1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 6
Critically Appraising Qualitative
Evidence for Clinical Decision
Making

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Qualitative Research and Decision-
Making
• Qualitative research is usually placed near the bottom of
hierarchies of evidence
• However, it is important in regard to clinical questions
that address human responses and meaning
• Recall that patient preferences and values are key
components of EBP
• Qualitative methods have evolved and expanded in
recent years

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Qualitative evidence is most likely to inform which of the
following aspects of the care of patients with cancer?
a. Cancer patients’ perceptions of hope during
chemotherapy treatment
b. Treatment options for chemotherapy-induced nausea
c. Clinicians’ choices of chemotherapeutic agents
d. The relationship between anxiety and nausea in patients
undergoing chemotherapy

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• a. Cancer patients’ perceptions of hope during
chemotherapy treatment
• Rationale: The concept of hope is an aspect of the human
responses and meaning that surround a health
experience. Treatment options and the relationships
between different concepts are likely better addressed by
quantitative evidence.

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Qualitative Research Traditions
• Clinicians must appreciate the diversity within the
methodology
• Ethnography - the study of a social group’s culture
through combining participant observation, in-depth
interviews, and the collection of artifacts
− Useful for elucidating
• People’s experiences of health/illness
• Issues of concern to caregivers
• Individuals’ experiences in certain types of settings

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Qualitative Research Traditions (cont’d)
• Grounded theory
− Purpose is to generate theory about how people deal
with life situations that is “grounded” in empirical
data
− Movement through time is often expressed in terms
of stages or phases
• Phenomenology - the study of essences (meaning
structures) intuited or grasped through descriptions of
lived experience
• Hermeneutics - viewing human “lived experience” as a
text that is to be understood through the interpreter’s
dialogical engagement

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Tell whether the following statement is true or false.
• Grounded theory is the most appropriate tradition for a
study that explores women’s coping as they move
through different stages of fertility treatment.

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• True
• Rationale: Grounded theory often focuses on changes in
the human experience as they move through time.

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Internal Diversity in Qualitative Research
• Representation and conceptualization
• Historical evolution
• Description, interpretation, and theory generation
• Qualitative descriptive studies
• Generic qualitative studies
• Qualitative evaluation and action research studies

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Qualitative Research Techniques
• Observation and field notes
• Interviews and focus groups
• Narrative and content analysis
• Sampling strategies
• Data management and analysis

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Appraising Qualitative Studies
• No single set of criteria can serve all qualitative
approaches equally well
• Lincoln and Guba’s (1985) trustworthiness criteria have
broad application
− Credibility
• Demonstrated by accuracy and validity that is
assured through documentation
• Roughly parallel to internal validity in quantitative
appraisal

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Appraising Qualitative Studies (cont’d)
Lincoln and Guba
• Transferability
− Demonstrated by information that is sufficient for a
research consumer to determine whether findings are
meaningful to other people in similar situations
− Parallels external validity
• Dependability
− Demonstrated by a research process that is carefully
documented to provide evidence of how conclusions
were reached and whether, under similar conditions, a
researcher might expect to obtain similar findings
− Parallels reliability

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Confirmability
− Demonstrated by providing substantiation that
findings and interpretations are grounded in the data
− Parallels objectivity
• Authenticity criteria (Guba & Lincoln, 1989)
− Less commonly used than Lincoln & Guba’s
trustworthiness criteria
Appraising Qualitative Studies (cont’d)
Lincoln and Guba

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• A nurse has examined whether the participants in a
qualitative study on the meaning of dependence among
IV drug users are similar to the clients that the nurse
works with. This nurse has evaluated this study’s:
a. Dependability
b. Confirmability
c. Transferability
d. Credibility

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• c. Transferability
• Rationale: Transferability addresses the question of
whether the findings of a qualitative study are applicable
to other people who are in similar situations.

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Synthesizing Qualitative Evidence
• Meta-studies
• Meta-summaries