Qualitative methods in public
health
METTE SAGBAKKEN
DEPARTMENT OF GENERAL PRACTICE AND
COMMUNITY MEDICINE
INSTITUTE OF HEALTH AND SOCIETY
"The cure of many diseases remains unknown to the
physicians of Hellos (Greece) because they do not study the
whole person." ~ Socrates, (470-399 BC)
"The control of many diseases remains difficult because
health professionals and policy makers do not study the
whole picture” ~ Sagbakken, (1966- AC)
Qualitative versus quantitative methods
 Prior to establishment of disciplines as anthropology,
epidemiology – health projects often combined methods
 Panum: investigated measles outbreak in the Faroe Islands
in 1846 – combined observations and syrveys
 Virchow: investigated typhus epidemic in 1848 – clinical,
pathological, epidemiological, anthropological findings
 Documented concrete links between social conditions and
diseases
Trostle J. (2005). Epidemiology and culture. Cambridge University Press.
Qualitative versus quantitative methods
 After discovery of bacteria specific to infectious diseases (1870s-
1880s) the germ theory of disease becomes dominant
 Development of laboratory disciplines as bacteriology,
virology – less focus on social, economic, and
cultural factors in disease control
Robert Koch (1843-1910)
 Growth of disciplines, growing emphasis on quantitative
research and dominance of medical profession in public health
 Separation of approaches to disease prevention and control
Yach. D (1992). The use and value of qualitative methods in health research in developing countries. Soc Sci Med, 4:603-12
Qualitative versus quantitative methods
“Not everything that can be counted counts, and
not everything that counts can be counted.”
Albert Einstein (1879-1955)
What knowledge ”counts”?
 Many tuberculosis (TB) patients do not complete treatment. How
many? (quantitative) Why? (qualitative)
 Many TB patients use several months to get the right diagnosis. How
many (quantitative)? Why? (qualitative)
 Predefined categories – a ”shot-gun” method? (Becker)
 Strength of qualitative methods – show how a multitude of factors may
act as causes
What knowledge ”counts”?
 Different methods important – can play complementary roles
 Ex: Qualitative methods help explain mortality rates (men, third class
passengers) in Titanic by exploring social and cultural rules
 Social rule about class implied higher status passengers saved at the
expense of lower-status passengers
 Cultural rule of lifeboat access caused more
 men to die (within economic status group)
Trostle J. (2005). Epidemiology and culture. Cambridge University Press.
Qualitative versus quantitative methods
 Which research method? Depends on the question
 Quantitative methods: Suitable for questions such as:
”How many…?”, ”How often ...?”, or ”Is X more efficient than
Y in treating Z?”
 Qualitative methods: Suitable for questions such as:
”How do people perceive…?”, ”What do people do?”, or ”How
do people experience ...?”
Qualitative methods
 The aim of qualitative research is not to measure or predict, but
to gain new knowledge/understanding of phenomena such as:


Human experience, beliefs, behaviour, interaction
Social practices, systems, cultural norms
 Involves collection of data not easily reduced to numbers
Qualitative methods
 Humans are contextual beings
 Understand the wider context in
which peoples’ preferences,
beliefs and behavior derive
 Understand processes and
dynamics of social life
 What causes changes in
behavior?
Qualitative methods
Identify processes
Impoverishment
Treatment
interruption
Loss of
job/income
Expenses
Becoming ill
Accumulated
burdens/costs
- tipping point
Treatment
interruption
Daily clinic
attendance –
new costs and
burdens
Impoverishment
Exhaustion
Hopelessness
New strategies
Qualitative methods..
 Allow people to speak in their own voice, rather than
conforming to categories and terms imposed by others
 Categories often not predefined: the fieldwork informs
you of relevant categories (inductive - abductive)
Qualitative methods
Through exploration of
meaning new and
unexpected categories of
meaning and experience can
be discovered –
….that did not fit the
original puzzle
Qualitative methods
Outcomes may have
multiple causes
Structural
factors
Sociocultural
factors
Important to get an
overview over causes –
and how they may
interrelate
Individual
factors
• Loss of income
• Distance to clinic
• Organization of
treatment
• Stigma in
community
• Cultural
obligations
• Different
explanatory
models
• Other obligations
Qualitative methods
 By identify processes and multiple causes – create time- and context
sensitive approaches to disease prevention and control:
 By identifying multiple causes – increase awareness of the need of linking
multiple actors/sectors/projects (food programs, labour organizations)
 Through a dialogue with those concerned :
- discover processes and experiences people go through being ill
- identify local barriers and enablers
- identify existing or non-existent support structures
- help identify mutiple and more sustainable solutions (beyond bio-med)
Qualitative data collection methods
Data collection methods
Interviews
 Individual interviews
 Semi-structured
 In-depth
 Informal conversations
 Group interviews
 Focus groups
Data collection methods
Individual interviews – advantages
 Opportunity to probe; explore further
 Get close to people; establish trust;
 Beneficial for sensitive issues. Several interviews can be done.
Individual interviews – challenges
 Do not discover discrepancy between what people say and what they do
 Structured situation – statements decontextualized
Informal conversations – advantages
 Often takes place in context – talk about what you see/hear
 People are more relaxed, more spontaneous answers
Informal conversations – challenges
 Less structured; less focused. Recall bias
Data collection methods
Focus groups – advantages
 Study interaction patterns
 Identify issues to include in subsequent individual interviews
 Validate findings from individual interviews
 Generate new meaning – several minds work together
 More data in less time
Focus groups – challenges
 Learn what people say they do, not what they actually do
 Some may dominate – consensus reached on wrong premises
 Less suitable for sensitive topics
Data collection methods
Observation
Participant or nonparticipant
“Fieldwork”
Data collection methods
Observation – advantages
 Behaviour/statements better
understood in light of context
 Move beyond the selective
perceptions of others
 Discover issues no one has
paid attention to (tacit
knowledge)
 Learn about issues people are
reluctant to talk about
 Insight into processes/
chronologies of events
 Understand complex topics
Observation - challenges
 To what extent, in what way are
you influencing the field?
 Is what you ”see” what is really
happening?
 Should know the local language
 Time consuming
Data collection in qualitative methods
Study of texts and documents
 Documents, books, articles, reports,
advertisements, newspapers, diaries
 Adds important contextual
information – understanding findings