Qualitative research in health education for second years students

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Addis Ababa Medical and Business College
Department Of BSC Nursing
Health Educaton Assisgment
June 2017

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OurTitel ;
Qualitative Research In Health Education

3. Outline
3
1,Research definition
2. Qualitative data collection and analysis

4. 1. Research
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 Systematic collection of pieces of information required to
answer particular questions that are helpful in understanding
a certain issue in a detailed and scientific manner.
 As one of the various health programs, health education
programs should be guided and directed by scientific
evidences drawn from researches.

5. Cont...
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 One important reason why many health education programs
fail to achieve their purposes is that often the activities are
planned and implemented with a poor understanding of the
health problem dealing with and poorer understanding of the
factors responsible for the problem.
 For health education programs to be effective, their planning,
implementation and evaluation should be directed with
scientific evidences drawn from the systematically conducted
research.

6. Cont...
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 There are two major categories of research methods in health
education.
1, Qualitative method
2,Quantitative method

7. Cont...
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 Quantitative and qualitative research methods differ
primarily in:
Their analytical objectives
The types of questions they pose
The types of data collection instruments they use
The forms of data they produce
The degree of flexibility built into study design

8. Cont...
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 In health education, mostly we use qualitative technique.
 This is because, qualitative research, by its very nature, deals
with the emotional and contextual aspects of human response
rather than with objective, measurable behaviour and
attitude.

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Qualitative data collection and analysis
Why qualitative research?
1. It provides greater depth of response
2. Cost- more economical
3. Timing-can be executed and analyzed quickly without the
necessity of data processing capabilities.
4. Direct link with target public- gives program management
the opportunity to actually view and experience the target
groups directly.

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5. Lack of technical facilities-can be done in areas where no
computer or other technical facilities are available

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Three Keys to Successful Qualitative Research
1.The research must develop the art of asking "why?”
2.The researcher must develop the art of listening
3.The researcher must approach the research as a creative
process of investigation.

12. Cont...
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Type of qualitative research
Phenomenology
Ethnography
Grounded theory
Action Research and so on

13. Phenomenology
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Assumes that people come to know a phenomena through
their experience of it
Focuses on individual meaning
Emphasizes a focus on people's subjective experiences and
interpretations of the world.
Understand how the world appears to others.

14. Ethnography
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Study of culture/specific cultural group. –What is the way of
life of this group of people? –Everyday life is worth of study.
Focuses on social meaning.
Researcher immerses self in cultural group. Field work -
primarily participant observation and interview data
Focuses on the context of communities
Used increasingly in healthcare to explore the relationship
between health and culture.

15. Grounded theory
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Develop theory grounded in real world;
Searches and generates theoretical explanations from
observations of the world (induction)
The constant collection and iterative analysis of data to enable
theory to emerge
Data are not constrained by predetermined theoretical
framework, but define boundaries of inquiry.

16. Action Research
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Basis in critical social science
Researchers interact with the participants to achieve change
Often community-based
– Used with implementation studies in healthcare
–Treats the individual as an autonomous being, capable of
exercising agency

17. Cont...
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 What are Core techniques of Qualitative Research in Health
Education/Promotion?
1. Observation
2. Interviews
3. Focus Groups Discussion

18. Cont...
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 Types of observation
There are essentially two types of observation:
A) Participant Observation
B) Non-participant Observation

19. A) Participant Observation
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Participant observation is a qualitative method research
technique with roots in traditional ethnographic research
This requires researchers to study the setting through their
own participation
As participant observers, they become a part of the group
and are fully engaged in experiencing what those in the study
group are experiencing

20. A) Participant Observation
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Most often, researchers as participants conduct casual and
informal interviews while watching and recording what they
see around them in order to increase their understanding
Can be open or concealed

21. B) Non-participant Observation
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Non-participant observation consists of systematically
observing and documenting something in its natural setting
The observer watches the situation, openly or concealed, but
does not participate
Video photography can be an asset as long as it is not
intrusive

22. B) Non-participant Observation
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Observations can be open (e.g., „shadowing a health worker
‟
with his/her permission during routine activities)
Concealed (e.g., „mystery clients trying to obtain antibiotics
‟
without medical prescription

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 In both types of observations what should researchers
observe and document?
1. Physical environment
Researchers should use all of their senses to describe the
setting (sight, sound, smell, taste, and touch)
This might be a school, a workplace, a village, a farm, a bar, a
private home, . . . etc

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2. Social environment
This means documenting the behavior and interaction of
different groups by gender, age, culture, race, and any other
category or grouping that is meaningful to research topic
3. Specific Language
Observers should also note the specific language used,
including idioms and slang

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 Youths and teens, in particular, often have their own form of
slang to refer to a specific action and related activity
Identifying language usage can influence the plan and design
of education, policy, or marketing programs targeting
specific groups

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4. Non-verbal communication
Researchers should also observe and document non-verbal
communication
Often the way a person moves his or her body can give
researchers substantial clues about group functioning and
decision making
How do people look when they are smoking?
How do they move when asked about health risks?Are they
comfortable? Complacent? Resigned??

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How do people behave on the tobacco auction floor
5. Decision-making patterns
Who accepts what?
Who acts first?
For example, If you are observing a group of smugglers or a
black market sale, who is the leader?
How are decisions made?

28. 2. In depth interview
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Are characterized by extensive probing
Open-ended questions
Conducted on a one-to-one basis between the respondent
and a highly skilled interviewer.
It lasts 30-90 minutes
When to use individual depth interview?
When the subject matter is highly sensitive
When the respondents are geographically dispersed.

29. 2. In depth interview
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Key interviewer behaviours important to the success of
conducting depth interviews
Accurately receive the information.
Accurately recall the information.
Critically evaluate the information
Act upon the information

30. 3. Focus group discussion
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Eight to12 people per group from similar backgrounds
Homogeneous samples are preferred
When to use focus group discussions?
 Group interaction. Interaction of respondents will generally
stimulate richer responses and allow new and valuable
thoughts to emerge.
Cost and timing. Focus groups can be done more quickly and
generally less expensively than a series of depth interviews.

31. 3. Focus group discussion
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When subject matter is not so sensitive
Arranging focus groups
Identify suitable discussion participants and invite a small group
to a meeting at an agreed place and time.
 Choose convenient location, and try to create a relaxed,
familiar atmosphere.
Recruit members of the target group as randomly as possible.
Better if group members do not know each other

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Have an observer-to note interaction
Maintain a neutral attitude and appearance
Do not start talking about the topic of interest before the
official opening of the group discussion.
The researcher need to remain alert to be able to observe,
listen, and keep the discussion on track.

33. Cont...
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Sample size
 No hard and fast rule
Selection continues to the point of redundancy (saturation)
Depend on available time and resources

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Factors to consider when determining sample size
1. Nature of the topic: Obvious and clear, easy to talk about
and articulate
2. Quality of the data: Depends on participants, researchers
and topics
3. Study design

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 General guidelines
Semi-structured interviews
30-60 participants
Phenomenology
Each person interviewed many times
6-10 participants
Grounded theory
20-30 participants

36. Types of sampling
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Types of sampling
Volunteer sampling
Judgement sampling
Convenience/Haphazard sampling
Quota sampling
Snowball sampling
Stakeholder sampling
Extreme/Deviant case sampling
Homogeneous group sampling

37. Types of sampling
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Maximum variation sampling
Typical case sampling
Criterion sampling
Opportunistic sampling
Triangulated sampling
Standardized sampling
Routes sampling
Self-sampling
Evaluative sampling

38. Types of sampling
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Volunteer sampling
Subjects selected are volunteers who show interest to the
study.
Common in trials demanding long duration.
Payments for subjects some times be involved.
Introduces strong bias/self selection bias.

39. Types of sampling
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Judgemental sampling
The researchers choose the sample based on who they think
would be appropriate for the study.
Primarily used when there is a limited number of people that
have expertise in the area being researched.
Appropriate when the study subjects are difficult to locate.
More efficient and economic where the sample sizes are
small.

40. Types of sampling
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Judgemental sampling
Used where randomization is not expected to provide
representative samples.
Advantage
Reduced cost and time involved in acquiring the
sample

41. Types of sampling
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Convenience/Haphazard
Selection of subjects based on easy availability and
accessibility
Examples: People who just happen walking
Often used in face to face interviews
Advantage - very easy to carry out
Disadvantage
Difficult to draw any meaningful conclusion.
May not be representative

42. Types of sampling
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Quota
The population is first segmented into mutually exclusive
sub-groups as in stratified sampling.
Convenience is used to select subjects until a specific number
of units/quota/ for various sub-groups has been filled.
Preferable to all non probability sampling methods
 forces the inclusion of members of different sub- population.

43. Types of sampling
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Snowball
Involves a process of “chain referrals”
Suitable for locating key informants.
You start with one or two key informants and ask them if
they know persons who know a lot about your topic of
interest.
Used when trying to interview hard to reach groups.

44. Types of sampling
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Stakeholder Sampling
Particularly useful in the context of evaluation research and
policy analysis
This strategy involves identifying the major stakeholders who
are involved in designing, giving, receiving, or administering
the programme or service being evaluated, and who might
otherwise be affected by it.

45. Types of sampling
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Extreme or Deviant Case Sampling
Cases are selected that are unusual or have distinctive
characteristics that illustrate the processes being examined.
• Eg., outstanding success, notable failures, dropouts,
exotic events, crises.
The aim is to elicit rich and detailed information that
provides a new perspective on more typical cases.

46. Types of sampling
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MaximumVariation Sampling
This sampling strategy aims to select cases that provide for
wide variations in the experience or process being examined.
Here you choose a sample of cases that cuts across a great
deal of program, participant, or respondent variation to get
at central themes or principal outcomes.

47. Types of sampling
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Examples:
Comparing people who recover extremely quickly with
those who take inordinate amounts of time to recover may
provide some important insights into the recovery process.
This would occur if you compared the educational
opportunities of children in an upper income area with those
in a low income area.

48. Types of sampling
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This approach can be useful in dealing with the heterogeneity
of small samples since it catches the common features of a
wide range of cases.
It can also define patterns in the variation of processes,
operations, programs, or effects.

49. Types of sampling
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Homogeneous Group Sampling
The participant is selected to minimize variation and to
maximize homogeneity in order to describe the experience
or process in as much depth and detail as possible.
Focus group participants are often selected along these lines

50. Types of sampling
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Typical Case Sampling
The case is specifically selected because it is not in any way
atypical, extreme, deviant or intensely unusual.
This strategy is often used when the units of analysis are
large, as for example in studies of villages in developing
countries.
Selecting a typical village allows the research to illustrate the
general process that occurs.

51. Types of sampling
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This strategy is particularly useful if the research report will
predominantly be read by people who are unfamiliar with the
area of research.
Criterion Sampling
All cases that meet a set of criteria are selected.
In criterion sampling it is important to select the criteria
carefully, so as to define cases that will provide detailed and
rich data relevant to the particular research problem.

52. Types of sampling
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For example, all former clients of an intensive care unit who
return to intensive care with the same complaint within three
weeks may constitute a sample for in-depth, qualitative study
These criteria would facilitate a study of the effectiveness of
after-care programs attached to intensive care units.

53. Types of sampling
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Opportunistic Sampling
Many qualitative studies include, as an aspect of their design,
the assumption that the full dimensions of the research will
not be known until the study is completed.
New opportunities to recruit participants or to gain access to
a new site may develop after the fieldwork has begun.
Opportunistic sampling takes advantage of these junctures.

54. Types of sampling
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Unexpected opportunities that occur during the research
may be used to facilitate sampling.
A researcher studying heart attacks may, for example, meet a
cardiologist while interviewing one of his or her patients.The
cardiologist may suggest how the researcher can contact
other cardiologists who would be willing to refer clients to
the researcher.

55. Types of sampling
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Triangulated Sampling
The above sampling strategies can be combined in a
multitude of ways to suit the particular needs of your
research project.
Ensuring the trustworthiness of qualitative research
The four common criteria for assessing the trustworthiness
of qualitative research findings are: truth value, applicability,
consistency and neutrality.

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Qualitative Issue
Credibility
• Subjective realties
Truth value
Transferability
• Lessons can be applied to other contexts
Applicability
Dependability
• Same method does not produce same result
Consistency
Conformability
• Neutrality to data, Honest to findings
Neutrality

57. Cont...
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There are two ways of Qualitative Data Analysis Methods
Manual Analysis
»Thematic framework Analysis
Software Supported Analysis
» Open-Code- Questionnaire
»Atals ti
» Nvivo

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One major objective of qualitative analysis is description.
The description process uses anecdotes, examples, and
quotes from subjects.
It may be organized chronologically, covering various periods
and process focusing on critical events with in those periods.
As soon as the data are collected, they are coded and
organized along different categories to facilitate later analysis

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The frequent review and editing of field notes is the
beginning of qualitative analysis.
Computes can be used to facilitate the filling and analysis
process.
Soft ware programs designed for qualitative data analysis can
be used to help analyze field notes.

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The analysis process which is important for producing the final
report, include:
a, Field notes and debriefings (notes and comments on both
verbal and non-verbal exchanges)
b, Session summaries (with in a day or two of the completion of
data collection)
c,Transcripts (documenting tape recorded data on note books)
.

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d, Log book (organizing the transcribed notes on table) and
finally
e,Thematic frame work analysis (identifying important themes,
coding categories, rating and ranking responses

62. Qualitative data interpretation
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Based on detailed descriptions, qualitative analysis then
integrates concepts and ideas to help explain and interpret
the actions, activities and beliefs described.
Results are attached significance and generated into patterns.
Interpretation involves explaining the findings of the study in
terms of the problem or the question that the researcher
wants to answer.

63. Qualitative data interpretation
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In the course of the study, the researcher may have developed
some idea about what the respondents are saying.
This is the time to question oneself about how significant the
information that the investigator has gathered to the problem
under investigation.
As much as possible, the principal researcher should involve
the rest of the team, particularly the moderators and
observers since they had a direct contact with the groups.

64. Cont…
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Majority and minority feelings, as well as apparent
differences in feelings by characteristics of respondents
(example- sex and age) should be distinguished.
Based on the discussion of the findings, the investigator may
make useful recommendations for planning and developing
an intervention programs.

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The reporting format should consist the following points:
Title of the study
Objectives and methods, including data analysis
Major findings in line with significant broad topics of the
guides
Discussion
Conclusions

66. Group Members
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1, Sultan Korme 12,AbebeTasfaye
2, Fikire Bisrat 13,Balay Amsalu
3,Tsalote Zeleke 14,Galanaa Birhanu
4,Abose Olana 15,Mekides Gemechu
5, Chemidesa kumsa 16,MartaTeaer
6, Tarefech Embibal
7, Mariam
8, Hirpha Alamayo
9, Girma Bekele
10, Asfetu Dinsa
11, Gemechis Hora

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ThankYou!!!