BRI

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W hat is qualitative research? How does it differ from quantitative research? Under what circumstances is one type of study more appropriate than the other? Are

there instances where one might consider a “mixed methods” approach using elements of both? A research- er beginning a project faces a bewildering array of deci- sions regarding the approach he or she will take to answer the questions associated with the problem being investigated. An analysis of peer-reviewed articles pub- lished in Radiologic Technology from September/ October 2010 to July/August 2016 yielded 90 total arti- cles. Quantitative survey studies or other quantitative research (eg, correlative studies) represented the largest percentage of articles, 36.6%. Experimental studies rep- resented 24.4% of articles; 20% were literature reviews, and 13.3% were case or technical reports. Mixed- methods studies (using both qualitative and quantita- tive methods of data collection) represented 3.3%, while purely qualitative studies represented only 2.2% of pub- lished articles.

Quantitative vs Qualitative Research Quantitative studies are appropriate for examining

relationships between and among variables, describing trends, attitudes, or opinions of a population, as well as for testing the effects of a treatment or intervention on an outcome.1 Although quantitative analysis allows for a high degree of precision in research, it represents a 2-D

view of findings as compared to the rich, deep descrip- tions offered by qualitative approaches. The role of the researcher in a quantitative study is to remain “distant and independent of what is being researched” (ie, as objective as possible).2

Conversely, in qualitative research, the researcher is aware of the socially constructed nature of reality and is embedded intimately in the context of the study— the research setting, participants, and the data being collected. The qualitative researcher is a ref lexive prac- titioner, aware of his or her own political and cultural perspectives, yet willing to engage in self-questioning and self-understanding.3 Qualitative research gets at the how and why of the story, in ways that quantitative research cannot. The key concept of the study is often referred to as central phenomenon in scholarly writ- ings. Other important differences include sample size, methods of data collection, analysis, and interpretation. Researchers within the radiologic science profession might consider using qualitative approaches alone or in combination with quantitative methods when planning future studies. Many comprehensive resources provide detailed information on designing qualitative research studies, and some are referenced in this column.

Developing the Qualitative Research Question

Developing the research question is the initial step in any research project. This frames the outline

Jennifer Yates, EdD, R.T.(R)(M)(BD) Tricia Leggett, DHEd, R.T.(R)(QM)

Qualitative Research: An Introduction

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methods include interviews, focus groups, observations, reviewing document studies, key informants, alterna- tive (authentic) assessments, and case studies.

An interview, rather than a paper-and-pencil or elec- tronic survey, is selected when interpersonal contact is important and when opportunities for follow-up of interesting comments are desired. Interview data can be recorded digitally (with participant permission), sum- marized in notes, or a combination of these methods. Detailed recording is a necessary component of inter- views because it forms the basis for analysis.4

A focus group can be considered an in-depth group interview. Typically, a group of about 10 participants is invited to a session that lasts approximately 2 hours. The researcher initiates discussion by asking open- ended questions so that the participants are motivated but not guided to discuss the relevant topic. The researcher listens and observes the discussions that follow, intervening as little as possible as long as the discussion remains on the topic. In such discussion, the participants are expected to unfold their knowl- edge and express their opinions about the subject matter.

Observations are guided by a structured protocol that can take a variety of forms, ranging from the request for a narrative describing events to a checklist or a rating scale of specific behaviors or activities. This level of standardization helps assure consistency with

and process for the work to follow. Once the area for investigation is determined, the research problem will be posed. The research problem is a topic or issue that specifies the value of the research study. In general, completion of sentences such as, “This study needs to be conducted because…” or “The topic for this research is…,” indicate the beginnings of the qualita- tive research study. Next, narrowing the broad topic is the basis for the purpose statement (a statement that provides the premise for the research project). The purpose statement typically is a single sentence that describes the specificity of the research study (eg, the central phenomenon, the participants, and where the researchers are located).1 The framework of the purpose statement might look similar to this example:

The purpose of this qualitative study is to understand the primary motivating factor for graduating radiologic science students in ambulatory care clinical settings.

Once the purpose statement is created, the research- er must develop qualitative research questions. For qualitative research, a central question often is followed by 3 to 5 subquestions to further refine various aspects of the central question. The central question typically is open-ended to avoid being too focused or making assumptions before data collection. The more specific subquestions are categorized as to either issue or proce- dure and follow the same guidelines as with the central question. Issue subquestions narrow the focus of the central question and typically are placed immediately after the central question; the procedures’ subquestions might evolve after the research has begun because they address the process of the study and data analysis. It is important to note that subquestions assist in the formu- lation of surveys, structured interviews, or focus groups needed to collect pertinent data. The Box illustrates some common guidelines in developing qualitative research questions.1

Qualitative Data Collection Qualitative data collection often is open-ended to

produce emerging themes during analysis. Common

Box

Central and Subquestion Guidelines for Qualitative Research1

 Begin with words such as how or what.

 Tell the reader what you are attempting to discover, generate, explore, identify, or describe.

 Ask “what happened?” to help craft your description.

 Ask “what was the meaning to the participants?” to better understand the results.

 Ask “what happened over time?” to explore the process.

 Avoid words such as relate, influence, impact, effect, and cause; these words typically are associated with quantitative research studies.

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studies can be validated by 1 of 3 generally accepted methods, or ideally by triangulation, which uses at least 2 of the methods. The first method to ensure valid data is the use of contradictory evidence, or deviant cases. This mode investigates any data that could be incor- rect or the analysis might be misrepresented because of potential researcher bias. This is especially important because the data collection process needs to be as objec- tive as possible. The next method is respondent validity, which provides the participants the opportunity to review the data and subsequent analysis for accuracy. Any inaccuracies can be corrected before further progress in the research study. Constant comparison is the final method, and it affords the ability to compare individual data sets to a larger set of data for consistency and continuity. This truly promotes a holistic analysis of the data.7

Designing a Qualitative Research Study Case Study Research

Case reports appearing in Radiologic Technology often involve the in-depth presentation of a particular imaging challenge or patient pathology. Case study research as a qualitative approach uses a particular design and methods of data collection. Typically, “case studies are the preferred strategy when ‘how’ or ‘why’ questions are being posed, when the inves- tigator has little control over events, and when the focus is on a contemporary phenomenon within some real-life context.”8 Case study research can be used to explore, describe, or explain.8 The case might involve an individual, multiple individuals, groups, organiza- tions, or a particular event.9 A multiple case study, as the name implies, uses sets of cases. The research setting is essential in providing context for the study. Often, multiple methods of data collection are used to triangulate findings. Sometimes quantitative meth- ods of data collection and analysis are used as well. An example of a multiple case study research pub- lished in Radiologic Technology is Mazal and Ludwig’s study, “Using Mobile Electronic Devices to Deliver Educational Resources in Developing Countries.”10 Four users of electronic radiography texts represented the set of cases. Email-based, open-ended dialogue

the data collection. Field notes frequently are used to provide more in-depth background or to help the observer remember events, if a form is not completed at the time of observation. Field notes contain the descrip- tion of what was observed and must be factual, accurate, and without bias.4

Incorporating social media into qualitative research is emerging as evidenced by the development of an innovative data collection meta-framework by Onwuegbuzie et al.5

Qualitative Data Analysis and Interpretation

Qualitative researchers must work directly and intimately with their data. This usually begins with reading interview transcripts or other textual mate- rial multiple times to identify emerging themes and categories. Researchers might analyze data inductively or deductively, depending on whether the study is exploratory or confirmatory. Many qualitative studies include elements of both. “Inductive analysis involves discovering patterns, themes, and categories in one’s data.”3 Deductive analysis begins with an existing framework. Often, researchers begin data analysis inductively, as a means for developing the conceptual framework and resulting codebook. The researcher then can move forward in a deductive manner, using the codes to identify and categorize pertinent quotes within the transcripts. Interpretation is the research- er’s process of making meaning of patterns, themes, and categories. In so doing, he or she determines ways in which the results answer the research ques- tions and sometimes the results raise new questions. Some researchers code and extract pertinent passages from the transcript manually, some use the com- ment feature in Microsoft Word, and some use more sophisticated software programs designed to assist with qualitative analysis, such as Atlas.ti, N Vivo, and NUDIST.

Validity of Qualitative Research The validity of qualitative research refers to the

extent to which findings accurately depict the phenom- enon it is designed to investigate.6 Qualitative research

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of a participatory action research article published in Radiologic Technology is the Lopez et al study, “Florida Mammographer Disability Training vs Needs.”14 That study was designed to address the problem of lack of access to screening mammography for women with dis- abilities. Demographic and qualitative interview data were collected from 3 participant groups: mammogra- phers, other health care providers (eg, physicians and nurses), and women with disabilities. The researchers concluded that mammographers were receiving disabil- ity training primarily on the job, and that they would benefit from training in “both technical and social aspects of performing mammography on women with disabilities, including positioning, disability etiquette, and disability advocacy.”

Narrative Research Narrative research is best described as the study

of lives through storytelling.15 Narrative research can be a singular approach or a research method of data collection used with other qualitative approaches. It can be biographical or autobiographical and “is best for capturing the detailed stories or life experi- ences of a single life or the lives of a small number of individuals.”16 In biographical narrative research, the researcher spends considerable time with the partici- pant, often meeting on multiple occasions to gain an in-depth understanding of the person’s stories. In so doing, the researcher and participant develop a col- laborative relationship. In general, most participants do not tell their stories in a strictly chronological order and it is the researcher’s task to order the stories and other data into a coherent whole. Aside from oral nar- ratives, materials such as other people’s stories about the person being studied, letters, emails, diaries, and school records can be collected, analyzed, and inter- preted. Narrative research is based on the premise that knowledge is socially constructed and situated within the context of the participants’ “personal experiences (their jobs, their home), their culture (racial or ethnic) and their historical contexts (time and place).”16 The researcher studies himself or herself in autobiography, and life history is the study of a person’s entire life. Narrative research can be focused upon individuals

with each recipient represented the qualitative data collected, analyzed, and interpreted for this study.

Participatory Action Research Qualitative methods, in addition to their use in

research studies, can be used for evaluation purposes. Yates used the participatory action research approach as a means of program assessment and policy devel- opment.11 As the name implies, participation by all stakeholders is key to this type of research. Rather than imposing research on “subjects,” people being studied also participate in the research or evaluation to varying degrees. Often a strong social justice focus on the research study or evaluation process exists. Participatory action research12:  Is about the improvement of practice and creation

of knowledge in social groups.  Can start anywhere and proceeds through com-

plete cycles of planning, acting, ref lecting, and observing.

 Involves participation in all stages of those affect- ed by changes in social practice and discourse.

 Is participatory, often conducted by an action group with at least one expert.

Action research is based in social inquiry and often is used to solve a pressing problem. Participatory action research involves collaboration and critical ref lection of the researcher’s own practices. An important feature of participatory action research is the preservation of the voices and practices of people being studied. Data frequently is collected in the form of interviews, focus groups, and written text (eg, open-ended survey ques- tions). W hen used effectively, participatory action research is a continuous cycle of “planning, acting, observing, and ref lecting”13 that results in continu- ous improvement. The research has the potential to work well in educational settings, particularly in pro- grams accredited by the Joint Review Committee on Education in Radiologic Technology, where the goal is continuous program improvement.

Participatory action research can be effective in solv- ing problems in imaging departments, where patient, staff, and physician input could improve delivery of ser- vice for continuous quality improvement. An example

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of grounded theory research in medicine appeared in Social Science and Medicine. In it, Charmaz provides a step-by-step guide to conducting grounded theory research by applying it to a discovery of a theory of chronic illness.18

Phenomenological Research Phenomenological research is “the study of the lived

experiences of persons.”16 Phenomenological studies focus on a shared human experience, such as surviv- ing breast cancer, experiencing the death of a child, or winning the lottery. The researcher collects data from participants (usually a small number) who have experienced the phenomenon, and through the process of analysis and interpretation, generates a descrip- tion of the participants’ “meaning, structure, and essence of the lived experience.”3 Qualitative data can be collected in the form of in-depth interviews (often multiple interviews with the each participant), open- ended survey questions, diaries, journals, art forms, and other media in which the participant describes or depicts his or her experience. Phenomenological studies frequently are used in the context of medicine and the descriptions they provide might inform the development of policies and practices. An example of a phenomenological research study performed in the context of emergency medicine was published in the Journal of Emergency Nursing. Granero-Molina et al focused on the lived experience of medical profes- sionals providing end-of-life care to patients in the emergency department.19 The authors examined fac- tors that undermined the dignity of these patients including “architectural and organizational character- istics, professional’s attitudes, and decisions made by family members.”

Ethnographic Research Ethnographic research is the study of an entire cul-

tural group. An ethnographer “describes and interprets the shared and learned patterns of values, behaviors, beliefs, and language of a culture sharing group.”16 The researcher gathers information in the field. Qualitative data frequently consists of direct observation and in-depth interviews, although materials such as art

who have shared similar experiences or centered on a particular research context, such as a hospital or school.16 Charon’s “Narrative Medicine: A Model for Empathy, Ref lection, Profession, and Trust” is an example of the narrative method used in the context of medicine published in the Journal of the American Medical Association.17 In the article, she stated, “The effective practice of medicine requires narrative com- petence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.” She described narrative knowledge as a process by which physicians can share in a discourse with patients to understand their stories and suffering: “Along with scientific ability, physicians need the ability to listen to the narratives of the patient, grasp and honor their meanings, and be moved to act on the patient’s behalf.” Through this physician–patient discourse and through the physician’s engagement in self-ref lection, care for sick patients can be delivered in a more sympathetic and humane manner.

Grounded Theory Research The purpose of grounded theory research is to

generate, rather than test, a theory.3 Grounded theory research is characterized by an iterative process used by the researcher. The researcher goes out to the field (ie, the natural setting in which the participants live and work) to collect data from individuals who share some common experience, or phenomenon. Data collection methods can include quantitative and qualitative data; but qualitative methods are used more commonly.16 The researcher goes back and forth from interviews to analysis, returning to the field to collect more data, until the themes and categories generated are saturated and no new information can be added. According to Creswell, “This process of taking information from data collection and comparing it to emerging categories is called the constant comparative method of data analy- sis.”16 The themes and categories centered on the shared experience of the participants (the phenomenon) are then used to identify causal conditions, strategies, inter- vening conditions, and consequences. In this manner, a hypothesis or theory emerges. Therefore, the theory is “‘grounded’ in data from the field.”16 An example

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4. Overview of qualitative methods and analytic techniques: common qualitative methods. National Science Foundation Web site. https://www.nsf.gov/pubs/1997/nsf97153/chap_3 .htm. Published 1997. Accessed September 13, 2016.

5. Onwuegbuzie A, Leech N, Collins K. Innovative data collection strategies in qualitative research. Qual Rep. 2010;15(3):696-726.

6. Fraenkel J, Wallen N. How to Design and Evaluate Research in Higher Education. 6th ed. New York City, NY: McGraw Hill Companies Inc; 2003.

7. Anderson C. Presenting and evaluating qualitative research. Am J Pharm Educ. 2010;74(8):141.

8. Yin RK. Case Study Research: Design and Methods. 3rd ed. Thousand Oaks, CA: Sage Publishing; 2003.

9. Robson C. Real World Research. 2nd ed. Malden, MA: Blackwell; 2002.

10. Mazal JR, Ludwig R. Using mobile electronic devices to deliver educational resources in developing countries. Radiol Technol. 2015;86(5):490-498.

11. Yates JL. Participatory action research for program planning. Radiol Sci Educ. 2006;11(1):7-18.

12. Hughes I. Action research electronic reader: introduction. Action Research & Action Learning Web site. http://www .aral.com.au/arow/rintro.html. Published 1997. Accessed September 7, 2016.

13. Action research. University of Warwick Learning and Development Centre Web site. https://www2.warwick.ac.uk /services/ldc/resource/evaluation/tools/action/. Revised July 10, 2012. Accessed September 7, 2016.

14. Lopez ED, Vasudevan V, Lanzone M, et al. Florida mam- mographer disability training vs needs. Radiol Technol. 2012;83(4):337-348.

15. Sandelowski M. Telling stories: narrative approaches to quali- tative research. Image J Nurs Sch. 1991;23(3):161-166. http:// academic.son.wisc.edu/courses/N701/week/sandelowski _tellingstories.pdf Accessed September 7, 2016.

16. Creswell JW. Qualitative Inquiry and Research Design: Choosing Among Five Approaches. 2nd ed. Thousand Oaks, CA: Sage Publishing; 2007.

17. Charon R. The patient-physician relationship. Narrative medicine: a model for empathy, ref lection, profession, and trust. JAMA. 2001;286(15):1897-1902.

18. Charmaz K. ‘Discovering’ chronic illness: using grounded theory. Soc Sci Med. 1990;30(11):1161-1172.

19. Granero-Molina J, Díaz-Cortés MM, Hernández-Padilla JM, Garcia-Caro MP, Fernández-Sola C. Loss of dignity in end-of-life care in the emergency department: a phenom-

forms and cultural artifacts might be useful as well. A fascinating and heartbreaking example of an ethno- graphic study relating to medicine is captured in Anne Fadiman’s book, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures.20 The book describes a Laotian refugee family’s experiences in the American medical system through the course of long-term treatment of a child with severe epilepsy. The clash of cultures creates profound challenges in caring for the child, with devas- tating consequences.

Conclusion The intent of this column is to provide an introduc-

tion to qualitative research and to present an overview of a limited number of possible approaches. Increasing the number of qualitative and mixed-methods stud- ies published in Radiologic Technology will enrich the body of knowledge within the radiologic science pro- fession.

Jennifer Yates, EdD, R.T.(R)(M)(BD), is program director for Merritt College in Oakland, California. She is a member of the Radiologic Technology Editorial Review Board and can be reached at [email protected].

Tricia Leggett, DHEd, R.T.(R)(QM), is vice president for student success for Zane State College in Zanesville, Ohio. She is vice chairman of the Radiologic Technology Editorial Review Board and can be reached at tleggett@ zanestate.edu.

References 1. Creswell JW. Research Design: Qualitative, Quantitative, and

Mixed Methods Approaches. 2nd ed. Thousand Oaks, CA: Sage; 2003.

2. Abawi K. Qualitative and quantitative research. Talk pre- sented at: Ministry of Public Health Reproductive Health Research Methodology Training; January 3-12, 2008; Kabul, Afghanistan. http://www.gfmer.ch/Medical_education_En /Afghanistan_2008/pdf/Qualitative_quantitative _research_Abawi_Afghanistan_2008.pdf. Accessed September 23, 2016.

3. Patton MQ. Qualitative Research & Evaluation Methods. 3rd ed. Thousand Oaks, CA: Sage Publishing; 2002.

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enological study with health professionals. J Emerg Nurs. 2016;42(3):233-239. doi:10.1016/j.jen.2015.10.020.

20. Fadiman A. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York City, NY: Farrar, Strauss, and Giroux; 1997.

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