Health Services Research Methods 3rd Edition by Leiyu Shi – Answer Key

Health Services Research Methods 3rd Edition by Leiyu Shi – Answer Key

Chapter 6
Answer Key

1. What are the purposes that qualitative research serves?
Qualitative research serves four major purposes. It can be used as an exploratory study method and is particularly oriented toward exploratory discovery and inductive logic. It can also be used as a complement to large-scale systematic research, and is often conducted first to provide leads and feedback for more structured or large-scale quantitative research that follows, or later to help confirm and elucidate information to add depth, substance, and meaning to survey and experimental results.

It can also be used as a method for specific research purposes, and is more appropriate than other methods for certain objects, topics, problem, and situations, such as the study of complete events, phenomena, or programs; developmental or transitional programs and events; attitudes, feelings, motivations, behaviors, and factors associated with the changing processes; complex events with interrelated phenomena; dynamic or rapidly changing situations; relationships between research subjects and settings; and processes, or how things happen, rather than outcomes, or what happens.

Qualitative research can also be used as an alternative when methodological problems and ethical concerns preclude the use of other methods. When subjects are unable or unwilling to participate in a formal survey or experiment, qualitative research may be used as a viable alternative. It is often a preferred alternative when the control and manipulation necessary for an experiment are not ethically feasible.

2. Draw distinctions among the various terms used to denote qualitative research.
The term qualitative research entails observations and analyses that are generally less numerically measurable, or less quantifiable, than typical methods used in quantitative research. Several other terms are synonymous with qualitative research in describing this methodological approach. The term field research is often used because researchers observe, describe, and analyze events happening in the natural social setting—that is, the field. Qualitative approaches emphasize the necessity of going to the field and getting close to the people and situations being studied so that researchers are personally aware of the realities and details of daily life. However, quantitative research can also take place in the field.

Another oft-used term is observational research or participant observation. This term is used because observation is a primary method of qualitative research and is used for the purpose of seeing the world from the subject’s perspective. The word observation is not used to specify qualitative research, though, because the term is basic to all scientific inquiry rather than limited to qualitative research. However, qualitative observation differs from other forms of scientific observation in two important ways. First, qualitative observation emphasizes direct observation rather than indirect observation. Second, qualitative observation takes place in the natural setting, rather than in a contrived situation or the laboratory.

Case study is another term often associated with qualitative research, because qualitative research typically examines a single social setting—a case—such as an organization, community, or association. However, while case studies may use qualitative approaches, they may also employ quantitative methods such as surveys and quasi-experiments. In addition, not all qualitative studies are concerned with the detailed description and analysis of study settings.

Qualitative studies may also be termed ethnographic, which refers to the description of a culture after extensive field research. The primary method of ethnographers is participant observation, but qualitative research is not limited to the study of culture. Researchers have to address the limitations of ethnographic studies in influencing public policy, but many additional topics pertain to qualitative research.

Qualitative research is also related to phenomenological inquiry, focusing on the experience of a phenomenon by particular people. In subject matter, phenomenological inquiry seeks to understand what people experience and how they perceive the world. In research methodology, phenomenological inquiry believes the best way for researchers to know what another person experiences is through participant observation. The qualitative methodology requires the researcher to have both sensitivity and sympathy, unlike in a strictly procedural or step-by-step researcher program.

Another commonly used term, heuristics, is a form of phenomenological inquiry that focuses on intense human experiences from the point of view of researchers to develop a sense of connectedness between researchers and subjects. Qualitative research encompasses both the research subject and the method of phenomenological inquiry, but is much broader in both areas. In addition to individuals, qualitative research may focus on a group, organization, community, or social phenomenon or entity. In addition to participant observation, it may also include focused interviews, case studies, or other methods suitable for qualitative fieldwork.

The field of symbolic interactionism also contributes to qualitative observation and analysis. In this practice, meaning is negotiated under ongoing interaction. The concept of objects is integral to interactionism, and participants who interact with others understand their world by interpreting how others act toward objects. Its unique emphasis on a common set of symbols and their interpretations by those who use them is important to qualitative research to explain human interactions and behaviors.

3. Why and how do researchers conduct a focus group study?
A focus group typically consists of six to twelve people who are brought together in a room to engage in a guided discussion of a given topic for up to two hours. Participants are selected for relevance to the topic under study and are unlikely to be randomly chosen. The purpose of the focus group study is to explore, rather than describe or explain in any definitive sense.

At least two investigators should be present during a focus group study—one serving as moderator and the other as recorder. The moderator, guided by the interview guide, facilitates and moderates the discussion to make sure it is not dominated by one or two highly verbal participants and that everyone has an opportunity to talk and share their views. Recording may be done in the same room or an adjacent room, and the study may be videotaped and analyzed later with permission by focus group participants.

Participants talk about their perceptions of the issues raised by the facilitator, hear one another’s views, and provide additional comments. These discussions can yield valuable information about group interactions and dynamics as people react to views they agree or disagree with. Participants are not required to reach consensus on any issues. Instead, the objective is to allow people to provide their own views on the topic of interest in the context of other people’s views.

4. What are the components of qualitative research? What does each component entail?
The essential components of the qualitative research process include preparation, access, design, data collection, analysis, and presentation. The preparation stage involves reviewing all relevant literature related to the topic in order to ascertain the current knowledge on the topic, the existing gaps in knowledge, and area(s)/gap(s) current research will address.

The access stage involves gaining access to the selected site. If the setting is a public place, the researcher may not have to negotiate for access, but if it is a formal organization, permission is critical. If researchers wish to conduct a study in a hospital, they must approach the administrator to obtain permission and cooperation, explain the general purpose of the study and its significance, and guarantee strict confidence. However, investigators may want to be ambiguous about the detailed research objectives to reduce potential biases such as creating a Hawthorne effect.

One approach often used to obtain entry is the known-sponsor approach, in which investigators rely on the legitimacy and credibility of another person or agency—the known sponsor—to establish their own legitimacy and credibility. However, before using this approach, researchers need to be certain that the known sponsor is a truly reliable source.

In identifying informants, researchers should recognize informal leadership, because the help of group leaders is often essential. Investigators should try to select a representative cross-section of people, including different sociodemographic groups, organizational units, and tasks, and atypical individuals should also be sought. To select the ideal mix of informants, researchers should become familiar with the study setting through a background reading of literature about the group or organization.

Another method for gaining access is a snowball strategy, which involves locating additional contacts through informants. Once researchers have established trust and rapport with informants, the informants may be able to reveal additional names of people who can provide more information about the questions of interest. Regardless of which methods are used to gain access, researchers should be able to provide the actual reasons that people should allow themselves to be interviewed.

The design stage is flexible because the design features generally cannot be completely specified prior to entering the research setting and because the design may change during the course of the study as a result of new or unforeseen events. However, researchers are better prepared if they know precisely what they are looking for and how to look for it ahead of data collection. One way to do so is through triangulation—the use of a combination of several methods in the study of the same topic, including both quantitative and qualitative. It is recommended for predicting phenomena such as participation and technology.

The components of design include the unit of analysis (the focus of analysis in the study); preliminary sampling procedures, which may include purposive or quota sampling, time sampling, typical case sampling, extreme (deviant) case sampling, intensity sampling, and stratified purposeful sampling; researchers’ roles in the study (observers or observer-participants); and ethical implications of fieldwork. The ethical implications include concerns such as the potential risk of harm to the subjects, data security, risk disclosure, obtaining informed consent from participants, and keeping promises of incentives in a timely manner.

In the data collection stage, qualitative researchers use multiple sources of evidence to address a broad range of issues related to a topic and to validate study findings. Data collection methods commonly include observations, interviews, and case studies. Qualitative investigators rely heavily on existing data sources, and also record data during a field study using methods such as relying simply on memory, taking notes by hand or using a computer, or recording the data electronically. An interview pilot test is typically implemented beforehand to identify limitations, flaws, or weaknesses prior to implementing the interview. During the interview, researchers should be good listeners, maintain neutrality, be sensitive and responsive to subjects, and understand that the interview setting may affect responses.

Few guidelines and procedures govern all types of qualitative analysis, but several major steps are common to most analyses of qualitative data. These include becoming familiar with the relevant literature in the field in order to develop hypotheses and analytic frameworks, reading one’s research notes carefully, coding important topics or observations, and developing classification schemes based on major themes. Researchers should also be watchful for biases and seek multiple sources of evidence to corroborate research findings. Based on detailed descriptions of actions, activities, and beliefs, a qualitative analysis integrates concepts and ideas to help explain and interpret them. Their underlying meaning is explored, significance is attached to the results, patterns are generated, and themes and concepts are identified and become the components of grounded theories.

To assist qualitative analysis, researchers think about analysis at the very start of data collection. Qualitative analysis begins with frequently reviewing and editing field notes. As soon as data are collected, they are coded and organized in different categories to facilitate later analysis. The initial set of coding categories acts as a foundation for analyzing the next segment of data. Categories may be added and refined as the investigator’s understanding of the data improves. Computers can be used to facilitate the filing and analysis process.

The methods of analysis used may include constant comparative analysis, which involves comparing different pieces of data among each other to understand the relationships among them; narrative analysis, which involves generating, interpreting, and representing people’s stories; or another specific qualitative analytic strategy.

The final stage involves the presentation of the results of the qualitative research. Results may be published as a book, journal article, or report submitted to the funding agencies. A summary of the findings may be presented at conferences or published by the media. A structured format for presentation of results is composed of six major sections: Introduction, Setting, Design, Findings, Discussion, and Bibliography. The method of presentation used is tied to the intended audience.

5. What are the various methods of data collection in qualitative research? Assess their pros and cons.
Three widely used methods in qualitative research are participant observation, the in-depth interview, and the case study. Participant observation involves directly participating in and observing the phenomena being studied. Observations enable researchers to go beyond the selective perceptions of others and to experience the setting firsthand. Participant observation sensitizes researchers to the research setting and to the members within. By becoming part of the group, researchers are more likely to see events from the perspective of insiders. By directly observing operations and activities within the setting, researchers gain a better understanding of the context and process of activities. The firsthand experience acquired through participant observation helps address the whys and hows of research questions.

The in-depth interview may take the form of an informal conversational interview, standardized open-ended interview, or general interview guide approach. In an informal conversational interview, specific questions and general topics are not predetermined, but instead emerge spontaneously in the natural flow of conversation. The standardized open-ended interview seeks in-depth information and understanding of participants’ knowledge and perspective in an environment, event, or experience. It consists of a questionnaire instrument with a set of carefully worded and sequenced questions, along with instructions for probing. This type of interview is used when it is important to minimize variation in questions posed to interviewees, particularly when studies involve multiple interviewers. The downside of this approach is that it is less flexible and less spontaneous. The general interview guide approach uses an outline of issues to be explored during the interview. The issues are unstructured, open-ended, and of variable length. Issues can be addressed in any order and can be altered to fit in with the flow of the actual interview. New findings during the interview may inform subsequent questions. Respondents can answer in their own words, whether briefly or at length. In-depth interviews may also be given to groups of individuals in the form of a focus group study.

The in-depth interview has several advantages. It is flexible, has high face validity, and is low in cost. The focus group study is an efficient data collection method, because during one setting investigators can gather information from six to twelve people instead of from only one person. The process also enhances data quality as participants provide checks and balances on each other that reduce inaccurate information and extreme views. Furthermore, it allows investigators to assess whether views are shared relatively consistently among participants on certain issues.

However, the in-depth interview also has several weaknesses. The number of questions to be asked or issues to be explored is limited, since it takes time for respondents to think about each open-ended question and then say what they think. A focus group study also affords the researcher less control than individual interviews do. When participants share opposing views in a nonconciliatory manner, the interview may be difficult to conduct. The in-depth interview also requires greater facilitating skill on the part of investigators. Other weaknesses include the difficulty of taking notes while simultaneously facilitating the interview, the time-consuming nature of transcribing notes, the need for release forms and obtaining informed consent, and the challenge of analyzing the data collected.

A case study is an empirical inquiry that uses multiple sources of evidence to investigate a real-life social entity or phenomenon. It often seeks to capture individual differences or unique variations across different settings or experiences. This method is flexible and diverse. It can be large or small, and may focus on an individual, event, community or organization, or time period. The type and quantity of data in a case study can vary greatly. Researchers usually use several methods of data collection, which enables them to get a more complete account of relevant issues. The costs and timetables vary significantly.

6. Discuss the potential strengths and weaknesses commonly associated with qualitative research.
The main strength of qualitative research is the validity of the data obtained: in-depth interviews are conducted with individuals in enough detail for the results to be considered accurate representations of their perspectives and experiences. The question “why” can usually be answered through qualitative research, although validity largely hinges on the skill, competence, and rigor of the researchers conducting the investigation. Qualitative research is more effective for studying topics that are difficult to analyze quantitatively, and the methods used are better suited for studying attitudes, meanings, perceptions, feelings, behaviors, motivations, interrelations among factors, changes, complexities, idiosyncrasies, and contextual background. Other strengths of qualitative research include its flexibility and cost savings.

The major weakness of qualitative research is its lack of generalizability. Its depth and detail typically derive from a small number of respondents or case studies that cannot be taken as representative, even if great care is taken to choose a cross-section of the type of people or research sites. It rarely yields descriptive statements about the characteristics of a large population, and the conclusions reached are generally regarded as less definitive. Another weakness is that because the measures are subjective and idiosyncratic, another researcher studying the same topic may use entirely different measures or analysis strategy and come to a different conclusion, so reliability is an issue. Other weaknesses include ethical issues that may arise when a case study is carried out by an active participant, practical difficulties in combining the sometimes conflicting roles of group member and researcher, and the demands placed on research skills.