This document provides an overview of research methods in health education, with a focus on qualitative data collection and analysis. It discusses key qualitative research techniques including observation, in-depth interviews, and focus group discussions. It also covers sampling strategies, qualitative data analysis methods, and ensuring trustworthiness. The main points covered are qualitative versus quantitative research, purposes and types of qualitative research, and qualitative data collection techniques commonly used in health education research.

1. Research in
health education
Samson Mideksa (PhD)
July, 2021

2. Outline
1. Research definition
2. Qualitative data collection and analysis
3. Mixed quantitative-qualitative designs and
triangulation approaches in research
4. Developing health measurement scales
(assessing validity and reliability of scales)
2

3. 1. Research
•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.
3

4. Cont . . .
• 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.
4

5. Cont . . .
• For health education programs to be
effective, their planning, implementation and
evaluation should be directed with scientific
evidences drawn from the systematically
conducted research.
5

6. Cont . . .
• There are two major categories of research
methods in health education.
–Qualitative method
–Quantitative method
6

7. Cont . . .
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
7

8. Qualitative Quantitative
Depth of understanding Measure level of Occurrence
Answer the question "Why?" Answer the question” How Many?" "How often?"
etc
Subjective Objective
Some aspects of the study are
flexible (for example, the addition,
exclusion, or wording of particular
interview questions)
Study design is stable from
beginning to end
Seek to explore phenomena Seek to confirm hypotheses about
phenomena
8

9. Use semi-structured methods such
as in-depth interviews, focus
groups, and participant observation
Use highly structured methods
such as questionnaires, surveys,
and structured observation
To describe variation To quantify variation
To describe and explain relationships To predict causal relationships
To describe individual experiences To describe characteristics of a
population
9

10. Cont . . .
• 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.
10

11. 2. 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.
5. Lack of technical facilities-can be done in areas
where no computer or other technical facilities are
available
11

12. Cont . . .
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

13. Cont . . .
Type of qualitative research
• Phenomenology
• Ethnography
• Grounded theory
• Action Research and so on
13

14. Cont . . .
Phenomenology
• 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

15. Cont . . .
Ethnography
• 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

16. Cont . . .
Grounded theory
• 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

17. Cont . . .
Action Research
• 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

18. 18
Cont . . .
 What are Core techniques of Qualitative
Research in Health Education/Promotion?
1. Observation
2. Interviews
3. Focus Groups Discussion

19. 19
Cont . . .
1. Types of observation
• There are essentially two types of observation:
A) Participant Observation
B) Non-participant Observation

20. 20
Cont . . .
A) Participant Observation
• 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

21. 21
Cont . . .
• 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

22. 22
Cont . . .
B) Non-participant Observation
• 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

23. 23
Cont . . .
• 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)

24. 24
Cont . . .
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
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

25. 25
Cont . . .
3. Specific Language
 Observers should also note the specific
language used, including idioms and slang
 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

26. 26
Cont . . .
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?
 How do people behave on the tobacco auction
floor?

27. 27
Cont . . .
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. Cont . . .
2. In depth interview
• 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
28

29. Cont . . .
When to use individual depth interview?
• When the subject matter is highly sensitive
• When the respondents are geographically
dispersed.
29

30. Cont . . .
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

31. Cont . . .
3. Focus group discussion
• Eight to12 people per group from similar
backgrounds
• Homogeneous samples are preferred
31

32. Cont . . .
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.
• When subject matter is not so sensitive
32

33. Cont . . .
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
33

34. Cont . . .
• 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.
34

35. Sample size
• No hard and fast rule
• Selection continues to the point of
redundancy (saturation)
• Depend on available time and resources
Cont . . .
35

36. 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
Cont . . .
36

37. General guidelines
 Semi-structured interviews
• 30-60 participants
 Phenomenology
• Each person interviewed many times
• 6-10 participants
 Grounded theory
• 20-30 participants
Cont . . .
37

38. Cont . . .
Types of sampling
•Volunteer sampling
•Judgement sampling
•Convenience/Haphazard
sampling
•Quota sampling
•Snowball sampling
•Stakeholder sampling
•Extreme/Deviant case
sampling
•Homogeneous group
sampling
•Maximum variation
sampling
•Typical case sampling
•Criterion sampling
•Opportunistic sampling
•Triangulated sampling
•Standardized sampling
•Routes sampling
•Self-sampling
•Evaluative sampling
38

39. Cont . . .
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

40. Cont . . .
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.
 Used where randomization is not expected to provide
representative samples.
Advantage
• Reduced cost and time involved in acquiring the sample
40

41. Cont . . .
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
41

42. Cont . . .
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.
42

43. Cont . . .
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.
43

44. Cont . . .
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.
44

45. Cont . . .
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.
45

46. Cont . . .
Maximum Variation 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.
46

47. Cont . . .
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.
• 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.
47

48. Cont . . .
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
48

49. Cont . . .
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.
• This strategy is particularly useful if the research
report will predominantly be read by people who
are unfamiliar with the area of research.
49

50. Cont . . .
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.
• 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.
50

51. Cont . . .
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.
51

52. Cont . . .
• 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.
52

53. Cont . . .
Triangulated Sampling
• The above sampling strategies can be combined in
a multitude of ways to suit the particular needs of
your research project.
53

54. 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.
Cont . . .
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
54

55. Cont . . .
• There are two ways of Qualitative Data
Analysis Methods
• Manual Analysis
»Thematic framework Analysis
• Software Supported Analysis
» Open-Code- Questionnaire
» Atals ti
» Nvivo
55

56. Cont . . .
• 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.
56

57. Cont . . .
• As soon as the data are collected, they are
coded and organized along different
categories to facilitate later analysis
• 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.
57

58. Cont . . .
• 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)
(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. 58

59. Cont . . .
S/No The
mes
Male youths Female youths Street boys Category
coding
Rate Rank
FGD-1 FGD-2 FGD-1 FGD-2 FGD-1 FGD-2 Male
youth
Femal
e
youth
Stre
et
boys
1
Wh
om
to
be
test
ed
for
HI
V
Majorit
y said
that
every
body
should
be
tested
Majority
said that
every
body
should
be tested
Majority
said that
every
body
should
be tested
Majority
said that
every
body
should
be tested
Majority
said that
unmarri
ed
youths
should
be tested
Majority
said that
every
body
should
be tested
1= every
body
2=
unmarrie
d youths
1 1 1,
2
First
=1
Seco
nd=
2
2 Inhibitin
g factors
for
utilizatio
n of
VCT
service
Fear of stigma
and
discrimination ,
fear of coping
,lack of
awareness
Fear of stigma and
discrimination , fear
of coping ,lack of
awareness
Fear of stigma and
discrimination , fear
of coping,
high HIV risk
perception
Fear of stigma and
discrimination , fear
of coping,
Low HIV risk
perception
Fear of stigma and
discrimination , fear
of coping,
unfixable VCT
service
Fear of stigma and
discrimination , fear
of coping,
high HIV risk
perception
1= stigma and
discrimination
2= fear of coping
3= lack of awareness
4= low HIV risk
perception
5= high HIV risk
perception.
6= unaffordable
service
1,2,3 1,2,4,5 1,2,5,
6
First =1,2
Second =5
Third=
3,4,6,
3 Enhanci
ng
factors
for
utilizatio
n of
VCT
service
Marriage plan,
changing sexual
behavior,
persuasion by
health
professional
Marriage plan,
presence of ART,
relief from tress
Preserve of ART,
high HIV risk
perception ,
persuasion by health
professionals
Marriage plan ‘
presence of ART,
plan for future life
Marriage plan
presence of ART,
repeated unless
Marriage plan
presence of ART,
high HIV risk
perception
1= marriage plan
2= change in sexual
behavior
3= presence of ART
4= persuasion by
health professional
5= Relief from stress
6= plan fro future life
7= repeated illness
8= high HIV risk
perception
1,2,3,4,5
,
1,3,4,6,8 1,3,7,
8,
First =1,3
Second=4,8
Third=
2,6,7,
59

60. Cont . . .
Qualitative data interpretation
• 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.
60

61. Cont . . .
• 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.
61

62. Cont . . .
• 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.
62

63. Cont . . .
• 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
63

64. 3. Mixed quantitative-qualitative designs
and triangulation approaches in research
Quantitative Research Method
• Collects specific information and facts that can
be expressed as numbers which can be
analyzed mathematically to produce a
summarized finding that can represent the
magnitude of health condition in the
community.
64

65. Cont . . .
• Usually, data are collected using structured
questionnaires with close-ended questions.
• The most commonly used quantitative research
in behaviour related studies are Knowledge,
Attitude and Practice surveys
• Knowledge, attitude and practice are thought
to be important determinants of health, in
addition to biological and health service
factors
65

66. Cont . . .
Knowledge
• It is assessed in terms of what the person knows
about the item
• Correct and incorrect statements must be
included
• The respondent is asked to indicate whether a
statement is true or false, or whether the
question should be answered Yes or No.
66

67. Cont . . .
Attitude
• It is assessed in terms of what the person
prefers to do
• What they would do if they had the choice
• How favourable - unfavourable or positive -
negative they are to the object.
67

68. Cont . . .
Practice
• It is assessed by asking what the person
currently does and giving an exhaustive list of
options, to each of which the person responds
yes or no.
68

69. Cont . . .
Mixed method
• When applied properly,
– Qualitative techniques are used along with
quantitative techniques in a manner that is
interrelated as complementary
69

70. 4. Developing health measurement scales
(assessing validity and reliability of scales)
 Reliability and validity are two concepts that
are important for defining and measuring
bias and distortion.
 Validity refers to the accuracy of an
assessment . . . whether or not it measures
what it is supposed to measure.
 It is a judgment based on various types of
evidence.
70

71. Cont . . .
Types of Validity
1. Face Validity ascertains that the measure appears
to be assessing the intended construct under
study.
• The stakeholders can easily assess face validity.
• Although this is not a very “scientific” type of
validity, it may be an essential component in
enlisting motivation of stakeholders.
• If the stakeholders do not believe the measure is
an accurate assessment of the ability, they may
become disengaged with the task.
71

72. Cont . . .
2. Construct Validity is used to ensure that the
measure is actually measure what it is
intended to measure (i.e. the construct), and
not other variables.
 Using a panel of “experts” familiar with the
construct is a way in which this type of
validity can be assessed.
 Students can be involved in this process to
obtain their feedback.
72

73. Cont . . .
3. Criterion-Related Validity is used to predict
future or current performance - it correlates
test results with another criterion of
interest.
4. Formative Validity when applied to
outcomes assessment it is used to assess how
well a measure is able to provide information
to help improve the program under study.
73

74. Cont . . .
5. Sampling Validity (similar to content
validity) ensures that the measure covers the
broad range of areas within the concept
under study.
• Not everything can be covered, so items need
to be sampled from all of the domains.
• A panel of “experts” ensure that the content
area is adequately sampled.
74

75. Cont . . .
What are some ways to improve validity?
• Match your assessment measure to your
goals and objectives.
• Have the test reviewed by faculty at other
schools to obtain feedback from an outside
party who is less invested in the instrument.
• Get students involved; have the students look
over the assessment for troublesome wording,
or other difficulties.
75

76. Cont . . .
 Reliability refers to the extent to which
assessments are consistent.
 Example: imagine a kitchen scale. If you
weigh five pounds of potatoes in the
morning, and the scale is reliable, the same
scale should register five pounds for the
potatoes an hour later (unless, of course,
you peeled and cooked them).
 What are some ways to improve reliability?
76

77. Cont . . .
• Even if a test is reliable, it may not provide a
valid measure.
– Let‟s imagine a bathroom scale that consistently
tells you that you weigh 130 pounds. The
reliability (consistency) of this scale is very good,
but it is not accurate (valid) because you actually
weigh 145 pounds (perhaps you re-set the scale in
a weak moment)
77

78. Cont . . .
78

79. The last!
Thank
you!
79