Qualitative Research in Qualitative Research in Health & LeisureHealth & LeisureFocus Groups and InterviewsFocus Groups and Interviews

Eimear Foley, BSc., MSc.Eimear Foley, BSc., MSc.

1919thth January 2006 January 2006

OverviewOverview What is qualitative research?What is qualitative research? Why use qualitative research?Why use qualitative research? Interviewing Interviewing Focus GroupsFocus Groups AnalysisAnalysis ReportingReporting Examples Examples

What is Qualitative Research?What is Qualitative Research? Qualitative research designs are those that Qualitative research designs are those that

are associated with interpretative are associated with interpretative approaches, from the participants point of approaches, from the participants point of view, rather than measuring discrete, view, rather than measuring discrete, observable behaviour. observable behaviour.

Qualitative methodologies are strong in Qualitative methodologies are strong in those areas that have been identified as those areas that have been identified as potential weaknesses within the quantitative potential weaknesses within the quantitative approach approach

Qualitative research …Qualitative research … Allows the researcher to explore the cognitive Allows the researcher to explore the cognitive

and affective aspects of the research question in and affective aspects of the research question in greater detailgreater detail

Encourages participants to introduce concepts Encourages participants to introduce concepts of importance to the issues rather than adhering of importance to the issues rather than adhering to pre-determined subject areato pre-determined subject area

Approaches ‘which seek to uncover the Approaches ‘which seek to uncover the thoughts, perceptions and feelings experienced thoughts, perceptions and feelings experienced by informants’ (Minichiello et al., 1995:10)by informants’ (Minichiello et al., 1995:10)

InterviewingInterviewing Structured – usually with a structured Structured – usually with a structured

questionnairequestionnaire Semi-structured Interviews- Guided Semi-structured Interviews- Guided

ConversationsConversations Allow for focused, conversational, two-way Allow for focused, conversational, two-way

conversationconversation Depth of information, time consumingDepth of information, time consuming Provide reasons for answersProvide reasons for answers Less intrusive – sensitive issuesLess intrusive – sensitive issues

In Depth – 1/2 issues covered in great detail, In Depth – 1/2 issues covered in great detail, questions are based on what the interviewee questions are based on what the interviewee says says

Qualitative interviewers should try to be Qualitative interviewers should try to be interactive and sensitive to the language and interactive and sensitive to the language and concepts used by the interviewee and also try concepts used by the interviewee and also try to keep the agenda flexible to keep the agenda flexible

Good questions in qualitative interviews Good questions in qualitative interviews should be open ended, neutral, sensitive, and should be open ended, neutral, sensitive, and clear to the interviewee (Patton, 1987)clear to the interviewee (Patton, 1987)

Types of questions for qualitative Types of questions for qualitative interview (Patton, 1987)interview (Patton, 1987)

Behaviour or experienceBehaviour or experience Opinion or beliefOpinion or belief FeelingsFeelings KnowledgeKnowledge SensorySensory Background or demographic Background or demographic

Use questions carefully, but informally Use questions carefully, but informally

Ask questions exactly as written Ask questions exactly as written

Follow the order given Follow the order given

Ask every question Ask every question

Don't finish sentences Don't finish sentences

Tips for interviewing…Tips for interviewing…

Obtaining Adequate Responses - The ProbeObtaining Adequate Responses - The Probe Silent probe Silent probe Pause and waitPause and wait

Overt encouragement Overt encouragement ““Uh-huh”, “OK”Uh-huh”, “OK”

Elaboration Elaboration ““Is there anything else you would like to add?”Is there anything else you would like to add?”

Ask for clarification Ask for clarification "A minute ago you were talking about the experience you had in "A minute ago you were talking about the experience you had in

primary school. Could you tell me more about that?"primary school. Could you tell me more about that?"

Repetition Repetition "What I'm hearing you say is that you found that experience "What I'm hearing you say is that you found that experience

very enjoyable." Followed by a pausevery enjoyable." Followed by a pause

Focus GroupsFocus Groups ““a group of individuals selected and assembled a group of individuals selected and assembled

by researchers to discuss and comment on, by researchers to discuss and comment on, from personal experience, the topic that is the from personal experience, the topic that is the subject of the researcher” subject of the researcher” (Powell et. al., 1996: 499)(Powell et. al., 1996: 499)

Focus groups rely on interaction within the Focus groups rely on interaction within the group based on topics that are supplied by the group based on topics that are supplied by the researcherresearcher

Why use focus groups?Why use focus groups? Draw upon participants attitudes, feelings, Draw upon participants attitudes, feelings,

beliefs, experiences and reactions – not beliefs, experiences and reactions – not feasible using other methods e.g. observation, feasible using other methods e.g. observation, one-to-one interviews, surveysone-to-one interviews, surveys

Attitudes etc. more likely to be revealed in Attitudes etc. more likely to be revealed in social group settingsocial group setting

Large amount of info – short amount of timeLarge amount of info – short amount of time Useful when interested in everyday use of Useful when interested in everyday use of

language and culture of particular groupslanguage and culture of particular groups Also to explore degree of consensusAlso to explore degree of consensus

BenefitsBenefits Interaction Interaction Information about why issue is salientInformation about why issue is salient Involvement in decision making process – Involvement in decision making process –

EmpowermentEmpowerment Forum for change Forum for change

LimitationsLimitations Researcher has less control over data producedResearcher has less control over data produced Social DesirabilitySocial Desirability Difficult to assembleDifficult to assemble Not fully confidential or anonymousNot fully confidential or anonymous

Organisation of Focus GroupOrganisation of Focus Group

No. of participants = 6 - 10 peopleNo. of participants = 6 - 10 people Duration = 1 – 2 hoursDuration = 1 – 2 hours Location = NeutralLocation = Neutral Same group meeting several timesSame group meeting several times One meeting, several groupsOne meeting, several groups

Participants:Participants: Heterogeneous vs. HomogeneousHeterogeneous vs. Homogeneous People need to feel comfortablePeople need to feel comfortable Possess similar characteristics or levels of Possess similar characteristics or levels of

understanding about topicunderstanding about topic Locating participantsLocating participants

Time consumingTime consuming Specific interests – word of mouth through key Specific interests – word of mouth through key

participants e.g. swimmers, parentsparticipants e.g. swimmers, parents Advertising or poster campaignAdvertising or poster campaign Existing social networks e.g. ARG, ICA, Musical Existing social networks e.g. ARG, ICA, Musical

SocietySociety

Role of moderatorRole of moderator Clear explanation of purpose Clear explanation of purpose Help people feel at ease Help people feel at ease Promote debate by asking open ended questionsPromote debate by asking open ended questions Tease out diverse range of meaningsTease out diverse range of meanings Probe for detail/Steer conversation back on Probe for detail/Steer conversation back on

coursecourse Facilitate interactionFacilitate interaction Avoid showing approval or giving personal Avoid showing approval or giving personal

opinionopinion One moderator facilitates and other takes notes, One moderator facilitates and other takes notes,

checks equipment and give feedbackchecks equipment and give feedback

Designing QuestionsDesigning Questions

Open-ended questions: allows respondents to Open-ended questions: allows respondents to give answers in their own waygive answers in their own way

Useful to get unanticipated answersUseful to get unanticipated answers Responses are open ended i.e. not yes or no Responses are open ended i.e. not yes or no

answersanswers Example: What can you tell me about diet? Example: What can you tell me about diet?

What are your thoughts on yoga? What are your thoughts on yoga?

Interpretational AnalysisInterpretational Analysis There is no one correct way of analysing There is no one correct way of analysing

qualitative dataqualitative data Essential to describe the planned method and Essential to describe the planned method and

decision criteriadecision criteria Transcript – written version of the interviewTranscript – written version of the interview Make notes when transcribing tape – provoke Make notes when transcribing tape – provoke

memories and thoughtsmemories and thoughts First transcript will be messy and uneditedFirst transcript will be messy and unedited Research question must be clearly defined in Research question must be clearly defined in

advanceadvance

Data Organisation: Data Organisation: Step 1 – Creating TagsStep 1 – Creating Tags

Creating Tags – aims to produce a set of Creating Tags – aims to produce a set of concepts which adequately represent the concepts which adequately represent the information included in interview transcriptinformation included in interview transcript

Separates relevant meaningful portions of Separates relevant meaningful portions of data from their contextdata from their context

Each unit is tagged with a provisional name Each unit is tagged with a provisional name describing the topicdescribing the topic

E.g. Barriers to physical activityE.g. Barriers to physical activity

Data Organisation Data Organisation Step 2 – Creating categoriesStep 2 – Creating categories

List and compare the tags already derived in List and compare the tags already derived in step 1step 1

Group similar tags and give a label that Group similar tags and give a label that captures the essence of the topic captures the essence of the topic (Miles & (Miles & Huberman, 1984)Huberman, 1984)

Set of categories serves as preliminary Set of categories serves as preliminary organising systemorganising system

Segments must remain flexibleSegments must remain flexible Higher order categoriesHigher order categories

CodesCodes You may decide to use a set of already existing codes

with your data. These are called a priori codes. A priori codes are codes that are developed before

examining the current data. Many qualitative researchers like to develop the

codes as they code the data. These codes are called inductive code.

Inductive codes are codes that are developed by the researcher by directly examining the data.

Writing the reportWriting the report In-depth analysis of higher order categoriesIn-depth analysis of higher order categories Intensity & Frequency of responsesIntensity & Frequency of responses Identify group consensus (agreement)Identify group consensus (agreement) Organise report by issue (instead of by group)Organise report by issue (instead of by group) Discuss similarities and differences by groups Discuss similarities and differences by groups

and by individuals and by individuals Restate and answer the research question(s) Restate and answer the research question(s) Quotes and comments should be used to Quotes and comments should be used to

support findingssupport findings

Analysing Focus GroupsAnalysing Focus Groups Distinct feature of working with focus group data is Distinct feature of working with focus group data is

the need to indicate the impact of the group dynamic the need to indicate the impact of the group dynamic and analyse the interaction between research and analyse the interaction between research participants participants

When coding, use special categories such asWhen coding, use special categories such as Jokes and anecdotesJokes and anecdotes QuestionsQuestions Deferring to the opinion of othersDeferring to the opinion of others Changes of mindChanges of mind

A focus group research report that is true to its data A focus group research report that is true to its data should also usually include at least some illustrations should also usually include at least some illustrations of the talk between participants, rather than simply of the talk between participants, rather than simply presenting isolated quotations taken out of context. presenting isolated quotations taken out of context.

(Kitzinger, 1995)(Kitzinger, 1995)

Example: Example: Dying from cancer in developed and developing Dying from cancer in developed and developing countries: lessons from two qualitative interview studies of countries: lessons from two qualitative interview studies of

patients and their carers (Murray et al., 2003)patients and their carers (Murray et al., 2003) Objective:Objective: To describe the experiences of illness and needs and To describe the experiences of illness and needs and

use of services in two groups of patients with incurable cancer, use of services in two groups of patients with incurable cancer, one in a developed country and the other in a developing country. one in a developed country and the other in a developing country. A qualitative approach was used so that accounts could be obtained A qualitative approach was used so that accounts could be obtained

sensitively without upsetting participants with advanced illnesses sensitively without upsetting participants with advanced illnesses Participants:Participants: Scotland: 20 patients with inoperable lung cancer Scotland: 20 patients with inoperable lung cancer

and their carers. Kenya: 24 patients with common advanced and their carers. Kenya: 24 patients with common advanced cancers and their main informal carers. cancers and their main informal carers.

Methodology: Methodology: Scotland - conducted and tape recorded in-depth interviews at Scotland - conducted and tape recorded in-depth interviews at

three monthly intervals for up to a year with patients and their three monthly intervals for up to a year with patients and their main informal carer in the patient's home. main informal carer in the patient's home.

Kenya - guided by staff at the hospital and affiliated nurse Kenya - guided by staff at the hospital and affiliated nurse training school, a semi-structured interview schedule was training school, a semi-structured interview schedule was developed. A local nurse conducted single interviews with developed. A local nurse conducted single interviews with patients and carers in the local language. patients and carers in the local language.

Data AnalysisData Analysis Results were analysed throughout the fieldwork to Results were analysed throughout the fieldwork to

allow emergent themes to be fed back into the data allow emergent themes to be fed back into the data collection. collection.

These themes and the research questions formed These themes and the research questions formed the basis of the coding strategies. the basis of the coding strategies.

QSR NVivoQSR NVivo At both sites transcripts and field notes were At both sites transcripts and field notes were

checked and coded by two experienced researchers checked and coded by two experienced researchers

Living with cancer in ScotlandLiving with cancer in Scotland Patients and their carers in Scotland were Patients and their carers in Scotland were predominantly concerned about the prospect of predominantly concerned about the prospect of death. "The doctor told me that you're actually death. "The doctor told me that you're actually on borrowed time with cancer . . . They're on borrowed time with cancer . . . They're hoping to shrink this cancer in the right lung, hoping to shrink this cancer in the right lung, but you're more or less a time bomb" (patient but you're more or less a time bomb" (patient 1). "You're wondering if you're going to see 1). "You're wondering if you're going to see tomorrow. When I first was told, that was the tomorrow. When I first was told, that was the first thing that went through my head, How first thing that went through my head, How long? When?" . . . it's been like going to hell long? When?" . . . it's been like going to hell and back" (patient 2).and back" (patient 2).

Example: Example: Fruits, vegetables, and football: Findings from Fruits, vegetables, and football: Findings from focus groups with alternative high school students regarding focus groups with alternative high school students regarding

eating and physical activityeating and physical activity (Kubik et al., 2005)(Kubik et al., 2005) Purpose: Purpose: To increase our understanding of factors that may influence the To increase our understanding of factors that may influence the

dietary and physical activity practices of adolescents attending an dietary and physical activity practices of adolescents attending an alternative high school (AHS)alternative high school (AHS)

Methodology: 7 schools (4 urban, 3 suburban); 76 students (36 f, 34 m); Methodology: 7 schools (4 urban, 3 suburban); 76 students (36 f, 34 m); 45-60 min focus groups; incentive – healthy snack & $20 gift voucher45-60 min focus groups; incentive – healthy snack & $20 gift voucher Trained moderator & co-moderator, audiotapedTrained moderator & co-moderator, audiotaped Questions developed by investigators & piloted with convenience sampleQuestions developed by investigators & piloted with convenience sample Introductory Q’s – last time you exercised, everything you had to eat or Introductory Q’s – last time you exercised, everything you had to eat or

drink yesterdaydrink yesterday Key Q’s – factors that influence food choice; circumstances that make it Key Q’s – factors that influence food choice; circumstances that make it

easier or harder to be active; ideas for a school health promotion easier or harder to be active; ideas for a school health promotion programmeprogramme

Semi-structured questioning to ensure consistency but allow flexibilitySemi-structured questioning to ensure consistency but allow flexibility

Audiotapes were transcribed verbatim to ensure systematic analysis of focus-group discussions.

Data then were analyzed using a 3-step process (Miles & Huberman, 1994) with the student as the unit of analysis.

1. Interviewers reviewed and edited transcripts and abstracted meaningful data.

2. Data were organized into categories representing emerging themes such as eating options at school and factors that influence being active.

3. Reviewers created a matrix that allowed for the tabulation of themes by school and a comparison of themes across schools. Results then were compared, contrasted, and rank ordered to create a textual summary of findings.

To control for possible bias, all transcripts were reviewed independently by 2 other investigators. The selection of categoriesand themes also was verified by independent review.

There was a high level of concordance between reviewers

Data AnalysisData Analysis

Students reported an interest in “fun” activities. Teamsports, particularly football, were considered fun by bothgirls and boys. Social support and role modeling behavior offriends and adults also were identified as factors that helpedone be active. Others liked the way it made them feel “goodabout yourself” and “lighter and stronger.” Having a goal,“something to work for,” was a motivator for both girls andboys. Boys liked the “adrenaline rush.”

“Now I feel like I have a lot more energy and a lothappier when I’m more active and just better able to dealwith the world” (male student at an urban school).

Points to notePoints to note Be aware of any biases you may have towards the Be aware of any biases you may have towards the

topictopic First, make a list of your characteristics e.g. age, First, make a list of your characteristics e.g. age,

gender, religion, interests. gender, religion, interests. It is likely that these characteristics will be the root It is likely that these characteristics will be the root

of the biasof the bias              1.1. List ways in which your characteristics might bias List ways in which your characteristics might bias

you in your efforts at research interviewing. you in your efforts at research interviewing. 2.2. Then write how you might counteract these biases. Then write how you might counteract these biases. 3.3. And then write how these efforts to counteract your And then write how these efforts to counteract your

biases might themselves lead to other biases!biases might themselves lead to other biases!

Ethical IssuesEthical Issues Same for all methods of social researchSame for all methods of social research Full information must be given to participants Full information must be given to participants

about the purpose and uses of the contributionsabout the purpose and uses of the contributions Need to clarify that participants contributions Need to clarify that participants contributions

will be shared by group and moderatorwill be shared by group and moderator Do not pressurise people to respondDo not pressurise people to respond Encourage participants to keep confidential Encourage participants to keep confidential

what they hearwhat they hear Anonymise data e.g. (Male, aged 46)Anonymise data e.g. (Male, aged 46)

ReferencesReferences Cote, J., Salmela, J., Baria, A., (1993) Organizing and Interpreting Unstructured Cote, J., Salmela, J., Baria, A., (1993) Organizing and Interpreting Unstructured

Qualitative Data. Qualitative Data. The Sport PsychologistThe Sport Psychologist, 7, 127-137, 7, 127-137 Flick, U. (2002) Flick, U. (2002) An Introduction to Qualitative ResearchAn Introduction to Qualitative Research (2 (2ndnd ed.) Sage ed.) Sage

publications; Londonpublications; London Grbich, C. (1999) Grbich, C. (1999) Qualitative Research in Health: An Introduction, Qualitative Research in Health: An Introduction, New South New South

Wales: SageWales: Sage Kubik, M., Lytle, L., Fulkerson, J. Fruits, vegetables, and football: Findings from Kubik, M., Lytle, L., Fulkerson, J. Fruits, vegetables, and football: Findings from

focus groups with alternative high school students regarding eating and physical focus groups with alternative high school students regarding eating and physical activity activity Journal of Adolescent Health Journal of Adolescent Health 2005 (36) 494-5002005 (36) 494-500

Miles MB, Huberman AM. Miles MB, Huberman AM. Qualitative Data AnalysisQualitative Data Analysis, 2nd ed. London:Sage, 1994., 2nd ed. London:Sage, 1994. Minichiello, V., Aroni, R., Timewell, E. and Alexander, L. (1995) Minichiello, V., Aroni, R., Timewell, E. and Alexander, L. (1995) In-depth In-depth

Interviewing: Principles, Techniques, AnalysisInterviewing: Principles, Techniques, Analysis , 2, 2ndnd edition. Melbourne: Longman edition. Melbourne: Longman Murray, SA., Grant, E., Grant, A., Kendall, M. (2003) Dying from cancer in Murray, SA., Grant, E., Grant, A., Kendall, M. (2003) Dying from cancer in

developed and developing countries: lessons from two qualitative interview studies developed and developing countries: lessons from two qualitative interview studies of patients and their carers. of patients and their carers. BMJBMJ, Feb 2003;326:368, Feb 2003;326:368

Patton MQ. (1987) Patton MQ. (1987) How to use qualitative methods in evaluation, How to use qualitative methods in evaluation, 108-43 London: 108-43 London: SageSage

Powell R.A. and Single H.M. (1996) ‘Focus groups’, Powell R.A. and Single H.M. (1996) ‘Focus groups’, International Journal of International Journal of Quality in Health CareQuality in Health Care 8 (5): 499-504. 8 (5): 499-504.