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RESEARCH IN HE

Takele G. (BSc., MPH, Asst. Prof.)


takele.gez44@gmail.com

Sept. 2021
Addis Ababa, Ethiopia
Outline
 Concept of research

 Types of research

 Research in health education

Qualitative Vs quantitative research methods

 How to develop Knowledge and Attitude –questions


for research in (KAP) Studies

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Objectives of the session
At the end of this chapter students will
be able to:
 Define research & explain the role of research in health education

 Describe the characteristics of Qualitative Research

 Compare and contrast qualitative & quantitative research

 Explain the processes of qualitative research method

 Data collection methods used in qualitative researches

 Explain the techniques of developing KAP questionnaire

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Brainstorming
• What is research?
• What research methods is used in HE/HP?
• What is the difference between qualitative and quantitative
researches?
• What are the criteria for research quality assurance or
trustworthiness?
• Explain the research processes
• Mention qualitative research design and data collection
methods

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“To invest in research is to
invest for a better future!”

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What is research?
 Research is a systematic collection and processing of data
required to answer particular questions in scientific
manner.
Is a systematic collection, analysis and interpretation of data to
solve health problem
As one of the various health programs, health education
programs (PIE in HEP) should be guided and directed by
scientific evidences drawn from systematically conducted
researches.
 poor understanding of the health problem and the
factors responsible for the problem will resulted in
failure of the HEP
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Purpose of health research
To generate knowledge and to effectively promote the health of
the population
Without this knowledge, effective action is impossible because
it has no logical or empirical basis

To find out in great detail about what exists and how and why it
exists or occurs
Progress in health (medicine) can only be achieved if good
quality information are generated through research to guide
interventions and to inform the general public.

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Types of Research
Research has been classified differently on the basis of
the following traits.
1) Based on outcome of the research
 Basic/Fundamental Research
 Applied research

2) Based on purpose (The reason why a research is


conducted
 Exploratory research
 Descriptive Research
 Analytic research
 Action research
 Comparative research
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Types of Research …
3) Based the environment in which the research is
carried out;
 Field research
 Laboratory research

4) Based on the time required to complete the


research;
 One -time research;
 Longitudinal research

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Types of Research…
 The basic and applied researches can be quantitative
or qualitative or even both;
A) Qualitative method
B) Quantitative method
C) Mixed
 These are the two major categories of research
methods in health education
 In HE, mostly we use qualitative technique.

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What is Qualitative Research?

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Qualitative Research
Definition:- QR involves finding out what people think,
and how they feel - or at any rate, what they say they
think and how they say they feel.

 This kind of information is subjective.


 It involves feelings and impressions, rather than
numbers.

 Qualitative research is a type of formative research


that offers specialized techniques for obtaining in-
depth responses about what people think & how they
feel.

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Qualitative….
 It emphasizes on processes and in depth understanding of
perceived meanings, interpretations, and behaviors

 QR is a method of studying things in their natural


settings, attempting to make sense of, or interpret
phenomena in terms of the meanings people bring to
them
 It is any kind of research that produces findings not
arrived at by means of statistical procedures or other
means of quantification

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What Qualitative….
 It help us to understand social phenomena in natural
settings giving emphasis to the meanings, experiences
and views of the participants.
 It is concerned with developing explanations of social
phenomena.

 It deals with the emotional & contextual aspects of human


response rather than with objective, measurable behaviour
& attitude.

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What Qualitative….
 It seeks to answer questions about:
 Why people behave the way they do?
 How opinions and attitudes are formed?
 How people are affected by the events that go on
around them?
 How and why cultures have developed in the way they?

Qualitative methods fill a gap in the PH toolbox;


 they help us understand behaviors, attitudes, perceptions,
and culture in a way that quantitative methods alone cannot.

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Why qualitative research?
There are many reasons for using QL research methods.
 It provides greater depth of response and understanding

 Cost-effective (more economical)

 Timing-saving (can be executed and analyzed quickly)


 Direct link with target public.
 Give the opportunity to actually view & experience the target
groups directly.
 Can be conducted where there is no technical facilities

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How QR is Used (Applications)
1) An idea generation tool

2) A preliminary step to aid in the development of a


quantitative study (for tool development or designing a
questionnaire)

3) As follow-up to aid in the understanding of the results of a


quantitative study

4) As a primary data collection method (purely qualitative)


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Model 1: QM are used to help develop quantitative
measures and instruments.
Qualitative Quantitative Result

Model 2: QM are used to help explain quantitative findings


Quantitative Result

Qualitative

Model 3: QM are used to embellish a primarily qualitative study

Qualitative Result

Quantitative
Model 4: Quant. & qualit. methods are used equally and
parallel
Qualitative Result Quantitative
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Characteristics of QR
 The Natural Setting
 The Researcher as Instrument
 Emergent Approach
 Interpretive Approach
 Reflexivity and Subjectivity
 A Holistic View
 Use of Deductive and Inductive Reasoning
 Strategies of Inquiry; Use multiple strategies
 Saturation or redundancy

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The Quan vs Qual Debate
 QR is often presented as the antithesis of quantitative
research and many researchers become entrenched on
one or other side.

 They should be seen as complementary rather than


exclusive.
 It is better to view not as dichotomous but as various
tools.

 Both methods have unique and valuable contributions.

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Qualitative Vs Quantitative Research
Method
Basic Difference
Quantitative and qualitative research methods
differ primarily in:
 Their analytical objectives
 Differences in analytical approach
 The types of questions they pose
 The types of data collection Methods & instruments
they use
 The forms of data they produce
 The degree of flexibility built into study design
 Differences in hierarchy of study phases
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Qualitative Vs Quantitative Research

Statistical

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Qualitative vs. Quantitative

• Non-numeric Numeric
• Inductive Deductive
• Non-generalizable Generalizable
• Small sample Large sample
• Generate Test hypothesis
hypothesis

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Hierarchy of Study Phases
Quantitative Qualitative
Linear path Circle
Identify problem collect data (2)

State hypothesis Identify problem (1) Analyze data (3)

Collect data

Analyze data Spiral to next cycle

Test hypothesis Generate working


“hypothesis” (4)
Report Report (5)

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Keys to Successful QR
Three Keys to Successful Qualitative Research:
 First, the research must develop the art of asking "why?”

 Second, the researcher must develop the art of listening.

 Third, the researcher must approach the research as a


creative process of investigation.

 A high level of creative thinking must be applied to each


new situation if the QR process is to be truly successful.

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The Process of QR
1) Defining an area of inquiry
2) Stating the research problem
3) Developing a conceptual framework (optional)
4) Formulating research questions (objectives)
5) Qualitative research methods (Design)
6) Ensuring trust worthiness
7) Sampling technique
8) Data collection
9) Qualitative data Analysis
10) Interpretation of the findings and Presentation
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5. QR Methods/Designs
 QR designs cannot be completely specified prior to field
work
 May change during the course of the study as a result of new or
unforeseen events.

 Some of the designs are:


1) Grounded Theory 6) Programmatic QR
2) Phenomenology 7) Historiography
3) Ethnography 8) Oral stories
4) Case studies 9) Content analysis
5) Narrative
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How they can help us
 Guidelines for conducting research

 Keywords for literature searches

 Understand how to interpret the literature and interact


with other qualitative researchers

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6. Sampling in QR
 In quantitative research, why random sample?
 Representativeness

 Generalizability

 What is our objective in qualitative research?


 Understanding

 Contextual richness

 Sampling should be related to the goal and the objectives of


the study
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6. Sampling in QR
Generally purposive sampling (techniques) :
Do not seek representativeness – seek the individuals with the
most information about the topic
Researcher deliberately samples groups or setting

Guided by a desire to select subjects/circumstances with rich


information
Sample design is flexible, and will usually evolve as the study
progresses

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Sampling techniques
• Purposive sampling can be achieved through different
techniques.

I. Snowball or chain sampling

 The first subject is used as a resource for identifying the


next informant.

 Valuable when the researcher does not know the field.

 Important when individuals to provide rich data are difficult


to reach.
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II. Extreme or deviant cases
• Selects extreme cases to highlight and understand conditions
of more typical situations.

 Learn from highly unusual manifestations

-Example: Two clinics with different levels of client


satisfactions

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III. Homogeneous sampling
 People with basically similar characteristics
 Done within certain strata, i.e., Among sub-groups to be
included in different FGDs.
 Focus groups typically use this approach.
 The purpose is to focus on similar types of respondents,
simplifies analysis, facilitates group interviewing.

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IV. Maximum variation sampling
 Used when all subjects chosen are to be as different from
each other as possible.

 Useful for studying issues that cut across individual or


program variation.

 The purpose is to identify common patterns that exist among


different groups.

E.g. urban/semi-urban/rural with regard to FGM

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V. Convenience sampling
 Selecting those most readily available

 Helps to save time, money and efforts.

 The weakest sampling scheme due to low credibility.

VI. Sampling politically important


subjects
• Selection of people who are politically important to give much
emphasis to the study

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Sampling Techniques in QR …

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Sampling Techniques in QR …

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Sampling Techniques in QR …

Purpose of the study dictates the sampling


approach!

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Sample size
 No hard and fast rule! (Always guidelines, never strict rules).

 Selection continues to the point of redundancy (saturation)

 Depend on available time and resources

 Too small
 Does not achieve informational redundancy or theoretical
saturation

 Too big
 Cannot manage and facilitate the deep case-oriented analysis
that is the hallmark/strength of qualitative research Just right!
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Sample size
 Get the most (information) from the least (number of
people)

 Related to the purpose, approach, methods, analysis strategy


of the particular study

 Inverse relationship between amount of data collected per


participant and total number of participants

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Practical Considerations
 Generally want to over-estimate sample size

 Research funds and ethical approval are generally okay if you


over-estimate, not if you underestimate,

 Iterative nature of qualitative research design must be


balanced with practical nature of planning, review, funding.

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7. Ensuring the Trustworthiness
of QR
 Ensuring the quality of data based on certain established criteria;

 This is important, particularly for QR, where the challenge of


understanding and making meaning is put upon the researcher.

 The four common criteria for assessing the trustworthiness of QR


findings are: truth value, applicability, consistency and
neutrality.

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Comparison of Trustworthiness and
Validity Criteria
Qualitative Issue Non- Qualitative
Credibility Truth value Internal validity
•Subjective realties •Lack of bias

Transferability Applicability External validity


•Lessons can be applied to • Generalizability to outside the
other contexts source population

Dependability Consistency Reliability


• Same method does not produce • Repeated measurements arrive
same result at the same result

Conformability Neutrality Objectivity


• Neutrality to data, Honest to • Researcher is distant and
findings detached observer
(Lincoln, 1985)
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Takele G. (MPH, Asst. Prof.)
Activities to achieve credibility
Qualitative techniques to increase trustworthiness
1) Prolonged engagement
2) Tick description
3) Persistent observation
4) Triangulation (combining)
5) Peer debriefing
6) Negative case analysis
7) Referential adequacy—testing archived data against raw data,
8) Member checks
9) Audit trial/Auditor checks: (The process of research, Record
keeping & Decision on emergent design).
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10) Ethical considerations
Triangulation: Combining
1) Data:- data triangulation (public/private, over time, different
perspectives)

2) Methods:- methodological triangulation(interviews,


observations, document analysis)

3) Investigators:- investigator triangulation

4) Analysis:- multiple analysts, independent analysis and


compare findings

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Ethical considerations
 The safety of researcher and respondent.
 Anonymity and confidentiality
 Informed consent
 Participant observation and ethics.
 Research ethics and the law.
 The uses of your research.
 Researching sensitive topics.
 Vulnerability and power
Basic Ethical Principles- Generally, three basic principles,
are particularly relevant to the ethics of research involving human subjects:
1) Respect of persons
2) Beneficence and
3) Justice
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8. Data Collection methods
 Document Analysis
 Photographs/Picture and Videos
 Observation (participant Vs Non-participant,
direct Vs Indirect, Mysterious)
 Interviewing (KII & IDI)
 FGD

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1. Document Analysis
 Negotiate access to important documents at the beginning of
the study Can help the researcher to identify what needs to be
pursued further in direct observation and interviews
 Use checklist to guide document review
 Examination of records
 newsletters, news releases
 records (student)
 minutes from meetings
 philosophy statements
 diaries, letters

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2. Photographs and Videos
 Use to gain insight into how people view and interpret their
world
 It's benefits are as an aid to recall, multiple interpretation,
and reaching a wider audience.
E.g. film on homeless to mobilize community action or
public funding.

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3. Observation
• Systematic watching and recording of what people do and say
in naturally occurring settings and careful recording of what
occurs.
• become involved in the social setting they are studying
• Non participant observers: more removed from the social
process
 The observer (he or she) does not normally question or
communicate with the people being observed.
 Both kinds of observers collect field notes

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• Participant-observers -The researcher becomes, or is part
of the group that is being investigated.
 become involved in the social setting they are studying
 Has its roots in ethnographic studies where researchers
would live in tribal villages attempting to understand the
customs and practices of that culture.

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3. Observation cont...
Advantages
• Collecting data in natural environment increases validity
• Allows investigator to gain sense of underlying beliefs, values,
explanations and meanings of an event for people.
• Non-verbal and verbal behavior recorded
• Behavior observed as it occurs, thus decreasing bias of faulty
memory
• Investigator not always dependent on subject to explain event
• Useful as pilot exercise to generate data or stimulate ideas for
investigation

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Disadvantages
 Time consuming and requires acute observational skills
 Small sample
 Between observer variability i.e. decreased reliability and
observer bias
 Difficulties-gaining entry –ethics
 Lacks numbers to persuade - for those who prefer numbers

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4. In-depth Interviews
• Face to face conversation to explore issues in more detail
• Last for 20-90 minutes
• Minimum sample size 20-30 individuals
• Use of open ended questions - WHAT, WHY, WHERE, HOW,
WHO WHEN- the power of probing
1) Informal conversational interview
2) General interview guide approach
3) Standardized open-ended interview
4) Closed fixed-response interview
5) Combination of approaches

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When to use individual depth interview?
• When the subject matter is highly sensitive. E.g. opinion of
abortion cases about FP
• Geographically dispersed respondents.

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Steps in Conducting the Interviews
Step 1. Formulate study questions.

Step 2. Prepare a short interview guide.

Step 3. Select informants.

Step 4. Conduct interviews.

Step 5. Take adequate notes.

Step 6. Analyse interview data.

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In-depth Interviews cont…
Advantages
 more informal approach
 Is flexible and responsive to the discussion taking place
 explore sensitive issues
 Enables introduction of other diagrammatic models for gaining
further in-depth and detailed information e.g. mapping,
ranking, seasonal calendars etc.
 greater participation of the informant

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Disadvantages
– Time consuming
– needs competent interviewer
– Applications is only feasible in small populations
– Between interviewer variation i.e. lower reliability
– Analysis is complex

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5. Focus Group Discussion
 Individuals assembled by a researcher
 Discussion from experiences
 Group interaction between the participants
 No right/wrong answer
 A minimum of 4 groups??
 The most widely used technique

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Purpose of FGD
 Assess respondents’ attitudes, feelings, beliefs, cultural norms,
experiences and reactions
 Record both words and non-verbal behaviors
 Used either at the beginning (exploratory) or at the end
(explanatory) of a large quantitative study
 Used either as a method in their own or as a complement to
other methods
 provides something more than the sum of its parts
 provides more and richer information and evokes information
that relates to emotional processes, inner reasons and less
overt determinants of behaviour
 It explores dominant and minority views

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Group Composition of FGD
• It is a group discussion of 6-12
persons guided by a facilitator,
during which group members talk
freely & spontaneously about a
certain topic.
• Homogeneous- diversity inhibits
free discussion
• Group composition influence
group interaction
• Moderator/recorder
• Time: lasts for 1-1:30hrs/group
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FGD Interview Guide
• FGD guides: unstructured or semi-structured

• Questions: General open-ended

• Discussion needs guiding and focusing

• The interview guide is modifiable (not fixed)

• The flow is from general to specific

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The Role of the FGD Moderator
• Should be experienced

• Ensures the discussion runs smoothly

• Ensures the discussion remains focused

• Maintains group dynamics

• Good verbal and interpersonal skill

• Non-judgmental (neither agree nor disagree)

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The Role of the Recorder
• Note-taking

• May use tape recorder (ensures that the whole interview is


captured, and provides complete data)

• Prepares detailed summaries at the end of each discussion

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When to use Focus groups?
• Group interaction. If Interaction stimulate richer
responses.

• Cost and timing. can be done more quickly and generally


less expensively

• When subject matter is not so sensitive.

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Steps in Carrying out FGDs
(1) Arrangements
 Process of consent,
 Where, when - convenient time?
 Travel costs,
 Equipment?,
 Seating arrangements
2) Introduction
 Introduce self (moderator), observer, recorder
 Objections to recording, efforts to ensure confidentiality
 Why you have been brought together (purpose)
 There are no right or wrong answers
 Any points of clarification? Threatening?

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Steps in Carrying out FGDs cont.…
(3) Discussion –
from the general to the specific to obtain an understanding
of the issues related to the topic
(4) Closure – summarising and asking for further points and
thanking participants

(5) Feedback - possibility of short questionnaire or opportunity


to speak to participants individually

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Advantages of FGD
Synergism. Likely to produce a richer insight, wider
range of information, and innovative.

Snowballing. One person’s comment often triggers a


chain reaction from the other participants and
generates more views.

Stimulation. General level of excitement over the topic


increases, and a large number of respondents want to
express their ideas and expose their feelings.

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Advantages of FGD Cont.…
Security. Enables participants to feel comfortable and
uninhibited to express their ideas/feelings.
Spontaneity. Responses can be spontaneous and unconventional
reflecting an accurate idea of their views

Inexpensive. Considering the richness of output, it is a relatively


inexpensive method of data collection.

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Disadvantages of FGD
Lack of representativeness. Not representative of the
general population.
Misjudgment. Susceptible to client and researcher
biases.
Misuse. Can be misused and abused by considering the
results as conclusive rather than exploratory.
Moderation. Skills of the moderator is a major determinant

Difficult to analyze. The unstructured nature of the


responses in focus group discussions makes coding, analysis,
and interpretation difficult.

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KEEP IN MIND
 what works in some groups may not work in others
 A moderator is not a teacher or a judge
 A moderator does not agree or disagree with what is said.
 There are no right or wrong answers.
 There may also be an observer +/or recorder
 Useful to ensure eye contact between moderator and
observer/recorder - draw picture

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 Do not try to cover too many issues.
 Try to outline key issues and special probing questions for
each issue, to be used if information does not come
spontaneously
 Be flexible, it is not a must to go from one question to the next
 Use simple language

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9. Qualitative Data Analysis

• Begin with the first field activities and may lead to


revisions or refinements in research questions

• Data could be:

– Field notes

– Transcripts

– Other written materials

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Transcribing qualitative data
• Producing a written version of the interview

• Transcript analysis/tape analysis

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Qualitative Data Analyzing
• Summarizing the mass of data collected and presenting
the results

• Quantitative data

– Labeling or coding every item is key

– Frequency (how often)

– Differences, means, proportions, statistical tests,


significance test
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• Qualitative data
– Coding requires different techniques

– Transcribing

– No pre-coding

– Reading and rereading

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Content analysis
• Are the data complete and as expected
• Coding and classifying data
• All items of data in one interview should be compared
with data collected from other interviewees
• Two levels:
– Descriptive = describing what was actually said
– Interpretive = concerned with what was meant,
inferred or implied
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Strengths & weaknesses of qual. research
Strengths
Less expensive
 flexible
 validity:- individuals are interviewed in sufficient detail for
the results to be taken as true, correct, complete, and
believable reports their views and experiences
However, validity in QR largely hinge on the skill &
competence of the researcher conducting the investigation
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Weaknesses
 No is made to draw firm conclusions or to
generalize results to the population at large

(Lacks generalizability)

 Less reliability (personal and idiosyncratic)

 Ethical issues

 Great demand for qualitative research skills (observational,


interviewing, interpretive, writing, & presentation skills)
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Quantitative Research Method (1)
Collects specific information and facts that can be expressed as
numbers which can be analyzed mathematically to produce a
summarized finding that can represent the magnitude of
health condition in the community.
Usually, data are collected using structured questionnaires
with close-ended questions.
The most commonly used quantitative research in behavior
related studies are KAP surveys.
In KAP survey, data are collected using questionnaires which
include questions that address Knowledge, Attitude and
Practice.
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Quantitative Research Method (2)
Knowledge, attitude and practice are thought to be important
determinants of health, in addition to biological and health
service factors.
 Many health educators believe that the best way to teach or change
practices is to teach correct knowledge and favorable attitudes, and that
good practices will follow.
Generally, it is assumed that Correct knowledge + Positive
Attitudes = Health Practices.
 Because of the importance attributed to knowledge, attitudes and
practices in health, researchers want to find out what people know, feel,
and practice.
For these purposes they develop and use KAP questionnaires.
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Quantitative Research Method (3)
 Practice is assessed by asking what the person currently does and
giving an exhaustive list of options, to each of which the person
responds yes or no.

 Attitude is assessed in terms of what the person prefers to do, what


they would do if they had the choice, or how favorable- unfavorable or
positive-negative they are to the object.

 Knowledge is assessed in terms of what the person knows about the


item and whether this knowledge is true or false.
 Correct and incorrect statements must be included and the respondent is
asked to indicate whether a statement is true or false, or whether the
question should be answered Yes or No.

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Quantitative Research Method (4)
How to Develop a KAP Questionnaire:
1) Define conceptually what is meant by Knowledge, Attitude and
Practice. Keep to these definitions when you make up the items.
2) Develop items systematically to include all the relevant ones. This may
first require a probing pilot test with personal or group interviews to elicit
the respondents' KAP spontaneously. The content must be complete and
include all important practices, attitudes and knowledge.
3) Phrase items in lay terms not in professional terms.
4) To improve reliability, include at least 10 items for each K, A, and P.
5) Order items as follows - PAK - to minimize contaminating P answers with
K items.

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References
1) http://www.trentrdsu.org.uk/triage.html Trent Research and
Development Unit (TRIAGE)
2) http://www.nova.edu/ssss/QR/ The Qualitative Report
3) http://kerlins.net/bobbi/research/qualresearch. Qualitative Research
Web Ring Centre for Qualitative Research
4) http://www.qsr.com.auThe Forum for Qualitative Research
5) http://wasis.ou.edu/docs/qualitative_methods.pdf
6) WHO 1969. Research in Health education Report of a WHO
scientific group. TRS 432. WHO Geneva
7) http://www.apmf.org.sg/264,7,Observation: Advantages and
Limitations
8) http://gild.cs.uvic.ca/docs/ltheory/276,9,Research Methods
9) http://sped.ed.utah.edu/courses/SPED%206610/Powerpoints/261,6,C
haracteristics of Qualitative Research
10) Leiyu shi, health service research methods; university of Carolina,
1997
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