CMEpalooza

1. Qualitative Research and CEHPQualitative Research and CEHP
CMEpalooza
Presented March 20, 2014
View archived presentation on youtube:
http://tinyurl.com/kg9kl9t
Wendy Turell, DrPH, CCMEP
Director
CME Outcomes and Analytics
PlatformQ Health
wturell@platformq.com
Alexandra Howson MA, PhD, CCMEP
Owner
Thistle Editorial, LLC
alexhowson@thistleeditorial.com

2. AgendaAgenda
- The Qualitative Approach
- Utilization in CEHP lifecycle
- Data Collection
- Questions and Interview Behavior
- Analysis
- Reporting

3. The qualitative approachThe qualitative approach

4. Qualitative ResearchQualitative Research
“Not everything that can be counted
counts, and not everything that counts can
be counted.”
- William Bruce Cameron

5. Search for
objective,
universal
truths using
standardized
data
gathering
techniques

6. Naturalistic/inte
rpretative
approach
Focus on how
people perceive
their worlds
and interpret
experience

7. ExplorationExploration
• Unearth a complete and detailed description of
the how and why behind physician, allied
healthcare provider, and patient behavior.
• Produce deep answers to research questions that
give voice and layered explanation to the answers
you seek.

8. Why Qualitative?Why Qualitative?
• Patient care is complex
• Semi-structured, open ended approach to inquiry
• Less limiting - explores beyond pre-selected answer
choices
• Interaction - researchers probe and react to study
subject comments

9. Data: What vs WhyData: What vs Why
Quantitative Data:
A 37% drop-off was observed in adherence to post
surgery medication regimens
Qualitative Data
“After their bypass surgery, when they have seen God
and all that, they listen, but after they are out of the
hospital and they are going through rehab and they
are fine, that period of after the bypass, they are
invincible.”

10. Qualitative Research Quantitative Research
Type of Questions
Probing “below the
surface”; immediate
follow up & adjustment
Limited probing; pre-
determined questions
NOT adjusted
Sample Size Small Any size including large
Information per
respondent
Much
Varies; Limited to
answer choices
Administration
Requires skilled
researcher
Fewer specialist skills
required
Type of Analysis
Follows structured steps;
subjective and
interpretative
Statistical; objective
Type of Research Exploratory, descriptive Descriptive or Causal

11. Applications in CEHPApplications in CEHP
Across research phases
With different research participants
Alone or mixed methods
Needs assessment
Intervention development
Formative evaluation
Outcomes evaluation
Survey development

12. Data CollectionData Collection

13. Sample MethodologiesSample Methodologies

14. Online MethodologiesOnline Methodologies
• Research methodologies = evolving with
communication styles
• Widely-used, often preferred options for researchers
and respondents
• Benefits
o Cost Savings
o Ease for wide geographical representation
o Ease for scheduling (no need for travel, sessions tailored to their availability)
o Anonymity = less inhibition / more honesty

15. Optional
Webcam-
enabled images
Text based chat
&
audio capable
Online Methodologies
Virtual Interview Room

16. Types of QuestionsTypes of Questions

17. Question TypesQuestion Types
• Open ended, neutral, sensitive, clear to
respondent
Patton, MQ. How to use qualitative methods in evaluation. London:
Sage, 1987.
1. Main questions
2. Probes
3. Follow ups
4. Specifying
5. Interpreting

18. More about QuestionsMore about Questions
• Use vocabulary of respondent
• Appropriate tone
• What open ended q looks like
• Language that may invoke defensiveness
• Q writing, q order

19. Interviewer BehaviorInterviewer Behavior
• Active Listening – Be ‘in the moment’
• Encourage respondent
o Give appropriate verbal and non-verbal feedback
• Stay neutral
o Avoid presenting your perspective (bias interview)
o Avoid counseling, teaching

20. Coding and AnalysisCoding and Analysis

21. CodingCoding
• Breaking down data into units which are then
grouped according to characteristics
• Proceeds linking diverse
observations
• Helps with understanding
• It’s practical!
• Organization = quick access
when you need it for analysis/description.

22. CodingCoding
• 1st
phase: review data:
o What’s happening?
o What’s important?
o What patterns are emerging?
• 2nd
stage: repeat, refine, expand/reject
categories
• Text can be tagged with >1 code

23. Grounded TheoryGrounded Theory
• Glaser & Straus (1967) – emphasis on developing
theory/explanation from data versus gathering
data to test a theory/hypothesis.
• The theory is grounded in reality as represented in
the data
• Benefits:
o Theory is derived from what speakers do, vs. what is believed
they should do
o Ensures the researchers maintain an open mind towards inquiry
vs. imposing existing beliefs on data

24. • Rigor
• Validity
• Saturation
Methodology
How can Software Assist?
GATHER
ORGANIZ
E
ANALYZE VISUALIZE RESULTS

25. How can Software Assist?
Source: Nvivo (QSR)
Coding Memoing
Visuals Queries
-Review
-Merge
-Refine
-Models
-Matrices
-Charts
-Key Ideas
-Reflect
-Link
-Text Search
-Word Frequency
-Matrix
-Coding Comparison

26. ReportingReporting

27. ReportingReporting
oReports = based on trends and
relationships found within the data
• Includes:
oTrend Description
oRespondent Quotes
oVisualizations (themes, their relationships,
demographic elements)
oInterpretation

28. Reporting: DescriptiveReporting: Descriptive
Patient Concern about high blood pressure:
The overwhelming response to the question "Should a
person be concerned about having high blood
pressure?" was "yes." Most people believed that being
unconcerned could result in serious health problems,
specifically heart disease or even death.
"A person can die if they have high blood pressure
because it can cause a stroke or it can cause
heart problems."

29. Reporting: TrendsReporting: Trends
Patients’ opinions on how well providers explain a
medication varies from “satisfied” to “very well”
For some patients, the nurse practitioner provides more
detail, as does the pharmacist and the information that
accompanies the medication.
Between the nurse practitioner and the physician,
respondents tend to trust the physician more. In many
cases, it appears that patients with a strong, long, and
trusting relationship with their providers perceive them as
explaining the medication better than those without
an established relationship or who distrust their providers.

30. Reporting: Giving VoiceReporting: Giving Voice
Provider: “After their bypass surgery, when they have seen
God and all that, they listen, but after they are out of the
hospital and they are going through rehab and they are
fine, that period of after the bypass, they are invincible.”
Patient: “I took [the prescription] to the pharmacy and
……they were only going to give me four pills because it is
so expensive, and I am saying to myself, ‘why did they
give me this, I am going to die because I will not be able
to afford it?’
In my head, I said ‘Oh Lord; please make this work without
any side effects so I can take it.’”

31. Reporting: QuoteReporting: Quote
IntegrationIntegration
Having a normal blood pressure level:
Living a calm life, feeling relaxed, and avoiding or
solving problems were seen as very effective ways
to keep blood pressure normal. "Be calm in
everything. Do not get angry over something small."
"I try not to have problems with anyone at home, in
the street, or anywhere else. If I were to have a
problem with anyone here, my blood pressure
would go up immediately. A person can burst."

32. Visualizing DataVisualizing Data

33. Visualizing DataVisualizing Data
Word Clouds

34. Visualizing DataVisualizing Data

35. Questions?Questions?

36. Follow-up Questions?Follow-up Questions?
Contact UsContact Us
Wendy Turell, DrPH, CCMEP
Director
CME Outcomes and Analytics
PlatformQ Health
wturell@platformq.com
Alexandra Howson MA, PhD, CCMEP
Owner
Thistle Editorial, LLC
alexhowson@thistleeditorial.com

37. AppendixAppendix

38. ResourcesResources

39. Software Resources:Software Resources:
Coding & OrganizationCoding & Organization
• Free (QDA Miner Lite)
o http://provalisresearch.com/products/qualitative-data-analysis-software/freewa
/
• Low Cost: dedoose
o http://www.dedoose.com/
• Bells and Whistles software: Nvivo or Atlas Ti
o http://www.qsrinternational.com/products_nvivo.aspx
o http://www.atlasti.com/index.html

40. Resources Cont.Resources Cont.
• Hopkins Open Coursework: http://ocw.jhsph.edu/
• Qualitative course materials:
o http://ocw.jhsph.edu/index.cfm/go/viewCourse/course/qualitativedataa
nalysis/coursePage/index/
• Online Qual. Textbook:
http://onlineqda.hud.ac.uk/Introduction/index.php

41. Resources Cont.Resources Cont.
• Cater JK. SKYPE: a cost-effective method for qualitative
research. Rehab, Counselors + Educators Journal.
20011;4:
• Cohen DJ, Crabtree BF. Evaluative criteria for qualitative
research in health care: controversies and
recommendations. Ann Fam Med. 2008;6:331-339.
• Curry L, Nembhard IM, Bradley EH. Qualitative and
mixed methods provide unique contributions to
outcomes research. Circulation. 2009. 119:1442-1452.