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A quantitative analysis of qualitative studies in clinical journals for the 2000 publishing year.

BACKGROUND: Quantitative studies are becoming more recognized as important to understanding health care with all of its richness and complexities. The purpose of this descriptive survey was to provide a quantitative evaluation of the qualitative studies published in 170 core clinical journals for 2000. METHODS: All identified studies that used qualitative methods were reviewed to ascertain which clinical journals publish qualitative studies and to extract research methods, content (persons and health care issues studied), and whether mixed methods (quantitative and qualitative methods) were used. RESULTS: 60 330 articles were reviewed. 355 reports of original qualitative studies and 12 systematic review articles were identified in 48 journals. Most of the journals were in the discipline of nursing. Only 4 of the most highly cited health care journals, based on ISI Science Citation Index (SCI) Impact Factors, published qualitative studies. 37 of the 355 original reports used both qualitative and quantitative (mixed) methods. Patients and non-health care settings were the most common groups of people studied. Diseases and conditions were cancer, mental health, pregnancy and childbirth, and cerebrovascular disease with many other diseases and conditions represented. Phenomenology and grounded theory were commonly used; substantial ethnography was also present. No substantial differences were noted for content or methods when articles published in all disciplines were compared with articles published in nursing titles or when studies with mixed methods were compared with studies that included only qualitative methods. CONCLUSIONS: The clinical literature includes many qualitative studies although they are often published in nursing journals or journals with low SCI Impact Factor journals. Many qualitative studies incorporate both qualitative and quantitative methods.

Bibliometrics↗

Study design in qualitative research--1: Developing questions and assessing resource needs.

This is the second in a series of four papers on understanding and doing qualitative research [Frankel & Devers (2000) Qualitative research: a consumer's guide, Education for Health, 13, 113-123; Devers & Frankel (2000) Study design in qualitative research--2: sampling and data collection strategies, Education for Health, 13, 263-271]. Here, we focus on problems of study design, including question development, literature review, identifying a target audience and resource needs assessment. We provide a step-by-step description of major issues and choice points in the process. There are three key differences between qualitative and quantitative research designs. First, the logic of qualitative research is often inductive, rather than deductive, and consists of describing people's and groups' particular situations, meanings and experiences. Second, qualitative research designs are often emergent and flexible, and the research itself is quite dynamic. Third, the qualitative research process is non-linear and non-sequential. There is agreement that good qualitative studies answer clearly stated, important research questions. How qualitative research questions are formulated has implications for conducting a literature review. Some scholars believe that literature should be reviewed prior to beginning a study; others argue that this may impede the researcher from truly listening, observing and remaining open to new concepts and ideas. We offer suggestions about formulating research questions and how and when to conduct a literature review. Another important issue in conducting qualitative research is determining the resources that will be needed to conduct a study. These include internal resources, such as research skills, and external resources, such as personnel (expertise and time), equipment, supplies and travel. A description of typical resource and management issues in conducting a qualitative research study is included.

Journal Article↗

Can health professionals learn qualitative evaluation methods on the World Wide Web? A case example.

The Enhancing Data Utilization Skills through Information Technology (EDUSIT) project trained Maternal and Child Health professionals to collect, analyze and interpret data via a year-long web-based course. The overall goal of the project was to strengthen the technology and analytic skills of the public health workforce. This article describes and analyzes a web-based module for training public health professionals to use qualitative research and evaluation methods that was one of six offered within the EDUSIT project. The qualitative module consisted of six units: overview of qualitative methods, planning qualitative studies, conducting field observations, qualitative interviewing, analyzing qualitative data and presenting qualitative findings. Evaluation results found no statistically significant changes in specific knowledge or beliefs about qualitative methods. However, the change in participants' self-efficacy was statistically significant. Participants' self-reports also showed significant changes in perceived skill levels in 'collecting qualitative data through an interview' and 'analyzing and interpreting qualitative data'. Most participants rated each lesson within the qualitative methods module as valuable, and most found the teaching methods used satisfactory, emphasizing the value of both the didactic teaching and the practical exercises and team project. The most common difficulty reported was finding the time to complete the module requirements while also working full-time. Implications of these findings for web-based teaching of public health professionals are discussed.

Adult↗

How will we know "good" qualitative research when we see it? Beginning the dialogue in health services research.

OBJECTIVE: To lay the foundation for an explicit review and dialogue concerning the criteria that should be used to evaluate qualitative health services research. Clear criteria are critical for the discipline because they provide a benchmark against which research can be assessed. DATA SOURCES: Existing literature in the social sciences and health services research, particularly in primary care and medicine. PRINCIPAL FINDING: Traditional criteria for evaluating qualitative research are rooted in the philosophical perspective (positivism) most closely associated with quantitative research and methods. As a result, qualitative research and methods may not be used as frequently as they can be and research results generated from qualitative studies may not be disseminated as widely as possible. However, alternative criteria for evaluating qualitative research have been proposed that reflect a different philosophical perspective (post-positivism). Moreover, these criteria are tailored to the unique purposes for which qualitative research is used and the research designs traditionally employed. While criteria based on these two different philosophical perspectives have much in common, some important differences exist. CONCLUSION: The field of health services research must engage in a collective, "qualitative" process to determine which criteria to adopt (positivist or post-positivist), or whether some combination of the two is most appropriate. Greater clarity about the criteria used to evaluate qualitative research will strengthen the discipline by fostering a more appropriate and improved use of qualitative methods, a greater willingness to fund and publish "good" qualitative research, and the development of more informed consumers of qualitative research results.

Health Services Research↗

Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care.

Interest in how qualitative health research might be used more widely to inform health policy and medical practice is growing. Synthesising findings from individual qualitative studies may be one method but application of conventional systematic review methodology to qualitative research presents significant philosophical and practical challenges. The aim here was to examine the feasibility of synthesising qualitative research using qualitative methodology including a formative evaluation of criteria for assessing the research to be synthesised. Ten qualitative studies of adult patients' perspectives of diabetes were purposefully selected and questions proposed by the critical appraisal skills programme (CASP) adapted and used to assess papers prior to synthesis. Each study was reviewed independently by two experienced social scientists. The level of agreement between reviewers was determined. Three papers were excluded: one because it turned out not to be qualitative research, one because the quality of the empirical work was poor and one because the qualitative findings reported were also recorded in another paper already included. The synthesis, which had two distinct elements, was conducted using the meta-ethnographic method. Firstly, four papers containing typologies of patient responses to diabetes were synthesised. Secondly, six key concepts were identified from all seven papers as being important in enabling a person with diabetes to achieve a balance in their lives and to attain a sense of well-being and control. These included: time and experience, trust in self, a less subservient approach to care providers, strategic non-compliance with medication, effective support from care providers and an acknowledgement that diabetes is serious. None of the studies included in the synthesis referenced any of the early papers nor did they appear to have taken account of or built upon previous findings. This evaluation confirmed that meta-ethnography can lead to a synthesis and extension of qualitative research in a defined field of study. In addition, from it a practical method of qualitative research assessment evolved. This process is promising but requires further testing and evaluation before it could be recommended for more widespread adoption.

Adult↗

Sample extensiveness in qualitative nutrition education research.

OBJECTIVE: Extensiveness represents the amount of information gathered in qualitative research. This study examined sample extensiveness in qualitative nutrition education research. DESIGN: Retrospective analysis was performed on articles published in the Journal of Nutrition Education (JNE) from 1969 to 1999 (Volumes 1 to 31). SUBJECTS: Content analysis was used to code articles and the studies they reported as units of analysis. OUTCOME MEASURES: Articles were coded to determine whether they included one or more studies using qualitative research and, if so, the types of qualitative studies performed, the sample extensiveness of each study, and mention of sample extensiveness limitations in the article. STATISTICAL ANALYSES: The statistics used were univariate (counts, percentages, means, medians, modes, ranges) and bivariate (chi-square, correlations). RESULTS: Of the published JNE articles, 71 (8%) used qualitative methods, and most (85%) qualitative articles were published in the 1990s. Some (19%) of these articles reported using multiple qualitative methods. The 30 studies using individual interviews interviewed an average of 45 people (range 15-155). The 38 studies using group interviews averaged 15 groups (range 1-180) and 141 people (range 9-900). Ten studies used observation/fieldwork, and eight used other types of qualitative research, with mixed [corrected] patterns of sample extensiveness in those studies. Few articles made specific statements about limitations based on sample extensiveness. IMPLICATIONS: Sample extensiveness in qualitative research in JNE varied considerably. Future qualitative research would benefit from more explicit attention to sample extensiveness.

Adult↗

Correlation of qualitative and quantitative results from testing respirator fit.

Three qualitative respirator fit tests were evaluated for their ability to adequately measure respiratory protection. The evaluated methods were the negative pressure test, the isoamyl acetate test, and the irritant smoke test. Each test was performed concurrently with a single quantitative fit test, the dioctylphthalate (DOP) test, during 274 half-mask and 274 full facepiece wearings. The quantitative values of DOP penetration obtained after passing or failing each qualitative fit test were lognormally distributed. For each qualitative test performed on each mask type, the average log penetration values obtained after passing and failing each test were statistically different from each other. The mean of the log penetration values associated with the failed qualitative test was always larger than the mean of the log penetration values associated with passed qualitative tests for all three qualitative methods. Most (95%) of the tested study had adequately fitting respirators as determined by quantitative testing. Of these subjects, 96% to 100% passed the qualitative fit tests. Of the 5% of the study subjects with inadequately fitting half mask respirators, 93% to 100% of the inadequate fits were detected by qualitative methods. Twenty three to 46% of the poorly fitting full face masks were detected by qualitative methods. The probability of passing or failing a qualitative test with an inadequately fitting respirator can be estimated; however, the uncertainty associated with each estimate is large due to the small number of study subjects with poorly fitting respirators.

Adult↗

Qualitative meta-synthesis: a question of dialoguing with texts.

AIMS: This paper discusses whether useful synthesis of research reports across different qualitative methodologies is possible, and whether qualitative meta-synthesis violates the tenets of the interpretive paradigm. BACKGROUND: Qualitative meta-synthesis is a recent development in qualitative inquiry that offers a means of enhancing the contribution of qualitative findings to the development of more formalized knowledge. However, there are a number of unanswered questions and areas that require debate. DISCUSSION: A brief overview of qualitative meta-synthesis as a method of inquiry is presented. The assumptions of phenomenology, ethnography and grounded theory are explored for their amenability to meta-synthesis and the possibility of coherent synthesis of findings across these methodologies. In addition, a summary of major philosophical commitments common to the interpretive paradigm is presented. Qualitative meta-synthesis as a methodology is then explored for its fit within this paradigm. An argument is made, with some caveats, for synthesis across qualitative methodologies. Gadamer's concepts of the hermeneutic circle, the fusion of horizons, and dialogue with the text are explored for the insight they provide into the place of qualitative meta-synthesis in inquiry. CONCLUSION: It is important for researchers to bring hermeneutic skill to the process of meta-synthesis in order to develop a comprehensive understanding of the various philosophical assumptions in which qualitative approaches are based. The particular challenge of combining analysis and interpretation from studies with markedly different approaches and intentions may prompt synthesists to create new and innovative approaches to the presentation of meta-synthesis.

Anthropology, Cultural↗

Developing optimal search strategies for detecting clinically relevant qualitative studies in MEDLINE.

BACKGROUND: The growing interest in qualitative research within the evidence based practice framework highlights the need for accurate search strategies to enhance the retrieval of qualitative studies. To date, little work has been done on developing optimal search filters for retrieving qualitative studies. The current study extends our earlier work, on developing optimal search strategies, to include qualitative studies. OBJECTIVE: To develop optimal search strategies for detecting clinically relevant qualitative studies in MEDLINE in the publishing year 2000. DESIGN: Comparison of the retrieval performance of methodologic search strategies in MEDLINE with a manual review ("gold standard") of each article for each issue of 161 core health care journals for the year 2000. METHODS: 6 experienced research assistants who had been trained and intensively calibrated reviewed all issues of 161 journals for the publishing year 2000. Each article was systematically classified for "format" (whether it was an original study, review article, general article, or case report), "interest" (whether or not it was of interest to the health care of humans), and "purpose" (whether it pertained to therapy, diagnosis, prognosis, causation, economics, costs, or clinical prediction; was of a qualitative nature; or was about something else). Search strategies were developed for all purpose categories, including qualitative studies. MAIN OUTCOME MEASURES: The sensitivity (recall), specificity, precision, and accuracy of single and combinations of search terms. RESULTS: 49,028 articles were identified after matching the hand search records with the data downloaded from MEDLINE, of which 366 (0.75%) were classified as qualitative. Combinations of search terms reached peak sensitivities of 95%. Compared with the best single term, a three-term strategy increased sensitivity for qualitative studies by 23.6% (absolute increase), but with some loss of specificity when sensitivity was maximized. When search terms were combined to optimize sensitivity and specificity, both these values peaked above 90%. CONCLUSION: Several search strategies can achieve high performance in retrieving qualitative studies from MEDLINE.

Hepatitis, Viral, Human↗

Doing qualitative research in general practice: methodological utility and engagement.

General practice uses an eclectic range of research methodology. This includes increasing reliance upon qualitative research methods. There seem to be two distinct treatments of qualitative research within primary care and, in particular, within general practice research. The first is characterized by a purely utilitarian and technical focus, using a qualitative method because it is the most appropriate means of realizing the aims of the research, while the second is characterized by in-depth engagement with the philosophical and paradigmatic aspects of qualitative methodology. In-depth engagement with methodology and theory, and theory building, is an important aspect of masterate and doctoral research within social sciences such as education and anthropology, and in the discipline of nursing, but has not been a feature of qualitative research in medicine. A practical difficulty encountered within postgraduate programmes such as the one in which the author teaches is that when innovative qualitative techniques are used by GPs in their postgraduate research dissertations and theses, it is often beyond GP examiners' own knowledge and experience, yet it fails to measure up to standards established in social sciences, particularly in sociology and anthropology where in-depth reflexive engagement with the theory and philosophy of qualitative methodology is expected. This paper suggests that the value of in-depth engagement with methodology when conducting qualitative research results in creative and innovative ways of conducting research that are consonant with the nature of general practice itself, and strengthens research findings. Therefore, as teachers of research methods and supervisors of research theses, it is important to encourage students conducting qualitative research to engage fully with theoretical and methodological issues.

Family Practice↗

An increasing number of qualitative research papers in oncology and palliative care: does it mean a thorough development of the methodology of research?

BACKGROUND: In the second half of the nineties, a scientific debate about the usefulness of qualitative research in medicine began in the main medical journals as well as the amount of "qualitative" papers published on peer reviewed journals has noticeably increased during these last years. Nevertheless the label of qualitative methodology has been assigned to an heterogeneous collection of studies. Some of them show a complete awareness of the specificity of this kind of research, while others are still largely influenced by the quantitative paradigm prevailing in the medical field. The concern with the rigour and credibility of qualitative methods has lead to the development of a number of checklist for assessing qualitative research. The purposes of this review were to describe the quality of the development of qualitative research in the medical field, focusing on oncology and palliative care, and to discuss the applicability of a descriptive checklist. METHODS: A review was conducted on Medline and PsycINFO databases. On the basis of their abstract, papers found have been classified considering: publication year, kind of journal, paper type, data gathering method, sample size and declared methodological approach. A sub sample of the previous papers was than selected and their methodological characteristics were evaluated based on a descriptive checklist. RESULTS: 351 abstracts and 26 full papers were analysed. An increase over time in the number of qualitative studies is evident. While most of the papers before 1999 were published on nursing journals (43%), afterwards also medical journals were largely represented. Psychological journals increased from 7% to 12%. The 22% of studies used a sample size lower than 15 and the 15% did not specify the sample size in the abstract. The methodological approach was also often not specified and the percentage increased in the second time period (from 73% to 80%). Grounded theory was the most employed methodological approach while phenomenology shows a decrease. Interview remains the most used data gathering method in both periods, even if it shows a 10% reductions, while focus group and multiple methods application both increase to 12%. The use of the descriptive checklist on the full text of the 26 papers shows that all the items present a larger percentage of satisfaction after 1 January 1999 than it was for the paper published before 1999. There seems to be two different types of quality criteria: specific and unspecific. The first ones mainly refer to qualitative paradigm (such as the relationship with the subject of research or evidence about how subjects perceived the research) and they are often not satisfied. In contrast unspecific criteria (such as the connection to an existing body of knowledge or systematic data gathering) which are mainly shared with the quantitative paradigm are more frequently satisfied. CONCLUSIONS: In oncology and palliative care the publication of qualitative studies increased during the nineties, reaching its peak in around 2000. The use of descriptive checklists even if it was not easy to apply, allows researchers to get a deeper insight into methodological facets that a global judgement may leave out.

Bibliometrics↗

The norm and the text: Denzin and Lincoln's handbooks of qualitative method.

Qualitative methods have lately enjoyed enhanced legitimacy and are increasingly used in academic and applied social research. Yet the field is marked by controversy about virtually every key tenet of qualitative inquiry, from matters of epistemology to purely practical matters of relations with research subjects. Not only is the practice of qualitative research hotly contested, consensus is lacking about the purpose of qualitative research and whether it has a distinctive role to play relative to other approaches to the study of social phenomena. Against this context, the handbooks of qualitative method edited by Norman Denzin and Yvonna Lincoln represent a significant attempt to capture the breadth of contemporary approaches to qualitative method. The article examines key contributions from the handbooks, drawing on these to develop a view of qualitative method from a pragmatic, realist perspective. Among the issues considered are the significance of relativism, subjectivity, post-modernism and feminist method, the politicization of the purposes of qualitative research, the debate over criteria of validity, and the move to treat qualitative research as an entertainment rather than a scientific practice.

Behavioral Research↗

Is the worldview of qualitative inquiry a proper guide for psychological research?

Qualitative methods are becoming increasingly popular in psychology. Although the distinction between qualitative and quantitative often is stated in terms of methods, the real distinction is between worldviews: that favored by most qualitative methodologists, which emphasizes subjective experience and multiple realities, and that commonly accepted in science. The worldview accepted by most adherents of qualitative inquiry suggests the exclusive use of methods that include verbal reports of lived experience. Qualitative methods serve an important function in psychology, but their use as recommended by their adherents is limited in 2 respects: The adherents use a narrow and unconventional approach to qualitative methods that differs from that normally understood, and they favor use of a restricted range of qualitative methods over other qualitative methods and quantitative methods. If qualitative inquiry is to make a greater contribution to psychology, researchers in that tradition must acquire a better understanding of contemporary science, correct their misunderstandings of the rationale for quantitative methods, and address the apparent limitations of their methods emphasizing reported experience.

Humans↗

Establishing the credibility of qualitative research findings: the plot thickens.

Qualitative research is increasingly recognized and valued and its unique place in nursing research is highlighted by many. Despite this, some nurse researchers continue to raise epistemological issues about the problems of objectivity and the validity of qualitative research findings. This paper explores the issues relating to the representativeness or credibility of qualitative research findings. It therefore critiques the existing distinct philosophical and methodological positions concerning the trustworthiness of qualitative research findings, which are described as follows: quantitative studies should be judged using the same criteria and terminology as quantitative studies; it is impossible, in a meaningful way, for any criteria to be used to judge qualitative studies; qualitative studies should be judged using criteria that are developed for and fit the qualitative paradigm; and the credibility of qualitative research findings could be established by testing out the emerging theory by means of conducting a deductive quantitative study. The authors conclude by providing some guidelines for establishing the credibility of qualitative research findings.

Data Interpretation, Statistical↗

Qualitative analysis: how to begin making sense.

The clinical process used to make sense of patient concerns closely parallels the analysis process of qualitative research. This partly explains why qualitative research methods are appropriate for many family practice research questions. Unfortunately, the language used by qualitative researchers, especially with regards to analysis, is often obscure. This impedes family physicians from implementing qualitative research. This paper overviews qualitative analysis and introduces a language and means by which family physicians can begin to make sense of qualitative data. The concepts, "reflexivity," "iteration," "data saturation," and "text," are defined. Three core steps of qualitative analysis are identified and compared to the diagnostic process. They consist of choosing an organizing system, reducing the data, and making connections. Four idealized ways for conducting these steps, editing, template, quasistatistical, and immersion/crystallization, are presented and compared to four ways of approaching patient concerns. Finally, the process of creating an appropriate qualitative analysis strategy is described for a hypothetical research study and some pitfalls and principles of qualitative analysis are reviewed.

Family Practice↗

Creating metasummaries of qualitative findings.

BACKGROUND: The translation and grounded theory techniques typically cited as the method for producing qualitative metasyntheses do not lend themselves well to qualitative survey findings as they do not contain the integrating concepts or controlling metaphors upon which these techniques depend. OBJECTIVES: The purpose of this article is to describe a process for creating metasummaries of qualitative survey findings. METHODS: This article is based on completed work in an ongoing methodological study aimed at developing a usable and transparent protocol for combining the findings in reports of health-related qualitative studies. The sample for this work included 45 published and unpublished reports of qualitative studies of HIV-positive women with findings on motherhood, 39 of which contained findings in the form of surveys of data. Almost 800 findings were extracted. These extracted findings were reduced to 93 abstracted findings, and manifest frequency and intensity effect sizes were calculated. RESULTS: Five findings had effect sizes ranging from 25-60%, with both published and unpublished reports contributing about equally to the strength of these findings. Seventy-three findings had effect sizes of <9%, 47 of them with effect sizes of only 2%. In most of these cases, only one work contained the finding and these works had generally fewer space restrictions. Four reports with few space restrictions contained 63% of the findings across all 45 reports. CONCLUSIONS: Qualitative metasummaries are useful end products of research integration studies involving reports of findings in the form of qualitative surveys, and may serve as a foundation for qualitative metasyntheses.

Abstracting and Indexing↗

Electronic searching to locate qualitative research: evaluation of three strategies.

AIM: This paper presents an evaluation of the effectiveness of three search strategies to identify research for a qualitative synthesis of patient experiences of living with a leg ulcer. BACKGROUND: Systematic reviews of research are increasingly the form of evidence used for evaluation of health care. There are well-established methods for conducting systematic reviews of effectiveness incorporating randomized controlled trials. Methods have been developed for the synthesis of qualitative research, but these are not widely used or evaluated. Searching for qualitative research is one of the least developed and tested areas in systematic reviewing of qualitative research. METHOD: The replication of three search strategies (free text, thesaurus and broad-based terms) developed for identification of qualitative research papers within electronic databases is described. Each strategy was run in seven electronic databases: MEDLINE, CINAHL, EMBASE, British Nursing Index, Social Science Citation Index, Applied Social Sciences Index and Abstracts, PsychInfo. The effectiveness of these strategies for identifying qualitative research for a synthesis of patients' experiences of living with a leg ulcer is discussed. FINDINGS: Each of the three search strategies produced similar numbers of potentially and actually relevant papers from each of the seven databases. These results were most striking for CINAHL, when all of the papers ultimately included in the review were identified by each search strategy. No other database identified all included papers. CONCLUSION: A simple search strategy using broad-based terms was as effective as a complex one (free text) in locating qualitative research examining patients' experiences of living with a leg ulcer. For a question with a clear nursing focus, it may be sufficient to search only CINAHL in order to locate qualitative research. This result needs replicating with other nursing topics.

Databases, Bibliographic↗

Qualitative research and the epidemiological imagination: a vital relationship.

This paper takes as its starting point the assumption that the 'Epidemiological Imagination' has a central role to play in the future development of policies and practice to improve population health and reduce health inequalities within and between states but suggests that by neglecting the contribution that qualitative research can make epidemiology is failing to deliver this potential. The paper briefly considers what qualitative research is, touching on epistemological questions--what type of "knowledge" is generated--and questions of methods--what approaches to data collection, analysis and interpretation are involved). Following this the paper presents two different models of the relationship between qualitative and quantitative research. The enhancement model (which assumes that qualitative research findings add something extra to the findings of quantitative research) suggests three related "roles" for qualitative research: generating hypothesis to be tested by quantitative research, helping to construct more sophisticated measures of social phenomena and explaining unexpected research from quantitative research. In contrast, the Epistemological Model suggests that qualitative research is equal but different from quantitative research making a unique contribution through: researching parts other research approaches can't reach, increasing understanding by adding conceptual and theoretical depth to knowledge, shifting the balance of power between researchers and researched and challenging traditional epidemiological ways of "knowing" the social world. The paper illustrates these different types of contributions with examples of qualitative research and finally discusses ways in which the "trustworthiness" of qualitative research can be assessed.

Epidemiology↗