Qualitative Research and CEHP (Turell & Howson)
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Qualitative Research and CEHP (Turell & Howson)

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  • This presentation will focus on Qualitative Research methods, including in depth interviews, focus groups, and online research communities, and their application in the life phases of a CE/CME activity (needs assessment, formative evaluation, outcomes evaluation). Learners will take away basic information regarding research planning, question development, data collection, and analysis- and how organizations in the CEHP world are taking advantage of this exciting research methodology. <br />
  • Generating theory/explanation, building hypotheses <br />
  • Many, diverse, interacting elements in healthcare, plus distinct organizational cultures, patterns of communication, tacit knowledge etc <br /> 2. Best way to understand in-depth motivations and feelings of providers and patients <br /> 3. Unrestrained sharing of information, experience, and viewpoint <br /> 4. Gain clarity, depth, and a “fuller picture” of understanding - Can improve effectiveness of quantitative research, e.g. use qualitative data to focus quantitative measures <br /> 5. Provides a blend of statistical quantifying and layered qualitative understanding of motivation, behavior, change – helpful to triangulate data, methods, researchers <br /> 6. Economical Option <br />
  • Qualitative interviews based on assumption that human behavior is framed by social and cultural context, and is influenced by beliefs, attitudes and values.[Goodson 2011] These characteristics make qualitative methodology an especially good fit for settings based interventions designed to foster changes in clinician behavior and practice, such as CME interventions in healthcare organizations, because they lend themselves to in-depth exploration of the context of intervention and recognize the complexity of change. <br /> Example of how interview data can flesh out survey data <br /> Interviews focus on generating Depth vs. breadth <br /> Instead of counting or identifying statistics….Understanding <br /> situations, individuals, groups, phenomena, relationships, environments, etc. <br />
  • Interviews (in person, virtual/online, telephonic) <br /> Focus Groups (in person, virtual/online facilities) <br /> Message Boards/Social Media Analysis <br /> Observation <br /> Document Analysis <br /> Mixed-Methods (Qualitative and Quantitative combination) <br />
  • Online adds deeper level of interactivity to the interviews. <br /> Research methodologies = evolving with communication styles <br /> Widely-used, often preferred options for researchers and respondents <br /> Benefits <br /> Cost Savings <br /> Ease for wide geographical representation <br /> Ease for scheduling (no need for travel, sessions tailored to their availability) <br /> Anonymity = less inhibition / more honesty <br />
  • What open ended q looks like <br /> Language that may invoke defensiveness <br /> Q writing, q order <br />
  • A filing system <br />
  • Interpretation tied closely to data <br />
  • GATHER- existing research, current information, data sources <br /> ORGANIZE – data sources, coding structure, demographics, lit review <br /> ANALYZE- coding, queries, memos, values <br /> VISUALIZE <br /> RESULTS reports, presentations <br />
  • GATHER- existing research, current information, data sources <br /> ORGANIZE – data sources, coding structure, demograhics, lit review <br /> ANALYZE- coding, queries, memos, values <br /> VISUALIZE <br /> RESULTS reports, presentations <br />
  • Give voice to perspectives of providers and patients (adherence example)- humanizes data you get from a survey <br />

Qualitative Research and CEHP (Turell & Howson) Qualitative Research and CEHP (Turell & Howson) Presentation Transcript

  • Qualitative Research and CEHPQualitative Research and CEHP CMEpalooza Presented March 20, 2014 View archived presentation on youtube: http://tinyurl.com/kg9kl9t Wendy Turell, DrPH, CCMEP Director CME Outcomes and Analytics PlatformQ Health wturell@platformq.com Alexandra Howson MA, PhD, CCMEP Owner Thistle Editorial, LLC alexhowson@thistleeditorial.com
  • AgendaAgenda - The Qualitative Approach - Utilization in CEHP lifecycle - Data Collection - Questions and Interview Behavior - Analysis - Reporting
  • The qualitative approachThe qualitative approach
  • Qualitative ResearchQualitative Research “Not everything that can be counted counts, and not everything that counts can be counted.” - William Bruce Cameron
  • Search for objective, universal truths using standardized data gathering techniques
  • Naturalistic/inte rpretative approach Focus on how people perceive their worlds and interpret experience
  • ExplorationExploration • 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.
  • Why Qualitative?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
  • Data: What vs WhyData: What vs Why Quantitative Data: A 37% drop-off was observed in adherence to post surgery medication regimens Qualitative Data “After their bypass surgery, when they have seen God and all that, they listen, but after they are out of the hospital and they are going through rehab and they are fine, that period of after the bypass, they are invincible.”
  •   Qualitative Research Quantitative Research Type of Questions Probing “below the surface”; immediate follow up & adjustment Limited probing; pre- determined questions NOT adjusted Sample Size Small Any size including large Information per respondent Much Varies; Limited to answer choices Administration Requires skilled researcher Fewer specialist skills required Type of Analysis Follows structured steps; subjective and interpretative Statistical; objective Type of Research Exploratory, descriptive Descriptive or Causal
  • Applications in CEHPApplications in CEHP Across research phases With different research participants Alone or mixed methods Needs assessment Intervention development Formative evaluation Outcomes evaluation Survey development
  • Data CollectionData Collection
  • Sample MethodologiesSample Methodologies
  • Online MethodologiesOnline Methodologies • Research methodologies = evolving with communication styles • Widely-used, often preferred options for researchers and respondents • Benefits o Cost Savings o Ease for wide geographical representation o Ease for scheduling (no need for travel, sessions tailored to their availability) o Anonymity = less inhibition / more honesty
  • Optional Webcam- enabled images Text based chat & audio capable Online Methodologies Virtual Interview Room
  • Types of QuestionsTypes of Questions
  • Question TypesQuestion Types • Open ended, neutral, sensitive, clear to respondent Patton, MQ. How to use qualitative methods in evaluation. London: Sage, 1987. 1. Main questions 2. Probes 3. Follow ups 4. Specifying 5. Interpreting
  • More about QuestionsMore about Questions • Use vocabulary of respondent • Appropriate tone • What open ended q looks like • Language that may invoke defensiveness • Q writing, q order
  • Interviewer BehaviorInterviewer Behavior • Active Listening – Be ‘in the moment’ • Encourage respondent o Give appropriate verbal and non-verbal feedback • Stay neutral o Avoid presenting your perspective (bias interview) o Avoid counseling, teaching
  • Coding and AnalysisCoding and Analysis
  • CodingCoding • 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.
  • CodingCoding • 1st phase: review data: o What’s happening? o What’s important? o What patterns are emerging? • 2nd stage: repeat, refine, expand/reject categories • Text can be tagged with >1 code
  • Grounded TheoryGrounded 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: o Theory is derived from what speakers do, vs. what is believed they should do o Ensures the researchers maintain an open mind towards inquiry vs. imposing existing beliefs on data
  • • Rigor • Validity • Saturation Methodology How can Software Assist? GATHER ORGANIZ E ANALYZE VISUALIZE RESULTS
  • How can Software Assist? Source: Nvivo (QSR) Coding Memoing Visuals Queries -Review -Merge -Refine -Models -Matrices -Charts -Key Ideas -Reflect -Link -Text Search -Word Frequency -Matrix -Coding Comparison
  • ReportingReporting
  • ReportingReporting oReports = based on trends and relationships found within the data • Includes: oTrend Description oRespondent Quotes oVisualizations (themes, their relationships, demographic elements) oInterpretation
  • Reporting: DescriptiveReporting: Descriptive Patient Concern about high blood pressure: The overwhelming response to the question "Should a person be concerned about having high blood pressure?" was "yes." Most people believed that being unconcerned could result in serious health problems, specifically heart disease or even death. "A person can die if they have high blood pressure because it can cause a stroke or it can cause heart problems."
  • Reporting: TrendsReporting: Trends Patients’ opinions on how well providers explain a medication varies from “satisfied” to “very well” For some patients, the nurse practitioner provides more detail, as does the pharmacist and the information that accompanies the medication. Between the nurse practitioner and the physician, respondents tend to trust the physician more. In many cases, it appears that patients with a strong, long, and trusting relationship with their providers perceive them as explaining the medication better than those without an established relationship or who distrust their providers.
  • Reporting: Giving VoiceReporting: Giving Voice Provider: “After their bypass surgery, when they have seen God and all that, they listen, but after they are out of the hospital and they are going through rehab and they are fine, 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 is so expensive, and I am saying to myself, ‘why did they give me this, I am going to die because I will not be able to afford it?’ In my head, I said ‘Oh Lord; please make this work without any side effects so I can take it.’”
  • Reporting: QuoteReporting: Quote IntegrationIntegration Having a normal blood pressure level: Living a calm life, feeling relaxed, and avoiding or solving problems were seen as very effective ways to keep blood pressure normal. "Be calm in everything. Do not get angry over something small." "I try not to have problems with anyone at home, in the street, or anywhere else. If I were to have a problem with anyone here, my blood pressure would go up immediately. A person can burst."
  • Visualizing DataVisualizing Data
  • Visualizing DataVisualizing Data Word Clouds
  • Visualizing DataVisualizing Data
  • Questions?Questions?
  • Follow-up Questions?Follow-up Questions? Contact UsContact Us Wendy Turell, DrPH, CCMEP Director CME Outcomes and Analytics PlatformQ Health wturell@platformq.com Alexandra Howson MA, PhD, CCMEP Owner Thistle Editorial, LLC alexhowson@thistleeditorial.com
  • AppendixAppendix
  • ResourcesResources
  • Software Resources:Software Resources: Coding & OrganizationCoding & Organization • Free (QDA Miner Lite) o http://provalisresearch.com/products/qualitative-data-analysis-software/freewa / • Low Cost: dedoose o http://www.dedoose.com/ • Bells and Whistles software: Nvivo or Atlas Ti o http://www.qsrinternational.com/products_nvivo.aspx o http://www.atlasti.com/index.html
  • Resources Cont.Resources Cont. • Hopkins Open Coursework: http://ocw.jhsph.edu/ • Qualitative course materials: o http://ocw.jhsph.edu/index.cfm/go/viewCourse/course/qualitativedataa nalysis/coursePage/index/ • Online Qual. Textbook: http://onlineqda.hud.ac.uk/Introduction/index.php
  • Resources Cont.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.