Overview of qualitative research

1
Overview of qualitative research

• Cochrane Qualitative Research Methods Group
• Qualitative Systematic Reviewing Workshop
• 20-21 October 2006

2
Background to the workshop

• To provide a summary of how the use of
  qualitative research has increased in health and
  social care
• To explore the reasons for greater use and
  acceptance of qualitative research
• To describe the use of qualitative research as a
  form of evidence in EBHC
• To list the ways that qualitative research can be
  used to inform systematic reviews (with specific
  reference to the sessions in the workshop)

3
Qualitative research no
longer the poor relation

• The use of qualitative research has increased in
  health and social care for a number of reasons
• Greater technological success with communicable
  disease control
• Demographic changes in types of diseases and
  conditions
• A population that lives longer

4
Changes in health and social care

• Health technologies have become more successful
  in the control and eradication of disease.
  Chronic conditions are now becoming
  a priority.
• As people live longer, treatment of chronic
  preventable conditions has become more time
  consuming and expensive.
• Reduction of some communicable diseases, such as
  HIV/AIDS, and other conditions such as type 2
  diabetes, are heavily dependent upon behaviour
  change.
• The reduction of preventable conditions is
  heavily dependent upon lifestyle factors

5
Implications for qualitative research

• As a result, models of disease control and health
  maintenance have had to become more holistic,
  taking account of the situations and environments
  in which people live.
• Disciplines such as health psychology,
  anthropology, and medical sociology are
  increasingly used to explore issues in health
  care. These disciplines have traditionally used
  qualitative research methods.

6

• Deductive approaches were traditionally used in
  health care, because they were congruent with a
  medical model that took a biological and
  physiological stance toward the control of
  disease and improvement of health.
• Funding bodies are now increasingly encouraging
  applicants to use inductive, qualitatively
  derived information to design experimental
  studies (Campbell, MRC development of studies to
  assess complex interventions).

7
Sequential phases of developing and testing
hypotheses
Long term implementation
Definitive randomised controlled trial
Adapted form M. Campbell, et al. BMJ
321694-696, 2000.
Exploratory trial
Modelling
Theory
Unable to explain results return to qualitative
research
Phase 1
Phase 5
Phase 4
Phase 3
Phase 2
Development of information for hypothesis testing
8
Complex interventions in health and social care

• Complex interventions are interventions that
  require more than one treatment, multiple contact
  with different providers, and/or treatment across
  more than one setting
• Assessing the effectiveness of a complex
  intervention, a pathway of care or a patient
  journey often needs multiple methods, including
  qualitative research

9

• Recent experience with complex interventions has
  also indicated that there are social and cultural
  dimensions to health that need to be taken into
  account at the design, implementation and
  assessment stages of research studies.
• As a result, there is an increasing use of
  qualitative research to inform study design,
  document stages of implementation, and enhance
  explanations of findings.

10
How can qualitative research be used in health
care?

• A. To assist in trial design
• To identify what participants see as important
• e.g. including important non-clinical outcomes
• To improve recruiting and support information
• To provide triangulation

11
B. To explore process issues for patients,
clients and staff

• To better understand the process of receiving or
  delivering treatments
• AND HENCE
• Assist in bridging the gap in identifying
  barriers to bringing the results of reviews into
  normal practice

12
C. To create better models of causation of
disease and of treatment and care

• To develop a fuller and more rigorous approach to
  the inductive stage of the research cycle
• Aggregating studies for improved theory building

13
D. To study service delivery processes

• Studying ways of organising services effectively
  and efficiently where controlled experiments are
  rarely possible e.g.
• barriers facilitators young people and mental
  health care (Harden et al, 2001)
• uptake of childhood immunisation (Roberts et
  al, 2002)
• adherence to tuberculosis management (Noyes et
  al, 2002)

14
E. To study topics not amenable to a Randomised
Controlled Trial

• Blinding is impossible in therapeutic
  approaches that require active engagement of the
  patient or client
• True randomisation is often not acceptable
  ethically, and often not practicable, in many
  psycho-social interventions
• Broadening the methods base overcomes some of the
  bias in topic selection

15
F. To study rare events

• Errors in service delivery processes, inc.
• Issues subject to legal action, judicial review,
  inquiry etc
• Maximising on studies that have accessed
  hard-to-reach populations
• Building understanding of sensitive topics

16
Why use qualitative data in systematic reviews?

17
To make best use of qualitative data

• ALL OF THE ABOVE, AND TO
• Improve understanding of quantitative synthesis
• Support qualitative inquiry as collective and
  developmental enterprise
• Ensure best use of research resources