Critical appraisal of qualitative research

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Critical appraisal of qualitative research

  1. 1. What is qualitative research? Qualitative research is a type of scientific research. In general terms, scientific research consists of an investigation that: • seeks answers to a question • systematically uses a predefined set of procedures to answer the question • collects evidence • produces findings that were not determined in advance • produces findings that are applicable Additionally, qualitative research seeks to understand a given research problem or topic from the perspectives of the local population it involves.
  2. 2. What can we learn from qualitative research?  Provides information about the “human” side of an issue – that is, the often contradictory behaviors, beliefs, opinions, emotions, and relationships of individuals.  Effective in identifying factors, such as social norms, socioeconomic status, gender roles, ethnicity, and religion, whose role in the research issue may not be readily apparent.  When used along with quantitative methods, qualitative research can help us to interpret and better understand the complex reality of a given situation and the implications of quantitative data.
  3. 3. Qualitative Methods Quantitative Methods 1. 1. Fixed response options Unstructured or semi-structured response options 2. No statistical tests 2. Statistical tests are used for analysis 3. Can be valid and reliable: largely depends on skill and rigor of the researcher 3. Can be valid and reliable: largely depends on the measurement device or instrument used 4. Time expenditure lighter on the planning end and heavier during the analysis phase 4. Time expenditure heavier on the planning phase and lighter on the analysis phase 5. Less generalizable 5. More generalizable
  4. 4.  Is the research question posed in a manner that resonate with the qualitative paradigm?  Are the Results Valid?  What Are the Results?  How Can I Apply the Results to Patient Care?
  5. 5. Example How often do breast cancer patients use drug x to treat their disease? As compared to What is the experience of breast cancer patients in the use of drug x in the management of their disease?
  6. 6. Are the Results Valid?  Was the choice of participants explicit and comprehensive?  Was data collection sufficiently comprehensive and detailed?  Were the data analyzed appropriately and the findings corroborated adequately?  Does the study adequately address potential ethical issues, including reflexivity?
  7. 7. Was the choice of participants explicit and comprehensive?  Readers of qualitative studies should look for sound reasoning describing and justifying the participant selection strategies. 1. Purposive sampling 2. Quota sampling 3. Snowball sampling  Sample size should be sufficient to achieve an adequate breadth and depth of perspective.
  8. 8. Purposive sampling  Purposive sampling groups participants according to preselected criteria relevant to a particular research question.  Sample sizes are often determined on the basis of theoretical saturation  Theoretical saturation is the point in data collection when new data no longer bring additional insights to the research questions).  Most successful when data review and analysis are done in conjunction with data collection.
  9. 9. Quota Sampling  In quota sampling, we decide while designing the study how many people with which characteristics to include as participants.  Then we go into the community and find people who fit these criteria, until we meet the prescribed quotas.  Purposive and quota sampling are similar in that they both seek to identify participants based on selected criteria.  However, quota sampling is more specific with respect to sizes and proportions of subsamples, with subgroups chosen to reflect corresponding proportions in the population.
  10. 10. Snowball sampling  Also known as chain referral sampling.  Participants or informants with whom contact has already been made use their social networks to refer the researcher to other people who could potentially participate in or contribute to the study.  Often used to find and recruit “hidden populations,” that is, groups not easily accessible to researchers through other sampling strategies.
  11. 11.  The number of observations  The duration of the study  The diversity of data collection techniques  The number of investigators  The degree of investigator involvement  All relevant people and situations should be captured.
  12. 12. Data Collection Techniques  Field observation - Direct/Indirect, - Participant/non-participant  Interviews - Semi-structured/Structured - Focus Group - In-depth  Document analysis
  13. 13. Direct vs. Indirect Field Observation 1. Direct observation by investigators themselves. 2. Indirect observation through audio or video recording. Advantage of audio or video recording: less intrusive methods of capturing data. Drawbacks of audio or video recording :  Recorders can occupy a social role and be experienced by participants as partaking in "surveillance", thus influencing participants' behavior.  Recorders' observational powers are limited by their range of operation.
  14. 14.  Direct observations are categorized into non-participant & participant observation.  Non-participant observation: the researcher stays relatively uninvolved in the social interactions she observes.  Participant-observation: the researcher is acknowledged as a part of the social setting, either as a researcher per se or as a more directly involved actor (e.g., social worker, committee member, etc.).  In both Participant non-participant observations, social setting might inadvertently influence participants' behavior.
  15. 15.  Semi-structured (most popular). open-ended, respondent-led, very detailed, inductive  Structured approaches e.g. Questionnaire:  Presuppose too much of what a respondent might say.  Don’t allow them to relate their experience in their own terms.  Can impose researchers’ pre-conceived concepts.  In-depth interviews e.g. for personal experiences on sensitive topics)  Focus groups e.g. for interpersonal dynamics and culture.
  16. 16.  Analysis of documents such as charts, journals, correspondence.  Counting specific content elements (e.g. particular words)  Interpreting text (e.g. differences in meanings and considering contexts)
  17. 17. Were the data analyzed appropriately and the findings corroborated adequately?  Continuous process starting from data collection  Transcribed in textual format  Systematic – identify major recurrent themes; Sorted, coded, organised into categories – ‘thematic framework’  Examine and chart themes –record and theorise emergent trends & associations  Independent analysis
  18. 18. Were the data analyzed appropriately and the findings corroborated adequately? Member Checking (Respondent Validation) involves sharing draft study findings with the participants, to inquire:  Whether their viewpoints were faithfully interpreted  Whether there are gross errors of fact  Whether the account makes sense to participants with different perspectives. Triangulation of findings: means that findings are corroborated using multiple sources of information
  19. 19.  Information triangulation Key findings are corroborated using multiple sources of information  Investigators triangulation requires more than one investigator to collect and analyze the raw data, such that the findings emerge through consensus between investigators.  Theory triangulation is a process whereby emergent findings are corroborated with existing social science theories.
  20. 20. Does the study adequately address potential ethical issues, including reflexivity?  Respect for persons  Informed consent (written/oral)  Autonomy  Confidentiality  Beneficence  Justice  Respect for communities
  21. 21. Reflexivity  Reflexivity: recognition of the influence a researcher brings to the research process.  Reflexivity highlights potential power relationships between the researcher and research participants that might shape the data being collected.  Reflexivity acknowledges how a researcher’s gender, ethnic background, profession, and social status influence the choices made within the study, such as the research question itself and the methods of data collection.
  22. 22.  Results should provide enough descriptive details to evoke a vivid picture of a social setting or interactions studied  Key findings should be illustrated with data excerpts
  23. 23. How can I apply the results to patient care?  Can I transfer the results of this study to my own setting? Generalizability / Transferability  Will the results of this study help me care for patients?
  24. 24. Can I transfer the results of this study to my own setting?  Though the study should discuss the extent of the findings’ resonance with the published literature, much of the burden of assessing transferability is left to readers.  The reader must decide if the setting of the study is sufficiently similar for its results to be transferable to their own context.  Transferability may be helped by the study’s discussion of how its results advance theoretical understandings that are relevant to multiple situations. e.g. a study of patients’ preferences in palliative care may contribute to theories of ethics and humanity in medicine, thus suggesting relevance to other clinical situations such as the informed consent exchange before treatment.
  25. 25.  Does the study help me understand the context of my practice? Does the study provide a useful road map for readers to understand and navigate similar social settings themselves?  Does the study help me understand my relationships with patients and their families? Does the research offer clinicians an understanding of roles, relationships and communication among patients, families and caregivers?

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