Research Methods in

Health Promotion
Qualitative methods in
Health Promotion (Part I)

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Prof. (Dr.) Madhumita Dobe
Chairperson, Foundation for Actions
and Innovations Towards Health
Promotion, and

N Former Director Professor and Head,

Dept. of Health Promotion and
Education, AIIH&PH
Email: madhumitadobe@[Link]
Lecture # 21
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• What is Qualitative Health Research?
• Why qualitative research is necessary for Health Promotion
• Basic characteristics of Qualitative Studies

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• Basic differences between quantitative and qualitative studies
• Research Design

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• Research Strategies in Qualitative studies

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 Qualitative Research in health promotion
Qualitative Research is required in health promotion for various reasons, some of
which are:

• understanding the diverse causes or the determinants of the problem, whether

they are due to biological, behavioral,

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• social or environmental factors; developing solutions or interventions that will
help to prevent or mitigate the problem;

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• facilitating better implementation or delivery of solutions through evidence-
based policies and programs;

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• Evaluating the impact of these solutions on the level and distribution of the
problem.

• Research in health promotion follows the same steps as in other types of

research

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What is Qualitative Research?
A field of inquiry characterized by its naturalistic and interpretive
practices.

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• Naturalistic - qualitative approaches take place in the natural
environment rather than in settings where control is an
important factor in research design.

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•
• Interpretive - constructing meaning from data (interpreting)
with the aim of explaining the phenomenon of study.
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• Contextual, in-depth procedures - rich exploration of complex
social experiences and phenomena.

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Basic characteristics of Qualitative Studies
 Information is gathered by talking directly to people and seeing them behave and act in their real context.
 Data is collected and interpreted by researchers themselves.
 Multiple open-ended forms of data are collected in which participants share their ideas freely, not constrained by
predetermined scales or instruments. The researchers then review the data, understanding and organizing it into
codes and themes.

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 Typically, inductive method is followed at first, moving from bottom upwards by organizing the evolving patterns,
categories, and themes into increasingly more general units of information. Then, the researchers look back at the
data from the themes to determine if additional information should be gathered for supporting each theme

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(deductive).
 The focus is on unfolding the meaning that the participants attribute to the problem.
 The initial plan for research cannot be tightly prescribed, since some or all phases of the process may change or shift
after the researcher begins to collect data. The questions may change, the forms of data collection may shift, the

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individuals studied and the sites visited may be modified as the researcher moves deeper into the topic.
 Researcher’s personal background, culture, and experiences influence interpretations and the meaning they ascribe to
the data.
 A holistic picture of the problem evolves from multiple perspectives, identifying many factors involved in a situation.
This is not a linear cause and effect model but that of multiple factors interacting in different ways in the actual setting.

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Basic differences between quantitative and qualitative studies:

Qualitative Research is suitable: Qualitative research will not be suitable:

• When there is no plan for quantification of • When there is need for statistical data, yes or no
collected data answers, or rated, scaled answers.

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• When the researcher wants to know how and
• When the researcher cannot ensure free
why than whether and how many. expression of the participants.
• When the researcher wants to learn what the
target population believes about a specific • When the researcher knows that participants

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subject. have problems with the social aspects of group
• When the researcher wants the reactions, participation.
ideas, and feelings of the target population in • When the researcher has language barriers.
their own words.
• When the researcher wants the freedom to

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probe beyond initial responses to a question.
• When the researcher is studying sensitive or
difficult topics where the range and intensity of
opinions are important.

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Basic differences between quantitative and qualitative studies:
Quantitative Qualitative

Confirm hypotheses about phenomena. Aims at Explore phenomena. Aims at developing a theory,
testing an existing theory, focusing on focusing on inductive reasoning, moving from
deductive reasoning, moving from broad specific observations to broad generalizations

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generalizations to specific observations

Examples include KAP surveys, structured Examples include in depth interviews, focus group

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interviews, structured observations discussions, participant-observation

Use more rigid Instruments for eliciting and Use more flexible Instruments like discussion

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categorizing responses and assigning numerical guides
values to responses and structured methods
such as questionnaires, surveys, structured
observations, to quantify variation, predict
causal relationships, describe characteristics of
a population etc.

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 Basic differences between quantitative and qualitative studies:
Quantitative Qualitative

• Answers questions of how many and how often. • Answers questions of why and how.
• Uses a series of closed ended questions that • Asks open-ended questions that allow
offer the respondent several choices when respondents to give detailed answers, thus
answering a question. For example: “Was your revealing their biases, the extent of their

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child immunized for polio? ___Yes ___No ___ knowledge, and the gaps in their thinking.
Don’t know.” For example: “Why is immunization
• Closed-ended questions limit the kinds of necessary?” might reveal a whole range of
responses that can be recorded, which keeps answers that can also help in addressing the

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data organized but limits the ability to probe the informational needs of the audience.
responsive. One may not be able to ask • Records in Open-ended Textual format
participants why they don’t know if their child was (audiotapes, videotapes, and field notes)
immunized for polio.

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• Follows the same Study design from beginning to • Elicitation and categorization of responses
end
• Participant responses do not influence, modify or
determine how and which questions researchers
may be modified progressively depending on
participant responses

ask

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 Basic differences between quantitative and qualitative studies:
Quantitative Qualitative

• Provides a measurement of the audience’s • Provides in-depth understanding about audience

responses in numerical [Link] example, responses. For example, after coming to know
only 40 percent of young adults reported that that mortality due to Covid 19 was less in young
they wore masks always in public places. adults, they did not feel the need to wear the mask

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always in public places
• Deals with objective, measurable behavior, • Deals with the contextual and emotional aspects
knowledge, and attitudes. of human responses.
• Large sample size. Involves large numbers of • Small sample size. Involves small numbers of

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participants and interviewers, generally making participants and interviewers, usually making this
this kind of research expensive. a less expensive form of research.
• Includes questions that are straightforward to ask • Yields results that are more difficult to analyze,
and yields answers that are straightforward to requiring contemplation, organization, and
analyze.
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• Draws firm conclusions and results that can be
generalized to the population at large.
interpretation. Rich with details, often providing
answers to questions no one thought of asking.
• Provides insights into attitudes, beliefs, motives,
concerns, fears, doubts and behaviors. Can be
used to add deeper meaning to quantitative
findings.

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 Research Design
• Nonlinear process; it is emergent and the stages are interdependent informing
one another in a nonlinear manner

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• Design decisions can and should be revisited and reconsidered throughout the
study based on what is learnt and what additional data is needed in order to
answer the research question.

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The research design must have :

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• (1) What are you asking (the research question)?
• (2) how are you asking it (the method and/or theoretical position/perspective)?
• (3) What data will you need in order to provide a good answer?

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 Approaches to Qualitative Research - Ethnography
• One of the oldest qualitative approaches with historical origins in
anthropology.
• Main focus is the exploration of “insider’s point of view” - emic perspective.
• Ethnography can help greater understanding of behavior surrounding health

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and illness e.g. how the effectiveness of therapeutic interventions can be
influenced by patients’ cultural practices and how ethnocentric assumptions
on the part of professionals can impede effective health promotion

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• Ethnographers also use a variety of strategies to conduct research -
participant observation, interviews, focus groups, field notes, video,
photography, art, and/ or other documents when conducting research.
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• Multiple kinds of ethnographies have developed over time—e.g.,
institutional ethnography, autoethnography

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Ethnography

• Institutional ethnography- link the barriers and difficulties

participants experienced to specific features of the health systems -
demonstrating how institutional processes could be linked to cancer

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disparities experienced by the women in the study

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• Autoethnography draws on ethnographic practices linking the
personal to the cultural through a self-narrative e.g. family’s

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experience of dementia and relational aspects of these experiences

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Approaches to Qualitative Research - Phenomenology
• Seeks to explore, describe, and analyze the “lived experience” & develop rich
descriptions of these experiences
• The researcher identifies an experience (e.g., pain). Participants who have
experienced the phenomenon are recruited and the researcher works to develop a

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description of “‘what’ they experienced and ‘how’ they experienced it”.
• The phenomenological nod: the audience should experience a resonance, a ring of

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truth, upon hearing and/or reading the portrayal of the lived experience
• E.g. Studying parents’ experiences of carrying their neonatal baby from hospital to
home environments. Transferring their new baby can give rise to unsuspected

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anxieties, pain, and worries in the parent. This l study has implications for health care
teams who provide care to neonatal infants and their families

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Approaches to Qualitative Research - Grounded theory
• Grounded theory focuses on deriving a theory or theories from systematically
collected and analysed data - data collection and analysis occur concurrently utilizing
induction, deduction, and verification.
• It is a method of comparing and contrasting data in order to establish categories and

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the relationships among the categories to develop a theory that explains the
phenomenon of study. This process continues until it reaches saturation - when new
cases do not bring any new information to light

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• E.g., Canales and Geller (2004) conducted a grounded theory study - examined
decision making regarding mammography for breast cancer screening among -
women who consistently got yearly mammograms, women who were inconsistent or

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failed to get annual mammogram, and breast cancer survivors. From the data, they
developed a theory titled “Moving in Between Mammography,” which described the
decision-making process and identified several factors that influenced their behaviour.

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 Approaches to Qualitative Research- Narrative inquiry
• It is a method where stories are understood as a social process and individuals make
(construct) meaning of their experiences in the stories
• Researchers listen to and record narratives about experiences of an individual,

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and discuss the meaning of the experience with the individual. Researcher interprets the
individual's stories.
• Narratives rely on the written or spoken words or visual representation of individuals.

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The information is obtained through interviews, family stories, journals, field notes,
letters, autobiography, conversations, photos etc.
• E.g., narrative methodology can be used to explore the views of men and women about

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cardiovascular disease and the emotions and social relations that were involved in their
personal experiences of cardiovascular disease. Their findings point to the gendered and
social influences on participants’ efforts to negotiate healing and rehabilitation.

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Approaches to Qualitative Research -Case study

• Used to generate an in-depth, multi-faceted understanding of a complex

issue in its real-life context.
• The case study allows critical events, interventions, policy developments

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and program-based service reforms to be studied in detail in a real-life
context.

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 Approaches to Qualitative Research - Observation
• Observational methods of data collection are used with other methods of data collection;
researchers observe what is happening around them (e.g., physical surroundings, behaviors of
people present, interactions among people) while recording their observations and
interpretations as field notes.

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• In nonparticipant observation, the investigator observes certain behaviors of the people he
or she is studying, either covertly or overtly in real-life settings.
• Observing is a special skill involving careful forethought regarding observational protocol that

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ensures data are collected systematically and relate to addressing the research question. ( bias)
Steps of observational data collection :
• select site and gain permission to access (when necessary);
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• determine who or what is the focus of observation including when and for how long;
• role of the observer (will they participate actively or be a complete observer or both);
• develop observational protocols for documenting notes in the field;
• plan for how to enter and leave the site (e.g., will someone introduce you?)

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Participant observation
• The researcher can be both a participant in the field and/or an observer.
• Participant observation is often employed for learning about unexamined
practices and beliefs, e.g. participant observation of family group meetings to

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study the impact of cancer on family relationships among patients. Based on their
findings, the researchers highlight the need for practitioners to focus on the entire
family when designing interventions to help patients cope with cancer.

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• Adams et al. (2010) used multiple methods of data collection (observational
techniques, interviews, and analysis of textual and visual data) to elicit children’s
views about the hospital environment at the hospital for Sick Children in Toronto.

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These findings “began to address the significant gap in understanding the
relationship between the perceptions of children and the settings where their
healthcare occurs”

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• Qualitative Research, a field of inquiry characterized by its naturalistic and interpretive practices, is required in health

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promotion for various reasons
• The focus is on unfolding the meaning that the participants attribute to the problem.
• Typically, inductive method is followed at first, moving from bottom upwards by organizing the evolving patterns,
categories, and themes into increasingly more general units of information. Then, the researchers look back at the data

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from the themes to determine if additional information should be gathered for supporting each theme (deductive).
• The initial plan for research cannot be tightly prescribed, since some or all phases of the process may change or shift
after the researcher begins to collect data.

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• Qualitative research is suitable when the researcher wants to learn what the target population believes about a specific
issue, wants the reactions, ideas, and feelings of the target population in their own words or the researcher is studying
sensitive or difficult topics where the range and intensity of opinions are important.
• The research design is Nonlinear and emergent and the stages are interdependent informing one another in a nonlinear
manner
• Some approaches to qualitative research include - Ethnography, Phenomenology,Grounded theory Narrative Inquiry,
Case study,Participant and Non participant Observation

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• Holloway, I. & Galvin, K. (2017). Qualitative research in nursing and healthcare (Fourth

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ed.): John Wiley & Sons Inc.
• Karen Glanz (Editor), Barbara K. Rimer (Editor), K. Viswanath (Editor); Health Behavior:
Theory, Research, and Practice, 5th Edition ISBN: 978-1-118-62898-0 July 2015 Jossey-

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Bass
• Bernard H Russell (1994). Research methods in anthropology: qualitative and quantitative
approaches (second edition). Walnut Creek, CA: AltaMira Pres
• Marshall, Catherine & Rossman, Gretchen B. (1995). Designing qualitative research.
Newbury Park, CA: Sage.
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• Dobe M; Health promotion and Education: Foundations for Changing Health Behavior1st
Edition 2022 Academic Publishers

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Research Methods in
Health Promotion Qualitative Methods in Health
Promotion (Part II)

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PT
Prof. (Dr.) Madhumita Dobe
Chairperson, Foundation for Actions
and Innovations Towards Health

N Promotion, and
Former Director Professor and Head,
Dept. of Health Promotion and
Education, AIIH&PH
Lecture # 22 Email: madhumitadobe@[Link]
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• Choosing a research method

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• Principles of Sampling for qualitative research
• Selecting a sample for qualitative study

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Choosing a method
• Aim of the study and the research question directs the qualitative approach and the overall design.
• For example, researchers interested in emergency room practices might approach this topic using
different qualitative methods depending on their aim.
• If they were interested in understanding how the cultural practices of the emergency department

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shape patient experiences, they would most likely use a form of ethnography.
• Another may want to understand the experiences of emergency patients waiting for admission in a
hospital where there is shortage of beds. Here, phenomenology would be a possible research

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approach.
• A researcher interested in explaining the social processes influencing family members’ decisions to
access the emergency ward upon experiencing chest pains might use grounded theory.

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• Another interested in how patients make meaning of their experiences of accessing the emergency
department during an acute illness episode might turn to narrative methods.

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SAMPLING IN QUALITATIVE RESEARCH
• In qualitative designs, participants are selected based on their relevance to the research topic/question,
the conceptual framework, and the method being employed. Thus, rather than informed by a commitment
to statistical representation, sampling decisions are driven by selecting participants who can provide
greatest insights regarding phenomenon of interest
Based on this, there are a number of different sampling procedures. Four common ones are

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• Theoretical sampling—participants are selected based on the emerging theoretical framework;
participants are selected to elaborate and refine the emerging categories and the theory. This is a core
aspect of grounded theory

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• Purposeful sampling—the researcher selects the best participants based on the quality of their insights
about and willingness to reflect upon the phenomenon of interest: “who (or what data) can give me the
most and the best information about my topic?”
• Snowball (or chain) sampling—participants in the study are asked to invite others who meet the

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sampling criteria to contact the researcher if they are interested in participating.
• Convenience sampling—participants are selected based on their availability to participate.

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Samples for qualitative studies are small. The sampling error of small sample is likely to be
large and sampling biases (the difference between the sample and the population) are inevitable
Studying a random sample provides the best opportunity to generalize the results to the
population but is not an effective way of understanding complex issues relating to human
behaviour because:
1. For selection of a truly random sample, the characteristics under study should be

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known for the whole population. This is rarely possible in a complex qualitative study.
2. Random sampling of a population is likely to produce a representative sample only if
the research characteristics are normally distributed within the population. Available

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evidence indicates that the values, beliefs and attitudes that form the core of qualitative
investigation are not normally distributed, so the probability approach is
inappropriate.
3. All people are not equally good at observing, understanding and interpreting their behaviour

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and that of people around them. some informants are more likely to provide better
insight and understanding for the researcher. They may be missed through random
sampling.

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Sample size determination for qualitative studies- The Ideal number
Ideal number of participants that constitute a valid observation (e.g., focus groups)
are there but there are no rules on how many observations are required to get
valid results.
In theory, sample size in qualitative designs should be determined by the saturation

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principle, where interviews are conducted until additional interviews provide no
additional insights into the topic.

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Saturation occurs when each category is rich & thick & no new information is
coming
Appropriate sample size in qualitative research depends on:
• nature of the topic;
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• amount of useful information from each participant (or source);
• number of interviews per participant (some designs propose to interview
participants more than once); and
• qualitative method and study design.

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Selecting a sample for qualitative study

1. Convenience sampling:
• most widely used technique - selection of most accessible subjects
(purposive sampling).

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• least rigorous + least costly (time, effort and money).
Participants are chosen according to preselected criteria relevant to a

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particular research question (for example, a class of students, a support
group for people with cancer, people in a vaccination clinic,).

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Sample sizes, may or may not be fixed prior to data collection and depend
on the resources and time available, as well as the study’s objectives.

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Selecting a sample for qualitative study
[Link]-Based time sampling:Recruitment at venues where population
of interest gathers
1. First-stage sampling: venue

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2. Second-stage sampling: venue and day-time combinations (VDTs)
3. Third-stage sampling: individuals within sample (conducted) VDTs

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• Used for hard to access hard-to-reach populations ( difficult through
traditional probability sampling techniques) e.g. Commercial sex workers,

likely not feasible. N

injecting drug users, seasonal migrants for which convenience sample is

• Two-stage sampling design.

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 Approaches to Qualitative Research - Ethnography
• One of the oldest qualitative approaches with historical origins in anthropology.
• Main focus is the exploration of “insider’s point of view” - emic perspective.
• Ethnography can help greater understanding of behaviour surrounding health and

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illness e.g. how the effectiveness of therapeutic interventions can be influenced by
patients’ cultural practices and how ethnocentric assumptions on the part of
professionals can impede effective health promotion

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• Ethnographers also use a variety of strategies to conduct research - participant
observation, interviews, focus groups, field notes, video, photography, art, and/ or
other documents when conducting research.
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• Multiple kinds of ethnographies have developed over time—e.g., institutional
ethnography, autoethnography

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Venue-Based time sampling
• In the first stage –in-depth interviews conducted to identify all potential venues which the
targeted population might visit. For example, street corners, parks, bars or restaurants.
1. Once the venue universe has been identified, enumeration of specific days and times that
will yield the most potential participants is conducted.

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2. Next the number of targeted population who visit the venue during these days and times are
counted so that the best days and times for that venue can be selected.
3. Devise the final sampling frame with all potential venue- day-times, from which a random

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sample is drawn.
• In the second stage there is actual recruitment of participants at the venue through a
systematic approach.
An imaginary area is predetermined and potential participants who cross into the area are

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approached, screened for eligibility, and, if they are eligible, they are asked to participate.
Systematic selection at the venue reduces the selection bias that occurs in convenience
sampling.

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• Choosing a research method needs careful consideration in health promotion
research and is directed by aim of the study and the research question

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• Five commonly used approaches include ethnography, phenomenology, grounded
theory, case study and general qualitative inquiry.

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• In qualitative designs, participants are selected based on their relevance to the
research topic/question. Thus, rather than a commitment to statistical
representation, sampling decisions are driven by selecting participants who can

•
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provide greatest insights regarding phenomenon of interest

Based on this, there are a number of different sampling procedures. Four

common ones are - Theoretical sampling, Purposeful sampling, Snowball (or
chain) sampling and Convenience sampling—participants are selected based on
their availability to participate.

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• Holloway, I. & Galvin, K. (2017). Qualitative research in nursing and healthcare (Fourth

EL
ed.): John Wiley & Sons Inc.
• Karen Glanz (Editor), Barbara K. Rimer (Editor), K. Viswanath (Editor); Health Behavior:
Theory, Research, and Practice, 5th Edition ISBN: 978-1-118-62898-0 July 2015 Jossey-

PT
Bass
• Bernard H Russell (1994). Research methods in anthropology: qualitative and quantitative
approaches (second edition). Walnut Creek, CA: AltaMira Pres
• Marshall, Catherine & Rossman, Gretchen B. (1995). Designing qualitative research.
Newbury Park, CA: Sage.
N
• Dobe M; Health promotion and Education: Foundations for Changing Health Behavior1st
Edition 2022 Academic Publishers

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Research Methods in
Health Promotion Qualitative Methods in Health
Promotion (Part III)

EL
PT
Prof. (Dr.) Madhumita Dobe
Chairperson, Foundation for Actions
and Innovations Towards Health

N Promotion, and
Former Director Professor and Head,
Dept. of Health Promotion and
Education, AIIH&PH
Lecture # 23 Email: madhumitadobe@[Link]
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•Interview – designs, procedures and protocols
•FGDs/IDIs

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•Ground rules, Do’s and Don’ts
•Visual methods N
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Interview designs
• Three main interview designs :
[Link] interview –
• Follows sequence of same questions asked in same order.

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• Includes open and closed-ended questions.
• Predetermined questions and wording reduces the risk of interviewers’ own biases and
offers consistency across interviews.

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• Particularly valuable in research involving multiple interviewers.
Highly structured nature of the interview leaves little freedom to draw fully on the

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participants’ knowledge through an exploration of their responses or through
encouragement of the participant to expand on their responses through the use of
probes.

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Interview designs
2 Semi-structured interviews
• Include specific predetermined items/questions, but latitude is given to interviewers to
explore participant responses pertaining to the research questions of interest.

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• Questions centre on selected topics and hypotheses, often from RoL, but the interviews
are not entirely predetermined.
3 Unstructured/open-ended interview - most common type of qualitative interview.

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Although frequently researchers plan an interview guide consisting of planned topics for
exploration, the aim of the unstructured interview is to allow the participant the
opportunity
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Interviewing
• Establish rapport with the participant and create a sense of trust; this may be affected by other issues,
such as gender.
• Begin the conversation with less sensitive, benign topics and then gradually ease the conversation
toward more sensitive and complex issues.
• During the interview or the conversation, identify responses that allow for more in-depth probing.

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• Probing is a technique where verbal or nonverbal communication is used to collect more information.
For example, the interviewer could:
• ask directive question such as “Could you tell me a little more about that?”

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• use echo probe, in which he or she paraphrases what the interviewee has just said.
• use comments such as “Uh-huh,” “I see, ”Yes,”.
• Probes should be as neutral as possible to avoid introducing bias e.g. if the participant says, “I don’t

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know,” or “I am not sure,” a neutral “clarification probe,” that could be used is, “There are no right or
wrong answers to these questions; we are only interested in finding out how you feel about this.”
Nonverbal probes are also effective; these include nods of the head or simply remaining silent to give the
interviewee time to reflect or prepare his next thought.

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 Deciding the interview protocol
• Consider the degree of detail required to fully answer the research question. Unstructured/open-ended
interview provides the most opportunity to elicit in-depth detail; however, the interviewer needs to be
trained and well-prepared in order to take advantage of the benefits of the unstructured interview.
• Be cognizant of how much is already known about the topic and what is to be learned

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• Consider the extent to which simplicity in data analysis (coding) is necessary; the more unstructured the
data (e.g., open-ended interviews), the more complex the analytic process.
• Practical issues e.g how the interview will be recorded (digitally?) Is the interviewer familiar with the

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recording device? Will the interviewer keep field notes?
• Process issues: Will the interview guide be pilot tested? In what order should the questions be asked?
Are there issues with language that need to be considered when developing the interview questions?
• Data management issues: Where will the recordings be kept? Where will the field notes and/or
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demographic information be stored? Finally, will the researcher be providing an honorarium for the
participants? What form will the honorarium be in (cash, a gift)? What if the participant withdraws from
the interview/study? What will happen with respect to the honorarium and what will happen with the
participant’s data?

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 What is a focus group?
• In 1991, marketing and psychological expert Ernest Dichter coined the name “Focus Group”. The
term described meetings held with a limited group of participants with the objective of discussion.
• A focus group is defined as a small group of carefully selected participants who contribute to open
discussions. The researcher carefully selects participants for the study to represent the larger
population they’re attempting to target.

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• Focus groups are the most common type of group interview used in qualitative research.
• A moderator ensures legitimate results and reduces bias in the discussions.
• A group of 6-10 people, usually 8, meet to explore and discuss a topic. The group shares their

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feedback, opinions, knowledge, and insights about the topic.
• The moderator takes notes on the discussion and opinions of group members.
• The right group members affect the results, so it’s vital to be picky when selecting members.

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• Given the obvious presence of group dynamics and interaction, group interaction is a necessary
focal point of both data generation and data analysis
• The purpose of a focus group is to better understand how people think or feel about the designated
topic

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When to conduct FGDs
• Flexible data gathering technique ;time and cost efficient.
• Can generate more ideas and issues about a topic than an individual conversation might because
participants build on each other’s ideas and shared experiences.
• Use focus groups when

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1. looking for a range of ideas that people have about a topic and the ideas emerge in the context of a group.
2. pilot testing ideas
3. obtaining information to design a larger quantitative study (e.g., finding appropriate language to use in an
instrument)

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4. seeking insight into quantitative data already obtained .
5. participatory action research is done for decision making and consensus seeking
Potential limitations - Some participants may be uncomfortable expressing their views or describing their

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experiences in a group setting, particularly for more sensitive topics; the researcher spend less time overall
with the total number of participants than when conducting individual interviews; group influences can distort
individual opinion; and, there are limits to confidentiality—i.e., members of the group may disclose aspects of
the group process outside of the group

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GROUND RULES FOR INTERVIEWING
• Greet the respondent at the beginning of the interview in a culturally appropriate manner.
• Explain the purpose of the interview and obtain informed consent.
• Explain how the information will be recorded. Ask for permission to audio record or video
record the session if you plan to do so.

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• Arrange comfortable seating to facilitate communication. ( Note taker)
• Use ice breakers
•

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Start with a topic that is not sensitive and is important to the respondent. This helps create
informal, friendly atmosphere, facilitating a natural flow of ideas and opinions.
• Be an active listener; look at your informant’s face (not at your interview guide), and always
behave in a culturally sensitive way.
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•
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Pick up phrases that the informant uses and use these to phrase your questions.
Avoid giving opinions or judgments about what the informant says, and treat her as an
equal.

14
GROUND RULES FOR INTERVIEWING
• Use open-ended questions rather than closed ones that allow for only “yes” or “no”
answers.
• Avoid asking leading questions.
•

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Allow free flow of the discussion, but make sure that all the topics are covered.
• Ask probing questions to clarify points or to encourage more explanation.
• Respond to any issues raised by your informants that are not on your interview guide, and

PT
probe on these as well.
• Thank the informant at the end and give her time to ask more questions.

Source: World Health Organization. N

15
Quality of interview
Strategies to improve the quality of interview:
• Active listening. Listen and rephrase what was said to ensure that you
completely understand what your respondent is intending.

EL
• Patience. Do not rush the respondent. Allow the respondent to speak
freely, while guiding the conversation to cover important issues, or gently

PT
re-focusing the conversation if it wanders off track. Always keep in mind
that in-depth interview questions are like invitations to share a story.
Allow your respondents to tell you theirs.

N
• Flexibility. Be open to slight deviations from the topic which may require
rearranging or reordering the questions, or coming up with new
questions.

16
Visual Methods
• Photovoice is a qualitative research method used
in community-based participatory research that
gathers participant-taken photographs and
narratives to translate experience into actionable
knowledge.

EL
Supports qualitative discussion. Captures
evidence –data that is rich and meaningful.
Develops community skills and understanding.

PT
Can be empowering and transformative for
participants

• Photovoice can be used to gather new insights

N
and perspectives that can raise awareness of
hidden or overlooked issues and aspects of a
given community. Participants are asked to
express their points of view or represent their
communities by photographing scenes that
highlight research themes.

17
 Visual Methods

Community Mapping

• Invite community members

EL
• Divide into groups

PT
Ask the groups to draw maps of
their environment including
resources/sites of importance to
the problem being studied

• N
Compare and discuss maps
noting similarities and
differences

18
• Interview is the most commonly used technique for data collection in qualitative
research.

EL
• There are several types of interview designs with different procedures and protocols

• The interviews most commonly used are FGDs and IDIs – each has its own procedure

PT
and protocol

• It is absolutely necessary to keep the Ground rules, Do’s and Don’ts in mind while
conducting these interviews

• N
Visual methods like photovoice, community mapping etc. support qualitative
discussion. Capture evidence –data that is rich and meaningful. Develop
community skills and understanding. Can be empowering and transformative for
participants

19
• Holloway, I. & Galvin, K. (2017). Qualitative research in nursing and healthcare (Fourth

EL
ed.): John Wiley & Sons Inc.
• Karen Glanz (Editor), Barbara K. Rimer (Editor), K. Viswanath (Editor); Health Behavior:
Theory, Research, and Practice, 5th Edition ISBN: 978-1-118-62898-0 July 2015 Jossey-

PT
Bass
• Bernard H Russell (1994). Research methods in anthropology: qualitative and quantitative
approaches (second edition). Walnut Creek, CA: AltaMira Pres
• Marshall, Catherine & Rossman, Gretchen B. (1995). Designing qualitative research.
Newbury Park, CA: Sage.
N
• Dobe M; Health promotion and Education: Foundations for Changing Health Behavior1st
Edition 2022 Academic Publishers

20
 N
21
PT
EL
Research Methods in
Health Promotion Qualitative Methods in Health
Promotion (Part IV)

N
PT
Prof. (Dr.) Madhumita Dobe

EL
Chairperson, Foundation for Actions
and Innovations Towards Health
Promotion, and
Former Director Professor and Head,
Dept. of Health Promotion and
Education, AIIH&PH
Lecture # 24 Email: madhumitadobe@[Link]
 N
•FORMS OF QUALITATIVE DATA

PT
•REASONING PROCESSES IN QUALITATIVE ANALYSIS
•APPROACHES IN QUALITATIVE DATA ANALYSIS

EL
•STEPS IN QUALITATIVE DATA ANALYSIS

2
Qualitative data
Data collected through qualitative studies are mostly descriptive data.
Descriptive data can have different forms, such as words, pictures, video, notes,
charts or records, and narratives.

N
e.g. Interview transcripts, Recorded observations (both video and participatory),

PT
texts and documents, multi-media or public domain sources, photographs, lay
accounts.
Unlike quantitative data, qualitative data are not represented in numerical terms.

EL
If some numerical interpretation is provided, it is to emphasize a pattern in the
data.

3
 Qualitative analytic reasoning
• Qualitative study usually relies on reasoning processes to interpret and structure the meanings
that can be derived from data.
• Analysis is an explicit step in conceptually interpreting the data set and transforming the raw data
into a coherent depiction of the thing being studied.

N
• Distinction between explaining how something operates (explanation) and why it operates in the

PT
way that it does (interpretation) distinguishes quantitative from qualitative analytic processes.
• Data collection and analysis are concurrent, analysis informs and guides additional data collection
• Although there are many qualitative data analysis computer programs available on the market

EL
today, these are essentially aids to sorting and organizing sets of qualitative data, and none are
capable of the intellectual and conceptualizing processes required to transform data into
meaningful findings.

4
Qualitative data analysis
[Link] management
• Qualitative data should first be clearly organized.
• Original data and subsequent analysis should be recorded in a file that includes dates,

N
locations, individual or group characteristics, interviewer characteristics, and other
defining features.

PT
• Digital recordings of interviews or visuals should be reviewed to see that the analyzed
data corresponds to original observations.
• If ethics agreements require that no names or identifying characteristics be recorded, all

EL
individual names must be removed from final transcriptions before analysis begins.
• If data are analyzed by using textual data analysis software, maintaining careful watch
over the data files is essential, especially when multiple coders are involved.

5
 Qualitative data analysis
2 Data condensation
• Condensing is the process of selecting, focusing, simplifying, and abstracting the original data
and transforming them into a data set that can be analyzed.

N
• In qualitative research, most of the time required to complete a study is spent after the fieldwork
is complete. A single hour of taped individual in-depth interview can take a full day to transcribe

PT
and additional time to translate if necessary. Focus Group interviews take even longer.
• Each stage of data condensation involves multiple decisions and close supervision to strike the
right balance between maintaining the original language and clarity of the translated version for

EL
analysis. For example, discussions among groups with little or no education should not sound like
university graduates after the transcription (and translation) process. Judgment must be exercised
about which terms should be translated and which terms should be kept in vernacular because no
appropriate term in English can capture the richness of its meaning in vernacular.

6
 Domains Qualitative data
Fear Myths about HIV transmission : 3 Data display
People should not interact socially with After condensation, data needs to be organized and displayed
spouses of PLWHA( people living with to facilitate comparison & increase the depth and detail of the
HIV/AIDS) to avoid infection conclusions.
PLWHA should not be allowed to cook food
Displays range from full verbatim transcripts of interviews to
for others
Acts reflecting fear:
bulleted summaries of interview notes.
A PLWHA was not allowed to watch TV at A useful display format is an overview chart in which key

N
the local youth club themes or research questions are listed in rows in a table or in
A PLWHA was not allowed to use the village a spreadsheet and individual informant or group entry

PT
pond characteristics are listed across columns. Overview charts allow
BLAME & Moral Connotation: easy, systematic comparison of results.
JUDGEMENT PLWHAs who have acquired the infection Source: Panda, Samiran, et al. “Exploring stigma in low HIV
through sexual promiscuity, should be

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prevalence settings in rural West Bengal, India: Identification of
punished intervention considerations.” Journal of Mixed Methods Research 9.4
Women having the infection were blamed to (2015): 362-385
destroy the family but men were not similarly
blamed.
SHAME Attitude towards sexual promiscuity:
HIV was associated with shame because it
was acquired through sexual promiscuity.

7
 Drawing and Verifying Conclusions
4 Analysis.
Thematic analysis - careful, systematic, and repeated reading of text to identify consistent themes
and interconnections emerging from the data. Repeated reading yields new themes, connections,
and deeper meanings. Reading the full text of interviews multiple times before subdividing according

N
to coded themes is necessary to appreciate the full context and flow before subdividing and
extracting coded sections of text.

PT
Content analysis - description and categorization of common words, phrases, and ideas in the
qualitative data. Quantifies qualitative information by systematically sorting and comparing items of
information in order to summarize them. Involves both conceptual analysis (more numbers-based)

EL
and relational analysis (focuses on the relationships between concepts and how they are connected).
Textual analysis examining the content, structure, and design of texts [Link] social media platforms
Frequencies, Magnitude, Structures,Processes, Causes, Consequences
.

8
Drawing and Verifying Conclusions
5 Coding.
Developing codes for labeling sections of text for selective retrieval in later stages of
analysis and verification.
Structural coding, follows the structure of the interview guide.

N
Thematic coding, based on the emerging themes.

PT
To avoid the problem of shift and drift in codes across time or multiple coders,
qualitative investigators should develop a standard codebook with written definitions
and rules about when codes should start and stop.

EL
Coding is a repetitive process in which new codes that emerge from repeated reading
are included with existing codes. Development and refinement of the codebook is an
integral part of the analysis.
• Computerized assignment of codes.

9
 EL
PT
10
N
 EL
PT
11
N
 Drawing and Verifying Conclusions
6 Analyzing and writing memos.
Answers to the research question emerge during coding and selective text retrieval, whereby similarities
within and between coding categories can be extracted & compared systematically.

N
Memoing is the process of writing notes or memos about thoughts related to the analysis of one's data
– Personal reflections & impressions - include phrases or ideas that surprise you, similarities or distinct
differences in responses, additional questions that the data brings to mind etc. We often record these

PT
reactions directly in the text if we have the ability to do so, such as making a comment in a word
document associated with a highlighted phrase.
Memos record evolving insights and emerging patterns in the data and how they relate to the original

EL
research questions - recording reflective notes about what the researcher (fieldworker, data coder
and/or analyst) is learning from the data
Memos accumulate as written ideas or records (Journals) about concepts and their relationship to initiate
further thinking about the data that lead to further coding and deeper understanding

12
• Data analysis is the most complex part of all of the phases of a qualitative study.
• Just creating a database is not sufficient. In order to transform raw data into new knowledge, a

N
qualitative researcher must engage in active and demanding analytic processes throughout all phases
of research. Reading, understanding, and interpreting it - is an important aspect of data analysis

PT
• Qualitative research analysis requires preparation and careful planning. Take time to familiarize with
the data before you begin analyzing.
• Once you begin your analysis, make sure that you have strategies for capture and recording both your

EL
reaction to the data and your corresponding developing understanding of what the collective
meaning of the data is .
• Qualitative research is not only invested in the end results but also the process at which you arrive at
them.
• Qualitative conclusions are subjective judgment; hence, it is beneficial to involve more than one
analyst to have discussion and debate before reaching consensus on conclusions.

13
• Holloway, I. & Galvin, K. (2017). Qualitative research in nursing and healthcare (Fourth

N
ed.): John Wiley & Sons Inc.
• Karen Glanz (Editor), Barbara K. Rimer (Editor), K. Viswanath (Editor); Health Behavior:

PT
Theory, Research, and Practice, 5th Edition ISBN: 978-1-118-62898-0 July 2015 Jossey-
Bass
• Bernard H Russell (1994). Research methods in anthropology: qualitative and quantitative

EL
approaches (second edition). Walnut Creek, CA: AltaMira Pres
• Marshall, Catherine & Rossman, Gretchen B. (1995). Designing qualitative research.
Newbury Park, CA: Sage.
• Dobe M; Health promotion and Education: Foundations for Changing Health Behavior1st
Edition 2022 Academic Publishers

14
 EL
PT
15
N
Research Methods in
Health Promotion Qualitative Methods in Health
Promotion (Part V)

EL
PT
Prof. (Dr.) Madhumita Dobe
Chairperson, Foundation for Actions

N and Innovations Towards Health

Promotion, and
Former Director Professor and Head,
Dept. of Health Promotion and
Lecture # 25 Education, AIIH&PH
Email: madhumitadobe@[Link]
• Summary of common concepts of qualitative methods

EL
• Broad types of qualitative research
• strengths & weaknesses of qualitative research

PT
• Limitations of qualitative research
• Challenges of qualitative research

N
• Multicentric qualitative research
• Using social data for qualitative research

2
SUMMARY OF COMMON CONCEPTS OF QUALITATIVE METHODS
• Qualitative researchers study things in their natural setting, attempting to make sense
of, or interpret, phenomena in terms of the meanings people bring to them.
• Qualitative method has the common purpose of creating a model for in-depth
understanding of the links among elements, i.e., of exploring an order that is invisible

EL
in the ordinary examination.
• Process is particularly powerful here, and not the product, that is, mathematically
estimated results.
• The inductive reasoning relates to the fact that these researchers would ground their

PT
work on field data, further exploring individualities and collecting information that
would gradually help to build up a plausible theory.
• Emic means that interpretations should be made from the interviewees’ perspective
N
and should not be a discussion from the researcher’s or the literature’s view.

3
3 BROAD TYPES OF QULITATIVE RESEARCH

EL
PT
N
4
STRENGTHS & WEAKNESSES

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PT
N
5
LIMITATIONS OF QUALITATIVE RESEARCH

• Limitations include possible small sample sizes, potential bias in answers, self-
selection bias, and potentially poor questions from researchers
• The Hawthorne Effect :

EL
“Participants in behavioral studies change their behavior or performance in response to
being observed.”

PT
N
6
CHALLENGES WITH QUALITATIVE RESEARCH

•Choosing a method.
•Avoiding bias.

EL
•Ensuring accuracy and consistency.

PT
•Managing tons of data.

N
7
MULTICENTRIC QUALITATIVE QUALITY ASSURANCE
• While each researcher collects data in their local settings using their native language - a
common language for coding and analysis is required to facilitate the sharing of
information across sites and to disseminate research findings to wider audiences.
• Develop codes for data analysis in English so that they could be shared but language

EL
fidelity and fluency of the participants in the respective centers require that the analysis
be conducted in the original language of the interviews by local research teams.
• Researchers in each center generate a list of narrative codes as they completed the

PT
stakeholder interviews and focus groups. The generated codes are circulated between
researchers in each of the centers.
• The list of codes are developed into a shared codebook, during face-to-face meetings,
N
conference calls and electronic mail correspondence - a consensus codebook

8
MULTICENTRIC QUALITATIVE QUALITY ASSURANCE
Creating a codebook for data analysis
• Coding is the interpretative process
in which conceptual labels are given
to the data.

EL
• Codes are words or devices for
identifying themes.

PT
• Overall quality assurance should
include data analysis plan with a
consensus approach to the analysis
process to maximise intercoder
reliability in coding open-ended
data.
N
9
MULTICENTRIC QUALITATIVE QUALITY ASSURANCE
• Multicentre studies present a particular methodological challenge in
qualitative research as local context adds complexity and opportunities for
introducing confounding variables.
• Generalizability—extending the research findings from the study population

EL
to the population at large—is not possible given that the size of the sample
(generally a small group of people or a small number of cases) and the

PT
context is generally not representative of the larger population.
• However, interventions may be applicable to other distinct populations,
and—in which investigators, based on what they learned, transfer and apply

N
the findings to other settings—may be appropriate.

10
 N
11
PT
EL
Why don’t we think of social data as qualitative data?
• What people share on social are rich, deep, unstructured stories
told through images, videos or text - qual data.
• When you think of social data as qual data, it opens a new set of

EL
tools for analysing it.
• Primary qual allows you to explore in-depth. Social qual allows you

PT
to explore the breadth
• Its value comes from the scale, being able to see the behaviours of
thousands of people to give you a more comprehensive picture.
N
12
How do you apply qual methods to social?
• Grounded Theory lends itself very well to the analysis of social data.
• Develop the right analytical tools: discourse, narrative and thematic analysis (among
others).
• Codify the data

EL
• Quantify the data: run the numbers to explore frequencies and patterns in it - gives
the outline of the story.

PT
• Deep dive: once the picture has an outline, start filling in the detail, using thematic and
narrative analysis techniques to find and understand the meaning in the data
• Synthesis: bring the elements together to complete the picture.

N
13
Case Study: How the British Red Cross learnt to talk about loneliness
• The question: The British Red Cross works to connect human crisis with human kindness and
encourage resilient communities where people look after each other. As part of this, it sought to
raise public awareness and understanding, provide suitable services, and influence policy
concerning loneliness.

EL
• The approach: Loneliness is often hidden and rarely spoken about out loud. There’s a stigma about
it, and our understanding is shaped by dated stereotypes. However, social media’s veil of
anonymity gives people a safe space to talk and an opportunity to better appreciate and
understand.

PT
• Scoping: started working to understand the nature of their challenge. What they already knew,
what activities and strategies were already in place and what they had tried before. Then from a
technical perspective, spent time working out what exactly they meant by loneliness so they could
map this audience profile onto the social data.

N
• Data collection: used social listening partner to find conversations among people dealing with
loneliness. A common misconception about social data is that it’s people showing off or arguing,
but the reality is it’s often much more reflective of actual life. The anonymity of online forums
makes people feel comfortable sharing very personal aspects of their lives.

14
• Qualitative research involves study in natural setting and interpreting phenomena in terms of the
meanings people bring to them - Emic
• Process is more important powerful here, and not the product, that is, mathematically estimated

EL
results.
• The process involves inductive reasoning to build up a plausible theory.
• Broad types of qualitative research include exploratory, descriptive and comparative

PT
• There are many strengths & weaknesses of qualitative research
• Major limitations of qualitative research include Limitations include possible small sample sizes,
potential bias in answers, self-selection bias, Hawthorne Effect and potentially poor questions from
researchers

consistency and Managing tons of data.

N
• Challenges of qualitative research involve addressing these limitations,Ensuring accuracy and

• Multicentric qualitative research studies present a particular methodological challenge in qualitative

research as local context adds complexity and opportunities for introducing confounding variables.
• Using social data for qualitative research allows to explore the breadth. Its value comes from the scale,
to give a more comprehensive picture.

15
• Holloway, I. & Galvin, K. (2017). Qualitative research in nursing and healthcare (Fourth

EL
ed.): John Wiley & Sons Inc.
• Karen Glanz (Editor), Barbara K. Rimer (Editor), K. Viswanath (Editor); Health Behavior:
Theory, Research, and Practice, 5th Edition ISBN: 978-1-118-62898-0 July 2015 Jossey-

PT
Bass
• Bernard H Russell (1994). Research methods in anthropology: qualitative and quantitative
approaches (second edition). Walnut Creek, CA: AltaMira Pres
• Marshall, Catherine & Rossman, Gretchen B. (1995). Designing qualitative research.
Newbury Park, CA: Sage.
N
• Dobe M; Health promotion and Education: Foundations for Changing Health Behavior1st
Edition 2022 Academic Publishers

16
 N
17
PT
EL