Applying Qualitative Methods
in Intervention Research
Glorian Sorensen, PhD, MPH
Harvard School of Public Health
Dana-Farber Cancer Institute
Boston, Massachusetts, USA
Overview
•
•
•
•
•
Uses of qualitative methods
Toolbox of qualitative methods
Integration of qualitative and quantitative methods
Focus group methods
Examples from my research in the US and India
Qualitative methods
Qualitative versus quantitative:
When to use what?
Qualitative
Quantitative
Subject matter is unfamiliar
Subject matter clearly defined
Exploratory research, when relevant When measurement problems are minor
concepts are unknown or their
and have been resolved
definitions unclear
When meaning rather than
frequencies are sought
When detailed numerical description of
a representative sample is required
When flexibility of approach is
needed to allow for discovery of
unexpected; in-depth investigation
When repeatability of measurements is
important
For studying selected issues, cases
or events in detail
When generalizability of results and
comparison across populations is needed
Qualitative methods
Study design
• Research question and guiding theoretical
framework
• Qualitative research study design and methods
– sampling (non-random, purposive, theoretically-based)
– gaining access
– choosing data collection methods (interviews, documents,
observation, etc)
– ethical considerations
– validity
• Analysis
• Reporting
Qualitative methods
Qualitative methods toolbox
• Individual interviews (structured, semi-structured)
• Group interviews (focus groups and non-focus
groups)
• Observation (participant, unstructured, structured)
• Document and archive reviews
Qualitative methods
On combining qualitative and
quantitative
•
•
•
•
•
•
Explore or refine constructs for surveys
Pre-test surveys
Pre-test intervention materials
Plan for survey administration
Interpret quantitative results
Understand process of change that may be
measured through surveys
Qualitative methods
Illustrative example combining
qualitative and quantitative
methods
• Research problem: High rates of smoking among
construction laborers
• Research aims:
– conduct formative research to assess smoking patterns and
factors associated with smoking among laborers
– develop and test a smoking cessation intervention, using an
RCT design
Qualitative methods
Laborers and smoking: How
can qualitative methods
enhance study?
•
•
•
•
Survey constructs and administration
Develop intervention strategies and messages
Assess intervention components
Interpret quantitative study results
Qualitative methods
Focus groups: What and why?
• Facilitated small group discussion
• Experiences and perspectives
• Exploring specific area of interest in detail;
particularly useful for sensitive topics
• Interaction among members is key
• Not for generalizing findings
Qualitative methods
Focus groups vs. other methods
Individual interviews
+
+
+
-
multiple perspectives
observe interactions
participants help each other clarify ideas
difficult to manage
reluctant to reveal in group setting
social norms influence responses
Qualitative methods
Focus groups vs. other methods
Observation
+ more efficient
+ easier access
- relying on reports of behavior vs. actual observations of
behavior
- not a natural setting
Qualitative methods
Ethical considerations
• Informed consent
• Provide project description at start of group
• Clarify confidentiality and anonymity (within group
as well)
Qualitative methods
Application of qualitative
methods: Example
• Research questions
– how do construction laborers view health risks associated
with occupational exposures, poor nutrition, and tobacco
use?
– what kinds of health promotion strategies will effective in
decreasing in tobacco use and increase in consumption of
fruits and vegetables?
Qualitative methods
Qualitative methods
• Direct observation of worksites (for project staff to
learn about range of work tasks, and understand
where/when/with whom workers smoke, what they
eat at break/meals, sources of food)
• Group and individual interviews (two waves of
interviews)
• Formed a qualitative research working group for
project
Qualitative methods
Sampling
• Observation: convenience sample; close by; no
major differences by region
• Group and individual interviews: stratified by
region; include racial/ethnic, gender, and age mix;
current and former smokers
• Recruitment and gaining access: through
international union; training sites (bias?)
Qualitative methods
Topic guide development
• Based on theoretical model we developed by mixing
existing models (behavioral theories and work
environment policy theory)
• Working group developed topic guide
• Pilot tested and refined guide
• Revised throughout data collection (iterative)
Qualitative methods
Data collection and analysis
• Trained staff to conduct interviews and code data
• Collected data and almost immediately began
analysis:
–
–
–
–
–
group discussions
coding (structural and thematic, multiple coders)
creation of themes document
revision of focus group guides
retrieving codes for thematic analysis
Qualitative methods
Application of results to the
intervention
•
•
•
•
•
•
Identify themes in qualitative data
Define intervention methods
Incorporate into intervention messages
Reflect in visuals in materials
Use in staff training
Apply to quality assurance
Qualitative methods
Examples within the laborers’
intervention materials
Value of being fit for work
“Being a Laborer is a demanding job. You face hazards every day,
and being healthy and fit enough to meet challenges is
important… Being healthy means you’ve got the strength you
need to get the job done — and take care of other
responsibilities too.”
[General President’s introduction to the TFR]
Qualitative methods
Examples within the laborers’
intervention materials
Value of family and friends
“Tobacco use can be a problem for your family members and your
LIUNA brothers and sisters too. That’s because secondhand
smoke causes over 53,000 deaths a year among people who
don’t even use tobacco — spouses, co-workers, buddies.”
Qualitative methods
Examples within the laborers’
intervention materials
Health concerns
“…[O]ne thing you can do is make good decisions about your
health. Sometimes that means talking to your steward if you’re
worried about on-the-job exposures or hazards. Other times, it
means taking control of your personal health, and doing what
you can to make your body stronger and healthier. This is where
[the program counselor] can help.”
Qualitative methods
Examples within the laborers’
intervention materials
Qualitative methods
Planned tobacco control
research in India
• Analysis of Global School Personnel Survey
• Focus groups to elucidate observed relationships
• Apply to intervention development
Qualitative methods
Summary: Applications of
qualitative methods in
intervention research
•
•
•
•
•
Understanding the social context of the population
Survey development
Intervention design
Staff training
Understanding the process of observed changes
Qualitative methods
Focus groups: Size and number
• Six to eight participants
• Over-recruit slightly and reminder about group day
before
• Three to five groups per topic of interest
• Saturation: when stop hearing new info
Qualitative methods
Constructing a topic guide
• Avoid close-ended questions: going for experience
and perspectives
• Based on your research questions
• Topic areas, then questions within each topic, list
probes
• Start with icebreakers and “easy” question
Qualitative methods
Data management and analysis
• Transcribe recordings and check
• In-depth analysis
• Analysis across groups by theme
Qualitative methods
Focus groups: Composition
• Purposive
• Sub-groups — return to your research question
• Homogenous vs. heterogeneous
Qualitative methods
Logistics
•
•
•
•
•
•
•
Eligibility screening
Conducted in primary language of group
Length: 1-2 hours, no more
Location: convenient
Tape record
Take notes (note-taker)
Incentives
Qualitative methods
Focus group facilitation
•
•
•
•
•
Two people: facilitator and note-taker
Show interest and respect
Introduce group members and yourself
Actively listen; follow leads but stay “on topic”
Encourage between-participant discussion; avoid
group interview dynamic
• Eye contact tip
Qualitative methods