Excellence in Qualitative Research Kathleen A. Knafl, PhD, FAAN Associate Dean for Research Frances Hill Fox Distinguished Professor The University of North Carolina at Chapel Hill Learning to Evaluate Qualitative Research Striving for quality as a researcher Being evaluated – successful/unsuccessful attempts to publish and secure funding Evaluating others – proposal and manuscript reviewer Overview of Presentation Nature and purpose of qualitative research Position statements and guidelines for evaluating qualitative research Common expectations and indicators of excellence Overall Goal Avoid an overly simplified or overly complex discussion of issues Present guidelines that address scientific rigor while recognizing the distinct qualities and contributions of qualitative research “Creativity must be preserved within qualitative research, but not at the expense of the quality of the science” (Maxwell, 1990) Nature and Purpose of Qualitative Research Multiple approaches Terminological jungle Ethnography Phenomenology Hermeneutics Constructivism Participatory action research Grounded theory, etc… Common Characteristics of Qualitative Research Focus on subjective perspective of respondents Emphasis on contextual understanding Design flexibility; emergent design Generation of narrative data Researcher as primary data collection instrument Differences Across Approaches Purpose Philosophical underpinnings Disciplinary roots Theoretical orientation Dominant methods for data collection and analysis Varying Purposes of Qualitative Research Description Conceptualization and theoretical understanding Empowerment and social change Description (e.g. descriptive phenomenology, ethnography, qualitative description) “The purpose of this study is to explore how spousal carers of people with MS interpreted their lived experience with their partner, the way in they assigned meaning to their being in such a situation, and the skills and knowledge they have developed to live with their situation” (Cheung & Hocking, 2004, p. 155). Conceptualization (e.g. grounded theory, concept development) “The author investigated decision-making experiences of 20 surrogates who assisted terminally ill family members for this grounded theory study. Findings describe a basic social process of Seeing them Through with Care and Respect” (Meeker, 2004, p.204). Empowerment and Change (e.g., feminist, participatory action research) “In this participatory research study, injured workers and academics together participated in setting the agenda, determining the research questions and methods, gathering the data, and interpreting the results. The process helped all understand more deeply the complicated reality of being an injured worker within a set of system and societal norms (Beardwood, et al., 2005, 33-344). The Challenge of Evaluating Qualitative Research Evaluative stance – Should the same criteria apply to all research? All qualitative research? Reasonable expectations – What should we expect to see included in a qualitative report/proposal? Appropriate criteria – What standards should we use to judge the merits of a qualitative report/proposal? Guidelines and Criteria Guidelines for reporting (Tong, et.all, 2007) Shared standards (Collingridge & Gantt, 2008; Guba & Lincoln, 1985) Alternative standards (Cheek, 2007; Cohen & Crabtree, 2008; Davies & Dodd, 2002; Fossey, et al., 2002; Whittemore, et al., 2001) Shared Standards (Lincoln & Guba, 1985) Truth Value (internal validity/credibility) Applicability (external validity/ transferability) Consistency (reliability/auditability) Neutrality (objectivity/confirmability) Qualitative standard Credibility (internal validity) Defined as adequate representation of group or situation studied Quality of the data Demonstrated by prolonged engagement, persistent observation, triangulation, external checks, negative case analysis, member checking Transferability (external validity) Defined as the degree of similarity between research site/participants and others Demonstrated by thick description, reporting of information for judgments about transferability Joint responsibility of researcher and consumer Dependability (reliability) Defined as differentiating real perspective/behavior of respondents from reactive effects of research. Demonstrated by audit of data collection processes Quality of interaction with subjects External review of data Confirmability (objectivity) Defined as the adequacy of the results, interpretations, and recommendations Demonstrated by audit of analytic procedures Data processing and reduction Data review and interpretation External auditor Alternative Standards (Davies & Dodd) “Incorporating the notion of ethics, the authors develop a cluster of terms around which they argue that qualitative research can meaningfully speak about rigor: attentiveness, empathy, carefulness, sensitivity, respect, reflection, conscientiousness, engagement, awareness and openness” (Davies & Dodd, 2002, p. 279) Common Evaluative Criteria (Cohen & Crabtree, 2008; Tong, et al., 2007; Whittemore, 2001) Importance of the research Use of appropriate methods Coherence of the research Clarity of the presentation Ethical conduct of research Application of Common Criteria to Research Reports/Proposals Reasonable expectations Indicators of excellence Importance of Research Reasonable expectations General statement of purpose, research questions, or aims Review of relevant literature Importance of Research Indicators of excellence Evidence of building on prior research; addressing an important gap Pragmatically or theoretically useful Focus on the research problem, not the method Making the Case for Importance “The aim of this study was to identify approaches primary care providers use to engage older men in depression care. We focus specifically on older men because previous work has shown that they suffer from higher levels of undertreatment and that men differ from women in gender-specific barriers to help seeking” (Apesoa-Varano, et al., 2010, p. 587) Use of Appropriate Methods – Study Design Reasonable expectations Varied approaches Emergent design Indicators of excellence Rationale for selection of approach; fit with study purpose Citations in support of the approach Rationale for Study Design “We chose grounded theory as the method for data collection and analysis. It is a method for conceptualizing patterns of behavior in which people are engaged (Glaser,1978;1998). In this study, the patterns of behavior are those in which nurses engage while caring for palliative cancer patients in hospitals” (Sandgren, et al., 2006, p. 80). Use of Appropriate Methods – Role of Theory (Sandelowski, 2003) Reasonable expectations Variation in the source, function, and temporal placement of theory Different qualitative traditions specify different roles of theory Prevailing (though misleading) belief that qualitative research is atheoretical Use of Appropriate Methods – Role of Theory Indicators of excellence Explicit statement of philosophical beliefs, concepts, or theories that informed design of study When a concept/theory is an outcome of the research, comparison to related concepts or theories Example - Use of Theory “The philosophical framework for this study was based on interpretive phenomenology” (Cheung, 2004, 155). “The purpose of this study was to examine older African American women’s perceptions of social and environmental stress in relation to their heart disease through the lens of the weathering conceptual framework” (WarrenFindlow, 2007, 234). Sample Size and Selection Reasonable expectations Purposive approach; non-probability sample Relatively small sample Single case to 50+ participants Likely range of number of participants Sample Size and Selection Indicators of excellence Statement of purposive intent (e.g. maximum variation, theoretical, intensity) Specification of unit of interest (individual, group, setting) Rationale for sample size; invoking the principle of saturation Purposive Sample – Maximum Variation “The base line criterion for inclusion in the sample was that all parents were employed and had at least one child whom they identified as disabled. The aim was to generate a sample that included a range of situations in which parents combined employment and care. This was not intended to achieve generalizability, but to enable examination of issues not related to a specific homogenous group” (Lewis, et. al, 2000, p.1035). Purposive Sample – Theoretical “ As data collection progressed, I conducted theoretical sampling to provide data needed to describe the categories thoroughly. For example, because early participants were all reporting that other family members had been very supportive, I sought participants who had experienced conflict (Meeker, 2004, p.208) . Data Collection – Interviewing and Observation Reasonable expectations Use of single or multiple data collection strategies Description of: • Setting for data collection • Duration of data collection • Identification of data collectors • Description of observational or interview guides • Method for recording data Data Collection – Interviewing and Observation Indicators of excellence Overall explicitness and thoroughness • Description of role of the investigators; nature of interactions with the participants • Options for follow-up contact with participants • Efforts to assure and monitor data quality • Evidence of sensitivity to incoming data; emergent design Example – Interviews Each participant was told, “I’d like you to tell me the story of your experience with a chronic health condition. Start at the time your symptoms began and describe the things that happened one after another regarding your health condition until today. I encourage details because whatever is important to you is of interest to me” (Lee & Poole, 2005, 349). Example - Observation “I collected data through participant observation in two cardiac rehabilitation programs. In both, I assisted in the day-to-day work of the staff, attended education sessions, and conversed with participants on an ongoing basis. When I introduced myself to clients, I indicated I was there to learn about heart disease from the participants’ point of view and that I was carrying out research (Wheatley, 2005, p. 440-441). Data Processing and Analysis Reasonable expectations Overview of the steps the researcher took to break the data into smaller units for the purpose of analysis Methodological citations that support the approach Variability in use of software programs to support analysis Data Processing and Analysis Indicators of excellence Analytic process is consistent with the qualitative approach • Line by line coding for grounded theory • Extraction of significant statements for phenomenology The unit of study is preserved in the analysis Evidence of thoroughness and checks on quality Explicitness Results Reasonable expectations Variation in organizing structure for presenting results • Process • Essential structure • Thematic description • Typology Use of illustrative quotes or vignettes Variable use of numbers Results Indicators of excellence Vividness • Compelling presentation • A good read • Creative Coherence • Integration of the data; more than a description of codes and themes • Convincingly addresses all study aims Discussion Reasonable expectations Possibly integrated with results Linkages to the body of knowledge in the field Statement of applied and/or theoretical implications of the findings Limitations and next steps Discussion Indicators of excellence Elaboration of pragmatic/theoretical implications Limitations that address the unique aspects of qualitative research (e.g. non-probability sample not a limitation) Explicit consideration of transferability Ethics Reasonable expectations Statement that IRB approval has been obtained Indicators of excellence Evidence of sensitivity to human, social, and cultural contexts Recognition of ongoing ethical issues and decisions Overall Coherence and Consistency Alignment across all aspects of the study Completeness and follow through Explicitness; thoroughness of presentation Creativity – thoughtful, innovative use of methods; insightful linkages Balancing Rigor and Creativity “We can preserve or kill the spirit of qualitative work; we can soften our notion of rigor to include playfulness, soulfulness, imagination, and technique we associate with more artistic endeavors, or we can further harden it by the uncritical application of rules. The choice is ours rigor or rigor mortis” (Sandelowski, 1993). The University of North Carolina at Chapel Hill