- last update
- Save as PDF
- page id
- 13230
- Peter G. Smith, Richard H. Morrow y David A. Ross
- London School of Hygiene and Tropical Medicine and Johns Hopkins Bloomberg School of Public HealthaboveOxford University Press
\( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}}}\) \( \newcommand{\vecd}[1]{\overset{-\!- \!\rightharpoonup}{\vphantom{a}\smash{#1}}} \)\(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{ span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{rango}\,}\) \( \newcommand{\RealPart }{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\ norma}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm {span}}\) \(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\ mathrm{nulo}\,}\) \( \newcommand{\rango}{\mathrm{rango}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{ \ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argumento}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{s pa n}}\)\( \newcommand{\AA}{\unicode[.8,0]{x212B}}\)
Qualitative research methods commonly used in field trials of health interventions include direct observation, key informant interviews, focus group discussions, and participatory methods. These relatively open-ended techniques are useful for exploring how an intervention may be perceived, the priorities of different community members, and how people view a study from the perspective of potential participants. These methods are used to provide relevant information for the development of intervention components, such as communication strategies, as well as for the development of experimental methods, for example, to ensure recruitment and design effective and appropriate data collection tools.
The goal of qualitative research is to understand the perspectives of certain groups of people. In doing so, researchers seek to learn about the social worlds in which others live: their experiences with specific issues, their reference points for specific issues, and the broader factors that shape them, ranging from the local to the global, historical and political. economic factors. . Looking at the world from a social perspective, it is recognized that what people say and do depends on the environment in which the words are spoken and what is done. Qualitative research seeks to understand or interpret phenomena in terms of the meanings that people ascribe to them, and qualitative research practice recognizes the role of the researcher in highlighting these meanings. Therefore, the central concerns of qualitative research are how best to interpret the perspectives of others and how to integrate the subjective nature of that interpretation into analyses. Both aspects are relevant in research to control the development of interventions and evaluate the results of the studies.
When considering methods for interpreting the perspectives of others, most qualitative research encompasses the following four concepts:exploratory flexibility, iteration, triangulation, micontextualization.Although the investigator will have specific questions to investigate, it is expected that new questions will arise frequently as the investigation progresses. Specific techniques and associated data collection methods are refined and modified throughout the research process. TOflexibleAn approach is taken that explores unexpected ideas as new research directions emerge, unproductive forms of data collection are discarded, and new methodologies are developed without losing sight of the original research goals. A thorough investigation is important. The same or different key informants and different respondents may be interviewed repeatedly, with each new interview building on the previous one with greater sophistication and focus. EITHERiterativeit applies not only to individual methods but to the qualitative research process as a whole. Various fieldwork strategies can be employed, including individual interviews, such as key informant interviews, group discussions, and direct observations of actual behavior. Using several methods together, ortriangulation, gives depth to an investigation of the phenomenon in question. More than a validation strategy, triangulation adds richness and breadth, allowing a more rigorous study of the complexity of a phenomenon through its multiple representations. Qualitative research can be used to help researchers understand the social, cultural, historical, political, and economic context in which an intervention study takes place. such ccontextualization it is particularly valuable in the early planning stages and also helps to understand unexpected study results.
When considering how to integrate the subjective nature of interpretation into analyses, the concept ofreflexivityIt is crucial for qualitative research. This assumes that the researcher explicitly acknowledges his motivations and theoretical positions in relation to a research paper and strives to reflect and articulate them in field research decisions and interpretations. For example, when a researcher feels aligned with the ideals of market-oriented health care delivery, this may affect the way in which they ask questions and interpret the answers, which may affect the form of intervention developed and the way and may affect how the outcome of an investigation is obtained. the study is interpreted. Reflection on the political, economic, and theoretical agendas underlying the motives or implementation of research can allow for greater transparency and the opportunity to challenge and reconsider these perspectives. Methods for achieving a reflective attitude include keeping reflective journals and field notes, and reflectively discussing decisions as a team. It has been proposed to extend this approach beyond qualitative activities to the conduct of studies in general, in order to promote transparency and encourage more realistic representations of study contexts, which are often constantly changing, thus reducing the barriers of recruitment and potential sources of bias that may be addressed in studies, activities or analyzes may be anticipated (Wells et al., 2012).
We describe some of the most important qualitative research methods in the social sciences. More detailed descriptions of the most important qualitative research methods can be found in Kielmann et al. (2011) and Bryan (2012). Chandler et al. (2013b) also produced a compilation of guidelines for conducting qualitative research related to health interventions and provides a model parallel protocol document that includes sample topic guides and standard operating procedures (SOPs) and a variety of training materials for field teams ( <www.actconsortium .org/resource...2/qualitative-methods-for-international-health-intervention-research>).
3.1 Direct observation
Direct observation includes both structured and unstructured observations. These methods are useful for understanding the everyday context relevant to an intervention. Spending an extended period of time observing this allows the investigator to assess factors that may be relevant to an intervention in relation to other community priorities and stakeholder activities and concerns. This may be important both for developing appropriate interventions and for interpreting study results.
3.1.1 Unstructured observation
Unstructured observation is the cornerstone of ethnography, the classical methodology of anthropology. Ethnographers often doparticipant observationas they strive to become a functioning member of a community and participate in local activities, closely watching what others are doing and how they react to the ethnographer's own behavior. The goal is to try to see the community from the perspective of a participating member and not as an outsider. in many situationsnon-participant observationit is more practical and may allow a more systematic description of activities in which the observer is not directly part of the activity being studied. Non-participant observations can focus on a person (eg, a pregnant woman), a place (eg, the kitchen or a water point), or an event (eg, a wedding party or a market). The observer attempts to record as much behavior as possible, including actions, conversations, physical location description, and other relevant characteristics. Focused observations generally require a prior study of the activity or location to prepare the observer. For example, the researcher may have a general idea of the furniture in a country house, but may not know the type and quantity of kitchen utensils or how they are washed or stored. Some research questions require detailed observations of how an intervention is actually carried out. For example, how a mother mixes water with rehydration salts to treat diarrhea at home, or how a healthcare professional interacts with a client and/or performs a medical procedure. These observations can be used in the design of questionnaires and to confirm or refine the data collected through interviews.
Unstructured observation activities are often carried out in conjunction with formal and informal interviews and group discussions. Observations and revisions of the discussion are usually recorded in detailed field notes after the activity. Analysis is ongoing and often involves daily review and reflection of events and how they were interpreted by the ethnographer. Unstructured observation can be useful at all stages of study-related research, for example, to understand how healthcare professionals use the guidelines in practice, when designing or evaluating an intervention to improve clinical practice related to a specific individual from the guideline, such as treatment with antimalarials or antibiotics. The rate-limiting step is often the availability of trained investigators to perform such ongoing activities and analyses.
3.1.2 Structured observation
Structured observations involve the recording of behaviors or behavioral outcomes by trained observers using a pre-coded or partially coded data collection instrument. Structured observation methods can be used for continuous monitoring or for random testing of behavior. These approaches are used when the behaviors to be studied in detail have been identified (perhaps through unstructured observation) and it is clear what information is needed (eg, time of day, frequency, duration, and behaviors). .
The researcher observes, as unobtrusively as possible, the occurrence of events or behaviors. Every observer is faced with the dilemma of where to focus their attention and what details to record. Data collection tools are designed to help focus researchers' attention on the issues most relevant to the research question. The structure provided limits discoverability, but ensures relevance and consistency. The complexity of structured observation tools varies. Some studies focus on breaking down one or two events of interest, breaking them down into small units of activity, and noting who performs them, where, with what tools, and for how long, as reported in a study of handwashing practices in Bangladesh conducted by Stanton and Clemens (1987). Structured observations can be part of larger ethnographic studies, which has the advantage that the results can be interpreted in a broader social context, allowing for more careful interpretation that can inform behavior change interventions. Chandler et al. (2008) conducted an ethnographic study of malaria management by health professionals, incorporating structured observations of clinic visits into a larger study of malaria overdiagnosis in Tanzania and reporting the design of interventions, which were pooled into one study. randomized 3-arm cluster trial. Proven Unlike most of the methods described in this chapter, structured observation can provide data amenable to statistical analysis. This has potential for repeated observations to monitor behavior changes over time.
3.2 In-depth interviews
In-depth interviews are generally aimed at gaining a full understanding, in their own words, of a participant's perspective on the issues being studied. Such interviews may have a narrative approach, where the interviewer seeks to hear the 'story' of the participant from a historical perspective and seeks more details about areas of research interest, e.g. eg B. Access to maternal health services. In-depth interviews can also be used to explore people's ideas and concepts about specific topics, with the interviewer asking questions about specific topics identified as being of interest to the research objective. In either case, a topic guide or list of questions can be used as a reminder and contain specific questions that have been tried. The goal is to use this guide to explore each interviewee's experience and perspective as they feel able and willing to explain themselves. Thinking of relevant and useful survey questions is an important skill for the interviewer, who must keep the research objective in mind while participating in and following the thought processes of respondents. She must be able to use new information to steer the interview in previously unplanned but relevant directions. Another key interview skill is the ability to establish rapport and maintain confidentiality so that the interviewee feels comfortable and safe in expressing her opinions and experiences.
In-depth interviews take a long time to prepare, conduct, transcribe (and translate), and interpret. Therefore, they can usually only be performed with a few carefully selected people. Depending on the objectives of the study, respondents for in-depth interviews may be “key informants” or individuals selected based on specific characteristics of interest (eg, mothers who have lost a child, migrants). In the context of intervention studies, there are typically three types of key informants: community managers/leaders or others in positions of power, community health workers, and people from the community with specialized knowledge or experience (eg, midwives). traditional, traditional healers). . . . Key informants are identified through casual interviews with formal and informal leaders and other key members of the community, or through more systematic methods such as consensus analysis or social network analysis (Bernard and Ryan, 2010). Whistleblowers become "key people" because they are more informed, cooperative and approachable than other respondents and are often interviewed multiple times. They serve to inform the researcher about selected aspects of the culture and customs of a community and can be used to provide information throughout the study.
3.3 Focus group discussions
Focus group discussions are a useful way to learn about shared values and benchmarks. Focus groups can also be a good opportunity to generate and test initial ideas for an intervention, with group members having the opportunity to offer, modify, or reject ideas for changes relevant to a particular health problem.
In a focus group discussion, a small group of participants (usually six to twelve), guided by a facilitator, are encouraged to talk about topics they believe are of particular importance to the respondents and to the research. The moderator uses the topic guides to stimulate discussion on areas of interest. Participants are selected from specific target groups whose ideas and experiences are relevant to the study. Participants in a focus group are best selected to avoid power imbalances that could result in a few individuals dominating the discussion. Participants are generally of the same gender and age group, but similarities in other characteristics may be important depending on the research question. For example, in the case of a study evaluation on improving maternal health services, participants may include those who used the intervention and those who did not, but should not also include health professionals (whether from the formal sector or from the formal sector). or informal). ) include ) that provide such services. It is important but difficult to ensure that participants are comfortable with what natural grouping might mean, such as being able to reveal sensitive information during discussion.
For discussions to be productive, the facilitator must have the ability to understand and facilitate positive group dynamics and be able to keep the research objectives in mind to guide the discussion so that as much time as possible is devoted to the Topics that may be relevant. to the research question. In addition to the facilitator, it is helpful to have an observer who takes notes and listens for nonverbal cues. This spotter can also collect attendee demographics and ensure they get refreshments. If possible, a focus group discussion should be recorded and then fully transcribed. However, if it is felt that this would unduly preclude open discussion, the observer should take detailed notes as verbatim as possible.
The number of focus groups conducted will depend on the number of different relevant groups in the community of interest. Focus group sessions typically last at least an hour and continue until the facilitator feels that all participants have adequately expressed their views on the issues under study. Transcription and translation of focus group discussions can be time consuming, and transcripts are typically 50-100 pages long. Coding and analysis of such transcripts is time consuming. Therefore, to get the most out of this method, it is important to think carefully about the sampling, the topics for discussion, and the facilitator's level of experience and familiarity with the research questions.
3.4 Participatory research
Participatory research methods aim to enable change at the local level through a process of sequential thought and action, carried out with and by the local population. This differs from the other methods described in this chapter, which can generally be thought of as being performed "on people." In their purest, participatory or 'action' form, research approaches do not start with a specific intervention in mind, but rather aim to respond to local priorities and needs and allow local agencies to define and develop their own interventions. This is done through a series of facilitated discussions, workshops, planning sessions and activities. In health research, several studies have taken a form of this approach, providing a framework within which local actors can define their priorities and methods of intervention. One example is the Health Workers for Change program, a series of six workshops designed to address the interpersonal component of quality of care, allowing participants to explore provider-client relationships in a gender-sensitive context. This program was implemented and evaluated in four countries, where the intervention was delivered differently with the guidance of local participants, and facilitated open discussion of difficult problems, encouraged problem solving, and helped health professionals develop plans and practical tools to solve them. problems that could strengthen district health systems (Fonn et al., 2001).