Farmakoepidemiologi 2 FINAL

PHARMACOEPIDEMIOLOGY
Qualitative Research
Approach
Prih Sarnianto
“If we knew what we were
doing, it wouldn’t be called
research, would it?”
Albert Einstein
Research Method, definition
• Study design:
A study design is a specific plan or
protocol for conducting the study,
which allows the investigator to
translate the conceptual hypothesis
into an operational one.
>> Qualitative… word, word, word…
>> Quantitative… number, number, number …
Research Method, perspectives
• Example:
The perception of being cured from leprosy.
>> From the leprosy specialist
>>> Treatment completed
>>> Treatment completed
>> What does the patient think?
Get the perspective of informants, more
information is needed for it to become intelligible
>>> “My patch is still here!”
>>> “I’m still disabled.”
Research Method, essence
• Essence [of qualitative research]:
>> Inquiry process of understanding
>> Based upon distinct methodological
tradition of inquiry that explore a social of
human problem
The qualitative researchers
>>> Build a complex, holistic picture
>>> Analyze words
>>> Report detailed views of informants
>>> Conduct the study in natural setting
>>>> Explain rather than just describing behavior
Qualitative Method, advantages
• Qualitative method can be used to:
>> Identify health determinants
>>> Underlying behaviors
>>> Attitudes
>>> Perceptions
>> Explain social and programmatic impediment to
>>> Informed choices
>>> Use of services
>> Shed light on the success of interventions
>> Facilitate understanding of policy, social, and
legal context in which decisions are made
Qualitative Method, advantages
• Qualitative method is:
>> Flexible
>> Encourage discoveries
>> Stimulate more investigation of the
unexpected
>>> May be important to quantitative
research but do not replace quantitative
method since:
It address different questions
Study Design, types
>> Qualitative disebut juga interpretative research
► Biography… life history, oral history
► Phenomenology… the lived experience
► Grounded theory… symbolic interactionism
► Ethnography… interpretation of cultural/social/system
► Case study… exploration of a “bounded system” or case
>>> Understanding central phenomenon: Y
>> Quantitative
► Experimental… with intervension
► Observational… no intervension
>>> Understanding relationship X Y
Study Design, comparison
When to use what
Qualitative Quantitative
> Subject matter is unfamiliar. > Subject matter is clearly
> Exploratory research, when defined
relevant concepts are > When measurement problems
unknown of their are minor and have been
definitions unclear. resolved.
> When meaning rather than > When detailed numerical
frequencies are sought. description of a representative
> When flexibility of approach sample is required.
is needed to allow for > When repeatability of
discovery of unexpected; in- measurement is important.
depth investigation. > When generalizability of
> For studying related issues, results and comparison across
cases, or events in detail. population is needed.
Basic assumptions
Based on the notion of Based upon the idea of
“constructivism”, which “logical positivism”, that
assumes multiple is, there is a singular
realities that are socially reality with stable, social
constructed through facts that are separate
individual and collective from the feelings and
perceptions or views of beliefs of individuals.
the same situation.
Basic objectives
Concern is with the Seeks to establish
understanding of the relationships and
social phenomenon explain causes of
from the participants’ changes in measured
perspectives. This variables. That is, the
requires, to some goal of science is to
degree, researcher explain and predict.
participation.
Method and Process
Use of emergent design The scientific method,
utilizing constant also known as a priori or
comparison and pre-established design.
revision.
Researchers’ roles
Immersion in situation Detachment from study
and the phenomenon in order to avoid bias.
being studied.
Context
Generalizations are Context-free
contextually-bound. generalizations
Characteristics:
Help readers understand Experimental or
the multiple perspectives of correlational designs are
the situation by the persons used to reduce error, bias
studied. Subjectivity in data and the influence of
analysis and interpretation extraneous variables--
is acknowledged. control of bias is through
>> Neutrality design.
>> Uniformity >> Accuracy
>> Objectivity >> Reliability
>> Replicability >> Freedom from bias
Precision
Provided by detailed Obtained through the
description of use of measurement
phenomenon. and statistics.
Verification
Extension of Results replicated by
understandings by others.
others.
Explanation
Summary through Traditionally, parsimonious
narrative—importance is explanations were sought,
placed on reducing but this may be changing
complex realities to due to technology.
simple explanations.
Logical reasoning
INDUCTIVE—anyone have DEDUCTIVE—What’s the
an example? classic example?
Conditional conclusions
Tentative summary Statements of statistical
interpretations. probability.
Therefore….
• Understanding • Prediction
• Interview/observation • Survey/questionnaires
• Discovering frameworks • Existing frameworks
• Textual [words… words… • Numerical [numbers…
words…] numbers…]
• Theory generating • Theory testing [experimental]
• Quality of informant is more • Sample size is the core issue in
important than sample size reliability of data
• Subjective • Objective
• Embedded knowledge • Public
• Models of analysis: Fidelity to • Model of analysis: Parametric,
text or words of interviewees non-parametric
Study Design, Sampling
>> No probability sampling
► Individual people
► Program, group organization or community
► Genders, ethnic groups, older and younger
>> Strategies
► Purposeful or judgment sampling…
Key informants
Maximum variations, homogenous, critical case,
theory based, confirming and de-confirming cases
► Snowball or chain
Extreme or defiant case, typical case, intensity, politically
important case s, random purposeful
► Stratified purposeful
Criterion, opportunistic, combination or mixed, convenience
Qualitative research, techniques
• Direct or participant observation [field notes]
• Interviews or focus group discussions [FGDs]
with key informants
• Video or text and image analysis [documents,
media data]
Skills
• Surveys • Observing
• User testing • Conversing
• Participating
• Interpreting
• Participant observation >> overt, must not be covert
>>> Gains insight into understanding cultural
patterns to determine what’s necessary and
needed in encouraging people to access
Puskesmas [complementary to interviews]
• Interviews or FGDs with stakeholders
>>> Explores how people seek treatment for their
sick family members.
>>> Gains insight into the meaning of Puskesmas for
people for getting healthcare.
• Focus Group >> What and Why?
>> Facilitated small group discussion.
>> Experience and perspectives.
>> Exploring specific area of interest in detail;
particularly useful for sensitive topics.
>> Interactions among members is key.
>> Not for generalizing findings
• FGD versus Other Methods
> Individual interviews
+ Multiple perspectives
+ Observe interactions
+ Participants help each others clarify ideas
– Difficult to manage
– Reluctant to reveal in group setting
– Social norms influence responses
• FGD versus Other Methods
> Observations
+ More efficient
+ Easier access
– Relying on reports of behavior versus actual
observations of behavior
– Not a natural setting
• Ethical considerations
> Informed consents
> Provide project description at start of the group
> Clarify confidentiality and anonymity [within
group as well]
• Data analysis
>>> Themes arising from data would provide insight
into current “healthcare seeking” issues and see
what is important to people in certain region.
• Survey
>>> Useful for verifying
Rigor in qualitative
results on a larger scale. research
• User testing • Dependability
• Credibility
>>> Useful for triangulating • Transferability
results. • Confirmability
Qualitative research, data
• Collecting data
>>> Primary tools are observations and interviews,
but can also include personal and official
documents, photographs, recordings, drawings,
e-mails, and informal conversations
>>> Multiple data source are normative
>>> The researcher records descriptive as well as
reflective notes about what one has seen,
heard, experienced, and thought about a during
an observation session.
• Qualitative data is information that is difficult
to measure, count, or express in numerical
terms. This type of data is used in research
involved detailed, verbal descriptions of
characteristics, cases, and settings.
>> Data which can be categorized in some way but

which cannot be reduced to numerical
measurements.
>> Data that is not quantitative.
.
• Regarding field notes
>> Put aside assumptions, experience context first
>> See phenomena through participants’ perspective
>> Write up notes immediately following an observation
>> Detail is critical: include date, site, time, and topic on
every set of field notes; leave wide margins for
writing impressions; use only one side of a page of
paper; draw diagram of site [if necessary].
>> List key words first, then outline one’s observations
>> Keep the descriptive and reflective sections separate
>> Use memos to record hunches, questions, and
insights after each observation
>> Number the lines or paragraphs for easy access
.
• Regarding interviews
>> The purpose is to explore and to probe the interviewee’s
responses in order to gather in-depth data
>> The interviewer inquires into the interviewees’ attitudes,
interests, feelings, concerns, and values as these relate to
the context being studied
>> Meaning is jointly constructed between the interviewer
and the interviewee; meaning is not just a construction
on the part of the interviewee
>> Be alert for openings in responses to probe more deeply,
starting with mundane questions and gradually easing
into more sensitive and more complex questions
>> Interview data collection techniques include taking notes
during the interview, writing notes after the interview, or
tape recording and transcribing the interview [the
transcript is a “verbatim”]
.
• Interview “do’s and don’ts…
>> Do listen and talk less
>> Do follow up on what is not clear and probe more
deeply into what is revealed
>> Don’t use leading questions; do use open-ended
questions [probes]
>> Don’t interrupt; do wait
>> Do keep interviewee[s] focused
>> Do ask for concrete details
>> Do tolerate silence and space between interviewee’s
responses; do allow the interviewee time to think
>> Don’t judgmental about or react to interviewee’s
opinions, views, or beliefs.
>> Don’t engage in debate with an interviewee
>> Do record everything the interviewee says and note
impressions of interviewee’s nonverbal behavior.
Qualitative research, data criteria
• Credibility or plausibility
>> To demonstrate that the study was conducted in
such a manner as to ensure that the subject was
accurately identified and described
• Transferability
>> To demonstrate that the results of the study are
generalizable to others in the original research
context or to contexts beyond the original study
• Including a method section
>> To provide an in-depth description of the
processes and methods used in the study
Qualitative research, data analysis
• Constant comparison method
>> Compares new evidence to prior evidence to
identify similarities and differences between
observations
• Negative case and discrepant data method
>> The search for contradictory, variant, or
disconfirming data within the body of data
collected that provides an alternative perspective
on an emerging category or pattern
• Analytic induction
>> A process concerned with developing and testing
a theory in order to generalize a study’s findings
Qualitative research, report
>> Provide a setting where the data were
collected
>> Identify characters who provide information
>> Describe the social action in which the
characters are engaged
>> Offers an interpretation of what the social
action means to the characters
>> Offers an interpretation of what the social
action means to the characters
>>> Do not forget to make the matrix for the
collected [interview and other written] data
Qualitative research, plus-minus
• Focus on the whole of the human experience and
the meanings ascribed to them by participants
• They provide the researcher with deep insights that
would not be possible using quantitative methods
• The major strength of qualitative work is the
validity of the data it produces
• Participants true reality is likely to be reflected
• Major limitation is its perceived lack of objectivity
and generalizability
• Researchers become the research tools and may
lack objectivity
Qualitative research, combination
• Combining Qualitative and Quantitative Method
>> Illustrative example
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 research, example
Methods
>>> Direct observation of worksites [for project
staffs to learn about range of work tasks,
and understand where/when/with whom
workers smoke, what they eat at
breakfast/meals, sources of food]
>>> Group and individual interviews [two wave
of interviews]
>>> Formed a qualitative research working group
for project
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?]
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]
Data collection and analysis
>>> Trained staff to conduct interviews and code
data
>>> Collected data and almost immediately
began analysis:
► Group discussion
► Coding [structural and thematic, multiple
codes]
► Creation of themes document
► Revision of focus group guides
► Retrieving codes for thematic analysis
Application of results to the intervention
>>> Identify themes in qualitative data
>>> Define intervention methods
>>> Incorporate into intervention messages
>>> Reflect in visual in materials
>>> Used in staff training
>>> Apply to quality assurance
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]

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.”
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 research, summary
• Application 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
• Focused 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
• Constructing a topic guide
>> Avoid a close-ended questions: Going for
experience and perspectives
>> Based on your research questions
>> Topic areas, then question each topic, list probes
>> Start with icebreakers and “easy” question
• Data management and analysis
>> Transcript recordings and check
>> In-depth analysis
>> Analysis across groups by theme
• Focused groups’ composition
>> Purposive
>> Sub-groups — return to your research questions
>> Homogenous versus heterogeneous
• Logistics
>> Eligibility screening
>> Conducted in primary language of group
>> Length: 1 to 2 hours, no more
>> Location: convenient
>> Tape record
>> Take notes [note-taker]
>> Incentives
• Focused groups’ 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
THANK YOU!
prih1488@gmail.com

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PHARMACOEPIDEMIOLOGY

>> Data which can be categorized in some way but

[General President’s introduction to the TFR]

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