Niran Okewole MBBS, FWACP

Research is every endeavour with defined methodology aimed at placing knowledge on a firm footing.

Broadly, there are two types of research: quantitative and qualitative research.

Quantitative research often involves numerical analysis of data obtained by measurement.

This encompasses data obtained by common sampling techniques and analysed using various measures of central tendency and dispersion, descriptive and inferential statistics.

In the physical sciences this is the standard and the biological sciences including psychiatry strive for the precision and accuracy that is associated with quantitative data.

However, quantitative techniques are only usable when the outcomes to be measured are known and there are instruments, such as validated questionnaires, available to measure those outcomes.

Qualitative research is often exploratory. It is suited to other kinds of enquiry which are often the precursor to quantitative analysis.

Those psychological researchers who prefer qualitative research argue that statistically-based research has limitations because it is less able to take into consideration the context of behaviour.

The two kinds are complementary. In psychiatry in particular, where laboratory

tests have little sensitivity and specificity, qualitative methods are inevitable.

The process of collecting a patient’s history relies on the clinician’s ability to draw out information from a patient and then organize that information to match up with diagnostic criteria and from there develop a suitable management plan.

Essential features of qualitative research (Rutter, 2006):

It is concerned with what, how, and why research questions, rather than how often and how many type questions.

It is linked to methods that do not predetermine the form or content of the data (though the data are likely to be verbal)

Qualitative research concerns the subjective meaning people give to their experiences.

Evidence of meaning comes from analyzing what people say or by observing what they do. This approach is often useful in clarifying ‘hidden’ processes such as clinical decision making and procedures.

Qualitative research studies have a developmental ‘feel’, taking a very open-ended stance as to what is relevant at the beginning and gradually homing in on aspects of the investigation as it becomes apparent what these are.

The study protocol is not rigid; the initial protocol may build in an interim analysis of preliminary findings, after which the plan for subsequent work will be finalized.

Quantitative approach, following scientific method

Qualitative approach

Aim/purpose of research 

Relationship of data to theory

Tests (proves/disproves a predetermined hypothesis

Deductive( by reason): data are collected to support /disprove a proposed theory (the hypothesis)

Exploratory, flexible; no initial hypothesis

Inductive: theories ‘emerge’ as the data are analysed, to be supported, refined or overturned by subsequent data

Quantitative Qualitative

Methodological plan  

Setting

Predetermined, experimental design: should not deviate from the protocol 

Setting is likely to be artificial in some sense (e.g. in the way participants are referred)

Has predetermined aims to explore specified areas of enquiry: design and methods may adapt to changing focus

More likely to take place in naturalistic setting (unless supports a trial in artificial setting)

Quantitative Qualitative

Outcome variables   

Measurement of outcomes

Tries to isolate one/two variables as primary outcome measures 

Measurable/quantifiable outcomes

Range of variables: Often not clear which are the most important to outcomes. How the variables interact may be a key aspect of study

Outcomes not predictable, rarely quantifiable

Quantitative Qualitative

Can studies be replicated?    

Are results generalisable?

Should be replicable with similar findings. Different findings from repeated studies may be inexplicable.  

Claims to be generalisable to like contexts

May be replicable in similar settings: findings may be dissimilar because of differences in context. Comparison of different findings may be instructive.

Maybe generalisable to like contexts, but identifying similar contexts may be problematic

Confirmability is a qualitative concept analogous to the concept of objectivity in quantitative research. It is the degree to which research results can be confirmed by other researchers.

Transferability has been proposed as a qualitative substitute for psychometric validity. Research findings are transferable to the extent to which they can be generalized to settings other than the one in which they were made.

Investigation of psychopathology e.g.: Speech patterns (Cloze technique) Items of descriptive psychopathology Theory based postulates: psychodynamic

concepts

Generation of operational criteria, instrument development

Focus groups Expert panels

Feasibility studies Focus groups

Evaluation of therapies/intervention strategies

Psychotherapy Community interventions Educational strategies Consumer service satisfaction

In relation to quantitative research Addressing shortcomings before evaluation.

Useful when existing policy, protocol or treatment is dysfunctional in some way

Feasibility studies. Obtaining information before the design of a quantitative study or to formulate policy.

Supplementing information available from quantitative research.

Evaluating quantitative research (review papers)

Semi-structured interviews - Diagnostic schedules - Personality inventories Unstructured interviews - Expert opinion

Focus group discussions Case studies/series Participant observation Protocol analysis: this involves eliciting

verbal reports from research participants. Used in cognitive studies (Crutcher, 1994), behavior analysis (Austin &Delaney, 1998).

Content analysis Also known as textual analysis. This is the

study of recorded communication in whatever form. Focus is on authorship, authenticity and meaning.

Holsti: “any technique for making inferences by objectively and systematically identifying specified characteristics of messages.”

Neuendorf (2002): “ Content analysis is a summarizing, quantitative analysis of messages that relies on the scientific method (including attention to subjectivity, intersubjectivity, a priori design, reliability, validity, generalisability, replicability, and hypothesis testing) and is not limited to the types of variables that may be measured or the context in which the messages are created or presented.”

Krippendorff (2004): Which data are analysed? How are they identified? What is the population from which they are

drawn? What is the context relative to which the

data are analysed? What are the boundaries of the analysis? What is the target of the inferences?

Harold Lasswell: “who says what, to whom, why, to what extent, and with what effect?”

The analysis could be, according to McKeone (1995):

Prescriptive: the context is a closely defined set of communication parameters (e.g. specific messages, subject matter)

Open : identifies the dominant messages and subject matter within the text.

The foregoing process generates a theory, a collection of explanations that explain the subject of the research. In effect, a reverse engineered hypothesis!

This involves the study of verbal/non-verbal interaction in everyday life. Attempts to describe the orderliness, structure and sequential patterns of interaction.

Features include sequence organization, preference organization, adjacency pairs.

Patterns – turn taking, turn allocation (speaker selection), turn construction. The latter involves identification of Turn Constructional Units (TCUs), or the basic units out of which turns are fashioned. Include lexical, clausal, phrasal, sentential devices.

Focus is on sounds (intonation, etc), gestures, syntax, lexicon, style, rhetoric, meanings, speech acts, moves, strategies.

Also genres of discourse; relations between text (discourse), context and subtext; relations between discourse and power, interaction, cognition, memory.

NVIVO 8

Free trial available at www.qsrinternational.com

Sources In NVivo, ‘sources’ are your research or

project materials – anything from video recordings of research settings, to typed memos capturing your thoughts and ideas. Sources include:

Internals: primary source materials such as field notes, audio interviews, video footage, photographs or whatever raw data is relevant to your project.

Externals: ‘proxy’ sources representing material that you cannot import into NVivo (newspaper articles, books, web pages and so on). In an external, you can record notes or summaries relating to the material. If the external represents a file on your computer, you can link to and open the file.

Memos: records of your thoughts and observations. If a memo is related to a particular project item you can create a ‘memo link’ to link the two together.

Nodes: You can ‘code’ sources to gather material by topic, for example, you could gather all the content relating to the concept of community.

The container for references to this material is called a ‘node’.

Free Nodes: ‘stand-alone’ nodes that have no clear logical connection with other nodes—they do not easily fit into a hierarchical structure.

Tree Nodes: nodes that are catalogued in a hierarchical structure, moving from a general category at the top (the parent node) to more specific categories (child nodes).

Cases: nodes used to gather material about people or sites that have attributes such as gender or age. Like tree nodes, cases can also be organized in hierarchies.

Relationships: nodes that describe the connection between two project items. For example, the relationship between two cases (Anne works with Bill) or between two nodes (Poverty impacts Health).

Matrices: a collection of nodes resulting from a matrix coding query. Although you can open and explore the nodes in a matrix, you cannot code at them.

Sets : Sets provide a flexible way of grouping project items of different types. For example, you might create a set for the photographs and videos taken in a particular setting. You can customize the order of the items in a set to make a virtual ‘album’ or photo gallery.

Queries: Queries enable you to question your data, find patterns and pursue ideas. You can save queries, re-run them through new data and track the evolution of results.

Models: Models can illustrate initial ideas about your project or identify emerging patterns and connections. Make a ‘static’ model to represent your project at a specific point in time. Make a ‘dynamic’ model to represent your project in real time.

Classifications: NVivo enables you to classify

cases by setting up attributes such as gender, age and location.

Relationships: by setting up relationship

types (loves, impacts, employs, is married to and so on).

Clear purpose/aims. Ask yourself and colleagues, what exactly are the our research questions? What will we want informants to tell us about?

Justification for methodology. Is qltative research the best way of exploring these questions?

Resources to carry out study. Who will collect and analyse the data? Do they have the time? Do we have a tape recorder, funds for transcribing, funds for travel?

Plan your sampling strategy. How many interviews or groups can you afford? Are there particular types of people you should include? How will you access them?

Topic guide. Draft your topic guides (to submit to funders, ethics committee, etc.) Include a list of areas you aim to cover in order to address the study aims.

Include non-leading questions to introduce the topic areas. Pre-planned prompts to encourage people to elaborate can be useful if respondents give very succinct answers.

Ethical approval. This is a technical rqmt for working with pxx or staff. Draft an information sheet and consent form for participants. Are there particular ethical issues?

Are you required to report any particular interviewee statements (such as intention to harm self or others), and if so, has the participant been explicitly warned?

Confidentiality or anonymity. Can you guarantee that no one not present at the interview will ever know what was said confidentially? Or do you envisage including unattributed quotations? The consent form should ask permission to use quotes.

Recording the interview/focus group. If manually recorded, the record will not be verbatim but a summary of key points.

Analysis. Has the project got an experienced analyst? The more data generated, the more complex the task.

Interview arrangements. How are the participants approached? Are the arrangements for the interview safe, private and convenient for all parties? Can you offer refreshments and travel expenses?

Data protection. Data could be on paper, on recorded tape, or on computer. How are these stored and protected? Are files anonymised? When will the data be destroyed? Have participants given informed consent to storage, use and destruction of data from their interviews?

Should include The stated aims of the research The prevalence of particular views within

the sample Factors that might influence the views of

the respondents Discussion of data that do not fit Consequences of views expressed for the

service or field of inquiry. 

1. Bias inherent in research team’s choices Consulting with experts Not taking decisions in isolation Constructing parallel independent topic

guides Conducting parallel independent analyses

2. Validity of the findings Purposive sampling strategy, considering

how all relevant groups can be included Reflexivity in conducting the interview: is

the interviewer leading informants? Conduct interim analysis to consider ‘gaps’

in the data

Triangulation: use of other methods/data sources to test findings and conclusions

Consider feeding back your preliminary findings to your informants: do they recognize your conclusions?

3. Generalisability of the findings Be specific about research context Express doubts about generalisability

Barriers to sexual and reproductive health care: urban male adolescents speak out.Lindberg C, Lewis-Spruill C, Crownover R.

CONTEXT: Risky sexual behaviors among adolescent males put them at risk for sexually transmitted diseases, HIV/AIDS, and unplanned fatherhood, yet few facilities in the United States provide focused sexual and reproductive health services to these young men. A general acknowledgement exists that the development of such services is needed, yet there is little research to guide providers in making existing services more attractive to young males and in developing new sexual health services for this population.

OBJECTIVES: This research aimed to explore attitudes and perceptions of urban black male adolescents regarding the availability of and access to reproductive healthcare.

METHODS: Eighteen black male adolescents participated in three focus group discussions held in a central New Jersey city. Transcripts of the discussions were analyzed using the constant comparative method. Resulting categories were grouped into themes, which reflected the adolescents' perceptions and experiences. Member checks were used to verify findings.

RESULTS: The adolescents felt that obtaining sexual health services was a stressful experience fraught with both internal and external barriers. Internal barriers included a fear of stigma and a loss of social status, shame, and embarrassment. External barriers included disrespectful providers, a lack of privacy/confidentiality, and challenges in accessing and negotiating the healthcare system. The young males described an idealized clinic environment as informal, welcoming, and respectful.

DISCUSSION and CONCLUSIONS: Providers should focus on improving the quality of care in existing clinics, particularly in the areas of access, privacy, and confidentiality, and on developing adolescent-friendly clinics focusing on male services. Adolescents should be encouraged to visit clinics prior to an acute need for services. There also is a need for providers who are comfortable with and able to communicate with male adolescents.

Int. Rev. Psychiatry, 2008 Jun;20(3):271-80. Assessment of need for a school-based

mental health programme in Nigeria: perspectives of school administrators.

Ibeziako PI, Omigbodun OO, Bella TT. Department of Psychiatry, Childrens

Hospital Boston/Harvard Medical School, Boston, Massachusetts, USA. patricia.ibeziako@childrens.harvard.edu

The majority of children in Nigeria are unable to access mental health services. In this resource-poor setting, a school-based mental health service can be used to reach children who would otherwise not have access. An essential first step in the development of a school-based mental health programme is a needs assessment. Key informants (KIs) from southwest Nigeria were interviewed to identify their perspectives on child mental illness and needs for a school mental health programme. Data were analysed using interpretative phenomenological analysis.

Although KIs sometimes used derogatory terms to describe mental illness, they were able to give full descriptions of different kinds of mental illnesses in children and a range of causes based on the bio-psychosocial model of disease. KIs acknowledged deficiencies in their training even though they currently use parent, child and environment-centred interventions to deal with mental health problems in school.

KIs reported teachers as comfortable with handling mental health issues in children and suggested interventions that included development of basic and ongoing training. Barriers, such as poverty, ignorance and stigma need to be addressed, while government involvement and enlightenment campaigns are critical components of a successful programme.

West Afr JMed, 2008 Oct;27(4):259-62. Suicide attempt by hanging in

preadolescent children: a case series. Omigbodun OO, Adejumo OA, Babalola OO. Department of Psychiatry, College of

Medicine, University of lbadan & University College Hospital, Ibadan, Nigeria. fouryinkas@yahoo.co.uk

Curr. Opin in Psychiatry, 2009 Sep;22(5):457-61.

Perspectives of intellectual disability in Africa: epidemiology and policy services for children and adults.

Njenga F. Upper Hill Medical Centre, Nairobi, Kenya.

fnjenga@africaonline.co.ke

TOPIC: Challenges of implementing the NICE guideline in a resource constrained setting

BACKGROUND:Clinical guidelines aim to implement available evidence and bridge the gap between research and practice. Very few have however been produced in this environment, in medical practice in general and for schizophrenia management in particular. The NICE (National Institute for Clinical Excellence) guideline for schizophrenia is an excellent, evidence based tool. However, the resource implications, even in an affluent society, can be enormous.

AIM: This study aimed to examine the suitability and challenges of implementing the NICE guidelines in this setting.

METHOD: The study was conducted at the Psychiatric Hospital, Yaba, Lagos, following a dual moderator focussed group discussion format. A panel comprising of consultants, senior registrars, senior psychologists and senior social workers and nurses discussed the guidelines, having been given ample time to study the document. Ethical approval was obtained from the hospital Ethics and Research committee. Analysis was done using NVIVO version 8 for qualitative research.

RESULTS: The NICE guidelines contain several key features which are already being practiced in the hospital to various extents. Constraints to full implementation include manpower and prevailing underdevelopment in the society. The guidelines need to factor in socio-cultural differences.

CONCLUSION: The NICE guidelines with modifications are suitable for use in this setting.