Qualitative Research Methods Overview, Schemes and Mind Maps of Qualitative research

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Qualitative Research Methods: A Data Collector’s Field Guide

Module 1

Qualitative Research Methods Overview

F A M I L Y H E A L T H I N T E R N A T I O N A L

OVERVIEW

Qualitative Research Methods Overview

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his module introduces the fundamental elements of a qualitative approach to research, to help you understand and become proficient in the qualitative methods discussed in subse- quent modules. We recommend that you consult the suggested readings at the end of the module for more in-depth treatment of the foundations of qualitative research.

This module covers the following topics:

• Introduction to Qualitative Research
• Comparing Qualitative and Quantitative Research
• Sampling in Qualitative Research
• Recruitment in Qualitative Research
• Ethical Guidelines in Qualitative Research
• Suggested Readings

Introduction to Qualitative Research

What is qualitative research?

Qualitative research is a type of scientific research. In general terms, scientific research consists of an investigation that:

• seeks answers to a question
• systematically uses a predefined set of procedures to answer the question
• collects evidence
• produces findings that were not determined in advance
• produces findings that are applicable beyond the immediate boundaries of the study

Qualitative research shares these characteristics. Additionally, it seeks to understand a given research problem or topic from the perspectives of the local population it involves. Qualitative research is especially effective in obtaining culturally specific information about the values, opinions, behaviors, and social contexts of particular populations.

What can we learn from qualitative research?

The strength of qualitative research is its ability to provide complex textual descriptions of how people experience a given research issue. It provides information about the “human” side of an issue – that is, the often contradictory behaviors, beliefs, opinions, emotions, and relationships of individuals. Qualitative methods are also effective in identifying intangible factors, such as social norms, socioeconomic status, gender roles, ethnicity, and religion, whose role in the research

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What is the most important difference between quantitative and qualitative methods?

The key difference between quantitative and qualitative methods is their flexibility. Generally, quantitative methods are fairly inflexible. With quantitative methods such as surveys and ques- tionnaires, for example, researchers ask all participants identical questions in the same order. The response categories from which participants may choose are “closed-ended” or fixed. The advan- tage of this inflexibility is that it allows for meaningful comparison of responses across partici- pants and study sites. However, it requires a thorough understanding of the important questions to ask, the best way to ask them, and the range of possible responses.

Overview

Table 1. Comparison of quantitative and qualitative research approaches^ OVERVIEW

General framework

Analytical objectives

Question format

Data format

Flexibility in study design

Quantitative Seek to confirm hypotheses about phenomena

Instruments use more rigid style of eliciting and categorizing responses to questions

Use highly structured methods such as questionnaires, surveys, and structured observation

To quantify variation

To predict causal relationships

To describe characteristics of a population

Closed-ended

Numerical (obtained by assigning numerical values to responses)

Study design is stable from beginning to end

Participant responses do not influence or determine how and which questions researchers ask next

Study design is subject to statistical assumptions and conditions

Qualitative Seek to explore phenomena

Instruments use more flexible, iterative style of eliciting and categorizing responses to questions

Use semi-structured methods such as in-depth interviews, focus groups, and participant observation

To describe variation

To describe and explain relationships

To describe individual experiences

To describe group norms

Open-ended

Textual (obtained from audiotapes, videotapes, and field notes)

Some aspects of the study are flexible (for example, the addition, exclusion, or wording of particular interview questions)

Participant responses affect how and which questions researchers ask next

Study design is iterative, that is, data collection and research questions are adjusted according to what is learned

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Qualitative methods are typically more flexible – that is, they allow greater spontaneity and adaptation of the interaction between the researcher and the study participant. For example, qual- itative methods ask mostly “open-ended” questions that are not necessarily worded in exactly the same way with each participant. With open-ended questions, participants are free to respond in their own words, and these responses tend to be more complex than simply “yes” or “no.”

In addition, with qualitative methods, the relationship between the researcher and the participant is often less formal than in quantitative research. Participants have the opportunity to respond more elaborately and in greater detail than is typically the case with quantitative methods. In turn, researchers have the opportunity to respond immediately to what participants say by tailor- ing subsequent questions to information the participant has provided.

It is important to note, however, that there is a range of flexibility among methods used in both quantitative and qualitative research and that flexibility is not an indication of how scientifically rigorous a method is. Rather, the degree of flexibility reflects the kind of understanding of the problem that is being pursued using the method.

What are the advantages of qualitative methods for exploratory research?

One advantage of qualitative methods in exploratory research is that use of open-ended questions and probing gives participants the opportunity to respond in their own words, rather than forcing them to choose from fixed responses, as quantitative methods do. Open-ended questions have the ability to evoke responses that are:

• meaningful and culturally salient to the participant
• unanticipated by the researcher
• rich and explanatory in nature

Another advantage of qualitative methods is that they allow the researcher the flexibility to probe initial participant responses – that is, to ask why or how. The researcher must listen carefully to what participants say, engage with them according to their individual personalities and styles, and use “probes” to encourage them to elaborate on their answers. (See the modules on In-Depth Interviews and Focus Groups, pages 42-43 and 64-65 respectively, for discussions of probes.)

Is my quantitative experience applicable to qualitative research?

Although the objectives of quantitative and qualitative research are not mutually exclusive, their approaches to deciphering the world involve distinct research techniques and thus separate skill sets. This guide is intended to train researchers in the skill set required for qualitative research. Experience in quantitative methods is not required, but neither is it a disadvantage. Essential for our purposes, rather, is that all qualitative data collectors have a clear understanding of the differ- ences between qualitative and quantitative research, in order to avoid confusing qualitative and quantitative techniques. Whatever a researcher’s experience in either approach, a general grasp of the premises and objectives motivating each helps develop and improve competence in the quali- tative data collection techniques detailed in this guide.

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participate in or contribute to the study. Snowball sampling is often used to find and recruit “hidden populations,” that is, groups not easily accessible to researchers through other sampling strategies.

Recruitment in Qualitative Research

A recruitment strategy is a project-specific plan for identifying and enrolling people to partici- pate in a research study. The plan should specify criteria for screening potential participants, the number of people to be recruited, the location, and the approach to be used. In this section, we address some of the questions that may come up during the recruitment of participants.

How are recruitment strategies decided?

Ideally, the local principal investigator and qualitative research team members work together, in close consultation with com- munity leaders and gatekeepers (that is, community members in positions of official or unofficial authority), to develop a plan to identify and recruit potential participants for each site. Recruitment strategies are determined by the type and number of data collection activities in the study and by the characteris- tics of the study population. They are typically flexible and can be modified if new topics, research questions, or subpopulations emerge as important to the study, or if initial strategies do not result in the desired number of recruits. The criteria for selec- tion can also be changed if certain data collection activities or subpopulations of people prove not to be useful in answering the research questions, as discussed in greater detail below.

What if we disagree with recommendations from local leaders’?

It is important for the research team to be respectful of and responsive to the guidance and advice of local experts and community leaders. Remember that they have had more opportunity to establish rapport with the local community and they will also have to maintain that rapport after the study is complete. Remember also that community members may hold community lead- ers and local organizations accountable for any misunderstandings or other problems resulting from the behavior of the field staff.

What should we say to people when we try to recruit them?

Each research team develops guidelines for the introductory comments staff make to potential participants at each site. These guidelines need to be sensitive to the social and cultural contexts from which participants will be recruited. They should also reflect the researchers’ awareness that willingness to participate in an interview or focus group will depend on how well the partici- pants understand what the study is about, what will be expected of them if they participate, and how their privacy will be respected.

In developing recruitment guidelines, it is important to take special care to avoid saying anything that could be interpreted as coercive. The voluntary nature of participation in research studies should always be emphasized.

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Can we recruit people who are legally under the care of a parent or guardian?

Yes, you may recruit minors, but in most cases you must obtain informed consent (discussed in detail in this module’s section on Ethical Guidelines in Qualitative Research, page 9) from the parent or guardian, as well as from the potential participant. Exceptions to the parental consent requirement include pregnant adolescents and homeless minors, but you should always consult the guidelines of the relevant ethics review boards before proceeding with recruitment. Moreover, recruitment of minors must be specifically approved by all relevant ethics review boards. Because they are considered a vulnerable population, recruiting minors for research studies is a highly sen- sitive issue, and extra measures are required to ensure their protection.

Do we always need to obtain informed consent? If so, oral or written?

The ethics committee that reviews and approves the study protocol determines whether informed consent needs to be obtained for each data collection activity. Typically, formal informed consent is necessary for all qualitative research methods except participant observation, regardless of the sampling method used to identify potential participants and the strategies used to recruit them. Whether this informed consent is oral or written depends on a number of project-specific factors and ultimately upon approval by the ethics committee. During recruitment, obtaining informed consent for qualitative research involves clearly explaining the project to potential study partici- pants. (See the section in this module on Ethical Guidelines in Qualitative Research, page 9, for more on informed consent.)

What if the recruitment strategy is not working?

After data collection is under way, the local principal investigator and field staff may find that the recruitment strategy is not working as well as anticipated. Because qualitative research is an iterative process, it is permissible to change the recruitment strategy, as long as the proper approvals are obtained.

For example, it may be necessary to develop a new recruitment strategy because following the original plan has resulted in inadequate enrollment or because researchers determine that they need participants who meet a different set of criteria. After meeting to discuss alternatives, the research team should write down reasons why the strategy was not working or needs to be changed and outline how they would like to change it.

Proposed changes in the recruitment strategy must be submitted to the sponsoring organization, and some will require submission of a protocol amendment for approval by the ethics committees that initially approved the research. If new criteria for participation are proposed, for instance, they must be approved by relevant ethics committees before the new phase of recruitment can begin. Similarly, increasing the number of recruits would also require ethics committee approval.

Because of the limited time frame for data collection, it is important that the field staff work closely with the site principal investigator and community gatekeepers to identify and recruit the new set of research participants.

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What are the fundamental research ethics principles?

Three core principles, originally articulated in The Belmont Report,^1 form the universally accepted basis for research ethics.

Respect for persons requires a commitment to ensuring the autonomy of research participants, and, where autonomy may be diminished, to protect people from exploitation of their vulnerabil- ity. The dignity of all research participants must be respected. Adherence to this principle ensures that people will not be used simply as a means to achieve research objectives.

Beneficence requires a commitment to minimizing the risks associated with research, including psychological and social risks, and maximizing the benefits that accrue to research participants. Researchers must articulate specific ways this will be achieved.

Justice requires a commitment to ensuring a fair distribution of the risks and benefits resulting from research. Those who take on the burdens of research participation should share in the bene- fits of the knowledge gained. Or, to put it another way, the people who are expected to benefit from the knowledge should be the ones who are asked to participate.

In addition to these established principles, some bioethicists have suggested that a fourth princi- ple, respect for communities , should be added. Respect for communities “confers on the researcher an obligation to respect the values and interests of the community in research and, wherever possible, to protect the community from harm.” 2 We believe that this principle is, in fact, fundamental for research when community-wide knowledge, values, and relationships are critical to research success and may in turn be affected by the research process or its outcomes.

What is informed consent?

Informed consent is a mechanism for ensuring that people understand what it means to partici- pate in a particular research study so they can decide in a conscious, deliberate way whether they want to participate. Informed consent is one of the most important tools for ensuring respect for persons during research.

Many people think of informed consent primarily as a form , that is, a piece of paper that describes in detail what the research is about, including the risks and benefits. This form gener- ally goes through ethics committee approval procedures, includes legalistic language, and is signed by the participant, the researcher, and possibly a witness. Such informed consent forms are appropriate for biomedical and other research – including qualitative – when the risks faced by participants may be substantial. They may also be necessary for minimal risk research when the foundation for trust between researchers and participants is weak.

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(^1) National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report. Ethical Principles and Guidelines for the Protection of Human Subjects of Research. Washington, DC: National Institutes of Health, 1979. Available: http://ohsr.od.nih.gov/guidelines/belmont.html.

(^2) Weijer C, Goldsand G, Emanuel EJ. Protecting communities in research: current guidelines and limits of extrapolation. Nature Genetics 1999;23(3):275-80.

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But forms are really only one part of an informed consent process. In some cases, forms may not be the best way to ensure informed consent. There are also situations where obtaining informed consent from individual participants may not be feasible or necessary. For example, a researcher using participant observation to learn about how transactions occur in a public market would find it very hard to get everyone observed in that setting to sign a consent form and would probably create unwarranted suspicion about her motives in the process of seeking such consent. Yet if people see a stranger hanging around, watching, asking questions, and perhaps taking discreet notes, they may be even more suspicious about why she is there. In these situations, qualitative researchers must use other mechanisms to achieve the goal of informed consent.

How do we achieve informed consent for qualitative research?

In general, informed consent procedures are based on national and international research ethics guidelines; a review of such guidance is an important part of ethics training. Research organiza- tions and ethics committees often have their own specific guidelines as well.

The first task in achieving informed consent is to inform people about the research in a way they can understand. This can be a multistep process. For example, you may begin by approaching community leaders and explaining the research to them. The leaders may then facilitate a com- munity forum where interested people can learn about the research and ask questions. You might distribute information sheets, advertisements, or brochures, or try to get local newspapers or radio stations to do a report on the research. A community advisory board might be set up. Or the researchers might spend a week or two just talking with people one-on-one. If the researchers will be spending a lot of time in the community setting, or if the research is potentially contro- versial or sensitive, such efforts can go a long way toward gaining trust as well as understanding. In some situations, it may be necessary to obtain formal permission from community leaders or gatekeepers before research can begin.

In general, data collection activities that require more than casual interaction with a person require individual informed consent from that person, regardless of whether community-level permissions exist. Examples of such activities include in-depth interviews and focus groups. The person should be told:

• the purpose of the research
• what is expected of a research participant, including the amount of time likely to be required for participation
• expected risks and benefits, including psychological and social
• the fact that participation is voluntary and that one can withdraw at any time with no nega- tive repercussions
• how confidentiality will be protected
• the name and contact information of the local lead investigator to be contacted for questions or problems related to the research
• the name and contact information of an appropriate person to contact with questions about one’s rights as a research participant (usually the chair of the local ethics committee oversee- ing the research)

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receptionists – or with the data – such as typists, transcribers, translators, and data managers. Research ethics training courses are available on-line from a number of organizations, including Family Health International ( http://www.fhi.org/training/en/RETC ), the U.S. National Institutes of Health ( http://cme.nci.nih.gov ), and the University of California, Los Angeles ( http://training. arc.ucla.edu ). These courses do not focus specifically on qualitative research issues, but they provide a valuable foundation for understanding ethical issues important for all research.

Many ethics courses include mechanisms for obtaining a certificate of completion. A copy of this certificate may be required by the organization sponsoring the research.

Suggested Readings

Bernard HR. Research Methods in Anthropology, Second Edition. London: Sage Publications, 1995.

Denzin NK, Lincoln YS (eds.). Handbook of Qualitative Research. London: Sage Publications, 2000.

Marshall PA. Human subjects protections, institutional review boards, and cultural anthropologi- cal research. Anthropol Q 2003;76(2):269-85.

National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report. Ethical Principles and Guidelines for the Protection of Human Subjects of Research. Washington, DC: National Institutes of Health, 1979. Available: http:// ohsr.od.nih.gov/guidelines/belmont.html.

Nkwi P, Nyamongo I, Ryan G. Field Research into Social Issues: Methodological Guidelines. Washington, DC: UNESCO, 2001.

Pelto P, Pelto G. Studying knowledge, culture and behavior in applied medical anthropology. Med Anthropol Q 1997;11(2):147-63.

Pope C, Mays N. Qualitative Research in Health Care. London: BMJ Books, 2000.

Schensul, J, LeCompte M. Ethnographer’s Toolkit. Walnut Creek, CA: Altamira Press, 1999.

For additional information on this topic, refer to Chapter 1: Invitation to Explore, Chapter 3: Designing the Study, Chapter 4: Collecting Qualitative Data: The Science and the Art, Chapter 5: Logistics in the Field, and Appendix 2: Examples of Oral Consent Forms in these companion guides:

Qualitative Methods in Public Health: A Field Guide for Applied Research

Qualitative Methods: A Field Guide for Applied Research in Sexual and Reproductive Health

Qualitative Research Methods: A Data Collector’s Field Guide