OVERVIEW OF
QUALITATIVE
RESEARCH METHODS
Dorthe S. Nielsen,
RN, MHS, PhD
Odense University Hospital
Institute of Clinical Research,
University of Southern Denmark
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Disclosure of Interest:
Nothing to declare
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The next 30 minutes
ƒ Short introduction to qualitative research
ƒ Presentation of the most used methods
ƒ Presentation of selected qualitative studies
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Qualitative research
The focus in qualitative methods is on the meanings that participants
attach to their social world
The researcher can probe deeper to obtain a great deal of in-depth
information that can be tested in subsequent quantitative studies if
necessary and appropriate.
Samples tend to be smaller compared with quantitative projects that
include much larger samples
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What
people
say
Culture
Qualitative
research
Mean,
need or
desire
What
people
do
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Quantitative and qualitative
research methods differ
primarily in:
Their analytical objectives
The types of questions they pose
The types of data collection instruments they use
The forms of data they produce
The degree of flexibility built into study design
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Qualitative methods
Interviews
• Individual interviews are optimal for collecting data
on individuals’ personal histories, perspectives, and
experiences, particularly when sensitive topics are
being explored
Focus
Groups
• Focus groups are effective in obtaining data on the
cultural norms of a group and in generating broad
overviews of issues of concern to the groups or
subgroups represented
Participant
observation
• Participant observation is appropriate for collecting
data on naturally occurring behaviours in patients
usual contexts
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Litterature search
Pubmed;
”Osteoporosis and qualitative interview”
=
22 articles
”Osteoporosis and focus group interview”
=
32 articles
”Osteoporosis and participant observation”
=
0 articles
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Adherence to treatment
Non-adherence to osteoporosis medications, is a
well-recognised problem, with estimates of
adherence at two year ranging from 50-80%.
Non-adherence has clinical implications, as the
expected fracture reduction seen with
medical treatment is mainly in those with
good compliance.
Although the rates of non-adherence have been
well studied – there are lack of knowledge
and studies on the individual patient reasons
for non-adherence
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Adherence to treatment
Interviews; Education regarding osteoporosis, diagnostic and therapeutic
interventions is essential for patients adherence to treatment
Allison et al. Drug Information Journal 1997
Focus groups; Each patients reasons for non-adherence might be
different, depending on individual beliefs or circumstances, strategies to
improve adherence to medication should be individualized accordingly
Lau E et al. Can Fam Physian 2008
Focus and interview; Factors that adversely influence osteoporosis
prevention and control have their root in misconceptions about
osteoporosis and its risk factors, and are barriers for taking preventive
action
Baheiraei et al. Maturitas. 2005
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Handling knowledge on
osteoporosis
Knowledge on osteoporosis has in
several studies been examined for
association to adherence to medical
treatment, lifestyle changes, etc.
Few studies have looked into patients
experiences on getting knowledge
about osteoporosis
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Handling knowledge on
osteoporosis
Interview; Osteoporosis among rural women caused them to
reassess their own self-concept and decrease their participation in
valued social activities
Roberto et al. Health Care for Women International 2001
Interview; Premenopausal women regard the consequences of
osteoporosis as something that lies far ahead of them
Backett-Millburn, Health Education Research. 2000
Interview; Awareness of osteoporosis risk caused a feeling of
uncertainty and worry in some women
Hvas et al. Scandinavian Journal of Public Health 2005
Study III
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Living with pain and
osteoporosis
Living with pain has great influence
on patients quality of life and
level of activity
Some qualitative studies have been
conducted on patients
perspectives on pain in everyday
life
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Living with pain and
osteoporosis
Focus groups; The lay construction of osteoporosis can be seen as one
that has developed from a situation where osteoporotic persons were
perceived as victims of harsh circumstances to one of individual
responsibility
Skoelbekken et al. Social Science & Medicine 2008
Interview; In many cases pain interfered with the patient’s social
relations and sexual activities forcing husband and wife to sleep in
separate bedrooms or prompting the couple to separate
Nielsen et al. PP372-T
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Men and osteoporosis
When men are diagnosed with
osteoporosis, they are generally in a
poorer health compared to women
Gennari et al. Curr Rheumatol Rep2007.
Osteoporosis under-diagnosed in men. In
women with a hip fracture, 27% were
evaluated with DXA as opposed to 11% of
men
Kiebzak et al. Arch Intern Med. 2002
The level of compliance to medical
treatment in men is below
50 % after two years of treatment
Solomon et al. Arch Intern Med. 2005
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Men and osteoporosis
Interviews; Most men consider Osteoporosis as being a female
disease - Information material is targeting women and not men
Rafael H, PhD thesis, University of South Hampton 2008
Focus groups; Men's sense of self was closely connected to
their level of activities – which had importance to how they
handled osteoporosis in conduct of everyday life
Nielsen D et al. American J. Men's Health 2010
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Living with risk of fracture
Research and clinical studies are focusing more
and more on risk and risk factors – with the
tool of FRAX - It is now possible to tell
patients about their risk-score of a future
fracture
Very few studies have looked into how patients
are handling this kind of knowledge and the
implications on their everyday life
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Living with risk of fractures
Interview; Perceived risk of osteoporosis may lead to decreased physical
activity and hence actually increase the risk
Rewentlow Scan. J. of Prim. Halth Care. 2007
Interview; The outlook on life has a greater influence than the acted
lifestyle behavior for bone development
Elgan et al. Scand J Caring Sci. 2005
Mixed; Patients who experience fragility fracture develop perceptions
about future fracture risk that are influenced by interaction with health
care providers, as well as beliefs about their fracture and beliefs that
they can modify their risk
Giangregorio L et al. Patient Educ Couns. 2009
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Mixed methods
A new paradigme?
Mixed methods research is the type of research in which a
researcher or team of researchers combines elements of
qualitative and quantitative research approaches (e.g. use of
qualitative and quantitative viewpoints, data collection,
analysis) for the broad purposes of breadth and depth of
understanding and corroboration.
Johnson et al. Journal of Mixed Methods Research. 2007;1; 112-133
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A group-based education program
Quantitative results
Significant more knowledge
about osteoporosis
Increased self-reported level
of adherence to treatment
Qualitative results
Knowledge had importance to
patients sense of self
Some patients got more control
Knowledge made some patient
more fearful
Some patients did not dare to
stop taking the medication
Some could discuss treatment
with doctors
Some chose not to take the
medicine
Nielsen, D PhD thesis 2010
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Final conclusion
Qualitative methods can help professionals to understand
patients way of living with diseases and chronic conditions
Qualitative methods can help professionals to understand the
patient perspective on treatment and lifestyle changes – and
to improve communication and clinical practice
Qualitative methods can be complementary to quantitative
methods
Qualitative studies should not be evaluated by the same
standards as quantitative studies
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