Rigorous Qualitative Methods Research Articles

A mixed methods approach to uncover common error patterns in student reasoning of supply and demand

Students of introductory economics are often able to predict changes in equilibrium price correctly on standardized assessments, but make consistent errors in predicting changes in equilibrium quantity. To examine the reasons for this pattern, the authors collected open-ended explanations written by students and categorized their reasoning using a rigorous multi-step qualitative method. Integrating the qualitative analysis with quantitative data, they find that students exhibit remarkable consistency in their reasoning errors. Common multiple choice assessments tend to reward some types of reasoning errors and thereby make it harder for students to acquire the correct reasoning method. The authors demonstrate that, with thoughtful consideration to avoid excessive subjectivity, a qualitative study can deepen our contextual understanding of the primarily quantitative assessment metrics utilized in economics education research.

Qualitative Analysis of Patient Perspectives on Vestibular Testing

Qualitative Analysis of Patient Perspectives on Vestibular Testing

Understanding the increase in opioid overdoses in New Hampshire: A rapid epidemiologic assessment

BackgroundNew Hampshire (NH) has had among the highest rates of fentanyl-related overdose deaths per capita in the United States for several years in a row—more than three times the national average in 2016. This mixed-methods study investigated drug-using practices and perspectives of NH residents who use opioids to inform policy in tackling the overdose crisis. MethodsSeventy-six participants from six NH counties completed demographic surveys and semi-structured interviews focused on drug-using practices and perspectives, including use precursors, fentanyl-seeking behaviors, and experiences with overdose. Rigorous qualitative methods were used to analyze interview data including transcription, coding and content analysis. Descriptive statistics were calculated on quantitative survey data. ResultsEighty-four percent of interviewees had knowingly used fentanyl in their lifetime, 70 % reported overdosing at least once, and 42 % had sought a batch of drugs known to have caused an overdose. The majority stated most heroin available in NH was laced with fentanyl and acknowledged that variability across batches increased overdose risk. Participants reported high availability of fentanyl and limited access to prevention, treatment, and harm reduction programs. There was widespread support for expanding education campaigns for youth, increasing treatment availability, and implementing needle exchange programs. ConclusionsA confluence of factors contribute to the NH opioid overdose crisis. Despite consensus that fentanyl is the primary cause of overdoses, individuals continue to use it and affirm limited availability of resources to address the problem. Policies targeting innovative prevention, harm reduction, and treatment efforts are needed to more effectively address the crisis.

The Benefits and Challenges of Interprofessional Training Programs Implemented to Increase Access to Primary Care for Medicaid Enrollees

Background: Interprofessional (IP) care teams that bring together health care providers from multiple disciplines can provide a broader scope of services and enhance efficiency so as to increase availability of providers. The use of IP teams may be of particular benefit for Medicaid enrollees who experience difficulty accessing care given socioeconomic barriers and limited provider availability. However, IP training is critical to ensure that health and social service providers understand their roles on these teams. Our study sought to understand the benefits and challenges of IP training programs, including how such programs could help improve access to health care for underserved populations. Methods: We conducted a qualitative study across 10 health care organizations where IP training programs had been implemented. Learners, preceptors, and program staff were interviewed and asked about the structure of the programs, individual roles within the programs, and satisfaction with the programs. Interviews were transcribed and analyzed using rigorous qualitative methods. Results: Two types of IP training programs were identified: those offering a specific program that integrated behavioral health and primary care, and those offering a general program that included multiple types of providers. Benefits of IP training included expanded access to primary care providers, increased ability to deliver ‘whole person care’ that addressed social determinants of health, and improved support across disciplines. Challenges included navigating logistics of integrating IP trainees into a program, changing expectations about approaches to IP care delivery, technology issues, and funding. Conclusions: IP training programs can increase access to care for Medicaid enrollees and improve primary care delivery by increasing the number of trained providers and improving the capacity of organizations to deliver care that addresses social determinants of health. Addressing challenges around logistics, technology, and funding can help IP training programs succeed and sustain their efforts to improve care for Medicaid enrollees.

Barriers to belonging: the need for relatedness amongst people living with severe asthma

Background Severe asthma, that is, asthma that is relatively refractory to conventional therapy, affects 3-10% of the asthma population. It is associated with a significant burden affecting social and working life. Supporting the need for relatedness facilitates health behavior change and improves overall well-being. However, this has not been closely examined from the patients’ perspective. This study examines relatedness in patients’ narratives about their experiences of living with and managing severe asthma. Methods Rigorous and systematic qualitative research methods were used to conduct in-depth semi-structured interviews. Participants were included if they were ≥18 years old and diagnosed with severe asthma. Interviews were video and/or audio recorded, transcribed, and analyzed inductively and deductively informed by the self‐determination theory construct of relatedness. Thirty-eight face-to-face interviews, lasting 1.5 - 4 hours, were conducted around Australia. Results Our findings show that living with a debilitating and unpredictable illness challenged participants’ sense of relatedness. Two themes emerged: 1) the desire to be understood: feeling isolated and 2) the desire to be accepted: ‘I’m supposed to be like everybody else’. For people living with severe asthma, feeling cared for, understood, connected to others and having a sense of belonging was valued. Their overall psychological well-being was dependent upon their sense of connection to others. Conclusion Future research should consider our findings of the challenges faced to preserve their sense of relatedness, when developing and implementing patient‐driven self‐management interventions for those living with severe asthma.

Impact of the Syrian crisis on the socio-spatial transformation of Eastern Amman, Jordan

Amman, the capital of Jordan, has been subjected to incremental spatial transformation under the pressure of the emerging migration of various refugees since the beginning of the Syrian conflict (2011–present). Only 17% of the Syrian refugee influx to Jordan resides in camps. Amman hosts 28% of non-camp refugees (NCRs) who are living in urban areas and creating multiple forms of urban settlements. Diverse forms of NCR settlements are emerging extensively in Eastern Amman districts. These settlements are contributing to new morphological structures and leading to a gradual spatial change—socially and physically. This research intends to contribute to the increasing amount of available data by improving the understanding of the socio-spatial patterns of Syrian NCR settlements and providing insights, forecasts, and recommendations regarding this pressing issue on the basis of overall trends. Comprehensively contextualized areas in Amman were mapped, and after considering specific site-selection criteria, Jubilee Neighborhood was selected. Jubilee was built by the government in 1985 for low-income Jordanian families. This study aims to unravel one layer of the complex multilayered Amman City. It intends to explore and describe the urban forms of NCR settlements in Jubilee Neighborhood as a case study by interrelating spatial, social, and physical concepts. In addition, this study extensively uses rigorous qualitative and traditional methods. The outcome of this study is a comprehensive and descriptive spatial analysis that can provide socio-spatial interpretations and recommend urban response policies to cope with the future spatial transformation of urban forms.

Framing the Bicyclist: A Qualitative Study of Media Discourse about Fatal Bicycle Crashes

This research examines the linguistic choices that frame relationships between bicyclists and other parties involved in fatal crash events. Textual data were collected from media reports of all bicyclist traffic fatalities that occurred from January 2009 through June 2018 in Hillsborough County, Florida, which has a disproportionately high number of bicyclist deaths compared with other areas of the U.S. The media reports were coded with a qualitative data analysis software and analyzed using critical discourse analysis (CDA), a rigorous qualitative method used to analyze oral and written communication developed by Fairclough. Through CDA, the study examines how linguistic choices produce meaning and reinforce the “common sense” or “taken-for-granted” lexicon of transportation. Results show the majority of news reports were episodic rather than thematic, focusing on the traffic event and the parties involved in the crash, particularly the bicyclist. Vocabulary, grammatical structure, and narrative framing of news reports largely functioned to remove blame from the motorist and to highlight the bicyclist’s actions. These linguistic strategies reflect the assumption that responsibility for safety rests on the bicyclist and detracts attention from potential social policy reform that would lead to fewer bicyclist fatalities. A minority of articles written with thematic frames focused on broader issues such as social capital, safety education, and advocacy. This interdisciplinary study is a unique contribution to transportation literature, employing a methodology typically reserved for communication scholars and linguists.

Adjournment in Community HIV Prevention: Exploring Transitions in Community-Academic Partnerships.

Barbershop-based interventions have been increasingly implemented as a means to support culturally relevant and community-accessible health promotion and disease prevention efforts. Specifically, in neighborhoods of Brooklyn, New York, with high HIV seroprevalence rates, barbers have volunteered to support an initiative to help reduce sexual risk behavior. After implementing the Barbershop Talk With Brothers program for 5 years, we explored how program participation has affected barbers' HIV prevention and counseling skills to promote their clients' health, and assessed their views of next stages of the community-academic partnership, once the specific project ended. Through employing rigorous qualitative research methods with personnel at participating barbershops, key results include that although barbers self-identify as community leaders and even as health educators, they want ongoing support in educating customers about other topics like nutrition and physical activity, including upstream social determinants of health, such as housing and employment. They are also concerned regarding how best to support continuity of efforts and maintenance of partnerships between projects. These findings provide insight toward adjourning community-based participatory research projects, which can inform other academic researchers, organizations, and businesses that partner with community members.

Scapegoating culture: Misunderstanding organizational culture as the problem in carceral institutions and beyond

AbstractOrganizational culture is an obscure and poorly understood part of organizational life. In scholarly work, researchers use organizational culture as both a catch‐all term and a black box of intrigue. The former suggests its omnipresence and ability to take the blame for all that ills organizations. The latter denotes a mythical and misunderstood invisible cloak that covers organizations and organizational life, yet is misconstrued, complex, and confusing. This paper presents a brief summary of the multidisciplinary history of organizational culture as a concept and operationalized term while simultaneously suggesting our knowledge of organizational culture remains at its infancy. Using prisons as a case study example, the authors consider how better to unpack organizational culture using sound and rigorous qualitative methods with careful attention to sampling and researcher–subject collaboration. Concluding thoughts note the importance of using culture as a dependent, rather than independent variable, so scholars will stop scapegoating culture as the answer to why organizational processes and outcomes fail and will instead recognize the study of culture as the problem itself.

Informed about Informed Consent: A Qualitative Study of Ethics Education

Informed consent is a foundational concept in modern medicine. Despite physicians’ ethical and legal obligations to obtain informed consent, no standard curriculum exists to teach residents relevant knowledge and skills. This paper presents a qualitative study of residents at one academic medical center. The authors conducted focus groups with trainees in the Departments of Internal Medicine, Emergency Medicine, and Ob/Gyn and analyzed their responses using rigorous qualitative methods. Four themes emerged: First, participants agreed that informed consent and decision-making capacity were relevant in many clinical situations. Second, participants varied widely in their understandings of consent. Third, current resident training was insufficient. Fourth, more training was needed. These results add to the growing literature that ethics education in residency is desired and useful. The findings will help educators craft instruments assessing the prevalence and degree of deficiencies related to informed consent competencies and aid in the development of a model curriculum.

The 2018 Visualization Career Award

The 2018 Visualization Career Award goes to Sheelagh Carpendale for her work in interactive data exploration, in visualization in novel contexts such as wall and tabletop display, in rigorous qualitative evaluation methods, in bringing aesthetic considerations to the research community, and for her contributions in a wide range of application domains, including medicine, digital humanities, geography, the environment, personal data, and emergency management. The IEEE Visualization & Graphics Technical Committee (VGTC) is pleased to award Sheelagh Carpendale the 2018 Visualization Career Award.

Patient-Oriented Research and Grounded Theory: A Case Study of How an Old Method Can Inform Cutting-Edge Research

Creating evidence that is both scientifically rigorous and patient oriented in addressing patients’ needs is essential to informing health-care professionals’ practice and meeting patient needs. Patient-oriented research (POR) aims to address this 2-fold mandate by engaging and incorporating patients’ voices throughout the research process through a variety of techniques. Currently, there is little methodological rigor or guidance to help qualitative patient-oriented researchers design, collect, and analyze patient data. Classical grounded theory (GT) is arguably one of the most rigorous qualitative research methods, focusing on the development of theory from data grounded in participants’ voices. As such, classical GT is an ideal methodological approach for conducting POR due to its rigor, patient-oriented focus, and generation of an empirical model focused on the topic of interest. The purpose of this article is to describe the convergence and divergence between classical GT and POR, based on the current literature and pragmatically through an ongoing classical GT study focused on combat veterans’ perspective on Operational Stress Injuries (OSIs). By describing the methodological principles and their implementation in a POR study, we provide readers with both substantive and practical knowledge to utilize classical GT in POR studies, particularly within study populations that may be averse to or experience challenges in participating in research. Classical GT therefore provides patient-oriented researchers with a pragmatic methodological framework for engaging patients and generating rigorous evidence.

Timing Is Everything: The Utility of Time-Series Analysis to Capture Causality in Qualitative Case-Based Policy Inquiry

While policy researchers call for new approaches to support the analysis of complex policies, the dominance of experimental and quasi-experimental designs limits the field’s possibilities. Innovative yet rigorous qualitative methods have been overlooked, despite strong arguments by seminal qualitative methodologists about the appropriateness of qualitative research for inquiry situated in particular contexts and that recognizes the influence of time, place, people, and belief systems on outcomes. We argue that qualitative time-series analysis is one such overlooked approach that has greater potential for educational policy research because of its ability to address complexity in causal relationships. This article contributes to the policy and methodological literature in two ways: First, by providing a synthesis of available methodological literature on qualitative time-series analysis; and second, by providing two illustrative qualitative case studies that used different time-series approaches to examine policy development over time while accounting for the contextual factors and meaning-making that inform policy and shape the policy process. The article concludes with a discussion of the contribution of qualitative time-series analysis for policy research with examples from the cases.

From the Editors

From the Editors

What drives members of an interprofessional care team: A sense of self

Abstract Background/purpose The purpose of this study is to identify what motivates practitioners who provide integrated, interprofessional, team-based care for triply-diagnosed adolescents: mental illness, medical illness and an appetitive drive disorder. Method Using rigorous qualitative methods, one author interviewed team members of the University of Texas Rio Grande Valley School of Medicine Integrated Care Collaborative Unit. The semi-structured interviews were recorded, transcribed verbatim and coded using Consensual Qualitative Research (CQR) methodology to determine key themes and domains. An interpretive analysis of the domains suggested an explanatory structure for the conceptualization of a collaborative team model focused on individual members’ motivations. Results/discussion Self-actualization, working in a team and a sense of altruism were the three domains identified as important motivators for collaborative integrated care. Individual personal meaning appears to be tied to motives associated with achieving positive perceptions from other team members and patients as well as self-fulfillment at the highest level of human need. Conclusions Key factors influencing individual team members contribute to an integrated healthcare collaborative model in a manner not previously elaborated. The findings of this study offer insight into an alternative, innovative best-practice care model that considers team members’ personal motivational attributes as a framework for team member selection, team structure and workplace environment.

Using Deliberative and Qualitative Methods to Mobilize Community Around the Mental Health Needs of Rural African Americans

—Deliberative methods obtain informed and well-reasoned public input on health topics but are rarely accompanied by rigorous qualitative methods that can ground findings in community members’ shared experiences. In this project, we used Deliberative Democracy Forums, a deliberative process, to bring diverse community members together to collectively discuss mental health among rural African Americans, brainstorm solutions to address mental health needs, deliberate alternate solutions, and indicate steps for future action. By using rigorous qualitative methods to document the deliberative process and analyze deliberative dialogue, we produced a strong evidence base to inform future health care policy and research. In this article, we document our approach, present forum findings, and discuss the impact of deliberation on policy and research. We conclude that the combination of deliberative process and qualitative methods used in our project can produce a deeply contextualized understanding of mental health and identify community-initiated solutions to address mental health needs in resource-poor communities, which can help guide public health research and provide an evidence base for public health policy.

Psychosocial concerns reported by Syrian refugees living in Jordan: systematic review of unpublished needs assessments.

Humanitarian organisations supporting Syrian refugees in Jordan have conducted needs assessments to direct resources appropriately. To present a model of psychosocial concerns reported by Syrian refugees and a peer review of research practices. Academic and grey literature databases, the United Nations Syria Regional Response website, key humanitarian organisation websites and Google were searched for needs assessments with Syrian refugees in Jordan between February 2011 and June 2015. Information directly reporting the views of Syrian refugees regarding psychosocial needs was extracted and a qualitative synthesis was conducted. Respondents reported that psychological distress was exacerbated by both environmental (financial, housing, employment) and psychosocial outcomes (loss of role and social support, inactivity), which are themselves stressors. Need for improvement in research methodology, participatory engagement and ethical reporting was evident. Participatory engagement strategies might help to address identified psychosocial outcomes. More rigorous qualitative methods are required to ensure accuracy of findings.

Development of a New Instrument to Assess Stool Form and Consistency in Irritable Bowel Syndrome with Diarrhea

Background: Available stool form scales do not optimally capture the continuum of stool consistency experienced by patients with irritable bowel syndrome with diarrhea (IBS-D). This paper describes the development of a new measure to assess stool form and consistency for IBS-D. Methods: Descriptors for a new scale were selected by comparing spontaneous descriptions of stools from patients with IBS-D (Rome III) with spontaneous patient descriptions of images in the Bristol Stool Form Scale (BSFS) and an adapted BSFS. New images were prepared by an artist based on the final descriptors and literature images. The new Astellas Stool Form Scale (ASFS) was assessed in cognitive interviews. Results: Spontaneous reports of stool descriptors from 50 patients with IBS-D were broadly grouped based on conceptual equivalence. From these, 8 final stool descriptors were selected, ranging from “like marbles or hard rocks” to “just liquid,” and an image was created for each descriptor. In 20 cognitive interviews, 75% of patients with IBS-D indicated that descriptors matched the appropriate images, 95% of patients indicated that there were enough images to depict each stool type, and 70% of patients indicated that all images were clear. Conclusion: The ASFS, developed using spontaneous patient reports and rigorous qualitative methods, was well understood by patients with IBS-D and was relevant to their experience of stool form and consistency with IBS-D. Further evaluation is ongoing to confirm its utility in clinical research and in the clinical setting as a tool to monitor change in patients with IBS-D and to assess treatments.

Te Pākeketanga: living and dying in advanced age--a study protocol.

BackgroundThe number of people dying in advanced old age is increasing rapidly and building the evidence base regarding end - of - life care for older people has been identified as an international policy priority. The unique opportunity to link longitudinal studies of ageing with studies exploring the end of life circumstances of older people remains under-exploited internationally. Very little is known about the specific circumstances, cultural needs and care preferences of indigenous older people, including Māori, at end - of - life and the needs of their whānau/ extended family carers.MethodsWe will use rigorous qualitative methods to conduct post-bereavement interviews with bereaved whānau and family of 50–60 people who died >80 years; approximately half of participants will be Maori. The older decedents were participants in the first longitudinal study of older people involving a specific indigenous cohort internationally: Te Puāwaitanga O Ngā Tapuwae Kia Ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ). Prior to death, they completed a questionnaire regarding their end-of-life preferences and nominated a family or whānau member to participate in this separate study exploring end-of-life circumstances of those in advanced age.DiscussionRecommendations to improve care will be formulated in collaboration with participants and their local hapū (sub-tribe). Ultimately this study has the potential to inform better outcomes for the growing numbers of people dying in advanced old age both in New Zealand and internationally, as well as their whānau and family caregivers. It also highlights the ability to generate an in-depth understanding of end-of-life circumstances by appending studies of palliative and end-of-life care onto existing longitudinal studies.

Interview-based Qualitative Research in Emergency Care Part II: Data Collection, Analysis and Results Reporting.

Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. In Part I of this two-article series, we provided an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field (observation, individual interviews, and focus groups). Here in Part II of this series, we outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research.