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Qualitative research methods
workshop
"Qualitative research aims to provide us with a rich
understanding of people's lived experiences and perspectives,
situated within the context of their particular circumstances and
settings" (Murphy et al. 1998).
• Familiarization with common qualitative research designs and
methods
• Assist the participants in developing the aim, design,
methods, tools and analysis plans for a qualitative sub-study.
• At the end of the workshop students should be able to:
– Explain when to use what methods, and their advantages and
disadvantages (SAT)
– Select appropriate sampling strategies and determine sample sizes
(SUN)
– Develop a guide using open ended questions in the most appropriate
order (MON)
– Use appropriate probing and facilitation skills in interviews and focus
groups (MON)
– Understand issues with transcribing and translating interviews and
FGDs (MON)
– Understand quality assurance in qualitative research and identify
things that may improve or hinder quality (TUE)
– Identify different approaches to analysis (TUE)
Selecting methods: Advantages and
disadvantages
1. In-depth interviews
2. Focus groups
3. Observations
In teams make a list of the ways an in-depth interview is similar
and a list of how in-depth interviews are different from a
conversation
Similarities
• 2 people discussing a topic of mutual interest in a relaxed and
open way
• Flexible and free flowing
Differences
• Interviewer directed to get as much relevant info as possible
and to ensure all topics are covered
• Question, response, probe
• Respondent opens up to a stranger who divulges little about
themselves
• Confidential and de-identified
• Power dynamics
In your teams work together to define a focus group and list their
unique properties
• Organized and focused discussion among 6-12 people
• Guided by a moderator in a permissive and non-threatening
environment
• Group interaction help participants explore and clarify their views
and encourage participation
• Interactions help clarify similarities and differences in
opinions/values
• Interaction are part of the research data: jokes, anecdotes, arguing
tell us a lot
• Participants are not asked questions in turn, rather encouraged to:
ask questions, exchange anecdotes, comment on views and
experiences
1. Describe what you think is the best use of IDIs and FGDs
2. Name 2 advantages and 2 disadvantages of each method
Method Main use
IDIs Understanding personal perspectives and experiences and
linking concepts at an individual level
FGDs Understanding social norms, dominant cultural values,
group opinions
Testing concepts and materials
Observation Understanding behaviors in their physical, social and
economic context
Advantages Disadvantages
• Can explore complex and
detailed issues
• Good for high volume issues
• Opportunity for probing and
clarifying questions
• One on one enhances rapport
• Time consuming and can result in
large volumes of data
• Interviewer must have good listening
and probing skills
• Respondent may want to please
interviewer
Advantages Disadvantages
• Gets information quickly and
cheaply
• Good for ‘low volume’ issues
• Group interaction can
stimulate response
• Peer pressure can challenge
thinking
• Good at identifying content
that do or do not resonate
• Cannot explore complex or detailed
issues
• Respondents may be concerned
about anonymity
• Responses influenced by peers
• Some participants may dominate,
others may not speak
• May not be suitable for sensitive
topics
• Skilled moderator required
• Can be logistically difficult
• Writing up from audio can be
difficult
Read the excerpts from the paper on FGD research. As you read
think about the following
1. What are the key points the paper is making
2. Do you think these points are relevant to the Ethiopian
situation – why/why not?
3. What is positionality
4. What are the conversational norms in Ethiopia, are they
different for men and women?
5. How might the Ethiopian cultural context affect the conduct of
a FGD? What modifications might be needed?
6. What is reflexivity and why is it important
Sampling approach size and
recruitment
• Stem logically from the research question- strategic and
thoughtful
• Focus on depth rather than generalizability
• Iterative
• Feasible
• Ethical
• Describe it in your research papers
• Most often need to think about selection of communities and of
respondents
• Standard criteria:
 ‘‘Good’’ and information rich informant: Articulate, reflective,
and willing to share
• Choices:
 Convenience- Select easily accessible subject
 Theoretical sampling: Analyse as you go along and adjust
sampling based on the findings, sampling controlled by
emerging theory
 Purposive- Select based on researchers judgement of who will
be information rich/useful
• Do not focus too much on names and definitions think about what
each type of sampling gives you and how this would help you
answer your questions
1. Give and example of a convenience sample
2. Discuss the advantages of convenience sampling
Advantages
• Cheap, fast and easy
Disadvantages
• May get information poor cases
• Least legitimate
Element of convenience sampling in all qualitative research but
needs to be done within a thoughtful and justifiable approach
to sampling
– Quota – A range or certain number of respondents with certain
characteristics that may influence responses/outcomes to
facilitate comparison
– Maximum variation – Broadest range possible to identify
common patterns that cut across variations and emerge out of
heterogeneity
– Extreme/Deviant – Sample outliers so can learn from an unusual
manifestations of phenomena of interest
– Intensity sampling: Sample those who manifest the phenomenon
intensely, but not extremely a the extremes may be too unusual
– Confirming and disconfirming – include people with expected and
exceptional outcomes to test variations and emerging trends in
the data – done in later stages of data collection
– Criterion- Those who meet specific criteria of importance
– Critical case – Decisive cases to allow test hypothesise and allow
generalization to other cases as if it's true of this case it's likely to
be true of others
– Typical case – An average person with no unusual characteristics
to highlight what is typical, normal or average
– Homogeneous – respondents have similar background and
experiences to describe a sub group in depth
– Deviant/Extreme sampling:
 Community health workers representing those having the
highest and lowest motivation scores
 Men who do not beat their wives in a culture where wife
abuse is culturally accepted
– Intensity sampling:
 Mothers who received above and below average number of
visits from community health workers
 Communities near and far from a facility but not the
extremes
– Maximum diversity:
 Women with a range of SES and education levels, parities
and ethnicities
 Communities with a range of ethnic or religious affiliations
– Criterion: Mothers who followed referral advice for their
newborn and did not receive treatment
– Typical case: Average communities
• Snowball
• Gatekeepers/key informants
• Key locations
• Adverts/flyers
• Networks
• Quantitative surveys
• Tally sheet
• Should be based on the concept of saturation:
 Theoretical: no new data, or themes/codes and the ability to
replicate
 Practical: diminishing returns’ from further data-collection i.e.
sufficient conceptual depth
• Very little written about sample size and no empirical reasons
given when sizes are given
• Rule of thumb
 Range from 20-50 interviews and 2-5 FGDs per category
 Some say that for interviews 15 is the smallest acceptable
and that >50 is too many
• Generally sample size depends on the level of homogeneity of
the sample, the complexity of the research and the quality of the
interviews
• Too large a sample is as harmful as too small as it reduces the
quality of the analysis.
• You are interested in understanding women's experiences with
long lasting injectable family planning in a Woreda. You think
there may be important differences in experiences for women
by parity and education
1. Describe the sampling criteria for your communities and the
women
2. Describe how you would identify and approach the women
3. How would you determine sample size for planning purposes
4. How will you know when saturation is reached
• Write down your research aims and objectives
• Where you plan to collect data
• Who you will sample and why
• How you will sample them
Getting good data from respondents:
interviews
Respondent 2: Are we not going?
Facilitator: We are only left with two questions.
Respondent 2: In Christ’s sake
Respondent 3: It is getting late
Respondent 1: We have already discussed on it. You are
asking repeatedly.
Facilitator: It is not a repeated question. Earlier we have
disused on the most important and less important behaviors.
Now I am asking you about what the Health workers
promote and encourage you to do and do not
F: Tell me about the birth of X
R: The strong labor pain started around 9:30 pm, when I felt the strong
labor pain I lie down on the floor….….
F: ummm
R: It is normal to call HEWs during labor, the usual practice is when a
mother felt labor pain, she immediately call HEW, then they call an
ambulance and the mother will be taken to the health center, this is
what they advise us to do while they are coming here.
F: It’s normal to call them
R: We have to call them as traditional birth attendants are not allowed
to attend in any delivery; they are not also willing to attend any delivery.
It is forbidden by the health facility and the Health extension worker.
HEWS advise every member of the community to deliver at the health
center, all people are advised by HEWs, we are told that traditional birth
attendants are not allowed to attend in any delivery, they are not also
willing to attend the delivery…
F: After M was delivered was anything other than breast-milk given for
the baby to take?
R: nothing was given
F: what of water
R: [moves closer, …whispers]…I gave water of the third day but I did not
give again after that…… I am confused with the advise I am getting,
some of my friends say give, some say do not give….. I want to follow
the HEW advice, it’s just that sometimes when you see a child crying,
you will feel like to take the water and give them thinking they are feeling
thirsty. But they said the breast milk is enough for him. Is it true? I am
confused
F: Tell me more about what you have heard
R: The HEW and the HDA told me that breast milk contains water, but I
talked to my neighbor who said my baby is crying because she is thirsty.
When I gave the water she stopped but I am afraid to give it again in
case the HEW hears of it and comes to shout at me. If the baby keeps
crying I don’t know what I will do. I don't want the neighbors to think I am
a bad mother but I don’t want the HEW to be angry.
F: Who makes decisions about the newborn in the household?
R2: It is the responsibility of the mother.
F-Tell me more
R2: The mother is the one who took the lesson from the HEW,
mother in law used to make decisions but now, they should give the
responsibility to the mother, it is the mother’s turn now.
R1:The grandmother could still give advice to the mother, she could
talk both the current and the past experiences, but the mother can
say I won’t accept this because I have been given education, they
could accept it or don’t accept it because they have been educated
by the HEW
R2: Yes we are the ones who know more, we have been educated
F: I want you to name all those things that make women to gave birth at home,
Ok lets start talking
R3: Lack of understanding of the reason for going to the hospital,
F: Okay what else?
R2: Lack of the husband’s permission, lack of transport, accessible road
R3: Attitudes of hospital workers, Like us here, in our hospitals, the doctors
don't sleep here.
F: Okay, what next? Why do women give birth at home?
R3: Some of the women are just too stubborn. Some of the women, you will be
persuading them, but there stubbornness will not allow them
R2: Some from the order of the mother in law, who will say I don't deserve this
embarrassment, how can a woman in my house not deliver in my hands?
R5: Sometimes the husband is willing to invite the TBA but his mother would
refuse him. Sometimes the closure of hospital facilities at night is a big problem
R3: No, it is not that hospital don't open at night but doctors don't stay till night
R2: Even me as CHW during the delivery of this my baby, we came to the
hospital, nobody was around and that's how we went back home to deliver, and
they hospital staff came back to quarrel me that why did I give birth at home
F=What changes have you seen in how newborns are cared for since
you started work?
R3=Previously families gave newborns butter to swallow, and bathed
the baby immediately they were delivered; but now that is avoided.
This is because the mothers have delivery preparation training. We
also have discussion with the mothers in law and also the family
members and thus we are seeing lots of changes.
R4= Yes our work is changing things, but our people do not change
overnight; you have to tell things over and over again. So starting from
the time when she knows that she is pregnant, we give her health
education, I give it, the HDA gives it and those at the health center
give it. Then the people become convinced.
What do we want from an interview?
• Relevant, truthful and detailed information.
• For this the respondent must:
1. Understand the purpose of the interview
2. Be interested in the interview
3. Feel comfortable and able to open up
4. Be asked the right questions
5. Be encouraged to talk and elaborate
6. Not deviate from the topic
What do we want from an interview?
• Interviewer must be:
1. Open minded
2. Flexible and responsive
3. Patient
3. Observant – remembers what has been said
4. Good listener and empathetic
5. Curious but gentle
6. Able to put people at ease
7. Knowledgeable
8. Critical –prepared to challenge
9. Ethically sensitive
• Who will your audience open up to?
• Select interviewers based on their skills/potential skills
• Make interviewers investigators rather than data collectors.
 Understand the intent of the questions
 Make interviewers passionate
 Hold reflection meetings
 Conduct pre-analysis
• Give timely and regular feedback and make adjustments to data
collection.
• Spend time in the field to understand context and support
interviewers.
Discuss the advantages and disadvantages of the following
1. You are doing a study to explore barriers and facilitators to
exclusive breastfeeding, you have asked the HEW to locate and
introduce you to women who delivered within the last year.
2. A young childless women versus a multiparous women collecting
data on child birth practices
3. A university lecturer versus a community member colleting data
on newborn illness
4. The use of a translator during a focus group vs recruiting a local
language speaker
Ensure respondents understands the purpose
of the interview
• Explain at the start that you want to know about their thoughts
and opinions in their own words
• Be sensitive about things like informed consent
• Explain that there are no correct answer to the questions and
that you want to learn from them - and mean it
• Be clear who you are and who you are not
Ensure respondents are interested in the
interview
• Select respondents who have information to give and are willing
to give it, if respondents know little politely end the interview
• Be enthusiastic, lively, humorous and show interest
• Show commitment: Arrive on time, be prepared and familiar with
all documentation, turn cell phones off and out of view, keep any
promises
• Observe non-verbal communication
– Be aware of your own tone of voice, facial expression and
body language and those of the participants
Good body language can include
• Sitting squarely facing the person you are listening to
• Leaning slightly toward the person to demonstrate interest in
what they are saying
• Maintaining eye contact as appropriate
• Maintaining a relaxed and open position to show you are at ease
with them - arms should not be crossed.
• Nodding the head
Respondents must feel comfortable and
able to open up
• Assure informants of confidentiality and anonymity
• Explain what will happen (e.g note taking)
• Choose a location which is neutral, sufficiently quiet and where
there will be no disturbances
• Build rapport: Be unthreatening, relaxed, humble, patient, non
judgmental, supportive and listen
• Use appropriate greetings and clothing
• Use words and phrases that give the respondent ‘permission’ to
talk
• Use appropriate seating arrangements
• We are going to look at some pictures that show an in-depth
interview
• Turn to your neighbour and comment on what you think of the
physical environment and comment on the interviewer and
respondent body language.
• List culturally appropriate ways to put someone at ease from the beginning to
the end of an interview. Address the following:
– How should you start the interaction?
– What could you say or do initially to make the participant feel relaxed?
– What could you say or do if the conversation becomes tense or boring?
– What would make a participant feel that he or she could trust you?
– What parting words or behaviours will help the participant leave feeling
they had a positive interview experience?
• List things an interviewer might do that would be offensive to a participant or
that would discourage the participant from speaking freely.
– What would make someone feel uncomfortable? Offended? Hurt? Angry?
– What kind of clothing would express disrespect for the participant in this
culture?
– What kinds of culturally specific words or gestures would convey
interviewer bias?
Exercise
• Open ended and non leading
• The list of questions is only a ‘guide’:
– If the respondent doesn't respond well to one of the
questions ask it in a different way
– if it makes sense to change the order of topics do so
– If an interesting & relevant issue comes up explore it
– Use knowledge from one interview to feed into the next.
• Conduct analysis in every interview:
– Does this response confirm something I already know?
– If not, Am I understanding the response? Exactly how does it
differ?
– Can I probe to see why there is a difference in the response?
Ask the respondents the right questions
• Content mapping and content mining
• Descriptive: Can you describe what happened to the baby after the
placenta came out?
• Contrast: You said that mothers take special care of babies that
come early what about babies born small? …..
• Check perspective: You said you were very happy with your care
after delivery but was there anything that fell short of your
expectations?’
• Projective questions: e.g. vignettes, asking about 'others'
Some useful ways of asking questions
• Direct questions (best at end so not too directive): Are you happy
with the way you and your husband decide how money should be
spent?’ Such questions are perhaps best left until
• Indirect questions: ‘What do most people round here think of the
ways that health workers treat patients?’ ‘Is that the way you feel
too?’,
• Specifying questions: ‘What did you do then?’; ‘How did X react to
what you said?’
• Interpreting questions: ‘Do you mean that your role has had to
change from one of encouraging others to a more directive one?’
• Top-of-mind: What’s the first thing that comes to mind I say ‘skin to
skin’?
• Querying the obvious. What does “starting breastfeeding” mean to
you?
Use a variety of questions
• Start with thematizing
• Use literature and theory do identify themes if appropriate
• Develop questions for each area/theme that will tap into
respondent's experiences and/or perceptions
• Limit to about 15 main questions
• Pilot
How to write a guide
• First question should put respondent at ease and be an opener –
easy to answer and not too long
• Use open ended and non-leading questions
• Order questions logically – factual before opinion
General to specific
“What activities were conducted?” before “What did you think
of the activities?”
• Use short, simple and clear questions that make no assumptions
and lead to long answers
• Carefully consider hypothetical questions – think back not to the
future
• Ask how rather than why questions 'How did you come to join this
training'
• Write in local and appropriate language
• End with 'is there anything else you would like to tell me?' and
leave the respondent feeling positive
How to write a guide
• What did you think of the program?
• How did you feel about the conference?
• Where do you get new information?
• What do you like best about the proposed program?
Good questions
In groups of three comment on and re write the following questions
1. What fears would you have if your baby was born small?
2. What actions do you take to stop his/her diarrhea?
3. Was the treatment your baby got at the health center good?
4. Do you know about the clinic’s services?”
Group exercises
Respondents should be encouraged to talk
and elaborate through probing
• Stimulate respondent to provide more information:
– Silence
– ‘Nod’, ‘I see’ or ‘uh-hu’
– Reflect: Repeat the last thing the respondent said to show
attention
– Paraphrase
– Be empathetic ‘I can see why that was difficult…’
– Act like you already have some knowledge ‘I heard around
here’
Respondents should be encouraged to talk
and elaborate through probing
• Stimulate respondent to provide more information:
– Give compliments to encourage the informant to carry on
– Act like you are confused to indicate that more information is
needed
– Show understanding so the informant knows their information
is understood and treasured
– Make small steps in questioning not big leaps
– Ask for more detail: Could you say more about….Can you give
me an example…what happened then….. How did you feel……
I am not sure I understand….What was it exactly that
you…What gave you that impression… How did you respond…
What effect did that have… What makes you say that
• Do not overuse why questions
• Don’t be afraid of silence but don’t let it get awkward:
– Informants need time to reflect, gather thoughts and prepare
to say something
– Try not to comment on everything that is said and avoid a
question and answer session
“The key to successful interviewing is learning how to probe effectively…that
is, to stimulate an informant to produce more information…without injecting
yourself so much into the interaction that you only get a reflection of yourself
in the data.” (Bernard, 1995)
Group exercise
1. Write out the main themes/topics for your main IDI
2. For your first theme write 5 questions
Interview 1:
Edward: What are the biggest health problems for children in this community?
Mother: Well there’s not enough food to eat...
Edward: Where I come from, measles is a big problem. Is measles a big problem here?
Mother: Yes. Children here sometimes get measles.
Edward: And diarrhea. Do children here get diarrhea?
Mother: Yes. Children around here get a lot of diarrhea.
Edward: And tetanus. In some countries tetanus is a big problem. Is tetanus a problem
here?
Mother: Sometimes a child will get tetanus after it is born.
Edward: So the main problems here are measles, diarrhea and tetanus
Interview 2:
Edward: What are the biggest health problems for children in this community?
Mother: Well, there’s not enough food for children to eat...
Edward: Uh huh.
Mother: They also get malaria a lot at some times of the year (silence).
Edward: So, children don’t have enough food to eat, and they get malaria a lot at
some times of the year. What other health problems do children in the community get?
Mother: Children get chest problems with coughing and trouble breathing. Often they die
from this.
Injecting yourself in the interview
Conducting a FGD
Steps in conducting a focus group
• Step 1: Recruit participants
• Step 2: Arrange the venue to encourage interaction
• Step 3: Conduct the session
• Step 4: Write up and analyze the results
Step 1: Recruit participants
• There should be between 8-10 people per group
• Participants should have a similar background as this will
facilitate discussion
• We often rely on ‘key informants’ to select participants, they
should:
– Understand the purpose and process of the FGD,
– Select talkative people with a range of views
– Invite participants at least a day or two in advance
– Explain the general purpose of the group to potential
participants
Step 2: Arrange the venue to encourage
interaction
• Choose a location which is neutral, sufficiently quiet, easy to
get to, not too hot and where there will be no disturbances
• Arrange the chairs in a circle
• Separate friends to avoid side conversations
Step 3: Conduct the session
• One of the members of the research team acts as a
‘facilitator’ and the other as a recorder
• The facilitator should preferably be similar to the participants
e.g same sex roughly same age
The facilitator
The facilitator:
1) Introduces the session
– Introduces themselves and the recorder
– Lets the participants introduce themselves
– Puts the participants at ease – use ice breaker if
appropriate
– Explains the purpose of the FGD, the rules of the FGD
and how the information will be used
– Ask for confidentiality
– Asks permission to use a tape recorder and to take notes
FGD rules (can ask participants to do)
 No right or wrong answers, only differing points of view
 We're tape recording, one person speaking at a time
 We're on a first name basis
 You don't need to agree with others, but you must listen
respectfully as others share their views
 Turn off your phones. If you cannot and if you must respond
to a call, please do so as quietly as possible and rejoin us as
quickly as you can.
 My role as moderator will be to guide the discussion
 Talk to each other
2) Encourages discussion
• Be enthusiastic, lively, humorous and show interest
• Show your commitment: Arrive on time, be prepared and
familiar with all documentation, turn cell phones off and out
of view, keep any promises
• Builds rapport with and between participants: Unthreatening,
relaxed, humble, patient, non judgmental, supportive and
listen
• Be aware of non-verbal communication
• Re-orients the discussion when it goes off track ‘Interesting
point but how about’
• Use exercises if appropriate
• Changes question order and rephrases if needed
3) Avoids a question and answer session:
– Asks for clarification ‘can you tell me more about…?’
– Does not to comment on everything that is said, if there is
a pause waits and see what happens
– Limits their own participation when discussions begin
– Using one persons response to involve another person
• Gloria said…. But how about you Mary?
• Does anyone else have an example of that?
• Does anyone have a different experience?
– Links ideas ‘what you are describing sounds similar to…..’
– Gives time for general discussions ‘are there any other
issues…’
4) Unobtrusively controls the rhythm of the group
– Subtly control the time allocated to each topic to maintain
interest
– Subtly move the discussion from topic to topic
– If participants change topic let them continue incase
useful information surfaces, then summarize the main
points & re-orient the discussion
– Deals with dominant participants by avoiding eye contact,
moving, away slightly, thanking the participant and
changing topic
– Deals with reluctant participants by using their name,
requesting their opinion, making more frequent eye
contact and thanking them when they talk
5) Takes time at the end of the meeting to summarize,
and thank the participants
– Summarize the main issues, check for agreement and
ask for additional comments
– Thank the participants and let them know their ideas were
useful
– Listen for additional comments and discussions that occur
after the meeting including during any refreshment
sessions
The recorder
The recorder
• Keeps a record of:
– Date, time, place
– Names and characteristics of participants
– Description of group dynamics
It is useful to map the respondents:
The recorder
• Is responsible for tape recording the FGD.
– Find a good place to place the recorder before the focus
group and do a short test recording.
– Ensure you have adequate supplies and spares.
– Listen to the recording immediately after the interview. If it
malfunctioned sit with the facilitator and add more detail
to your field notes.
The recorder
• Takes field notes (see narrative slides for more tips
– Give each participant a code (p1, p2).
– Take notes of who said what, even if it is a repeat of what
was said before.
– Include what the facilitator said (prefix by F and put in
bold).
– Capture the ‘voice’ of the respondents.
– Record non verbal communication (e.g majority nodded
their head in agreement).
– Describes of group dynamics and write comments (did
the participants seem rushed, how did they react to the
facilitator, were some participants dominant).
The recorder
• Help resolve conflict situations that the facilitator finds difficult
to handle
Translating and transcribing
Fieldnotes
• They can be in any language using your own shorthand. Use
abbreviations and acronyms.
• Use key words and phrases that will trigger your memory when you
expand notes.
• Note body language, attitudes, the general environment and other
relevant information.
• Note taking should not detract from the rapport of the interview.
• Fieldnotes should be written in a bound notebook and kept safe.
• Do not write down the participants name in the notebook.
• A single sheet written by interviewer summarizing main themes,
ideas, comparison to other interviews or FGDs, areas to focus on
in next contact
• Comments on the interviews
• Uses
• Encourages reflection and planning
• Gives supervisors something to read if interview will be
transcribed later
• Basis for data analysis
• Reminder of the contact at a later date
Summary sheets
• Interviewer takes notes and records. Verbatim write up using
the notes as a back up and to add contextual information.
• Interviewer takes notes and records and expands notes as soon
as possible using the recording to check content/and or add
quotes.
• Interviewer takes notes during interview and expands them as
soon as possible.
• Whichever option agree the format and conventions for labeling
files and writing up in advance.
Options for writing up
Stay true to the participants words
• The participant said: “Men like me should be responsible for the
well-being of our families. We should support our wives when they
want to go to the family planning clinic.”
• Which of the expanded notes below is better and why?
1. Men should take care of their families and let their wives visit
the clinic whenever they want to.
2. Men should be responsible for families’ well-being and
support wives when they want to go to the family planning
clinic.
Advantages Disadvantages
• Captures respondents
language and responses most
accurately
• Brings researchers closer to
their data
• Allows for nuanced analysis
• Gold standard
• Allows for quality assurance
• Transcription often delayed resulting
in delayed feedback
• Transcription errors common
especially if transcription not done
by interviewer
• Transcription and analysis is time
consuming which increases costs.
• Relies on clear recordings
Advantages Disadvantages
• Reduces write up and analysis
time and cost
• Encourages reflection
• Allows rapid feedback
• Loose the voice of the respondent
• Written through the interviewer
eyes
• Requires conscientious fieldworkers
and initially intensive supervision
Common expanded note mistakes:
• Interviewer presents only a few highlights or main points
from the interview, and fails to give details.
• The expanded notes do not include any verbatim quotations,
are not in the local language, or have no explanations for
special or unusual information.
• The interviewer fails to present the flow of the interview and
tries to organize all the information about a particular point
into a summary paragraph.
• The notes are all written in the third person, so the ‘voice of
the informant’ is totally missing.
Methods of data analysis
Introduction to analysis
• Qualitative analysis revolves around discerning, examining,
comparing and contrasting, and interpreting meaningful patterns or
themes
• Few universal rules or standard procedures
• Analysis starts during the interview, through reflection and
debriefings and during transcription
Step 1: Think about your research question and
analysis perspective
Slide from ACT consortium
Step 2: Get to know your data
1. Knowing your data is key for a high quality analysis. Read and re-
read transcripts.
2. As you read
 Note down your initial impressions and thoughts – these can
be useful later on.
 Think about the quality and the limitations of the data. Are
there likely to be any reporting biases? Note down any issues
as this will help ensure that you do not over interpret the
data.
 Think if you are likely to have any biases in interpreting the
data? This reflexivity is an important part of qualitative
analysis.
95
Step 2: Code your data
• Pre-set codes if appropriate (e.g using interim-analysis data,
research questions)
• Code only relevant text by using the Auerbach and Silverstein (2003),
criteria:
 Does the text relate to your research concern?
 Does it help you to understand your participants better?
Does it clarify your thinking?
 Does it simply seem important, even if you can’t say why?
• Read the transcript line by and apply relevant codes
 Descriptive: based on the specific research question
 Analytical: the underlying meaning/concepts behind the
responses
 Theoretical: Cross cutting constructs such as women’s
empowerment, self efficacy
Step 4: Identify patterns and connections
• As you code themes will begin to emerge:
• You may begin to see patterns and connections within and
between your codes
 Two concepts may always occur together (connection
between codes).
 A concepts may vary by respondent characteristics (patterns
within a code).
• It can be useful to think about ‘doers and non-doers’, critical cases
etc
• Patterns and connections can be captured in a memo/note.
97
Analytic induction
• The researcher examines a set of cases, develops hypotheses or
constructs and examines further cases to 'test' findings.
98
Note: Be flexible
• Group codes on the same topic into themes and sub themes
• Delete, merge or add codes as needed
• Too few or too many codes usually means you need to rethink
your coding.
99
Step 5: Weigh the findings
1. Identify which themes are key and which are lesser themes.
 Total number of times a theme appears
 Total number of respondents with the theme
 Total number of respondent groups with the theme
 Level of detail and spontaneity of the response
 Intensity of response
 Specific or experiential responses given more weight
 Whether described with active verbs ‘did or does’
versus ‘should or could’
100
Framework analysis
1. Case and theme based approach
2. Matrix display which aids question focused analysis and allows
easy sharing of the analysis
3. Allows you to look across rows which helps maintain the context
and down columns which aids development of themes
101
Slide from QSR Natcen learniung
Rigour in analysis
1. Challenge your coding: look for possible alternative explanations,
look for and understand negative cases
2. Focus on interpretation and not robotic coding
3. Triangulation
4. If you are using multiple coders
 Initially code together
 Then code the same transcript separately (consensus coding)
and discuss differences. Continue until coding is similar.
 Develop a code book
5. If using a single coder have some coding peer reviewed
6. Discuss codes with colleagues and give feedback
7. Be careful with data management to ensure your codes can be traced
back to the original transcript
8. Reflexivity
9. Comparison with other findings
10. Feedback from participants – member checking
103
The logistics of coding
Cut and paste: manual
106
Cut and paste into word or excel
Theme
Motivation
 Bringing health to the community and doing something important (8, 11, 12, 13)
‘The distance[to the facility] is very long so I realize it was an opportunity for me to serve the
community…..such a strategy would reduce on deaths among people especially children and this
prompted him to serve the community’ (12, basic, rural, poor network coverage, no supervision)
‘The desire to change people’s lives is what drives me’ (8, basic, urban, good network 5km from
supervising facility)
‘Because of the free support we get from government in form of free drugs, we cannot waste this
opportunity by refusing to volunteer. There is a strong desire to help others since government helps
us with free drugs”’ (11, basic, rural, poor network, no supervision)
 Becoming more knowledgeable (8,13)
‘The kind of information I would like to receive is anything that contributes to VHT knowledge…
such information is motivating to me and helps me like my work’ (8, basic, urban, good network
5km from supervising facility)
 Community showing trust and respect (11,13)
‘When I explain to the community and they respond to what I have told them, I feel happy ….. it
shows they can trust and follow my words.’ (13, basic, rural, poor network coverage, 4 miles from
supervising facility)
107
Sub -themes Emerging issues Evidence
Appetite in early
Pregnancy
Inability to eat in early pregnancy
 Women lose appetite in the first 4 months
of pregnancy (nausea/ vomiting) [E2]
 Food intake decreases in early pregnancy
[U]
 Vomiting, weakness, headache, are
common problems during first 3 months of
pregnancy.[EU]
 Women take herbal tea for nausea. [E]
‘ In the initial 3 months i
had vomiting and could
not retain any food”
IDIPME050911.1;5
“I do not feel hungry
and have vomiting as
well” (3 months preg)
IDIPME070911.1;3
108
Cluster: Fear
Theme: Participant File: Quote: Page:
Fear of illness 238 “…but I’m like switched out,
there’s nothing left. I’m living
this close to fear right now, it’s
always right there.”
p. 6
76 “What’s going on, I can’t leave
y’all alone for five minutes
everybody is dropping off of
here. They said you know they
were sick, and I said to myself,
well I’m sick too…damn that
could happen to me.’ Seeing
other people get sick obviously
worried and scared Debbie.
She is afraid that the same
thing is going to happen to
her.”
p. 11
Fear of treatment 76 “Debbie [didn’t want] to eat so
[she was] not taking her
medicine for fear of getting the
shocks.”
p. 10
153 “James…found beginning care
hard, and frightening. ‘That
place [HOP] scared the hell out
of me…I felt very threatened by
the building, threatened by the
fact that I knew I had this
illness that I had to go to this
clinic to get help, and very
threatened by the people I was
p. 3 - 4
109
Use an analysis package
110
Advantages and disadvantages if analysis package
Slide from Kodish 2012
Quality
112
1. Reflexivity – including field diaries, debriefs
2. Saturation
3. Triangulation (data – multiple sources; method; investigator
– analysis)
4. Transparent and systematic
5. Explore deviant or negative cases
6. Peer review
7. Multiple data coders
8. Thick descriptions of context and participants -
transferability
9. Prolonged engagement in study site and with data
10.Careful selection of quotes
References:
1. USAID: Training in qualitative research methods: building the capacity of pvo, ngo, and
moh partners
2. Mack et al (2005) Qualitative Research Methods: a data collector’s field guide FHI
3. de Negri, B. & Thomas, E. (2003). Making Sense of Focus Group Findings: A
Systematic Participatory Analysis Approach. Washington, DC: Academy for Educational
Development.
4. WHO: Guidelines for formative research for interventions to improve care of newborns
(DRAFT)
5. The Handbook for Excellence in Focus Group Research, Mary Debus, AED
6. Chandler (2009) The ACT consortium manual for qualitative data analysis
7. Creswell JW. Qualitative inquiry and research design: choosing among five
approaches. 2nd ed. Thousand Oaks: Sage Publications, 2007.
8. RAND Corporation Data Collection Methods. Semi-Structured Interviews and Focus
Groups Training Manual
9. O’Sullivan, G.A., Yonkler, J.A., Morgan, W., and Merritt, A.P. A Field Guide to Designing
a Health Communication Strategy, Baltimore, MD: Johns Hopkins Bloomberg School of
Public Health/Center for Communication Programs, March 2003.
10. Kodish S (2012) Systematic data analysis in qualitative health research. Site and life; 25: 2.

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Day four qualitative workshop presentation

  • 1. Qualitative research methods workshop "Qualitative research aims to provide us with a rich understanding of people's lived experiences and perspectives, situated within the context of their particular circumstances and settings" (Murphy et al. 1998).
  • 2. • Familiarization with common qualitative research designs and methods • Assist the participants in developing the aim, design, methods, tools and analysis plans for a qualitative sub-study.
  • 3. • At the end of the workshop students should be able to: – Explain when to use what methods, and their advantages and disadvantages (SAT) – Select appropriate sampling strategies and determine sample sizes (SUN) – Develop a guide using open ended questions in the most appropriate order (MON) – Use appropriate probing and facilitation skills in interviews and focus groups (MON) – Understand issues with transcribing and translating interviews and FGDs (MON) – Understand quality assurance in qualitative research and identify things that may improve or hinder quality (TUE) – Identify different approaches to analysis (TUE)
  • 4. Selecting methods: Advantages and disadvantages
  • 5. 1. In-depth interviews 2. Focus groups 3. Observations
  • 6. In teams make a list of the ways an in-depth interview is similar and a list of how in-depth interviews are different from a conversation
  • 7. Similarities • 2 people discussing a topic of mutual interest in a relaxed and open way • Flexible and free flowing Differences • Interviewer directed to get as much relevant info as possible and to ensure all topics are covered • Question, response, probe • Respondent opens up to a stranger who divulges little about themselves • Confidential and de-identified • Power dynamics
  • 8. In your teams work together to define a focus group and list their unique properties
  • 9. • Organized and focused discussion among 6-12 people • Guided by a moderator in a permissive and non-threatening environment • Group interaction help participants explore and clarify their views and encourage participation • Interactions help clarify similarities and differences in opinions/values • Interaction are part of the research data: jokes, anecdotes, arguing tell us a lot • Participants are not asked questions in turn, rather encouraged to: ask questions, exchange anecdotes, comment on views and experiences
  • 10. 1. Describe what you think is the best use of IDIs and FGDs 2. Name 2 advantages and 2 disadvantages of each method
  • 11. Method Main use IDIs Understanding personal perspectives and experiences and linking concepts at an individual level FGDs Understanding social norms, dominant cultural values, group opinions Testing concepts and materials Observation Understanding behaviors in their physical, social and economic context
  • 12. Advantages Disadvantages • Can explore complex and detailed issues • Good for high volume issues • Opportunity for probing and clarifying questions • One on one enhances rapport • Time consuming and can result in large volumes of data • Interviewer must have good listening and probing skills • Respondent may want to please interviewer
  • 13. Advantages Disadvantages • Gets information quickly and cheaply • Good for ‘low volume’ issues • Group interaction can stimulate response • Peer pressure can challenge thinking • Good at identifying content that do or do not resonate • Cannot explore complex or detailed issues • Respondents may be concerned about anonymity • Responses influenced by peers • Some participants may dominate, others may not speak • May not be suitable for sensitive topics • Skilled moderator required • Can be logistically difficult • Writing up from audio can be difficult
  • 14. Read the excerpts from the paper on FGD research. As you read think about the following 1. What are the key points the paper is making 2. Do you think these points are relevant to the Ethiopian situation – why/why not? 3. What is positionality 4. What are the conversational norms in Ethiopia, are they different for men and women? 5. How might the Ethiopian cultural context affect the conduct of a FGD? What modifications might be needed? 6. What is reflexivity and why is it important
  • 15. Sampling approach size and recruitment
  • 16. • Stem logically from the research question- strategic and thoughtful • Focus on depth rather than generalizability • Iterative • Feasible • Ethical • Describe it in your research papers • Most often need to think about selection of communities and of respondents
  • 17. • Standard criteria:  ‘‘Good’’ and information rich informant: Articulate, reflective, and willing to share • Choices:  Convenience- Select easily accessible subject  Theoretical sampling: Analyse as you go along and adjust sampling based on the findings, sampling controlled by emerging theory  Purposive- Select based on researchers judgement of who will be information rich/useful • Do not focus too much on names and definitions think about what each type of sampling gives you and how this would help you answer your questions
  • 18. 1. Give and example of a convenience sample 2. Discuss the advantages of convenience sampling
  • 19. Advantages • Cheap, fast and easy Disadvantages • May get information poor cases • Least legitimate Element of convenience sampling in all qualitative research but needs to be done within a thoughtful and justifiable approach to sampling
  • 20. – Quota – A range or certain number of respondents with certain characteristics that may influence responses/outcomes to facilitate comparison – Maximum variation – Broadest range possible to identify common patterns that cut across variations and emerge out of heterogeneity – Extreme/Deviant – Sample outliers so can learn from an unusual manifestations of phenomena of interest – Intensity sampling: Sample those who manifest the phenomenon intensely, but not extremely a the extremes may be too unusual – Confirming and disconfirming – include people with expected and exceptional outcomes to test variations and emerging trends in the data – done in later stages of data collection
  • 21. – Criterion- Those who meet specific criteria of importance – Critical case – Decisive cases to allow test hypothesise and allow generalization to other cases as if it's true of this case it's likely to be true of others – Typical case – An average person with no unusual characteristics to highlight what is typical, normal or average – Homogeneous – respondents have similar background and experiences to describe a sub group in depth
  • 22. – Deviant/Extreme sampling:  Community health workers representing those having the highest and lowest motivation scores  Men who do not beat their wives in a culture where wife abuse is culturally accepted – Intensity sampling:  Mothers who received above and below average number of visits from community health workers  Communities near and far from a facility but not the extremes – Maximum diversity:  Women with a range of SES and education levels, parities and ethnicities  Communities with a range of ethnic or religious affiliations
  • 23. – Criterion: Mothers who followed referral advice for their newborn and did not receive treatment – Typical case: Average communities
  • 24.
  • 25. • Snowball • Gatekeepers/key informants • Key locations • Adverts/flyers • Networks • Quantitative surveys • Tally sheet
  • 26. • Should be based on the concept of saturation:  Theoretical: no new data, or themes/codes and the ability to replicate  Practical: diminishing returns’ from further data-collection i.e. sufficient conceptual depth • Very little written about sample size and no empirical reasons given when sizes are given
  • 27. • Rule of thumb  Range from 20-50 interviews and 2-5 FGDs per category  Some say that for interviews 15 is the smallest acceptable and that >50 is too many • Generally sample size depends on the level of homogeneity of the sample, the complexity of the research and the quality of the interviews • Too large a sample is as harmful as too small as it reduces the quality of the analysis.
  • 28. • You are interested in understanding women's experiences with long lasting injectable family planning in a Woreda. You think there may be important differences in experiences for women by parity and education 1. Describe the sampling criteria for your communities and the women 2. Describe how you would identify and approach the women 3. How would you determine sample size for planning purposes 4. How will you know when saturation is reached
  • 29. • Write down your research aims and objectives • Where you plan to collect data • Who you will sample and why • How you will sample them
  • 30. Getting good data from respondents: interviews Respondent 2: Are we not going? Facilitator: We are only left with two questions. Respondent 2: In Christ’s sake Respondent 3: It is getting late Respondent 1: We have already discussed on it. You are asking repeatedly. Facilitator: It is not a repeated question. Earlier we have disused on the most important and less important behaviors. Now I am asking you about what the Health workers promote and encourage you to do and do not
  • 31. F: Tell me about the birth of X R: The strong labor pain started around 9:30 pm, when I felt the strong labor pain I lie down on the floor….…. F: ummm R: It is normal to call HEWs during labor, the usual practice is when a mother felt labor pain, she immediately call HEW, then they call an ambulance and the mother will be taken to the health center, this is what they advise us to do while they are coming here. F: It’s normal to call them R: We have to call them as traditional birth attendants are not allowed to attend in any delivery; they are not also willing to attend any delivery. It is forbidden by the health facility and the Health extension worker. HEWS advise every member of the community to deliver at the health center, all people are advised by HEWs, we are told that traditional birth attendants are not allowed to attend in any delivery, they are not also willing to attend the delivery…
  • 32. F: After M was delivered was anything other than breast-milk given for the baby to take? R: nothing was given F: what of water R: [moves closer, …whispers]…I gave water of the third day but I did not give again after that…… I am confused with the advise I am getting, some of my friends say give, some say do not give….. I want to follow the HEW advice, it’s just that sometimes when you see a child crying, you will feel like to take the water and give them thinking they are feeling thirsty. But they said the breast milk is enough for him. Is it true? I am confused F: Tell me more about what you have heard R: The HEW and the HDA told me that breast milk contains water, but I talked to my neighbor who said my baby is crying because she is thirsty. When I gave the water she stopped but I am afraid to give it again in case the HEW hears of it and comes to shout at me. If the baby keeps crying I don’t know what I will do. I don't want the neighbors to think I am a bad mother but I don’t want the HEW to be angry.
  • 33. F: Who makes decisions about the newborn in the household? R2: It is the responsibility of the mother. F-Tell me more R2: The mother is the one who took the lesson from the HEW, mother in law used to make decisions but now, they should give the responsibility to the mother, it is the mother’s turn now. R1:The grandmother could still give advice to the mother, she could talk both the current and the past experiences, but the mother can say I won’t accept this because I have been given education, they could accept it or don’t accept it because they have been educated by the HEW R2: Yes we are the ones who know more, we have been educated
  • 34. F: I want you to name all those things that make women to gave birth at home, Ok lets start talking R3: Lack of understanding of the reason for going to the hospital, F: Okay what else? R2: Lack of the husband’s permission, lack of transport, accessible road R3: Attitudes of hospital workers, Like us here, in our hospitals, the doctors don't sleep here. F: Okay, what next? Why do women give birth at home? R3: Some of the women are just too stubborn. Some of the women, you will be persuading them, but there stubbornness will not allow them R2: Some from the order of the mother in law, who will say I don't deserve this embarrassment, how can a woman in my house not deliver in my hands? R5: Sometimes the husband is willing to invite the TBA but his mother would refuse him. Sometimes the closure of hospital facilities at night is a big problem R3: No, it is not that hospital don't open at night but doctors don't stay till night R2: Even me as CHW during the delivery of this my baby, we came to the hospital, nobody was around and that's how we went back home to deliver, and they hospital staff came back to quarrel me that why did I give birth at home
  • 35. F=What changes have you seen in how newborns are cared for since you started work? R3=Previously families gave newborns butter to swallow, and bathed the baby immediately they were delivered; but now that is avoided. This is because the mothers have delivery preparation training. We also have discussion with the mothers in law and also the family members and thus we are seeing lots of changes. R4= Yes our work is changing things, but our people do not change overnight; you have to tell things over and over again. So starting from the time when she knows that she is pregnant, we give her health education, I give it, the HDA gives it and those at the health center give it. Then the people become convinced.
  • 36. What do we want from an interview? • Relevant, truthful and detailed information. • For this the respondent must: 1. Understand the purpose of the interview 2. Be interested in the interview 3. Feel comfortable and able to open up 4. Be asked the right questions 5. Be encouraged to talk and elaborate 6. Not deviate from the topic
  • 37. What do we want from an interview? • Interviewer must be: 1. Open minded 2. Flexible and responsive 3. Patient 3. Observant – remembers what has been said 4. Good listener and empathetic 5. Curious but gentle 6. Able to put people at ease 7. Knowledgeable 8. Critical –prepared to challenge 9. Ethically sensitive
  • 38. • Who will your audience open up to? • Select interviewers based on their skills/potential skills • Make interviewers investigators rather than data collectors.  Understand the intent of the questions  Make interviewers passionate  Hold reflection meetings  Conduct pre-analysis • Give timely and regular feedback and make adjustments to data collection. • Spend time in the field to understand context and support interviewers.
  • 39. Discuss the advantages and disadvantages of the following 1. You are doing a study to explore barriers and facilitators to exclusive breastfeeding, you have asked the HEW to locate and introduce you to women who delivered within the last year. 2. A young childless women versus a multiparous women collecting data on child birth practices 3. A university lecturer versus a community member colleting data on newborn illness 4. The use of a translator during a focus group vs recruiting a local language speaker
  • 40. Ensure respondents understands the purpose of the interview • Explain at the start that you want to know about their thoughts and opinions in their own words • Be sensitive about things like informed consent • Explain that there are no correct answer to the questions and that you want to learn from them - and mean it • Be clear who you are and who you are not
  • 41. Ensure respondents are interested in the interview • Select respondents who have information to give and are willing to give it, if respondents know little politely end the interview • Be enthusiastic, lively, humorous and show interest • Show commitment: Arrive on time, be prepared and familiar with all documentation, turn cell phones off and out of view, keep any promises • Observe non-verbal communication – Be aware of your own tone of voice, facial expression and body language and those of the participants
  • 42. Good body language can include • Sitting squarely facing the person you are listening to • Leaning slightly toward the person to demonstrate interest in what they are saying • Maintaining eye contact as appropriate • Maintaining a relaxed and open position to show you are at ease with them - arms should not be crossed. • Nodding the head
  • 43. Respondents must feel comfortable and able to open up • Assure informants of confidentiality and anonymity • Explain what will happen (e.g note taking) • Choose a location which is neutral, sufficiently quiet and where there will be no disturbances • Build rapport: Be unthreatening, relaxed, humble, patient, non judgmental, supportive and listen • Use appropriate greetings and clothing • Use words and phrases that give the respondent ‘permission’ to talk • Use appropriate seating arrangements
  • 44. • We are going to look at some pictures that show an in-depth interview • Turn to your neighbour and comment on what you think of the physical environment and comment on the interviewer and respondent body language.
  • 45.
  • 46.
  • 47.
  • 48.
  • 49.
  • 50.
  • 51. • List culturally appropriate ways to put someone at ease from the beginning to the end of an interview. Address the following: – How should you start the interaction? – What could you say or do initially to make the participant feel relaxed? – What could you say or do if the conversation becomes tense or boring? – What would make a participant feel that he or she could trust you? – What parting words or behaviours will help the participant leave feeling they had a positive interview experience? • List things an interviewer might do that would be offensive to a participant or that would discourage the participant from speaking freely. – What would make someone feel uncomfortable? Offended? Hurt? Angry? – What kind of clothing would express disrespect for the participant in this culture? – What kinds of culturally specific words or gestures would convey interviewer bias? Exercise
  • 52. • Open ended and non leading • The list of questions is only a ‘guide’: – If the respondent doesn't respond well to one of the questions ask it in a different way – if it makes sense to change the order of topics do so – If an interesting & relevant issue comes up explore it – Use knowledge from one interview to feed into the next. • Conduct analysis in every interview: – Does this response confirm something I already know? – If not, Am I understanding the response? Exactly how does it differ? – Can I probe to see why there is a difference in the response? Ask the respondents the right questions
  • 53. • Content mapping and content mining • Descriptive: Can you describe what happened to the baby after the placenta came out? • Contrast: You said that mothers take special care of babies that come early what about babies born small? ….. • Check perspective: You said you were very happy with your care after delivery but was there anything that fell short of your expectations?’ • Projective questions: e.g. vignettes, asking about 'others' Some useful ways of asking questions
  • 54. • Direct questions (best at end so not too directive): Are you happy with the way you and your husband decide how money should be spent?’ Such questions are perhaps best left until • Indirect questions: ‘What do most people round here think of the ways that health workers treat patients?’ ‘Is that the way you feel too?’, • Specifying questions: ‘What did you do then?’; ‘How did X react to what you said?’ • Interpreting questions: ‘Do you mean that your role has had to change from one of encouraging others to a more directive one?’ • Top-of-mind: What’s the first thing that comes to mind I say ‘skin to skin’? • Querying the obvious. What does “starting breastfeeding” mean to you? Use a variety of questions
  • 55.
  • 56. • Start with thematizing • Use literature and theory do identify themes if appropriate • Develop questions for each area/theme that will tap into respondent's experiences and/or perceptions • Limit to about 15 main questions • Pilot How to write a guide
  • 57. • First question should put respondent at ease and be an opener – easy to answer and not too long • Use open ended and non-leading questions • Order questions logically – factual before opinion General to specific “What activities were conducted?” before “What did you think of the activities?” • Use short, simple and clear questions that make no assumptions and lead to long answers • Carefully consider hypothetical questions – think back not to the future • Ask how rather than why questions 'How did you come to join this training' • Write in local and appropriate language • End with 'is there anything else you would like to tell me?' and leave the respondent feeling positive How to write a guide
  • 58. • What did you think of the program? • How did you feel about the conference? • Where do you get new information? • What do you like best about the proposed program? Good questions
  • 59. In groups of three comment on and re write the following questions 1. What fears would you have if your baby was born small? 2. What actions do you take to stop his/her diarrhea? 3. Was the treatment your baby got at the health center good? 4. Do you know about the clinic’s services?” Group exercises
  • 60. Respondents should be encouraged to talk and elaborate through probing • Stimulate respondent to provide more information: – Silence – ‘Nod’, ‘I see’ or ‘uh-hu’ – Reflect: Repeat the last thing the respondent said to show attention – Paraphrase – Be empathetic ‘I can see why that was difficult…’ – Act like you already have some knowledge ‘I heard around here’
  • 61. Respondents should be encouraged to talk and elaborate through probing • Stimulate respondent to provide more information: – Give compliments to encourage the informant to carry on – Act like you are confused to indicate that more information is needed – Show understanding so the informant knows their information is understood and treasured – Make small steps in questioning not big leaps – Ask for more detail: Could you say more about….Can you give me an example…what happened then….. How did you feel…… I am not sure I understand….What was it exactly that you…What gave you that impression… How did you respond… What effect did that have… What makes you say that
  • 62. • Do not overuse why questions • Don’t be afraid of silence but don’t let it get awkward: – Informants need time to reflect, gather thoughts and prepare to say something – Try not to comment on everything that is said and avoid a question and answer session “The key to successful interviewing is learning how to probe effectively…that is, to stimulate an informant to produce more information…without injecting yourself so much into the interaction that you only get a reflection of yourself in the data.” (Bernard, 1995)
  • 63. Group exercise 1. Write out the main themes/topics for your main IDI 2. For your first theme write 5 questions
  • 64. Interview 1: Edward: What are the biggest health problems for children in this community? Mother: Well there’s not enough food to eat... Edward: Where I come from, measles is a big problem. Is measles a big problem here? Mother: Yes. Children here sometimes get measles. Edward: And diarrhea. Do children here get diarrhea? Mother: Yes. Children around here get a lot of diarrhea. Edward: And tetanus. In some countries tetanus is a big problem. Is tetanus a problem here? Mother: Sometimes a child will get tetanus after it is born. Edward: So the main problems here are measles, diarrhea and tetanus Interview 2: Edward: What are the biggest health problems for children in this community? Mother: Well, there’s not enough food for children to eat... Edward: Uh huh. Mother: They also get malaria a lot at some times of the year (silence). Edward: So, children don’t have enough food to eat, and they get malaria a lot at some times of the year. What other health problems do children in the community get? Mother: Children get chest problems with coughing and trouble breathing. Often they die from this. Injecting yourself in the interview
  • 66. Steps in conducting a focus group • Step 1: Recruit participants • Step 2: Arrange the venue to encourage interaction • Step 3: Conduct the session • Step 4: Write up and analyze the results
  • 67. Step 1: Recruit participants • There should be between 8-10 people per group • Participants should have a similar background as this will facilitate discussion • We often rely on ‘key informants’ to select participants, they should: – Understand the purpose and process of the FGD, – Select talkative people with a range of views – Invite participants at least a day or two in advance – Explain the general purpose of the group to potential participants
  • 68. Step 2: Arrange the venue to encourage interaction • Choose a location which is neutral, sufficiently quiet, easy to get to, not too hot and where there will be no disturbances • Arrange the chairs in a circle • Separate friends to avoid side conversations
  • 69. Step 3: Conduct the session • One of the members of the research team acts as a ‘facilitator’ and the other as a recorder • The facilitator should preferably be similar to the participants e.g same sex roughly same age
  • 71. The facilitator: 1) Introduces the session – Introduces themselves and the recorder – Lets the participants introduce themselves – Puts the participants at ease – use ice breaker if appropriate – Explains the purpose of the FGD, the rules of the FGD and how the information will be used – Ask for confidentiality – Asks permission to use a tape recorder and to take notes
  • 72. FGD rules (can ask participants to do)  No right or wrong answers, only differing points of view  We're tape recording, one person speaking at a time  We're on a first name basis  You don't need to agree with others, but you must listen respectfully as others share their views  Turn off your phones. If you cannot and if you must respond to a call, please do so as quietly as possible and rejoin us as quickly as you can.  My role as moderator will be to guide the discussion  Talk to each other
  • 73. 2) Encourages discussion • Be enthusiastic, lively, humorous and show interest • Show your commitment: Arrive on time, be prepared and familiar with all documentation, turn cell phones off and out of view, keep any promises • Builds rapport with and between participants: Unthreatening, relaxed, humble, patient, non judgmental, supportive and listen • Be aware of non-verbal communication • Re-orients the discussion when it goes off track ‘Interesting point but how about’ • Use exercises if appropriate • Changes question order and rephrases if needed
  • 74. 3) Avoids a question and answer session: – Asks for clarification ‘can you tell me more about…?’ – Does not to comment on everything that is said, if there is a pause waits and see what happens – Limits their own participation when discussions begin – Using one persons response to involve another person • Gloria said…. But how about you Mary? • Does anyone else have an example of that? • Does anyone have a different experience? – Links ideas ‘what you are describing sounds similar to…..’ – Gives time for general discussions ‘are there any other issues…’
  • 75. 4) Unobtrusively controls the rhythm of the group – Subtly control the time allocated to each topic to maintain interest – Subtly move the discussion from topic to topic – If participants change topic let them continue incase useful information surfaces, then summarize the main points & re-orient the discussion – Deals with dominant participants by avoiding eye contact, moving, away slightly, thanking the participant and changing topic – Deals with reluctant participants by using their name, requesting their opinion, making more frequent eye contact and thanking them when they talk
  • 76. 5) Takes time at the end of the meeting to summarize, and thank the participants – Summarize the main issues, check for agreement and ask for additional comments – Thank the participants and let them know their ideas were useful – Listen for additional comments and discussions that occur after the meeting including during any refreshment sessions
  • 78. The recorder • Keeps a record of: – Date, time, place – Names and characteristics of participants – Description of group dynamics
  • 79. It is useful to map the respondents:
  • 80. The recorder • Is responsible for tape recording the FGD. – Find a good place to place the recorder before the focus group and do a short test recording. – Ensure you have adequate supplies and spares. – Listen to the recording immediately after the interview. If it malfunctioned sit with the facilitator and add more detail to your field notes.
  • 81. The recorder • Takes field notes (see narrative slides for more tips – Give each participant a code (p1, p2). – Take notes of who said what, even if it is a repeat of what was said before. – Include what the facilitator said (prefix by F and put in bold). – Capture the ‘voice’ of the respondents. – Record non verbal communication (e.g majority nodded their head in agreement). – Describes of group dynamics and write comments (did the participants seem rushed, how did they react to the facilitator, were some participants dominant).
  • 82. The recorder • Help resolve conflict situations that the facilitator finds difficult to handle
  • 84. Fieldnotes • They can be in any language using your own shorthand. Use abbreviations and acronyms. • Use key words and phrases that will trigger your memory when you expand notes. • Note body language, attitudes, the general environment and other relevant information. • Note taking should not detract from the rapport of the interview. • Fieldnotes should be written in a bound notebook and kept safe. • Do not write down the participants name in the notebook.
  • 85. • A single sheet written by interviewer summarizing main themes, ideas, comparison to other interviews or FGDs, areas to focus on in next contact • Comments on the interviews • Uses • Encourages reflection and planning • Gives supervisors something to read if interview will be transcribed later • Basis for data analysis • Reminder of the contact at a later date Summary sheets
  • 86. • Interviewer takes notes and records. Verbatim write up using the notes as a back up and to add contextual information. • Interviewer takes notes and records and expands notes as soon as possible using the recording to check content/and or add quotes. • Interviewer takes notes during interview and expands them as soon as possible. • Whichever option agree the format and conventions for labeling files and writing up in advance. Options for writing up
  • 87. Stay true to the participants words • The participant said: “Men like me should be responsible for the well-being of our families. We should support our wives when they want to go to the family planning clinic.” • Which of the expanded notes below is better and why? 1. Men should take care of their families and let their wives visit the clinic whenever they want to. 2. Men should be responsible for families’ well-being and support wives when they want to go to the family planning clinic.
  • 88.
  • 89. Advantages Disadvantages • Captures respondents language and responses most accurately • Brings researchers closer to their data • Allows for nuanced analysis • Gold standard • Allows for quality assurance • Transcription often delayed resulting in delayed feedback • Transcription errors common especially if transcription not done by interviewer • Transcription and analysis is time consuming which increases costs. • Relies on clear recordings
  • 90. Advantages Disadvantages • Reduces write up and analysis time and cost • Encourages reflection • Allows rapid feedback • Loose the voice of the respondent • Written through the interviewer eyes • Requires conscientious fieldworkers and initially intensive supervision
  • 91. Common expanded note mistakes: • Interviewer presents only a few highlights or main points from the interview, and fails to give details. • The expanded notes do not include any verbatim quotations, are not in the local language, or have no explanations for special or unusual information. • The interviewer fails to present the flow of the interview and tries to organize all the information about a particular point into a summary paragraph. • The notes are all written in the third person, so the ‘voice of the informant’ is totally missing.
  • 92. Methods of data analysis
  • 93. Introduction to analysis • Qualitative analysis revolves around discerning, examining, comparing and contrasting, and interpreting meaningful patterns or themes • Few universal rules or standard procedures • Analysis starts during the interview, through reflection and debriefings and during transcription
  • 94. Step 1: Think about your research question and analysis perspective Slide from ACT consortium
  • 95. Step 2: Get to know your data 1. Knowing your data is key for a high quality analysis. Read and re- read transcripts. 2. As you read  Note down your initial impressions and thoughts – these can be useful later on.  Think about the quality and the limitations of the data. Are there likely to be any reporting biases? Note down any issues as this will help ensure that you do not over interpret the data.  Think if you are likely to have any biases in interpreting the data? This reflexivity is an important part of qualitative analysis. 95
  • 96. Step 2: Code your data • Pre-set codes if appropriate (e.g using interim-analysis data, research questions) • Code only relevant text by using the Auerbach and Silverstein (2003), criteria:  Does the text relate to your research concern?  Does it help you to understand your participants better? Does it clarify your thinking?  Does it simply seem important, even if you can’t say why? • Read the transcript line by and apply relevant codes  Descriptive: based on the specific research question  Analytical: the underlying meaning/concepts behind the responses  Theoretical: Cross cutting constructs such as women’s empowerment, self efficacy
  • 97. Step 4: Identify patterns and connections • As you code themes will begin to emerge: • You may begin to see patterns and connections within and between your codes  Two concepts may always occur together (connection between codes).  A concepts may vary by respondent characteristics (patterns within a code). • It can be useful to think about ‘doers and non-doers’, critical cases etc • Patterns and connections can be captured in a memo/note. 97
  • 98. Analytic induction • The researcher examines a set of cases, develops hypotheses or constructs and examines further cases to 'test' findings. 98
  • 99. Note: Be flexible • Group codes on the same topic into themes and sub themes • Delete, merge or add codes as needed • Too few or too many codes usually means you need to rethink your coding. 99
  • 100. Step 5: Weigh the findings 1. Identify which themes are key and which are lesser themes.  Total number of times a theme appears  Total number of respondents with the theme  Total number of respondent groups with the theme  Level of detail and spontaneity of the response  Intensity of response  Specific or experiential responses given more weight  Whether described with active verbs ‘did or does’ versus ‘should or could’ 100
  • 101. Framework analysis 1. Case and theme based approach 2. Matrix display which aids question focused analysis and allows easy sharing of the analysis 3. Allows you to look across rows which helps maintain the context and down columns which aids development of themes 101
  • 102. Slide from QSR Natcen learniung
  • 103. Rigour in analysis 1. Challenge your coding: look for possible alternative explanations, look for and understand negative cases 2. Focus on interpretation and not robotic coding 3. Triangulation 4. If you are using multiple coders  Initially code together  Then code the same transcript separately (consensus coding) and discuss differences. Continue until coding is similar.  Develop a code book 5. If using a single coder have some coding peer reviewed 6. Discuss codes with colleagues and give feedback 7. Be careful with data management to ensure your codes can be traced back to the original transcript 8. Reflexivity 9. Comparison with other findings 10. Feedback from participants – member checking 103
  • 104.
  • 105. The logistics of coding
  • 106. Cut and paste: manual 106
  • 107. Cut and paste into word or excel Theme Motivation  Bringing health to the community and doing something important (8, 11, 12, 13) ‘The distance[to the facility] is very long so I realize it was an opportunity for me to serve the community…..such a strategy would reduce on deaths among people especially children and this prompted him to serve the community’ (12, basic, rural, poor network coverage, no supervision) ‘The desire to change people’s lives is what drives me’ (8, basic, urban, good network 5km from supervising facility) ‘Because of the free support we get from government in form of free drugs, we cannot waste this opportunity by refusing to volunteer. There is a strong desire to help others since government helps us with free drugs”’ (11, basic, rural, poor network, no supervision)  Becoming more knowledgeable (8,13) ‘The kind of information I would like to receive is anything that contributes to VHT knowledge… such information is motivating to me and helps me like my work’ (8, basic, urban, good network 5km from supervising facility)  Community showing trust and respect (11,13) ‘When I explain to the community and they respond to what I have told them, I feel happy ….. it shows they can trust and follow my words.’ (13, basic, rural, poor network coverage, 4 miles from supervising facility) 107
  • 108. Sub -themes Emerging issues Evidence Appetite in early Pregnancy Inability to eat in early pregnancy  Women lose appetite in the first 4 months of pregnancy (nausea/ vomiting) [E2]  Food intake decreases in early pregnancy [U]  Vomiting, weakness, headache, are common problems during first 3 months of pregnancy.[EU]  Women take herbal tea for nausea. [E] ‘ In the initial 3 months i had vomiting and could not retain any food” IDIPME050911.1;5 “I do not feel hungry and have vomiting as well” (3 months preg) IDIPME070911.1;3 108
  • 109. Cluster: Fear Theme: Participant File: Quote: Page: Fear of illness 238 “…but I’m like switched out, there’s nothing left. I’m living this close to fear right now, it’s always right there.” p. 6 76 “What’s going on, I can’t leave y’all alone for five minutes everybody is dropping off of here. They said you know they were sick, and I said to myself, well I’m sick too…damn that could happen to me.’ Seeing other people get sick obviously worried and scared Debbie. She is afraid that the same thing is going to happen to her.” p. 11 Fear of treatment 76 “Debbie [didn’t want] to eat so [she was] not taking her medicine for fear of getting the shocks.” p. 10 153 “James…found beginning care hard, and frightening. ‘That place [HOP] scared the hell out of me…I felt very threatened by the building, threatened by the fact that I knew I had this illness that I had to go to this clinic to get help, and very threatened by the people I was p. 3 - 4 109
  • 110. Use an analysis package 110
  • 111. Advantages and disadvantages if analysis package Slide from Kodish 2012
  • 112. Quality 112 1. Reflexivity – including field diaries, debriefs 2. Saturation 3. Triangulation (data – multiple sources; method; investigator – analysis) 4. Transparent and systematic 5. Explore deviant or negative cases 6. Peer review 7. Multiple data coders 8. Thick descriptions of context and participants - transferability 9. Prolonged engagement in study site and with data 10.Careful selection of quotes
  • 113. References: 1. USAID: Training in qualitative research methods: building the capacity of pvo, ngo, and moh partners 2. Mack et al (2005) Qualitative Research Methods: a data collector’s field guide FHI 3. de Negri, B. & Thomas, E. (2003). Making Sense of Focus Group Findings: A Systematic Participatory Analysis Approach. Washington, DC: Academy for Educational Development. 4. WHO: Guidelines for formative research for interventions to improve care of newborns (DRAFT) 5. The Handbook for Excellence in Focus Group Research, Mary Debus, AED 6. Chandler (2009) The ACT consortium manual for qualitative data analysis 7. Creswell JW. Qualitative inquiry and research design: choosing among five approaches. 2nd ed. Thousand Oaks: Sage Publications, 2007. 8. RAND Corporation Data Collection Methods. Semi-Structured Interviews and Focus Groups Training Manual 9. O’Sullivan, G.A., Yonkler, J.A., Morgan, W., and Merritt, A.P. A Field Guide to Designing a Health Communication Strategy, Baltimore, MD: Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs, March 2003. 10. Kodish S (2012) Systematic data analysis in qualitative health research. Site and life; 25: 2.