A Brief Introduction to Qualitative Research Cathryne Palmer, M.R.T.(T.), MSc, Medical Radiation Sciences Program, Department of Radiation Oncology, University of Toronto, ON Amanda Bolderston, M.R.T.(T.), MSc, Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, ON
ABSTRACT
RÉSUMÉ
his paper provides an overview of qualitative research and highlights the benefits of a qualitative approach to research in the radiation sciences milieu. Qualitative research methodologies can be used independently of, or to enhance, quantitative approaches. We draw attention to the process of generating a qualitative research question. In addition, we provide an overview of the purpose, benefits and drawbacks of the four main qualitative research methodologies: interviews, focus groups, observation studies and chart (document review), for you to consider for your next research endeavour.
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WHAT IS RESEARCH AND WHY DO WE DO IT?
Qualitative research is an interpretative approach, which attempts to gain insight into the specific meanings and behaviours experienced in a certain social phenomena3 through the subjective experiences of the participants. The researcher builds abstracts, concepts, hypotheses, or theories by asking such questions as “why”, “how” and “in what way?”.5,6 Quantitative methods use a highly objective, systematic approach and work with numerical data. Conversely, qualitative methods use descriptions and categories (words) to study human experiences and realities from the subject’s perspective. It is often an iterative process whereby the theory/hypotheses emerge from the data as it is collected, making the researcher key in the data collection and analysis processes. The study design is emergent and flexible, responsive to the changing conditions as the study progresses. The goal is to understand the phenomenon from the viewpoint of the participants; with its particular institutional and social context intact; this data and context is lost if attempts to quantify the data are made.7 The validity of qualitative methods can be improved by using a combination of data collection methods (a process known as triangulation) and by analysis of the data by more than one person. Examples of qualitative methodologies that will be discussed include the interview, the focus group, observation and/or chart review.
Research is used at many levels in the radiological sciences. The approach may vary from a technologist carrying out routine daily equipment audit to a radiation therapist participating in a large multi-centre randomised trial. More formally, research can be defined as “the systematic investigation into and the study of materials, sources, etc. in order to establish facts and reach new conclusions”.1 In general, most research conducted in the radiological sciences is designed around quantitative methodologies (involving the structured and impartial analysis of numerical data). However, qualitative research can initially identify and define an area of interest (which can lead to the generation of the hypotheses for a quantitative study) as well as complement quantitative research by supplementing and validating the results. Qualitative research reports are usually rich with description, and may be a more appropriate choice for some subjects from the reader’s perspective because “if you want people to understand better…provide them with information in the form in which they usually experience it”.2 Today the trend is towards blending aspects of the two research approaches in order to ensure a more rigorous process. In our evidence-based healthcare environment it is becoming increasingly important that data generated are not a product of a single methodology.3
WHAT IS QUALITATIVE RESEARCH? “The motivation for doing qualitative research, as opposed to quantitative research, comes from the observation that, if there is one thing which distinguishes humans from the natural world, it is our ability to talk! Qualitative research methods are designed to help researchers understand people and the social and cultural contexts within which they live.”4
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et article donne un aperçu de la recherche qualitative et met en valeur les bénéfices d’une approche qualitative pour effectuer de la recherche dans le milieu des sciences de la radiation. Les méthodes employées pour les études qualitatives peuvent être utilisées de façon indépendantes des approches quantitatives ou pour les améliorer. Nous portons attention au processus de création d’une question de recherche qualitative. De plus, nous traçons, pour votre considération lors de votre prochain projet de recherche, un aperçu du but, des bénéfices et de l’apport des quatre grandes méthodologies de recherches qualitatives: les interviews, les groupes de discussions, les études d’observation et les diagrammes (revues documentaires).
RESEARCH DESIGN Qualitative research is predominantly an emergent process, whereby the designs and outcomes are formed as the research takes place. However, there are some general steps that should be considered (after Lincoln and Guba2): 1.
Decide on an initial focus and inclusion/exclusion criteria for new information (bearing in mind these may change with time)
2.
Determine whether qualitative research is an appropriate paradigm for your focus.
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3.
Decide where and from whom data will be gathered.
4.
Plan the methods for each stage of the research and whether any additional instruments will need to be designed.
5.
Plan how data will be collected/recorded (including scheduling and budgeting)
6.
Decide how the data will be analysed.
7.
Plan the techniques that will be used to determine trustworthiness.
GENERATING THE RESEARCH QUESTION A research question arises either through a passionate interest in the subject matter on the part of the researcher, or through environmental/ cultural influences driving the need for investigation.3 Either way, developing or generating a research question should not be undertaken lightly. The formulation of the question in qualitative research should be the result of some prior investigation, either through a review of literature that is incomplete or invalid; or anecdotal comments made by patients or healthcare colleagues.3 Remember that qualitative research studies questions of how, why and what. For example, the “greying” of our society is currently a hot-topic in the media. If we were to brainstorm with our colleagues about this topic some of the qualitative research questions generated could be: What impact does the increasing number of elderly patients have in our departments? How does this change the way we work? How can we improve the experience of our older patients? These questions could be answered using qualitative research because the answers would be embedded in the participants’ interpretation of the issue (both our experiences and understanding as medical radiation technologists and the patients’ experiences in the health care setting).
QUALITATIVE RESEARCH METHODOLOGIES Data collection methodologies that are commonly used in qualitative research are the interview, the focus group, observation and/or chart review. The purpose, benefits and potential drawbacks of each will be discussed to help you determine the most appropriate methodology for your study. See Table 1 for a concise view of the benefits and drawbacks of each methodology. Interviews: An interview offers the possibility of gaining insight into the interviewee’s world and a deeper understanding of the nature or meaning of the interviewee’s everyday experiences. The interview may also be used to test a hypothesis.7 There are three approaches; namely structured, semi-structured and unstructured interviews. In a structured interview the interviewees are asked the same questions in exactly the same way, including tone of voice. A structured interview is somewhat similar to a survey as there is no room for deviation or exploration of issues outside of the set questions. In contrast, unstructured interviews are free flowing discussions, which can take the interviewer and interviewee in a direction that deviates from the intended subject. A semi-structured interview is an amalgamation – the questions are formatted but the interviewer may deviate from the scheduled questions if an unforeseen discussion point is proving fruitful.8 The data that can be generated from unstructured and semi-structured interviews can be rich and provide more in-depth appreciation of a subject matter than a questionnaire.8 In our example, an interview could be used to ask elderly patients about their expectations for treatment when they come to an Imaging or Radiation Therapy Department.
Focus Groups: A focus group is an extension of the interview but with a larger group of people. It is a moderated discussion with 5-10 participants about a particular subject that aims to identify and understand the participants’ views.3,7,8 One advantage of the focus group when compared to the interview is that group discussions can lead to forgotten or repressed information thus enhancing the data collected.3 Also the group dynamics can lead to a richer discussion. It is usual practice to have the focus group facilitated by someone external to the social context being investigated but familiar with the subject matter, this reduces the interviewer bias (or power differential). Since there are a vast amount of data generated it is also helpful to have a separate note taker and/or audiotape of the session. In the investigation of elderly patients’ experiences in our departments, a focus group would be an invaluable way of eliciting information from a number of technologists regarding their perceptions of the needs of this group. Chart/Document Review: Many projects undertaken by undergraduate radiation science students, involve the review of documents or charts. The authors believe that this maybe due to a misconception that a chart review is deemed to be a fairly straightforward research methodology. However it too has benefits and drawbacks. Sources of primary documents that a researcher may consider reviewing for data include minutes from meetings, departmental policies, publications from national and provincial associations, newspaper articles. The first thing a researcher must ensure is the accessibility of the documents in question: this can be a significant issue if certain documents are considered confidential.8 If accessible and available, then management of the selection of the documents is essential, as this method could result in huge amounts of paper (data), which may not necessarily be required. Similarly, an analysis of the content of the documents could result in data irrelevant to the initial research question.7,8 Reflection on the content, and the document itself, is also vital. This evaluation is divided into two processes: external and internal criticism. External criticism questions the authenticity of the documents (i.e. that it truthfully reports on the subject), and ensuring the document is genuine. Internal criticism is the rigorous analysis of the content of the document, seeking answers to questions such as, “…What kind of document is it; policy, government statute, minutes, etc., What does it actually say? Who produced it? What is known about the author? When was it produced? Is it complete?”.8 While the evidence or data generated can be both thorough and worthwhile, the researcher should be aware that data overload and the time demands of processing and coding are considerable.7,8 A chart review would be a useful adjunct and could be used in several ways in our example. The researcher could review departmental minutes, policies, codes of practice, mission statements etc. to see if there was any evidence of organisational commitment to improving care for elderly patients. In addition she/he could review incident reports or complaints data to discover actual events involving elderly patients and look for themes (for example, a breakdown in communication between medical radiation technologist and patient). Observation Studies: The main purpose of using observation studies in health care research is that the researcher has the opportunity to witness first hand what individuals say and do in “real life”, rather than relying on the individual’s interpretation of the situation.3,8 There are two main types of observation studies: participant observation and non-participant observation. Participant observation
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relies on the researcher becoming immersed in the social situation that is being investigated, to the point that they are accepted as an integral member of the community. This method is ideal when the researcher is investigating areas of their own practice, as the researcher is already an insider.7,8 The researcher enters the situation with no clear intentions or objectives and as the events/behaviour unfolds the researcher records the observations after the event has occurred. This is also known as unstructured observation.3,7,8 Whereas participant observation is complete participation, Cohen et al7 describe non-participant observation, as complete detachment. This method often relies on charts or checklists to allow the researcher to catalogue events as they occur. The nature of the interaction, process undertaken, or the behaviours of the subjects are all themes that could be observed. In our research example, the investigator could use participant observation in her/his department and record examples of actual encounters with elderly patients. This data could be used in conjunction with any of the other approaches to triangulate the results. Hopefully what is found using both approaches will be similar – if not a whole new research project could emerge!
TRUSTWORTHINESS Whereas quantitative research is concerned with issues of validity, reliability and objectivity, the realities of qualitative work require these terms to be redefined.9 Naturalistic terms include credibility (the explanations are consistent and understandable), transferability (there is enough information provided to allow the results to be adapted to another context or population), confirmability (there is a distinction between the researchers and the subject’s ideas) and dependability (the process used to obtain the results can be replicated). Methods to ensure trustworthiness include the following steps: 1. Audit Trail: Detailed documentation of all decisions made during data collection/analysis to ensure a transparent process. 2. Peer Review: This can include an independent review of the themes by research team members or a review of themes by peer(s) not involved in the research. 3. Member Checking: Interpretations of the data are shared with participants to ensure that meaning has been preserved. 4. Triangulation: Compare data with those from other sources (e.g., focus groups with surveys). 5. Negative Case Analysis: Deliberately look for contrasting experiences/examples to disprove emerging theories. 6. Data saturation: Gather data until all themes are exhausted.
ANALYSIS Data collection usually continues until the researcher begins to achieve data saturation or until resources (or the researcher!) are exhausted. Qualitative researchers predominately use inductive data analysis, which means that critical themes emerge out of the data.10 The data can be sorted, broken into sub-units and worked with until patterns emerge. In this way, the raw data is organised into meaningful categories for communication to others.11 There may be hundreds of pages of raw data and sorting it can be done by hand, using a word processing system to “cut and paste” text into
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categories or organised using one of several analytical computer software programs for qualitative data such as NVIVO, ATLAS or N6 (formerly nud*ist).
SUMMARY The strength of qualitative research is in its ability to capture the details, practice and experience of the subjects as it occurs. The types and qualities of interactions are described, thereby providing meaning to subjective experiences. This paper provides a brief introductory overview of the value of qualitative research methodologies . A running example relates the theoretical underpinning of qualitative research to the radiation sciences. To conclude, the qualitative approach can be a useful and enlightening way to research issues in many areas of our daily practice: “The decision to use qualitative methodologies should be considered carefully; by its very nature qualitative research can be emotionally taxing and extraordinarily time consuming. At the same time, it can yield rich information not obtainable through statistical sampling techniques.”11
REFERENCES: 1.
Barber K. ed. The Canadian Oxford Dictionary. Oxford University Press Canada; 1998.
2.
Lincoln YS and Guba EG. Naturalistic Inquiry. Beverley Hills, CA. Sage Publications; 1985.
3.
Polgar S and Thomas S. Introduction to Research in the Health Sciences 4th Ed., Churchill Livingstone, U.K.; 2000.
4.
Myers MD. Qualitative research in information systems. MIS Quarterly 1997;21(2):241-242.
5.
Cresswell JW. Qualitative inquiry and research design. Thousand Oaks, CA: Sage Publications; 1998.
6.
Mertens DM. Research and evaluation in education and psychology. Thousand Oaks, CA: Sage Publications; 2005.
7.
Cohen L, Manion L, Morrison K. Research Methods in Education. 5th Ed., Routledge, USA; 2001.
8.
Bell J. Doing your research project: A guide for first-time researchers in education and social science 3rd Ed., Oxford University Press, U.K.; 1999.
9.
Strauss A and Corbin J. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Newbury Park, CA. Sage Publications; 1990.
10. Patton MQ. Qualitative Evaluation and Research Methods. Newbury Park, CA. Sage Publications; 1990. 11. Hoepfl MC. Choosing qualitative research: a primer for technology education researchers. The Journal of Technology Education Fall 1997;9(1):47-63.
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TABLE 1: BENEFITS AND DRAWBACKS OF QUALITATIVE RESEARCH METHODOLOGIES DRAWBACKS
BENEFITS INTERVIEWS •
Closer rapport between interviewer and the interviewee.
•
Preparation time/Time consuming.
•
Semi-structured less time consuming than unstructured.
•
Potential for interviewer bias.
•
Allows for the same basic information to be collected from all interviewees.
Lack of structured consistency leads to questions of reliability of the collected data. FOCUS GROUPS
•
Gather a range of information in a relatively short time span
•
Considerable preplanning and organizing
•
Activate forgotten details of experience
•
Sample is not random nor representative
•
Release inhibitions among participants
•
•
Facilitator can explore related but unanticipated topics as they come up
Data quality is influenced by the skills and motivation of the facilitator
•
Use the actual words & behaviours of participants to answer research questions, can’t count and measure
•
Do not require complex sampling techniques
CHART REVIEW •
Useful adjunct to triangulate the data
•
Time demands of processing the information
•
Rich in information
•
Potential data overload
OBSERVATION STUDIES •
Researcher witnesses subjects “first-hand”
•
Researcher bias
•
Process, behaviours and interactions can all be studied
•
Observation aids/tools may be more difficult to use
Cathryne Palmer has worked as a radiation therapist at the Princess Margaret Hospital, University Health Network in Toronto since coming to Canada from England in 1990. Cathryne is currently the Academic Coordinator, in the Department of Radiation Oncology, University of Toronto for the joint degree/diploma program in Medical Radiation Sciences in collaboration with the Michener Institute for Applied Health Sciences. Amanda Bolderston is a radiation therapist who trained at the Oxford Regional School of Radiography in the UK. Amanda is currently the Clinical Education Manager at Princess Margaret Hospital, University Health Network in Toronto and a Lecturer for the University of Toronto. Her job involves the supervision of undergraduate and graduate education as well as patient education provision. Her professional interests include the application of evidence-based guidelines for radiotherapy practice and advanced practice issues for radiation therapists. She is currently working towards her doctorate in education.
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