Rigorous Qualitative Methods Research Articles

Qualitative Research in Emergency Care Part I: Research Principles and Common Applications.

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. This article, Part I of a two-article series, provides 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, including observation, individual interviews, and focus groups. In Part II of this series, we will 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.

Patient engagement and the design of digital health.

Digital health is an area of growing interest for physicians, patients, and technology companies alike. It promises the ability to engage patients in their care, before, during, and after an emergency department visit. Current efforts to create, study, and disseminate digital health have been limited by lack of user engagement. In this commentary, we outline the imperative for engaging end-users in each phase of digital health design, as well as a few techniques to facilitate better digital health design and implementation.

Using Qualitative Research Methods to Assess the Degree of Fit between Teachers’ Reported Self-efficacy Beliefs and their Practical Knowledge during Teacher Education

There is a need for qualitative research into teachers’ self-efficacy beliefs so that the relationship between these beliefs and other cognitions possessed by teachers, including their practical knowledge, can be better understood by teacher educators. Teachers’ self-efficacy beliefs may need supporting if they seem too low or challenging if they seem too high. However, clear criteria are needed to facilitate assessment, together with the use of rigorous qualitative methods. This article explores these issues while reporting on research conducted in Oman into the cognitions of two in-service English language teachers. There is a focus on how qualitative case study research methodology was used to assess the degree of fit between teachers’ reported self-efficacy beliefs and their practical knowledge, aiding subsequent intervention to support professional development. Implications for teacher educators and researchers are discussed.

Insights from introspection: a commentary on Gould et al. (2014), "An extended case study on the phenomenology of spatial form synaesthesia".

Insights from introspection: a commentary on Gould et al. (2014), "An extended case study on the phenomenology of spatial form synaesthesia".

Creating an infrastructure for comparative effectiveness research in emergency medical services.

Emergency medical services (EMS) providers deliver the initial care for millions of people in the United States each year. The Institute of Medicine noted a deficit in research necessary to improve prehospital care, created by the existence of data silos, absence of long-term outcomes, and limited stakeholder engagement in research. This article describes a regional effort to create a high-performing infrastructure in southwestern Pennsylvania addressing these fundamental barriers. Regional EMS records from 33 agencies in January 2011 were linked to hospital-based electronic health records (EHRs) in a single nine-hospital system, with manual review of matches for accuracy. The use of community stakeholder engagement was included to guide scientific inquiry, as well as 2-year follow up for patient-centered outcomes. Local EMS medicine stakeholders emphasized the limits of single-agency EMS research and suggested that studies focus on improving cross-cutting, long-term outcomes. Guided by this input, more than 95% of EMS records (2,675 of 2,800) were linked to hospital-based EHRs. More than 80% of records were linked to 2-year mortality, with more deaths among EMS patients with prehospital hypotension (30.5%) or respiratory distress (19.5%) than chest pain (5.4%) or nonspecific complaints (9.4%). A prehospital comparative effectiveness research infrastructure composed of patient-level EMS data, EHRs at multiple hospitals, long-term outcomes, and community stakeholder perspectives is feasible and may be scalable to larger regions and networks. The lessons learned and barriers identified offer a roadmap to answering community and policy-relevant research questions in prehospital care.

Policy climates and climate policies: Analysing the politics of building urban climate change resilience

This paper examines the process of building resilience to climate change in urban areas by scrutinising the manner in which initiatives to build resilience interact with the urban policy environments in which they unfold. The urban policy environment is broken into three analytical areas of actors, spaces and discourses. This illustrates the influence of actor networks, epistemic communities and policy entrepreneurs in helping climate change resilience gain traction in urban settings, how discourses attached to urban resilience are dissonant with those prevailing in ossified urban policy environments, and the dynamic interaction of interest, agendas and power in decision making that accompanies resilience building processes. The paper applies this framework to case studies of two Indian cities within a major international urban climate change resilience initiative. Using data gathered through a variety of rigorous qualitative research methods, the paper provides insights into the politics of policy processes around urban climate change initiatives. Findings from this study can inform urban development policies and allow resilience project planners to calibrate their efforts to better suit urban policy environments. The paper highlights how issues of politics and power are more significant determinants of such policy processes than conventional, science-led analyses would suggest.

Motivations for Sex Among Low-Income African American Young Women

African American young women exhibit higher risk for sexually transmitted infections, including HIV/AIDS, compared with European American women, and this is particularly true for African American women living in low-income contexts. We used rigorous qualitative methods, that is, domain analysis, including free listing (n = 20), similarity assessment (n = 25), and focus groups (four groups), to elicit self-described motivations for sex among low-income African American young women (19-22 years). Analyses revealed six clusters: Love/Feelings, For Fun, Curiosity, Pressured, For Money, and For Material Things. Focus groups explored how African American women interpreted the clusters in light of condom use expectations. Participants expressed the importance of using condoms in risky situations, yet endorsed condom use during casual sexual encounters less than half the time. This study highlights the need for more effective intervention strategies to increase condom use expectations among low-income African American women, particularly in casual relationships where perceived risk is already high.

Nascent Entrepreneurs Access and Use of Network Resources in a Technology Incubator

This study utilized the setting of a technology incubator to analyze how nascent entrepreneurs develop and leverage networks to secure resources as part of the venture creation process. Through rigorous qualitative methods, we examined how six medical device entrepreneurs used networks to obtain needed resources, the types of resources pursued and differences among entrepreneurs based on their level of network skill. Our findings illustrate the importance of the incubator in providing both tangible resources (funding, space, equipment) and less tangible but equally important resources (credibility, relationships, access to networks). Initial findings suggest that differences in the level of an entrepreneurs’ network skill relate to the development, but not necessarily the success, of the venture.

Best Practices: Recovery Centers for People With a Mental Illness: an Emerging Best Practice?

The authors report a process evaluation that used rigorous qualitative methods consistent with best practice to assess the development and impact of a nascent recovery center in the New York City area. The center successfully delivered services that focused on helping increasing numbers of consumers achieve educational and functional improvements. Consumers perceived the center as providing a strong sense of community while also serving as a "stepping stone" to wider opportunities. Because they offer a feasible and popular means to help individuals with mental illness acquire skills, recovery centers may be an emerging best practice. Further research is necessary to test their efficacy.

Understanding Qualitative Metasynthesis

Qualitative metasynthesis is an intentional and coherent approach to analyzing data across qualitative studies. It is a process that enables researchers to identify a specific research question and then search for, select, appraise, summarize, and combine qualitative evidence to address the research question. This process uses rigorous qualitative methods to synthesize existing qualitative studies to construct greater meaning through an interpretative process. The purpose of this article is to describe qualitative metasynthesis as an innovative research approach for the field of early childhood intervention. Although this is not a new research approach in other fields, the authors suggest that it can offer a promising practice in the field of early childhood intervention. In this article, the authors explore how qualitative metasynthesis can be a practical and effective approach of inquiry as they continue to broaden their understanding about young children with disabilities and their families.

PRO development: rigorous qualitative research as the crucial foundation

Recently published articles have described criteria to assess qualitative research in the health field in general, but very few articles have delineated qualitative methods to be used in the development of Patient-Reported Outcomes (PROs). In fact, how PROs are developed with subject input through focus groups and interviews has been given relatively short shrift in the PRO literature when compared to the plethora of quantitative articles on the psychometric properties of PROs. If documented at all, most PRO validation articles give little for the reader to evaluate the content validity of the measures and the credibility and trustworthiness of the methods used to develop them. Increasingly, however, scientists and authorities want to be assured that PRO items and scales have meaning and relevance to subjects. This article was developed by an international, interdisciplinary group of psychologists, psychometricians, regulatory experts, a physician, and a sociologist. It presents rigorous and appropriate qualitative research methods for developing PROs with content validity. The approach described combines an overarching phenomenological theoretical framework with grounded theory data collection and analysis methods to yield PRO items and scales that have content validity.

Problematics of grounded theory: innovations for developing an increasingly rigorous qualitative method

Our purpose in this article is to identify and suggest resolution for two core problematics of grounded theory. First, while grounded theory provides transparency to one part of the conceptualization process, where codes emerge directly from the data, it provides no such systematic or transparent way for gaining insight into the conceptual relationships between discovered codes. Producing a grounded theory depends not only on the definition of conceptual pieces, but the delineation of a relationship between at least two of those pieces. Second, the conceptualization process of grounded theory is done in hierarchical fashion, where individual codes emerge from the data but then are used to generate insight into more general concepts and thematic statements. But various works on grounded theory have failed to provide any systematic way of using data specific levels of scale (the codes) to gain insight into more macro levels of scale (concepts and themes). We offer fractal concept analysis as a means of resolving both of these issues. By using a logic structure generator, fractal concept analysis delineates self-similar conceptual frameworks at various levels of abstraction, yielding a method for linking concepts together within and between levels of scale encountered in the grounded theory coding and categorization process. We conclude that this fractal analytic technique can bolster the aims of grounded theory as a formalized and systematic process for generating theory from empirical data.

Investigating Choice Experiments for Preferences of Older People (ICEPOP): Evaluative spaces in health economics

This paper deals with three concerns about the evaluative framework that is currently dominant within health economics. These concerns are: that the evaluative framework is concerned entirely with health; that the evaluative framework has an individualistic focus on patients alone; and that the methods used to estimate 'health' within the current evaluative framework could be improved both in terms of the generation of descriptive systems and in using valuation methods that rely less on people's ability to express their preferences on a cardinal scale. In exploring these issues the Investigating Choice Experiments for Preferences of Older People (ICEPOP) programme has explicitly focused on both the topic of older people and the methods of discrete choice experiments. A capability index has been developed and attributes for an economic measure of end-of-life care are currently being generated, providing the possibility of extending the evaluative framework beyond health alone. A measure of carer's experience and a framework for extending measurement in end-of-life care to loved ones are both also in development, thus extending the evaluative framework beyond the patient alone. Rigorous qualitative methods employing an iterative approach have been developed for use in constructing attributes, and best-worst scaling has been utilized to reduce task complexity and provide insights into heterogeneity. There are a number of avenues for further research in all these areas, but in particular there is need for greater attention to be paid to the theory underlying the evaluative framework within health economics.

Extra Curricular Life Of Overseas Student-Teachers

Overseas student-teaching is becoming increasingly popular among American college students. Unfortunately, relatively little is known empirically regarding how these students find their experiences—academically or outside of the teaching classroom. Consequently, the present research study used rigorous qualitative methods in order to appraise extra-curricular experiences from a sample of 13 students who completed their student teaching overseas. Results showed students to experience surface relationships with nationals and deeper connections with faculty. While the student teachers reported participating in various excursions alongside nationals, they generally categorized their connections with these people on surface levels, explaining that relationships were hindered by language barrier inhibitions. In contrast, when our participants described their interactions with faculty, they spoke in terms of meaningful connections and bonding experiences.

Affective Responses Of Overseas Student-Teachers

Universities offering teacher education degrees are finding the world to be significantly smaller than did previous generations. Increasingly, American students are completing their required student teaching in foreign contexts. The present research study used rigorous qualitative methods in order to appraise the affective experiences from a sample of 13 students who completed their student teaching overseas. Results showed, affectively, students experienced a bell-shaped curve phenomenon. Particularly, they underwent stages of excitement when entering the teaching experience, followed by significant dysphoria, and then completed their student teaching with a positive emotional set.

Three-Year Outcome Effects of Former AWANA Timothy-Award Recipients

The present study follows Firmin, Kuhn, Michonski, and Posten (2005) in a series of empirical investigations regarding residual effects of former AWANA participants. We selected 24 Timothy award conducted in-depth interviews with each participant, utilizing a rigorous qualitative research method. Four themes were evident in analyzing the data: salient AWANA influences during the time of the child's participation in AWANA, the current life of the participants, social trends of the participants through their time in AWANA to present day, and the participants' thoughts and feelings on how they perceived AWANA to have been conducted.

Developing Long-Term Physical Activity Participation: A Grounded Theory Study With African American Women

Regular physical activity is linked to a reduced risk of obesity and chronic disease. African American women bear a disproportionate burden from these conditions and many do not get the recommended amount of physical activity. Long-term success of interventions to initiate and maintain a physically active lifestyle among African American women has not been realized. By clearly elucidating the process of physical activity adoption and maintenance, effective programming could be implemented to reduce African American women's burden from chronic conditions. In-depth interviews were conducted with physically active African American women. Grounded theory, a rigorous qualitative research method used to develop theoretical explanation of human behavior grounded in data collected from those exhibiting that behavior, was used to guide the data collection and analysis process. Data derived inductively from the interviews and focus groups guided the development of a behavioral framework explaining the process of physical activity evolution.

Primary care physicians, office-based practice, and the meaning of quality improvement

Primary care physicians, office-based practice, and the meaning of quality improvement

Priority-Setting in Health Authorities: Moving beyond the Barriers The Calgary Experience

The objective of this study was to identify key issues relevant to the development and implementation of a macro-level priority-setting framework (i.e., across broad service areas) within the Calgary Health Region. We used rigorous qualitative methods, including focus groups, meeting observations and interviews to identify views of decision-makers. Key issues relevant to macro-level priority-setting included: application of evidence, incentives, physician involvement, public involvement and application of values. Detailed insight into each of these issues was derived, including how best to handle related barriers to priority-setting in health organizations and important lessons for framework development. These lessons learned should provide insight for similar activity in other jurisdictions.

Research for Knowledge and Practice: Carrying on the Tradition

This issue marks my beginning as the editor-in-chief for Social Work Research. I am grateful for the fine contributions of my predecessor, Enola Proctor, who worked diligently to improve the quality of manuscripts submitted and to increase the rigor and timeliness of the review process. She accomplished a great deal in her four years as editor-in-chief. The profession and I owe her our deepest gratitude. Social Work Research has a tradition of publishing manuscripts that use cutting-edge analytic tools in the pursuit of practice-relevant knowledge. I am honored to add my name to the list of seven prior editors-in-chief who have worked tirelessly to create a vital dissemination outlet for social work scholars, educators, and practitioners. My term as editor-in-chief comes at a critical juncture in the pursuit of knowledge related to the etiology, prevention, and treatment of individual and societal problems. We are in the midst of a revolution of sorts, best characterized by the growing attention paid to principles of evidence-based practice (Bilson, 2004; Gambrill, 1999; Gilgun, 2005; Howard & Jenson, 2003; Rosen & Proctor, 2003). Articles and books containing the phrase evidence-based practice have proliferated in the past five years. Yet, despite extensive discussion of evidence-based approaches, there remains a shortage of empirically supported interventions in our profession. Only a relatively small percentage of articles in core social work journals examine the effects of treatment intervention on client outcomes (Rosen, Proctor, & Staudt, 1999; Taylor & White, 2002).To engage practitioners in evidence-based practices we must increase the number of well-conducted outcome studies published in the social work literature. Social Work Research is an excellent publication source for studies assessing the efficacy and effectiveness of social programs and interventions. As editor-in-chief, I am particularly interested in publishing findings from investigations that use rigorous qualitative or quantitative methods to produce new knowledge about the effects of social interventions on society's most pressing problems. I urge you to send the results of your work to us. Articles in this issue reflect the journal's longstanding commitment to publishing manuscripts that aim to improve etiological knowledge and practice approaches for the nation's most vulnerable populations. Two articles address the concerns of mothers struggling with limited economic resources or mental illness. The first of these articles by Jackson and Scheines examines the relationship among low-wage employment, self-efficacy, depression, parenting behaviors, and behavioral and cognitive child outcomes during preschool and early elementary school. Previous evidence suggests that a number of single mothers who have exited welfare since the 1996 welfare reform law continue to live in poverty and to display depressive symptoms despite their entry in the job force (Elwood, 2000). Single African American women, the subjects in Jackson and Scheines's study, are disproportionately represented among welfare recipients and are at elevated risk of these problems. The authors' findings trace a complex causal path suggesting that employment is critical in reducing depressive symptoms and increasing the frequency of nonresident father-to-child contacts. Interestingly, Jackson and Scheines report that nonresident father contacts predict better maternal parenting, which in turn leads to improved behavioral and cognitive functioning for children in school. The second article, by Mowbray, Bybee, Hollingsworth, Goodkind, and Oyserman, focuses on the influence of alternative living arrangements on the well-being of women experiencing serious mental illness. In this NIMH-funded study, the authors compare overall functioning and parenting abilities of mothers living with their children only, mothers living with their children and partners, and mothers living with their children and extended family members. …