Kampot Province, Cambodia
10-16 November 2003
EH/GTZ/November
2003

Research Question:
Who are the health providers in the village and what care do they provide?
EH/GTZ/November
2003

Training objectives
1. To familiarize the participants with the principles and practice of qualitative research methods in public health
2. To discuss a mix of qualitative methods and their application in public health research and programming
3. To practice using qualitative research methods in an applied context
EH/GTZ/November
2003

Qualitative Research Methods
Social mapping
In-depth interviews
Observation
Free-lists and ratings
EH/GTZ/November
2003

Meaning of Methods
1.
Epistemology or the study of how we do things
2.
At a general level, it is about strategic choices, for example, whether we do participant observation fieldwork, document analysis or an experiment
3. At the specific level, it is about what sample you select, whether you do face to face interviews or use a telephone or use an interpreter or learn the language and do the interviews yourself
EH/GTZ/November
2003

Rationalism is the idea that human beings achieve knowledge because of their power of reason. That is, there are a priori of truths, and if we prepare our minds adequately those truths will be evident to us.
Versus Empiricism, who consider that the only knowledge that human beings acquire is from sensory experience. They consider that we are born with brains like empty boxes and that boxes are filled with the experiences throughout our life. We come to understand what is true from what we are exposed to.
EH/GTZ/November
2003

Scientific method
Science is “ an objective, logical, and systematic method of analysis of phenomena, devised to permit the accumulation of reliable knowledge ”
(Lastrucci, 1963:6).
EH/GTZ/November
2003

Objective – “ the idea of truly objective inquiry has long been understood to be a delusion.
Scientists do hold, however, that striving for objectivity is useful. In practice this means constantly trying to improve measurement (to make it more precise and accurate) and submitting our findings to peer review ” (Bernard
1995).
EH/GTZ/November
2003

Method – Each scientific discipline has developed a set of techniques for gathering and handling data, but there is, in general, a single scientific method.
The METHOD is based on 3 assumptions:
(a) reality is “ out there ” to be discovered;
(b) direct observation is the way to observe it;
(c) material explanations for observable phenomenon are always sufficient, and that metaphysical explanations are never needed.
EH/GTZ/November
2003

Reliable – something that is true in Phnom
Penh, for example, is equally true in
Kampot Province
EH/GTZ/November
2003

Social Science
·
Asks questions and seeks to explore the answers
Social science uses various methods to answer the question/s
Most anthropological work is qualitative. In applied anthropology there is a growing interest in mixing qualitative and quantitative research to answer the research question/s
Important not to mix quantification and science. Keep them separate.
Quantification is important in anthropology, as it is in any science. But all sciences are not quantified and all quantification is not science
EH/GTZ/November
2003

Some social scientists do not use quantitative methods, for example, sociologists.
Ethnography does not mean qualitative. As a noun it means a description of a culture. As a verb it is ‘ doing ethnography ’ , and it means collection of data that describes a culture .
EH/GTZ/November
2003

The rest of the training program will be about methods that will let you build an ethnographic record. Some of these methods involve fieldwork. Some methods involved in building an ethnographic record include, watching, listening. Some methods result in words and OTHERS result in numbers.
EH/GTZ/November
2003

Characteristics of Qualitative and
Quantitative Research
Qualitative research
Inductive
Holistic
Subjective/insider centered
Process orientated
Actor ’ s world view
Relative lack of control
Goal to understand actor ’ s view
Discovery orientated
Explanatory
Quantitative research
Deductive
Particularistic
Objective / Outsider centered
Outcome orientated
Natural science
Attempt to control variables
Goal to find facts & causes
Verification orientated
Confirmatory
EH/GTZ/November
2003

Quantitative Research
Use numbers and statistics, examples, experiments, correlation studies using surveys & standardized observational protocols, simulations, supportive materials from case studies (example, test scores).
General sequence of research :
1.
Observe events / present questionnaire / ask questions with fixed answers
2.
Tabulate
3.
Summarize data
4.
Analyze
5.
Draw conclusions
EH/GTZ/November
2003

EH/GTZ/November
2003

Qualitative Research
Use descriptions and categories (words).
Examples: open-ended interviews, naturalistic observation (common in anthropology) document analysis, casestudies, life histories, mapping, pile sorts and ratings, descriptive and self-reflective supplements to experiments and correlation studies.
EH/GTZ/November
2003

General sequence of qualitative
research:
1. Observe events / ask questions with open ended answers
2. Record/log what is said (or not said) and done (or not done)
3.
I nterpret (personal reactions, write emergent speculations or hypotheses, monitor methods)
4. Return to observe, or ask more questions of people
5. [recurring cycles of 2-4 – iteration]
6. Formal theorizing [emerges out of speculations and hypotheses]
7.
Draw conclusions
EH/GTZ/November
2003

Three key methods
1.Detailed open-ended interviews (not highly structured or limited responses)
2.
Direct observation
3. Written documents (work with words and visual data, not numbers)
EH/GTZ/November
2003

Strengths of qualitative research
Depth and detail (versus standardized questionnaire)
Openness – can generate new theories and recognize phenomena ignored by most or all previous researchers and literature
Helps people see the world view of those studiedtheir categories, rather than imposing categories; simulates their experience of the world
Attempts to avoid pre-judgment (this is questionable in reality).Present people on their terms, without being judgmental, try to respect them from their perspective so the reader can see their views (always difficult)
EH/GTZ/November
2003

Weaknesses of qualitative research
Fewer people studied (usually)
Less easily generalized because of few people / locations in studies
Difficult to aggregate data and make systematic comparisons
Dependent on researchers personal attributes and skills
Participation in the research can always change the social situation (although, not participating can also change the social situation as well)
EH/GTZ/November
2003

Ten themes of qualitative research
Naturalistic – not manipulating the situation, watch naturally occurring events, not controlling them.
Inductive – categories emerge from observing, creation and exploration centered, theories emerge from data. Often induce hypothesis, test it, then look for other possible explanation or additional hypothesis.
Holistic – look at total, what unifies phenomenon, it is a complex system, see overall perspective. Often research and academics study smaller and smaller parts and overlook the big picture. Need to try and get a larger picture, including the specific and unique context. But can look at specific variables too.
EH/GTZ/November
2003

Characteristics of Qualitative
Research
Personal contact – share the experience, not trying to be the objective outsider. Must know people to understand them, and gain insight by reflecting and being empathetic with them. If try to be objective probably won ’ t understand their views (but might understand things about them).
Dynamic constant shifting with the changing phenomenon and context: what method fits now and also, use trial and error. Don ’ t stick with the one method when you know that it is not working.
Stop. Realize that things may unfold differently than you expected, go with the flow. Respond creatively.
Unique case selection – not as concerned about generalizability (actually generalization is a cooperative venture of researcher and reader = researcher describes context fully and reader decides if new context is similar in crucial respects)
EH/GTZ/November
2003

Characteristics of Qualitative
Research con ’ t
Thick description – lots of detail, lots of quotations
Context sensitivity - emphasize many aspects of social, historical and physical context.
Empathetic – trying to take a view of the other person and be non-judgmental. Not subjective in terms of my biases, not objective in terms of no bias, but taking on their perspective to the degree possible.
How does reality appear to those being studied. Yet, also reporting own feelings and experiences as part of the data. Try to omit judgments, but freely admit own feelings. Do not try and hide them. Admitting them adds to the validity of the data.
EH/GTZ/November
2003

Characteristics of Qualitative
Research con ’ t
Flexible design - You don ’ t always specify it completely before research; variables and hypotheses and sampling and methods are at least partly emergent – need to unfold. Need to be able to tolerate contradictions. Trial and error with categories too – need to reformulate categories many times. Go from parts to whole and then back again. Cycle back and forth. Then reconstruct, pull data apart again, make better reconstructions, etc. Use multiple methods or as many as feasible, as long as you get a better picture of what is happening and how it is understood – even use quantitative methods.
EH/GTZ/November
2003

Researcher Roles
The ‘ traditional ’ role for a qualitative researcher is to be nonexistent . This is ideal but not always possible and practical. The ideal is that participant act exactly as they would if you were not present.
Problem – tends to ignore differences made in the environment by the researcher.
Qualitative research states that the researcher should document these differences.
It is difficult to obtain the participants views without interacting
EH/GTZ/November
2003

Researcher Roles con ’ t
The presence of the researcher could cause other reactions, eg suspicion, affected behavior, demonstrations for the researcher ’ s behalf. But time and familiarity tend to blur these responses. In time the researcher becomes part of the environment. But not initially.
Researcher is an instrument in qualitative research. To gather data. People reading the research need to know about the instrument. So, you need to describe relevant aspects of the yourself, your biases and assumptions, expectations, relevant history. Keep track in your field notes personal reactions, insights into the self and past.
In a separate journal – write your personal notes.
EH/GTZ/November
2003

Emic = an insider, become full participant in activity, helps minimize distinction/difference between researcher and participants
Etic = an outside view, A fly on the wall. Lots of variation in between, can vary role within a study – starts as outside and move to membership. Or change to outsider role at end to verify hypothesis generated as participant.
EH/GTZ/November
2003

Gatekeepers
Initial entry into the field of study
Control access
Problems with / for gatekeepers
Position of gatekeeper in the research
Gatekeepers’ perception of the researchers, eg. Spy
Expectations of gatekeepers on researchers, eg, outcomes such as reports, relationships, money
Compromises
Gatekeepers and problems for the research and researcher
DO NO HARM
EH/GTZ/November
2003

Access to research subjects
Access to subjects is often challenging for the researcher
Trust and respect is very important
Difficulties when participants are not very verbal
Role of key informant in research process
Positives and Negatives of involving key informant, eg, not always representative view of
‘ others ’ , vested interest in research subject, access to resources, political position, looking for a friend, have problems with others in the community, most educated person, others?
EH/GTZ/November
2003

Access to research subjects con ’ t
Stay around the study site early in the research process. This is sometimes called the “ mapping phase ” , ie, map the area, social context of environment, kinship relations, services or networks. Physical mapping is an excellent way to “ meet and greet ” and learn about the physical environment. Doing a video often helps.
If physical environment is very familiar, try to look for the ‘ other ’ aspects of the environment, eg, other health providers
EH/GTZ/November
2003

Sample and Selection
Study a subsection of a population
Look at selection in a probabilistic manner – try to get a representative sample of the group under study.
Not generalizable for the whole population, but generalizable for the population under study.
Choosing a population to study is dynamic and ongoing. The choice of who to study next are products of what is being found, not the initial plan.
EH/GTZ/November
2003

Suggestions for accessing subjects
1. Maximum variation of participants, example, women who attend health services and women who do not, different age groups, social and economic backgrounds, and so on.
2. Snowball approach and networking – each person studied is chosen by the previous participant - this will show linkages between participants. This is sometimes the only way to find and obtain a sample of certain population groups, eg, women who have been trafficked for prostitution.
3. Extreme cases – studying one or more people at some extreme. This needs to be included in the sample with the ‘ average ’ and the ‘ opposite ’ . This may or may not be possible, but you have to seek these people out. There may only be one or two people, but you have to include them
EH/GTZ/November
.
2003

4. Typical case - decide what characterizes
‘ typical ’ and go and look for them.
5. Unique case – very rare combination of things – usually found by accident.
6. Ideal case – perfect situation. “ if it won ’ t work here, it won ’ t work anywhere.
EH/GTZ/November
2003

It is very important to be able to say how and why you sampled in a given manner. So, keep detailed field notes on the decisions you made about sampling and why you made them. Go into detail in the field notes, give examples and the reasons for the choices you made.
EH/GTZ/November
2003

Informed consent
Definition of informed consent consists of the elementsinformation , comprehension , and choice .
Country specific laws provide conditions for informed consent.
Local standards and protocols when conducting research with human subjects
Oral or written consent
Anonymous
Difficulties obtaining informed consent in special populations, for example, children and refugees.
Costs and benefits of obtaining informed consent
EH/GTZ/November
2003

Ethical behavior in research
Courtesy
Respect
Empathy
Honesty
EH/GTZ/November
2003

Triangulation
TRIANGULATION involves using a combination of methods, researchers, data sources and theories in a research project.
Outcomes:
Different results will be obtained by using different researchers and different data sources
Methods are not neutral tools that will produce the same results regardless of the method. Triangulation addresses this problem.
EH/GTZ/November
2003

Recording field work data
Two types of note-taking
1.
Field-notes
2.
Interview transcriptions
EH/GTZ/November
2003

Field-notes
Ideal situation is to write field-notes by hand, and at the study site
Field-notes can be written in point form at the study site and expanded later
Field-notes can be typed into the computer later.
Many people do not put field-notes into the computer, they work from their journal.
EH/GTZ/November
2003

Recording Observations in the field
Write about actual events
Avoid inferences and generalizations
Write down detail
Describe the obvious
Take photographs if you can
Describe actions without evaluating
Push yourself to get details
Write your opinion in separate section
When NOTHING is happening record physical environment in detail
EH/GTZ/November
2003

Practical field-note taking
Use large margins on the page. This gives space for comments, additional information, evolving questions or theories
Feel free to draw pictures, diagrams and symbols
Write clearly
Feel comfortable where you write fieldnotes
EH/GTZ/November
2003

REMEMBER
You need reliable data [FACTS] to be able to generalize
Qualitative research relies upon carefully documented data so that conclusions can be formed
EH/GTZ/November
2003

Interview transcriptions
Include open-ended questions in the transcription
(most formed before the interview)
Include a large margin on the page for comments, quotes, etc.
Write clearly
Word for word transcription is best
Talk and write slowly, if possible
If information is not clear, ask the person to repeat the information before writing it down
Do not summarize information
Record your opinion and thoughts (separately)
EH/GTZ/November
2003

Observations
Data about the environment, people, events, activities that are under study
Traditions and life-ways of people
‘ Special ’ locations or events
Confirm what has been said or not said
Find more key informants
Check accuracy of information gained in interviews and social mapping
Provide information previously unknown
Develop relationship with participants
Provide additional data
EH/GTZ/November
2003

Key points when making observations
Begin with informal conversation
Then introduce the project
Obtain consent to take notes
Explain the purpose of note taking and getting more detailed data
Identify key informant or additional key informants
Take in-depth field notes of observations
EH/GTZ/November
2003

Free-list and rating
Simple, yet powerful research method
Generally used to study a cultural domain
Everyone knows the same free-list, example, diseases, plants, occupations, health workers
Easy to develop & analyse
Enjoyable
Compliments other research methods, especially social mapping and interviews
EH/GTZ/November
2003

Key points when making free-list
Ask informants to list all the people who provide care when they are sick (plus, those that come into the village and those outside)
Ideal to have (15) or more free-lists from the same study site (good sample for analysis)
Analyse free-lists by:
Order and frequency of recall
Gender
Age
Occupation / practitioner
Location
EH/GTZ/November
2003

Using free-lists
Opening technique to obtain information to use in interviews
Probe local terminology
Explore ‘ special ’ terminology
Explore cultural and social domains
Inform programs
EH/GTZ/November
2003

Rating free-lists
Produce ordinal data
Easy to administer
Combined with interviews they are powerful data generators
Used in a variety of research settings
Useful when exploring many subjects, eg, foods, diseases, health seeking practices, and so on
EH/GTZ/November
2003

Key points when making a free-lists and rating the list
Ask participants to make a list of the subject under study,eg, childhood illnesses
The order is ‘ up to the participant ’
DO NOT probe
Let the the informant make their own list and the
‘ natural ’ order will occur
Obtain at least 15 free-lists, good for analysis
Analyse the free-lists by rating them, for example, in order of priority 1,2,3,4,5 … .
EH/GTZ/November
2003

Group Presentations
Guidelines
Introduction (includes literature review)
Background to the research
Research Question
Research Objectives
EH/GTZ/November
2003

Methods
Ø Methods used and why
Ø Study site
Ø Study population
Ø Research process
Ø Consent
Ø Confidentiality
Ø Ethical issues
Ø Constraints / problems
Ø Researcher role/s
Ø Unexpected outcomes
Ø
Method of analyzing data
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2003

Ø Who
Ø Why
Ø When
Ø Where
Ø How
Ø What
Ø What for
Findings
“ Seven Steps of Planning ”
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2003

Group Presentations
(2) Persons / group
15 minutes each presentation
EH/GTZ/November
2003

Data Analysis:
Phases
Code Various Units
Develop Categories (Subcategories, &
Superordinate categories)
Give Examples of Categories
Linkages Between Categories
EH/GTZ/November
2003

Coding Data
Can have multiple codes for a unit of data
Work towards developing many and varying codes
Theory – preexisting or emergent theories influences coding
May need to code the same data several times
Computers help, but not essential
EH/GTZ/November
2003

Develop Categories
(main & sub categories)
Requires tat you develop definitions for each category
Categories and definitions need to be revised several times during analysis
Keep track of revision of categories and reasons why you revise categories and definitions in notes. For example, data indicates that previous definitions were not sufficient.
EH/GTZ/November
2003

Making Linkages between
Categories
Need to be specified manually or on computer
Document the kinds of linkages developed
Consider these kinds of linkages:
Time
Space
Causation
Social/Interpersonal
Many others are possible
EH/GTZ/November
2003

Coding:
Continual & dynamic
Look at the document, such as interviews
Read document (data) many times
Look for indicators of categories in events and behavior-name them and code them on the document
Compare codes (often many times) to find consistencies and differences
Consistencies between codes (similar or pointing to a basic idea) reveals categories.
EH/GTZ/November
2003

Coding:
Continual & Dynamic con ’ t
Manually, you can cut apart copies of field notes/interviews. Now people use computers.
Write ‘ memo ’ on the comparisons of emerging categories
Eventually you reach category saturation when no new codes related to the research project are formed
Eventually certain categories become more of a central focus – axial and core categories
Then – you write about (report) the data in each category
EH/GTZ/November
2003