College Maiden Seminar on Scientific Writing, 14th September 2011 Qualitative Health Research Presented at the College Maiden Seminar on Scientific Writing, 14th September 2011 Dr. A. Adindu Dept. of Public Health College of Medical Sciences University of Calabar 1

Objectives At the end of this presentation we should be able to discuss: differences between qualitative and quantitative research; paradigms shaping qualitative research; basic principles of qualitative reserch; qualitative research techniques; 2

importance of qualitative methods in health research; and Objectives continue importance of qualitative methods in health research; and methodological issues in qualitative research. 3

Introduction Health researchers increasingly apply qualitative methods in studying social, cultural, and economic dimensions of health, ill health and service delivery. However, health researchers in Nigeria tend to stay away from qualitative methods. 4

Introduction Cont. Understanding the complex nature of human behaviour in health and illness requires different approaches in collecting data, analysing and reporting. Qualitative health research is critical, and indeed indispensable in the process. 5

Quantitative Methods Revisited 1. Natural science models founded on positivism, and application of mathematical methods support quantitative research. 2. Principles therein continue to influence social science research, and indeed health research. 6

Quantitative Methods Revisited 3. Positivism presupposes that people, the objects of social sciences, are the same as chemicals and particles. 4. Positivists view as knowledge only phenomena observable by the senses or with instruments. 5. These, weaken the use of quantitative data in describing social reality. 7

Quantitative Methods Revisited 6. Yet, positivists believe that methods and procedures of the natural sciences have universal application and appropriate for the social sciences and indeed, health sciences. 8

Quantitative Methods Revisited Characteristics: Hard Fixed Objective Deductive Tests Hypothesis Rigorous Positivistic Imposes Theory Empiricist Universalitic Abstract Provides Proof Measures level of occurrence Measures level of actions Asks how many, how often 9

Implications of quantitative methods in Health Research 1. Study of health and illness behaviour excludes phenomena not observed directly. 2. Quantifying subjective feelings is difficult. 3. Numerical results strong in statistical evidence give no insight into health behaviours from which they emerged. 10

Qualitative Research Why qualitative research? Drawbacks in quantitative research, reaction to positivism led to the development of qualitative approach to study the social world, describe, and analyse the culture and behaviour of humans from their point of view. 11

Qualitative Research What is qualitative research? Qualitative research covers broad range of interpretive techniques, which seek to describe, decode, translate, and come to terms with the meaning and not the frequency of certain natural occurring phenomena in the social world (Maanen, 1985). 12

Qualitative Research Attributes Uses specialised techniques to obtain in-depth data in natural settings. Focuses on complex and dynamic social processes. Looks into meanings of how people live, what they think and feel, beliefs, and motives. 13

Qualitative Research Attributes Uses methods that respect the nature of the empirical world under study. Discovers and interprets using small numbers of respondents not based on probability sampling. Qualitative techniques applied throughout the process. 7

Qualitative Research Attributes Data collection and data analysis go on at the same time during fieldwork. Analytical induction and gradually theoretical discourse start during fieldwork. 14

Qualitative Research Viewed as: Soft/Dry Flexible/Fluid Grounded Inductive Subjective Allows for Discovery Phenomenological Interpretive Holistic Contextual Asks why, and gives insight into behaviour and action. 15

Views events and actions from point of view of those being studied. Basic Principles Views events and actions from point of view of those being studied. Provides detailed description of social setting under investigation. Views social life as a dynamic process rather than static. Uses unstructured strategies. Formulates and tests theories along with data collection. 16

Perspectives Shaping QR Interpretive paradigm covers broad philosophical and sociological thoughts which try to understand and explain the social world from view of those directly involved in the social process. It seeks to understand the world as it is, and the fundamental nature of social world at the level of subjective experience (Burrell and Morgan, 1994). 17

Perspectives Shaping QR Interpretive scientists strive to understand the essence and source of social reality by penetrating the depth of human consciousness to understand the fundamental meanings of social life. Immanuel Kant (1724–1803) gave interpretive paradigm initial foundation. 18

Perspectives Shaping QR Recent theorists Husserl, Schutz, Weber and Dilthey established interpretive perspective as framework for social analysis. The main paradigms that give QR distinct epistemology include: Phenomenology, Verstehen Symbolic interaction, Ethnogenetics, Hermeneutics, Ethnomethodology Linguistic Philosopy 20

Perspectives Shaping QR From these sociological and philosophical ideas, naturalistic approach draws strength, emerging as alternative view of the proper nature of social research, and indeed health research. 21

Tries to understand structure and essence of experienced phenomenon; Phenomenology & Qualitative Research Tries to understand structure and essence of experienced phenomenon; Behaviour comes from peoples’ interpretation of the world; This process of interpretation must be captured in social & health research; Researcher attempts to see things from perspective of actors; 22

Phenomenology & Qualitative Research Researcher focuses on how experienced phenomena are assembled to make sense of the world; and Understands people's experiences by experiencing it. The process allows the phenomenon to speak for itself with full revelation. 23

Phenomenology & Qualitative Research Phenomenological reduction expects researchers to set aside assumptions, biases, prejudices, theories about a phenomenon in order to listen effectively. Researcher captures what the phenomenon is and not what it might or ought to be. 24

Provides depth and detail not obtainable with quantitative methods. Need for Qualitative Health Research Provides depth and detail not obtainable with quantitative methods. Depth of knowledge expected compels health researcher to spend more time in the facility or community. Enhances study of complex health problems, uncovering difficult issues. 25

Need for Qualitative Health Research Respects context of health behaviour, and presents social life of individuals, and groups holistically. Indispensable to studying structure and process of health care. Researcher is flexible not constrained by pre-selected categories for analysis. Flexibilty allows for depth, detail, openness, and more understanding. 26

Qualitative Research Methods Case Studies Case study is a common qualitative method that studies a phenomenon in its real life situation. Action Research This has many names: participatory research, collaborative, practitioner research, action learning, and contextual research among others. 27

Qualitative Research Methods Ethnography Ethnography is another qualitative research approach, popularised by anthropologists. The ethnographer spends time largely with those being studied. 28

Qualitative Techniques Participant Observation Non-participant Observation Individual Indepth Interview Group Indepth Inerview (Focus Group Discussion) Document Analysis 29

Methodological Issues Complexity, fluidity and flexibility in qualitative research raises some issues. Context Triangulation Framework for Data Collection Validating Results Analysing Data 30

Methodological Issues Context Context is about the setting where behaviour occurs and other aspects of the situation. It is critical in qualitative research for holistic understaning of the people. Interaction with context increases accuracy of interpretations, expands value of findings, and creates conditions for understanding life processes. 31

Methodological Issues Triangulation Collecting data for understanding human realities and depth of health behaviour requires the integration of qualitative and quantitative methods in data collection, analysis and report. This is termed triangulation. Quantitative methods alone depth data and paints only partial picture of reality. 32

Methodological Issues Framework for Data Collection Validating Results Analysing Data 33

Finally Qualitative research is complex, requires discipline, commitment, and proper training. Researcher embarks on fieldwork with flexibility without pre-selected categories for analysis. Flexibilty gives room for depth, detail, openness, and greater understanding. 34

Thank you. For further reading on my presentation, please see: Adindu, A. (2011) Qualitative Health Research. Clear Lines Press, Calabar. 35