Do you have responses to open-ended questions or want to use qualitative data to evaluate CE/QI interventions? Qualitative Analysis Boot Camp at the ACEHP 2013 meeting in San Francisco on 1 February has tools to get you started.

1. Qualitative Analysis Boot Camp
Session F48
Friday, 2/1/13 - 4:30 - 5:30 pm PST
Yerba Buena 3-4/Lower B2
38th ACEHP Annual Conference
Presenters:
Wendy Turell, DrPH, CCMEP
Contextive Research LLC
Alexandra Howson, MA(Hons) PhD, CCMEP
Thistle Editorial LLC

2. Today!
 Qualitative Research Introduction
 Data Collection
 Coding and Analysis
 Reporting
 Resources
 Coding Practice!
 Questions/Discussion

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

4. Exploration
 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.

5. Qualitative vs. Quantitative
Qualitative Research Quantitative Research
Probing; allowing
Limited probing; pre-
Type of Questions immediate interactive
determined questions
follow up & adjustment
Sample Size Small Any size including large
Information per Varies; Limited to answer
Much
respondent choices
Fewer specialist skills
Administration Requires skilled researcher
required
Follows structured steps;
Type of Analysis subjective and Statistical; objective
interpretative
Type of Research Exploratory, descriptive Descriptive or Causal

6. 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
 Mixed methods

7. Applications in CEHP
 Research Phases  Research Subjects
 Needs Assessment  Physicians
 Intervention Development  Allied Healthcare Providers
 Formative Evaluation  Healthcare Staff
 Post Intervention Assessment  Patients/Caregivers
(“Outcomes”)
 Instrument Development
 Methodological Focus  Help inform development of
 Pure Qualitative quantitative tools
 Mixed Methods

8. Data Collection

9. Sample Methodologies/Tools
• Interviews (in person, virtual/online, telephonic)
• Focus Groups (in person, virtual/online facilities)
• Message Boards/Social Media Analysis
• Observation
• Document Analysis
• Mixed-Methods (Qualitative and Quantitative
combination)

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

12. One-on-One In-Depth Interviews
Webcam-
enabled
images.
Text based chat
&
audio capable

13. One-on-One In-Depth Interviews
Whiteboard may
also be filled
with text, video,
images, or
interactive ranking,
posting, or writing
activities. The
interviewee can
move objects
onscreen, as in this
card-sorting
exercise.

14. Online Research Community

16. Coding and Analysis

17. Coding
 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.

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

19. Grounded 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:
 Theory is derived from what speakers do, vs. what is
believed they should do
 Ensures the researchers maintain an open mind towards
inquiry vs. imposing existing beliefs on data

20. How can Software Assist?
Methodology
GATHER ORGANIZE ANALYZE VISUALIZE RESULTS
• Rigor
• Validity
• Saturation

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

22. Visualizing Data

23. Visualizing Data
Word Clouds

24. Visualizing Data

25. “Many who had once supported lobotomy began
to disavow it. "It is inconceivable," reported the
American Medical Association, "that any
procedure that effectively destroys the brain could
possibly restore the patient to a normal state."
Lobotomy, one former supporter declared, was
really no more subtle than a gunshot to the head.
Especially vehement were Freudian
psychoanalysts, who condemned lobotomy as a
brutal assault on the brain. But Walter Freeman
had little patience for his critics.”

27. Analysis: Coding with Software

28. Reporting

29. Reporting
 Reports = based on trends and relationships
found within the data
Includes:
 Trend Description
 Respondent Quotes
 Visualizations (themes, their relationships,
demographic elements)
 Interpretation

30. Reporting: 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."

31. Reporting: 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.

32. Reporting: 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.‟”

33. Reporting: Quote Integration
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."

34. Resources

35. Software Resources: Coding &
Organization
 Free (QDA Miner Lite)
 http://provalisresearch.com/products/qualitative-data-
analysis-software/freeware/
 Low Cost: dedoose ($10 per month)
 http://www.dedoose.com/
 Bells and Whistles software: Nvivo or Atlas Ti
 http://www.qsrinternational.com/products_nvivo.aspx
 http://www.atlasti.com/index.html

36. Resources Cont.
 Hopkins Open Coursework: http://ocw.jhsph.edu/
 Qualitative course materials:
 http://ocw.jhsph.edu/index.cfm/go/viewCourse/course
/qualitativedataanalysis/coursePage/index/
 Online Qual. Textbook:
http://onlineqda.hud.ac.uk/Introduction/index.php

37. 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.

38. Coding Exercise
What’s happening?
What’s important?
What patterns are
emerging?

39. For Additional Information or Questions:
wendy@contextiveresearch.com
alexhowson@thistleeditorial.com