Evidenced Based Medicine and Research Methods

Qualitative Methods
2023/24 Student Notes

Aims of the SGT

 To highlight and discuss the value of qualitative research within a variety of clinical contexts
(SGT part A)
 To undertake a modified critical appraisal of a qualitative study using a structured approach
(SGT part B)
 To identify clinical areas of interest or questions that could be explored using qualitative
research methods (SGT part C)

SGT Learning objectives

 To develop an understanding of the value of qualitative research
 To undertake a modified critical appraisal of a qualitative study
 To articulate the strengths and limitations of qualitative research methods
 To identify and formulate clinical questions that could be answered using qualitative
research methods

Key learning points for students

 Qualitative research is important to help us to understanding participants’ behaviour(s) and
the reasons for it (which can be complex). The participant is the ‘expert’ by experience.
 Qualitative research can lead to new insights and issues that cannot be explored using
quantitative methods.
 Qualitative research can be used in a variety of different clinical scenarios (e.g., individual
patient experiences of living with a condition, as part of the development and evaluation of
complex interventions, and to inform guidelines, policy and practice).
 Qualitative research tends to focus on depth rather than breadth. We’re not aiming for
large, representative samples (like you would in some quantitative studies), rather we’re
looking for smaller samples of “information rich participants” where the findings are
transferable to other similar samples and contexts.
 As qualitative studies have very flexible methods, researchers need to report in detail the
methodology and methods used and the reasons behind their decision making.
 Reflexivity is very important in qualitative research so that researchers can consider and be
open about how the research process and their positionality (who they are) might influence
the study.
 There is debate about “what makes good qualitative research” and how to critically appraise
and “judge” strengths and weaknesses or methodological rigour.

Structure of SGT Session

 This SGT will be split into three sections.
 Lecture + SGT part A: will help you to understand what qualitative research is and what the
value of qualitative research can be in a variety of clinical contexts.

EBM&RM Qualitative SGT Student Notes (2023)Page 1

  Lecture + SGT part B: will help you to understand the strengths and limitations of qualitative
research and what makes a “good” qualitative study.
 Lecture + SGT part C: will help you to think about identifying potential clinical areas of
interest that could be explored using qualitative research methods.
 At the end of this document is a table of key qualitative research study definitions that
might be helpful to you. Your tutor may signpost you to these during the session.

What do you need to do before the SGT?

 Have a think about what you know about qualitative research. For example, is it valuable,
what kind of questions can you answer, who might participate? (~5 mins).
 Watch the lecture “How are qualitative research methods used in healthcare?” (~70 mins).
 Read this qualitative paper: Hersch et al. 2013 “Women’s views on overdiagnosis in breast
cancer screening: a qualitative study” (see below for link and full citation – it is also on
canvas) and use this information from the lecture to think about the strengths and weakness
of qualitative research in relation to this study (~40 mins)?
 It is important to watch the lecture and then read the paper in that order.
 You will then have the opportunity to discuss your thoughts on the paper with your tutor
and peers (in small groups and as a whole group) and will undertake a modified critical
appraisal of this paper and think about clinical questions that could be addressed using
qualitative methods (in small groups and as a whole group) during the tutorial.
 Please allow up to 2 hours to watch the recorded lecture and prepare for this SGT.

Paper (click below to access the paper or the PDF is available on Canvas)
Hersch J, Jansen J, Barratt A, Irwig L, Houssami N, Howard K, McCaffery K. Women’s views on
overdiagnosis in breast cancer screening: a qualitative study British Medical Journal 2013; 346:f158

You will complete the rest of this document during the SGT. You do not need to do
anything further if you have completed the tasks above in preparation for the SGT.
Please make your own notes during the SGT. The detailed tutor notes will be available to
you via Canvas before the EBM exam in December.

SGT Part A: Discussion of the value of qualitative research (10-15 minutes)

 This whole group discussion will be led by your tutor. Please be prepared to
contribute your thoughts on qualitative research.

SGT Part B: Modified critical appraisal of Hersch Paper in small groups and
full group (60 minutes)
Your tutor will likely split you into small groups (depending on the number of students and the
teaching space available). You will have ~35 minutes in your small groups to work through a
modified critical appraisal of the Hersch paper. The questions can be found below.

EBM&RM Qualitative SGT Student Notes (2023)Page 2

You will be undertaking a modified version of the Qualitative Research CASP checklist in this SGT.
Using a modified version is perfectly acceptable for when you are preparing for the EBM exam, but
you would likely need to use the full version for instance if appraising qualitative research as part of
your HIER project. Please note that you do not need to memorise the CASP checklist for the exam.
Within the detail tutor notes that you’ll get access to once teaching is finished, there are flags to
potential qualitative exam questions so please look out for these to help guide your revision.
Your tutor may ask you to work through specific questions or all the questions below depending on
how they decide to run the session. You will work through all the questions as a whole group even if
you don’t answer all of them as a small group.
Please respond to the questions with “yes”, “no”, “unclear” and write notes on how you came to
that decision and why. Your tutor will move round the small groups throughout the 35 minutes to
check how you are getting on and to answer any questions that you might have.

Modified Critical Appraisal Questions

1. Was there a clear research question/aim that suits a qualitative research design? (Yes)
- Clear design
- Don’t tell the type of qualitative study (e.g narrative)

2. Was the sampling approach and recruitment strategy appropriate to the aims of the
research? Is there a good description of who took part in the research study (e.g., sample
characteristics) to judge this?

- Excluding pts who had breast cancer => want to focus on impact of overgiadnosis
- Varying socioeconomic status
- Looked for varied participation screening
- Purposing sampling => some pts had screening experience and some didn’t
- Snowballing sampling
- Convenient sampling ( can’t get diversity in sampling)
- From random sampling to purposing sampling
o No indication how this was made (e.g. what sampling frame was used )
- Sensible not to include pts with breast cancer => different research question
- Non-english speakers
o Have different healthcare needs
o Not good to exclude them

3. Are the methods for data collection (e.g., interviews/focus groups, topics for discussion)
clearly described and justified?
- Justified focus groups a lot
- Aimed a follow p
- Giving a presentation=> gives info at the beginning => but do not know what these
women already know about overdiagnosis /baseline knowledge

EBM&RM Qualitative SGT Student Notes (2023)Page 3

 4. Is the analytical approach well described, including the use of any strategies (e.g., multiple
coders) to ensure that the analysis has rigour?
Aimed to identify a “set of main themes that captured the diverse views
and feelings
- expressed”. No further explanation of what the authors meant by
this
- Do more than 1 person doing the thematic analysis => good to
have more than 1 analysist
- How do you go from interviews to 6 thematic categories
- Also

5. What are the main findings and are these clearly described and illustrated (e.g., with links
to underlying data via use of quotations and have they highlighted participants who say
something different (discordant/divergence cases))?

- Results -> quotes are from women from wide range of age
- Good to have opinions of those who disagreed from the general consensus in terms of
the general themes

6. Have the researchers given a clear description of their involvement in the research process
and how this might have influenced the conduct of the research (reflexivity)?
- No indication of how they could have mitigated any influence due to researcher’s
backgrounds

7. Have the researchers considered the implications of their research findings (e.g.,
recommendations for practice, recommendations for future research)? Are these
appropriate?

- Communication about overdiagnosis to the gen pop should be considered

- sample was not designed to be statistically representative, we cannot conclude
- that our findings reflect general population views”.
- Follow up ( just 18??) => validation is important
o Allow for them to openly in 1:1 disucssion
o But if pt says they have changed, how can you remove that from the
data/results
o Another way => interviews in the communities and ask them if themes from
the focus groups resonate

EBM&RM Qualitative SGT Student Notes (2023)Page 4

Additional questions to consider if you have time/your tutor asks you to look at them.

1. Have ethical considerations been addressed in the paper?

- Who took consent from them
-

2. How transferable do you think the findings from this research will be to other settings?

Be prepared to share your answers with your tutor and the rest of the group.

SGT Part C: Identification and development of clinical issues/questions that

could be explored using qualitative research methods in small groups and
whole group (35 minutes)

You will be asked to get back into your small groups. You will need to work as a small group to
identify a clinical scenario or issue from your placement experiences that could be addressed using a
qualitative research study.

You will have 15 minutes in total for this group activity. Please:
 Discuss and identify clinical scenarios or issues that you have witnessed during your clinical
placements to date (e.g., CBM and hospital) where a qualitative research study could
potentially provide useful new insights. If you have time think about how you would conduct
a study (e.g., who would you recruit and what sort of data would you collect and the reasons
why).

Spend no more than 10 minutes on this.

Hint: this could relate to patient perspectives on a clinical issue or topic; to something relevant to
clinical decision-making; to optimising patient experience of services and treatments; or could be
focused on healthcare professionals (e.g. why GPs practice in certain ways in specific clinical
scenarios or where you have observed variation in their clinical practice for the same condition).

 Pick one or two examples that you have discussed to feedback to your small group.
 Identify one or two members of your group to provide 3-4 minutes of feedback on your
ideas to your tutor and the other students who were not part of your small group during the

EBM&RM Qualitative SGT Student Notes (2023)Page 5

 feedback session.

Spend no more than 5 minutes on this.

Hint: for your chosen scenario/s you will need to briefly justify why it is relevant to use a qualitative
research design and if you have time how you might conduct (e.g., who and how might you recruit,
what data collection methods might you use) such a study/ies.

EBM Important Qualitative Research Study Definitions

Term Definition
(Some of the) ways that qualitative 1. Understanding experience of living with a
research can be used in clinical condition
practice 2. Understanding help seeking behaviours
3. Part of a clinical trial
4. Patient reported outcomes/measures
(PRO/M)
5. Guideline development
Confirmability (links with reflexive The degree of neutrality in the research study’s
practice) findings. In other words, this means that the findings
are based on participants’ responses and not any
potential bias or personal motivations of the
researcher. This involves making sure that
researcher bias does not skew the interpretation of
what the research participants said to fit a certain
narrative. To establish confirmability, qualitative
researchers can provide an audit trail, which
highlights every step of data analysis that was made
in order to provide a rationale for the decisions
made. This helps establish that the research study’s
findings accurately portray participants’ responses.
Credibility The confidence that can be placed in the truth of the
research findings. Credibility establishes whether
the research findings represent plausible
information drawn from the participants’ original
data and is a correct interpretation of the
participants’ original views.
Data saturation Refers to the quality and quantity of information in a
qualitative research study. Researchers usually
define data saturation as the point when “no new
information or themes are observed in the data”.
Dependability The extent that the study could be repeated by
other researchers and that the findings would be
consistent. In other words, if a person wanted to
replicate your study, they should have enough
information from your research report to do so and
obtain similar findings as your study did. A
qualitative researcher can use inquiry audit in order
to establish dependability, which requires an
outside person to review and examine the research

EBM&RM Qualitative SGT Student Notes (2023)Page 6

 process and the data analysis in order to ensure that
the findings are consistent and could be repeated.
Discordant/disconfirming/divergent Divergent cases are those that differ from the more
cases general pattern of observations within a qualitative
dataset. They are valued for what they can reveal
about underlying processes as further data are
gathered and/or an attempt is made to understand
why they differ.
Iterative approach Using findings from initial analysis of data from early
participants to further refine data collection and
analysis from later participants
Member checking or validation Member checking, also known as participant or
respondent validation, is a technique for exploring
the credibility of results. Data or results are returned
to participants to check for accuracy and resonance
with their experiences.
Purposive sampling The purposive identification and recruitment of
“information rich participants” related to the
research topic of interest. Researchers achieve
diversity (or variation) in the sample through
recruitment of participants with a range of different
characteristics (e.g., age, gender, ethnicity, socio-
economic status) in addition to anticipated
differences in experiences related to the topic of
interest.
Qualitative approaches 1. Grounded theory: developing theory
grounded in data from the field
2. Ethnography: describing/ interpreting a
cultural or social group
3. Case study: in depth analysis of a single case
or multiple cases
4. Narrative: Eliciting meaning of experiences
expressed as stories of individuals
5. Phenomenology: Understanding the
essence of experience of a phenomenon
6. Also generic/descriptive studies
Reflexivity Reflexivity refers to a researcher identifying and
reflecting on how their own views, beliefs, attitudes
and/or experiences may have influenced the whole
research process including for example the
formulation of the research questions; data
collection, analysis and interpretation, and their
relationship with the participants.
Thematic analysis Analysis process to identify patterns or themes
within qualitative data.
Transferability How the qualitative researcher demonstrates that
the research study’s findings are applicable to other
contexts. Other “contexts” can mean similar
situations, similar populations, and similar
phenomena. Qualitative researchers can use thick
description to show that the research study’s

EBM&RM Qualitative SGT Student Notes (2023)Page 7

 findings can be applicable to other contexts,
circumstances, and situations.
Triangulation The use of multiple theories, data sources, methods
and/or investigators within the study of a single
phenomenon. Technique used as a means to avoid
potential biases arising from the use of a single
methodology, data source, investigators etc.
Trustworthiness How qualitative researchers establish that the
research study’s findings are credible, transferable,
confirmable and dependable.

EBM&RM Qualitative SGT Student Notes (2023)Page 8