INTRODUCTION

Research is any activity undertaken to increase our knowledge; it is the systematic

investigation of a problem, issue or question. This may mean reviewing all the
literature on a given topic and drawing new conclusions about the topic, manipulating
certain variables to see what happens to other variables, or merely searching in an
organized manner for relationships between characteristics or entities.

Two means of discovering and using knowledge are inductive and deductive
reasoning:
Induction begins with the observation and measurement of phenomena and then
develops ideas and general theories about the universe of interest. In other wards, in
using inductive reasoning, one accepts or believes a finding about an individual and
then applies that belief to all similar individuals, assuming that it will be true for all.
Deduction a theoretical or mental process of reasoning by which the investigator
starts off with an idea, and develops a theory and hypothesis from it, then phenomena
are assessed in order to determine whether the theory is consistent with the
observations. In other wards, in using deductive reasoning, one accepts or believes a
general principle, then applies that principle to an individual case.

Research has many problems, to mention some:

- Some clients may not want to participate,
- Numerous ethical issues need to be considered in doing research on
human beings,
- Takes time and other resources, etc.

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The basic types of research can be categorized in several ways. For example, research
may be pure or applied, experimental or descriptive, clinical or laboratory.

A. Pure Applied
Abstract and general, concerned with Designed to answer a practical question, to
generating new theory, and gaining help people do their jobs better.
new knowledge for the knowledge‟s
sake.
B. Experimental Descriptive
Manipulating one variable to see its Describing a group, a situation, or an
effect on another variables, while individual to gain knowledge, which may
controlling for as many other be applied, to further groups or situations,
variables as possible and randomly as in case studies or trend analysis.
assigning subjects to groups.
C. Clinical Laboratory
Performed in the “real world” where Performed in “unreal” or laboratory
control over variables is quite surroundings that are tightly controlled.
difficult.

It is useful to remember that research is a circular process. The researcher starts with a
question in mind, goes through the investigative stages, and ends up with an answer to
the question. More often than not, further questions arise during the analysis and
interpretation of the data, leading to yet more research ideas, which is true in
quantitative research. But it may happen the other way round in the case of qualitative
research, “You are not putting together a puzzle, whose picture you already know.
You are constructing a picture which takes shape as you collect and examine the
parts”.
Whatever the entry point, the steps required to complete a research project follow a
logical sequence:
1. Identify a problem that needs to be solved or a question that needs to be answered.
2. Review the existing writing on that issue.
3. Formulate a question or hypothesis about the problem based on the reading.
4. Design a procedure that will address the question or hypothesis.

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 5. Carry out the procedure.
6. Collect and interpret the findings.
7. Publish the answer to the question so that others may benefit from the identified
Knowledge.
Having followed the above research steps, to conduct a research one has to choose the
method to be used. That means what design you will use to answer the questions you
have posed. You must decide whether to use a qualitative or a quantitative research
design. In order to make decision, you must understand the underpinnings of each
type of research.

Qualitative research approach nowadays is growing and applied in many basic and
applied researches. Many texts are produced on how to go about it. This module is
prepared after referring those selected books listed at the reference section, by looking
some journals, and by incorporating the short notes that were given by the co-
producer. It needs further development and modifications by inserting examples on
qualitative researches performed in Ethiopia, in particular at Gondar College of
Medical Sciences.

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PRE-TEST
1. What is “qualitative research”?
2. List the methods for the application of qualitative research?
3. List down the main differences between qualitative
and quantitative research approaches?
4. Can we use both qualitative and quantitative research approaches
and methods in a research?
Yes No
5. Which one of them aims to generate hypothesis and to describe
rather than testing hypothesis and generalizing?
Quantitative Qualitative
6. Which favours counting rather than natural observation?

Quantitative Qualitative

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INTRODUCTION TO QUALITATIVE RESEARCH

1. SCOPE AND DEFINITIONS

Qualitative research is a method of naturalistic enquiry, which is usually less

obtrusive than quantitative investigations and does not manipulate a research setting.
It aims to study people in their natural social settings and to collect naturally
occurring data. The focus is on the meanings the participants in the study setting
attach to their social world. Its strength is the ability to study people in the „field’, i.e.
in their natural settings.
Qualitative research describes in words rather than numbers the qualities of social
phenomena through observation (direct and unobtrusive or participative and reactive),
unstructured interviews (or „exploratory‟, „in-depth‟, „free-style‟ interviews, usually
tape recorded and then transcribed before analysis), diary methods, life histories
(biography), group interviews and focus group techniques, analysis of historical and
contemporary records, documents and cultural products (e.g. media, literature).
Demonstrable advantage of qualitative research over quantitative methods have been
shown in situations in which there is little pre-existing knowledge, the issues are
sensitive or complex and the maximum opportunity for exploration and inductive
hypothesis generation is desired.

Qualitative research methods allow the researcher to work with the primary and
secondary data (transcribed from interviews, observational notes, and documents), to
explore the nature of the stories people tell or the way they behave to look at the
different perspectives, understandings and interpretations that social beings bring to
each social situation in which they participate. Thus the methods used by the
researcher to collect and analyse qualitative data need to allow those data to be
collected and worked with in their „natural‟ form. The researcher‟s role is to listen,
observe, theory test (in the case of interviews), and then interpret or make sense of
what she/he sees and hears. As the extent and nature of the data cannot be known
before they are collected, the process of collecting and analysing qualitative data often
intermingle. The collection of some data from perhaps a small number of in-depth
interviews may be followed by analysis, which then helps the researcher to identify
further data that are needed to test out or develop his/her preliminary interpretations.

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For example, if some research was being conducted into patients‟ experiences of
waiting to see the doctors, initial interviews might suggest that people waiting by
themselves have a different experience from those waiting with children.
The researcher is in close touch with the real situations of the data, close to the
ground.

“Qualitative research is multi-method in focus, involving an interpretive, naturalistic

approach to its subject matter” (Denzin and Lincoln, 1998:3)

The definition of qualitative research methods is that they are methods for collection,
analysis, and interpretation of data on phenomena that are not easily reduced to
numbers or that might be destroyed by an attempt to do so, e.g. „love‟ is a
phenomenon that is fundamentally qualitative. Health is another phenomenon, which
could be said to be fundamentally qualitative in nature.

Characteristics of Qualitative Research

The eight characteristics of qualitative research, which are important to consider:
A. An exploratory and descriptive focus
Research studies are qualitative and designed to discover what can be learned about
some phenomenon of interest, particularly social phenomena where people are
participant (or as traditionally referred to – subjects). Qualitative researchers
develop a general „focus of inquiry‟ that helps to guide the discovery of what is to
be known about some social phenomenon. Researchers are interested in
investigating and responding to exploratory and descriptive questions such as „what
is young children‟s conception of “mind”?‟ „In what ways do people in this rural
town build informal social networks?‟ „How do people who work in this place think
the physical environment could be improved?‟ The outcome of any of these studied
is not the generalization of results, but a deep understanding of experience from the
perspectives of the participants selected for study.
B. Emergent design
Important leads are identified in the early phases of data analysis and pursued by
asking new questions, observing new situations or previous situations with a slightly
different lens, or examining previously unimportant documents. This broadening or
narrowing of what is important to study (i.e., the focus of inquiry) and the

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 consequent sampling of new people and settings is anticipated and planned for, as
best one can, in qualitative research designs.
C. A purposive sample
In qualitative research, participants (or settings, such as schools or organizations)
are carefully selected for inclusion, based on the possibility that each participant (or
setting) will expand the variability of the sample. Purposive sampling increases the
likelihood that variability common in any social phenomenon will be represented in
the data, in contrast to random sampling which tries to achieve variation through the
use of random selection and large sample size.
D. Data collection in the natural setting
Qualitative researchers are interested in understanding people‟s experience in
context. The natural setting is the place where the researcher is most likely to
discover, or uncover, what is to be known about the phenomenon of interest. The
characteristic of qualitative research again reflects the philosophic underpinnings of
the alternate paradigm. Personal meaning is tied to context. To explore how parents
go about informally teaching their children, one goes to the places where this might
happen, such as family homes, shopping centres, social events, etc. Extended
amounts of time with people in the places they inhabit is a critical feature of
indwelling, fostering the development of both explicit and tacit knowledge.
E. Emphasis on ‘human-as-instrument’
The qualitative researcher has the added responsibility of being both the collector of
relevant data – data whose relevance changes as the study proceeds – and the culler
of meaning from the data, which most often is in the form of people‟s words and
actions. It is possible to include other formal instruments, such as questionnaires or
tests, in a qualitative study.
F. Qualitative methods of data collection
The data of qualitative inquiry is most often people‟s words and actions, and thus
requires methods that allow the researcher to capture language and behaviour. The
most useful ways of gathering these forms of data are participant observation, in-
depth interviews, group interviews, and the collection of relevant documents. The
researcher in the form of field notes collects observation and interview data and
audiotaped interviews, which are later transcribed for use in data analysis. There is
also some qualitative research being done with photographs and videotaped
observations as primary sources of data.

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G. Early and ongoing inductive data analysis
The characteristics of qualitative research described so far point to two important
characteristics of qualitative data analysis: a/. It is an going research activity, in
contrast to an end stage, when the design is emergent; b/. It is primarily inductive.
Analysis begins when one has accumulated a subset of the data, providing an
opportunity for the salient aspects of the phenomenon under study to begin to
emerge. Pursuing the relevant persons, settings, follows these initial leads or
documents that will help illuminate the phenomenon of interest. In other words,
there is a broadening or narrowing of the focus of inquiry as the data suggest it.
What is important is not predetermined by the researcher. Within the broad
boundaries of the researcher‟s focus of inquiry, the data studied for what is
meaningful to the participants in the study or „participant perspectives‟. The
outcomes of the research study evolve from the systematic building of
homogeneous categories of meaning inductively derived from the data.
H. A case study approach to reporting research outcomes
The results of a qualitative research study are most effectively presented with a rich
narrative, sometimes referred to as a case study. The number of cases varies with
each study, from one case to several. With book length reports, the researcher has an
opportunity to provide many excerpts from the actual data that let the participants
speak for themselves – in word or action – thereby giving the reader sufficient
information for understanding the research outcomes. In article length reports, the
researcher by necessity is briefer, using a modified case-study mode of reporting. A
qualitative research report characterised by rich description should provide the
reader with enough information to determine whether the findings of the study
possibly apply to other people or settings.

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 Figure Showing Characteristics of Qualitative Research

Emergent Design

Focus of inquiry

indicates need suggests

to refine

Early and ongoing Emphasis Purposive sample

inductive on
data analysis human-as-instrument

yield data for explored through

Qualitative methods
of data collection in
natural settings

Research outcomes
presented using a
case study approach

(Adapted from „Beginning Qualitative Research, A philosophic and Practical Guide‟.

Pamela M. and Richard M.).

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2. PRICNCIPLES

The nature of qualitative Research

Qualitative research is the main method used by anthropologists in participant
observations and/or qualitative interviewing of members of a culture (ethnography),
and by social scientists whose approach is rooted in a phenomenological perspective.
 Originates in social anthropology.
 Concerned with developing explanations of the social world.
 Predicted upon the socially constructed nature of reality – ontology
 In opposition to positivist thinking which dominates quantitative research.
 Develops out of a naturalistic paradigm.

The two main paradigms in the social sciences

 Positivism –provides the theoretical basis for quantitative approaches
 Naturalism – provides the theoretical basis for qualitative approaches.

The main features of Positivism:

The method of investigation used depends on the investigator‟s assumptions about
society. A considerable body of social science is directed by research methods drawn
from the natural science. This approach is known as positivism.
Positivism aims to discover laws using quantitative methods and emphasises positive
facts. Thus, positivism assumes that there is a single objective reality, which can be
ascertained by the senses, and tested subject to the laws of the scientific method.
Positivism in social science assumes that human behaviour is a reaction to external
stimuli and that is possible to observe and measure social phenomena, using the
principles of the natural scientists, and the hypothetico-deductive method, and thereby
to establish a reliable and valid body of knowledge about its operations based on
empiricism (actual evidence gathered through use of senses, i.e. observed).
Deductive reasoning means that the investigator starts with general ideas and
develops specific theories and hypothesis from them, which are then tested by
collecting and analysing data.

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Positivists are not concerned with measuring the meaning of situations to people
because they cannot be measured in a scientific and objective manner.
 Belief in objective nature of reality that can be studied and understood.
 Experimental design is the model for social research.
 Emphasis on the quantification of observations using neutral/standardised
language.
 Discounts subjective understandings and intentions of humans.
 Theory testing.

Main Features of Naturalism

 Social world should be studied in its natural state.
 World cannot be understood as a set of causal relationships because human
actions are based on meanings.
 Getting close/ focus on the micro – about sharing life of those being studied to
share people‟s interpretations of their world.
 Theory generating/ emphasis on induction. Researcher does not describe the
phenomena using pre-determined categories.
Inductive reasoning begins with observations and builds up general statements
and hypotheses from them for testing.
 A holistic approach – open to gathering any data that will shed light on the
problem.
The natural scientist systematically observes and measures the behaviour of matter
and the results of these investigations are regarded as „facts‟; these are believed to be
undistorted by the value judgement of the scientist.

Features of Qualitative Research

In qualitative research methods the emphasis on an accurate or true reflection of

social reality (telling it like it really) rather than on precision (saying how much it is
like this or that). Thus to this effect numbers are not of the essences in determining
the worthiness or otherwise of a piece of research. This is often taken to mean that
numbers are of no consequences whatsoever in qualitative research, but this would
overstate the case.

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Thus in qualitative research the sample size cannot often be determined in advance, in
the way that is often can be in quantitative research.
In many forms of qualitative research what limits the numbers required is the arrival
at a point at which one seems to have “bottomed the problem”, or where additional
data collection seems to reveal no new information or insight. This moment is known
as “saturation” and this is a matter of judgement. Sometimes the limitations on the
sampling frame are one of feasibility or funding.
Another feature of qualitative research is the nature of the end product. Data in
quantitative research are clearly numeric, and can usually be condensed by the use of
mathematical tools, most notable those of statistics. The conclusion can usually also
be stated in the concise form of theory or hypothesis with, ideally, some
measurements of the precision of that conclusion, such as confidence interval or P
value.
In qualitative research the data usually take the form of verbatim quotations from
research participants, often referred to as respondents or informants. Often these
quotations will be organized into a framework or template, which illustrates how they
support each other in reaching the conclusions. The conclusions will sometimes be
expressed as a theory or hypothesis, but more often as a social construction or model
of how the world is with regard to the topic of the study. This clearly presents
difficulties in communicating the research results within the traditional IMRAD
(Introduction, Methods, Results, and Discussion) framework imposed by the most
scientific journals.
The end product of qualitative research is also more likely to be a better or clearer
description of how things are, rather than predictive of how things might be. That is to
say that qualitative research is more naturalistic and descriptive than experimental.
Qualitative research methods can be used to generate descriptions and hypothesis, and
quantitative research methods can be used to test hypothesis. Thus anything
concluded from a piece of qualitative research is likely to be probabilistic rather than
deterministic, and is more contexts specific then generalizable.
 Naturalism
Understanding health behaviour in its everyday context.

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 Interpretation
- Investigating how patients and practitioners make sense of certain facts.
- Subjective meanings are crucial to an understanding of how treatment regimes
integrate with everyday life.
- People don‟t define themselves as having asthma thought acute/ „bad chest‟.
- Strategies to avoid the onset of attacks – extreme? But not as bad as having to take
daily medicine=> Stigma.
 Process
- Any interventions or changes need to be accommodated in person‟s biography.
- May have to manage drugs long term – asthma identity.
- People with epilepsy come off drugs to test themselves.
 Interaction and relativism
- Focus on the relationships between people and the fact there are multiple realities.
- For example, doctor and the patient may have different views of reality, e.g.
research on difficult patients crossed off GP lists.
- Also research on medication for asthma patients shows it can decrease morbidity
and mortality.
- Patients have negative views about medication. Worry about dependence on drugs
and long- term effects.
Realities
“Regarding patients‟ views of reality as ignorant or misguided and attempting to
persuade them of the value of the biomedical approach have limited value in
increasing adherence, and the need to integrate patient‟ perspectives has been
recognized recently”. (Green and Britten, 1998:1231).

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3. APPLICATION AND TECHNIQUES

Uses of Qualitative Research in Health Services Researches

Qualitative techniques have a wide range of applications in health care research.
Qualitative research methods have been commonly used in research documenting the
experience of chronic illness, and in the functioning of organizations, although they
have been less frequently used in the assessment of outcomes of treatment. This is
because the testing of causal hypothesis takes place in a context that subscribes to the
traditional, positivist view of science, which requires adherence to the scientific
method and uses experimental research designs and structured, standardized methods.
While qualitative methods were not designed to test causal hypothesis, it is
appropriate for the investigator to exercise curiosity and devise qualified hypothesis
about cause and effect relationships in relation to the phenomenon observed (e.g. „It is
possible that…). The qualitative investigator has the advantage of getting close to the
research material, and can obtain a grate deal of in-depth information that can be
tested in subsequent quantitative studies if necessary and appropriate.

When is it appropriate to use in health services research?

 To open up a new field of study.
 To identify salient issues
 To explain unanticipated or inconclusive findings.
 To explain contradictory findings from quantitative studies.
 As a precursor to quantitative studies.
 In combination with quantitative studies (thicker understanding and triangulation).

Preparing for a Qualitative Research Study

You must identify the problem you wish to study and generate research questions
concerning the problem. Review the literature to gain an understanding of the depth
and parameters of your problem, as well as other people‟s views on the topic. You
will need to formulate background material and decide on a theoretical base within
which to design the study. Finally you will choose a research design encompassing
data collection and analysis techniques.

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General Components of Qualitative Research
The Problem
Qualitative research begins with a problem or issue of interest that guides the entire
project. It will dictate the style of the research design, the data collection techniques,
and even the presentation of the findings.

Theory
No study, naturalistic or other wise can be conducted without an underlying theory or
model. It may be a formal anthropological or psychosocial theory or a personal model
about how things work, but theory is crucial in the definition of the problem and in
deciding how to tackle it.
Theories need not be elaborate sets of constructs, assumptions, propositions, or
generalizations. They can be personal theories about how the world, or some small
part of it, works.

Research Questions
Although the qualitative researcher will have developed some research questions
during the research design phase, any more questions will typically be generated
during the initial survey phase of fieldwork.
Research questions are fluid in naturalistic research, unlike the fixed hypothesis mode
of quantitative research. Some questions may be dropped as irrelevant; some may be
modified as additional data are gathered; and new questions may be added as the
study proceeds.

Participant Selection
Qualitative research can be characterized as an inquiry in which the investigator
observes and questions participants in their own setting, to learn their perspective on
things – a naturalistic inquiry. Therefore, researchers will use purposeful sampling to
choose participants who can offer the fullest and most relevant information about the
topic under study. In purposeful sampling, you must establish the criteria or
conditions necessary to be included in the study, the purposefully, choose a case or
cases that match these criteria. The participants who turn out to be the most reliable
and informative become the key informants. Others may have useful information to
add and will be seen as secondary informants.

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There are several types of purposeful sampling, and they are chosen according to the
researcher‟s needs for a particular study. Some of the most popular types are:
 Typical: A case is chosen because it is thought to be like the majority (i.e.
typical). For example, a therapist might want to see how a typical person with
hemiplegia proceeds through a particular rehabilitation program.
 Extreme or deviant: After the norm for a typical case is established, the
researcher might want to explore extreme cases in order to make a comparison, for
example, a person with hemiplegia who does not complete the rehabilitation
program or a person who completes the program in an extremely short time.
 Comprehensive: A situation in which all the cases in a sample can be examined,
fro example, all the people with hemiplegia completing rehabilitation program
with a particular treatment regimen.
 Unique-case selection: Selection is based on unique or rare attributes, for
example, a person with double lower extremity amputations who becomes an
athlete.
 Reputational-case selection: A case is chosen on the recommendation of
experienced experts, based on its reputation, for example, a highly successful
caregiver support program for persons caring for a spouse with Alzheimer‟s
disease. The program is recommended by an expert in caregiver support programs
because of its excellent reputation.
 Comparable-case selection: Selecting cases on the same relevant characteristics
over a period of time in order to compare results for replication, for example,
selecting a person with hemiplegia who successfully completes a rehabilitation
program, for each month, over a 6-month program.
 Critical case selection: The one case that makes the point dramatically, for
example, a program succeeding in a particularly difficult location, a successful
program with especially low overhead costs, or a rehabilitative program showing
an extremely high success rate with severely disabled clients.
 Convenience sample: The case or cases that can be studied most easily, cheaply,
or quickly, for example, persons with hemiplegia participating in the rehabilitation
program run by the researcher.

Data Collection

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Often, the only data collection “instruments” used during qualitative research are the
investigators themselves. Qualitative researchers generally collect data via
observation, interviewing, and tape recording in the field. Because they are the ones
observing the events and asking the questions, they are considered the data collection
“instruments”. Some of the actual processes of collecting data include observation,
interviewing, filming, photography, and record and artefact review.

Data Analysis
Qualitative data analysis is the process of systematically organizing the field notes,
interview transcripts, and other accumulated materials until you understand them in
such a way as to address the research questions and can present that understanding to
others. Several techniques can be used to analyze qualitative data; the technique
chosen depends on the goal of the study.

Report Writing
Naturalistic reports generally take the form of long narratives, sometimes interspersed
with pictorial presentations. There are many formats to choose from. You will still
need a beginning, middle, and an end.

The beginning:
The beginning portion of the report should include a general background to help
readers understand the focus of your paper. The introduction often concludes with a
description of the design of the rest of the paper. The description should include a
discussion of the research methods and techniques used, the time and length of the
study, the number of settings and subjects, the nature of the data, where and how the
documents were located, researcher-subject relations, checks on data, and other
information that might help the reader evaluate the soundness of your study.

The middle:
The middle of the paper makes up the bulk of the work. This where you argue your
thesis, present your theme, and illuminate your topic. Everything in the core of the
paper should relate to the focus specified in the introduction. The material comes from
the data analysis and can be patterns, themes, and relationships that arose from coding

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and categorizing the data. Use the most salient quotations you can find judiciously to
illustrate the main points of the thesis.
The end:
The end section should be written as a conclusion. Often the focus is decisively
restated, the arguments reviewed, and the implications elaborated.

Exercise 1 and 2

Instruction
Read the two articles on Annex IV-A and Annex IV-B (on pages 50 and 58), and try
to address the following questions.

 Annex IV-A. ‘Disability and Parenting’

What makes the research qualitative? Is the research qualitative?
Exploration in pairs about whether the research outlined in the „Disability and
Parenting‟ proposal is qualitative.

Questions to consider
 Does the research allow respondents to shape the research agenda (questions)
and interview content (responses), e.g. how structured is the schedule?
 What kinds of questions are asked? e.g. are some questions more qualitative?
 Consider whether there is probing, e.g. drawing out of the explanations?
 Is there a set order to the questions?
 Are the interviews transcribed? How long are the interviews?
 How is the analysis conducted, e.g. what is done with the responses/ text?
 What is the theoretical position of the researchers?

 Anne IV-B. ‘Barriers to referral in patients with angina: qualitative study’

Reviewing the quality of a qualitative study

Examination of a published qualitative study in the British Medical Journal
(BMJ), „Barriers to referral in patients with angina: a qualitative study‟, by Katy
Gardner and Alison Chapple.

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 Read this article and make notes about its quality, Address the following issues in
your investigation:
 In what way is the study qualitative?
 Is the sampling frame adequate?
 Are the results valid?
 Are the results generalizable?

4. QUALITATIVE RESEARCH METHODS

Choosing a method depends on:

 Subject under investigation
 Researcher‟s preferences
 Time and money available
 Funders and/or audience

Qualitative methods in applied research, what questions can they investigate?

 Contextual: identifying the form and nature of what exists
- What are the dimensions of attitudes/ perceptions that are held?
- What is the nature of people‟s experiences?
- What needs does the population of the study have?
 Diagnostic: examining the reasons for, or causes of, what exists?
- What factors underlie particular attitudes or perceptions?
- Why are decisions or actions taken, or not taken?
- Why do particular needs arise?
- Why are services or programmes not being used?
 Evaluative: appraising the effectiveness of what exists
- How are objectives achieved?
- What affects the successful delivery of programmes or services?
- How do experiences affect subsequent behaviours?
- What barriers exist to systems operating?
 Strategic: identifying new theories, policies, plans and actions
- What types of services are required to meet needs?
- What actions are needed to make services more effective?

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 - How can systems be improved?
- What strategies are required to overcome identified problems?

The qualitative methods are:

A. OBSERVATION
Observation of behaviours, actions, activities and interactions is a tool for
understanding more than what people say about (complex) situations, and can help
to understand these complex situations more fully.
It can be participative or non-participative, structured and quantitative (with a
checklist, categories to check, rating scales) or unstructured and qualitative (direct
recording of events and stories as they occur). It can be acknowledged and overt
or concealed.
In social science, the definition of observation is not limited to „watching‟ but
extended to the direct gathering of information by the investigator using the
senses, generally both sight and hearing. Observation is a research method in
which the investigator systematically watches, listens to and records the
phenomenon of interest.
Observation does not depend on people being willing to be interviewed or the
existence of accurate and complete documents. It does not depend on the memory
of knowledge of interviewees, or their reporting of attitudes and behaviour – all of
which can be the subject of bias.
Observation has other limitations, however, such as observer bias, the reactive effects
of the observer‟s presence and the impossibility of observing a large random
sample of people, organizations or other units of study.
As the settings for the investigator usually deliberatively chooses the observations, the
sampling technique is purposive. The settings are usually natural, but they can be
laboratory settings, as in psychological research.
Qualitative observations are frequently referred to as ethnography. Ethnography is
derived from anthropology and adheres to the philosophy of phenomenology. It is
based on the need of the investigator to understand the „symbolic world‟ of the
group of interest (the meanings of people develop about their experiences) and the
study of behaviour in natural, as opposed to the experimental, laboratory settings
of, e.g. psychologists. It involves a triangulated approach to research: for example,

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using a combination of unstructured interviews and record research to supplement
and validate the observations.

Participant Observation
It is a qualitative observational technique, which involves the observer
(researcher) in the activities of the group being observed. Events are observed and
recorded, together with the interpretation and explanation of them by the other
„actors‟ (participants). It is the best method for understanding the experiences of
people, and the meanings they attach to them, although the types of observations
are limited by the social role undertaken by the observer.

Concealed Participant Observation (Covert participant observationion)

The participant observer may be honest about his/her role in the group, or may
conceal the investigation and pretend to be a normal member of the group.
Concealment does raise ethical questions in relation to the lack of informed
consent. On the other hand, concealment is sometimes the only way to increase
knowledge about the society. One of the most well known examples is
Rosenhan‟s (1973) participant observation study in the USA, in which the
members of his research team feigned the characteristics and behaviour of people
with a diagnosis of schizophrenia (e.g. „hearing voices‟). They acted as „pseudo-
patients‟ in order to a psychiatric hospital for their observations.
Concealment can also lead to a grate deal of emotional stress on the part of the
observer: the stress of not „fitting in‟, of knowingly creating deception, of
discovery, and even stress owing to the desire to abandon the research and
properly join the group under study.

Overt (Non-participant observation)

Observation and participant observation may be overt. Gaining access to the
desired setting in overt observational studies is potentially a problematic area.
There may be suspicions about academics and their motives among local
communities, as well as feelings of personal and professional threat. Time must be
spent forging links with the community of interest before access can be expected,
and explanations should be offered about how the study can be mutually
advantageous.

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In overt observation, access is usually obtained through negotiations with a
„gatekeeper‟ (e.g. the head of an organization). The first step is writing to the heads
of organizations on the official headed paper about the aims, nature and
confidentiality of the study, and its potential value. This permission is often given
without consulting the members being studied, and the investigator needs to be aware
of this, because the observations then become covert.

Structured Observations: what to record?

The researcher has begun with a conceptual definition, specified what is to be
observed and standardised with a validated measuring instrument, and the proceeds to
make the observations in order to test the theory.

Box: Structuring Observations

 The setting. What is the physical environment like? What is
the context? What kinds of behaviour are promoted or
prevented?
 The participants. Describe who is in the setting, how many
people and their roles. What brings them together and who is
allowed there?
 Activities and interactions. What is going on? Is there a
definable sequence of activities? How do people relate to the
activity and relate to, and interact with, each other?
 Frequency and duration. When did the situation being
observed begin? How long does it last? Is it recurring and, if
so, how often, or is it unique? How typical of such situations
is it?
Subtle factors. Informal and unplanned activities;
symbolic and connotative meanings of words; non-
verbal communication (e.g. dress, space); unreactive
indicators such as physical clues; what does not happen
but should? (Merriam, 1988 in Bowling, 1997).

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“The primary advantage of observational methods is… to gain access to behaviour of
which individuals themselves may provide biased accounts, or indeed be unaware.
However, the primary advantage is that it is particularly labour intensive in terms of
both data collection and analysis” (Fitzpatrick and Boulton, 1996, 124-6).
Note
 Easier to be an observer in a public rather than a private place.
 Need to be in the right place at the right time.
 Can be unproductive and time wasting.
 Observe what people do as well as how they talk about it.
 Observer needs to keep careful field notes.
 Be particularly well in looking at doctor-patient relations and community studies.
(Ethnography: studying human behaviour in its natural context).
 Use structured/ unstructured questionnaires.
 Problems:
- Observer effect (Hawthorne effect)
- Rich data but may be hard to quantify or replicate.

B. INTERVIEWS
There are different types of interviews:
Structured
Standardised questions; closed questions; set order of questions
Semi-structured
Open and closed questions together or the fixed interview guide approach where
agenda set but open questions? Pre-determined questions.
In-depth (Unstructured/focused)
Issues covered in detail; respondent leads the interviews/sets the agenda; no fixed
order? Method of analysis?
In-depth or Semi-structured Interviews
An in-depth interview is a conversion between the researcher and the subject about
the research area or topic. It is designed to allow the respondent to tell their story in
their own way, while ensuring that the aspects the researcher wants to explore are
covered. It also allows the subject matter to be explored in some depth to discover the
nature of the experience, feelings and perceptions of the respondent

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Characteristics of structured questionnaires and semi-structured interviews
Structured Questionnaires Semi-structured Interviews
Asks the same questions of each Allows the respondent to express
respondent using the same wording their ideas in their own way using and
typically has a limited range of their own words and determining
possible answers. the range of aspects and issues
they want to raise.

Conducting an in-depth interview

An interview guide is usually prepared. An interview guide:
 Helps the interviewer to remember the points to cover.
 Suggests ways of approaching and talking about topics.
 Reminds the interviewer about probes and ways of asking questions.
 Includes an introduction and way of ending the interview.
 Ensures that the interviewer covers all the topics.
 Gives a possible order of topics.
 Helps the interviewer to enable people to talk in their own way, and fully as
possible.

Beginning the Interview

The first questions should be designed to put the respondent at ease and to help them
to begin to talk. Asking them to describe their situation or something that has
happened to them will help them to fell they have something to say, and will begin to
give them a clearer idea of the nature of the interview.

The Body of the Interview

The interview then moves into the areas of particular interest to the researcher, and as
the interview progresses the rapport between researcher and respondent develops and
more detailed or sensitive areas may be discussed. The respondent may not talk about
the topics raised in the same order or way that the researcher has anticipated, and
he/she must be prepared to be flexible and to come back to explore in more depth
areas that have been mentioned but not developed by the respondent.

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Ending the Interview
As the interview draws to its close the researcher moves on to less sensitive and more
general matters. The respondent should be reminded again that the interview is
confidential, and the researcher should ensure that the respondent is content with the
way in which the interview has developed.

Reading the Interview

In-depth interviews are usually recorded and then transcribed. The interviewer must
be familiar with the tape-recorded and have sufficient tapes and batteries.
If notes are being made these can be limited to reminders during the interview and
then written up as fully as possible immediately after the event, using the interview
guide as a reminder of the areas covered.

Box: Tips on In-depth Interviewing

 Remember the interview is a conversation, not an interrogation

 Have a naïve curiosity: don‟t assume that you understand what the
respondent means – ask:
- „Can you tell me more about that?‟
- „Can you tell me how you feel about that?‟
- „In what way was that a good/bad experience?‟
 Try to sit an angle to the respondent and maintain eye contact
 Don‟t be thrown if they say something which shocks or surprise you
 Look expectant, and encouragingly, say „that‟s interesting!‟
 Use probes to encourage people to tell you more:
- „What happened next?‟
- „Can you tell me more about…..?‟
- „You said earlier that…could we talk a bit more about that?‟
- „How do you mean?‟
- „In what way?‟
 Embarrassing situations and sensitive issues may be tackled by:
- „What about you? How do you feel about that?‟
- Some people say that…what do you think about?‟

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  Avoid double questions, e.g. „How do you feel about going there with
other people and having to do what they want to do?‟
 Avoid leading questions, e.g. „don‟t you think it would be better if…?‟
 Don‟t sum up what people say: rather, say:
- „Am I right in thinking that you…?
 Don‟t interrupt the flow if they don‟t immediately answer the question,
but don‟t let them stray too far away from the topic – gently bring them
back!
„That‟s very interesting; I wonder if we could now move on to talk about…?

C. FOCUS GROUPS
Focus groups are used as a research method to find out what groups of people think
and how they discuss ideas together. The focus group therefore attempts to recreate a
natural phenomenon: a group of people with something in common discussing an
issue, an experience or an event. A focus group is not used to find out what each
individual thinks or has experienced, but rather how the group discusses the topic
being researched. The group will often be given a task. The group discussion is then
structured to allow the group to discuss the issue before moving on to complete the
task, which may be, for example, to identify the most important point that have been
raised in the discussion, or to prioritise areas for improvement in service provision.
The focus group facilitator prepares a guide to help in structuring the discussion while
allowing the interaction between the members of the group to develop.
A focus group is:
 A group discussion i.e. group discusses views with each other.
 8-10 homogenous group.
 Focused on a particular topic.
 Have members who have something in common.
 Led by a facilitator.
 Time limited.
 Task limited.

Running Focus Groups

Like the in-depth interview, the focus group has a beginning, middle and an end.

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 Beginning - getting people talking, relating experiences and ideas.
 Middle - helping people to focus by asking more specific questions.
 End - completing the group task.

Advantages:
- May encourage people to participate who otherwise may not want to.
- Inter-interviewee ideas.
- May be able to generate breadth quicker than interviews.
- Quick method for establishing parameters.

Disadvantages:
- Some topics may be too „sensitive‟ and too personal.
- Deviant views may be inhibited.

D. DOCUMENT
Documentary evidence
- Independent evidence e.g. medical records, patient diaries.
- May provide an historical context.
- Useful for subjects difficult to study – „inside story‟.
- Autobiographical/ semi-autobiographical material valuable to both researcher
and Health professionals.

What Qualitative Research Methods are Good for?

- Help to explain the social world and some phenomena.
- They can be used to test/examine hypothesis or models.
- They are also useful for comparing the views of social groups. E.g. to understand
the perspectives of two groups such as doctors and patients on an issue.
- Helps to study social networks, or the interconnection between people in a
community.
- Ethnological techniques can be used to study the impact of social events.
- Sociological phenomena, such as medical pluralism, i.e. the idea that patients can
simultaneously participate in allopathic medicine and other alternative techniques
such as homoeopathy.

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 - The whole phenomenon of „deviance‟ (in its sociological sense) is best studied by
qualitative techniques.
- Particularly suited to understanding groups of people and their behaviour, in
addition to that of individual people. Thus they can be used to understand the
behaviour and needs of particular subgroups of society, such as single parents, the
elderly, ethnic minorities, and even such sociologically bizarre groups as doctors.
In short qualitative methods are good to:
 Study of explanatory models (e.g. Health Belief Model)
 Comparing different perspectives of different groups (e.g. doctors and patients)
 Identifying social networks
 Assessing the social impact of events
 Studying medical pluralism
 Study deviance (e.g. non-compliance)
 Understanding behaviour of social groups.

Examples of Qualitative Research Methodologies.

Perhaps one of the original methods that are exclusively qualitative is that of
„participant observation’, and is particularly associated with the early development of
anthropology as a discipline.
Originally it involved the anthropologists going and living in the social world of others
who he/she sought to understand, typically in those days „undiscovered‟ African
tribes. By „immersing‟ him- or her in the social world of the subject tribe, the
anthropologists would be able to understand the culture in greater depth than would
be possible from any lesser degree of involvement. Field notes, transcripts of
conversations and cultural artefacts, along with explanations of their meaning to the
tribe and so forth, constituted the ‘data’.
Observation is never either entirely participant- one can never actually go completely
native- or entirely non-participant, in that to gain people‟s trust sufficiently to
understand them one must to some degree give up one‟s objective stance.
Thus, participation or non-participation in sociological observation is never absolute, but
it is always just a matter of degree.
Qualitative research, including both participant and non-participant observation, will
usually involve some interviews.

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Interviews are usually classified as structured, in-depth (unstructured), and semi-
structured. There is no such thing as a totally unstructured interview, as the
participants structure all interviews in real time, either consciously or unconsciously.
‘Focused interview’ is another term you will hear which suggests more rather than
less structure.
Some other methodologies are
- Ethnology: the actual study of peoples and culture.
- Ethnography: the description of peoples and culture.
- Ethnomethodology: encompasses some of the methods used.
All derived from the Greek ethnos, meaning nation. It is the same word that give rise
to the more commonly word ‘ethnic’, referring to a supposedly culturally
homogenous group.
There is a host of other terms that describe various aspects of the qualitative research
tradition. Many depend on the analysis of artefacts, usually written such as archives,
literature, reports, etc. Such documentary materials is analysed using techniques
broadly described as ‘contents analysis’.
Other methods rely rather more on oral accounts and histories, sometimes described
as ‘narratives’.
Other less familiar and conceptually more difficult terms include phenomenology,
hermeneutics and Grounded theory, etc. Grounded theory looked at more detail and it
is a very common methodology approved by health service researchers.
In summary, some examples of qualitative research methods are:
 Participant Observation
 Non-participant observation
 Unstructured Interviews
 Semi-structured interviews
 Focused interviews
Methodologies are:
 Ethnology
 Ethnography
 Pathography (= the skill of ethnography applied to the particular context of
medicine)
 Content analysis

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 5. DATA COLLECTION AND DATA ANALYSIS IN QUALITATIVE
RESEARCH: FRAME WORK APPROACH AND GROUNDED THEORY

Aims of qualitative data analysis:

 Qualitative data is text from observation notes, in-depth interviews, or
documentation.
 Produces a large volume of data (an interview is 20 plus pages and 6 hours
transcription).
 Researcher aims to provide a coherence and structure.
 Detection concerns defining, categorizing, theorising and mapping.
 Balance between external and internal: maintain context and richness.
 Analysis is in and out of the field: it is a process not a stage.
 Analysis needs to be explicit: researcher as instrument idea.

Characteristics of qualitative data analysis:

 Analysis begins as soon as the first data are collected.
 Analysis is systematic but not rigid.
 Analytical notes are recorded during data collection.
 Need to keep sense of the whole.
 Not a mechanical process – interpretive.
 Analysis relies on cutting, sorting and pasting.

The goal of analysis: it has to go beyond descriptive summation… it needs to establish

meaning… and reach for explanation.
In qualitative research data collection data analysis are interwoven. In much qualitative
research the analytical process begins during data collection as the data already
gathered are analysed and shape the ongoing data collection. This sequential analysis
has the advantage of following the researcher to go back and refine questions, develop
hypotheses, and pursue emerging avenues of inquiry in further depth. Crucially, it
also enables the researcher to look for deviant or negative cases; that is, examples of
talk or events that run counter to the emerging propositions or hypotheses and can be
used to refine them. Such continuous analysis is almost inevitable in qualitative
research.

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The two main approaches to data collection and data analysis are:
a. Framework- practical and quicker
b. Grounded Theory- more theoretical, sociological and extensive.

Framework Analysis
 Used to analyse in-depth and focus group data.
 Facilitates systematic analysis.
 Based on content analysis method.
 Involves summarizing and classifying data within a thematic framework (code
book).
 Relies on „skills‟ of the analyst.

The five stages of Framework Analysis:

Stage I. Familiarization
 Fresh look at the data as analyst rather than collector.
 Gain an overview of the data collected.
 Need to see the data (listening to tapes/reading transcripts)
 Selection of interviews to ensure full range if time limits.
 Make notes on key ideas and recurrent themes.

Stage II. Identifying a thematic framework

 Return to notes made in the familiarization stage and any reading/literature
review.
 Pull together the key issues, concepts and themes that are noted.
 Refer to the topic guide for (a priori) structure.
 Draw up a thematic framework (or code book).
 Construct an index, which draws on priori issues and emergent themes –
inductive.
 Refine as they are applied to the data.

Stage III. Indexing

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 Process of systematically applying the thematic framework to the data.
 Provides a mechanism for labelling data.
 Makes data manageable.
 Keep index broad at first.
 Make in pencil initial categories in the margins of each transcript.
 Be flexible about categories.
 Indexing ensures process of analysis is visible to others.

Stage IV. Charting

 Need to build picture of the data as a whole.
 Use A3 paper: Data is lifted out of the text and put into a thematic reference.
 On the left mark the interviewees with brief relevant demographic details.
 Use codes for interviewee‟s names where possible.
 Along top of chart mark the sub-categories. Put the title of the chart along the top.
 Summarise sections from transcripts into relevant boxes.
 Highlight good quotes/interesting comments.
 Don‟t try to write too much in a box/can refer back.

Stage V. Classifying and interpreting qualitative data

 Conceptual definition.
 Form and nature of the phenomena: processes; systems; attitudes; behaviours;
decisions and judgements.
 Creating typologies.
 Finding associations between attitudes and behaviour; experiences and attitudes;
circumstances and needs.
 Providing explanations (explicit or implicit).
 Developing/ identifying strategies, ideas, theories/hypothesis.

Grounded Theory
The grounded theory is a method for discovering theories, concepts, hypothesis, and
propositions directly from data, rather than from prior assumptions, other research, or
existing theoretical frameworks.

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In social science it is common to use „grounded theory‟ approach in qualitative
approach. This refers to a process of discovering theory from data that have been
systematically gathered and analysed: „generating a theory from data means that most
hypothesis and concepts not only come from the data, but are systematically worked
out in relation to the data during the course of the research‟ (Glaser and Strauss
1967). It is a theory that is inductively derived from the study of the phenomena it
represents rather than deductive. Thus data gathering, analysis and theory have a
reciprocal relationship. In social science, where it is not always possible to control the
conditions under which social phenomena are observed, there is greater need to build
theory inductively from several observations before a predictive, explanatory theory
can be derived.

Grounded theory is frequently used in research:

- “To denote an approach to data analysis in which theory has emerged from the
data. Rarely is there a genuine interweaving of data collection and theorising …”
(Bryman and Burgess, 1994:6).
- “As a general indicator of the desirability of making theory from data, rather than
a guide to a method of handling data”. (Richards and Richard, 1994:149).

Defining the Grounded Theory Approach

“The Grounded Theory Approach encourages the initiation of research without any
preconceived theoretical ideas about the topic being researched (such as patient care
in hospitals) or the findings that might result from such research. The aim is to
develop theory and concepts from the data as the research unfolds. Obviously,
researchers cannot rid themselves of all preconceived notions, but the point of
grounded theory is to encourage the researcher to be as flexible as possible when
interpreting the findings of the research. In this respect, the researcher should adopt
theoretical ideas which fit the data collected during the research rather than collecting
data that fit a pre-conceived hypothesis or theoretical idea” (Layder, 1993).

Grounded Theory: how inductive is it?

“It is inductive in so far as understandings, categories and theory are developed
directly from the data, rather than through approaching the data with predefined
constructs to investigate and hypotheses to test. However, as analysis proceeds, the

33
researcher actively seeks to develop understandings and hypotheses as to what is
going on and how it is ordered. This stage is essential in developing a theory of the
phenomenon. These ideas are then tested deductively through further data collection
and analysis. Thus, doing grounded theory involves a sequence of deductive and
inductive thinking throughout the process. The inductive label is often given to
grounded theory because of its emphasis on the principle that all aspects of this
process must be grounded in the data.” (Murray and Chamberlain, 1999: 184.

Stages of collection and analysis in Grounded Theory

Data collection (sampling) and analysis occur simultaneously so that each stage of
data analysis has a different form of sampling. There are three stages:

Stage I. Open sampling and open coding

Text is broken into this first stage and sampling is preferably systematic but
sometimes fortuitous to obtain data are relevant to the research question.

Sampling is about the explicit generation of information to refine and develop theory
rather than the notion of randomness or representation.

Saturation of the theory is when no new categories are found which relate to the
central issue or process being researched, and the theory can account for all the data
that have been obtained (check by examining the negative instances).

Stage II. Purposive sampling and axial coding

Purposive sampling is about locating more data to confirm/ elaborate categories,
identify relationships or suggest limits to their applicability. Analysis is axial coding –
categories are refined, developed and related to one another.

Coding: The process of making the data manageable by classifying into topics and
sub topics and attaching labels to concepts and themes that appear in the data.
- A priori labels – are those that are formulated before the research has begun.
- Inductive codes – emerge out of the process of analysis and collection of data.

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 Constant comparative method
Involves comparing incidents, informants or categories systematically for differences
between them. This will promote the identification of the properties of the categories
(for example when does this category not apply), and also of the links between
properties. Constant comparative method interweaved with other processes such as
memo writing, questioning and hypothesis testing. It is a method of generating theory.

Stage III. Discriminate sampling and selective analysis

Deliberate and directed selection of further data from persons, sites or documents to
confirm that the theoretical account is saturated. Core category is identified and
related to the other categories.

Theory Development
A. Analytical questioning
Early stage questioning:
What is the event characteristic of?
Whom does it apply to?
Where does it occur? Why is
it happening?

Later stage questioning:

What does this incident reveal? What
does it mean?
How does it relate to other incidents? Does it
apply to all informants?
Is it specific to one kind of setting?
Questioning moves from the specific to the abstract as data analysis proceeds. Researcher
is developing theories about the properties of the categories and the relationship
between them.
B. Memo writing and diagrams
Memos: long hand notes of ideas, interpretations and hypothesis written during the
fieldwork and analysis. Provides an opportunity for the researcher to engage with the
material and examine emergent properties.

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Diagrams: visual representations of the analysis, which provide an overview of it.
Assists in identifying relationships between categories and showing where there are
theoretical gaps.

C. Core categories
The predominant category is the category that ties all other categories together. It can
account for the wide variation in the phenomenon and links all the categories together.
Often it is a social process and typically only one in a Grounded Theory analysis.
Examples:
Normalcy - Aftermath of coronary artery bypass surgery (Keller, 1991)
Taboo – Patients experiences of dying with cancer (Exley, 1999)
Stigma – Mental health problems (Glaser and Strauss).

Level of abstraction in Grounded Theory: substantive or formal?

 Substantive Theory is theory “developed for a substantive area such as patient
care, race relations, professional education, geriatric lifestyles, delinquency or
financial organizations”.
 Formal Theory is “developed for a formal or conceptual area of sociological
inquiry such as career, status passage, stigma, deviant behaviour, socialization…”
(Glaser and Strauss, 1971: 177-8).
Formal Theory develops out of substantive theory.

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6. ASSESSING QUALITY IN QUALITATIVE RESEARCH

Some questions about quality that may be asked of a qualitative study:

 Are the processes of data collection adequately described?
Sampling: Did the sample include the full range of possible cases or settings so that
conceptual rather than statistical generalisations could be made (i.e. more than
convenience sampling)? If appropriate, were efforts made to obtain data that might
contradict or modify the analysis by extending the sample (for example, to a different
type of area)?

Data collection and analysis: Were the data collection and analysis procedures
systematic? Did the analysis incorporate all the observations? To what extent did the
analysis develop concepts that explained observations? Was it possible to follow the
iteration? Did the researcher search for disconfirming cases? Is evidence provided in
support of the analysis? Is sufficient original material presented?

Reflexivity of the account: Did the researcher assess the likely impact of the
methods used on the data obtained? Was sufficient data included in the reports of the
study to provide evidence for the conclusions that were drawn? (Mays and Pope
(2000). Assessing quality in qualitative research).
 Worth or relevance: was this piece of work worth doing at all? Has it contributed
usefully to knowledge?
 Clarity of research question: if not at all the outset of the study was it clear by
the end? Was the researcher able to set aside his/her research pre-conceptions?
 Appropriateness of the design of the question: would a different method have
been more appropriate? For example, if a causal hypothesis was being tested, was
a qualitative approach appropriate?
 Context: is the context adequately described so that the reader could relate the
findings to other settings? Is there evidence that supporting material is
representative? Is there evidence to establish validity? Is there evidence of efforts
to establish reliability? Is the study set in a broader context?

Why Qualitative Methods are suited to Primary Care Research?

 Focus on people as social beings rather than as physiological systems

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  Shared concern with the meaning of events for people
 Holistic approach
 Small numbers are acceptable
 Depth understanding may be acquired over time
 Access to „private worlds‟.

Why the good GP is already an Ethnographer?

 Uses case histories as main investigative tool
 Takes a social and personal history
 Allows patients to express the meaning of events
 See patients in their cultural context
 Already belongs to the community under study
 Open-minded (few preconceived notions)
 Used to unorganized illness
 Open to the unexpected.

Exercise 3: Choosing the appropriate method

In pairs consider the following scenarios and consider how you would conduct some
qualitative research with group and the pros and cons of using interviews, observation
or focus groups with each:

 Children‟s experiences of asthma clinics

 Women‟s experiences of undergoing cervical smear tests

 Multiple Sclerosis patients‟ difficulties of accessing dental health services

 GPs perceptions and experiences of providing care for refugees and asylum
seekers.

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 7. QUALITATIVE VERSUS QUANTIATIVE RESEARECH APPROACHES

The following summarized points will help the researcher to compare and decide which
type of research method to choose for his/her study.

A. Purpose
Quantitative: The purpose is theory testing: to establish facts, show causal explanations
and relationships between variables, allow prediction, and strive for generalizability.

Qualitative: The purpose is to develop concepts that will sensitize readers to different
cultures, describe multiple realities and interpretations, develop grounded theory, and
develop an understanding of the perspectives of the actors and of that particular
setting.

B. Designs
Quantitative: The designs are predetermined and structured, and do not change during
the course of the study; they are formal and specific according to a defined plan of
operation.

Qualitative: The design fall at the other end of the spectrum. They are general in nature
rather than confined, evolving through out the study and remaining flexible to allow
for change; they are used as a “hunch” as to how to proceed.

C. Data
Quantitative: The data gathered in quantitative research designs are quantifiable and
statistical, using counts and measures. Variables are defined ahead of time, and data
are managed according to the procedures outlined in the research proposal.

Qualitative: Data gathered in qualitative designs are descriptive and deal with qualities.
They may consist of field notes, artefacts, people‟s own words, personal documents,
or official documents. Qualitative data are extensive and difficult to manage. Their
management requires specific techniques, just as numerical data do.
- Qualitative research can produce vast amount of data. These may include:

39
  Verbatim notes or transcribed recordings of interviews or focus groups,
 Jotted notes and more detailed “field notes” of observational research,
 A diary or chronological account, and
 The researcher‟s reflective notes made during the research.

- Transcripts and notes are the raw data of the research. They provide a descriptive
record of the research, but they cannot provide explanations. The researcher has to
make sense of the data by sifting and interpreting them.

Collecting the Data

Qualitative data are often relatively unstructured: they come in the form presented by the
subjects of the research, rather than being pre-packaged by the researcher. The
researcher needs flexibility and adaptability to respond to the research subjects, rather
than imposing a structure upon them. The researcher is, in effect, creating a natural
situation, be it a conversation or a group discussion or observing a natural situation, in
order to collect the data. Qualitative data come in many forms, and the ways of
collecting are limited only by the researcher‟s imagination and skill. They include:
 Semi-or unstructured interviews, individual or group
 Stories, poems
 Diaries
 Documents, reports, minutes
 Observations of situations and events, participant or non-participant
 Videos, pictures, photographs
 Others!
The two most commonly used of these sources of qualitative data are in-depth
interviews and group interviews, often called focus groups.

D. Subject Samples
Quantitative: The subject samples tend to be large, requiring random selection to yield
precisely defined subjects who will be typical of those in the population. There is
usually a control group to control for extraneous variables.

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Quantitative enquiry:
Purpose: forecast, estimate population parameters, identify trends; explore
correlation and causation, indicate frequency, and make statistical inferences.
Achieved by: using random, probability samples; large samples, minimize sample
error, increase confidence; statistical representatives.

Qualitative: The group of participants is small and may be non-representative of the

larger group. Sometimes researchers stratify their participant selection in order to
sample people with different roles or status in the community.
 Theoretical determinants (not a „rag bag‟).
New cases must continue to provide new insights. Informational needs guide the size.
 Practical considerations (controlled sampling).
What do you want to know?
The nature and diversity of the target sample.
Available time and resources.
 Optimum size
Range between 20-60 interviewees. When designing think of lower and upper limits.
Qualitative enquiry:
Purpose: in-depth illumination and explanation, representation.
Achieved by: using purposeful selection of information rich cases; study in-depth.

E. Investigator’s Relationship with Subjects

Quantitative: The quantitative researcher has circumscribed contact with the subjects
on a short-term basis. He/she is detached and distant, keeping the roles of researcher
and subject distinct. The researcher‟s role is to observe and measure, and care is taken
to prevent the researcher from influencing the data through personal involvement with
the research subjects. It is of utmost concern that the researcher be objective.
Qualitative: The investigator usually has intense contact with participants over a
long period of time. There is an emphasis on trust. The informants are viewed as
participants in an egalitarian relationship, and the investigator may empathize with the
informants and their situations.

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F. Techniques or Methods
Quantitative: Those used in quantitative methods include experiments and quasi-
experiments, structured surveys, structured interviewing (market research),
structured observation/ formal observation (quantifiable boxes), data sets,
manipulation, control and statistical analysis of data.

Qualitative: Techniques used in qualitative methods include observation,

participant observation, reviewing documents and artefacts, open-ended/ informal
interviewing, in-depth interviews, focus groups, coding, searches for patterns,
pattern matching, and narrative and displays for portrayal of data.

G. Instruments and Tools

Quantitative: The instruments and tools for data collection used in quantitative
studies are varied and can be quite complicated. They may consist of scales and
tests, inventories, questionnaires, or various types of hardware.

Qualitative: The researcher is often the only “tool” for data collection. He/she may
make use of guiding questions, as in an interview, as well as using mechanical tools
such as audio or video tape recorders and a transcriber.

H. Data Analysis
Quantitative: Data analysis occurs at the conclusion of the data collection in a
quantitative study. It tends to be deductive and tends to use statistical manipulation
in accordance with the proposal guidelines. It is a straightforward operation that is
often complicated rather than speedily.
A fundamental difference is that the quantitative researcher seeks evidence to prove
or disprove hypothesis that were developed before the study.

Qualitative: On the other hand, data analysis is ongoing throughout qualitative

studies, using a constant comparison method. Data are analyzed as they are
gathered, then reanalysed in the light of new information, in a recursive manner.
Qualitative data analysis is inductive in nature and addresses models, themes, and
concepts. Techniques such as coding, memoing, event listing, pattern- matching,
charting, matrices, and triangulation may be used.

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 In qualitative data analysis theory is built as the data are grouped and analyzed –
theory emerges from the bottom up.
In much qualitative research the analytical process begins during data collection as
the data already gathered are analysed and shape the ongoing data collection. This
sequential analysis has the advantage of following the researcher to go back and
refine questions, develop hypotheses, and pursue emerging avenues of inquiry in
further depth. Crucially, it also enables the researcher to look for deviant or negative
cases; that is, examples of talk or events that run counter to the emerging
propositions or hypotheses and can be used to refine them. Such continuous analysis
is almost inevitable in qualitative research.
The analysis:
 In general, qualitative research does not seek to quantify data. Simple counts are
sometimes used and may provide a useful summary of some aspects of the
analysis.
 Qualitative sampling strategies do not aim to identify a statistically
representative set of respondents.
 In most qualitative analysis the data are preserved in their textual form and
“indexed” to generate or develop analytical categories and theoretical
explanations.
 Qualitative research uses analytical categories to describe and explain social
phenomena. These categories may be derived inductively, i.e. obtained gradually
from the data- or used deductively, either at the beginning or part way through
the analysis as a way of approaching the data. Deductive analysis is less common
in qualitative research.
The term grounded theory is used to describe the inductive process of identifying
analytical categories as they emerge from the data (developing hypothesis from the
ground or research field upwards rather defining them a priori).
 All the data relevant to each category are identified and examined using a process
called constant comparison, in which each item is checked or compared with the
rest of the data to establish analytical categories. The key point about this process
is that it is inclusive; categories are added to reflect as many of the nuances in the
data as possible, rather than reducing the data to a few numerical codes.

43
  Analysing qualitative data is not a simple or quick task. Done properly, it is
systematic and rigorous, and therefore labour-intensive and time consuming.
 Good qualitative analysis relies on the skill, vision and integrity of the researcher
doing that analysis.

I. Outcome
Quantitative: Quantitative research studies will answer specific research questions by
producing statistical evidence to prove a point. While the researcher certainly
discusses the findings, there is in common saying that the data, meaning the statistical
outcomes, speak for themselves.

Qualitative: The outcome of qualitative research, more often than not, is a lengthy
descriptive document, presenting the data in words than rather than numbers. The
write-up is rich, textural, anecdotal, and full of thick description in narrative form.
The final analysis provides either verifications of an existing theory or new-grounded
theory, together with well-formulated research questions that now need to be
investigated.

J. Problems
Quantitative:
a. The researcher may have difficulty controlling variables that will affect the
study;
b. The study‟s validity may be called into questions, as some may feel
that highly controlled experimental studies have little relevance to real
life;
c. Obtrusiveness the investigator and data collection methods may affect the
subjects or environment; and
d. The researcher (or readers) may be tempted to rectify the topic variables- that is
to regard these abstractions as if they were material things.

Qualitative:
a. The non-standardization of procedures;
b. The difficulty of managing large amounts of data and data reduction methods;
c. The extremely time-consuming nature of the whole process; and

44
 d. The difficulty of using naturalistic methods to study large populations.
K. Other Points

Quantitative:
What does quantitative research involve?
 How often? – How many Xs are there?
 Collects numbers e.g. the X% of pregnant women smoke and X% of people
would like to give up.
 Begins with idea/hypotheses
 By deduction allows conclusions to be drawn
 Strength is reliability (repeatability).
 Available data, e.g. official statistics (Census, GHS= general health survey)
 Experiments, e.g. RCT = randomised control trial
 Surveys – Cross sectional (GHS)/ cohort
- most common social research tool
- large number of people can be questioned relatively quickly
- results are easily quantified and analysed
- limited application (simple factual information but not able to extract meanings).
 Reliable: measure consistently. Reliability through standardized tools, focus
on measuring patterns of behaviour
 Valid: measure what they are claiming to measure
 Standardise: published questionnaires with established properties of validity
and reliability.

Qualitative
What does qualitative research involve?
 What? Why? How?
 Collects words, e.g. “I can‟t cope with the stress of giving up smoking”.
 Generates ideas, hypothesis and future research questions
 Often inductive
 Strength is validity – closeness to the truth. Validity focus on how people
behave, what people actually mean when they describe their behaviour/ attitudes.

45
  Aims to make sense of phenomena in terms of the meanings that people bring to
them.
 Develop concepts to help understand social phenomena in a natural setting.
 What stops people giving up smoking?
- Need to listen to what people have to say, understand their perspective.
- Emphasises meaning, experience and views of respondents.
 Able to uncover information which is difficult to get at
 Focus on meaning of individuals‟ or organizations‟ behaviour
 Explores respondents‟ own experience
 Data = rich in detail
 Closer to the respondents‟ perceived world
 Giving people a voice
 Does not produce quantified answers.

Features that Qualitative and Quantitative Methods Have in Common

Attempt to be „scientific‟, by which it is meant that they seek to produce, by an approach
that strives very hard to steer clear of sources of error, an understanding of
phenomena that is reasonably true and trustworthy.
One of the cardinal features of both approaches is the quest for rigour in method and
interpretation, and the consciousness that truth is never absolute but always to
challenge, as long as the same standards of scientific rigour are applied.
Corresponding terms describing trust worthiness of quantitative and qualitative research,
and all-embracing terms relating to the rigour under pinning all research.

Quantitative Research All-embracing Term Qualitative

Validity Veracity Credibility
Reliability Consistency Dependability
Objectivity Neutrality Conformability
Generalizability Applicability Transferability

Thus, corresponding to the concept of reliability there is the concept of dependability, and
corresponding to the concept of validity is the concept of credibility. The means

46
to these ends are also described, and include such techniques as triangulation deriving
(data from several perspectives or sources).
It is most important to understand that qualitative and quantitative researches are
rather complementary approaches, which when used together, will usually reveal
more about the world and how it works than will either used alone. Certain topics
lending themselves more naturally to one or other approaches.
The kind of knowledge produced by such different endeavours is different, but neither
type is any absolute sense superior or inferior to the other, and in the progress of
medicine, as was stressed in the introduction, both types of knowledge are required.

Both approaches use different kinds of data:

 Primary: data generated by the researcher
 Secondary: sources already available e.g. previous research, documentary
evidence.

How does qualitative work complement quantitative research?

‘Ground work’
 Interviews, observation => description and understanding
 Help formulate a hypothesis
 Generate questions for a questionnaire
 Check out terms being used for sense.
 Triangulation
 Three or more methods used and results compared for convergence
 Comprehensiveness.

In summary:
 Both approaches now widely used in health services researches.
 Understanding social research methods is important for appraising published
research.
 Be wary of artificially dividing qualitative and quantitative research.
 Important to use the right method for the research question.

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 Exercise 4. ‘The Warring Paradigms’
Aim: To consolidate and apply your understanding of the main features of qualitative
and quantitative methods.

The Task: You will be given a table showing the features of qualitative and quantitative
approaches. This table will be incorrect. It is your task to re-shuffle the answers so
that they are in the right places. Individually select the appropriate answer for each of
the boxes in the table.

Logical Positivist, Naturalist, Interpretivist,

Scientific, Quantitative, Qualitative
Positivism
Aims Generating hypothesis/ describing Testing hypothesis/ generalising
Purpose Discovery Verification
Approach Top-down Bottom-up
Preferred Quantitative Qualitative
Technique
Research strategy Un-structured Structured
Stance Reductionist/ inferential/ Expansionist/exploratory/inductive/process-
hypothetico-deductive/outcome oriented/intuitive
oriented/rational
Method Observing/ participant observation, Counting/ obtrusive and controlled
interviewing, action research, case measurement, surveys, experiments,
studies, focus groups structured observations, statistical records
Implementation of Decide in field setting Decided a priori
method
Values Value-free Value-bound
Instrument The researcher Physical device/ pen and paper
Researcher’s stance Outsider Insider
Relationship of Close/ interactive and inseparable Distant/ independent
researcher and
‘subject’
Setting Laboratory Nature
Data Rich, deep and valid Hard, reliable and replicable
Data analysis Specified in advance Worked out during the study

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Analytic units Patterns and natural events Pre-defined variables
Quality criterion Rigour/ proof/ evidence/ statistical Relevance/ plausibility/ illustrativeness/
significance responsiveness to subjects‟ experiences
Source of theory A prior/ confirmation/ rejection Grounded/ emergent
Nature of truth Only time and context bound Time and context-free generalizations are
statements working hypothesis are possible possible
Image of reality Multiple, holistic, dynamic, Singular, tangible, static, external
socially constructed
Research product Stress the validity of research Stress meaningfulness of research findings
findings for scholarly community to both scholarly and user communities

8. RESEARCHER EFFECTS
The researcher can affect the findings of a qualitative research study in four ways:
A. Program participants behaving differently because of the presence of the
researcher. There may be a “halo effect” so that staff perform in an exemplary
manner, or there may be so much tension and anxiety that staff perform below par.

B. Investigators becoming personally involved with participants during the

study. Should this happen, researchers may lose their sensitivity to the full range of
events occurring in the setting.

C. Researcher predispositions or biases. Researcher biases definitely influence data

interpretations, particularly because the outcome of a qualitative study is presentation
of perspective. Qualitative research is subjective by definition. It contributes to the
quality of the observations made by the investigator and allows the investigator to
employ the phenomenological approach desirable in most qualitative research.

D. Researcher competence: Competence can be demonstrated by using the

verification and validation methods listed earlier to establish the quality of the data
analysis; by showing fairness and responsibility in the write-up; and by not going
overboard in the interpretations of the findings.

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GLOSSARY

Archives ongoing records maintained by institutions within society.

Bias deviation in one direction of the observed value from the true value of
the construct being measured (as opposed to random error).
Case a single unit in a study (e.g. a person or setting, such as clinic,
hospital).
Case Study a research method, which focuses on the circumstances, dynamics and
complexity of a single case, or a small number of cases.
Closed question the question is followed by predetermined response choices into
which the respondent‟s reply is placed.
Coding the assignation of (usually numerical) codes to each category of each
variable.
Content analysis the systematic analysis of observations obtained from records,
documents and field notes.
Coping the cognitive and behavioural efforts to manage the internal and
external demands of the stressful situation.
Ecological studies research where the unit of observation is a group of people
rather than an individual (e.g. schools, cities, nations).
Empirical based on observation.
Empiricism a philosophical approach that the only valid form of knowledge is that
which is gathered by use of the sense; explanation should be based on
actual observations, rather than theoretical statements.
Ethnography the study of people in their natural settings; a descriptive accounts of
social life and culture in a defined social system, based on qualitative
methods (e.g. detailed observations, unstructured interviews, analysis
of documents). This method is used by anthropologists.
Ethnomethodology a method for the study of a cultural group (ethno), and more
specifically meaning the methods of the people; the study of how
people use social interaction to make sense of situations (to create their
„reality‟).
Field research, research which takes place in a natural setting.

50
Focus groups a research method of interviewing people while they are interacting in
small groups.
Grounded theory the investigator develops conceptual categories from the data and
then makes new observations to develop these categories. Hypotheses
are derived directly from the data.
Holistic the phenomenon of interest is viewed in terms of the relationships
between each level of the system. Holism identifies the whole of the
social system as more than the simple sum of individuals within it.
Holism is at the centre of sociological theory.
Hypothesis a tentative solution to a research question, expressed in the form of a
prediction about the relationship between the dependent and
independent variables.
Hypothetico-deductive method beginning with a theory and, in a deductive way,
deriving testable hypothesis from it, the hypothesis are then tested by
gathering and analyzing data and the theory is supported or refuted.
Information bias misclassification of, for example, people‟s responses due to error
or bias.
Interpretive approach the theoretical perspective that social scientists must
include the meaning that social actors give to events and behaviour;
symbolic interactionists and ethnomethodologists hold interpretive
perspectives and subscribe to the philosophy of phenomenology.
Interview a research method, which involves a trained interviewer asking
questions and recording respondents‟ replies. Interview questions can
be structured (printed on a questionnaire with set question wording and
pre-coded response categories), semi-structured (mostly open-ended
questions, i.e. with no pre-coded response categories) or unstructured
and in-depth (listed topics about which interviewers probe respondents
for their views and experiences).
Leading question question phrased in a way, which leads the respondent to believe
that a certain reply, is expected.
Naturalistic research descriptive research in natural, unmanipulated, social settings
using les obtrusive, qualitative method.
Need includes felt need (want), expressed need (demand), normative need
(experts‟ definitions which can change over time in response to

51
 knowledge) and comparative need (comparisons with others and
considerations of equity).
Observation a research method in which the investigator systematically watches
listens to and records the phenomenon of interest.
P value P is the symbol of probability associated with the outcome of a test of a
null hypothesis (i.e. the probability that an observed inferential statistic
occurred by chance, as in P<0.05); p (small p) is used for proportions.
Statistical tests exist which, in appropriate study designs and samples,
can test for the probability of observing the values obtained.
Paradigm a set of ideas (hypothesis) about the phenomena under inquiry.
Paradigm shift this occurs, over time, evidence accumulates which refutes, or is
incompatible with, the paradigm, and thus the old paradigm is replaced
by the new one.
Participant observation a research method in which the investigator takes part in
(i.e. has a „role‟ in) the social phenomenon of interest.
Perspective a way of interpreting empirical phenomena.
Phenomenology the philosophical belief that, unlike matter, humans have a
consciousness. They interpret and experience the world in terms of
meanings and actively construct an individual social reality.
Phenomenological sociology based on the concept of social structure of reality
through the social interaction of people (social actors), who use
symbols to interpret each other and assign meanings to perceptions and
experiences.
Positivism aims to discover laws using quantitative methods and emphasises
positive facts. It assumes that human behaviour is a reaction to (i.e.
determined by) external stimuli and that is possible to observe and
measure social phenomena, using the principles of the natural scientist,
and to establish a reliable and valid body of knowledge about its
operation based on empiricism and the hypothetico-deductive method.
Precision the ability of a measure to detect small changes in an attribute.
Prospective study collection of data over the forward passage of time (future).
Qualitative research social research, which carried, out in the field (natural settings)
and analysed largely in non-statistical ways.

52
Quantitative research the measurement and analysis of observations in a numerical
way.
Random error the errors in the study (usually from the sampling) randomly vary
and sum to zero over enough cases; random error results in an estimate
being equally likely to be above or below the true value.
Random sampling this gives each of the units in the target population a calculable
and non-zero probability of being selected.
Randomisation assignment at random of people to experimental and control groups
in experiments.
Reactive (Hawthorne) effect a guinea pig effect (awareness of being studied). If
people feel they are being tested they may feel the need to create a
good impression, or if the study stimulates new interest in the topic
under investigation then the results will be distorted.
Relativism no single system of knowledge or beliefs (or „social facts‟) exists; it is
dependent on context (i.e. culture).
Reliability the extent to which the measure is consistent and minimises random
error (its repeatability).
Research design this refers to the strategy of the research - how the sampling is
conducted, whether a descriptive or experimental design is selected,
whether control groups are needed, what variables need to be
operationalised and measured, what analysis will be conducted.
Research methods, or techniques these are methods of data collection – interview,
telephone, postal surveys, diaries and analysis of documents,
observational methods and so on. They are also the instruments to be
used.
Responsiveness a measure of the association between the change in the observed
score and the change in the true value of the construct.
Sample a subset of a population.
Sampling techniques used to obtain a subset of a population without the expense
of conducting a census (gathering of information from all members of
a population).
Sampling distribution the distribution of means of all possible different samples of
n observations that can be obtained from this population. It has a mean

53
 equal to the population mean. It is a normal distribution (assuming the
sample size is large enough).
Sampling error any sample is just one of an almost infinite number that might have
been selected, all of which can produce slightly different estimates.
Sampling error is the probability that any one sample is not completely
representative of the population from which it was drawn.
Sampling frame a list of the sampling units from which the sample can be drawn.
Selection bias bias in the sample obtained.
Sensitivity ability of the actual gradations in the scale‟s scores to reflect these
changes adequately; probability of correctly identified affected
person („case‟).
Sensitivity analysis a method for making plausible assumptions about the margins
of errors in the results, and assessing whether they affect the
implications of the results. The margins of error can be calculated
using the confidence intervals of the results or they can be guessed.
Simple random sample a probability sampling method that gives each sampling
unit an equal chance of being selected in the sample.
Social stratification the structured inequalities that exist between social groups
owing to the unequal and systematic distribution of rewards and
resources.
Specificity a measure of the probability of correctly identifying a non-affected
person (i.e. „non-case‟) with the measure.
Standard deviation this is the most common measure of dispersion. It is based on
the difference of values from the mean value (the spread of
individuals results round a mean value); it is the square root of the
arithmetic mean of the squared deviations from the mean.
Standard error this a measure of the uncertainty in a sample statistic; the standard
deviation of the sampling distribution is called the standard error. It
is related to the population variation. The standard error of a mean
is the standard deviation of the population divided by the square
root of the sample size.
Statistical significance significance at the 0.05 per cent level means that five times
in 100 the results could have occurred by chance, i.e. if the test was

54
 performed 100 times, on five occasions significant results will
occur by chance.
Stigma the social reaction which leads to a spoilt identity and application
of the label of deviant society.
Survey a method of collecting information from a sample of the population
of interest (known as a sample survey).
Systematic error the errors in the study result in an estimate being more likely to be
either above or below the true value, depending upon the nature of
the systematic error in any particular case.
Systematic research the process of research should be based on an agreed set of
rules and processes which are rigorously adhered to, and
against which the research can be evaluated.
Systematic review of the literature review prepared with a systematic approach to
minimising biases and random errors, and including
components on materials and methods.
Systematic random sampling a sample in which every kth case is selected from
the population (n) (with a random starting point).
Theory a set of logically interrelated propositions and their
implications.
Triangulation the use of three or more different research methods (i.e.
multiple methods) to investigate the phenomenon of interest.
Type I error (or alpha error) the error of rejecting a true null hypothesis.
Type II error (or beta error) the failure of reject (i.e. acceptance of) a null
hypothesis when it is actually false.
Validity, external the extent to which the research findings can be generalised to
the wider population of interest and applied to different
settings.
Validity, internal the extent to which the instrument is really measuring what it
purports to measure.
Variable an indicator assumed to represent the underlying construct or
concept, produced by the operationalisation of the latter.

55
REFERENCES

1. Ann Bowling. Research Methods in Health. 1997. Buckingham.

2. Diana M. Bailey. Research for the Health Professional. A Practical
Guide. Second Edition. 1997. USA.
3. John Qvertveit. Evaluating Health Interventions. 1998. Buckingham.
4. Norman K. Denzin & Yvonna S. Lincoln. Strategies of Qualitative Inquiry.
[Link].
5. Pamela Maykut & Richard Morehouse. Beginning Qualitative Research. A
Philosophic and Practical Guide. 1995. The Falmer Press. UK.
6. Yvonne Carter and Cathryn Thomas. Research Methods in Primary Care. 1997.
UK.

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 ANNEX

ANNEX I. CHOOSING QUALITATIVE DESIGNS

Choose one of the following qualitative designs:
1. Ethnography – You wish to study a group and its culture; you are able to go into
the field; you will gather data via observation, interviews, and examination of
documents; you will be able to select key informants and key events.
2. The Case Method Research Design – You wish to study one unit (person,
situation, group setting); you have access to that unit; you will gather data via
observation, interviews, videotaping, and examining documents; you will analyze
the unit in its environmental context.
3. The Historical Research Design – You wish to study a past event or person in
order to better understand the present; you have access to adequate primary
sources; you are able to the principles of causality, generalization and
argumentation.
4. Unstructured Interviews – You have limited experience with qualitative
research and limited time to conduct your study; you wish to address sensitive
issues; you have access to key informants.

After you have selected the design for your study, answer the following question:
1. Do you have access to an appropriate site for the
study? Name the site:
How will you gain permission to enter the site?
2. Are there appropriate participants for your study?
List the criteria for participants who would be appropriate for your study: How
many people will you be able to choose from?
How will you gain their permission to be participants?
3. Data Collection:
Can you enter the field often enough to gather data? How
often do you calculate that will be?
What data collection techniques will you use?
A. Observation: Which people, interactions, or behaviours do you wish to
observe?

57
B. Interviews: Which participants do you wish to interview
Outline the topics you wish to gain information or opinions about
C. Audiotape recording (do you have equipment?)
Videotape recording (do you have equipment?)
Do you need separate permission for this
activity? If yes, how will you get that permission?
Which events, interactions, or behaviours do you wish to record
D. Artefact Review: What kinds of documents or objects will you need to
examine?
Where will you locate such artefacts?
E. Client Record Review: Do you need separate permission for this
activity? If yes, how will you get that permission?
Which client records will you need to review? What are the selection criteria?
How many records will you need?

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ANNEX II- FORMAT FOR THESIS ON QUALITATIVE RESEARCH

Title Page
Abstract
Acknowledgement
List of Tables
List of Figures
Chapter I Introduction
Background
Purpose of the study
Significance of the
study Research
questions Assumptions
Limitations
Chapter II Literature Review
Chapter III Research Method
Research design
Research questions
Procedures:
Participants
Data collection methods
Data analysis
Chapter IV Analysis and Discussion
Results of coding and early
analysis In-depth analysis
Data displays
Checks on the analysis
Hypothesis generation
Appendices
Appendix A: Permission forms

59
 Appendix B: Interview outlines
Appendix C: Start codes

Annex IV: Exercises

Annex IV- A
‘Parenting and Disability: The Role of Informal and Formal Support Networks’
Parker, Gillian Mary
Abstract
This study will identify the support, which disabled parents need to enable them to
continue parenting successfully when impairment disrupts their parental activity.
Stage one will survey 100 disabled parents and their families to explore their
experiences around the time of onset; the impact this had on parenting; the role of
health and social care services and informal networks; the impact of impairment on
family life and relationships; impact on the children; the ways in which household
tasks are allocated between family members; the extent to which and reasons why
children may have become involved in additional household duties and „caring‟
activity; how responsibility of parenting and parental activity id allocated within the
family; and basic socio-demographic data. „Looking after children‟ materials will be
adapted for use with the children of disabled parents. Stage two will be 12 in-depth,
longitudinal case studies of recently disabled parents and their children‟s experiences
during the first twelve months of disablement. As in the first stage the emphasis will
be on the roles of formal and informal structures in supporting (or not) parenting
activity and children through this period.

Purpose of the proposed study

This study will identify the support, which disabled parents need to enable them to
continue parenting successfully when impairment disrupts their parental activity. It
will explore the difficulties disabled people experiences as parents, the type of
supports they find most effective, and the best ways in which both formal and
informal support systems can continue to successful parenting. The4 study thus
addresses issues under topic one and topic three of the programme.

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Background
The principles of Children Act are that intervention with families should promote
parental independence and responsibility, and be withdrawn once parents are in a
position to parent (Aldgate et al, 1994). However, recent research and policy debates
on the issue of „young carers‟ has emphasised assessing the child‟s needs separately,
providing services to replace a „lost childhood‟, and training young carers to make
their role more bearable (Cohen, 1995). The sentiment underpinning services for
young carers thus involves substituting rather than enabling the parental role. We
have made a critique of this focus on the support needs of the child ‟as a carer‟
(Parker and Olsen, 1995a), arguing instead that research should focus on why some
children of disabled parents become over-involved in caring activity in the first place.
A recent „Chief Inspector‟ letter has, similarly, stressed that social service assessment
in situations of this sort should identify both parents‟ and children‟s needs.
A crucial distinction which research on both disability and „child carers‟ usually fails
to make is between parenting – „the concern that parents have for their child‟s
welfare in all its various manifestations – and parental activity – the things that
parents do as parents (Parker 1993, p.99). There is little to suggest that disability
affects parents‟ desire or ability to parent; however, in the absence of adequate
support, disability may affect parents‟ parental activity. This lack of support can lead
to children being taken into care or non-disabled partners being given custody after
divorce (Morris, 1989). Prejudice from both professionals and the population at large
may deny disabled parents their right to parent.
Existing research
The research literature on parenting and disability is fragmented. In particular, it has
been characterized by the dominance of a medical model of disability (focusing on the
illness or impairment as the source of the problem rather than the need for support)
and has therefore asked a limited range of questions about the relationship between
parental disability and children. Furthermore, its emphasis has been on pathologising
the parenting of disabled people and measuring outcomes for children in largely
psychological and psych-social terms.

It is not surprising that researchers in different areas of enquiry have asked different
kinds of questions in assessing disability and parenting. One body of research has
principally been interested in finding out whether children of mentally ill parents are

61
more likely to suffer mental health problems themselves (Rutter, 1996 and 1981;
Rutter and Madge 1976; Rytter et al, 1976; Cytryn et al, 1984). Whilst finding some
associations between parental and child mental illness, this literature has very rarely
to unpack the role of poverty, unemployment, poor housing, institutionalisation, and
so on, in the development of problems in children.

Research into learning disability has focused more on IQ and parenting skills in the
early years of child‟s life (for a review see Andron and Tymchuk, 1987). The research
of Booth and Booth (1994a) has exposed the different standards by which parents
with learning difficulties are judged and how the lack of support at critical stages can
make parenting much more stressful and difficult. They, and other authors (for
example, Dowdney and Skuse, 1993), also criticise intelligence indicators as tools for
analysing parenting skills, arguing that they are static measurements of „intelligence‟,
which do not allow for skill development and learning. As with research into mental
illness and parenting, the evidence in this are is equivocal, with other mediating
factors paying important roles in the relationship between parental and child IQ.

Studies of physical disability have focused on particular conditions, such as multiple

sclerosis (for a review, see Roy, 1990). Multiple sclerosis is of particular interest for
research into young carers, given the profile of MS sufferers, and the likelihood that
the illness will progress at a time when parents are likely to have grown children
(Segal and Simkins, 1993). Whilst with mental illness and learning disabilities the
focus has been on the appearance of similar „problems‟ in the children, with physical
disability, questions have been asked regarding the ability of parents of discipline
children, behavioural problems in the children, the risk of accident and injury to
children (LeClere and Kowaleski, 1994), and role-model and self-esteem issues in
young children who gain competencies over their parents abnormally early in their
development (Greer, 1985).

The literature on disability and parenting has therefore asked different questions in
relation to different illnesses and impairment and, whilst this is a natural result of
focusing on the individual and their illness rather than on support, it has prevented
most researchers from looking at the broader factors which structure the experience of
disability and parenting. Disabled parents have been judged by different standards to

62
their non-disabled peers (George, 1994), and have been given less chance to prove
their parenting ability (Booth and Booth, 1994b, p. 164). There is often little attempt
to consider the impact of social class and poverty on disabled parents, and insufficient
weight is given to the effects of services) or lack of them) on parenting.
In addition, the focus in this literature has tended to be on measures of children‟s
psychological adjustment to illness and disability in the family. Attention has not
focused on the likelihood of children either doing too much by way of domestic and
other tasks, or of doing things that are age-inappropriate. By contrast, however, the
last few years have been a tremendous growth of interest, comment and prescription
regarding „young carers‟ – children „caring‟ for ill or disabled relatives (Aldridge
and Becker, 1993a, and 1993b; Mahon and Higgins, 1995). This has been
accompanied by a similar growth in embryonic services for „young carers‟, with
many authorities now providing some kind of child-centred service (befriending,
activities, sign-posting and so on). We, as well as other authors, have made a
sustained critique of both the empirical and political bases to this growth in services
aimed at making caring more acceptable for children of disabled and ill parents.
(Olson, 1996; Parker and Olson, 1995a and 1995b; Keith and Morris, 1995).

Our empirical concerns can be grouped into two themes.

1. We are interested in the reasons why some disabled parents become dependent on
their children for support and others do not. We are therefore interested primarily in
the formal and informal support that prevents parenting breakdown in these situations.
In line with our argument that policy priorities which focus on how to support
families out of dependence should take precedence over those which seek to make the
„caring‟ activities more bearable for the child (for instance, in providing training in
lifting or money management (Cohen, 1995), the central aim of the research will be to
investigate the factors which lead some families into these situations. The research
evidence is largely anecdotal in this regard. Two particular issues stand out as worthy
of particular attention, however.
First, household composition may be extremely important. Research suggests that in
situations where a single parent becomes ill or disabled, the absence of another adults
is likely to increase the chances of children taking on „caring‟ responsibilities
(Aldridge and Becker, 1993a). This may also be the case in two-parent families where
the non-disabled parent is metaphorically „absent‟ and elects one or other children to

63
carry out the support tasks. Clearly, the influence of household composition will
intersect with gender directly. We might hypothetically expect that in two-parent
families with a disabled father, mothers would be more willing to provide assistance
than if the disabled parent is the mother. Household composition is thus one of the
key analytic variables in the proposed research.
Secondly, the literature has emphasised the radically different „caring‟ agenda that
children with mentally ill parents may have (Clements, 1995; Mapp, 1994). Whereas
„care‟ for physically disabled parents has been characterised as essentially task-based
(shopping, cleaning, carrying, and so on), it has been in more emotional and
psychological terms by those looking at „young carers‟ of mentally ill parents. Whilst
physical impairment has no bearing on the quality of parenting) love, support,
guidance, and so on), mental illness, by its nature, may well involve periods where
parenting is poor. It is therefore important to search for formal and informal support
mechanisms, which are particularly appropriate for parents with mental health
problems.

2. Our second empirical concern is the extent to which children labelled as „young
carers‟ differ in their experiences from their peers, and from other children in
situations (for instance, large families) which might engender large domestic
responsibilities. These questions from the basis of a large-scale, nationally
representative survey of children‟s caring and other work, short listed under the
ESRC Children 5-16 Research Programme: Growing into the Twenty-First Century.
However, in research proposed here, we would like to tackle the problem of
understanding outcomes for children in families with ill and/or disabled parents. We
aim to do this by modifying the Looking After Children schedules, developed as a
tool for analysing outcomes for children in social work (Ward, 1995). These
instruments, covering health, education, identity, family and social relationships,
social presentation, emotional and behavioural development and self-care, attempt to
set agreed standards as to what is best for children, and what desirable goals are in
child health and development. They provide some valid and reliable measures of
outcomes for children and will contribute to answering the questions, „How do
„young‟ carers‟ differ from their peers?‟.

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Research which takes a family approach towards the support needs of disabled
parents, and explores what enables them to go on being parents and prevents
dependence on their children for assistance and care, is urgently needed. This team is
well placed to do such research.

Plan of Study
Design and
Method Stage I
This stage will be a retrospective, descriptive survey of around 100 households
containing a disabled parent and one or more dependent children aged seven or over.
Methods will be largely interview-based and will include suitability-adapted versions
of the „Looking After Children‟ instruments.

Sampling frame
No wholly adequate sampling frames for younger disabled adults exist. Local
authority registers of disabled people vary considerably both in their range and
coverage. The sample for stage 1 will thus be opportunistic, recruited in the East
Midlands via voluntary organizations, newsletters, GP surgeries, contact with hospital
clinics and through advertisement. We will develop existing contacts with local
organizations of and for disabled people to publicise the research, and inserts in
organizations‟ newsletters will invite people to identify themselves as possible
participants. Articles in local newsletters will invite people to identify themselves as
possible participants. Articles in local newspapers and „free sheets‟ and items on
local radio will raise awareness of the research. Local contacts with day centres for
people with minimal mental health problems will also be used to recruit
participants.
„Snowballing‟ techniques – asking people who have already agreed to participate in
the research if they know of anyone else in a similar position who might be willing it
take part will also be used.

Sample size and construction

We propose to identify a sample of around 100 disabled adults with at least one child
over the age of seven. Given the likely size of the population of younger disabled
people with children, and the absence of adequate sampling frames, we feel that a
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sample 100 is achievable without extending the project timetable to unreasonable
lengths. Choice of children aged 7 and over is driven by our wish to include children‟
own perspective on the situation and, therefore, the need to feel confident that they
will be able to give a reasoned account. This does not, of course, preclude the
possibility that there will be children under the age of seven in the families we visit.

The sample will be stratified to ensure roughly equal numbers of people from single
and dual parent households and with mental health problems and physical
impairments, Beyond this we will try to achieve a spread of key characteristics such
as more or less recent onset and ethnicity, as well families who feel that they have
coped more and less well. We will also include people who have become disabled
since becoming parents as well as those who have become parents while disabled.
Clearly, with a sample of 100 there are limits on the extent of the analysis, which is
possible. By constructing the sample in this way we will have sufficient numbers to
analyse the statistical importance of the two main variables of interest (single vs dual
parenthood and physical impairments vs mental health problems) while also being
able to describe other aspects of parents‟ experiences.

Pre-pilot work
A small group of families (around 10) will be recruited initially and interviewed in-
depth. The first visit will involve a conversation with the family as a whole the issues
that they see as important in relation to disability and parenting. The materiel from
these interviews will be tape-recorded and used to influence the structure and content
of interview schedules for the main element of stage 1. It is possible that we will not
cover the children‟s perspective sufficiently using this approach. If this proves to be
the case, we will ask parents for their permission to talk to children separately.

Pilot and main interviews

Using insights generated from the pre-pilot work, interview schedules will be
developed for use with the parent(s), any significant other adults in the household, and
all children over the age of seven.

The content of the interview schedules will be determined after pre-pilot work but is
likely to cover: experiences around the time of onset and the impact that this had on

66
parenting and parental activity; the role of health and social care services and informal
networks in helping family members to cope; the impact of the onset of impairment
on family life and relationships; impact on the children initially and subsequently; the
ways in which households tasks are allocated between family members; the extent to
which and reasons why children may have become involved in additional household
duties and „caring‟ activity; how responsibility for parenting and parental activity is
allocated within the family; and basic socio-economic information.

Schedules for children will vary slightly according to their age and, as with those for
the adults, the content will be determined after the pre-pilot work. Clearly, at least
part of what we can cover will depend on whether or not the children were born
before or after their parent was disabled and, if the latter, if they remember much
about that time. It seems likely that the interviews will work best if they focus on the
present and children‟s perceptions of their and their parents‟ current circumstances.

Outcomes for children (health status, education, social activity and so on) will be
explored by using suitable adapted versions of the „Looking After Children‟ materials
for the appropriate age groups. Whilst the schedules give a guide to the sorts of age-
appropriate tasks and responsibilities that children should have learned, they do not
enable us to identify a) situations where a child may have learned a desirable task (for
instance „to cook simple meals‟) but may be doing that task an unreasonable number
of times and b) situation where a child has responsibilities for tasks (for instance
undertaking simple electrical repairs, undertaking first aid) earlier in life than is
reasonable. Given that one of the current anxieties about the children of disabled
parents is that they become involved in certain activities „too soon‟ or too much, we
plan to modify the schedules to explore this issue. We will examine how to use parts
of the 110-15 and 16+ schedules with children below those ages.

The interview schedules and the adapted „Looking After Children‟ materials will
piloted on the families used for the pre-pilot work and revised in the light of that
experience and the families‟ reactions to the interviews.

Interviews with 100 disabled parents, any of their children aged 7 to 18 living at
home, and any other „significant‟ adults in the households will then be carried out. At

67
this stage, parents and children will be interviewed separately. Wherever possible,
parents will be interviewed first, followed by the children, on a single visit to the
household. However, in some cases it may not be possible to carry out all the
interviews on a single visit, either because of time constraints (for example, if the
interviews are carried out in the evening) or because it is not easy to assemble all the
relevant participants at the same time. Provision for more than one visit per household
has thus been made both in the timetable and the fieldwork budget.

All interviews will be carried out by research associates and appoint a woman to his
post so that parents and children get the opportunity to choose the sex of the person
who interviews the child (ren), if they wish. This issue may be particularly important
in relation to parents and children from minority ethnic communities.

Stage 2
The design of this stage will be in-depth, longitudinal case studies of 12 families
where a parent has recently become disabled. Methods will be predominantly
qualitative. This is appropriate in an area where knowledge is limited and where the
topics are both complex and potentially sensitive.

Sample
Twelve disabled parents will be identified soon after initial onset or diagnosis. We
plan to work with local clinicians in the three Leicester acute hospitals to identify
these adults via hospital clinics and wards. Previous research by one of the proposers
(Seymour and Parker, 1994) used this method of sample generation successfully.

We will recruit parents with serious mental health problems, four with trauma-related
impairments, and four with deteriorating or fluctuating conditions such as rheumatoid
arthritis or multiple sclerosis. This will allow us to compare and contrast experiences
across a number of axes: sudden versus gradual onset; stable versus fluctuating
conditions; mental versus physical impairment.

Interviews
Disabled parents (and their partners, if they have one) will be interviewed as soon as
is feasible after identification. We would aim to achieve this within a month where at

68
all possible although previous experience (Seymour and Parker, 1994) suggests that
this may not be possible for people with serious or fluctuating conditions. This first
interview, which will be in-depth, will cover the immediate impact of disability and
the support needs it has generated, particularly in relation to parenting. The roles of
formal and informal support will be explored in detail.

Where there are two parents, the couple will be interviewed briefly together and then
separately, but simultaneously. This a pattern used successfully by one of the
researchers in previous work with couples (Parker, 1993), which ensures that partners
do not worry excessively about what the other is saying. It also allows the parents to
express views and feelings that they feel might distress the other.

Participants will be interviewed at home whenever this possible. We anticipate there

may be occasions where this is not possible; for example people may have to wait
many months for home adaptations, or in some cases, move to a completely new
home because their previous one is totally unsuitable for their new way of life. In
these circumstances we will arrange to interview the disabled parent in as private a
setting as possible within the hospital.
We do not propose to interview children at this stage for ethical reasons. Anxiety
about their parent‟s condition and the future is likely to be high at this point and we
do not consider it appropriate, or methodologically sound, to interview children in
such circumstances.

Follow up interviews three months and nine months later will review the current
position. Interviews with the parents will use critical incident techniques to identify
significant events, which have occurred since the first interview and explore how
these were coped with. We will identify events of any sort, including the „normal‟
events that families go through but which may prove particularly challenging where a
parent is disabled, for example, illness of either parent, admission to hospital, a
child‟s move from one school to another, moving house, death or illness of
grandparents or other significant adults, change in employment, change in formal
support arrangements and so on. As in the first stage, the emphasis will be on the roles
of formal and informal structures in supporting (or not) parenting activity and the

69
children through these changes. As before, parents in dual parent families will be
interviewed separately but at the same time, after a brief joint interview.

At the follow up stage, separate interviews with children over the age of 7 will
explore their perceptions of the impact of their parents‟ impairment and the effect that
this has had, if any, on the family. Although we will cover their involvement in
domestic or caring activities, and any changes that their parents‟ condition had had on
this, we would expect the children‟s own perceptions of what has been significant to
guide the interviews. We will also cover, where possible, the significant events
identified by the parents and explore with the children any impact that they feel these
have had on their involvement in domestic or caring activities. The adapted „Looking
After Children‟ instruments used in stage 1 will be used with the children in stage 2 at
the follow-up interviews.

As in the first stage, it may not be possible to achieve all the interviews in a family on
one occasion and the timetable and resources requested reflect this. Similarly, we will
offer the parents and children the choice of interviewer for the work with the children.

We will also interview selected other adults identified as providing significant support
to the parents and children. Participates will be asked to identify those individuals
from both the formal and the informal sector whom they feel have been most helpful,
particularly in relation to parenting issues. Grandparents or siblings of the disabled
adult, for example, may play important roles in helping the family to cope. Similarly,
social workers, GPs, head teachers or teachers may have proved supportive. Where
this is the case we will seek the disabled parents‟ permission to approach these people
for interview. Again, the approach will be qualitative and will explore the individual‟s
perspective of their role in supporting the family, whether they felt that others might
more appropriately have provided support, how long they feel the family will need the
support currently being provided and any other issues that emerge from the interviews
with the disabled parents (and their partners).

Analysis
The stage 1 survey is predominantly descriptive. However, where appropriate,
material will be analyzed quantitatively to explore the contribution of our two main

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analytic variables (single vs dual parents, mental illness vs physical impairment).
Bivariate analysis will use the chi-squared statistic, which is appropriate for
categorical data that are not necessarily normally distributed. Where possible, logistic
techniques will be used to explore the relative contributions of different.

Commentary: Generalisability and validity in qualitative

research Judith Green, senior lecturer in sociology.

Gardner and Chapple's study illustrates both the valuable insights that can be
derived from qualitative work and the difficulties of demonstrating the credibility of
such findings in medical journals. This study "sensitises" practitioners to possible
barriers to referral, such as fear of hospitals and fatalism about the inevitability of
morbidity with ageing. It also reminds us that in the real world symptoms are
experienced and accounted for in consultations not as diseases with textbook clarity
but as facets of a more diffuse illness experience. Rather than identifying the exact
proportion of a population with particular health beliefs, qualitative research can
unearth beliefs that may be hidden in less respondent centred study designs or within
a busy consultation with a doctor.

Such insights, however, can also be derived from novels, patient anecdotes, or
journalism, which clinicians have always used to inform their communication with
patients, alongside evidence from research studies. It is the purported credibility of
findings that sets qualitative research apart from these other non-research sources: it
makes claims, however implicitly, to being valid and to having some generalisability
beyond the particular situation or setting described.

Set against the conventions of good research design, a study carried out by a single
general practitioner on patients from his or her own practice in one site surely raises
legitimate questions about objectivity and generalisability. To what extent are the
barriers reported here an artefact of the interviewer-interviewee relationship for
instance, what patients thought the general practitioner wanted to hear? To what
extent is fear of hospitals rooted in local myths, which have no relevance in other
parts of the country? How far can we really conclude from this evidence that cultural

71
gaps between deprived populations and their healthcare providers really contribute to
the "health divide" without a comparative group of more affluent patients?

In qualitative research, issues of validity and generalisability are essentially the same
as those in quantitative studies establishing the truth of accounts (in that they
represent some reality outside the research itself) and adding to theory (in that the
findings are applicable to a population or setting wider than that of the study).
Attention to questions of reliability is essential.1 In interview studies, this involves
careful transcription, thorough and systematic coding, and a justification for data
extracts chosen for illustration for instance on grounds of representativeness. In
addition, credibility in the findings and conclusions drawn depends on information
about context. This includes information about the prompts used to generate data and
the research setting, both of which can have a significant impact on the content of
accounts given by participants,2 and the theoretical framework used to make sense of
the data. Data extracts taken out of context tell us little about the situated nature of
beliefs and behaviour, and inferences that are not rooted in a theoretical
understanding are unlikely to be generalizable to other settings. Most important is
evidence that the researchers have explicitly sought to falsify emergent hypotheses,
for instance by theoretical sampling and accounting for deviant cases within their
dataset.3

The use of a single site or a small sample size does not in itself threaten the validity or
potential generalisability of a qualitative study. Although there is not enough space in
a short paper to ground the findings in a broader literature or to discuss how deviant
cases were handled, the authors have used comparative material to strengthen the
credibility of their findings, and the second author was involved in the analysis
providing some analytical distance on the data. The generalisability of this study does
not derive from the representativeness of the sample, but from the concepts (such as
fear of hospitals or fatalism about ageing) that may well be relevant to other settings
andpatientgroups.

References
1. Silverman D. The quality of qualitative health research: the open ended interview
and its alternatives. Soc Sci Health 1998; 4: 104-118.
2. Green J, Hart L. The impact of context on data. In: Barbour R, Kitzinger J, eds.

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 Developing focus group research. London: Sage, 1999.
3. Green J. Grounded theory and the constant comparative method. (Commentary.)
BMJ 1998; 316: 1064-1065[Medline].

© BMJ 1999

ANNEX V. EXERCISES’ CORRECT ANSWERS

Exercise 3 (for questions on page 30)
1. Children‟s experiences of asthma clinics.
Two issues have to be cleared before answering, i.e.
a/ The age range of children
b/ Are the children asthmatic cases?
After clearing the above issues, you may take:
 Focus group discussion and semi-structured interview could be used if the children
are teenagers (14-16 years old).
 Observation may not be practical, but may be appropriate if they are under aged.
 Adults (parents) can be interviewed.

2. Women‟s experiences of undergoing cervical smear

tests. This is a sensitive issue; hence, it needs good
approach.
 Interview (in-depth and semi-structured interview) may be the chose.
 Focus group discussion can be done but the sensitivity may matter.
 Observation cannot be performed due to the sensitivity of the test.

3. Multiple sclerosis patients difficulties of accessing dental health services.

The severity of the disease may not allow you to perform the study.
 Interview (in-depth interview) may be chosen.
 Difficult to organize focus group discussions.
 Inaccessible to perform observational study.
4. GPs perceptions and experiences of providing care for refugees and
asylum seekers.
 Interview (in-depth and semi-structured interview) can be done but the problem is
time.

73
74
 Focus group discussion can be performed but if they are practicing at that moment
may limit the finding.
 Observation may not be important.
N.B. [Link] consent, should not be forgotten
2. Political, cultural and other sensitive issues have to be addr

Logical Positivist, Naturalist, Interpretivist,

Scientific, Quantitative, Qualitative
Positivism
Aims Testing hypothesis/ generalising Generating hypothesis/ describing
Purpose Verification Discovery
Approach Top-down Bottom-up
Preferred Quantitative Qualitative
Technique
Research strategy Structured Un-structured
Stance Reductionist/ inferential/ Expansionist/exploratory/inductive/process-
hypothetico-deductive/outcome oriented/intuitive
oriented/rational
Method Counting/ obtrusive and controlled Observing/ participant observation,
measurement, surveys, interviewing, action research, case studies,
experiments, structured focus groups
observations, statistical records
Implementation of Decide a priori Decided in field setting
method
Values Value-free Value-bound
Instrument Physical device/ pen and paper The researcher
Researcher’s stance Outsider Insider
Relationship of Distant/ independent Close/ interactive and inseparable
researcher and
‘subject’
Setting Laboratory Nature
Data Hard, reliable and replicable Rich, deep and valid
Data analysis Specified in advance Worked out during the study
Analytic units Pre-defined variables Patterns and natural events
Quality criterion Rigour/ proof/ evidence/ statistical Relevance/ plausibility/ illustrativeness/
significance responsiveness to subjects‟ experiences
Source of theory A prior/ confirmation/ rejection Grounded/ emergent
Nature of truth Time and context-free Only time and context bound working
statements generalisations are possible hypothesis are possible
Image of reality Singular, tangible, static, external Multiple, holistic, dynamic, socially
constructed
Research product Stress the validity of research Stress meaningfulness of research findings
findings for scholarly community to both scholarly and user communities

75