Qualitative

Define evidence-based practice and identify how it is used in occupational therapy.

EBP evolved from evidence-based medicine which prompted the era of accountability; The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. -EBP is about Integrating INDIVIDUAL CLINICAL EXPERTISE with the best available EXTERNAL CLINICAL EVIDENCE from systematic research.

2. Discuss problems with studying the experiential realm, according to Polkinghorne.

ER is not available for public inspection, and cannot be known objectively. Complex phenomenon that consists of multiple activities that produce what appears in consciousness and meaning of the content of what is produced; 'Only the person whose consciousness it is can observe, although only partially, his or her experiential processes and contents'; 'Language descriptions offer only an approximation of participants' actual experiencing';**Using numbers to study the experiential realm misses the depth and breadth of human experience. Relationships among "variables" are not static and permanent in the human experiential realm, content varies across individuals in irregular ways- uniqueness of experiential realm, meaning is derived from connectedness to other experiences, mathematical formulas covers over the flux and evolving characteristic of the realm, individual differences are not often distributed in a normal variation around a mean- inferences of population characteristics of the experiential realm from random samples is dubious at best.

Why does he identify them as such?

No answer yet!!!!!

2. Discuss the importance of ethics in qualitative research and relate ethical concerns to the processes involved in qualitative research, as outlined by Creswell.

"Ethical issues need to be anticipated and planned for in designing a qualitative study. These issues arise in many phases of the research process. They develop prior to conducting the study when researchers seek approval for the inquiry (eg. university approval, professional assoc standards, negotiate authorship). They arise at the beginning of the study when the researchers first contact the participants, gain consent to participate in the study (eg. disclose purpose, be sensitive to needs of vulnerable populations), and acknowledge the customs, culture, and charters of the research site. The ethical issues especially arise during data collection with respect for the site and the participants (eg. disrupt minimally, avoid deception), and gathering data in ways that will not create power imbalances and "use" the participants. They also come during the data analysis phase when researchers do not side with participants (eg. "going native"- siding w/ participants, disclosing only positive results), shape findings in a particular direction, and respect the privacy of individuals as their information is reported. In the reporting phase, inquirers need to be honest, not plagiarize the work of others; refrain from presenting information that potentially harms participants; and communicate in a useful, clear way to stakeholders. In publishing, inquirers need to openly share data with others, avoid duplicating their studies, and comply with procedures asked by publishers" (p. 62-63). Creswell Table 3.2 p.58-59: Reciprocity/power considerations - need to give back/provide value for participants (particularly emphasized in transformative/participatory research) - or at least minimize power differentials; Informed consent - what does this really mean? How consent documents work; legal protection vs. true informed consent (do people truly understand what they are agreeing to?); Sensitive or vulnerable populations - particular considerations; protection and non-exploitation; Respect for cultural norms - when working with groups dissimilar from your own culture; cultures exist at many levels (e.g. institutions, ethnic groups, societies); Incentives/rewards - where is the line between fair and reasonable compensation and coercion?; Maintaining privacy/confidentiality - concealing identity of research site, participants, etc. What if you are working with photo/video data?; Distress and difficult emotions - some research topics may evoke emotional reactions; how to respond/manage; Relationships with participants - developing rapport; maintaining boundaries; exiting "the field"

Qualitative Research - Studying the Experiential Realm (Polkinghorne reading); 1. Identify what the "experiential realm" means.

-People's thoughts, understandings, emotions, beliefs, remembrances, imaginations, perceptions, and other mental performances. ; Links between experience-meaning-action (people ascribe meaning to experiences and meaning influences action), all the productions of mental activity **Shaped by context, past experience and future goals/desired actions -- meaning influences action!; 'The study of the experiential realm requires the refocus of attention to the appearances as they occur in a person's consciousness'; 'People's experiential realms are not things; they are historical processes and their primary dimension is time'

Identify the relationship between evidence-based practice and qualitative research.

-Qualitative research ranks low in terms of answering clinical questions about effectiveness of interventions (just above expert opinion) -Ranks top in for answering clinical questions about meaning/experiences. -Can also be first research regarding emerging topics (ex. HIV/AIDS). -Provide preliminary findings of a newly discovered/emerging topic, which can be further explored through quantitative research- good quant research takes a long time to create. -Qualitative assists in getting at patient perspective and values, contributes to clinical expertise on questions of lived experience, disability, meaning, etc. lays the groundwork for clinical effectiveness studies by contributing to the development of more relevant interventions, may be best available evidence, may help in understanding/interpreting whether the findings of an RCT are relevant to your client

Steps for EBP:

0) Cultivate a spirit of inquiry 1) Develop an answerable question (clear & specific) 2) Search for & collect most relevant, best evidence 3) Critically appraise the evidence 4) Integrate best evidence with clinical expertise + patient's preferences/values 5) Evaluate the outcome 6) Disseminate the outcomes of the EBP decision/change.

Gestalt: According to Denzin & Lincoln:

1) Commitment to some version of the naturalistic, interpretive approach to its subject matter. 2) An ongoing critique of the politics and methods of postpositivism. Qualitative researchers stress the socially constructed nature of reality, the relationship between the researcher & what is studied, and the situational constraints that shape inquiry. ; Positivism= scientific method is best (there is a reality to be studied, captured, and understood); Post-positivism= There's an objective reality, but it can't be fully understood-only Approximated. Multiple methods should be used to capture as much as possible. Also emphasizes the discovery and verification of theories. ;Constructivism= reality is socially constructed. There's no reality separate from our Construction of it. MORE: qualitative research has gained acceptance in the social sciences as an alternate, though not equal to quantitative → initially aimed to mainstream it by making it fit the quant mold. **1970s and 80s - historical movements that brought up questions about human experience, a need for both kinds of science, fitting qualitative into the mainstream. Industrial revolution, world wars and information age had an influence too so were colonialism and postcolonialism and civil rights movement.

6. Explain how qualitative and quantitative research might be combined in a trajectory of translational research on a particular phenomenon (see USC blueprint).

1) ID a problem, 2) Develop theoretical understanding of the problem/ ID concerns & needs. THIS IS THE QUALITATIVE PHASE (interviews can be helpful), 3) Develop intervention, 4) test intervention efficacy (RCT), 5) Evaluate cost-effectiveness, 6) Evaluate intervention effectiveness (RCT), 7) study theoretical model for why outcomes were produced (basic qualitative/quantitative research), 8) Knowledge translation, transportation, dissemination; *Produces theoretically informed intervention design and new knowledge on occupation and health.

Identify and describe the design characteristics of qualitative research. Be able to apply them to a potential study. (page 45 Creswell)

1) Natural setting- "in the field", setting contributes to understanding phenomenon 2) Researcher as key instrument- directly engages with participants, personal characteristics influence research process 3) multiple methods- of identifying participants, collecting data, analysis and presentation 4) complex reasoning- inductive and deductive 5) focus on meaning- understanding and awareness of nature of human experiences by those experiencing it 6) emergent design- openness and flexibility, can change as data is generated 7) reflexivity- researcher is part of data generations and needs to be aware of own biases & perceptions 8) holistic account- research findings are complete and valuable in and of themselves.

More on describing the design characteristics of qualitative research:

1) Natural setting- "in the field", setting contributes to understanding phenomenon; don't bring individuals into the lab, nor do they send out instruments for the participants to complete i.e. surveys; gather close up information by actually talking directly to people and see them behave within their context, 2) Researcher as key instrument- directly engages with participants, personal characteristics influence research process; may use an instrument, but one designed by the researcher, such as open-ended questions (usually not questionnaires created by other researchers), 3) Multiple methods- of identifying participants, collecting data, analysis and presentation; typically collects multiple forms of data i.e. interviews, observations, and documents, 4) Complex reasoning- inductive and deductive; inductive reasoning- organizing data into increasingly more abstract units of information, working back and forth between the themes and the database until they establish a comprehensive set of themes - can involve collaboration with participants to help establish themes "bottom - up reasoning" data to themes; deductive reasoning- build themes that are constantly being checked against the data "top down reasoning' theme to data, 5) Focus on meaning- understanding and awareness of nature of human experiences by those experiencing it → participants meaning -should reflect multiple perspectives of the participants in the study, 6) Emergent design- openness and flexibility, can change as data is generated; questions may change, forms of data collection may be altered, individuals studied may be modified during process 7) Reflexivity- researcher is part of data generations and needs to be aware of own biases & perceptions → researcher conveys their background and how it may inform their interpretation of the the information in a study, 8) Holistic account- research findings are complete and valuable in and of themselves; develop a complex picture of the problem or issue under study→ convey multiple perspectives, identify many factors -->sketch a larger picture (don't simplify).**qualitative research begins with assumptions and the use of interpretive/theoretical frameworks that inform the study of research problems addressing the meaning individuals or groups ascribe to a social or human problem. 2 things- commitment to some version of the naturalistic, interpretive approach to its subject matter and an ongoing critique of the politics and methods of positivism.

EBP Involves clinical reasoning to integrate information from four resources:

1. Best Research evidence, 2. Clinical expertise, 3. Clients' values & circumstances, 4. The practice context.

Explain the philosophical/historical underpinnings and gestalt of qualitative research.

1600s= Scientific Revolution; 1800s= Inc. in scientific institutionalization, formal disciplines, theory of evolution & eugenics; 1900s= strengthening of social sciences in response to problems of Industrial Revolution, hypothesis development & falsification theory. ; 1970s & 1980s= Civil rights movement, increased awareness of diversity of experience. Re-emergence of qualitative research **Qualitative research studies things in their natural setting, attempting to make sense of/interpret phenomena in terms of the meaning people bring to them

Discuss the significance of philosophical assumptions to research endeavors. Describe the philosophical assumptions of qualitative research as outlined by Creswell. Link those philosophical assumptions to characteristics of qualitative research.

According to Creswell, qualitative research begins with assumptions & use of interpretive/theoretical frameworks to address the meaning ppl ascribe to a social problem. Emerging qualitative approaches are used to study this problem, data in natural setting is collected (sensitive to ppl & place being studied) data analysis is inductive + deductive + establishes patterns/themes. Final written report includes voice of participants, reflexivity of research, complex description + interpretation of problem + contribution to literature OR call for change. 4 key philosophical assumptions: 1) ontology: what is the nature of reality? 2) epistemology: what counts as knowledge? 3) axiology: what is the role of values? 4) methodology: what is the process of research? ; ontology: qualitative= multiple perspectives. quantitative= fixed; epistemology: qualitative= subjective experiences of participant co-created with researcher.; quantitative= objective data; axiology: qualitative= intrinsic biases. quantitative= objective results are separate from subjective interpretation; methodology: qualitative=emergent design, particularities. quantitative= pre-specified design, generalities. **Ontology- what is the nature of reality? Multiple perspectives, reality differs depending on vantage point, reality is fixed.; Epistemology- what counts as knowledge? Subjective experience as expressed by participant, co-created by researcher and participant, objective data gathered by standardized, validated instruments, researcher is removed from the process.; Axiology - what is the role of values? Research is value-laden and biases are intrinsic, objective results separated from subjective interpretation; Methodology - what is the process of research? Emergent design, concern with particularities, topic studied in natural context, design pre-specified, concern with generalities/averages, context may be irrelevant.

3. Discuss Polkinghorne's perspective on basic and expert competencies in qualitative research-what does he think they should be and why does he identify them as such? (Pg.14)

Basic- concerned with knowledge about qualitative research including its theories and principles and its history and traditions. Demonstrated when able to read and understand qualitative articles- know and understand the principles and rationales, and to analyze and synthesize data and communicate results -Factual knowledge about qualitative research'; Expert- concerned with mastery of skills required to carry out a qualitative study. Demonstrated by ably conducting and reporting a qualitative study and by production of a critical evaluation of a qualitative study; in order to produce a quality qualitative study→ need to have mastery or expert competencies.**Basic Expert understanding of principles and rationales including mastery of skills needed to carry out qualitative studies concerned with knowledge about qualitative research including its theories and principles and its history and traditions- know and understand principles that guide the conduct of qualitative research, know and understand the rationales that inform the processes used to generate data, to analyze and synthesize data and communicate results and know about history and traditions concerned with mastery of skills required to carry out demonstrated by ably conducting and reporting a qualitative study and by the production of a critical evaluation of a qualitative study attaining competency in the qualitative principles of inquiry involves coming to understand that qualitative approaches produce a different type of knowledge than that produced by quantitative studies.

Identify and explain trends within the history of qualitative research.

Colonialism/imperialism: ethnographic approach to documenting the "other": belief that data could objectively be collected by observation (Museum-like & timeless); 1950s-1970s= Formation of qualitative methods; different approaches linked to different disciplines 1. (psychology=phenomenology; anthropology= ethnography; sociology=grounded theory); attempts to fit qualitative methods to standards of quantitative research 2. (Postpositivism= belief that information from multiple perspectives is needed to try to understand reality); 1970s-1980s= More variety in paradigms, and methods; increase in applied qualitative research; shift from positivist perspective to interpretive (positivist= belief that the researcher could be objective); blurring boundaries between social sciences and humanities. 1980s-2000s= Reflexivity in research (researcher reflects on self in writing; transparency); issues of gender, class & race are more prominent, new methods of ethnography; action, participatory & activist-oriented research (activist-oriented is research co-conducted between a researcher & participants to attack a very large social problem).; Today= Qualitative research responds to EBP movement, reflexive/interpretative, debated.; interpretative= theoretical/ideological lens (set of assumptions about the world) guides & influences decisions & approaches used to collect & interpret qualitative data.

Critical Appraisal of Qualitative Research 1. Describe the difference between methods-specific approaches and general criteria for appraisal of qualitative research.

Creswell P.255-265, discusses the evaluation of method-specific approaches. Narrative Research: 1. Is the individual representative? 2. What are the sources of bias (about the participant, the researcher, and the participant-researcher interaction)? How has the researcher avoided making himself or herself simply the voice of the subject? 3. Is the account valid when subjects are asked to read it, when it is compared to official records, and when it is compared to accounts from other participant? • Focuses on a single individual (or two or three individuals) • Collects stories about a significant issue related to this individual's life. • Develops a chronology that connects different phases or aspects of a story. • Tells a story that reports what was said (themes), how it was said (unfolding story), and how speakers interact or perform the narrative. • Reflexively brings himself or herself into the study. Phenomenological Research: "Does the general structural description provide an accurate portrait of the common features and structural connections that are manifest in the examples collected?" Polkinghorne, p.57

Discuss the "best" research for answering particular types of questions. Link types of questions with different types of research.

Questions about interventions= RCT; Questions about Dx & prognosis= Cohort/case control; Questions about clinical expertise & concerns= qualitative; Timeframe= cross-sectional (data collected at once) vs. longitudinal; Manipulation= experimental vs. observational-philosophy= positivist (objective reality separate from observer) vs. constructionist (observation shapes reality).

More recent definition of EBP=

best research + clinical expertise + patient values

Discuss the way(s) in which qualitative research differed from prior research approaches, especially empirical/positivist research.

established the importance of the study of human group life; based in the idea that humans have a unique way of seeing the world; observations are subjective, as opposed to in quantitative research observations are objective; constructivism- reality is socially constructed; positivism- there is a reality out there to be studied, captured, and understood. **previous types of research were very systematic, qualitative focused on the human and the human experience. Qualitative emphasizes the qualities of entities and processes and meanings that are not experimentally examined or measured. Stresses the socially constructed nature of reality, intimate relationship between the researcher and what is studied and the situational constraints that shape inquiry.

4. Discuss the purpose of qualitative data and research findings according to Polkinghorne.

● Develop extensive knowledge about individuals ● Provides individualized descriptions of participants' experiences as they are enveloped within historical and cultural contexts ● A kinship to knowledge gained by clinicians about clients understanding and approach to their life events ● Can enlarge sensitivity of clinicians to possible range and complexity of clients' experiences ● Used as lenses to notice possible experiential subtleties and nuances of others who were not studied ● processes and interactions within the experiential realm more closely resemble those operating in naturally spoken language than numbers. ● "The purpose of qualitative data is to provide a basis for increased understanding of aspects of participants' experiential realms that are being studied..." (p. 24).**extensive knowledge about individuals rather than populations - provides descriptions of participants' experiences as they are enveloped within their historical and cultural contexts. Kinship to the knowledge gained by clinicians about the manner in which clients understand and approach their life events. Enlarges sensitivity of clinicians to the possible range and complexity of clients' experiences. Also meant to be used as lenses through which we can notice possible experiential subtleties and nuances in others who were not studied, sensitizes one to notice differences and variations in experiences of similar events, encourages looking below the surface impressions of people's experiences, generalizable truth pertains to sample, not individual.

3. Identify basic characteristics of the following research traditions: grounded theory, ethnography, phenomenology, narrative, case study, and qualitative descriptive research.

● Grounded Theory- purpose is generating a theory of a process or action "grounded" in real life experiences. Positivist and constructivist approaches. Emphasizes constant comparison (iterative data collection and analysis) and saturation. Traditional analysis highly structured- not emergent. Open coding, axial coding, and selective coding. Constructivist allows more interpretation and flexibility. Developed in the field of Sociology. ● Ethnography- unit of analysis is culture-sharing group (derived from anthropology). Aim is to discern group's underlying values, ideas, behaviors, and beliefs. May have realist or critical orientation. Primary method is participant observation and fieldwork. Analysis incorporates emic (participants) and etic (researchers) perspective ● Phenomenology- Common/shared meaning of a lived experience. Rooted in philosophy; emphasis on suspension of judgment (Bracketing) and integration of subjective and objective properties of experience. Analysis focused on uncovering the "essence" of the lived experience (core elements). Typically interviews people in-depth and multiple times ● Narrative- Emphasis on stories- chronology (past, present, future) or may be "turning points" or trouble. Analysis may focus on: theme (story that is being told), structure (form of the story), or dialogue/performance (how the story is produced). Focus on life experience of one or a small number of individuals. ● Case Study- Unit of analysis is one or more bounded systems (discrete event, community, project). Case may be unique (intrinsic case) or represent a larger issue or concern (instrumental case). Aim is to achieve in-depth understanding - multiple forms of data (interviews, documents, observations) and extensive data collection. Analysis describes overall case or specific aspect of case. ● Qualitative Descriptive- Offers a comprehensive summary of an event in everyday terms of those events. Theoretical orientation draws from naturalistic inquiry. Minimal interpretation of data- emphasis on content analysis to summarize content of data. Descriptive validity- accurately describe meaning given by participants.

Describe ways in which a practitioner might combine various types of evidence in clinical decision-making.

● Ideally, all 3 research studies contribute important elements to the therapy session: ○ RCT demonstrates that an intervention is effective, but the population is different cultural group than your client ○ Qualitative study provides information on differences in acceptability according to cultural beliefs, giving you insight into possible patient preferences. ○ Qualitative study helps clinician learn effective communication and collaboration strategies, enhancing clinical judgment. ● Result: OT and client have productive conversation about what is right for that client, and agree on best treatment option (which may or may not be the intervention tested in the RCT) **RCT can show that an intervention is effective, but with a different population than you're working with, qual study provides info on differences in acceptability according to cultural beliefs, giving insight into possible patient preferences, also helps clinician learn effective communication and collaboration strategies, enhancing clinical judgment.

1. Describe the steps in the qualitative research process. Be familiar with the characteristics of each step.

● Identify underlying assumptions and theoretical perspective ● Identify topic area and review literature (1)- study focused on understanding a single concept or idea, then later incorporate the comparison ● Select appropriate approach- frame study within the assumptions and characteristics of the qualitative approach to research, including evolving design, presentation of multiple realities, researcher as an instrument of data collection, and focus on participants' views. ● Develop research question(s)- (Review literature(2)) ● Generate data- collect multiple forms of data and detail and spend adequate time in field ● Conduct analysis- using multiple levels of abstraction. Themes analyzed with unusual angles/perspectives. ● Present findings- write persuasively, verisimilitude (clear, engaging, and full of unexpected ideas). Reflecting all the complexities that exist in real life.

4. Identify and describe different methods of generating data, including interviews, observation, document review, and audiovisual materials.

● Interviews: potential participants (individuals, dyad, groups), ranging from closed-end to open-end, general types (structured, semi-structured, informal conversational, focus group, narrative) ● Participant Observation: Hanging out, Doing with, ranging from non-participant to participant, and includes field notes and memos ● Archival information and other sources- notes, photos, albums, books, poems, emails, documents/notes ● Audiovisual materials- photos, albums, videos ● Audiovisual materials- photos, albums, videos, videotape or film a social situation, individual, or group, collect email or discussion board messages, examine favorite possessions or ritual objects ● Document: review medical records, conduct chart audits, have participants take photographs or videotapes, analyze public documents, collect personal letters from participants, have a participant keep a journal or diary during the research study; *Purpose of data is to provide a basis for increased understanding of aspects of participants' experiential realms that are being studied.

5. Identify problems associated with the write-up of qualitative research reports.

● Qualitative research findings do not fit the current research article format. Information regarding the background, methods used, researcher reflexivity, context setting, etc would make the write-up too lengthy. Format fits quantitative studies better than qual. ● APA format assumes that results are produced by mathematical analytic techniques familiar to readers and therefore no need to describe how analysis produced its results from the data ● assumes prior understanding of how study results are produced ● Also assumes that all of the data will be gathered prior to analysis **Qualitative Research - Approaches and Design