Qualitative Research in
Medicine
Deepak Dath
CORE program in Surgery
BACKGROUND
• Used in the Social Sciences for a long
time
• Felt to be “soft science” by those using
quantitative methodology
• Generally was rare in medicine
• Gained popularity in the nursing literature
• Now being embraced slowly in medicine
as “real” science
Why the lag?
• Push to EBM
– Values numerical data
– Values typical EBM research designs
– Little previous techniques for determining the
quality of the qualitative research design
• Very time (researcher time) intensive
• Inertia and unfamiliarity
• Infrastructure for quantitative research
Objectives
• What is Qualitative Research
• What are the types of Qualitative
Research methodologies
• Do something to wake up and to ‘feel’ the
topic
• How do we use qualitative research in
medicine
What is it?
• Helps to answer questions like
– What?
– Why?
– How?
– What does that mean?
• Can help generate new theories or
hypotheses
• Helps to generate a deeper understanding
of an issue or topic
What is it?
• Inductive vs deductive
– Deductive:
premise 1 and premise 2 and….
therefore ……….
• All men are mortal. (major premise)
• Socrates is a man. (minor premise)
• Socrates is mortal. (conclusion)
– Inductive:
fact 1 and fact 2 and …
therefore new fact is….
after touching much ice, I can say that all ice is cold
What is it?
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Descriptive
Analytical
Selective
Experiential
Begins with broad, exploratory aims that
provide a focus for study without preempting which aspects of the experience
may be deemed important or relevant
What is it?
• When there is a gap in knowledge or when
little is known about a particular
phenomenon, experience, or concept
• Researchers study people in natural
settings
• Attempts to make sense of, or interpret the
meanings people attribute to their
experiences
Many types of Quantitative
Research
• Participant observation
– Intensive, lengthy
• Direct observation
– Trained observers
• Unstructured Interviewing
– Can be very in-depth and focussed
• Case studies
• Focus groups
Techniques used in Qualitative
Research
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Interviews
Focus groups
Surveys
Observation
Data Analysis
• Data collected is
– Variable i.e. not determined apriori
– Written (notes/written comments) or spoken,
– Large volume
• Requires consolidation and summarization
according to the researchers’ meaningful
interpretation
• Multiple iterations of data consolidiation
Data Analysis
• Data analysis starts the minute you start
collecting data, and affects how and what is
collected.
– As meaning or interest is generated, the data
collection is focused to increase the understanding
• Grounded theory
– Previous concepts
• Thematic analysis
– Previous concepts and emergent concepts used to
help collate data
Data Analysis
• Software used to streamline analysis
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Categorizes
Links
Summarizes
Compares
Functions as a textual database
• The actual analysis is the meaning that you
interpret/generate from the raw data and the
discussion that convinces the reader
Data Validation
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Member checks
Triangulation
Post-analysis observation
Repeat study or observational validation in
a different setting to determine
generalizability
Case #1
• Dr. Osteo Blast notices that some patients
with arthroscopies do well and others do
less well – its just an impression, and he
wants to know just what that means and
what is involved.
Case # 2
• Dr. Islets Langerhans wants to know
whether the patients who come to see
him in consultation leave the office
satisfied with the consultation. He is a
HPB surgeon who spends a great deal of
time describing treatment approaches or
discussing cases without surgical options.
Case # 3
• Dr. Ed Ucator is keen to understand what
makes a good operative teacher.
• Dr. Osteone notices that some patients with
arthroscopies do well and others do less well –
its just an impression, and he wants to know just
what that means and what is involved.
• Dr. Langerhans wants to know whether the
patients who come to see him in consultation
leave the office satisfied with the consultation.
He is a HPB surgeon who spends a great deal of
time describing treatment approaches or
discussing cases without surgical options.
• Dr. Ed Ucator is keen to understand what makes
a good operative teacher.
Questions
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How do you need to ask?
What design would you use?
What instruments do you need?
How many will need to participate?
How can you disseminate the data?
In Summary
• A technique of research that you need to
understand to interpret the results
• Useful as a first step in understanding a
question/process
• A well-validated science
• Resources on the web:
• http://www.socialresearchmethods.net/kb/index.php
• Poor literature on qualitative research methodology in journals
• Suggest that if you decide on a qualitative project, you include a
qualitative expert in your process at the start.