U10A1-68 - Qualitative Research Plan - ***TUTOR FOLLOW ALL INSTRUCTIONS AS OUTLINED TO COMPLETE THIS WORK. READ ATTACHMENTS.

BIRTHING A RESEARCH PROJECT I/ Marcella Hart

Design 1 hope you have been moving along in the birth of your research project. If you have identified your problem statement and your variables and made a good effort in collecting and reading your literature, you have com- pleted important prep work. I would say you are through the first trimester in the birth of your project. As a result of your literature review you may have even found some ideas about how you would like to proceed with your study design. This column starts Research Step 4, Meth- odology, which includes design, sampling, data collec- tion, and data analysis. This column will discuss design.

Your design is the blueprint, map, guide, or recipe for your research project. Experimental designs are the type of design most people think of when they think of research. They imagine the research carried out by folks in white coats in a laboratory. As you will see, research can be carried out anywhere and does not have to involve a true experiment.

I categorize design into three types. First there is the control aspect or the process of eliminating factors that might influence the relationships between the study vari- ables. When looking at control, I divide studies into quantitative versus qualitative and experimental versus non-experimental. The second category is the time dimen-

Table 1 .

Comparison of Quantitative and Qualitative Designs

Quantitative Design

1 2 3 4 5 6 7

Objective Deductive Reasoning Control Instrunnents Numbers—Stats Generalization Tests Theory

Quaiitative Design

1 2 3 4 5 6 7

Subjective Inductive Reasoning No Control Communication & Observation Words — Interpretation Uniqueness Develops Theory

Table 2.

Comparison of Experimental and Non-Experimental Design

Experimentai Design must itave tite foiiowing:

Control Manipulation Randomization

Can test hypothesis

Non-experimentai design:

Does not have control, or manipulation and/or randomization

Can explore Can predict Can test a concept Can look at relationships

sion. Studies viewed in this way can be divided into prospective versus retrcjspective and cross-sectional ver- sus longitudinal. The final way to look at design is the "other" category, for those that do not fit into the previ- ous categories. This category could also include combina- tion study designs. Let us look at these groups in greater detail. ]

CbNTROL

Quantitative/Qualitative ' The simplest way to explain the difference between quan- titative and qualitative studies is to say that quantitative studies involve the collection and analysis of numerical data while qualitative studies involve analyzing words obtained in various ways. Quantitative studies are more objective in that the researcher or others collect the numerical data and let statistics do the analysis. In con- trast, the researcher is generally personally involved in the collection and interpretation of data in qualitative studies. !

Quantitative studies involve deductive reasoning or developing specific predictions from the literature or other sources and involve testing hypotheses while quali- tative studies utilize inductive reasoning or developing conclusions from specific observations or narratives to look for patterns to develop new ideas. Instruments that gather numerical data that can be analyzed using statis- tics are used in quantitative studies while words or obser- vations are written down' and interpreted by the researcher in qualitative studies. In-quantitative studies the outcome results in generalization^ to the larger population or test- ing a theory while qualî tative studies look at the unique- ness of situations and is the beginning of theory development. (See Table 1.)

Experimental/Non-experimental A true experimental design involves three properties. The first is control or the management of the study to be sure that it is the expeirimental (independent) variable that really changed or affected the dependent variable. This involves the use of a control group. The second is manipulation or what the researcher does to the study participants in relation' to the experimental variable. Finally, randomization or assigning the participants to the experimental and control groups in a randomized way is the third property. Experimental studies are al- ways quantitative. Non-experimental studies usually omit one or more of the previous properties. Qualitative stud- ies can be listed as a special type of non-experimental study. (See Table 2.) ;

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TIME

The time category of studies looks at when the indepen- dent and dependent variables were observed. There are two types.

Retrospect/Ve/Prospect;Ve Retrospective studies examine the data related to the dependent variable and look backward to find the cause or influence. This type of design studies variables after the fact looking at a known outcome from readily avail- able data. The best example of this type of study is the retrospective chart review. Prospective studies look at variables from present time forward, examine events over time, describe variables of interest, and search for cause and effect. Experimental studies are always pro- spective. (See Table 3.)

Cross-sect/onal/longitud/nal Cross-sectional studies involve collecting data at a single point in time. Longitudinal studies involve collecting data at two or more points in time over an extended period.

OTHER

This category includes studies that do not fit into the categories listed above and is different depending on the researcher. I will put surveys and case studies into this category.

QUALITATIVE STUDIES

I will now discuss some specific designs under each of the above categories. Let me talk about qualitative studies first. Because of the nature of qualitative studies, 1 cannot use the study example we have been using in this column series; however, I will provide potential ideas for quali- tative studies related to parenting education. Qualitative studies utilize narrative data gathered in a variety of ways to provide meaning, insight, and understanding of the subjects' experiences. Five categories are identified: phe- nomenological, grounded theory, ethnography, histori- cal, and triangulation.

Phenomenological studies are the studies you often find titled "The lived experience of...." You might at- tempt a phenomenological study about knowledge in childbirth classes by collecting information for a study entitled "The lived experience of attending childbirth education classes." This study might be done by complet- ing extensive interviews of selected couples as they at- tend your classes. Grounded theory studies are an attempt to discover new theory related to a certain idea. A suggestion here might be gaining insight into how participation in parenting classes really influences the pregnant woman's views of childbirth. Again extensive interviews of selected women might be carried out.

Table 3. Comparison of Prospective and Retrospective Studies

Prospective

Study phenomena from present time forward

Examine events over time Describe phenomena Search for cause and effect Example: experimental

studies

Retrospective

Study phenomena after the fact

Outcome is already known Data already available Passive observation Example: chart review NEVER Experimental

Ethnographic research is an in-depth study of a cul- ture. In this case culture has a broader meaning to include organizations or groups other than cultural groups. It might be interesting to complete an ethnographic study by interviewing different cultural groups and their perceptions of childbirth. Historical studies carefully analyze past information to provide an understanding of the impact of the past on the present and future. To complete an historical study of childbirth education and labor and delivery, the researcher could complete an extensive review of the actual writings of childbirth educators such as Grantly Dick-Read (1959), Lamaze (1965), etc.

Triangulation studies are a new category of research design that some researchers list under the qualitative category. This design involves utilizing narrative as well as numerical or other types of data to answer research questions. A possible triangulation study might be uti- lized to study the stress of childbirth by utilizing in-depth interviews and the administration of some instrument to measure stress.

Because qualitative studies do not involve statistics, many researchers think this type of study is easy. This is not true. I do not recommend this type of study as a first research project.

EXPERIMENTAL STUDIES

Experimental studies have many forms. Because of space limitations I will only discuss one or two of the relatively easier-to-understand designs. 1 will use the purpose state- ment example of the previous columns: fhe purpose of this study is to determine if class participants increase their knowledge of labor and delivery. Remember, a true experi- mental study involves control, manipulation, and ran- domization.

Pre-test/post-test randomized control group design The easiest of the true experimental studies to under- stand is the pre-test/post-test control group design. In the case of our purpose statement, there are several ways to complete this as true experimental design. First you must think of how you would manipulate your independent variable. That is, what is it that you want to look at and

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how might it influence the knowledge childbirth partici- pants acquire in your classes. You could look at ways knowledge is presented to the groups comparing use of various media such as films, internet, and texts. You might look at it in terms of how much time is devoted to education by evaluating a class series and the weekend approach.

Second, you must consider how you obtain your experimental group and your control group. You could compare two different class sessions, two groups in one class, or groups in two different locations. Finally, you need to consider how you would put participants into the two different groups in a random way.

For my example I want to look at the differences in knowledge level comparing participants in a 4-week se- ries of childbirth classes to participants in a weekend session. My independent variable is length of education (4-week series and weekend session) and the dependent variable is knowledge. Because the use of a series of classes has been around for a long time, 1 will call participants in this class my control group, while the weekend participants will be called the experimental group. I would then get my list of couples who want to attend childbirth classes and randomly assign them to the two groups. For this example, 1 will use the flip of a coin to assign the couples to their classes. Knowledge would be operationalized by a test I would develop to determine what I want them to know. The couples would take the test before the start of the class and at the end of the class. The scores the participants achieve on the tests would be analyzed. This type of study would answer two research questions: 1.) Is there a difference in knowl- edge of labor and delivery before and after childbirth education class attendance? 2.) Is there a difference in

the knowledge of labor and delivery when attending the 4-week class versus the weekend class? This second ques- tion could also be stated as a hypothesis as follows: Childbirth couples who attend the 4-week series of childbirth education classes will have more knowledge of labor and delivery than couples who attend a weekend class. (See Table 4.)

Post-test only randomized control group design You probably realized that sometimes giving a pre-test might affect the post-test results. By just eliminating the pre-test in the design above you make it a post-test only randomized control group design.

QUASIE EXPERIMENTAL STUDIES

Quasie experimental studies generally are performed in the same manner as above except there is no random assignment. This is often easier to do.

The study discussed above is turned into a quasie experimental study when the couples are not randomly assigned to the different groups. You would compare childbirth couples who attended different class sessions in the same setting or different settings. This would be called the non-equivalent control group design. (See Table 5.) If the researcher did not have two sessions running at the same time, two groups could be com- pared at different times. (See Table 6.)

The researcher could also make this a longitudinal study simply by giving the labor and delivery test after the class, three weeks after completion of the test, and, though it might not really be feasible, on admission to the hospital. You would then be adding a question re- lated to change in knowledge over time.

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Table 4. Pre-test/Post-test Randomized Control Group Design

Participants randomly assigned to groups

Group A (control gp) (4 week )

Group B (Exp gp) (Weekend)

Pre-test (Knowledge test)

Pre-test (Knowledge test)

Manipulation Attend 4 weeks

Attend weekend

Post-test (Repeat test)

Post-test (Repeat test)

Table 5. Non-equivalent Control Group Design (Same Time)

Couples attend as registered

Group A (control gp) (4 week )

Group B (Exp gp) (Weekend)

Pre-test (Knowledge test)

Pre-test (Knowledge test)

Manipulation Attend 4 weeks

Attend weekend

Post-test (Repeat test)

Post-test (Repeat test)

Table 6. Non-equivalent Control Group Design (Different Times)

Couples attend as registered

Group A (control) Pre-test Manipulation Post-test (4 week) (Knowledge test) Attend 4 weeks (Repeat test)

Group B (Exp gp) Pre-test (Weekend) Knowledge test)

Attend weekend Post-test (Repeat test)

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NON-EXPERIMENTAL DESIGNS

Non-experimental designs are those that omit one or more of the control, manipulation, or randomization properties. The best example is the one group pre-test/ post-test design. You would just develop a test and give it to one of your classes before and after the class. You would answer the research question, "Is there a differ- ence in knowledge of labor and delivery before and after attendance in childbirth education classes?" In this ex- ample the properties of control and randomization are not present.

Another common non-experimental design is the retrospective study. This type of study could easily be done to determine knowledge of labor and delivery obtained in childbirth education classes. The researcher could get permission from couples and look at labor and delivery results of those couples who were enrolled in the childbirth classes. The researcher could review nurses' notes to determine if the laboring women used various childbirth techniques to answer the question, "Do women who attend childbirth classes use the techniques they learned in class?" In this case you have operationalized knowledge to mean "use of childbirth techniques in labor."

OTHER TYPES OF DESIGN

As stated previously this category is made up of many designs that do not fit in the previous categories. I will focus on two designs here, the survey and the case study.

Survey Using the survey design the researcher collects informa- tion from subjects about one issue or variable at one point in time. There is no experiment or manipulation of any variables. Survey data can be collected in person, by interview, by mail, by phone, and the internet. Depend- ing on the number of surveys returned, much data can be obtained and the results analyzed in many ways.

Using our purpose statement, a researcher could operationalize knowledge to mean types of techniques used in labor and delivery. The researcher could then develop a questionnaire related to these labor techniques and mail it to previous childbirth couples to determine what techniques they used in their labors. The researcher can complete correlation analyses, compare two or more groups, and obtain descriptive information, among other things. This type of study might be your first effort.

Case studies Case studies are the in-depth study of one single subject. In this instance a variety of data collection procedures are used. This is a common research design in medicine in which a physician provides a detailed report of a patient presenting with a specific disease. The physician utilizes his physical observations, patient, and perhaps family comments as well as the medical record. Perhaps you

have had a unique client with an unusual medical, emo- tional, or family problem in one of your classes. Using the case study design to present and discuss this client might be appropriate.

VALIDITY OF DESIGN

A discussion of design is not complete without discussing validity issues. Understanding the validity of design is important in evaluating your design to see if it was the best possible choice for your purpose and that it obtained the best data. Four types of validity will be discussed: 1.) internal validity; 2.) external validity; 3.) construct validity; and 4.) statistical conclusion valid- ity. Only the first two will be discussed in this article. Construct validity will be discussed in a column about data collection, and statistical conclusion validity will be discussed in a column on data analysis.

Internal validity Internal validity refers to the extent to which it is possible that the independent variable is truly causing or influenc- ing the dependent variable. Factors other than the inde- pendent variable that affect the results are called threats. When planning a research study the researcher must be aware of these threats to internal validity and try to deal with them before the study begins or acknowledge they may have affected the study results after the study is completed.

History: History refers to another event that occurs external to the independent variable that may affect the dependent variable. In our study looking at length of classes, a possible threat to internal validity might be the presentation of a television show about childbirth educa- tion. The information in this show may have some spe- cifics that are contrary to your teaching or it may verify what you are teaching. The researcher will have to deter- mine if the couples viewed the show and elect to stop the study or continue the study but acknowledge that the show did occur and report the number of couples who watched the television show.

Maturation: Maturation refers to a process occur- ring in the subjects over time that may affect the depen- dent variable. Examples of maturation threats are growth and development changes within the participants, and, in the case of pregnant women, the various pregnancy changes might affect a study. Again, because the re- searcher has no control over such threats they merely have to be acknowledged.

Testing: Testing is the degree to which a pre-test may influence the results of a post-test. The solution to this threat is to develop two different tests or only have a post-test.

Instrumentation: Instrumentation threats arise from changes in the measurement methods. The best example of this is the breakdown of equipment such as a sphyg- momanometer that may be used in research. In the

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survey example, it might be that a set of questionnaires were misprinted. The solution is to double-check and choose the best instrument possible.

Mortality: Mortality is the loss of subjects during the study thus affecting the sample size. The obvious ex- ample in our study would be subjects delivering before the class is completed. The way to avoid this problem is to include more subjects if possible. This is especially important in longitudinal studies.

Selection bias: Selection bias results when subjects chosen are not representative of the population of inter- est. The best way to avoid this threat is to use a random sample.

External validity External validity is the extent to which the study results can be generalized or applied to the larger or other population(s). Threats to external validity include prob- lems with the sample or the environment.

Sampling threats: Having an inadequate number for your sample is the key threat. The second is not choosing your sample in a random manner. 1 will speak to this in greater detail in a column about sampling.

Environmental threats: Where the researcher car- ries out the research is important. Two possible concerns may occur. The general environment may not be condu- cive to research. For instance, conducting an interview in an office waiting room will not provide good data. An- other issue related to environment is the potential inter- action of subjects. Subjects may discuss questionnaires

much like students taking an exam and this will influence results. The solution to this threat is to carefully choose where you will conduct your study.

SUMMARY

I have briefly discussed research design and I mean briefly. Anyone of these areas could be discussed in its own separate article. Remember if this is your first re- search effort, keep it simple. Perhaps try a survey of pregnant women, a retrospective chart review, or a one- group pre-test/post-test design. You now have the first part of your research plan and are well into your second trimester of birthing a research project. Begin to evaluate such factors as resources available to you including li- brary assistance, research helpers, and issues related to validity. In the next column 1 will discuss sampling tech- niques and the ethics of research.

References Dick-Read, G. 1959. Childbirth Without Fear: The Principles and Practice

of Natural Childbirth, 2nd ed. New York: Dell Publishing Co.

Lamaze, F. 1955. Painless Childbirth: The Lamaze Method. New York: Pocket Books.

Marcella A. Hart earned her undergraduate nursing degree in 1962 from St. John College in Cleveland, Ohio, a MN from the University of Washing- ton in 1964, and a PhD in 1993 from Case Western Reserve University. She has been teaching childbirth education since ) 966, and recently retired as both a childbirth educator and nursing faculty member. Childbirth educa- tion remains her first love.

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