Research Methods in Public Health

Introduction to

Qualitative Research

Taiwo Gboluwaga

Amole

Department of

Community Medicine,

AKTH/BUK.

MSc 2021

9/19/2024

Why Qualitative?

•

Qualitative methods help to:

•

Answer 

“how” 

or 

“why” 

questions

•

Explain

 the factors that influence health

•

Understand

 how individuals and

communities interpret certain public health

issues or concepts

•

Study/observe

 the interactions related to a

public health issue or phenomenon

•

Identify

 problems with implementation or

relevance of public health tools or services

9/19/2024

What are some differences between

qualitative and quantitative research?

9/19/2024

Qualitative vs. Quantitative

•

Qualitative Research:

–

Answers “how” and “why”

–

Participant’s perspective

–

Explores hypotheses

–

Describes (text)

–

Common methods

include: focus groups,

individual interviews, and

participation/observations

–

Small sample size, more

depth, less structure



Quantitative Research:



Answers “who”, “what”, “how

much” & “where”



Researcher’s perspective



Confirms hypotheses



Quantifies (numbers)



Common methods include:

surveys, interviews,

longitudinal studies, and

controlled observations.



Large sample size, less depth,

more structure

9/19/2024

Would you conduct a qualitative or quantitative

study? 

•

RQ: Does the post-natal health education

program in Malawi improve the health

status of children up to one year old?

9/19/2024

Would you conduct a qualitative or quantitative

study? 

•

RQ: What are the experiences of parents

with sick children at Kampala General

hospital?

9/19/2024

Would you conduct a qualitative or

quantitative study?

•

RQ: How do women in Lagos choose their

husbands?

9/19/2024

Would you conduct a qualitative or

quantitative study?

•

RQ: Do adolescent women served by the

Family Planning Clinic in Addis return to

the clinic on-time for their Depo-Provera

shots?

9/19/2024

What types of qualitative studies

have you worked on or heard of?

9/19/2024

Common Qualitative Methods

–

Observation

–

Interviews

–

Unstructured: questions generated

spontaneously from interviewee’s responses

–

Structured: adherence to specific set of

questions

–

Semi-structured: happy medium—allow space

for interviewees to answer in their own words

but covers same topics and questions across

interviews

–

Focus Group Discussions

9/19/2024

Data Collection Materials

–

Note taking

•

Field note journal

•

Structured observation note grid

•

Brief notations while in the field

–

Video and/or tape recording (with permission)

–

Collection of all relevant supporting materials

9/19/2024

Considerations in Planning

Qualitative Research

•

Before forming qualitative research

questions, there are a few key things to

consider which differ from the

considerations made for quantitative

research:

–

Goals and objectives of the study

–

Who

 you are studying (vs. 

what

, as studied in quantitative)

–

Sample is often not random

–

Sample may not be representative of the total

population

–

Level of rigor may not be the same as quantitative

–

Triangulation: use of different methods to check for

consistency

–

Role of the researcher

–

Maintaining objectivity

9/19/2024

Qualitative Research

Questions

–

Open-ended

–

Purpose:

–

To understand thoughts, ideas,

perspectives, attitudes, and/or beliefs

–

To help inform a hypothesis

–

To understand how/why people interpret

certain public health issues

–

To generate new avenues of study

–

To inform an intervention, service, or study

design

–

May begin with “how”, “why”, “in what ways”, etc.

–

May change over time

9/19/2024

Practice

What are some questions from your own

work that would be better asked

qualitatively than quantitatively?



How would you frame the question?



What type of qualitative research

would you do?



How would you design the study?

9/19/2024

Focus Group

Discussions (FGDs)

9/19/2024

Definition: 

a research technique

that collects data through group

interaction on a topic determined

by the researcher

9/19/2024

When focus groups are used?

•

Suitable for:

–

Social norms

–

Feedback on a product

–

Observations of how participants talk to each

other about a topic

–

Insights into group interaction

•

Must be:

–

For research purposes

–

Focused on one topic

–

Require discussion between participants

9/19/2024

Strengths of focus groups

•

Need to know group/population

consensus

•

Relative to individual interviews

–

Direct evidence about similarities and

differences

–

Less threatening (safety in numbers)

–

Sense of varied responses in public vs. private

•

Relative to observations

–

Keeps discussion on a topic

–

Phenomena that are unobservable (decision-

making, private or rare actions)

9/19/2024

Advantages/disadvantages of

focus groups

•

Advantages

–

Relatively cheap

–

Accepting

environment

–

Comments

stimulate others to

think about the

topic



Disadvantages



Logistically challenging to gather

that many people



Must have a skilled moderator



Participants can have lengthy

responses or a few people can

dominate the discussion



Not useful for gathering in-depth

data on personal or sensitive

topics



Confidentiality cannot be assured

9/19/2024

Purpose of FGD guide

•

To inform moderator of key questions

•

To guide phrasing of questions and

transitioning

•

To keep session on track

–

Includes fewer questions but centers them

each around one theme or dimension

•

Probe more deeply if necessary—use

this only as a guide

9/19/2024

Planning & organization

•

Who: Recruitment, invitation, and organization of groups

–

Want participants similar in background, not attitudes

•

Where/When: Convenience, accessibility, and type

–

Want a neutral, convenient, private place

–

Each group lasts 1-2 hours (time/travel considerations)

•

What: Participatory activities

–

Moderator involvement only to allow free flowing

conversation and ensure research topics covered

•

Snacks: Yes/no, before/during/after

•

How many: Number and size of groups

–

Ideally 6-10, or <12 participants per group

–

3-5 groups per project/subgroup

9/19/2024

Roles of the FGD team

•

Two interviewers per FGD:

–

Moderator

–

Notetaker/ Logistics Coordinator

•

May need to switch hats

•

Important to plan ahead:

–

Discuss roles

–

Prepare using mock or pilot FGDs

–

Anticipate challenges, cross-critique, exchange roles as needed

–

Continuous training via daily debriefings

9/19/2024

Moderator

•

Must be a good listener and a good observer

•

Goals:

–

Keep the discussion on track and paced

–

Maximize interaction between participants

–

Stress each participant's value and contribution

–

Emphasizes own role as a LEARNER, not a TEACHER

–

Allow and value outbursts

•

Plan:

1.

Obtain informed consent/assent

2.

Start audio-recording with oral group consent

3.

Introduction, establish ground rules

4.

Self-introductions and ice-breakers

9/19/2024

Notetaker/ Logistics

Coordinator

•

Notetaking goal: to

ensure detailed

documentation of

the FGD

–

Setting and participant

description

–

Participant responses

•

Note who is speaking

using naming

convention (quotes)

–

Notetaker's observations



Logistics goals:



Limit distraction to FGD



Respond to all

unanticipated

interruptions or problems



Prepare and coordinate

research tools



Offer insight on unnoticed

group interactions



Check recording device



Keep track of time

9/19/2024

Positive dynamics to

encourage



Participants are relaxed and mutually respectful of the group



Be relaxed, use pleasant tone



Be patient, don't rush to respond



Incorporate humor



Co-create/omit ground rules



Avoid judging comments



Avoid informing/educating during the group ("expert")



Group has taken a comfortably outgoing, serious, or quiet tone

or dynamic



Allow group to follow it's own style and pace



Be flexible



Ask one question at a time

9/19/2024

Difficult dynamics to manage

•

Moderator has to work to keep the group attention/focus

on topic

–

Modify guide to get in sync with participant's

perspectives/terms

–

Use less moderator involvement

•

Dissenters suppress disagreement to maintain group

consensus

–

Opening/final statements to discussion questions

–

Emphasize wanting diverse views

•

Discussion angers, slows down, or is monopolized

–

Acknowledge emotion, take a break

–

Redirect towards interests

–

Invite others to comment

9/19/2024

What are some ground rules

that you could set to help

manage these difficult

situations?

9/19/2024

Final tips

•

Moderator needs to anticipate language/translation

needs

•

Notetaker to be prepared to fill-in for moderator

•

Notetaker to be aware if note-taking is distracting

•

All familiar with recording devices

•

Notetaker to be prepared to ensure ongoing private

and noise-free space

9/19/2024

Overview of

In-depth

Interviews (IDIs)

9/19/2024

Why conduct interviews?

•

Interviews allow for a more incisive look

into the context, issue, or public health

concept

•

Help to gain an understanding of

underlying reasons, opinions, and

motivations for certain trends or issues

•

Provide a safe space for exploring

deeper into a problem or concept

9/19/2024

Types of Interviews

•

Informal

:

–

Conversations in the field

•

Unstructured

:

–

Interview setting with no formal guide

•

Semi-structured

:

–

Interview setting with an interview guide & probes

•

Structured

:

–

Interview setting with a rigid question list

9/19/2024

Structured vs. Unstructured:

Interviewer Perspective

STRUCTURED

•

Standardized across multiple

interviewers

•

Can rely on the script

•

Data has less researcher influence

•

May be self-administered if

necessary

•

May constrain depth of

understanding

•

Some relevant or important topics

may not get covered

SEMI- OR UN-STRUCTURED

•

Less or not standardized

•

Ideal for fewer interviewers

•

Personal style/influence of the

researcher is a key factor

•

Room to develop rapport and

explore certain themes/topics

•

Quality of data depends on the

interviewer's skills and judgement

•

Can't be self-administered

9/19/2024

Structured vs. Unstructured:

Data Collection Perspective

STRUCTURED

•

Pre-determined

•

Systematic

•

Pre-set range of responses

•

Quantitative

•

Good for getting specifics

•

Not ideal for deep discussion or

understanding

SEMI- OR UN-STRUCTURED

•

Not pre-determined

•

Open-ended, free response

•

Less control over nature of

responses

•

Qualitative/narrative research

•

Allowed to change based on

responses

•

Good for in-depth knowledge

•

Difficult to compare data between

respondents

9/19/2024

Before the Interview:

Considerations

•

Time of day, venue, environment

•

Audience dynamics and demographics

–

Cost to the participant (time, money, energy) to attend

•

Safety consideration

•

Written materials:

–

Literacy of the audience

–

Language barriers that may affect the presentation

•

Recording and note taking

•

Ethical considerations

•

Personal influence/role of the researcher (reflexivity)

9/19/2024

Consent

•

Types: 

Oral

and 

Written

•

Can be done before or at the time of the interview

•

Purposes:

–

Provides a brief introduction to the study team and project

–

Ensures the participant fully understands her/his involvement in

the interview/discussion and the confidentiality of responses

–

Makes participant aware of how personal details, responses,

and observations will be recorded, collected, and disseminated

–

Allows the participant to opt out, express hesitations/concerns,

or ask questions

9/19/2024

Building Rapport

•

Rapport

: Establishing a mutually trusting

and respectful relationship with the

participant

•

Rapport can change or develop over time

and circumstances

•

Depends on:

–

Culture-sharing group

–

Participant(s)

–

Interviewer(s)

•

Stages of an interview

:

Apprehension

Exploration

Cooperation

Participation

9/19/2024

Apprehension

•

 Sense of uncertainty

•

 Interviewee doesn’t know what to expect,

purpose, or motivation

•

 Uneasy about potential judgment of

responses

•

 Doubtful of adequate experience to

report

•

What to do?

–

“Keep informants talking” (...?)

–

Expand on informed consent process/explanations

–

Start and demonstrate...

9/19/2024

Exploration

•

Apprehension gives way to “trying out the

relationship”

•

Form opinion about what interviewer

really wants

–

Answering questions appropriately?

–

Is it OK to talk about a specific topic?

•

Begins to become familiar with process

•

How do you know you’re in this stage?

–

 May offer tangential story

–

 Appears to be at ease

–

 States unspoken questions

9/19/2024

Cooperation

•

 Interviewer/-ee know what to expect

from one another and move into full

cooperation

•

 Work together towards same end

•

 Difference b/t “rich” vs. “thin” data

•

 How do you know you’re here?

–

 Mutual less concern about offense/mistakes

–

 Interviewee may self-probe, correct, verify

–

 Satisfaction with exchange

9/19/2024

Participation

•

 Final stage in rapport building process

•

After multiple encounters

•

Interviewee takes more assertive role

•

On look-out for new information, consideration

•

Involvement in analysis or dissemination

•

Is this stage crucial?

–

 Empowerment, mobilization

–

 Member checking/validation

–

 Qualitative rapid assessment

–

In-depth cooperation gives saturation

9/19/2024

Conversation vs. Qualitative

Interview

9/19/2024

Introduction

•

Introduce yourself

•

Help the participant(s) to feel comfortable

•

Get consent, if not already done

•

State the purpose of your interview or discussion

–

Provide a basic outline of what he/she should expect

(duration, interactive components, etc.)

•

Allow room for questions or concerns to be

voiced

9/19/2024

Questions

•

Ask the same questions in the same manner to each

participant

•

Important to consider the sensitive nature of

questions

•

For structured or semi-structured interviews, follow

the script as closely as possible

–

Do not offer extraneous information

–

Do not lead, suggest, or inject an opinion

•

Remain neutral throughout the interview

–

If you disagree with the participant, do not argue

•

Provide 

clarification

and 

probing

questions as

needed

9/19/2024

Probes

•

Natural phrase, question, gesture, and/or sound to

encourage the participant to speak more or

elaborate on her answer

•

Probing

–

Probes help to dig deeper and help guide the

discussion

–

Not all probing questions have to be used

–

Use when response is brief or unclear

–

Indicate active listening

–

Important not to probe too much or too little

9/19/2024

Types of Probes

•

Direct questions 

on “how”, “why”, “what do you mean”?

•

Neutral

verbal expressions, nodding (“Uh-huh” probe)

•

Mirroring technique

/ Echo probe (repeating prior point)

•

Silent

probe

(remaining quiet)

•

Exploratory

probe (“What else?” “Tell me more about...”)

•

Baiting/phased assertion 

probes (Hint of already

knowing)

9/19/2024

Clarification

•

If a participant asks for clarification, goes off topic, or

gives an irrelevant answer, then there a few key

methods for responding:

–

Repeat the question

–

Frame the question a different way

•

Provide context

•

Use different descriptors that provide the same or

similar meaning

–

Utilize the probing questions

•

Paint a clearer picture of what you are trying to

understand

9/19/2024

Balancing Listening, Talking, & Silence

•

 Some silence is OK!

•

 Listen more, talk less

•

 Explore laughter

•

 Follow-up, but don’t interrupt

•

 Only share personal experiences occasionally

•

 Ask questions when you don’t understand

9/19/2024

Closing

•

Remember to thank the participant for his or her

time

•

Remain professional and pleasant, and provide

contact information for any questions the

participant may have about the investigation

and/or the survey.

•

Quickly review what was discussed before you

conclude the interview to make sure all questions

have been answered

•

Allow room for any remaining thoughts or

questions

•

Administer the exit survey as applicable

•

Ensure participants have a safe and reliable means

of transportation

–

Connect to local resources as needed

9/19/2024

Qualitative

Research Ethics

9/19/2024

Top priority in research

•

Protect the 

well-being

 of research

participants

•

Research question is always of

secondary importance

•

Choice between doing harm to

participant and doing harm to the

research: 

always protect the

participant!

9/19/2024

Principles for research to protect

human subjects

•

Respect for persons

: ensure autonomy of

research participants and protect people

from exploitation; informed consent &

refusal

•

Beneficence

: minimize risks and maximize

benefits of participating in research;

protect privacy and confidentiality

•

Justice

: ensure fair distribution of risks and

benefits, no individual or groups should be

over-burdened without gaining potential

benefits; protect vulnerable populations

9/19/2024

Institutional Review Board

(IRB)

•

Research protocol submitted to and

approved by ?? Kano State Health

Research and Ethic Committee; AKTH

HREC, Bayero University of Kano

•

IRB ensures research protocol adheres

to principles of human research

•

Ultimately, researchers are responsible

for protecting participants!

9/19/2024

Ethics in Qualitative Research

•

Desire for person to participate depends

on willingness to share his or her

experiences

•

Qualitative research involves:

1.

researcher/participant relationship

2.

researchers’ subjective interpretation of data

3.

the study design

9/19/2024

Five Ethical Considerations for

Qualitative Research

•

Informed consent

: ongoing process

•

Participant rapport

: trust, care around

sensitive topics, but don’t feign friendship to

encourage disclosure/ don’t act as a therapist

(refer)

•

Disclosure

: remove personal identifiers, option

to share “off the record”

•

Representation

: QR is interpretive, respect

narratives about self and community, avoid

stereotyping

•

Power differentials

: involve community,

acknowledge influence of research relationships

9/19/2024

Vulnerable populations

•

Persons with 

limited opportunities or

abilities 

within a society

•

Examples:

–

Children and youth

–

Pregnant women

–

Elderly

–

Prisoners

–

The homeless

–

People with intellectual disabilities

–

People with limited access to health care

9/19/2024

Adverse events

•

During the course of a study or

interview, an 

unfavorable situation

may occur

•

This can include:

–

a participants’ negative reaction to a question or discussion

–

accidental breach of confidentiality

–

deviation from study protocol so that confidential

information becomes public

•

What’s your role as an interviewer?

–

Report any adverse event to supervisor and principle

investigator so they can resolve the issue

9/19/2024

Informed consent

•

Ensure people 

fully understand

 what is

involved in participating in research study so

they can 

decide

 whether to participate

•

Consent is a process

:

–

Written forms contain important information including:

•

purpose of research

•

time commitment

•

potential risks and benefits

•

voluntariness of participation & withdrawing

•

protection of confidentiality

•

names and contact info of study lead and ethics committee

–

Participants have opportunities to ask questions throughout

–

Participants can refuse or stop at any point

9/19/2024

Protecting confidentiality &

privacy

•

Conduct interviews in places with privacy

•

Do not share information from interviews with other research

participants or anyone else outside of the research study team

•

Use numeric codes for participants during transcription of interviews

•

Personal information collected form participants will be used for

research purposes only

•

Individual responses will be analyzed together with information

collected from other participants

•

Audio recordings will be destroyed after validation of transcripts

•

Files will be stored so that only study team members have access

9/19/2024

Transcription

and Audio Files

9/19/2024

Your friend sends you an SMS/

text message. This is what it says:

•

“I don’t want you to come to visit me at my house

tonight. Just come another time.”

9/19/2024

Your friend talks to your mom,

and your mom leaves you a note:

•

“Joseph said he prefers you do not go to his place, but

maybe you can go later.”

9/19/2024

Objectives of transcription

1.

Translate audio recording into text

2.

Ensure the person who reads the transcript

understands the interview as if he/she were present

for the interview

3.

Create an exact record in words (

verbatim

transcription

) of what took place during interview

(verbal and non-verbal)

9/19/2024

Contents of transcript

1.

Background information

2.

Legend

3.

Interviewer notes/ reflections

4.

Main text body

5.

Non-verbal information

6.

Transcriber notes/ reflections

9/19/2024

1. Background information

•

Interview type: IDI

•

Location of interview

•

Date of interview

•

Respondent number: e.g. R8

•

Name of interviewer

•

Time duration of interview

•

Date of transcription

•

Name of transcriber

9/19/2024

2. Legend

[ ] 

Analytical notes or comments

( ) 

Gestures or tone of voice

(Missing)

Missing information

(Not clear)

Unclear/ inaudible section of

recording

(…)

Silence

CK

Initials of interviewer (Celia Karp)

R

Respondent

*

Replacement for a name mentioned

in an interview

9/19/2024

3. Interviewer notes/

reflections

•

Description of the context, atmosphere, and

circumstances of the interview

•

Allows reader of transcript to better understand the

interview and respondent’s answers, which may

assist and improve data analysis

9/19/2024

Example

This interview was one of the most difficult I have ever done. It

was impossible to speak without being interrupted. The

interview occurred in the house of an old women, which was

messy and in absolute disarray. At 10:00am I knocked on the

door of the house and was received by a girl. She took me into

the living room, which was full of old furniture, mattresses,

torn sheets, and smelled terrible. The girl called her mother,

who was in the kitchen preparing breakfast for her family. R is

a tall woman with very dark complexion. As soon as she saw

me she smiled and apologized for the mess. I asked if I could

interview her. She stopped me immediately, began to clean up

the mess, then served me tea. The woman seemed so happy

and excited to be interviewed that I could barely ask a

question without her beginning to speak. She often got off

topic, wanting to discuss things irrelevant to my questions.

9/19/2024

4. Main text body

•

Use fonts that allow reader to distinguish people

speaking. Type questions from interviewer in ALL CAPS.

•

Skip a line when the speaker changes

•

Do not include names or identifiable information about

respondents. Use R for respondent if names are said

aloud.

•

Use correct spelling

•

Type words verbatim (exact words used originally)

9/19/2024

Example

CAN YOU TELL ME ABOUT THE TOWN WHERE YOU

WORK?

It is a very nice town. People settled here for trade,

and residents are from all over Nigeria. (Another

participant leave the room). Even neighboring

countries. (…)

INTERESTING. WHAT ELSE? CAN YOU TELL ME MORE

ABOUT WHAT IT”S LIKE?

People are friendly. My husband has a shop in town

and people come to greet us every day. (Coughs).

There is no jealousy here, hum hum [local expression

that means yes]. Everyone looks out for each other

and is happy for you if you are prosperous.

9/19/2024

5. Non-verbal information

•

Tone of voice, speed of talk, pauses, etc.:

•

Information that indicates dynamics and mood of the

interview and emotions of the respondent

9/19/2024

Example: Doctor & Patient (1a)

Dr9: I would suggest yes ibuprofen is a good

symptomatic treatment, and you’ll be fine.

Pt3: Fine, okay, well, thank you very much.

9/19/2024

Example: Doctor & Patient (1b)

Dr9: (…) I would suggest (…) yes ibuprofen is a good

symptomatic treatment (…) um (slaps hand on knee),

and you’ll be fine.

Pt3: Fine, okay, (not clear) well, (…) thank you very much

[very quiet]?

Patients words seem to indicate

agreement, but the way the words are

said seems to indicate the opposite.

9/19/2024

6. Transcriber notes/

reflections

•

Comments and reflections about the interview overall

•

Convey impression of interview and emphasize [ ]

notes

9/19/2024

Example

The respondent sounded as if she became angry during

several points in the interview, which are noted in [ ]. The

interviewer remained patient, often speaking softly and

apologizing. Despite the respondent’s anger, the interviewer

was able to complete the interview. Based on this interview,

it seems the respondent is excited about where she lives and

likes her neighbors. This relevant to our research question

because it tells us that Ugandans who like where they live

because they have relationships with people in their

communities that are rewarding and meaningful.

9/19/2024

Transcription is an 

INTERPRETIVE

process

•

Not as simple and straight-forward as it might seem

–

“I don’t know” versus “I don’t (…), no”

•

You must interpret data and make decisions about

how to represent data

•

The goal is to make the written record as readable and

meaningful as possible

9/19/2024

Frequently Asked Questions

•

When should 

terms

 or 

concepts

 be kept in the

local language

?

–

In general, translate and transcribe in English

–

Sayings, proverbs, terms that are difficult to translate

or may lose some meaning in translation may be kept,

but 

ALWAYS PROVIDE A TRANSLATION IN ENGLISH

•

To what extent should the exact words of the

respondent, including grammatical errors, be

transcribed exactly?

•

Should we transcribe discussions that have nothing

to do with study

–

Yes, you have to transcribe; information may be important or informative

9/19/2024

Translation

•

Translation should occur at the same time as transcription

–

Ideally, we would want an English and a Hausa/Igbo

transcript

–

Unfortunately, this is time intensive and we need these

transcripts quickly

•

If a phrase or word is not easily translated, please keep in

local language

–

Make footnote to them describe the word or phrase in

English

•

Ask others for assistance!

9/19/2024