Qualitative studies

Question 1

What is qualitative evidence good for?

Answer 1

important to understand pt experience of healthcare- it can affect outcomes.
How people communicate and interact
E.g. early diagnosis depends on pt seeking help, outcome depends on whether pts are compliant with mediation

Question 2

What are the areas of information we want to find out from the patients ? “how and why questions”

Answer 2

Health literacy - awareness, beliefs - who do they think gets the disease
Emotions - fear, embarrassment - it can stop you seeking help
Social interactions - role of the family
Decision making - when is a symptom serious

Question 3

What is qualitative data?

Answer 3

anything which sheds light on understandings, attitudes, experiences
Most commonly interviews or focus groups where participants explore the topic
- diaries and photography can also be qualitative data

Question 4

What is the hierarchy of evidence?

Answer 4

systematic reviews
RCTs
cohort studies
case-control studies 
case series and reports 
anecdotal evidence= qualitative methods

Question 5

What are the pros a cons of RCTs?

Answer 5

High levels of control over participants to gain generalisability (v. specific population)
But
less representative of their normal environment

Question 6

What are the pros and cons of cohort study?

Answer 6

overtime/real world - more environmentally representative

no control over participants

Question 7

What are the pros and cons of case control studies?

Answer 7

-good at capturing rare outcomes
but
- retrospective comparison

Question 8

What are the pros and cons of case series and reports?

Answer 8

Good focus on detail/individual

but not generalisable

Question 9

What are the strengths of qualitative methods?

Answer 9

• focus on the “real world” and real patients
• High level of detail and context
• Can capture and explain experiences, understandings..

Question 10

What are the weaknesses of qualitative methods?

Answer 10

• Loss of auditability (need to trust researchers)
• Cannot predict (but can suggest) causations or outcomes
• generalisable only with caution

Question 11

Why do we need qualitative data?

Answer 11

• Important to find out about patient’s and provider’s experiences/opinions to improve care
• describes and explains health behaviour
• Improves quantitative research by informing questions to ask
• helps understands study findings

Question 12

What are key features of quantitative research?

Answer 12

numbers
how many?
hypothesis 
representative sample
statistical power 
replicable
information

Question 13

What are key features of qualitative research?

Answer 13

words
how and why
emerging themes
purposive sample
small numbers 
depend on context 
understanding

Question 14

What are the differences in collecting information for qualitative research compared to scientific data collection?

Answer 14

You can do data collection concurrently with analysis
You can change your methods depending on what you find - alter methods based on what you find
- this includes modifying the research question

Question 15

What does it mean by iterative method?

Answer 15

repeating cycles of data collection and analysis

- ideally you do this until no more insights are gained = saturations (no more questions arise)

Question 16

What does qualitative analysis do?

Answer 16

Transcripts are “coded”- topics and issues raised by participants are identified and labelled
- main themes are identified
- especially important are the emerging themes that were not researcher led
Researchers interpret the data throughout and not only in discussion sections

Question 17

What does CASP stand for?

Answer 17

critical appraisal skills programme - most widely used for qualitative data

• focus on whether methods used are appropriate to research questions
• important methods/findings are clearly described as every study is unique

Question 18

Why is bias common in qualitative research and how is it prevented?

Answer 18

As humans collect and analyse data their thoughts and feelings influence their findings
- need to be reflexive
There needs to be detail on researchers, backgrounds, data collection, analysis, interaction with participant
- as there is not statistics it is a matter of judgment whether findings fairly represent the data

Vital there is sufficient information available for researchers to make a judgement

Question 19

Can we trust the results of qualitative research?

Answer 19

• difficult to judge as researchers are not separate from the research
• there is no one true interpretation
• aim is to find one insightful, consistent and useful interpretation
• multiplicity of perspectives on developing this is valuable

Question 20

What are type 1 errors in interpretation?

Answer 20

finding something in the data that is NOT there

• suspicious / conflicts of interest - may not have been discussed
• social pressure on participants to give positive answers
• cherry picking quotes that support
• forcing a predefined model onto the data

Hard to prove but might be suspected if there is little evidence of how conclusions were obtained from the data/conclusions do not match data

Question 21

What are type 2 errors in interpretation?

Answer 21

Ignoring something that is THERE

• overly influence by a particular context, theoretical approach, researcher interest
• forcing participants into categories
• overly simplistic where data is complex; ignoring contradictions and different perspectives within the data

Results would still be legitimately obtained from the data but will be very thin

Question 22

What are some key elements that need to be carried out so qualitative research is rigorously analysed

Answer 22

Transparency - explicitness of methods and analysis
Validity - justify interpretation; possibly return to participants/invite their comments - to fully capture their experiences
Reliability - different researchers will analyse differently but using more than one coder can flag up blind spots and increase complexity
Comparative - compare b/w and within individual participants accounts, compare with other studies
Reflexivity - account for role of researcher - what is their background and interest

Question 23

How can the research be justified properly?

Answer 23

Needs to answer the research question(s)

• need to justify the qual methods and the use of a specific methodology e.g. grounded theory - methodologies are used in different ways but the author still needs to define and describe them
• Are the methods used for data collection and analysis clearly described and justified ?

Question 24

Is the data collection appropriate ?

Answer 24

Sampling is not statistics led, but purposive (wide range of perspectives/demographics)
This process needs to be explained: how have researchers selected their participants?
Is it clear what was done? - interviews/focus groups/audio recordings
Do we know what questions were asked? - summary of questions/interview topic guide

Question 25

What does it mean by reflexive stance of researchers?

Answer 25

Humans interpret data

• Their background experience, personality matters
• this does not need to be a systematic bias but researchers need to think about this: reflexivity
• What is the nature of authors relationship with research participants- are they researching their own practice? delivering interventions? Introductive themselves as HCPs?

Question 26

What ethics need to be done in qual research?

Answer 26

As a minimum formal ethics need to be stated
- ethical concerns raised throughout the study e.g. confidentiality, interviews can exhaust participants / raise painful issues, negotiating health provider/researcher role

Question 27

Has the data been thoroughly analysed?

Answer 27

needs to be described clearly:
- who was involved and did what 
- how themes were derived from the data 
Illustrated with participant quotes clearly linked to the themes 
complexity 
No just description but interpretation

Question 28

Is there a clear and credible statement of findings?

Answer 28

Are the main findings made explicit? Can they be supported by the data presented?
Have the authors discussed the strengths and limitations of their research and possible alternative interpretation
Do the findings link back to the research question?

Question 29

How valuable is the research?

Answer 29

Do the authors discuss practical use of the research?

• to inform current clinical practice
• to develop health interventions
• to inform health policy
• to inform and shape future research
• to give voice to seldom heard patients or the public

Is the setting similar enough to your own clinical context?