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NEWS AND FILLER QUALITATIVE RESEARCH: A BRIEF DESCRIPTION UMESH KEMPARAJ, SANGEETA CHAVAN

ABSTRACT Qualitative research refers to, a range of methodological approaches which aim to generate an in‑depth and interpreted understanding of the social world, by learning about people’s social and material circumstances, their experiences, perspectives, and histories. Requires researchers to become intensely involved, often remaining in field for lengthy periods of time. The greatest value of qualitative research is its ability to address questions of relevance to public health knowledge and practice which are difficult to answer satisfactorily using quantitative methods. Key words: Primary care, public health, quality, research

INTRODUCTION “Research is to see what everybody else has seen and to think what nobody else has thought” by Albert Szent. This leads to generation of new information or strengthen the old ones. It is defined as, “A quest for knowledge through diligent search or investigation or experimentation aimed at the discovery and interpretation of new knowledge.”[1] Research and development in primary health care is now seen as a National Health Service priority and an important element in achieving high quality clinical care. To achieve HEALTH is the ultimate goal of all health services. Health

being multidimensional is influenced by various other factors like, culture, belief, experience, behavior, and these parameters are best understood through qualitative research. Complex interaction of socio‑behavioral factors which influence the health and health related factors are the domain of qualitative research. Although qualitative research has theoretical foundations within sociology, anthropology, and psychology, in recent years those working in the health services have shown an interest in the possible contribution of qualitative research methods to health service research. Access this article online

Department of Public Health Dentistry, Narsinhbhai Patel Dental College and Hospital, Visnagar, Gujrat, India. Address for correspondence: Dr. Umesh Kemparaj, Department of Public Health Dentistry, Narsinhbhai Patel Dental College and Hospital, Kamana Crossing, Visnagar-384315, North Gujrat, India E‑mail: [email protected]

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QUALITATIVE RESEARCH The term ‘‘qualitative research’’ refers to a range of methodological approaches which aim to generate an in‑depth and interpreted understanding of the social world, by learning about people’s social and material circumstances, their experiences, perspectives, and histories’. Qualitative research aims to explore, interpret, or obtain a deeper understanding of social phenomena. Qualitative methodology allows researchers to ask different research questions and explore and understand phenomena from a contrasting perspective. The WHAT, WHY, and HOW questions about the phenomenon are addressed rather than questions such as, WHAT IS THE PREVELENCE OF, IS THERE A SIGNIFICANT DIFFERENCE BETWEEN, OR WHAT ARE THE STRONGEST PREDICTORS OF?[2]

CHARACTERISTICS OF QUALITATIVE RESEARCH • The analysis and generation of narrative or non‑numeric information. • Requires researchers to become intensely involved, often remaining in field for lengthy periods of time. • Phenomena are usually explored from the participant’s perspective and there is a focus on meaning and understanding. • There is an emphasis on social context and studying phenomena in natural environment rather than in experimental settings. • Data collection and analysis are usually

flexible to allow for the exploration of emergent issues. • It generates a distinctive output in the form of detailed descriptions, classifications, typologies, patterns of association, and explanations.

ACTIVITIES IN QUALITATIVE RESEARCH In qualitative study the progression is closer to a circle than to a straight line ‑ qualitative researchers are continually examining and interpreting data and making decisions about how to proceed based on what has already been discovered. Following are the various activities involved in qualitative research. Conceptualizing and planning a qualitative study Identifying a research problem A critique of the research problem involves multiple dimensions, including a substantive dimension. Qualitative researchers generally begin with a general topic area, often focusing on an aspect of a topic that is poorly understood and about which is little known. They therefore do not develop hypotheses or pose refined research questions at the outset.[3] Doing a literature review The selection of available documents (both published and unpublished) on the topic, which contain information, ideas, data, and evidence written from a particular standpoint to fulfill certain aims or express certain views on the nature of the topic and how it is to be investigated.[3] Qualitative researchers have varying opinions of the literature reviews with some deliberately

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avoiding an in – depth literature search before entering the field as it may prejudice the views and ideas of the investigator. On the other hand, the second school of thought is that literature review provides readers with a background for understanding current knowledge on a topic and illuminates the significance of the new study.[3] In any event, qualitative researchers typically find a relatively small body of relevant literature because of the type of question asked. Selecting and gaining entry into the Research Sites Before going into the field, qualitative researchers must identify a site that is consistent with the research topic. Researchers need to make preliminary contacts with key actors in the site to ensure co‑operation and access to the informants. Gaining entry typically involves negotiations with gate keepers who have the authority to permit entry into their world. Designing Qualitative Studies The study design typically evolves over the course of the project. The design for qualitative studies is an emergent design – a design that emerges as researchers make ongoing decisions reflecting what has already been learned. Although design decisions are not specified in advance, qualitative researchers typically do advance planning that supports their flexibility in developing an emergent design. In the absence of planning, design choices might actually be constrained. Qualitative

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researchers plan for broad contingencies that may be expected to pose decision opportunities after the study has begun. Advance planning is usually important with regard to the following: • Selection of a research tradition that will guide certain design and analytical decisions. • Selection of a study site and identification of settings within the site that is likely to be especially fruitful for data collection. • Identification of the key “gatekeepers.” • Determination of the maximum time available for the study, given cost, and other constraints. • Identification of all needed equipment for collection and analysis of data in the field (e.g.,  audio and video recording equipment, laptop computers, and so forth). • One task that qualitative researchers typically undertake before collecting data is an analysis of their own biases and ideology. It is particularly important because of the intensely personal nature of the data collection and data analysis experience.[3] Addressing ethical issues Ethical issues are indeed of special concerns in qualitative studies because of the more intimate nature of the relationship that typically develops between researchers and study participants.[4] Conducting a qualitative research In qualitative studies, the activities of sampling, data collection, data analysis, and interpretation typically take place iteratively. Qualitative researchers begin by talking with or observing people who have first hand experience with the phenomenon

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under study. Analysis and interpretation are ongoing, concurrent activities, used to guide decisions about whom to sample next and what questions to ask or observations to make. As the analysis and interpretation progress, the researcher begins to identify themes and categories, which are used to build a descriptive theory of the phenomenon. Qualitative researchers are the main data collection instrument and thus must take steps to ensure the trustworthiness of the data while in the field. The central feature of these efforts is to confirm that the findings accurately reflect the experiences and viewpoints of the participants, rather than researchers’ perception.

PHASES IN QUALITATIVE STUDY Orientation and overview: A  qualitative researcher enters the study “not knowing what is not known” (i.e., not knowing what is about the phenomenon that will drive the inquiry forward). Therefore, the first phase of many qualitative studies is to get a handle on what is salient about the phenomenon or culture of interest. Focused exploration:Focused scrutiny and in‑depth exploration of aspects of the phenomenon judged to be salient. The questions asked and the types of people invited to participate in the study are shaped by the understandings developed in the first phase. Conf ir m a ti o n a n d c losure: Q ualit at ive researches undertake efforts to establish that their findings are trustworthy, often by going back and discussing their understanding with the study participants.

SAMPLING STRATEGIES Qualitative research usually employs probability samples. A random sample is not the best method of selecting people who will make good informants – people who are knowledgeable, articulate, reflective, and willing to talk at length with researcher. Convenience sampling: (volunteer sample) they are likely to be used when researchers need participants to come forward to identify themselves (e.g., placing notices in news paper for people with certain experience). Snow ball sampling: Is asking early informants to make referrals for other study participants (nominated sampling, because it relies on the nominations of others already in the sample). Weakness – sample might be restricted to a rather small network of acquaintances. Purposive sampling: A strategy to which researchers hand pick the cases or types of cases that will best contribute to the information needs of the study. Who to sample next depends on who has been sampled already. Maximum variation sampling: Range of variation on dimensions of interest. Homogenous sampling: Involves deliberate reduction of variation to permit a more focused inquiry. Extreme/deviant case sampling: (Outstanding successes and notable failure) learning from the most unusual and extreme informants.

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Criterion sampling: Involves study cases that meet a predetermined criterion. Theoretical sampling: The process of data collection for generating theory whereby the analyst jointly collects, codes, and analyzes his data and decides what data to collect next and where to find them, in order to develop his theory as it emerges.

SAMPLE SIZE IN QUALITATIVE STUDIES There are no established rules for sample size. In qualitative research, sample size is usually determined based on informational needs. Hence, a guiding principle in sampling is data saturation (i.e., sampling to a point at which no new information is obtained and redundancy in achieved).

DATA COLLECTION STRATEGIES • Interviews: Participant is encouraged to talk in depth about their perspectives on a research topic. • Focus group interview:  Group discussion facilitated by researchers. Group is composed of approximately 6-10 people. It can be naturally occurring or composed of recruited individuals. Interaction between the individuals generates the data.[3] • Life histories: Are narrative self‑disclosure about individual life experiences. Researchers ask the resonant to describe, often in chronologic sequence, their experience regarding a specified theme, either orally or in writing. • Think a loud method: Used to collect data about cognitive processes, such as thinking, problem solving, and decision making. This

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involves having people use audio recording devices to talk about decisions as they are made or while problems are being solved, over an extended period. This method produces an inventory of decisions and underlying processes as they occur in a naturalistic context.[3,5] • Critical incidents technique:  Is a method of gathering information about people’s behavior by examining specific incidents relating to the behavior under study. The technique focuses on a factual incident. Critical means the incident must have had a discernable impact on some outcome. • Observation:  Researcher observes the behavior events and interaction. It includes: (a) Participant observation  −  researcher experiences the phenomena himself. (b) Direct observation‑ researchers merely watches the participants.[3] • Existing documents/Archives/Artifacts: study of documents to explore content and meaning. Disseminating qualitative findings Qualitative reports are generally filled with rich verbatim passages directly from study participants. Experts are used in an evidential fashion to support or illustrate researchers’ interpretation and thematic construction.

ASSESSMENT OF QUALITATIVE DATA[6] Lincoln and Guba (1985) – suggested four criteria for establishing the trustworthiness of qualitative data: • Credibility • Dependability • Confirmability • Transferability

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These criteria go beyond an assessment of qualitative data alone, but rather are concerned with evaluations of interpretation and conclusions as well.

CREDIBILITY Refers to confidence in truth of the data and interpretations of them. Credibility of inquiry involves two aspects: first, carrying out the investigation in a way that believability is enhanced, and secondly, taking steps to demonstrate credibility. The various majors that can be taken are: • Prolonged engagement: The investment of sufficient time in date collection activities to have an in‑depth understanding of the culture, language, or views of the group under study and to test for misinformation. Prolonged engagement may also be essential for building trust and rapport with informants.[6] • Persistence observation: Refers to the researchers focus on the aspects of a situation that are relevant to the phenomena being studied.[7] • Triangulation: Aim of triangulation is to “overcome the intrinsic bias that comes from single – method, single‑observer, and single theory studies” • Denzin (1989) identified four types of triangulation[8] • Data source triangulation: Using multiple data source • Investigator triangulations: Using more than one person to collect analyze, or interpret a set of data. • Theory triangulation: Using multiple perspectives to interpret a set of data. • Method triangulation: Using multiple

methods to address a research problem (e.g., observations plus interviews).[7] External checks: (peer debriefing and member checks) Peer Debriefing: Is a session held where peers review and explore various aspects of the inquiry. Peer debriefing exposes investigators to the searching questions of others who are experienced in either qualitative research or in the phenomenon being studied, or both. These sessions can also be useful to researchers interested in testing some working hypothesis or in exploring new avenues in the emergent research design. Member checks: Involve soliciting study participant’s reactions to preliminary findings and interpretations. Member checking can be carried out both formally in an ongoing way as the data are being collected and more formally after data have been collected and analyzed. Giorgi [1989] argued that asking participants to evaluate the researcher’s psychological interpretation of their own descriptions exceeds the role of participants. Searching for disconfirming evidence: Data credibility can be enhanced by researcher’s systematic search for data that challenge an emerging conceptualization or descriptive theory. The sampling of individuals who can offer conflicting viewpoints can greatly strengthen a comprehensive description of a phenomenon. Negative case analysis: Process by which researchers revise their hypothesis through the inclusion of cases that appear to confirm earlier hypotheses. Researchers credibility: Is the faith that

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can be put in the researcher. In qualitative studies, researchers are the data collecting instruments as well as creators of the analytic process – and, therefore, the researchers’ training, qualifications, and experience are important in establishing confidence in the data.

• Data reduction and analysis products • Process notes • Materials relating to intentions and dispositions • Instrument development information • Data reconstruction products

DEPENDABILITY

Auditability can be enhanced by maintaining an adequate decision trail. A decision trial articulates the researchers’ decision rules for categorizing data and making inferences in the analysis. When researchers share decision trail information in their research report, readers are in a better position to evaluate the soundness of the decisions and to draw conclusions about the trustworthiness of the study.

The dependability of qualitative data refers to data stability over time and over conditions. Dependability is to reliability in quantitative study. Step wise replication: Involves having several researchers who can be divided into two teams. These teams deal with data sources separately and conduct, essentially, two independent inquiries through which data and conclusions can be compared. Inquiry audit: Involves a scrutiny of the data and relevant supporting documents by an external reviewer.

CONFIRMABILITY Refers to the objectivity or neutrality of the data, that is, the potential for congruence between two or more independent people about the data’s accuracy, relevance, or meaning. Inquiry audits can be used to establish both the dependability and confirmability of the data. In an inquiry audit, the investigator develops an audit trial, which is a systematic collection of documentation that allows an independent auditor to come to conclusions about the data. Six cases of records are important in creating an adequate audit trial; • Raw data

TRANSFERABILITY Refers to the extent to which the findings from the data can be transferred to other settings or groups and is thus similar to the concept of generalizability. It requires thick description – it refers to a rich, thorough description of the research setting, and the transactions and processes observed during the inquiry. Thus, if there is to be transferability, the burden of proof rests with researcher to provide sufficient information to permit judgments about contextual similarity.

ANALYZING QUALITATIVE DATA There are two basic approaches to the analysis of qualitative data: the inductive approach and the deductive approach. Deductive techniques of qualitative data analysis De d u cti ve te ch n i q u e s co mme n ce w i th

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an explicit structure and then use that structure to analyze the data, for example, if a series of interviews are carried out exploring patients’ reasons for making a complaint. The researcher might carry out a series of in‑depth qualitative interviews with patients that have made complaints. A schedule could then be drawn up listing the major reasons for patients’ complaints (for example, trauma following treatment, difficulties of communication, unexpected adverse outcomes. etc). The data analysis would then consist of examining each interview to determine how many patients had complaints of each type and the extent to which complaints of each type co‑occur. The key point is that in the deductive approach the researcher imposes their own structure on the data and then uses this to analyze the interviews. Deductive approaches are useful for research questions where the Researcher is confident that they know what the full range of answers will be. These answers might be based on previous empirical or theoretical knowledge. An example of a deductive approach is content analysis.[9] Inductive techniques of qualitative data analysis Inductive techniques use the data themselves to derive the structure of the analysis. The researcher starts by assuming that the categories which can be used to summarize the data are a theoretical ‘‘blank sheet.’’ For example, an inductive approach to the analysis of the complaints data we mentioned above would examine each example of a complaint and identify a category to which it belonged (for example, communication errors). The next complaint would then be compared with the

previous one to determine whether it was a similar type. If not then a new category is devised (for example, poor outcome) and so on for all the interviews. Grounded theory is an example of an inductive approach to qualitative data analysis. Combining inductive and deductive approaches In practice most qualitative researchers use (either implicitly or explicitly) a combination of inductive and deductive approaches. An example is interpretive phenomenological analysis. This approach adopts an inductive approach to the categorization of data, but then uses these categories deductively to give an idea of how commonly categories occur and the nature of their relationships.[9]

MIXED METHOD STUDY Rationale for mixed method studies Many areas of inquiry can be enriched and the evidence base enhanced through the judicious blending of qualitative and quantitative data. The advantages of an integrated design include the following: Complementarity: Qualitative and quantitative data represent words and numbers, the two fundamental languages of human communication. The strengths and weaknesses of these two types of data and associated methods are complementary. Incrementality: Progress on a topic tends to be incremental, relying on multiple feedback loops. Qualitative findings can generate hypothesis to be tested quantitatively, and quantitative findings sometimes need

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clarification through in‑depth probing. It can be productive to build such a loop into the design of a single study. Enhanced validity: When a hypothesis or model is supported by multiple or complementary types of data, researchers can be more confident about the validity of their results. Creating new frontiers: Sometimes qualitative and quantitative findings are inconsistent with each other this lack of congruity – when it happens in a single investigation – can lead to insight that can push a line of inquiry further. In a single study, discrepancies can be used as a spring board for further exploration. Advantages of mixed method strategies • Adding qualitative methods to a survey • Embedding qualitative measures into an ethnography • Embedding qualitative approaches into experimental research

THE CONTRIBUTIONS OF QUALITATIVE RESEARCH TOWARD PUBLIC HEALTH PRACTICE

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CONCLUSIONS Though investigator bias is present, qualitative research is a critical addition to science. Qualitative research methods have a long history in the social sciences and deserve to be an essential component in health and health services research. Qualitative interviewing is a flexible and powerful tool which can open up many new areas for research. Enable practicing clinicians to investigate research questions of immediate relevance to their everyday work, which would otherwise be difficult to investigate. It provides ample opportunity to satisfy organized curiosity and add to the knowledge base in dental science. Qualitative research can broaden the evidence base for dental public health policy and practice. The greatest value of qualitative research is its ability to address questions of relevance to DPH knowledge and practice which are difficult to answer satisfactorily using quantitative methods.

REFERENCES 1. WHO. Health research methodology: A guide for training in research methods. 2nd ed. WHO, Philippines; 2001.

The greatest value of qualitative research is its ability to address questions of relevance to public health knowledge and practice which are difficult to answer satisfactorily using quantitative methods alone. • Describing a process or phenomenon or mapping the features of a phenomenon • Explaining social phenomena • Understanding perspectives, motivations, and frames of reference • Generating new ways of perceiving or understanding a social phenomenon

2. Hancock B. Trend Focus Group for Research and Development in Primary Health Care: An Introduction to Qualitative Research. 2002. p. 1. 3. Polit DF, Beck CT. Essentials of nursing research. 6th ed. Lippincott; 2006 4. Qualitative Research Methods: AData Collector's Field Guide. Module 1 Qualitative Research Methods Overview Family Health International. Guidestar, Watertown MA 02472; 2000. 5. Meadows LM, Verdi AJ, Crabtree BF. Keeping up appearances: using qualitative research to enhance knowledge of dental practice. J Dent Educ 2003;67:981‑90.

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6. Lincoln Y, Guba EG. Naturalist Inquiry. Newbury Park, CA: Sage Publications; 1985. 7. Patton MQ. Enhancing the quality and credibility

9. Williams AC, Bower EJ, Newton JT. Research in primary dental care Part 6: Data analysis. Br Dent J 2004;197:67‑73.

of qualitative analysis; Health Serv Res 1999;34 (5 pt 2):1189‑208. 8. Denzin N, Lincoln Y, editors. Handbook of Qualitative Research. London: Sage Publication Inc.; 2000.

How to cite this article: Kemparaj U, Chavan S. Qualitative research: A brief description. Indian J Med Sci 2013;67:89-98. Source of Support: Nil. Conflict of Interest: None declared.

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Copyright of Indian Journal of Medical Sciences is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Qualitative research: a brief description.

Qualitative research refers to, a range of methodological approaches which aim to generate an in-depth and interpreted understanding of the social wor...
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