Overview of Qualitative Research
Methods for Primary Care
and Public Health
ROBERTA E. GOLDMAN, PHD
DEPARTMENT OF FAMILY MEDICINE
ALPERT MEDICAL SCHOOL
OF BROWN UNIVERSITY
JULY 2012
Qualitative Research Overview
 Qualitative research provides data about meaning
and context regarding the people and environments
of study
 Study populations are increasingly alert to how they
are being approached by interventionists, and how
they are represented in research
Roberta Goldman, PH.D., Brown University and HSPH, 2012
The Qualitative Perspective
“I want to understand the world from your point of
view. I want to know what you know in the way
you know it. I want to understand the meaning of
your experience, to walk in your shoes, to feel
things as you feel them, to explain things as you
explain them. Will you become my teacher and
help me understand?”
James P. Spradley (1979)
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Nature of Qualitative Research
 Attempts to “make sense of” the social world in
terms of the meanings people bring to it
 To uncover ideas, insights, or ways of thinking of
and explaining phenomena about which little is
known
 To gain novel and fresh perspectives on things
about which quite a bit is already known
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Qualitative Research Approach
 Differs in approach and results from surveys
 Looking for range of phenomena in sample studied
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Rarely use statistical analysis
Not representative of the total population
 Purposive, stratified samples
 Generally not random samples
 Multi-method (i.e. multiple qualitative methods;
mixed qualitative and quantitative methods)
Roberta Goldman, PH.D., Brown University and HSPH, 2012
How to Choose your Methods
 The methods are in service to your research
questions and goals.
 The quantity of your interviews, focus groups, or
observations is dependent on the participant
characteristics you need to include, and the purpose
of your research.
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Uses of Qualitative Research
in Primary Care and Public Health
 Obtain data that are useful on their own
 Detailed, contextually-based data on subtle
meanings associated with attitudes, beliefs, and
behaviors
 What, how, and why people conceptualize issues
differently in different contextual circumstances
 Generate “indigenous” terms and categories
 Generate new avenues for study
 Process evaluation
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Uses of Qualitative Research
in Primary Care and Public Health
 Obtain data that serve as building blocks or
can be triangulated with other data: mixed
qualitative/quantitative design
Information that enhances intervention design
 Information that informs survey design and
implementation
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Understand the range of relevant survey questions and
responses
Test surveys and intervention elements
 Cognitive interviewing and pilot testing
Information that complements and/or explains other
results
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Example:
 Hablemos de Tí: Let’s Talk about You (PI: R.
Goldman)
 Focus groups of middle-aged and older
Latinas about perspectives on social, cultural,
physical elements of menopausal transition
(n=9 groups)
 “Reunion” groups (n=9 groups)
 Individual interviews (n=18 participants)
 Interactive internet intervention (n=81
Roberta Goldman, PH.D., Brown University and HSPH,
participants)
2012
The Qualitative Study Question
 Ask an overall study question that has open-
ended possibilities for answers:
What are the emotional experiences of public middle
school children who change schools mid-year?
 How do Portuguese older adults conceptualize the
diabetic diet?
 In what ways do culture and religion play a role in
Hmong adults’ views of health care?
 How do political ads on television influence adults’
perceptions of health care reform?
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Roberta Goldman, PH.D., Brown University and HSPH, 2012
Entering the Community
Preparation for Research
 Preparatory steps are essential for community-based
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qualitative research
Define your community
Involve community representatives at all stages from
the very beginning
Get involved in the community
Stay involved in the community
Decide how to represent yourself
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Entering the Community
 Learn what you can from previous studies and
secondary data sources:
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Academic and popular media
Public health and other disciplines
Maps
Demographic statistics
Urban planning documents
Etc.
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Entering the Community
 Learn what you can from knowledgeable
individuals:
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Community, civic, political, economic, health, education,
business, unions, social service, etc.
Academics
Other key informants
Assess the quality of your key informants
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Entering the Community
 Learn what you can through participant
observation
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e.g. neighborhoods, organizations, resources, businesses,
housing, transportation, health sites, educational
resources, financial structures, community events
Be able to recognize what people are talking about or
alluding to
Recognize relevant social fields for inquiry
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Selected Qualitative Research Methods
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Participant observation
Individual interviews
Focus groups
Media content analysis
Visual (i.e. video or still image)
All in conjunction with broad literature review, including
ethnographic literature
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The more you know before you start, the better your
research will be
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Participant Observation – More than just
hanging around
 What is it?
 Etic view
 Observation
 Reflection
 Ranges from high to no participation
 Informal interviewing for emic explanation
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Participant Observation
 Why do it?
 See what’s really going on
 Counterbalance: Triangulate data from other methods
Understand
and “test” what people say
Know what to ask people about because you’ve
seen it already
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Participant Observation
 How to really see:
Know what you’re looking for, and
 Be open to seeing what you don’t expect
 Be cognizant of what you’re looking at
 Observe the details, variations, etc.
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Take notes
 Reflect on observations and notes; question what you saw
 Discuss observations and notes
 Go look again
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and so on. . .
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Participant Observation
 Spectrum of observation
Full participant
Passive Observer
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Participant Observation - Fieldnotes
 Document your observations
 Fieldnote journal – running record of observations AND
observer comments
 Structured observation note grid
 Brief notations while in the field
 Expand upon and organize notes as soon as possible – thick
description
 Truism in anthropology:
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For every hour of observation you need 3 hours of writing
fieldnotes
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Types of Individual Qualitative
Interviewing
Categories of Individual Qualitative Interviews
 *Informal
 Conversations in the field
 Unstructured
 Interview setting with no formal guide
 **Semi-structured
 Interview setting with an interview guide; probes
 Structured
 Interview setting with a rigid question list
Roberta Goldman, PH.D., Brown University and HSPH, 2012
In-Depth Interviews
 Various kinds and purposes
 Open-ended questions
 Looking for meaning and context and
information in respondents’ own words
 Combine structure with flexibility
 Interactive
 Follow new lines of inquiry as they arise
 Explore a topic in-depth with follow-ups
and probes: whys, hows, examples, etc.
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Key Informant Interviews
 Insider/outsider
 Know something about your topic area, in a way
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different from your way of knowing
Can articulate their knowledge
Choose broadly
Can connect you with other KIs and information
Semi-structured using flexible question guide
Maybe informed consent
Usually no monetary compensation
Exploratory; process evaluation; explanatory
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Life History Interviews
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In-depth exploration of a small number of illustrative
individual cases
Useful for collecting detailed, contextual, diachronic data
Life history interview goes both backward and forward in
time
Places the topic of interest within the context of
interviewees’ daily lives, both past, present, and looking
into the future
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Conducting Individual Semi-Structured Interviews
 Consider the setting – privacy, comfort, security,
noise level, impact of others present, where you
put the mic, etc.
 Consider your appearance, dress, behavior,
demeanor; be tranquil
 Introduce yourself, project, sponsor
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Conducting Individual Semi-Structured Interviews
 Informed consent and assurance of
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confidentiality
Explain process of the interview
Ask permission to record and take notes
Gain rapport – friendly AND professional
Be real, but stay professional and
appropriate
Be empathic because you are a human being,
but you are not a counselor
Develop strategies to redirect
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Conducting Individual Semi-Structured Interviews
 Always bring a question guide that you know well and have
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practiced in pilot interviews
Can use guide flexibly in terms of wording and question
order
Stay alert for new avenues of inquiry that arise due to
participant’s responses
Make quick notes on guide as reminders – started a topic;
want to return to a topic
If returning to a question, note that it was discussed before
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Conducting Individual Qualitative Interviews
 Listen alertly; make quick decisions
 Do you need a follow-up question?
 Do you need a probe?
 Is it time to move on to the next question?
 Don’t use leading phrasing or paraphrasing
 Ask for clarity
 Be sure you can explain to someone else what the
participant said in the interview; if not, you need
clarity from the participant: PROBE
 Use a variety of neutral probes
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Writing Open-Ended Questions
Philosophy
 Few questions with broad reach
or
 Many specific questions
or
 Start broad, get more narrow
 Your design of the question guide depends on your goals for
the research, your participants, your moderator’s skills,
nature of the topics
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Know why you’re asking questions
 Be very familiar with your objectives: know what you want;
know what you mean
 Write questions to get at content, context and meaning – go
for the why’s and when’s and how’s in addition to and
maybe more than the what’s
 Ask for explanations, feelings, understandings, personal
interpretations
 Use scripted and/or spontaneous probes
Roberta Goldman, PH.D., Brown University and
HSPH, 2012
It’s an iterative process. . .
 Relax, think broadly, then more narrowly
 Blitz out your topics
 Review, edit topics
 Talk to colleagues about topics, edit
 Form into open-ended questions
 Edit and revise your questions – multiple times!
Roberta Goldman, PH.D., Brown University and HSPH, 2012
It’s an iterative process. . .
 Critique questions for
 Quality (are they truly open-ended?)
 Impartiality (do they avoid leading phrasing?)
 Literacy (are most participants likely to understand the
words in the questions and the meaning of the
questions?)
 Clarity (does the wording of the questions adequately
reflect what you intend the questions to ask?)
 Assess appropriateness (given your topic and interview
setting, will the questions upset your participants –
unsettling personal questions, test-like questions, etc?)
Roberta Goldman, PH.D., Brown University and HSPH, 2012
It’s an iterative process. . .
 Review, discuss, edit, refine questions
 Consider order and placement
Often start with easy to answer, ‘grand tour’ question
 Consider impact of earlier questions on later questions
Show questions to people who are familiar with your objectives and
those who are not
Consider the usefulness of every question and delete
Pilot the questions with people similar to your study population – some
form of Cognitive Interviewing
Modify and finalize questions
Be willing to revisit question script as study proceeds
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Change wording or order; Add/delete questions
Roberta Goldman, PH.D., Brown University and HSPH, 2012
What to Include in your Question Script
 Core questions
 Follow-up questions: Specific anticipated
questions that follow core question
 Probes: Anticipated general probes to ask
why, why not, how, when, etc.
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Here’s the hard part: What will NOT be in your
question script
 Directions for spontaneously re-ordering
questions
 Follow-up questions to:
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Seek clarification
Seek explanation for unanticipated response
Follow new lines of inquiry that arise due to a previous
response
This is where the real action lies!
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Focus Groups
What is a Focus Group?
“A carefully planned series of discussions designed
to obtain perceptions of a defined area of interest
in a permissive, non-threatening environment.”
Krueger RA, Casey MA. 2000. Focus Groups: A Practical Guide for
Applied Research. Thousand Oaks, CA: Sage
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Why do Focus Groups?
 Focus groups are about human interaction
 Benefit from social discourse
 Research question lends itself to collecting more
superficial data from an interactive group of people
 Discussion of ideas, opinions, beliefs, knowledge,
preferences, etc.
 Not looking for in-depth case histories
Roberta Goldman, PH.D., Brown University and HSPH, 2012
Other Qualitative Methods
 Media content analysis
 Visual methods
Roberta Goldman, PH.D., Brown University and HSPH, 2012