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PubMed2006

Reconceptualizing qualitative evidence.

As qualitative researchers, we have not explored our own work from the qualitative evidence perspective. The author suggests that qualitative researchers need to explore the conflicting agendas of evidence-based medicine and qualitative inquiry, compare the anatomy of qualitative data and evidenced-based data, and explore the autonomy of qualitative inquiry within the context of evidenced-based medicine. By attending to and communicating the differences in qualitative and quantitative evidence, and by accepting the differences in our research agendas, qualitative researchers will achieve the legitimacy that they deserve and which they require.

Evidence-Based Medicine↗
PubMedDate not supplied

[Encounters and disencounters between qualitative and quantitative perspective in History of Medicine].

The presentation of qualitative research methods in the health care field underlines how these methods are irrelevant to and inconsistent with scientific traditions in the Health Sciences field. These methods are to of a quantitative nature--epidemiology usually being cited as an example--the connection between but qualitative methods and what are referred to as the Social Sciences seems predominant. This article is aimed, on the contrary, at pointing out that qualitative methodologies, which are richer and more highly complex that the quantitative approach, do comprise an intrinsic part of Health Science traditions. A run through the major milestones and events throughout the history of Medicine reveals the paradoxical protocol of Health Sciences, overlapping the Natural Sciences and Social Sciences, overlapping qualitative and the quantitative view. More specifically, this analysis revolves around a twofold approach to illness, by way of signs and symptoms, as a condensing these paradoxical protocol considered. A historical analysis reveals how the twofold, complex way of signs and symptoms is equivalent to the complex relationship which exists between the qualitative and the quantitative perspective. The signs correspond to quantitative approach and the symptoms to the more qualitative. The relationships between the two would be similar to that existing come to bear between the qualitative and quantitative perspectives in the field of the Social Sciences. These results show the qualitative perspective to be rooted in medical tradition itself and may therefore facilitate its use these by all health care professionals as a whole. The fact that the "semiology" so in vogue today in the social sciences stems from "clinical semiology" should not be overlooked.

Clinical Medicine↗
PubMed2002

[Low-level agreement between qualitative and quantitative criteria (NCEP-II) proposed by the Ministry of Health for the lipid-lowering drug therapy in persons without coronary artery disease].

BACKGROUND: To evaluate the impact in Catalonia and the agreement between the qualitative (NCEP-II) and quantitative criteria proposed by the Health Ministry for the lipid-lowering drug therapy among individuais without coronary artery disease. METHODS: Both qualitative (NCEP-II) and quantitative methods were used in individuals without coronary artery disease studied in a random sample of adult populations in Catalonia (n = 304) aged >/= 16 years. Patients with a LDL-cholesterol levels >/= l90 mg/dl or 160-189 mg/dl plus at least two risk factors fulfilled the qualitative criteria for the lipid-lowering drug therapy; patients with a risk >/= 20% in 10 years fulfilled the quantitative criteria. The agreement between both qualitative and quantitative criteria was evaluated by means of the Kappa index. RESULTS: 20% of males and 20.1% of females, and 24% of males and 33.1% of females fulfilled the qualitative and quantitative criteria for lipid-lowering drug therapy, respectively. A low (Kappa = 0.30) and a moderate (Kappa = 0.44) agreement was observed among males and females, respectively, regarding qualitative and quantitative criteria. Increased serum cholesterol was the determinant risk factor for fulfilling qualitative criteria (ORadj) y whereas age, increased blood pressure and increased serum cholesterol were determinants for fulfilling the quantitative criteria. CONCLUSION: The results obtained in this study showed a low agreement between qualitative and quantitative criteria proposed by the report of the Ministry of Health Report to lower cholesterol levels by means of drug therapy among healthy people. Clear and unequivocal criteria to decide what persons are candidates for cholesterol-lowering drug therapy should be developed.

Adult↗
PubMed2004

Expert qualitative researchers and the use of audit trails.

BACKGROUND: Determining the credibility of qualitative research findings remains a contested area and leaves the way open for additional theoretical and methodological discussion. AIMS: In this paper we focus on audit trails and confirmability, within the context of 'expert' qualitative researchers. Having outlined the audit trail process, we develop existing arguments about the 'expert' qualitative researcher. We then juxtapose the two, highlighting a number of issues in an attempt to advance the debate. DISCUSSION: These issues discussed are: (1) The shifting sands of methodological orthodoxy - the historical context in which audit trails emerged. (2) The individual construction of logic. (3) 'Grounded in the data' or 'going beyond the words'- the key differences between descriptive and interpretive findings. (4) The singular relationship between qualitative researcher and their data. (5) The growing acknowledgement that method alone is insufficient. (6) The challenging example of visionaries. CONCLUSION: We argue that using audit trails as a means to achieve confirmability of qualitative research findings is an exaggeration of the case for method, and may do little to establish the credibility of the findings. We also introduce a preliminary case for testing the credibility of theory induced by expert qualitative researchers, in part by means of its usefulness; its 'fit and grab', rather than by the researcher's adherence to contemporary methodological orthodoxy. In other words, the absence of audit trails does not necessarily challenge the credibility of qualitative findings, particularly if an expert qualitative researcher produced the findings.

Data Collection↗
PubMed1989

Qualitative research: comments and controversies.

Larry Locke's timely and well-written introduction to qualitative research procedures will undoubtedly serve its purpose. It makes us reassess our traditional beliefs and practices, educates us on the rudiments of qualitative methodology, and, hopefully, makes us more tolerant and appreciative of alternate ways of conducting research. Although Locke focuses his paper on pedagogical research issues, it is important to realize that many other sub-disciplines within the general field of physical education also utilize qualitative procedures. For example, 10 years ago Martens (1979) called for a paradigm shift in sport psychology by appealing to researchers to abandon their labs and to embark on naturalistic field studies. While North American sport psychologists, and psychologists in general, have been slow to formalize qualitative techniques, the European psychology community has been much more active (e.g., Ashworth, Giorgi, & de Koning, 1986). Perhaps Locke's article will encourage researchers in all our sub-disciplines to consider the utility of qualitative research. Hopefully, readers will treat Locke's article as an introduction to the broad area of qualitative research and not as a rigorous set of procedures for conducting participant observation research in school physical education studies. Additionally, it must be recognized that there are other approaches and other applications, that the area has its critics and its unresolved methodological problems, and that qualitative research does not necessarily exclude the application of formalized data analyses. Keeping these issues in mind, the addition of qualitative approaches to our repetoire of research methodologies can only enhance the quality of research in physical education and exercise and sport science.

Data Interpretation, Statistical↗
PubMed2004

Qualitative research: contributions to the study of drug use, drug abuse, and drug use(r)-related interventions.

This article describes how qualitative social science research has and can contribute to the emerging field of drug and alcohol studies. An eight-stage model of formative-reformative research is presented as a heuristic to outline the different ways in which qualitative research may be used to better understand micro and macro dimensions of drug use and distribution; more effectively design, monitor and evaluate drug use(r)-related interventions; and address the politics of drug/drug program representation. Tobacco is used as an exemplar to introduce the reader to the range of research issues that a qualitative researcher may focus upon during the initial stage of formative research. Ethnographic research on alcohol use among Native Americans is highlighted to illustrate the importance of closely examining ethnicity as well as class when investigating patterns of drug use. To familiarize the reader with qualitative research, we describe the range of methods commonly employed and the ways in which qualitative research may complement as well as contribute to quantitative research. In describing the later stages of the formative-reformative process, we consider both the use of qualitative research in the evaluation and critical assessment of drug use(r)-intervention programs, and the role of qualitative research in critically assessing the politics of prevention programs. Finally, we discuss the challenges faced by qualitative researchers when engaging in transdisciplinary research.

Anthropology, Cultural↗
PubMed2002

Ethics of qualitative research: are there special issues for health services research?

BACKGROUND: An increasing volume of qualitative research and articles about qualitative methods has been published recently in medical journals. However, compared with the extensive debate in social sciences literature, there has been little consideration in medical journals of the ethical issues surrounding qualitative research. A possible explanation for this lack of discussion is that it is assumed commonly that qualitative research is unlikely to cause significant harm to participants. There are no agreed guidelines for judging the ethics of qualitative research proposals and there is some evidence that medical research ethics committees have difficulty making these judgements. OBJECTIVES: Our aim was to consider the ethical issues which arise when planning and carrying out qualitative research into health and health care, and to offer a framework within which health services researchers can consider these issues. RESULTS: Four potential risks to research participants are discussed: anxiety and distress; exploitation; misrepresentation; and identification of the participant in published papers, by themselves or others. Recommended strategies for reducing the risk of harm include ensuring scientific soundness, organizing follow-up care where appropriate, considering obtaining consent as a process, ensuring confidentiality and taking a reflexive stance towards analysis. CONCLUSIONS: While recognizing the reservations held about strict ethical guidelines for qualitative research, we argue for further debate of these issues so that the health services research community can move towards the adoption of agreed standards of good practice. In addition, we suggest that empirical research is desirable in order to quantify the actual risks to participants in qualitative studies.

Confidentiality↗
PubMed1998

Qualitative versus quantitative assessment of cerebrovascular reserves.

OBJECTIVE: Quantitative studies of cerebral blood flow (CBF) combined with a vasodilatory challenge have defined a subgroup of patients with symptomatic carotid occlusion who have an increased risk for stroke. These are patients whose CBF paradoxically decreases in response to a vasodilatory challenge. Recent reports suggest that qualitative CBF techniques, such as single photon emission tomography with 99m-hexamethylpropyleneamine oxime, can also define the same high-risk subgroup. To determine whether qualitative measures of CBF are sufficient for predicting the risk of stroke, we converted our quantitative CBF data, obtained with xenon-enhanced computed tomography (Xe/CT), to qualitative ratios in a manner similar to that used with single photon emission tomography data. METHODS: We analyzed CBF values within the territory of the middle cerebral artery for 94 patients with symptomatic carotid occlusion. Values obtained using Xe/CT before and after the intravenous administration of 1 g of acetazolamide were used to derive an asymmetry index: (Coccl - Cnon)/Cavg x 100. The difference between the postacetazolamide asymmetry index and the baseline asymmetry index was used to classify the patients into groups according to CBF values. The threshold for abnormal qualitative CBF reactivity was defined as a percent change in the asymmetry index of less than -10%. Quantitative (Xe/CT) CBF was considered abnormal ("steal" response) when the response to acetazolamide (percent change) on the occluded side was a decrease of 5% or greater. RESULTS: Of 34 patients whose cerebrovascular reserves were considered compromised based on qualitative criteria, 17 (50%) did not have a steal response as defined by quantitative Xe/CT CBF (i.e., false positive). Eleven of 62 (18%) who were not considered compromised by qualitative criteria had a steal response (i.e., false negative). Our data indicate that a qualitative approach has a 61% sensitivity and a 75% specificity for detecting patients with compromised reserves. Further, the positive predictive value of this method is only 50%. Therefore, the two methodologies do not predict the same patients as having compromised reserves. CONCLUSION: Previous studies have shown that patients at high risk for stroke can be identified with quantitative CBF methods. This study shows that the important subgroup cannot be accurately defined with qualitative methodology. The implications of using the more reliable methodology are important for individual patient management and for designing clinical trials.

Acetazolamide↗
PubMed2006

Validity, trustworthiness and rigour: quality and the idea of qualitative research.

AIM: In this paper, I call into question the widely-held assumption of a single, more or less unified paradigm of 'qualitative research' whose methodologies share certain epistemological and ontological characteristics, and explore the implications of this position for judgements about the quality of research studies. BACKGROUND: After a quarter of a century of debate in nursing about how best to judge the quality of qualitative research, we appear to be no closer to a consensus, or even to deciding whether it is appropriate to try to achieve a consensus. The literature on this issue can be broadly divided into three positions: those writers who wish qualitative research to be judged according to the same criteria as quantitative research; those who believe that a different set of criteria is required; and those who question the appropriateness of any predetermined criteria for judging qualitative research. Of the three positions, the second appears to have generated most debate, and a number of different frameworks and guidelines for judging the quality of qualitative research have been devised over recent years. DISCUSSION: The second of the above positions is rejected in favour of the third. It argues that, if there is no unified qualitative research paradigm, then it makes little sense to attempt to establish a set of generic criteria for making quality judgements about qualitative research studies. We need either to acknowledge that the commonly perceived quantitative-qualitative dichotomy is in fact a continuum which requires a continuum of quality criteria, or to recognize that each study is individual and unique, and that the task of producing frameworks and predetermined criteria for assessing the quality of research studies is futile. CONCLUSION: Some of the implications of this latter position are explored, including the requirement that all published research reports should include a reflexive research diary.

Data Collection↗
PubMed2005

Some limitations of qualitative risk rating systems.

Qualitative systems for rating animal antimicrobial risks using ordered categorical labels such as "high,""medium," and "low" can potentially simplify risk assessment input requirements used to inform risk management decisions. But do they improve decisions? This article compares the results of qualitative and quantitative risk assessment systems and establishes some theoretical limitations on the extent to which they are compatible. In general, qualitative risk rating systems satisfying conditions found in real-world rating systems and guidance documents and proposed as reasonable make two types of errors: (1) Reversed rankings, i.e., assigning higher qualitative risk ratings to situations that have lower quantitative risks; and (2) Uninformative ratings, e.g., frequently assigning the most severe qualitative risk label (such as "high") to situations with arbitrarily small quantitative risks and assigning the same ratings to risks that differ by many orders of magnitude. Therefore, despite their appealing consensus-building properties, flexibility, and appearance of thoughtful process in input requirements, qualitative rating systems as currently proposed often do not provide sufficient information to discriminate accurately between quantitatively small and quantitatively large risks. The value of information (VOI) that they provide for improving risk management decisions can be zero if most risks are small but a few are large, since qualitative ratings may then be unable to confidently distinguish the large risks from the small. These limitations suggest that it is important to continue to develop and apply practical quantitative risk assessment methods, since qualitative ones are often unreliable.

Animals↗
PubMed2000

Part I: an introduction to conducting qualitative research in children with cancer.

Over the past decade, pediatric nurse researchers have acknowledged the need to study children's cancer illness experiences within the qualitative research framework. Support for more qualitative research is based on the belief that it will afford researchers the opportunity to get closer to understanding children's perspectives of their cancer experience. A priori theories or generalizations by the researcher are not imposed; therefore, information emerging from the research is believed to be more a reflection of the perspectives of child participants and not adult researchers. Although pediatric oncology nurses may be interested in using more qualitative methods in their research, deciding on the appropriate qualitative research design may not always be so evident, considering that the adoption of qualitative inquiry in the study of childhood cancer is in its infancy. Accordingly, the purpose of this article is to increase the reader's understanding of the use of the qualitative research paradigm in the study of children's experiences with cancer. An overview of four qualitative research designs that pediatric oncology nurse researchers may adopt is presented. Specifically, the qualitative designs of grounded theory, ethnography, phenomenology, and biography or illness narratives are examined. To facilitate discussion, each of the four designs are applied to the study of symptom experiences in children with cancer.

Adaptation, Psychological↗
PubMed1996

Early pregnancy diagnosis in the sow by saliva progesterone measurement using a bovine milk progesterone qualitative test EIA kit.

We attempted to measure the qualitative saliva progesterone concentration in the sow using a commercial bovine milk progesterone qualitative test EIA kit (qualitative kit), which can measure the progesterone concentration in approximately 10 min, and investigated the possibility of applying this method of progesterone concentration measurement to early pregnancy diagnosis in the sow. The accuracy of pregnancy diagnosis at 17-24 days after last mating for 138 sows was 91.3% (105/115) for positive cases and 100% (6/6) for negative cases. The overall pregnancy diagnosis accuracy, including 17 indeterminable cases, was 80.4% (111/138). A comparison of the diagnoses based on progesterone concentrations measured by the qualitative kit and the saliva progesterone concentrations of identical samples measured by the quantitative kit showed close agreement: 6 cases diagnosed as negative pregnancy by the qualitative kit all had a progesterone concentration of less than 5 ng/ml, while 111 out of 115 cases diagnosed as positive pregnancy by the qualitative kit all showed a progesterone concentration over 5 ng/ml. Thus, the results of this study show that qualitative measurement of the saliva progesterone concentration in the sow using a bovine milk progesterone qualitative test EIA kit is a practical method for early pregnancy diagnosis.

Animals↗
PubMed1999

Evolving guidelines for publication of qualitative research studies in psychology and related fields.

We present a set of evolving guidelines for reviewing qualitative research, to serve four functions: to contribute to the process of legitimizing qualitative research; to ensure more appropriate and valid scientific reviews of qualitative manuscripts, theses, and dissertations; to encourage better quality control in qualitative research through better self- and other-monitoring; and to encourage further developments in approach and method. Building on a review of existing principles of good practice in qualitative research, we used an iterative process of revision and feedback from colleagues who engage in qualitative research, resulting in a set of seven guidelines common to both qualitative and quantitative research and seven guidelines especially pertinent to qualitative investigations in psychology and related social sciences. The Evolving Guidelines are subject to continuing revision and should not be used in a rigid manner, in order to avoid stifling creativity in this rapidly evolving, rich research tradition.

Guidelines as Topic↗
PubMed2003

Contributions of qualitative research to evidence-based practice in nursing.

AIM: This article aims to identify the contributions of qualitative research to evidence-based practice in nursing. BACKGROUND: Qualitative research dates back to the 1920s and 1930s, when anthropologists and sociologists used qualitative research methods to study human phenomena in naturalistic settings and from a holistic viewpoint. Afterwards, other subject matters, including nursing, adopted qualitative methods to answer their research questions. The restructuring of health care over the past decade has brought about increased accountability in nursing research. One method for increasing this accountability is evidence-based practice. METHOD: The method used was a search in the Cumulative Index to Nursing and Allied Health Literature database from 1999-present. The search resulted in 61 citations for evidence-based practice in nursing research; however, only 5 citations focused on evidence-based practice and qualitative research. FINDINGS: The authors' findings revealed six contributions of qualitative research to evidence-based practice: generation of hypotheses; development and validation of instruments; provision of context for evaluation; development of nursing interventions; development of new research questions; and application of Qualitative Outcome Analysis. CONCLUSION: Qualitative research makes important contributions to the quality of evidence-based practice.

Evidence-Based Medicine↗
PubMedDate not supplied

Qualitative and quantitative knowledge of results: effects on motor learning.

OBJECTIVE: This study investigated the effects of qualitative and quantitative knowledge of results (KR) on the acquisition of a motor skill. It was hypothesized that there would be differences in performance during skill acquisition and retention, depending on the type of feedback given. Qualitative KR was in the form of verbal encouragement and quantitative KR was in the form of an algebraic number representing an error score. METHODS: Seventy-seven adults were randomly assigned to one of four feedback conditions, Quantitative, Qualitative, Quantitative and Qualitative, and no feedback (Control). Participants learned an isometric force production skill. Data were collected during skill acquisition and retention phases. Computer hardware and custom software were used to collect data and administer the feedback conditions of the independent variable. RESULTS: There was a statistically significant difference in the Acquisition Phase for the main effect of Condition F(3,73) = 6.35, p < .05, and for Block F(9,657) = 2.07, p < .05, but there was no statistically significant Condition X Block interaction F(27,657) = 1.02, p > .05. Pair-wise comparisons revealed statistically significant differences between conditions containing qualitative feedback and conditions containing no qualitative feedback (p < .05). The main effect of condition was significant F(3,73) = 3.00, p < .05 in the retention phase, however there were no significant pair-wise comparisons (p > .05). CONCLUSION: The results of this study suggest that in a healthy adult population, qualitative feedback, by itself and when combined with quantitative feedback, resulted in superior skill acquisition, but not in the retention of that skill. The artificiality of the task along with differing modes of feedback (audible versus visual) are two potentially limiting factors to this study. Future research that controls for these factors may yield more definitive findings about the role that qualitative feedback has in improving motor performance and learning.

Adolescent↗
PubMed2006

A hierarchy of evidence for assessing qualitative health research.

OBJECTIVE: The objective of this study is to outline explicit criteria for assessing the contribution of qualitative empirical studies in health and medicine, leading to a hierarchy of evidence specific to qualitative methods. STUDY DESIGN AND SETTING: This paper arose from a series of critical appraisal exercises based on recent qualitative research studies in the health literature. We focused on the central methodological procedures of qualitative method (defining a research framework, sampling and data collection, data analysis, and drawing research conclusions) to devise a hierarchy of qualitative research designs, reflecting the reliability of study conclusions for decisions made in health practice and policy. RESULTS: We describe four levels of a qualitative hierarchy of evidence-for-practice. The least likely studies to produce good evidence-for-practice are single case studies, followed by descriptive studies that may provide helpful lists of quotations but do not offer detailed analysis. More weight is given to conceptual studies that analyze all data according to conceptual themes but may be limited by a lack of diversity in the sample. Generalizable studies using conceptual frameworks to derive an appropriately diversified sample with analysis accounting for all data are considered to provide the best evidence-for-practice. Explicit criteria and illustrative examples are described for each level. CONCLUSION: A hierarchy of evidence-for-practice specific to qualitative methods provides a useful guide for the critical appraisal of papers using these methods and for defining the strength of evidence as a basis for decision making and policy generation.

Evidence-Based Medicine↗
PubMed2006

Aggregation of qualitative studies--From theory to practice: Patient priorities and family medicine/general practice evaluations.

OBJECTIVE: Aggregation (i.e., meta-ethnography or meta-synthesis) of qualitative studies remains relatively rare and controversial. We have attempted this procedure within an investigation of patient priorities and evaluations of primary care in order to triangulate an instrument development process as well as explore associated dilemmas. METHODS: The procedures included a literature search of qualitative research on patient priorities and evaluations and creation of a framework for quality assessment of retrieved papers. The tool for the evaluation of quality in qualitative studies was piloted, refined, and applied to the retrieved literature. The articles were equally distributed between two teams in random fashion, and inter-rater agreement calculated. Finally, we formulated and applied a strategy for aggregation of data from included papers that allowed comparison to a systematic review of quantitative studies on the topic. RESULTS: Thirty-seven articles met inclusion criteria. Twenty-four of these articles were of sufficient quality to be included in the qualitative aggregation. Inter-rater agreement ranged from 0.22 to 0.77 and 0.38 to 0.60 for pair and assessor comparisons, respectively. The aggregation strategy enabled synthesis within sub-categories of the heterogeneous papers. CONCLUSIONS: We have devised a modestly reliable instrument to assess the quality of qualitative work. The procedure for quality assessment and aggregation appears to be both feasible and potentially useful, though both theoretical and practical problems underline the need for further refinement prior to widespread utilization of this approach. PRACTICE IMPLICATIONS: An instrument to assess the quality of qualitative work within the context of aggregation efforts is described. Calculating inter-rater reliability in this framework can support future quality assessments. A method of breaking a heterogeneous collection of included papers into sub-categories to enable aggregation of qualitative studies is applied and demonstrates its feasibility and potential usefulness.

Anthropology, Cultural↗
PubMed2003

Health care policy: qualitative evidence and health technology assessment.

Since the late 1990s health technology assessment (HTA) has gained influence as a research and evaluation approach supporting health care policy. The focus on this methodology is congruent with the growing importance of evidence-based health care. Although HTA is a multidisciplinary discipline from a theoretical point of view, practice shows that social, ethical and psychological aspects are seldom truly integrated into the assessment of health technology. HTA is still very much biased by the medical and pharmaceutical research traditions. This contribution focuses on the question of how qualitative research findings could be useful as an additional source of information or as 'evidence' in HTA. Medical and health care scientists are seldom acquainted with qualitative research or judge it as a less (or un-)reliable form of research. 'Qualitative dimensions' of health care are not considered 'real' evidence. This contribution argues that qualitative findings could be put higher in the hierarchy of evidence generating research in health care. First it can be realized by improving the knowledge of the nature of qualitative research. Second qualitative findings can become more trustworthy information, if researchers themselves respect methodological prerequisites and clarify their theoretical perspective, research aims and use of research methods. Some methodological characteristics of qualitative research and 'evidence' are discussed for their contribution to HTA and evidence-based health care.

Evidence-Based Medicine↗