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Qualitative Research and CEHP (Turell & Howson)
1. Qualitative Research and CEHPQualitative Research and CEHP
CMEpalooza
Presented March 20, 2014
View archived presentation on youtube:
http://tinyurl.com/kg9kl9t
Wendy Turell, DrPH, CCMEP
Director
CME Outcomes and Analytics
PlatformQ Health
wturell@platformq.com
Alexandra Howson MA, PhD, CCMEP
Owner
Thistle Editorial, LLC
alexhowson@thistleeditorial.com
2. AgendaAgenda
- The Qualitative Approach
- Utilization in CEHP lifecycle
- Data Collection
- Questions and Interview Behavior
- Analysis
- Reporting
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. 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. 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. 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. 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
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
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. 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. 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
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. 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. 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. • Rigor
• Validity
• Saturation
Methodology
How can Software Assist?
GATHER
ORGANIZ
E
ANALYZE VISUALIZE RESULTS
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
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. 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. 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. 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. 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."
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.
Notes de l'éditeur
This presentation will focus on Qualitative Research methods, including in depth interviews, focus groups, and online research communities, and their application in the life phases of a CE/CME activity (needs assessment, formative evaluation, outcomes evaluation). Learners will take away basic information regarding research planning, question development, data collection, and analysis- and how organizations in the CEHP world are taking advantage of this exciting research methodology.
Generating theory/explanation, building hypotheses
Many, diverse, interacting elements in healthcare, plus distinct organizational cultures, patterns of communication, tacit knowledge etc
2. Best way to understand in-depth motivations and feelings of providers and patients
3. Unrestrained sharing of information, experience, and viewpoint
4. Gain clarity, depth, and a “fuller picture” of understanding - Can improve effectiveness of quantitative research, e.g. use qualitative data to focus quantitative measures
5. Provides a blend of statistical quantifying and layered qualitative understanding of motivation, behavior, change – helpful to triangulate data, methods, researchers
6. Economical Option
Qualitative interviews based on assumption that human behavior is framed by social and cultural context, and is influenced by beliefs, attitudes and values.[Goodson 2011] These characteristics make qualitative methodology an especially good fit for settings based interventions designed to foster changes in clinician behavior and practice, such as CME interventions in healthcare organizations, because they lend themselves to in-depth exploration of the context of intervention and recognize the complexity of change.
Example of how interview data can flesh out survey data
Interviews focus on generating Depth vs. breadth
Instead of counting or identifying statistics….Understanding
situations, individuals, groups, phenomena, relationships, environments, etc.
Interviews (in person, virtual/online, telephonic)
Focus Groups (in person, virtual/online facilities)
Message Boards/Social Media Analysis
Observation
Document Analysis
Mixed-Methods (Qualitative and Quantitative combination)
Online adds deeper level of interactivity to the interviews.
Research methodologies = evolving with communication styles
Widely-used, often preferred options for researchers and respondents
Benefits
Cost Savings
Ease for wide geographical representation
Ease for scheduling (no need for travel, sessions tailored to their availability)
Anonymity = less inhibition / more honesty
What open ended q looks like
Language that may invoke defensiveness
Q writing, q order
A filing system
Interpretation tied closely to data
GATHER- existing research, current information, data sources
ORGANIZE – data sources, coding structure, demographics, lit review
ANALYZE- coding, queries, memos, values
VISUALIZE
RESULTS reports, presentations
GATHER- existing research, current information, data sources
ORGANIZE – data sources, coding structure, demograhics, lit review
ANALYZE- coding, queries, memos, values
VISUALIZE
RESULTS reports, presentations
Give voice to perspectives of providers and patients (adherence example)- humanizes data you get from a survey