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Qualitative Research and CEHP (Turell & Howson)


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Qualitative Research and CEHP (Turell & Howson)

  1. 1. Qualitative Research and CEHPQualitative Research and CEHP CMEpalooza Presented March 20, 2014 View archived presentation on youtube: Wendy Turell, DrPH, CCMEP Director CME Outcomes and Analytics PlatformQ Health Alexandra Howson MA, PhD, CCMEP Owner Thistle Editorial, LLC
  2. 2. AgendaAgenda - The Qualitative Approach - Utilization in CEHP lifecycle - Data Collection - Questions and Interview Behavior - Analysis - Reporting
  3. 3. The qualitative approachThe qualitative approach
  4. 4. Qualitative ResearchQualitative Research “Not everything that can be counted counts, and not everything that counts can be counted.” - William Bruce Cameron
  5. 5. Search for objective, universal truths using standardized data gathering techniques
  6. 6. Naturalistic/inte rpretative approach Focus on how people perceive their worlds and interpret experience
  7. 7. ExplorationExploration • Unearth a complete and detailed description of the how and why behind physician, allied healthcare provider, and patient behavior. • Produce deep answers to research questions that give voice and layered explanation to the answers you seek.
  8. 8. Why Qualitative?Why Qualitative? • Patient care is complex • Semi-structured, open ended approach to inquiry • Less limiting - explores beyond pre-selected answer choices • Interaction - researchers probe and react to study subject comments
  9. 9. Data: What vs WhyData: What vs Why Quantitative Data: A 37% drop-off was observed in adherence to post surgery medication regimens Qualitative Data “After their bypass surgery, when they have seen God and all that, they listen, but after they are out of the hospital and they are going through rehab and they are fine, that period of after the bypass, they are invincible.”
  10. 10.   Qualitative Research Quantitative Research Type of Questions Probing “below the surface”; immediate follow up & adjustment Limited probing; pre- determined questions NOT adjusted Sample Size Small Any size including large Information per respondent Much Varies; Limited to answer choices Administration Requires skilled researcher Fewer specialist skills required Type of Analysis Follows structured steps; subjective and interpretative Statistical; objective Type of Research Exploratory, descriptive Descriptive or Causal
  11. 11. Applications in CEHPApplications in CEHP Across research phases With different research participants Alone or mixed methods Needs assessment Intervention development Formative evaluation Outcomes evaluation Survey development
  12. 12. Data CollectionData Collection
  13. 13. Sample MethodologiesSample Methodologies
  14. 14. Online MethodologiesOnline Methodologies • Research methodologies = evolving with communication styles • Widely-used, often preferred options for researchers and respondents • Benefits o Cost Savings o Ease for wide geographical representation o Ease for scheduling (no need for travel, sessions tailored to their availability) o Anonymity = less inhibition / more honesty
  15. 15. Optional Webcam- enabled images Text based chat & audio capable Online Methodologies Virtual Interview Room
  16. 16. Types of QuestionsTypes of Questions
  17. 17. Question TypesQuestion Types • Open ended, neutral, sensitive, clear to respondent Patton, MQ. How to use qualitative methods in evaluation. London: Sage, 1987. 1. Main questions 2. Probes 3. Follow ups 4. Specifying 5. Interpreting
  18. 18. More about QuestionsMore about Questions • Use vocabulary of respondent • Appropriate tone • What open ended q looks like • Language that may invoke defensiveness • Q writing, q order
  19. 19. Interviewer BehaviorInterviewer Behavior • Active Listening – Be ‘in the moment’ • Encourage respondent o Give appropriate verbal and non-verbal feedback • Stay neutral o Avoid presenting your perspective (bias interview) o Avoid counseling, teaching
  20. 20. Coding and AnalysisCoding and Analysis
  21. 21. CodingCoding • Breaking down data into units which are then grouped according to characteristics • Proceeds linking diverse observations • Helps with understanding • It’s practical! • Organization = quick access when you need it for analysis/description.
  22. 22. CodingCoding • 1st phase: review data: o What’s happening? o What’s important? o What patterns are emerging? • 2nd stage: repeat, refine, expand/reject categories • Text can be tagged with >1 code
  23. 23. Grounded TheoryGrounded Theory • Glaser & Straus (1967) – emphasis on developing theory/explanation from data versus gathering data to test a theory/hypothesis. • The theory is grounded in reality as represented in the data • Benefits: o Theory is derived from what speakers do, vs. what is believed they should do o Ensures the researchers maintain an open mind towards inquiry vs. imposing existing beliefs on data
  24. 24. • Rigor • Validity • Saturation Methodology How can Software Assist? GATHER ORGANIZ E ANALYZE VISUALIZE RESULTS
  25. 25. How can Software Assist? Source: Nvivo (QSR) Coding Memoing Visuals Queries -Review -Merge -Refine -Models -Matrices -Charts -Key Ideas -Reflect -Link -Text Search -Word Frequency -Matrix -Coding Comparison
  26. 26. ReportingReporting
  27. 27. ReportingReporting oReports = based on trends and relationships found within the data • Includes: oTrend Description oRespondent Quotes oVisualizations (themes, their relationships, demographic elements) oInterpretation
  28. 28. Reporting: DescriptiveReporting: Descriptive Patient Concern about high blood pressure: The overwhelming response to the question "Should a person be concerned about having high blood pressure?" was "yes." Most people believed that being unconcerned could result in serious health problems, specifically heart disease or even death. "A person can die if they have high blood pressure because it can cause a stroke or it can cause heart problems."
  29. 29. Reporting: TrendsReporting: Trends Patients’ opinions on how well providers explain a medication varies from “satisfied” to “very well” For some patients, the nurse practitioner provides more detail, as does the pharmacist and the information that accompanies the medication. Between the nurse practitioner and the physician, respondents tend to trust the physician more. In many cases, it appears that patients with a strong, long, and trusting relationship with their providers perceive them as explaining the medication better than those without an established relationship or who distrust their providers.
  30. 30. Reporting: Giving VoiceReporting: Giving Voice Provider: “After their bypass surgery, when they have seen God and all that, they listen, but after they are out of the hospital and they are going through rehab and they are fine, that period of after the bypass, they are invincible.” Patient: “I took [the prescription] to the pharmacy and ……they were only going to give me four pills because it is so expensive, and I am saying to myself, ‘why did they give me this, I am going to die because I will not be able to afford it?’ In my head, I said ‘Oh Lord; please make this work without any side effects so I can take it.’”
  31. 31. Reporting: QuoteReporting: Quote IntegrationIntegration Having a normal blood pressure level: Living a calm life, feeling relaxed, and avoiding or solving problems were seen as very effective ways to keep blood pressure normal. "Be calm in everything. Do not get angry over something small." "I try not to have problems with anyone at home, in the street, or anywhere else. If I were to have a problem with anyone here, my blood pressure would go up immediately. A person can burst."
  32. 32. Visualizing DataVisualizing Data
  33. 33. Visualizing DataVisualizing Data Word Clouds
  34. 34. Visualizing DataVisualizing Data
  35. 35. Questions?Questions?
  36. 36. Follow-up Questions?Follow-up Questions? Contact UsContact Us Wendy Turell, DrPH, CCMEP Director CME Outcomes and Analytics PlatformQ Health Alexandra Howson MA, PhD, CCMEP Owner Thistle Editorial, LLC
  37. 37. AppendixAppendix
  38. 38. ResourcesResources
  39. 39. Software Resources:Software Resources: Coding & OrganizationCoding & Organization • Free (QDA Miner Lite) o / • Low Cost: dedoose o • Bells and Whistles software: Nvivo or Atlas Ti o o
  40. 40. Resources Cont.Resources Cont. • Hopkins Open Coursework: • Qualitative course materials: o nalysis/coursePage/index/ • Online Qual. Textbook:
  41. 41. Resources Cont.Resources Cont. • Cater JK. SKYPE: a cost-effective method for qualitative research. Rehab, Counselors + Educators Journal. 20011;4: • Cohen DJ, Crabtree BF. Evaluative criteria for qualitative research in health care: controversies and recommendations. Ann Fam Med. 2008;6:331-339.   • Curry L, Nembhard IM, Bradley EH. Qualitative and mixed methods provide unique contributions to outcomes research. Circulation. 2009. 119:1442-1452.