You can access it on the MSF open reposi-tory (http://msf.openrepository.com/msf).By following their ethical framework, youwill be sure to receive a quick responsefrom them.
    • (a) The research questionFirst and foremost you will need to identifythe research question. This is one of themost important parts of your research.Identifing the right question will get youhalf way there!‘WHAT’ – what is the question that youwant to answer?Has this research already been done?=> Find out through a literature search.If you have access to universitylibraries, electronic databases can besearched by key words to identifypublished literature, and the web canbe searched for unpublished reports.Is this a problem that research canaddress?=> Not all ‘problems’ are those that can beanswered by research.Research is most useful when there isgenuine uncertainty about the answerto a question. For instance, if healthcare is very expensive, and localpeople are poor, you probably don’tneed to interview people to identifythe main barrier to care. It might beuseful to interview people to gathermaterial for publicity, but we don’treally have any uncertainty about theanswer.Some problems are clearly problemsof funding, or management, orpolitics, rather than knowledge. Becareful not to be persuaded to doresearch just to put off managing aproblem where the solution is alreadyknown.Is a qualitative approach appropriate?=> If you want to:Understand the perspectives ofparticipants; orExplore the meaning they give tophenomena; orObserve a process in depth...... if the answer is yes, then qualitativemethodology is appropriate.2. How to develop qualitative research designsIdentify the research questionDevelop your research protocol7
    • (b) The research protocolA research protocol is essentially a map of your research, of what you will be doing, how and why. Protocols typically have the follow-ing headings:The WHAT of the study, including broad aim (what you are going to do) broken down into measurable objectivesExample:Aim: To identify preferred sources of health care in X area.Objectives: To interview 30 mothers from 3 villages. To identify where they sought help for their last illness. To identify where they sought help for their child’s last illness.Aims and ObjectivesWHY this is an interesting, important or policy relevant question, and what we already know about the topic.BackgroundMethods HOW, with a detailed description of data you will collect. This includes:the setting; the participants (your sample); how you will recruit them; how you will collect data; plans for analysisEthical issues raised by this study, including whether there is a need for ethical appraisal, and how you will address them.Ethical issuesResources Costs of the project, e.g.:Travel expensesSalaries of staffAccommodationStationeryOther resources neededSkills: interpreting/translationdata input/help with analysisHow long is it going to take? Identify key milestones, such as completing data collection, analysis, report-writing, holdingmeetings for stakeholders.Time scaleDissemination/output Who will you target and how do you want to disseminate your conclusions?Possible dissemination:Internal reports; External reports; Conferences; Workshop (internal/external)Possible target audience:MSF, including home societies; Other NGOs; Academics; Governments;International institutions; Community – local, and more global8
    • (c) A word on samplingIt is important to select your sample in asystematic way so as to ensure that thecommunity/users/external actors see it asa credible and indicative sample. However,statistical representativeness is not the aim.Instead, samples in qualitative research areusually purposive. This means participantsare selected because they are likely togenerate useful data for the project. Toensure that this sample is credible, andcovers the main groups you are interestedin, one strategy is a maximum variationsample. This involves selecting keydemographic variables that are likely tohave an impact on participants’ view ofthe topic. You can then create a sampling‘grid’ and recruit groups that reflectvarious combinations of variables. For ex-ample: age (adolescents, adults, elderly);male/female; low income/high income;rural/urban; ethnicity. Samplingstrategies should therefore always bedetermined by the purpose of the researchproject.While the aim is not to be able togeneralise statistically, it is useful to thinkin terms of minimizing sample bias. Thissimply means that you need to recognisethat the people you are selecting will notrepresent all people in the population,and you cannot make claims about, forinstance, the prevalence of views in acommunity from a qualitative study. Butwe can aim to include a range so thatthe research does not have obviouslimitations, such as only including olderwomen, if we are interested in all women,or choosing just people who are in touchwith the clinic.Sample sizes are typically small inqualitative work. One way of identifyinghow many people you need is to keepinterviewing until, in analysis, nothingnew comes from the data – a point called‘saturation’.A more practical method for short termstudies is to estimate this point as around15 people for any homogeneous group(which could be based on age, gender,skill, etc). Thus, if we were interestedin the experiences of conflict in a campof internally displaced people from twoethnic groups, we might decide that ourkey demographic variables were: ethnicity,gender, age, arrival at camp before or afterlast outbreak of violence. The samplinggrid might look like this: Men Men Women WomenAge: <20 20+ <20 20+Ethnicity Aarrivedthis yearEthnicity Aarrivedlast yearEthnicity Barrivedthis yearEthnicity Barrivedlast yearIn our sampling grid, we would then have16 cells. If we interview 3-5 people in eachcell, our total sample is around 50-60,but we also have, for instance, around 10young men, or 20 from A Ethnicity to aidcomparisons in the analysis. We have also9
    • ensured that readers of any reportswill not dismiss them because theresearch only included some impor-tant groups within the camp.There are practical ways of choos-ing individuals from the sample tominimise the chance of includingan atypical groups. For instance,the camp could be divided intoa number of segments, and youcould choose every tenth (or third,depending on size) household toinvite participants from, until youhave enough people meeting thecriteria.Type of sampling Purpose ExampleIntensity samplingDeviant casesamplingStratified purposefulsamplingSnowball or chain sampling(locate one or two key indi-viduals, and then ask them toname other likely informants)Maximum variation sampling(purposely select a widerange of variation ondimensions of interest)Convenience sampling(Select whoever is easiest,closest, etc.)Criterion samplingTypes of sampling methodsTo provide rich information froma few select cases that manifestthe phenomenon intensely butare not extreme casesTo learn from highly unusualmanifestations of the phenom-enon in questionTo illustrate characteristics ofparticular subgroups of interest;to facilitate comparisonsTo facilitate the identification ofhard-to-find casesTo document diverse variations;can help to identify commonpatterns that cut across variationsTo save time, money and effort.Information collected generallyhas very low credibilityTo investigate in depth a par-ticular “type” of case; identify allsources of variationInterviewing survivors of date rape to learn moreabout how coerced sex affects women’s sexualityInterviewing men who do not beat their wives in aculture where wife abuse is culturallyacceptedInterviewing different types of service provider(police, social workers, doctors, clergy) to com-pare their attitudes toward and treatment of abusevictimsFinding commercial sex workers to interviewabout experiences of childhood sexual abuse bygetting cases referred through friendship networksResearching variations in norms about the accepti-bility of wife beating by conducting focus groups:young urban women, old urban women, youngrural men, old rural men, women who have beenabused, women who have not experienced abuseForming focus groups based on who is availablethat day at the local community centre, ratherthan according to clear criteriaSpecifically interviewing only abused womenwho have left their partners within the last year inorder to better understand the variety of factorsthat spur women to leaveSource: Ellsberg M and Heise L (2005: 106)Researching Violence Against Women - APractical Guide for researchers and activists,Washington DC, United States, World HealthOrganisation and PATH, 200510
    • Semi-structuredThese are conducted on the basis of aloose structure (topic guide, see below)made up of open-ended questionsdefining the area to be explored.In-depth (also referred to asqualitative or unstructured)In-depth interviews are less structuredthan semi-structured ones and maycover only one or two issues (a topicguide may not be used, or may justhave a few broad questions on it). Thistype of interview is used to explore indetail the respondent’s ownperceptions and accounts. This methodis used on topics for which little isknown and where it is important togain an in-depth understanding. Theymight start with very open questionssuch as ‘Tell me about how you came tobe here’.To use qualitative methods means that youwill be generating data that is primarily inthe form of words, not numbers. Some ofthe most common data collection methodsare different types of individual interviews(general or key informants) and groupdiscussions. In this section, we alsodiscuss other types of data that might helpyou understand the context.INTERVIEWS(a) Interviews - What are they?Interviews resemble everydayconversations, although they are focused(to a greater or lesser extent) on theresearcher’s needs for data. They alsodiffer from everyday conversation becausewe are concerned to conduct them in themost rigorous way we can in order toensure reliability and validity (i.e.‘trustworthiness’). This means that boththe researchers and the users of thefindings can be as confident as possiblethat the findings reflect what the researchset out to answer, rather than reflectingthe bias of the researcher, or a very atypicalgroup. In practical terms, this means thatour techniques should aim to be:Reproducible: that is, someone elsecould use the same topic guide togenerate similar information;Systematic: to ensure that we arenot just picking interviewees or datathat support our pre-existing ideasabout the answers;Credible: the questions we ask, forinstance, and the ways in which weask them should be reasonable ones forgenerating valid (or ‘truthful’) accountsof phenomena.Transparent: methods should bewritten up so that readers can seeexactly how the data were collectedand analysed.The skills and training of the interviewers iscrucial for maximising validity andreliability. There are different types ofinterviews used in qualitative methods thatrange from semi-structured (using a topic-guide) through to less structured and verydetailed (such as life histories).3. How to generate data11
    • Life histories are one type of in-depthinterviews. They are illustrative casestudies which are very good atlooking at people’s lives in generaland setting health in its wider context.They will tell you how much thingshave changed, evolved over decadesand how broader social change hasaffected the lives of individuals.(b) Topic guidesThe topic guide is used mostly in semi-structured interviews. It is very impor-tant to develop the right question to askand to remember that the respondent isunlikely to share your perspective on theworld. A topic guide usually has a list ofthe key questions the interviewer wouldlike to cover, with some useful prompts toencourage the interviewee to talk aboutspecific issues if they do not come upspontaneously.This is an extract from a topic guideon sight disability and access to care:1) When did the problems with your eyesstart?PROMPTS: What happened next? Didyou seek any advice? From whom?2) What do you think might have causedthis?3) Have you seen a doctor/nurse aboutyour eyesight problems?PROMPTS: When? Where? What did theyadvise?4) IF NO:Have you ever thought about visiting orbeen advised to visit the clinic?Explore why not: awareness of clinicservices/awareness of cost/availability oftransport and escort.5) Has your eyesight got worse/betterover the last few years? How has thisaffected your everyday life?PROMPTS: ask about activities of dailyliving (work; in the house; social activities)12
    • (c) Asking questionsFor any kind of interview, it may take awhile to develop the right question forgetting precisely the kind of data you areinterested in. Pilot questions with col-leagues first – does it make sense? Do theyrespond in the ways you expected? Thenpilot them with people similar to yourparticipants. Sometimes small changes inhow you ask can make a large difference tothe information you are given.Some rules of thumb for asking questions41) Start with a general question toorientate interview to the topic2) Gauge the level at which you need toexpress yourself, the type of languagethat you should use so that the peopleyou speak to understand you and donot feel intimidated by complexvocabulary or patronised by asimplistic one either3) Use everyday vocabulary, don’t usetechnical words or overly complicatedones4) Put more sensitive questions towardsthe end5) Ask open questions, i.e. requiringmore than ‘yes’ or ’no’ in answer6) Ask neutral questions. For example donot ask: ‘why haven’t you had yourchildren immunized’ but rather ‘how didyou decide whether or not to immuniseyour children’?7) Use concrete rather than abstractquestions. For example ‘think about lasttime you were pregnant. What did youlike about services then?’, rather than‘what do you think about ante-natalservices?’8) Use concrete events to help peopleremember – eg ‘After your last child wasborn’ or ‘the day of the earthquake’rather than ‘January the 3rd’If questions are not generatinguseful data, try these methods:Diary question: ask people to describea day in their life, or their last shift in theclinic, as a way to introduce the interviewCritical incidents: ask about worst/bestexperiences to understand what isimportant about a topicFree listing: ask people to list all causesof malaria, for example, or all thepossible treatments to use in case of feverin childrenRanking: ask people to rank itemsgenerated by free listing in order ofimportance or efficacy4Adapted from Neuman W L (2000)13
    • (d) Interviewing skillsInterviewing people is very enjoyable, butit is a skill which takes practice. You needto think about a number of issues beforeyou start and whilst you are doing it.AccessHow are you going to gain access to thepeople you need to interview? As amedical organisation, it might be possibleto get a doctor to ask patients whetherthey want to be interviewed; you couldalso use key informants (communityleaders, teacher). However, if using healthcare workers or other informants to ask forparticipants you need to consider:Ethical issues – make sure the informantis not persuading or coercing people totake part. Also, community leaders maynot invite certain ‘marginal’ members ofthe community – if you want their voicesincluded, you may need other methods ofaccess.Bias – Health care workers will only haveaccess to patients, not to those notaccessing services. Teachers orcommunity leaders might favour the ‘highstatus’ respondents, or those they thinkwill give you the answers you want.SettingRemember that the place where you willdo the interview will have an impact onthe answers that you will get: is thereenough privacy for the interviewee to feelcomfortable in giving honest answers?Is there too much privacy, making theinterviewee uncomfortable? How can youorganise the space and people to makesure the interviewee is relaxed?RapportAll qualitative researchers need to considerhow they are perceived by intervieweesand the effects of personal characteristicssuch as ethnicity, status, gender and socialdistance. It might be sensible, for instance,not to conduct interviews with your ownpatients if you are their doctor. Thinkabout what you are wearing and how youpresent yourself – is it appropriate for thecontext? Wearing a lot of expensivejewellery and clothes could beintimidating, but a scruffy appearancemight make interviewees feel disrespected.The interviewee needs to trust you. Thismeans that you have to show that you areinterested in them and what they have tosay, and most importantly that you will notjudge them whatever their answers.You will therefore need to start by intro-ducing yourself (giving your name), theaims of the interview, a reminder that theinterview can stop at any time (should theinterviewee feel uncomfortable/unhappy),and allow time for questions.You will need to be sensitive to the needsof your respondents. They will need to becomfortable, helped if they are frail or donot hear well, for example.A key issue is to remember that a researchinterview is not like a clinical interviewor an interrogation. The aim is to be asnon-judgemental as possible, and not tolead the respondent to particular answers:you are interested in their views, not theirresponses to your views!14
    • Some things to bear in mindThe ‘rules’ for interaction differ acrosscultural contexts, but some general issuesto consider are:Is eye contact acceptable?Is sitting in certain positionsdisrespectful (eg: feet towardsinterviewees)?Make appropriate non-verbal noises,Follow-up points where appropriate,Do not interrupt – allow silences, if thisis culturally acceptable, to giverespondent time to think,Do not give your opinion or disagree.It is vital that you check whether youhave understood respondents’meanings instead of relying on yourown assumption (for example, patientsmay not use medical terminology in thesame way as professionals).Some things to avoid whileinterviewing:Competing distractions (such aschildren)Asking interviewee embarrassing/awkward questionsAsking leading questions. These arequestions that may suggest aspecific answer. e.g. instead of asking:‘Did you take the drugs exactly as thedoctor advised?’ ask ‘Tell me how youused the drugs...’Jumping too quickly from one subjectto anotherHaving more than one idea perquestion - to ensure focusTeaching, for example givinginterviewee medical adviceCounselling, for example summarisingresponses too earlyPresenting your own perspective, thuspotentially biasing interviewRemaining at a superficial level, forinstance by asking questions too rapidlyInterruption from outside (peopleintruding, etc) should be minimised asmuch as possible(e) Managing ExpectationsIt is very important in any interview thatyou do not create expectations which MSFcannot fulfil. Don’t lead people to believethat you will accomplish more than youare able. Always do what you say you willdo. The best way to avoid creating toohigh expectations is to tell the person whatyou plan to do with the information andthen do it.15
    • (a) What is a group interview?A group interview is any discussion with agroup of people. This could includeinformal, spontaneous ‘chats’ with groupsas they are waiting for services, or meetingat a social event. These are discussedunder contextual information (below);here we discuss more formal groups,which are organised on purpose. It ishelpful to think about two different kindsof formal group interview: the focus groupand the natural group interview.(b) Advantages of group interviewsOne advantage of group data is that youhave access to how people talk to eachother. For example, in a study of clinichealth workers, it was noticed that in amixed group, nurses said very little, andtended to agree with what doctors said.If we notice these kinds of power rela-tionships, they can inform our work – forinstance, in this setting, it would not be agood idea to rely on nurses to implementchanges in treatment protocols.Bear in mind for focus groups what youwill get is a measure of the interactionbetween people and your analysis will bedone at the group level rather than theindividual. If you want to gain access tothe perspective of vulnerable or marginalpeople, then group interviews will not bethe best way, as they may not be comfort-able or able to speak in a mixed group.GROUP INTERVIEWSGroup discussions may be more appropri-ate for some topics. Some issues, suchas dissatisfaction with health services, areoften more readily discussed in groups.Some sensitive topics work better with agroup, if all members of the group sharean experience. Group interviews will alsotell you more about the social structure ofthe community in which you will be work-ing and give you a more in-depth under-standing of the context and social fabric ofthe community, and of how opinions andknowledge are formed in social contexts.Group interview type Features Typical useFocus groupsNatural groupParticipants selected to meet sampling criteriaSeeks broad range of ideas on open-endedtopicFormal, controlled pre-arranged time andplaceUsually audio-taped and transcribed foranalysisGroup exists independently of the researchstudyFormal or informal formatInterview guide loosely followedOften recorded by written notesTesting health promotionmaterials, exploringservice users’ viewsEthnographic datacollection (informal)social research (formal)Project planning,programme evaluation16
    • Groups typically have between 6 and10 people. Below 6, it may bedifficult to sustain a discussion;above 10, it may be difficult tocontrol it. If you aim for 10, it isusually a good idea to over recruit byabout 25%, ie recruit 13. In contextswhere you expect neighbours and familyto join in with the recruited member, over-recruitment may be a problem, especiallyin settings where it is usual for a wholecommunity to turn up. Do think aboutwhat you would do with the extra people,or how you will manage a very largegroup, for example would you split thegroup in two?To recruit your participants, you can askfor volunteers from the population ofinterest, or ask for the help of ‘gate-keepers’, leaders or contacts in thecommunity who can invite participants foryou. The other option is to recruit peoplesystematically from a sampling frame forthe population of interest. So for exampleuse the list of all patients from a particularclinic, and invite every tenth person.Obviously, if you want a natural group,you need to invite a group that already ex-ists. You can invite one individual to invitetheir colleagues or other members of thehousehold as well. Or invite all the clinicstaff together.Running a groupThe moderator’s role is crucial: you willneed to provide a clear explanation of thepurpose of the group, help people feelat ease and facilitate interaction betweengroup members.The moderator will need to promote thedebate by using the topic guide,sometimes challenging participants,drawing out differences in opinion, askingfor details and tactfully moving thingsforward when the conversation is drifting.The moderator will also need to ensurethat everyone speaks while not favouringany particular participant.It is usual to have two moderators, so thatone can concentrate on the topic guideand managing the discussion, while theother takes notes, checks the tape(c) Practical issuesIf you want to organise a focus group ornatural group interview, you will need tothink about the following issues:How will you recruit the participants?What will you include in the topic guide?How will you run the groups?Where will you hold the sessions?How will you record the data?The recruitment of focus groupparticipantsTo run group discussions, you will needpeople who will discuss! It is often difficultto get the participation needed and inad-equate recruitment efforts are a commonsource of problems in research projects.Whether people will want to come willdepend on how involved the researchers ortheir organisation are with the community,how well they understand the topic of yourresearch, how interested the community isin the research topic, and what they thinkthey will gain by attending the discussions.17
    • recorders and helps with the organisation(eg meeting and greeting participants).Both can take notes on body language,attitudes etc.How many groups should you run?The general rule of thumb is that youshould stop when additional datacollection no longer generates newunderstanding, also called the saturationpoint. Whether you will need to run three,five or six groups will vary depending onthe questions you’re asking, the context,and what will be credible for youraudience.SettingMake sure that you have your discussion ina quiet, comfortable place so that peoplefeel relaxed and inclined to speak. Whatfeels comfortable and just the right levelof intimacy will depend on the context.Think about the space and the seating –organise in a circle, so people can see eachother and there is space for a flip chart orsome other way of recording issues.Recording the dataIdeally, it is useful to have full transcriptsavailable to analyse the group discussion,so wherever possible use tape recorders(two are advisable). In many situations,it is politically or practically not possible,though. Here, there should be a dedicatednote taker. At key points through the dis-cussion, the note taker should summarisefor the group what issues have come up,and check they have interpreted themcorrectly. For literate populations, a flipchart or similar is a useful way of recordinggroup consensus or divergent opinions asthey emerge.Have a look at the later chapter on Analysisof data for a few things to look out for suchas enthusiasm of participants etc whenrecording the data.These are some of the questions used ina guide for focus group discussions inDadaab Refugee Camp in Kenya as partof a study looking at sexual violence.51) What problems have women and girlsexperienced in health and security in yourcommunity?2) Can you give examples of sexual violence inthe camps?3) When and where does violence occur?4) Who are the perpetrators (PROBE: inside /outside the camp, people you know/don’tknow). What happens to the perpetrators?5) What are the problems that face womenafter the attack? (PROBE: physical /psychological / social problems)6) How do survivors of sexual violence copeafter the attack?7) What are community responses when sexualviolence occurs? What is done to preventviolence? What is done to help survivors?How could these efforts be improved?8) What social and legal services exist to helpto address these problems? Who providesthese services? How could they beimproved?9) Has the problem of sexual violence becomeworse, better or stayed the same since youarrived in Dadaab?5Igras, S; Monahan, B; Syphrines O. (1998) Issues and responses to sexual violence. Assessment Reportof the Dadaab Refugee Camps, Kenya. Nairobi, Kenya: CARE International. Reproduced with kindpermission of CARE.Advantages/ Disadvantages of naturaland focus groups.Natural groups are most useful if you are inter-ested in group norms; focus groups if you wanta range of views18
    • How to run a discussionThe topic guideThis is a more or less structured interviewschedule for the discussion.Generally, the order of questions should beas follows:Early questions should be directlyrelated to topic of research.Most relevant/interesting questionsshould be asked as soon as possible tointerest intervieweeEmbarrassing/sensitive questionsshould be left till laterPut general questions before specificonesThe startA good icebreaker is to ask each person inthe group to give a brief self-introduction.If you want to relax the atmosphere, youcould start by asking each person to saysomething about what they like to do intheir spare time.Discussion starterYou then need to move on to the‘discussion starter’ question. Thediscussion starter question will presentthe basic topic for the session and throwthe discussion open to the group as awhole. When you start the actualdiscussion, the aim is to get eachparticipant to give some meaningfulresponse or opening statement. Hence akey feature of the discussion-starterquestion is that one should be easily ableto respond to it. This should get everyoneon record with their different experiencesand opinions before a consensus emergesduring the group discussion. Examplesmight be getting each participant to saytheir name and one thing about theirexperiences of the topic, such as last timethey used the local clinic, or how long theyhave lived in the camp.The discussionAfter this first discussion starter, you canstart tapping into your topic guide. Do tryto relate your questions to what has beenmentioned during the opening statements.It is also useful to provide a clearindication of when the session isending. Focus groups should lastabout 90 minutes but it is better toannounce to the group that it willtake two hours. To indicate that thediscussion is coming to a close, you couldfor example ask each participant for a finalsummary statement within which youshould ask them to point out what theythink are the most important points (willhelp for the analysis part).Also, do remember common courtesy at theend and thank all participants for their timeand energy, and provide whatever refresh-ments might be appropriate in the setting.CONTEXTUAL DATAInterviews (of various kinds) are the mostcommon source of data for qualitativeprojects. However, most researchers alsodraw on a number of other sources, evenif these are less formal than the interviews.These are useful techniques to use notsimply when undertaking research but also19
    • when working in the field. It will help youbetter understand the community in whichyou work.(a) ObservationsTo understand fully the complexities ofmany situations, direct participation in,and observation of, the phenomenon ofinterest may be the best research method.The data collected must be descriptiveso that the reader can understand whathappened and how it happened. In mostapplied projects, there is not enough timeto carry out a detailed observational study,but some observation, as part of your dailywork, will help.Observational data is also very useful inovercoming discrepancies between whatpeople say and what they actually doand might help you uncover behaviour ofwhich the participants themselves may notbe aware.The following are not guidelines for a fullobservational study, but they containuseful hints for developing our skills inthinking about what we are observing.You could include observations of:Who does what tasks, and where?What routines are there in this setting?For instance, when is water collected?When do people eat? When do theywash their hands?Is there a pattern to the week, or year?How do people relate to peers, those ofhigher social status, outsiders?What is considered ‘public’ and what is‘private’? To put it more simply, whatdo people believe belongs to them andwhat belongs to all/the community?As well as providing you with usefulcontextual information about the setting,this data is also vital for designing goodinterviews, and suggesting who mightbe an appropriate person to conduct theinterviews.Recommendations for taking field notes6Record notes as soon as possible after eachperiod in the field, and do not talk with othersuntil observations are recorded.Begin the record of each field visit with a newpage, with the date and time noted.Use wide margins to make it easy to add tonotes at any time. Go back and add to the notesif you remember something later.Record events in the order in which they occurand note how long they last.Make notes as concrete, complete, andcomprehensive as possible.Record small talk or routines that do notappear to be significant at the time; they maybecome important later.Let your feelings flow, and write quicklywithout worrying about spelling. Assume thatno one else will use the notes.Include diagrams or maps of the setting, andoutline your own movements and those ofothers during the period of observation.Record emotional feelings and privatethoughts in a separate section.Avoid evaluative summarizing words. Insteadof ‘the sink looked disgusting’ say ‘the sink wasrust-stained and looked as though it had notbeen cleaned for a long time’.Reread notes periodically and record ideasgenerated by the rereading.6Neuman W L (2000:364) Social research methods – qualitative and quantitative approaches20
    • (b) Reports and other written dataSome written sources of data that mighthelp you answer your research questioninclude:Reports of previous research:A literature search should identify otherstudies in this area, and other studies onthe same topic in different areas. As wellas providing background, use thisinformation in your analysis to think aboutwhat is the same and what is different inyour study, and why.Clinic and other service records:If you have access to them, this will give anoverview of who is using services and why.Are there obvious ‘gaps’ of those who arenot accessing services? Other providersmay have published summaries of serviceusers, or surveys of the local population.Policy reports:As essential background to the study, youwill want to familiarise yourself with therelevant policy documents, which mightinclude those from local healthdepartments and NGOs as well as theinternational literature (such as WHOpolicies) that frame your research.(c) Oral dataMany cultures are primarily oral ratherthan literary. Just talking to peopleinformally is an ideal way of understandingmore about a setting. Listen to storiespeople tell, what they complain about,what can and can’t be said in varioussituations.Informal conversations while people aregoing about their business can be moreinformative than a formal group interview.While people are collecting water, theymay be talking to each other about healthcare problems, and how they managethem. If you are privileged enough tobe included in these conversations, theyare an excellent way of accessing what isimportant to people locally, and how theythink about it.21
    • (a) Data management7: some practicalissues:Confidentiality and security issuesAlways consider the safety of thosebeing interviewed. Think about stigma-tisation of the person, further humilia-tion, additional trauma, victimisation,your own security, and the security ofyour MSF team.Be careful to chose a good interpreterand take time to brief him or her andlimit those present during the interviewto a minimum. Try to find a privateplace, if this is appropriate. In manysettings, you will need to ‘match’ thegender of interviewers and interpretersto that of interviewees.Don’t leave transcripts lying around. Besure that no-one can access yourmaterial. If you are dealing withparticularly sensitive issues such ashuman rights abuses, make sure that ifthe information falls into wrong handsit could not be traced to a specificperson. That may mean writingfamily names and place names in codeor even not taking the person’s name atall. If you hear something potentiallyvery dangerous, be extremely carefulabout making notes. Do so in code, ornot at all.TranslationEven if the person being interviewedtrusts you, they might not trust yourtranslator, especially if they believethe translator is connected to one of thewarring parties or is a member of adifferent ethnic or religious group. Beaware of this. Choose your translatorcarefully. Take time to brief the person.Always insist that your translator gives aliteral sentence-by-sentence translation(a good translator uses the ‘I’ person,not ‘he or she’), not a summary. Briefthe translator well about the reason forthe interviews and about the risks. Thetranslator is outside the interview. S/Heis a facilitator, and should not start toask the questions himself. You shouldnot have eye contact with yourtranslator when asking questions butalways with the interviewee.Recording/ transcribing interviewsYou can either write notes at the sametime as you are speaking (it is easierto have a transcriber do this), or writethe notes afterwards (but you willforget a lot of what has been said, sonot advisable) or even audiotape.The best method is generally to ask atranscriber to take notes whilst taping,and ask the transcriber to go throughthe notes he has taken afterwardschecking with the recording whethers/he has forgotten anything.If an audiotape is going to be used, therespondent’s prior permission must besought. You will need to explain thatthe reason why you are recording themis to help you check whether you haverecorded their views correctly. If peopleare anxious about a tape recorder, doreassure them that they will soon forgetit’s there. But if they refuse, you needto respect their choice and put your4. Data management and analysis7some of these considerations were outlined in Schockaert L document for the Analysis and Advocacy Unit (MSF B)22
    • audio recorder away. When talkingabout a very delicate/sensitive issue orin a tense context, DO NOT USE taperecording. It might be dangerous foryour respondent.If you do tape, one common approachis to turn the recorder off at the endof the interview and to continuechatting with the respondents. Youshould be able to gauge whether to berecorded has inhibited or not yourrespondent.(b) AnalysisIt wasn’t curiosity that killed the catIt was trying to make sense of all thedata curiosity generated Halcom8The analysis of qualitative data is oftenseen as the most difficult part of theexercise. Yet it is very enjoyable to seepatterns emerge and be able to draw outof all the discussions some meaningfulconclusions.There are many different ways toanalyse qualitative data. You can either usea thematic, descriptive approach, or morein-depth methods. For most appliedprojects, thematic analysis is sufficient.Thematic analysis of dataA thematic analysis is one that looks acrossall the data to identify the common issuesthat recur, and identify the main themesthat summarise all the views you have col-lected. This is the most common methodfor descriptive qualitative projects. The keystages in a thematic analysis are:1. Read and annotate transcripts:this is the most basic stage. Here you donot provide an overview of the data, butmake preliminary observations. This isparticularly useful with the first few tran-scripts, where you are still trying to get afeel for the data.2. Identify themes:The next step is to start looking in detail atthe data to start identifying themes:summaries of ‘what is going on here’. Inthe margins of each transcript or set ofnotes, start to note what the interviewee isreferring to. Try to make these as abstractas possible. This means not justsummarising the text, but trying to thinkwhat the text is an example of.For instance, this extract comes from aninterview with a mother about access tohealth care:1. my baby was very hot with a fever in themorning2. he cried and cried3. my mother in law said to put a flannelon his head4. but he was so hot I knew it was not right5. and I told my husband to hurry to gethim to the clinicWe could just see this as an example of thetheme ‘coping with fever’, but we will getmore out of the data if we think in detailabout the various different things that aregoing on here, such as: sources of infor-mation and advice; remedies; triggers tohealth care seeking.Note that it is useful to number the lines,to make it easy to refer to each segmentof data when coding or discussing it withcolleagues.As you look through the data, make a listof these themes.8As quoted in Patton (2002:440)23
    • 3. Developing a coding schemeThese initial themes can now be gatheredtogether to begin to develop a codingscheme. This is a list of all the themes,and the ‘codes’ that we will apply to thedata. From the small extract above, someof the codes might be:Initial symptoms (could be given codenumber 1)Informal help seeking (could be givencode number 2)Giving advice on what to do (codenumber 3)Formal help seeking (code number 4)Responsibility for taking child (husband,self, other) (code number 5)Each broad code can have a number of subcodes.It is useful to begin developing the codingscheme as soon as initial data have beencollected. This early analysis can helpshape later data collection (are we askingthe right questions? Have we included theright people?) as well as giving feedback tothe interviewers. Whenever possible,develop the coding scheme withcolleagues. This helps avoid going downnarrow analysis paths, and ensures thatindividual bias about ‘what is going on’ iskept in check.4. Coding the dataThe next step is to start applying thesecodes to the whole set of data, by eitherwriting codes on the margins of transcriptsor notes or (if using computer software)marking the text on line.Notes: The same line(s) of data may becoded in several different ways, fromvery basic codes to categories that reflectbroader analytic themes.You will amend your coding scheme as youstart going through the data in detail.Ideally, the whole data set should becoded. This ensures that the analysis doesnot just concentrate on the atypical, or‘exotic’ extracts of data, and is a trulycomprehensive analysis.1 He had a fever in the night,Code1 - Initial symptoms2 we noticed when he woke up crying3 and would not go back to sleep.4 It got worse and worse.5 I called my mother-in-law from herCode 2 - Informal Help-Seeking6 room, I was so worried.7 She said to wait till morning, it was8 nothing serious, so I stayed up all9 night with him crying and sweating.Code 1 - Initial symptoms10 In the morning, my husband andCode 5 - Responsibility11 mother-in-law said we shouldCode 3 - AdviceCode 5 - Responsibility for decision12 take him to the clinicCode 4 - Formal Help-SeekingThis is what another extract from the samestudy might look like after initial coding:24
    • Cut and PasteWhen all the data have been coded, youcan ‘cut and paste’ codes into piles bycode. This is the point where you take dataextracts out of their original context (theinterview or focus group transcript) andput them together with other examples ofdata on the same topic to start looking forpatterns across the data. So all theexamples of ‘Responsibility for decision’can be gathered together to look atpatterns. This is point where you can askquestions such as: in which situations domothers in law make the decision? Howand when do daughters/husbands overridethis?Cutting and pasting can be done verysimply with scissors and paste – cut upcopies of notes or transcripts and pastethem together on large sheets of paper.A word processor makes this easier, andthere are now a number of computerpackages designed to enable you tomanage this kind of analysis. For smalldata sets, it is not usually worth investingin computer aided analysis packages. It isof course vital to know where the extractsyou are cutting and pasting came from.With small data sets, one practical way ofdoing this is to put a different colouredline lengthways down each page beforecutting – you can then see at a glancewhere each extract came from.The patterns and relationships you find un-der these themes are then the basis of yourreport. In our example, there might be asection for instance on the role of moth-ers in law in advising when to access care.In the pile of extracts on this theme, wewould have identified patterns across thedata and perhaps some typologies. Onetypology might be ‘usual’ and ‘unusual’illnesses, if for instance, it was found thatmothers only asked for advice for feversin children when the fevers were seen asunusual in some way.Narrative analysisAs well as the themes that cut across thedata, you will also want to look narra-tively within each case, so the ‘story’ of anindividual’s health care access is not lost.Cutting and pasting can lose some of thenarrative context, so you may also want tolook in detail at some cases to see how thethemes interrelate in a particular case.25
    • How to interpret the dataHow much emphasis should you givea specific topic in your final report?There are three basic factors that influencehow much emphasis to give a topic: howmany groups mentioned the topic, howmany people within each of these groupsmentioned the topic, and how much en-ergy and enthusiasm the topic generatedfrom the participants. This is called ‘group-to-group validation’. For any specific topic,group-to-group validation means thatwhenever a topic comes up, it generates aconsistent level of energy among aconsistent proportion of the participantsacross nearly all the groups.Despite the relatively unstructured formin which qualitative data is collected, itremains important to ensure that youranalysis is reliable and its validitysafeguarded.To ensure reliability of your analysis, youwill need to maintain meticulous recordsof all the interviews and group discussionsand document the process of analysis youwent through in detail.Validation strategiesYou will also need to ensure that thevalidity (or ‘trustworthiness’) of yourfindings is maximised.Triangulation is one method forincreasing validity of findings, throughdeliberately seeking evidence from a widerange of sources and comparing findingsfrom those different sources. For exampleif you have done interviews and focusgroups, compare the findings from each.If they coincide, that strengthens our faithin having identified important issues.Remember, though, that people talk aboutthings very differently in different contexts:any differences you find are an importantsource of data in themselves.Another validation strategy is calledmember checking. This involves feedingfindings of the analysis back to theparticipants, through focus groups forexample, and assessing how far theyconsider them to reflect the issues fromtheir perspective.A key element of improving validity isdealing with what are known as deviantcases or findings: these are those that donot fit with your conclusions. Be sure tolook in detail at the deviant cases, andaccount for why they differ. Explainingthis will strengthen your analysis.You will need to be as rigorous as possibleto get the most out of the collectedinformation, and for your results to becredible both inside and outside MSF.There are a number of ‘good practice’guidelines to bear in mind throughout theanalysis process9(see table overleaf).9as per Thorogood and Green (2004:191)© 2002 Michael Quinn Patton and Michael CochranReproduced with kind permissionof Michael Quinn Patton26
    • Criteria Possible methodsTransparencyi) are yourmethods clear?ii) could othersrepeat yourwork?MaximisevalidityMaximisereliabilityComparabilityYour role as aconfounding factorProvide a clear account of procedure used, an ‘audit trail’ thatothers can follow (i.e. ensure that the evidence – fieldworknotes, interview transcripts etc - can be inspectedindependently, and that procedures for data analysis areclearly described and justified.)Ensure that your conclusions are based on supportingevidence and include analysis of cases that do fit within yourconclusions and enough context for reader to judgeinterpretation.Analyse the whole set of dataUse more than one analyst / coderCompare data between and within cases in the data setCompare findings to other studiesAccount for the role of you, the researcher, in the research.Take into consideration the impact that you being part ofa wealthy organisation such as MSF might have had on theresponses given. Do you think people might have exaggeratedcertain problems for example?Don’t be swayed by favourite findings! Be careful not to pull outonly those findings that you find interesting. For example, don’tjust include in your analysis those who might say that MSFprovides the right type of aid if others disagreed.Good Practice Guidelines27
    • The use of computer software tohelp manage dataThere are a number of dedicated softwarepackages designated to help managequalitative data and aid analysis. Thesepackages do not do the analysis for youthough and you will still have to developa coding system and code the data. Alsobeware that each package will require aparticular format, so make sure at thebeginning of your research that you usethe appropriate format for your analysis.The time taken to familiarise yourself withcomputer aided qualitative analysispackages can be substantial, and manynovice researchers report that they canget rather distracted with the mechanicsof coding. For smaller projects, it is notusually worth the investment. However,if generating a large data set, or onewhich will be spread across many sites,and with different people working onit, it is worth the effort as they facilitateeasier management and retrieval of data.The following website is devoted tocomputer assisted qualitative analysis, andgives you links to demo versions of a rangeof qualitative analysis packages:http://www.caqdas.soc.surrey.ac.ukFinally, in writing up your analysis, it isworth bearing in mind the kinds ofquestions readers might be askingthemselves when judging how useful orcredible they think your findings are.Assessing rigour in qualitative research10Was the theoretical framework of the studyand the methods used always explicit?Was the context of the research clearlydescribed?Was the sampling strategy clearlydescribed and justified?Was the fieldwork clearly described indetail?Were the procedures for analysis clearlydescribed and justified?Were triangulated methods used to test thevalidity of the data and analysis?10Bowling A (2002:354)28
    • We hope you have found this interesting.Throughout 2007 we will be distributing case studies on:perception study of national staffaccess to healthcareviolencesexual and reproductive healthConlusion:This is all the theory you need to start using qualitative methods. These simple steps should help youobtain sound and reliable results!29
    • BibliographyBowling A (2002) Research methods in health – Investigating health and health services,Open University PressGreen J and Thorogood N (2004) Qualitative Methods for Health Research, London: SageNeuman W L (2000) Social research methods – Qualitative and quantitative approaches,Allyn and Bacon Pub (4th ed)Rocha S (2004) ‘Has anyone said “ethics”? “Safety” of beneficiaries? Some considerationsabout info gathering in the field’, Analysis and Advocacy Unit, MSF BRotchford, A.P., Rotchford, K.M., Mthethwa, L.P. and Johnson, G.J. (2002) ‘Reasons forpoor cataract surgery uptake – a qualitative study in rural South Africa’, Tropical Medi-cine and International Health, 7(3): 288-292.Tom Beauchamp and Jim Childress (1983), Principals of biomedical ethics (2nd ed)Oxford: Oxford University PressWHO Ethical and Safety Recommendations for Interviewing Trafficked Women, 2003.World Health Organization, London School of Hygiene and Tropical Medicine andDaphne Programme of the European Commission.Suggested further readingThese are resources on particular topics ormethods that you might want to look inmore detail before carrying out aqualitative study.Campbell, O et al (1999) Social sciencemethods for research on reproductivehealth. WHOEllsberg M and Heise L (2005) Researchingviolence against women: a practical guidefor researchers and activists. WHO/PATHKrueger, RA and Casey, MA (2000) FocusGroups: a Practical Guide for AppliedResearch, (3rd Edition) SageHorizons Populations Council (2005)Ethical approaches to gatheringinformation from children and adolescentsin international settings: guidelines andresourceswww. popcouncil.org/horizons/childrenethics.html30
    • 31Notes:
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    • Good luck with all your (qualitative) research!February 2007Nouria Brikci - Research Officer, MSF UKJudith Green - Senior Lecturer in Sociology, Health ServicesResearch Unit, London School of Hygiene and Tropical Medicine