Qualitative methods are used to understand why and how things occur rather than measuring statistical significance or quantities. The document discusses qualitative research basics including developing a research question, selecting participants, and collecting and analyzing data. It provides examples of participant selection methods like maximum variation and key informants. Data collection methods covered include interviews, observation, and document review. Analysis styles like template, editing, and immersion/crystallization are also outlined. Case studies are then used to demonstrate applying these concepts.

1. Qualitative Methods for Community &
Practice-Based Research
Nancy Elder, MD, MSPH
Saundra Regan, PhD
The Intersection of Primary Care & Public Health: Practice-Based Research Workshop
2013 Ohio Practice-Based Research Festival 2.0
December 7, 2013

2. Conflict of Interest Disclosure
• We have no conflicts to report.
2013 Ohio Practice-Based Research Festival 2.0 - December 7, 2013

3. What We Will Cover
• Short didactic
– Qualitative 101
– Choosing participants
– Data collection
– Data analysis
• Structured discussion of case studies demonstrating
various qualitative techniques for participant
selection, data collection & data analysis.

4. Qualitative 101
Use qualitative research when…
you want to know why, not is it statistically significant
you want to know how come, not how many
you want to know the reasons and the understanding
you want to know what part matters, not by how
much it matters

5. Basics of qualitative research
There are many approaches to qualitative research, but
all projects contain these elements:
Participant selection
Data collection
Data analysis
Study design is driven in large part by your research
question and your research paradigm.

6. Defining the question
• This is the most important step!
• Sets the stage for all subsequent steps
• If done poorly, all your work may be for
naught

7. Asking the Right Question…
• What are you interested in?
• What knowledge gap exists?
• What do you want to do?

8. Primary Care!

9. Research
Aims

10. Where to find questions
•
•
•
•
•
Community Assessments
Clinical Questions (1999 study 3.2 questions/10 patients)
Reading, surfing, tweeting, texting
Thinking
Talking and Discussion
– Patients, friends, family, colleagues, etc.
• Questions about questions

11. Qualitative research questions…
• Quantitative research questions should be
pretty firm BEFORE data collection
– Additional questions may arise (“post hoc”)
– Strongest question is the one for which the study
was designed
• Qualitative research questions can change
during data collection
– Data collection and data analysis proceed together,
by same researchers
– If original questions are found not to be the most
important, etc., may change question

12. Choosing Participants
• Multiple methods exist
• Need to justify method used with purpose of
study
2013 Ohio Practice-Based Research Festival 2.0 - December 7, 2013

13. Choosing participants
• Maximum variation
– Seek broadest range of information and ideas
– Can ask “who thinks very differently than you?”
– Choose selection criteria theoretically diverse around topic of
interest
• Key Informants
– A cost efficient way to gain access and understanding
– Around the issue or culture being studied, these individuals are
well entrenched, active, reflective and articulate
– Usually have multiple, in-depth encounters with researcher, but
can be used for more specific purposes
• Snowball
• Purposeful
• Convenience

14. Participants in focus groups
• Look for “homogenous strangers”
– Can be “natural” group vs. just for research
– Homogenous around research topic or area
• Age, gender, ethnicity, social status, powerfulness, etc.
– Strangers traditionally preferred, but not necessary
• Can do multiple groups
• Use skilled moderator

15. Data collection
• Data collection methods:
– Interviews
• Individual interviews
• Focus groups
– Observation and Participant/Observation
– Printed and historical documents
• primarily medical chart reviews in primary care
2013 Ohio Practice-Based Research Festival 2.0 - December 7, 2013

16. Interviews
• Unstructured
– conversation
• Semi-structured
– Focus group – more breadth on a topic
– Individual – more in-depth on a topic
• In-depth interviews, life history, critical incident, oral
history
• Structured
– Surveys/questionnaires
– Rank order methods

17. Structured interviews
• Spoken questionnaire or survey
• Appropriate when you know enough to ask
specific, quantifiable questions
• Types of questions include:
– How important is something
– How commonly does something occur
– Rank order some issues in order of importance
– How do you feel about something
– Etc.

18. Semi-structured
individual interviews
• Designed to explore areas of interest to
investigator
– Guided, focused, concentrated and open-ended
– Co-created by investigator and interviewee
• Uses an interview guide
– Questions, probes and prompts
• Recording preferred
– Investigator takes brief notes, later expands
– Audiotape less expensive, less intrusive than video
– Recording can be transcribed for analysis

19. Choosing a semi-structured individual
method
• In-Depth interviews
– Intensively explore a particular topic
• Life histories
– Personal biographies
• Oral histories
– Personal experiences of some event
• Critical incident technique
– Exploration of defining moments

20. Designing the interview guide
• What do you want to know?
• How long do you have for the interview?
• Major questions
– Begin with less sensitive questions
– Probes – delve deeper into question
– Prompts – when responses are not forthcoming
– Demographics – best at end

21. Group semi-structured interviews:
focus groups
• Definition:
A group of people (usually 6 – 12) who have
been selected because they have something in
common to share their feelings or thoughts
about an issue, product, service or idea in a
comfortable, permissive environment, led by a
skilled moderator
• “Unit of analysis” is the group
– A focus group of 8 does not equal 8 individual
interviews

22. Why use focus groups
• Works well when power differential exists
between participants and decision makers
• Can investigate complex behaviors and
motivations
• Can learn about degree of consensus on a topic
• Respectful to participants

23. Disadvantages of focus groups
• Purpose must be research
– A bunch of people talking together is not
necessarily a focus group
• Topic and participants must be appropriate for
a group discussion
• Does not supply data for statistics

24. Analysis Styles
Crabtree and Miller: three main analysis styles that are
used with the variety of research approaches:
Template
Editing
Immersion/Crystallization
2013 Ohio Practice-Based Research Festival 2.0 - December 7, 2013

25. Analysis styles: Template
• Makes use of a template or organizing codebook that
is applied to the text being analyzed
• The codebook may be a priori (before data are
collected) or a posteriori (developed during or after
data collection)
• The codebook may look for structure (like in content
analysis), ideas, phrases, etc.
• If the text reveals inadequacies in the template,
modifications and revisions are made and the text is
reexamined

26. Analysis styles: Editing
• The researcher enters the text much like an editor
searching for meaningful segments
• Once identified, these units are sorted and organized
into categories or codes
• The codebook comes directly from the analysis
• It is these categories that are explored for patterns
and themes in the connecting phase of analysis

27. Analysis styles: Immersion and crystallization
•
•
The researcher spends prolonged time with
the text, and emerges, after concerned
reflection, with an intuitive crystallization of
the data
This cycle is repeated until the reported
interpretation is reached

28. Choice of analytic/organizing style
–
–
–
–
Depends on: self-analysis, the research question and aims,
prior or emerging knowledge about the topic and the
potential audience for the research
Template style especially helpful when there is a good prior
knowledge of the topic, a clinical audience is anticipated, a
research aim is theory testing, or it is one’s aesthetic
preference
Editing and I/C styles useful when research aim is one of
exploration and/or discovery, when scant knowledge
already exists, the research is participatory or these styles
have more personal aesthetic appeal to the research team
Multiple styles can be used during the course of the
research

29. Summary
• Qualitative research:
– What is going on here?
– How can I make sense of it?
– How could it be better?
• Begins with a good research question
• Participant selection, data collection, data
analysis

30. Case Studies: Qualitative
practice based research
Work together to:
–Write a possible research question
–Select potential participants
–Explore data collection possibilities
2013 Ohio Practice-Based Research Festival 2.0 - December 7, 2013

31. Case Study
Patient Safety in Home Hospice
• How might an initial research question look?

32. Case study
Clinician-MA Teams
• Within small family medicine offices, what are
the factors that shape the clinician-MA
relationship?
• How might you select participants for this
study?
• How might you collect data for this study?

33. Case study
COPD Care Providers
• How do different providers of care to patients
with COPD perceive their role and their
relationship to other providers?
• How might you select participants for this
study?
• How might you collect data for this study?