Qualitative Study Designs &

Mixed Methods Research

Lecture 5

Dr. Suman Sheraz

Qualitative Research
• Qualitative Research is primarily exploratory
research.
• Understanding of underlying reasons, opinions, and
motivations.
• Provides insights into the problem or helps to
develop ideas or hypotheses for potential
quantitative research.
Qualitative Study Designs

• Ethnography
• Phenomenology
• Grounded theory
Ethnography

• Focuses on human behaviors in the cultural context

• Ethnography is the way of describing a culture
• Culture is the knowledge, beliefs and behaviors
• Groups can be societal e.g., French Canadian, Local
Pakistani cultures on provincial level.
• Groups can be small like physiotherapists working
in burn unit, wheelchair basketball players etc.
Phenomenology

• Focuses on the meaning from the

perspective of participants.
• ‘‘Give voice’’ to the participants being
studied
• Researchers present participants’ views of
his world
• For example, a physiotherapist’s experience
of being a team member of a rehabilitation
team.
Grounded Theory

• Focuses on developing a theory to explain

underlying social processes of a cultural
group.
• Useful in areas where little is known or
when a new perspective is needed.
• Used for exploratory, descriptive studies

• Because the theory emerges from the data,

it is said to be grounded in the data.
Qualitative Methods
• Sampling
• Data collection methods
• Data Analysis
 Sampling
• Informants
• Researcher establishes clear criteria and rationale for sample
selection.
• Goal is not generalization of findings but phenomenon by those
who have experienced it.
– Purposive sampling
– Snowball sampling

• “Informant-driven” rather than “theory-driven”

• Data is collected in the “field” – the natural world where people live
and experience life
Informants

• People being studied are viewed as

participant or informant, not
“subject”
– Viewed as active participants in
the research
– They “inform” the researcher
about their culture
Types of Interviews

Interviews

With respect With respect to With respect to

number of proximity of the
to Structure Interviewees Interviewer

in person
Structured In depth telephone
Semi-Structured
Unstructured
Focus Group interactive two way video
email
Interviews with respect to Structure

Semi-
Structured Unstructured
Structured
 1. Structured Interview
• A structured interview is essentially an oral administration of a
written questionnaire.
• E.g When a surveyor stops you in the shopping mall to determine
whether you have purchased a certain brand of facial tissue within
the past 6 weeks, he or she is using a structured interview.
• Appropriate for factual information
• Not the choice for capturing the depth and breath of response that
is desired in qualitative research.
2. Semi-Structured Interviews

• Semi-structured interviews are based on pre-

developed questions, but the format permits the
interviewer to clarify questions to help the
participant provide more information for the study.
• Appropriate when information of a somewhat
abstract nature is sought.
3.Unstructured Interview

• Unstructured interviewing is the general method used by

qualitative researchers to come to an understanding of the
opinions and beliefs of informants.
• In an unstructured interview, researchers have a general idea
of the topics that they hope to cover during the interview.
• The interviewer is free to follow up on unexpected responses
that lead in a direction that was unanticipated by the
researcher.
Interviews with Respect to number of
Interviewees

In-depth
(single)

Focus
groups
1. In-depth Interviews

• Some studies cannot employ the participant

observation method.
• In-depth interviews allow participants to
describe their experiences and the meaning of
events taking place in their lives.
• Individual interviews may elicit more confidential
information about the informant or more frank
information about other individuals within the
setting.
2. Focus Group Interviews

• Interview format, but in a group setting

– 6-12 participants with common
experience

• Transcript of discussion is ‘‘the data’’

– Plus accompanying notes
2. Focus Group Interviews

Strengths:
– Open-ended question
• Spontaneously deal with issues as they arise
– Cost-effective method of collecting data
– Less time-consuming

Weaknesses:
– One or two participants may dominate
– Not done in a natural setting
Concerns Regarding Interviews

1. The interviewer’s vocabulary must match that of the individuals being interviewed,
including the use of lay versus health care terminology when appropriate.

2. Interviewers must be sensitive to the meaning of specific words that they use. For
example, when interviewing individuals who are members of racial or ethnic
groups, the interviewers should determine informants’ preferences for identifying
terms such as black versus African American, American Indian versus Native
American, and Latino versus Hispanic.
Concerns Regarding Interviews

3. Interviewers must do what they can to establish rapport and

make the interviewee comfortable.
4. Interviewers must ensure that subjects give their informed
consent to participate in the interview. If the researcher is
going to audiotape or videotape the interview, the participant
needs additional assurances about the provisions for
confidentiality of the recorded information.
Data Analysis
• Researcher immerses self in data to bring order and meaning
to vast narrative
– Come to truly understand what the data are saying?
• Cyclical process – data analysis occurs simultaneously with
data collection
– Analysis begins when data collection begins
– Reading, rereading, analyzing and reporting on data
– Sometimes called theoretical sampling (collect data until
saturation is reached)
Data Saturation
Refers to a situation in data analysis where
participants’ descriptions become repetitive
and confirm previously collected data
– An indication that data analysis is
complete
– When data analysis is complete, data
collection is terminated
Data Analysis
Three general steps in data analysis process:

1. Data Management
2. Generating meaning
3. Verification
1. Data Management
• Collection, storage, and retrieval of information
• If one does three interviews with each of 10
informants, this could easily result in more than 600
pages of data.
• Therefore, the qualitative researcher needs to develop
a system for organizing and storing the information
collected throughout the study.
• Allot identification codes.
2. Generating Meaning
• Generating meaning from qualitative data, then,
involves an interpretive process in which data are
reduced into small components (coding), reorganized
into larger components (themes), and then displayed in
ways that illustrate the relationships among
components.

• Coding…… themes……..category
 3. Verification
A final step in data analysis is the process of verifying the conclusions that have been drawn. Different
methods of verification:
1. Triangulation of results. This is done by comparing multiple sources of information to determine
whether they all point to similar conclusions.
Example: In a study exploring patients' experiences with chronic pain, the researcher might use:
• Interviews with patients
• Observation of patient behavior during therapy sessions
• Review of patient diaries or medical records

2. A second form of verification is the use of multiple researchers to code data independently. 2 or more
researchers independently code a small amount of data at the beginning of the study, compare their
results, discuss discrepancies, and code another small set of data until they are satisfied that they have a
common understanding of what the codes mean.
3. Verification
3. Member checking: In this process, informants review
the interpretive “story” that the researcher has
generated and have the opportunity to correct
technical errors or take issue with ways in which the
researcher has interpreted their situation.
4. Have an outside researcher audit the analysis.
Data Analysis

Stage Purpose

Codes Identification of key points of the data

Collections of codes of similar content that allows the data

Themes
to be grouped

Broad groups of similar concepts that are used to generate

Categories
a theory

A collection of explanations that explain the subject of the

Theory
research
"In the physio we trust": A qualitative study on patients' preferences for
physiotherapy.

• BACKGROUND: Patients' preferences should be integrated in evidence-based practice. This

study aimed to explore patients' preferences for physiotherapy treatment and participation in
decision making.
• METHODS: A qualitative study set in an urban physiotherapy clinic in Gothenburg, Sweden.
Individual, semi-structured interviews were conducted with 20 individuals who sought
physiotherapy for musculoskeletal disorders. The interviews were recorded, transcribed, and
analyzed with qualitative content analysis.
• RESULTS: An overarching theme, embracing six categories, was conceptualized: Trust in the
physiotherapist fosters active engagement in therapy. The participants preferred active
treatment strategies such as exercise and advice for self-management, allowing them to
actively engage in their therapy. Some preferred passive treatments.
• Key influencers on treatment preferences were previous experiences and media. All
participants wanted to be involved in the clinical decision making, but to varying extents. Some
expressed a preference for an active role and wanting to share decisions while others were
content with a passive role. Expectations for a professional management were reflected in trust
and confidence in physiotherapists' skills and competence, expectations for good outcomes,
and believing that treatment methods should be evidence-based.
• CONCLUSION: Trust in the physiotherapist's competence, as well as a desire to participate in
clinical decision making, fosters active engagement in physiotherapy.
Mixed Methods Research
Introduction to Mixed Methods Research

Definition: Mixed methods research combines

both quantitative and qualitative approaches
in a single study or series of studies.
Purpose: Provides a comprehensive
understanding of research problems by
leveraging the strengths of both methods.
Growing acceptance in health research.
Why Use Mixed Methods?

• Provides a more complete understanding of

complex health issues.
• Bridges the gap between numerical data
(quantitative) and personal experiences
(qualitative).
• Enhances the credibility and depth of research
findings.
• Common in health services research and
rehabilitation sciences.
Key Features of Mixed Methods Research

Integration of quantitative (e.g., surveys,

clinical trials) and qualitative (e.g., interviews,
focus groups) data.

Systematic approach in data collection,

analysis, and interpretation.

Can be conducted in parallel, sequentially, or

through embedded designs.
Mixed Methods Study Designs

1. Convergent Design: Quantitative and qualitative data collected

simultaneously and integrated.
2. Explanatory Sequential Design: Quantitative data collected first,
followed by qualitative to explain findings.
3. Exploratory Sequential Design: Qualitative data collected first to
develop a quantitative study.
4. Embedded Design: One data type is embedded within another (e.g., a
qualitative component within a clinical trial).
5. Mixed Methods Systematic Review: Integrates both types of literature
to synthesize findings.
Advantages and Challenges
of Mixed Methods
Advantages
Captures different dimensions of a research problem.
Provides richer data for analysis.
Allows triangulation of data sources for increased reliability.
Challenges:
Requires expertise in both quantitative and qualitative research.
Time-consuming and resource-intensive.
Data integration can be complex.
Examples of Mixed Methods in
Physiotherapy Research
Understanding Stroke • Quantitative: Survey of stroke patients measuring adherence to
exercise programs.
Rehabilitation • Qualitative: Interviews with patients and therapists exploring
Adherence barriers to adherence.

Effectiveness of • Quantitative: Randomized controlled trials (RCTs) measuring

functional outcomes.
Physiotherapy • Qualitative: Focus groups exploring patient experiences and
Interventions satisfaction.

• Quantitative: Pain intensity scores before and after intervention.

Pain Management in • Qualitative: Patient narratives on coping strategies and
Chronic Conditions treatment impact.
Data Integration in Mixed Methods Research

Separate analysis of quantitative and

qualitative data, then integrating findings.

Transforming qualitative data into

numerical data (quantitizing).

Merging both datasets to identify

patterns and discrepancies.
Steps to Conducting Mixed Methods Research

1. Define research objectives and justify the mixed methods

approach.
2. Select an appropriate mixed methods design.
3. Collect quantitative and qualitative data.
4. Analyze data separately and then integrate findings.
5. Interpret results, highlighting how the integration
enriches understanding.
6. Report findings with a clear explanation of the
methodology and results.
Conclusion

Mixed methods research is a valuable approach for

complex health research questions.

Provides deeper insights by combining numerical

data with patient and clinician perspectives.

Important in evidence-based physiotherapy

practice.

Encouraged for future research to enhance patient

care and rehabilitation outcomes.