1. Growing the Evidence Base for Telemedicine Using Qualitative Research Methodologies
Suparna Qanungo, PhD
Assistant Professor, College of Nursing
Co-Director
Telehealth Research Program
Medical University of South Carolina

2. Telehealth Use in Research

3. Qualitative vs. Quantitative Research
ASPECT
QUALITATIVE
QUANTITATIVE
Focus of research
Quality (nature, essence)
Quantity (how much, how many)
Philosophical Roots
Phenomenology, symbolic interaction
Positivism, logical empiricism
Common Purpose
Understanding, interpretation, discover ideas, hypothesis generating
Prediction, control, confirmation, causal explanation, hypothesis testing
Approach
Observe and interpret
Measure and test
Design Characteristics
Flexible, free form, evolving, emergent
Predetermined, structured
Setting
Natural, familiar
Artificial, unfamiliar
Sample
Small, non-random, theoretical
Large, random, representative, generalizability
Researcher independence
Researcher is intimately involved, “Emic” (insider perspective)
Researcher uninvolved observer,
“Etic” (outsider perspective)
View of reality
Subjective
Objective
Data collection
Researcher as primary instrument, interviews, observation
Inanimate instruments (scales, tests, surveys, questionnaires)
Mode of analysis
Inductive (by researchers)
Deductive (by statistical methods)
Findings
Comprehensive, holistic
Precise, narrow, reductionist
Based on Merriam, 1988 and Sandelowski, 1986

4. Qualitative Research
An inquiry process that addresses a social or human problem, analyzes words, reports detailed views of informants and is conducted in a natural setting (Creswell, 1998)

5. Qualitative Research
Managing Life with Spinal Cord Injury (Experience, Environment)
Research involving health workers visiting homes and communities (Experience, Environment)
Community integration for wheelchair bound individuals

6. Data Collection Techniques and Sources
Observations (e.g. photovoice)
Documents
Artifacts
Interviews
Focus groups
Some contents in this slide is courtesy Dr. Julie Barosso, Chair, College of Nursing, MUSC

7. KI Interviews: how hard can THAT be?
Mainstay of qualitative research
Conduct the interview in a place and at a time which is most comfortable and convenient for the participant
Unstructured conversation with a purpose
Outcome of the interview is an understanding (e.g. experience, perceptions, barriers, facilitators) for those who are part of it
Features audiotaping and verbatim transcription of data, and use of an interview guide
Researcher must:
Learn the roles of the informants
Understand the culture
Must have mutual trust and respect with the interviewee
Must be fully engaged
Communicate clearly and focused observation
Understand the language
Anything, phones etc. should be turned off. Fully engaged.
Some contents in this slide is courtesy Dr. Julie Barosso, Chair, College of Nursing, MUSC

8. Focus groups…
Should be done IF the data are appropriate for collection in a group
Ideal group size is 6-10 members
Should be observed for group dynamics
Should be developed based on some a priori grouping
Require at least 2 researchers: one to ask questions, and one to monitor equipment and observe group interactions
Have to watch for “groupthink”
You have to shut down overpowering people and if someone who do not speak, get them to speak
Two people needed: one to conduct and other to observe interaction. If more than 2, better
Some contents in this slide is courtesy Dr. Julie Barosso, Chair, College of Nursing, MUSC

9. So how do we get participants?
Think about where/how they live; you can only do this if you are very well acquainted with your population
Flyer distribution
Community Gatekeepers
Snowballing (word of mouth)
Snowballing: word of mouth, give out flyers to give people who might need other people
Some contents in this slide is courtesy Dr. Julie Barosso, Chair, College of Nursing, MUSC

10. Qualitative Process Key Informant Interviews (KII) Focus Groups (FG)
Individual
Group
Ask, Listen, Interact, Record
Audio Recording (Digital)
Video/ Photos
Field Notes
Transcribe/Translate
Software
Human
1 hr KII/FG >6-10 hrs transcription time
Data Analysis (Nvivo/Dedoose)
Themes, sub-themes, barriers, facilitators
Snowballing: word of mouth, give out flyers to give people who might need other people

11. Data Analysis
Step 1. Get familiar with your data (listen to your recordings, read notes and transcripts or summaries again) Step 2. Identify codes and themes (look for regularities in data and identify segments that fit) Step 3. Coding your data (match content to coding scheme) Step 4. Organize your codes and themes (cutting out data extracts and putting them together under each code)
Snowballing: word of mouth, give out flyers to give people who might need other people
Some contents in this slide is courtesy Dr. Julie Barosso, Chair, College of Nursing, MUSC

12. Data Analysis
For scientific findings, you have to analyze the data and not just say out the quotes and interviews.

13. Data Analysis
Research on telehealth rehab training using gaming interventions
Snowballing: word of mouth, give out flyers to give people who might need other people
Some contents in this slide is courtesy Dr. Julie Barosso, Chair, College of Nursing, MUSC

14. Telehealth Use in Research at MUSC
Mealtime Interventions for Caregivers/Dementia Patients at Respite Care Centers
HIV and substance use prevention program in Latina adolescents
Telehealth research for prenatal care
Patient navigation to Enhance palliative cancer care services in rural India
Peer Navigator interventions for individuals with spinal cord injury
Nurse-guided community based outreach for stroke recovery in African-Americans
Interventions to provide relief to patients with chronic leg venous ulcers

15. Telehealth Use in Research

16. THANK YOU!