OVERVIEW OF QUALITATIVE AND MIXED METHODS RESEARCH. Elyse R. Park, Ph.D., M.P.H Director, Qualitative Research Core MGH Division of Clinical Research

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1 OVERVIEW OF QUALITATIVE AND MIXED METHODS RESEARCH Elyse R. Park, Ph.D., M.P.H Director, Qualitative Research Core MGH Division of Clinical Research

2 INTRODUCTIONS

3 COURSE OVERVIEW

4 Advanced Courses Date September 9/20 11:00-12:00 October 10/11 11:00-12:00 November 11/16 11:00-12:00 December 12/13 11:00-12:00 January /10 11:00-12:00 February /7 11:00-12:00 March /1 11:00-12:00 April /19 12:00-1:00 Qualitative Research Topics 2017/2018 Qualitative Coding Nvivo Software boot camp Cognitive Interviewing Qualitative Interviewing-Focus groups and individual interviews Consensus Methods-Modified Delphi and Nominal Groups Interpreting and Presenting Resultsqualitative and mixed methods Qualitative Coding Nvivo Software boot camp Speaker Christina Lara Elyse Christina Elyse Lara Christina Lara

5 QUALITATIVE RESEARCH UNIT Consultations Advanced lecture series Qualitative Investigator cohort 1 st Thursday of the 5:00 p.m.

6 Course Sessions Overview of qualitative and mixed methods Selecting your design, recruitment and sample size Development of qualitative research instrument (i.e., interview guide) Focus group and individual interviewing methodology Qualitative data analysis

7 Considerations when using Qualitative Methods Developing a research question Selecting data collection modality Recruitment & sampling Developing the interview guide Piloting the interview guide Qualitative analysis Determining quality of research

8 Features of Qualitative Research Researcher s role Main task is to determine how people understand & behave Most analysis is done with words

9 lovestats.worldpress.com HISTORY

10 QUALITATIVE PAPERS IN PubMed Year PubMed Qualitative research Ratio Pubs Pubs (per 1,000 articles) , , , , , ,080, ,191,

11 Anticipating Clinical Integration of Genetically-Tailored Tobacco Treatment: Perspectives of PCPs AIMS Explore physicians attitudes toward treatment strategies that matched patients according to genotype Understand patient-based & physician-based barriers Identify concerns about external factors that would need to be addressed prior to clinical integration of a genetic test to tailor smoking cessation treatment. Park et al., Nicotine & Tobacco Research, 2007

12 Aims: patient version To explore attitudes and beliefs of black and white participants regarding the role of genetics in addiction to nicotine To explore attitudes of black and white participants about use of genetic testing to be matched to optimal smoking cessation treatment Park et al., Addictive Behaviors, 2011

13 What Type of Question Is It? Question What (exploratory) What (how many, how much) Who & Where Why & How (explanatory) Strategy Qualitative Quantitative Quantitative Qualitative

14 Qualitative vs. Quantitative Qualitative Subject matter is unfamiliar When relevant concepts are unknown or unclear When meaning rather than frequencies are sought When flexibility of approach is needed For studying selected issues, cases or events in detail Quantitative Subject matter clearly defined When measurements are known When detailed numerical description of a representative sample is required When repeatability of measurements is important When generalizability of results & comparison across populations is needed

15 Research Questions & Hypotheses Research Questions Quantitative: HYPOTHESES Qualitative: PROPOSITIONS

16 Purposes of Qualitative Research Stand alone hypothesis development, learn about a cancer population To inform survey development To elucidate survey findings To inform program development (curriculum, interventions)

17 Linking Qualitative Data With Surveys Qualitative data Contribute to the creation of survey items by: 1) Capturing survey domains 2) Determining dimensions 3) Item wordings (cultural idioms)

18 Qualitative Methods to Enhance Quantitative Work Explore or refine constructs for surveys Pre-test surveys Pre-test intervention materials Plan for survey administration Interpret quantitative results

19 Qualitative Data to Elucidate Study Findings Analysis of Temel Early PC RCT (NEJM, 2010) Qualitative analysis of PC clinician documentation of all visits with patients receiving early PC Elements Emphasis in illness trajectory In initial visits Throughout In later visits Relationship and rapport building Addressing symptoms Addressing coping Establishing illness understanding Discussing cancer treatments End-of-life planning Engaging family members Yoong et al., Annals of Internal Medicine, 2013

20 Using Qualitative Data to Inform Survey Development SURVEY GOAL: To develop a national survey to assess residents attitudes about crosscultural care: 1) Perceptions of preparedness to deliver care to diverse populations 2) Educational experiences 3) Educational climate Weissman et al., JAMA, 2005 QUALITATIVE STUDY GOAL: To elucidate the 3 survey domains Park et al., Academic Medicine, 2005

21 Mixed Methods 1. Interactive or independent Interactive: mixing of study questions, data collection and/or analysis Independent: mixing during interpretation 2. Priority of each study 3. Timing of each study Concurrent Sequential Multiphase/combined Creswell & Clark, 2011

22 Mixed Methods Design 1) Convergent: separate quantitative and qualitative data collection, separate analyses & comparison of the two 2) Explanatory: quantitative data collected first; qualitative data collection is subsequent 3) Exploratory: qualitative data collection explores a topic and analysis results are used to build a quantitative data collection procedure

23 Exploring The Role of Mood on Postpartum Relapse to Smoking Purpose: To examine how anxiety & depression impact postpartum relapse to smoking Design: Pilot study (n=65) Smokers who quit during pregnancy Repeated surveys during 6 months postpartum In-depth interviews for participants 1) who relapse or 2) report symptoms of anxiety/depression (Park et al., Nicotine & Tobacco Research, 2009; Park et al, Addictive Behaviors, 20009)

24 Exploring The Role of Mood on Postpartum Relapse to Smoking Purpose: To examine how anxiety & depression impact postpartum relapse to smoking Design: Pilot study (n=65) Smokers who quit during pregnancy Repeated surveys during 6 months postpartum In-depth interviews for participants 1) who relapse or 2) report symptoms of anxiety/depression (Park et al., Nicotine & Tobacco Research, 2009; Park et al, Addictive Behaviors, 20009)

25 Exploring The Role of Mood on Postpartum Relapse to Smoking Survey questions: Smoking status If relapse: Time to relapse Hours of sleep Ratings of confidence & support Health care visits/clinician intervention Smoking cessation aids Mood (BDI-2, BAI, SCID, PSS, Stress checklist)

26 Exploring The Role of Mood on Postpartum Relapse to Smoking In-depth interview questions Mood symptoms: Tell me about your mood. Symptom attributions: What do you think causes these symptoms? Coping and support: What do you do to cope with these symptoms?

27 The Behavioral Effects of Lung Screening 1) To determine whether lung screening is a cue to action. 2) To elucidate risk perceptions and underlying behavior change determinants for lung cancer. 3) To explore post-screening behavioral intentions and changes. Park et al., NTR, 2014

28 ACRIN/NLST Study Design Current & former smokers who smoked minimum of 30 pack years, aged (if quit, within past 15 years) Phone Eligibility Screen Enrollment/Baseline forms + Risk Perception Substudy Questionnaire Randomize Experimental (LDCT Scan) Control (X-Ray) + Risk Perception Qualitative Interviews 12-Month Survey 12-Month Survey Repeat CT scan 1 Repeat X-Ray Repeat In-Person Scans at 2-year and 3-year f/u Primary Outcome (mortality) at 8 year f/u + Risk Perception Substudy Questionnaire

29 Health Belief Model Cue to Action Perceived Severity Perceived Risk Perceived Benefit Confidence

30 Deductive Coding HBM criteria Lung Screening participants Cue to action Screening not a trigger Risk beliefs High risk, but perceptions not well formed Perceived severity High severity/disconnected from causality Confidence to change behavior Low Worry (Self Regulatory Model) Low Park et al., NTR, 2014

31 Qualitative Data Collection Individual in depth interviews Narratives Focus group interviews Consensus methods Participant observation Case studies Document analysis

32 Qualitative Sampling Purposeful/purposive sampling Particular settings, persons, or events are deliberately selected according to 1) research purpose and 2) theoretical development Stratification: deliberate selection of participants based on certain criteria (Patton, 1990; Miles & Huberman, 1994)

33 Determining the Structure of Interviews 3 Levels: Un Semi Highly Structure determines the: Content The number of questions Sequencing

34 Components of Data Analysis: Interactive Model Data Collection Data Display Data Reduction Conclusions: Drawing/Verifying Miles and Huberman, 1994

35 Data analysis Inductive: categories and themes emerge (grounded theory) from data Deductive: processes of fitting the data into categories and themes (apriori codes -framework analysis)

36 Robert Wood Johnson Qualitative Research Guidelines Project

37 Robert Wood Johnson Qualitative Research Guidelines Project

38 Interactive Exercise 1) Write down an idea for a study that you may want to conduct qualitatively. 2) Explain your idea/question and discuss what you bring to the study: your background, beliefs, clinical training, & patient population. 3) Discuss the answers to the following questions: a. I want to ask this question because b. One thing I m sure about what s going on is c. I would be really surprised if I learned

39 Racial Disparities in Coping with Lung Cancer Use CanCORS dataset to 1) compare rates of depression in non-hispanic Black (NHB) and White (NHW) lung cancer patients and 2) identify rates of mental healthcare utilization) Trager & Park, JCO 2014 Conduct in-depth interviews with patients recruited from the Dana-Farber Harvard Cancer Center to characterize Phase 1 findings (n=20)

40 Qualitative Interview Domains Quantitative: Questionnaire derived from Phase 1 CanCORS items Qualitative: Perceptions of depression & cancer Factors influencing interest in psychological services Perceived barriers to psychosocial service utilization Intervention preferences

41 Primary Themes Based on high-level content analysis (n=20) Patients couldn t identify mood symptoms Dearth of conversations about mental health care needs & cancer center resources Patients were not able to differentiate between different types of mental health treatments Patients might perceive suggested need for help as a stigma No evident, consistent racial differences