HSERV 526
Qualitative Research in Public Health
Stephen Bezruchka
TA: Anthony Sok-Heng Tessandori
Qualitative Research in Public Health
Understanding a culture by getting to know it
personally, rather than counting/measuring aspects
of it
Leads to hypotheses that can be investigated by
quantitative techniques
Rigor and validity in qualitative research
Cultural familiarity
respect for adherents
adherents respecting you
Qualitative Research: soft science?
DRAFT
Qualitative Methods Compe tencies
March 1, 2005
1. Be able to use qualitative methods for practical applications in public
health, including document review, qualitative research, instrument
developmen t, direct observation, informant interviews, focus groups, and
other formal group methods.
Health Services
Department
Social and
Behavioral
Sciences track
COMPETENCIES
2. Students should be able to describe the comp lementary features and app ropriate
integration of qualitative and qua ntitative approaches to research regarding health
problems of a population
3. Situate qualitative research in an epistemological frame work as a toolbox to gain
depth in viewi ng social phenomena that produces insight into mean ings and a ctions.
4. Basic terms and concepts of qua litative approaches including subjectivity, reflexivity,
ethnography, epistemiology, deconstruction, position and voice
5. Be able to classify the types of findings produced by different levels of data synthesis
and interpretation (e.g., No f indings, Topical survey, Thema tic survey,
Conceptual/thema tic description, Interpretive explanation)
6. Articulate how the researcherХssociocultural position affects the ques tions asked, the
methods of inquiry, data collection, interpretation and dissemination and the role of
position and voice in situating the researcher in the research
7. Identify ways to increase trustworthiness of the qualitative process and findings (e.g.,
multiple coders, memos/audit trail to document evo lution of thinking,
exercises/memos in reflexivity, participant checks, theo retical saturation, negative
cases, etc.)
8. Be able to write a methods section for a proposal using qua litative methods that
would describe (1) why this methods is suited to the research question/data; (2) what
procedures are entailed in data collection; (3) how the student will organize the data
once collected; (4) describe the analytic procedures; (5) assure trustworthiness of
the process; and (6) give a sense of how th e data will be reported (i.e., themes,
theory development, contextual factors, etc.)К(This last one kind of encompa sses all
the above so may just be a restatemen t of everything else.)
9. Describe different qualitative methods including:
 content analysis
 thema tic description
 grounded theory
 Pheno menology
 Hermeneu tics
 Discourse analysis
 Narrative analysis
 Ethnography
Qualitative Competencies
document review, qualitative research, bias: how the researcher’s
sociocultural position affects the
instrument development, direct
questions asked, methods of data
observation, informant interviews,
collection, interpretation and
focus groups, formal methods
dissemination
describe complementary features and
ways to increase trustworthiness of
appropriate integration of qualitative
the qualitative process and findings
and quantitative approaches to
write a methods section for a proposal
research regarding health problems
methods:
of a population
• content analysis
epistemological toolbox to view social
• thematic description
phenomena & gain insight into
• grounded theory
meanings and actions
• Phenomenology
subjectivity, reflexivity, ethnography,
• Hermeneutics
epistemology, deconstruction,
• Discourse analysis
position and voice
• Narrative analysis
classify the types of findings produced
• Ethnography
by different levels of data synthesis
and interpretation
Other Qualitative Research Courses
Seminar in Advanced Qualitative Methods
James Pfeiffer, Autumn 2006, Hserv 590
– Theoretical foundations, in-depth analysis and use of
computers (ATLAS ti)
Interpretive methods (phenomenology, narrative
analysis, and grounded theory)
Helene Starks, Winter 2006, Medical History Ethics
MHE 497
Learning Objectives for this session
review syllabus
describe the terms emic and etic
list methods of qualitative investigations
discuss possible research questions and choosing
teams
recount the attributes of a cultural domain
Examples of qualitative research and relationship to
quantitative work
Handouts
• Course schedule with exercise due dates
• Syllabus with readings
• Exercises
SIGN THE SHEET BEING HANDED OUT
– Those taking course for credit only
WORK of course
Overview of many methods
Attending lectures
Rapid pace, INTERRUPT
Exercises in class
Group project
Individual exercises
Group presentation and report
Extra session needed as a group
Grading
• Exercises (12 each)
• Project report (20)
• Project Presentation (20)
Lecture notes
http://courses.washington.edu/hserv526/
Course readings
Course Packet
Rams Copy Center 4144 Univ Way NE
Recording of lectures
Textbooks
Required:
-Bernard Research methods in Anthropology (2006) or
2002 Third Edition
– Ulin, P. R., E. T. Robinson, et al. (2005). Qualitative
Methods: A field guide for applied research. San
Francisco, Jossey-Bass.
Recommended
– Krueger, Focus Groups
– LeCompte Ethnographer's Toolkit
– Morse Qual. Res Methods for Health Prof.
– Scrimshaw RAP
– Spradley Ethnographic Interview
TODAY’S READING
Body Ritual Among the Nacirema
In course packet
Past Students suggest
• Focus on techniques in exercises, not research
question
• Coding is important
• Much of material is "common sense"
• Why do it? See flaws in outsiders programs
• when you listen to what someone says or watch
what they do, you learn much about that setting that
you won’t see from counting how many people
came to the health center
PROJECTS
• PAST YEAR'S Titles in today' syllabus
• PAST YEAR'S Reports on reserve in library
• Guidelines: no sensitive topics, receptive
population, everyone mentally competent, adult,
easily accessible, 5 minute rule, focused topic
• Groups with non-native English speakers to have
one native English speaker
Past Projects
Others
UW Cultures
student groups:
smokers, Muslims,
international, activists
specific settings:
computer labs,
instructional center,
WAC, IMA, museums
specific employee groups:
IMA, copy workers,
food service workers,
janitors, bus drivers
Near UW cultures:
Agua Verde workers, Ave
street people, tanners,
Greenlake walkers, movie
goers, bus riders
Stress-related:
pool players, computer lab
noise, relationships, knitting
Health related
Seattle groups:p-patch
gardening
Project suggestions (my interests)
• Perceptions of progress? US relative health
decline
• Beliefs about dominant ideology (if you work
hard, you will succeed, so America's system in
which there is a big gap is necessary for our
society to function best
• Student beliefs about equality and equity
• Faculty beliefs about distributive justice
• Beliefs about whether rich people's health is worse
off with more inequality?
NEXT SESSION (THURSDAY)
Think of questions/topics for study TODAY
FILL OUT THE FORM including TIMES
TALK TO OTHERS ABOUT FORMING A GROUP
Your email to Anthony by WEDS NOON should
include the contents of the six columns
NO LATE SUBMISSIONS
Anthony will collate them all and email them to
everyone by Wednesday10 PM to help you decide
THURSDAY we will form groups
EMAIL TO BE SENT TO Anthony see syllabus
PLUS MEETING TIMES
Specific Topic
EXAMPLE Discrimination of wheelchair users in Health Sciences Center or in community
YOUR TOPIC
Population to study EXAMPLE Users of wheelchairs
YOUR POPULATION
Specific place to access population
EXAMPLE University Hospital 3rd floor entry
YOUR PLACE TO ACCESS
Specific site for direct observation EXAMPLE Wheelchair users as they arrive at the
hospital
YOUR OBSERVATION SITE
Informant Interview focus EXAMPLE What is it like as you go from home to the hospital?
YOUR INTERVIEW FOCUS
Participant Observation Activity EXAMPLE Spend an hour in a wheelchair in the
University Hospital complex
YOUR PARTIPANT ACTIVITY
NAME______, PHONE NUMBER _________
CRUCIAL STEP BEFORE
THURSDAY (AFTER SENDING
YOUR EMAILED EXERCISE
PROBLEM
• Study the email Anthony sends with the projects
people have thought of, serial numbered to identify
them (Wednesday 10 pm)
• Rank the ones you are interested in working in, and
bring the top three to Thursday's class
– Look at the times for possible meeting on that project,
and don't rank them if the meeting time suggested is not
possible for you.
Qualitative Research
try to understand how
communities perceive a concept
that is a part of their culture
-
INHERENTLY POLITICAL
QUALITATIVE RESEARCH
•
•
•
•
•
•
•
OBSERVATION,
INFORMANT INTERVIEWS,
formal methods (free list, pile sort)
FOCUS GROUPS
PARTICIPATORY METHODS
RAP (similar to fast food)
CODING, ANALYSIS
Qualitative Research
•
•
•
•
•
Iterative
Cyclical
Refinement of focus
Flexible
Triangulation
COMPARING QUALITATIVE AND QUANTITATIVE RESEARCH METHODS
QUALITATIVE
GENERAL
METHODS
SAMPLING
CONTEXT
(style or
manner of
data collection)
QUANTITATIVE
Perspective
insider's (emic)
exploratory
outsider's (etic)
confirmatory
Hypothesis
generating
testing
words
numbers
less (a continuum)
more
Why questions
fewer
more
Dynamic
more
less
Structured
number
small
large
depth
more
less
type
purposeful or 'random'
random
Richness
more
multiple methods
less
single method
WHY STUDY HOW TO LEARN
ABOUT A CULTURE?
• Many problems today stem from not respecting
OTHER cultural values
• need to get an emic perspective of a culture
(population)
• tools to do that are taught in this course
• in the process of learning about that culture, you
begin to respect it
• then holders of the culture begin to respect you
• you can begin to work together to make positive
changes
CULTURE
• “knowledge that people learn as part of a group
that is used to interpret experience and generate
social behavior”
• elements include
–
–
–
–
shared, collective
systematic, organized
both explicit and implicit elements
variability across population
"Culture is a way of life shared by the members of one group but
not necessarily with the members or other groups of the same
species. It covers knowledge, habits, and skills, including
underlying tendencies and preferences, derived from exposure to
and learning from others. Whenever systematic variation in
knowledge, habits, and skills between groups cannot be attributed
to genetic or ecological factors, it is probably cultural. The way
individuals learn from each other is secondary, but that they learn
from each other is a requirement. Thus, the "culture" label does
not apply to knowledge, habits or skills that individuals readily
acquire on their own." Frans de Waal The Ape and the Sushi
Master
Cultural attributes
• “cultural consensus”, shared among people in the
same group
• holistic, interconnected, usually studied by long
intensive field studies, seeing how things relate in
broad patterns
• aspects are overt or covert
– people within the culture may not want to tell you, or
can’t generate the answer
– differences in way behavior is organized and
characterized
Cultural differences
• Man in hospital with ventricular tachycardia
• Baby massaged with ghee in cold after delivery
• bikas
emic etic
Insider’s perspective
CULTURE
• Hard to describe one's culture
• Understanding another culture is difficult
• How do you learn about cultures?
CULTURAL DOMAINS
• defined as category of cultural meaning that
includes other cultural categories, (from an emic
perspective),
– domain can be related to a place/location (e.g. school or
clinic), a concept (diarrhea, food flexibility), material
things (medicines, cars), or people (shamans, gypsies,
nuns)
• Cognitive Anthropology (semantic distinctions)
• Componential analysis (building blocks of meaning
in semantics)
Domain attributes
• cover term (that indicates a category of
cultural knowledge) words used in plural
– tree
– illnesses that women get in a village in Nepal
• included terms (at least 2, that are the
elements that comprise a domain)
– oak, yew, pine, maple
– mutu khane
Domain attributes
• semantic relationship where all included
terms are related to cover term in same way
– pine and maple are “kinds of trees”
– mutu khane is an illness that women get in
Nepal
• DOMAINS ARE NOT THEMES
– (Spradley reading on themes in packet)
– comes out in Analysis later
Domain attributes
• boundaries: certain things are not part of
that domain
– a tulip is not within the domain of a tree
– e.g. sunburn is not an illness that women in a
village get in Nepal
• OFTEN/USUALLY, domains are not found
in many qualitative studies
Cultural Domain
Research Topic
included terms
Student Eating Habits on Campus
Healthy Foods
Unhealthy Foods
Convenience Foods
Domain analysis
• Read interview texts
• Look for names of things (esp. plural)
• See if one of names could be cover term
– Name used for more than one thing
– Name could be used as “kind of”
– Others become included terms
• Semantic relationships
• Boundary
Class exercise
• Take notes on interview of TA by instructor
• Look for included terms
– Cover term
– Semantic relationship
– Boundary
Cultural Domain
People who Scuba Dive
included terms
Scuba Diving
???????????
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EXAMPLES: Qualitative studies
STD’s in minority women prevention trial
(reading packet)
– Behavioral intervention based on knowledge of cultural
beliefs produced large decline in re-infection rate
• 18 months of qual. research
• Create culture- and sexspecific small-group
interventions
– Af Am & Mex Am fe.
• 2 groups randomized
• 1 group standard
counseling
• 1 group culture specific
counseling
2nd Aquisition STD
30
25
20
% 15
10
5
0
34%
49%
38%
6 months 12 months
Overall
TIme after enrolment
control
intervention
AIDS Risk reduction model
Pre-tested with 13 groups
(85) women
2nd Aquisition STD
30
25
20
% 15
10
5
0
34%
49%
38%
6 months 12 months
Overall
TIme after enrolment
control
intervention
Summary of session
• Qualitative and quantitative methods are
complementary
• Cultural domains are a useful way to understand
how groups organize words