Qualitative Research in Health Care

CATHERINE POPE is Professor of Medical Sociology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. She serves on the editorial boards of Sociology of Health & Illness, Digital Health, and the Journal of Health Services Research & Policy. NICHOLAS MAYS is Professor of Health Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. He directs the National Institute for Health Research funded Policy Innovation and Evaluation Research Unit. He was co-editor of the Journal of Health Services Research & Policy for over 20 years and is now on its editorial advisory board.

Preface to the Fourth Edition xiii

List of Contributors xvii

1 Introduction 1
Nicholas Mays and Catherine Pope

1.1 What Is Qualitative Research? 1

1.2 The Uses of Qualitative Research 4

1.3 Methods Used in Qualitative Research 6

1.4 The Place of Qualitative Methods in Health Care Research 7

1.5 Outline of the Structure of the Book 9

References 10

Further Reading 13

2 The Role of Theory in Qualitative Research 15
Catherine Pope and Nicholas Mays

2.1 Introduction 15

2.2 Differences in Ontology and Epistemology 16

2.3 Implications of Ontology and Epistemology 18

2.4 Choose Your Philosophical Umbrella – Positivism or Interpretivism? 19

2.5 Theoretical Perspectives 21

2.6 Methodology 24

References 25

Further Reading 26

3 Ethical Issues in Qualitative Research 27
Dawn Goodwin, Nicholas Mays, and Catherine Pope

3.1 Introduction 27

3.2 Ethical Principles 28

3.2.1 Informed Consent 30

3.2.2 Confidentiality 31

3.2.3 Anonymity 34

3.3 Situational Ethics 35

3.4 Relational Ethics 38

3.5 Conclusion 39

References 40

Further Reading 41

4 Interviews 43
Lisa Hinton and Sara Ryan

4.1 Introduction 43

4.2 What Makes a Good Qualitative Interview? 46

4.3 Role of the Interviewer 47

4.4 The Practicalities of Qualitative Interviews 48

4.4.1 How Many Interviews Is Enough? 48

4.4.2 Sampling 49

4.4.3 Recruitment 50

4.4.4 Fundamentals – Quiet Space, Recording, and Transcription 51

4.4.5 Designing a Topic Guide 51

4.4.6 Data Saturation 52

4.5 Reflexivity 52

4.6 Conclusion 53

References 54

Further Reading 55

5 Focus Groups 57
Jonathan Q. Tritter and Bodil J. Landstad

5.1 Introduction 57

5.2 What Is a Focus Group? 58

5.3 Doing Focus Group Research 58

5.3.1 Recruitment and Sampling 59

5.3.2 Initiating the Focus Group 61

5.3.3 Follow‐on or Second Focus Groups 62

5.4 Analysis 62

5.5 Ethical Issues 63

5.6 Conclusion 64

References 64

Further Reading 66

6 Observational Methods 67
Catherine Pope and Davina Allen

6.1 Introduction 67

6.2 Observational Methods and Ethnography 68

6.3 Rationales for Observational Studies in Health Care Research 69

6.4 Practical Issues to Consider When Using Observational Methods 72

6.4.1 Ethical Issues 72

6.4.2 Access to the Field 72

6.4.3 Research Roles 73

6.4.4 Recording Observational Data 74

6.5 The Relationship Between Theory and Observational Research 76

6.6 Analysis 76

6.7 Quality in Observational Studies 77

References 78

Further Reading 81

7 Documentary Analysis 83
Martin Gorsky and Alex Mold

7.1 Introduction 83

7.2 Uses of Documentary Methods 84

7.3 Sources and Location 86

7.4 Selection, Recording, and Storing 89

7.5 Approaches to Analysis 90

7.6 Conclusion 93

References 94

Further Reading 96

8 Digital Data and Online Qualitative Research 97
John Powell and Michelle H. van Velthoven

8.1 Introduction 97

8.2 Types of Digital and Virtual Data 98

8.3 Who Goes Online? The Have‐Nets and the Have‐Nots 99

8.4 Using Existing Online Data for Qualitative Health Research 100

8.5 Eliciting Qualitative Data Using Online Methods 103

8.6 Big Data and Digital Qualitative Research 104

8.7 Ethics of Using Digital Data and Conducting Online Research 105

8.8 Conclusions 108

References 108

Further Reading 109

9 Analysis 111
Catherine Pope, Sue Ziebland, and Nicholas Mays

9.1 The Nature and Scale of Qualitative Data 111

9.2 Data Preparation 112

9.3 The Relationship Between Data and Analysis 113

9.4 Counting and Qualitative Data 114

9.5 Initial Steps in Analysis 116

9.6 Thematic Analysis 119

9.7 Grounded Theory 120

9.8 IPA 122

9.9 The ‘Framework’ Approach 123

9.10 Software Packages Designed to Handle Qualitative Data 124

9.11 Developing Explanations – The Role of the Researcher 126

9.12 Working in a Team 128

9.13 Conclusion 131

References 131

Further Reading 133

10 Conversation Analysis 135
Geraldine M. Leydon and Rebecca K. Barnes

10.1 Introduction 135

10.2 What Is CA? 135

10.3 What Kinds of Questions Can CA Be Used to Answer? 137

10.4 Collecting Naturalistic Data 137

10.5 Transcription 139

10.6 Analysis 141

10.7 Sharing CA to Inform Health Care Practice 144

10.8 Conclusion 145

10.9 Further Considerations for CA Research 146

References 146

Further Reading 150

11 Synthesising Qualitative Research 151
Nicholas Mays and Catherine Pope

11.1 Introduction 151

11.2 Should We Synthesise Qualitative Research at all? 152

11.3 The Purposes of Synthesis 153

11.4 Generic Issues in Qualitative Synthesis 154

11.4.1 Refining the Research Question and Search Strategy 154

11.4.2 Data Extraction 155

11.4.3 Quality Appraisal of Studies 156

11.4.4 Analysis and Interpretation 156

11.5 Methods for Synthesising Qualitative Research 157

11.5.1 Narrative Synthesis 157

11.5.2 Framework Synthesis 158

11.5.3 Qualitative Cross‐Case Analysis 158

11.5.4 Meta‐ethnography 159

11.6 Synthesis of Qualitative and Quantitative Evidence 160

11.6.1 Integrating at the Review Level 161

11.6.2 Integrating Using a Common Structure, Framework, or Model 161

11.6.3 Integrating Through ‘Transformation’ of Data 162

11.6.4 Using an Integrative Method 164

11.7 Conclusion 165

References 166

Further Reading 168

12 Mixed Methods Research 169
Alicia O’Cathain

12.1 Introduction 169

12.2 Dealing with the ‘Paradigm Wars’ 170

12.3 Getting to Grips with Mixed Methodology 170

12.4 Mixed Methods Study Designs 171

12.4.1 Evaluation 171

12.4.2 Survey and Interviews 173

12.4.3 Development of Questionnaires and Measures 173

12.5 Integration of Qualitative and Quantitative Data and Findings 174

12.6 Thinking About Quality 175

12.7 Team Working 176

12.8 Publishing 176

12.9 Conclusions 177

References 177

Further Reading 180

13 Case Studies 181
Alec Fraser and Nicholas Mays

13.1 Introduction 181

13.2 Types of Case Study Research 182

13.3 Practical Considerations for Using Case Study Approaches in Health Care Settings 184

13.3.1 Defining Cases 184

13.3.2 Sampling 185

13.3.3 Data Collection Methods 187

13.3.4 Analysis 188

13.4 Conclusions 189

References 189

Further Reading 191

14 Participatory Research in Health Care 193
Kath Maguire and Nicky Britten

14.1 Introduction 193

14.2 Co‐production 196

14.3 Participatory Action Research 199

14.4 Service User‐Controlled Research 201

14.5 Citizen Science 204

14.6 Conclusion 206

References 207

Further Reading 210

15 Quality in Qualitative Research 211
Nicholas Mays and Catherine Pope

15.1 Introduction 211

15.2 Can We Use the Same Quality Criteria to Judge Qualitative and Quantitative Research? 213

15.2.1 Qualitative and Quantitative Research are Separate and Different: The Anti‐Realist Position 214

15.2.2 It Is Possible to Assess Qualitative and Quantitative Research Using Similar Criteria: The Subtle Realist Position 216

15.3 Assuring and Assessing the Validity of Qualitative Research 216

15.3.1 Triangulation 217

15.3.2 Respondent Validation 218

15.3.3 Clear Exposition of Methods of Data Collection and Analysis 218

15.3.4 Reflexivity 219

15.3.5 Attention to Negative Cases 220

15.3.6 Fair Dealing 220

15.4 Relevance 221

15.5 The Appropriate Role for Quality Guidelines in Qualitative Research 222

15.5.1 Spencer and Colleagues’ Framework for Assessing the Quality of Qualitative Research Evidence 223

15.5.1.1 Guiding Principles 223

15.5.1.2 Appraisal Questions 224

15.5.1.3 Quality Indicators 224

15.5.1.4 The Framework 224

15.5.2 Additional Quality Assessment Criteria 224

15.5.2.1 Data Collection 224

15.5.2.2 Analysis 230

15.6 Conclusion 230

References 231

Further Reading 233

Index 235