Qualitative research
Abstract
Background Tuberculosis is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Poor adherence to treatment is common despite various interventions aimed at improving treatment completion. Lack of a comprehensive and holistic understanding of barriers to and facilitators of, treatment adherence is currently a major obstacle to finding effective solutions. The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, carers and health care providers in contributing to tuberculosis medication adherence. Method We searched 19 electronic databases (1966-current) for qualitative studies on patients, carers or healthcare providers perceptions of adherence to preventive or curative tuberculosis treatment with the free text terms Tuberculosis AND (adherence OR compliance OR concordance). We supplemented our search with citation searches and by consulting experts. For included studies, study quality was assessed using a predetermined checklist and data were extracted independently onto a standard form. We then followed Noblit and Hares method of meta-ethnography to synthesize the findings, using both reciprocal translation and line of argument synthesis. Findings We screened 7814 citations and selected 44 articles that met the pre-specified inclusion criteria. The synthesis offers an overview of qualitative evidence derived from these multiple international studies. We identified eight major themes across the studies: the financial burden of tuberculosis treatment; the organisation of treatment and care; knowledge, attitudes and beliefs in relation to treatment; interpretations of illness and wellness; family, community, and household support; personal factors; side effects; and law and immigration. Our interpretation of the themes across all studies produced a line of argument synthesis which shows how four major factors interact to affect adherence to TB treatment: structural factors, including poverty and gender discrimination; the social context; health service factors; and personal factors. Conclusions Patients decisions to stop taking medication were influenced by a number of interacting factors. Adherence to the long course of tuberculosis treatment is a complex, dynamic phenomenon with a wide range of interacting factors impacting on treatment taking behaviour. The findings of our review could help inform the development of patient- centred interventions and of interventions to address structural barriers to treatment adherence.
Qualitative research
1
QUALITATIVE RESEARCH
Qualitative is a diverse field. Not a unified set of methods/philosophy like surveys and
experiments.
Grew out of many disciplines: sociology, anthropology, education, linguistics, history
Theories which match well with qualitative research: SI, ethnomethodology,
postmodernism, critical theories
These disciplines and theories have different philosophies on human behavior and
different methods for applying qualitative principles/techniques.
Types of Qualitative Research
interviewing
participant and nonparticipant observation
documents
content analysis - written, visual
discourse analysis
case studies
informal, structured or unstructured interviews
correspondence
Characteristics of Qualitative Research
1. With these methods we try to answer the general RQ “What is going on here?”
To do that you focus is on people’s perceptions and experiences. How they make sense
of their lives. Data = what they say they believe, what they do, feelings expressed,
explanations given.
Assumption: “People make sense out of their experiences and in doing so create their own
reality. They can share those experiences and that reality. What people say is valid and
reliable. It is meaningful.
2. Qualitative is primarily interpretivist, rather than positivist like surveys and experiments.
Not seeking to verify some “truth”. Multiple truths, realities, meanings, etc... Look for
patterns to build explanations. Try to understand how participants understand themselves
or their world.
2
3. Research design steps in Qualitative Research are not linear (unlike surveys and
experiments). Come up with an initial game plan, but it can unravel in multiple ways.
Always go back and forth between steps/research issues. Each influences each. Need to
be flexible, open to change.
More so than in surveys and experiments, every decision the researcher makes (explicit or
implicit) about research design influences every aspect of research.
4. Two general ways to conduct qualitative research:
a. Don’t develop hypotheses apriori. Let the data do the explaining. Theory is created from
the data. Don’t test hypotheses or theory.
Or,
b. Develop preliminary conceptual hypotheses, and gather evidence to support/refute them.
(more positivist approach)
5. Can’t anticipate all issues/problems apriori. Have to deal with them “in the field” (unlike
surveys and experiments, where you deal with them ahead of time or afterwards,
statistically).
6. Researcher is the main data collection instrument. Researcher’s beliefs, values,
predispositions influence the entire process. So there is a potential for bias here, and
replication of findings is more difficult than in quantitative research. Hence, more so than in
surveys and experiments, researchers make their values/biases explicit in the research.
They share their motivations for doing the study up front (intro). In the Methods section they
say how their beliefs/values influenced the research.
Example: Gay Friendships study and my ideas on masculinity, inequality, sexuality
7. Goal is to produce an understanding/explanation that is true to all the data. No error.
Different from experiments and surveys. Inductive rather than deductive.
8. Not a standardized data collection.
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