Exploratory studies

(Qualitative research and

Survey)
Not everything that can be counted counts and
not everything that counts can be counted.
Albert Einstein

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 Objectives
Objectives of qualitative research
Main features in quantitative and qualitative
research
Limitations in qualitative research
Concept of using combined research
Survey
Questionnaire design

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 When developing questions we
need to keep in mind
Quantitative
What is the difference between two treatments ?
Where is the prevalence of this disease?
When will the response be better ?
Who will be benefitted by the treatment?
Qualitative
Why should we worry about the disease or drug
resistance?

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 What is a qualitative research?
An approach which seeks to understand by means of
exploration, human experience, perceptions, motivations,
intentions and behavior.

A method traditionally used in social sciences often labelled

unscientific

Defined with reference to quantitative research no clear

definition

May define preliminary questions: later addressed in

quantitative studies

any kind of research that produces findings not arrived at by

means of statistical procedures or other means of quantification4
Qualitative Vs Quantitative research
Qualitative Research Quantitative Research

To generate research question To confirm hypothesis

Flexible instruments & design Rigid instruments & design

Semi structured methods Highly structured method

(monitor all observations) (predetermine what to observe)

Describe variation Quantify variation

Open ended questions Close ended questions

Textual data Numerical data

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Textual analysis Statistical analysis
 Exploratory research
Unstructured, informal research undertaken to gain
background information about general nature of
research problem.

Usually conducted when researcher does not know

much about the problem and needs additional
information or desires new or more recent information.

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 Exploratory research
Exploratory

To gain background information, to define terms, to

establish research priorities, to develop questions to be
answered
Efficacy and tolerability of oral lactoferrin
supplementation in mild to moderate acne vulgaris: an
exploratory study.

How do I cope? Factors affecting mothers' abilities to

cope with pediatric cancer.
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 Examples
Questionnaire survey on use of placebo

Exploration of social support available to mothers of

children with cancer, their health status, and other
factors related to their family function

Symptoms and behaviors prior to the first major affective

episode of bipolar disorder. An exploratory study

The experience of cough in patients diagnosed with lung

cancer.
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 Exploratory cont..
Do women and men consider abortion as an
alternative to contraception in the United States?
An exploratory study.

Health literacy and health education: what

do these terms mean?

Distress due to lithium-induced polyuria:

Exploratory study.

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 Ways of qualitative research..
Documents Study of documentary accounts
Passive observation Systematic watching of
behaviour in natural setting
Participant observation Researcher also
occupies a role in the setting
In depth interviews Face to face conversation
Focus groups Group interview

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Types of qualitative study designs

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 Case Study
Interest is in an individual case.
Focus on what can be learned from the individual
case
Study of single event
The experience of a person with chronic kidney
disease in hemodialysis
Useful for evaluating the effect of an intervention
Pulsed radiofrequency of the second cervical
ganglion (C2) for the treatment of cervicogenic
headache. 12
 Case Study
Study of situation in a group over time
Study of events involving same people over a
period of time
Physical activity in pregnancy: a qualitative
study of the beliefs of overweight and obese
pregnant women.
Not generalisable

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 Types of case study
Intrinsic
The case itself is of interest
Instrumental case study
A particular case is studied to provide insight into
an issue or to refine theory
Collective case study
A number of cases are studied jointly in order to
investigate a phenomenon (instrumental study
extended to several cases)

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 Ethnography
Rooted in anthropology
Also called participant observation/ naturalistic
enquiry
Ethno = people
Graphy = describing something
Characterised by immersion
Focuses on observation of socio-cultural phenomena.
Typically, the ethnographer focuses on a community.
Problematic when researchers are not sufficiently
familiar with social customs 17
 Ethnography
The people under investigation have something in
common
geographical; religious; tribal; shared experience

Cultural parameter affecting response

Working with culture: culturally appropriate mental

health care for Asian Americans.

The meaning of illness among Korean Americans

with chronic hepatitis B.
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 Grounded Theory
This methodology originated with Glaser and Strauss
Rooted in social sciences
Emphasises the development of theory
Simultaneous collection and analysis of data
Looks for generalisable theory - by making
comparisons across situations
Focus is on patterns of action and interaction
Emerging ideas are included in the next field
Approach to health promotion
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 Features of Phenomenology
Rooted in philosophy
Central question: what is the meaning, structure,
and essence of the experience of this
phenomenon for this person/group of people?
How is each individuals subjective reality
applied to make experiences meaningful?
Describes experience as they present themselves,
without recourse to theory, deduction, or
assumptions
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Describing something that exists as it is

Does not provide definitive explanations

Raise awareness and increases insight

Back pain: But what is it actually like to live with

back pain?

"I feel like half my body is clogged up": Lay

models of stroke in Central Aceh, Indonesia.

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 Participatory Action Research
Concerned about building self-awareness and
constructing knowledge
Disciplined process of inquiry conducted by and for
those taking the action.
To assist the actor in improving and refining his or her
actions.
STEPS:
Research question.
Analysing data and report of results.
Taking informed action.
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 Participatory Action Research (PAR)

Build action theories - action science

Aim is to develop effective action, improve
practice, and implement change
Cyclical process, alternating between action and
reflection

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 Operational research
Scientific approach to the solution of problems
in the management of complex systems.
Team effort, requiring close cooperation among
the decision-makers

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Limitations of Qualitative Research

1.It is anecdotal
( dramatic quality without critical evaluation)
2.Unscientific
3. Produce findings that are not generalisable
4. Impressionistic
5. Subjective

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Qualitative research with quantitative
research - advantages

Supports or checks reliability of findings of

quantitative study
Identifies variables to be studied
Explains unexpected responses
Source of hypothesis

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 Summary
Case study focuses on investigating a phenomenon
Ethnography focuses on culture
Phenomenology on consciousness
Ground theory aims the development of theory
through induction.
Participatory action research focuses on effective
action and implementing a change
Operational research solution to complex problem
Can be both the alpha and omega of health
care by being the vehicle for both the
discovery of need and the evaluation of the
outcome of care and treatment
SURVEY

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 Overview
What is survey ?
Structure and standardisation
Types of survey
Advantages and limitations
Modes of survey
Questionnaire design
Validity

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 Survey
Method of collecting information from a sample of
population or sometimes organisations we are
interested in.

Systematic collection of data in a structured

format.

Surveys are used to collect quantitative information

about items in population.

Survey is conducted to measure characteristics of

a population.

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 How survey work to produce statistics
Characteristics of the
population

Inference

Characteristics of a
respondent Statistical Characteristics of the
computing sample

Inference

Respondent
answers to
quenstions
 Structure and standardisation

to reduce bias
(eg)question does not influence
Structured the response to subsequent
questions.

to ensure
reliability,generalizability, and
Standardized validity
should be presented with same
question in same order.

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 Advantages of survey
Efficient way of collecting information from large
number of respondents.
Very large samples possible.
To study attitudes, values, beliefs, and past
behaviors.
Relatively easy to administer.
Economy in data collection due to focus provided
by standardized questions.
Questions of interest to researcher asked,
recorded, codified, and analyzed. 35
 Disadvantages of survey

Depend on subjects motivation, honesty,

memory, and ability to respond.

Structured surveys with closed ended

questions have low validity.

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 Types of survey design

Cross- Longitud
sectional inal Surveys of
surveys Data are surveys
collected at sample
population at
a point of different
time. points in time

Draws new Study of same

population
sample each time over
each time a period
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 Types of survey

The prevalence and trends of overweight,

obesity and nutrition-related non-communicable
diseases in the Arabian Gulf States.-
Longitudinal survey

Improving lipid profiles and increasing use of

lipid-lowering therapy in England: results from
a national cross-sectional survey - 2006.
Cross sectional survey
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 Longitudinal surveys
Trends
Surveys of sample population at different points in time
(eg) Early changes in inflammatory and pro-thrombotic
biomarkers in patients initiating antiretroviral therapy with
abacavir or tenofovir.
Cohort
Study of same population each time over a period
(eg) Income, wealth and risk of diabetes among older adults:
cohort study using the English longitudinal study of ageing.
Panel
Study of same sample of respondents at various time
points.
(eg) Lifestyle Physical Activity and Walking Impairment over
Time in Relapsing-Remitting Multiple Sclerosis: Results from
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a Panel Study.
 Types of survey design

Researcher-administered surveys
The questions are administered by a
researcher

Self-administered surveys
The questions are administered by the
respondent

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Researcher-administered survey
Advantages:
Higher response rate, lowest refusal rates
Record non-verbal behavior, activities, facilities,
attitudes, beliefs.
Record spontaneity of response
Probing to some questions
Respondents only answer/participate
Completeness
Complex questionnaire may be used
Illiterate respondents may participate
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Researcher-administered survey

Disadvantages
Cost (expensive), Time consuming
Less accessibility
Inconvenience regarding sensitive topics
Interview bias (e.g. answers influenced by desire
to impress interviewer)
Often no opportunity to consult records, families,
relatives

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 Self-Administered Surveys
Advantages:
Cost (less expensive), Time
Accessibility (greater coverage, even in remote areas)
Convenience to respondents (may complete any time at
his/her own convenient time)
No interviewer bias
o Allows shy respondents to answer sensitive questions .
o Respondents can read whole questionnaire before
answering any questions
o Provide more reliable information (e.g., may consult with
others or check records to avoid recall bias)
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 Self-Administered Surveys
Disadvantages:
Low response rate. Respondents cannot ask for
clarification.
May not return questionnaire within specified time
May not respond to all questions
Lack of probing
Must be literate so that questionnaire could be
read and understood
Not suitable for complex questionnaire
Respondents more likely to stop participating
mid-way through survey (drop-offs). 44
 Steps in Survey
Setting the study objectives
What are the objectives of study?
Is survey best procedure to collect data?
Why other study design is not appropriate for
the study?
What information/data need to be collected?

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 Steps in Survey

Interviewer selection:

background characteristics (race, sex,

education, culture)

listening skill

recording skill

experience

unbiased observation/recording
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 Steps in Survey
Defining the study population

Representativeness
Questionnaire design & Pre-test:
Appropriateness- culturally

Acceptability

Understandable

will answer
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 Steps in Survey

Fieldwork

Training/Supervision

Quality monitoring

Timing: seasonality

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 Modes of survey administration
Personal interview
Telephone
Mail
Computer assisted self-interviewing(CASI)
Variants: CAPI (personal interview); CATI
(telephone interview) Replaces the paper
Combination of methods

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 Comparison of Modes of Survey Administration
Variable Mail Phone F/F
Cost Cheapest Moderate Costly
Speed Moderate Fast Slow
Response rate Low to moderate Moderate High
Sampling need Address Telephone number Address
Burden on respondent High Moderate Low
Control participation
Unknown High Variable
Of others
Length of
Short Moderate Long
Questionnaire
Sensitive questions Best Moderate Poor
Lengthy answer
Poor Good Best
choices
Open-ended responses Poor Good Best
Complexity of
Poor Good Best
Questionnaire
Possibility of
None Moderate High
interviewer bias
Deciding on the mode of data collection
Population
+
Characteristics Of The Sample
+
Types of Questions
+
Question Topic
+
Response Rate
+
$$ Cost $$
+
Time
 Types of survey questions

Open-ended question
Respondent writes response in own words
Considerations for using open-ended questions:
Need to enter data by hand

Develop a coding scheme for responses

Content analysis?

Frequently used in exploratory studies to facilitate better

understanding of a concept
open-ended question giving the respondent the
opportunity to add any additional comments.
 Types of survey questions

Open-ended question
Advantages:
Allows the respondent to answer the question with few
limitations
Report more information than with discrete answers

Disadvantage:
Need qualitative methods or coding system to analyze the
responses

Example:
What habits increase a persons risk for being
overweight?
Describe the pain you experience with walking?
 Basic types of survey questions

Closed response:
Multiple-choice" questions where a person has to
choose
Two types of closed response questions:
ordered answer choices represent points along a
continuum.
Pain on a scale of 0 (none) to 10 (worst pain
ever)
unordered answer choices with each choice an
independent answer.
Examples: ethnicity and marital status
 Types of survey questions
Which of the following do you believe increases
cardiovascular disease?
Yes No Dont know

Smoking
Overweight
Stress
Drinking alcohol
 Types of survey questions

Closed response:
Advantages:
Quicker and easier to answer
Easier to tabulate and analyze
List of possible responses helps participant understand
meaning of question
Suitable to multi-item scales designed to provide a single
score
Disadvantages:
Do not allow participants to express their own answers
Set of answers may not be exhaustive
Must be clear about selection of items
 Types of survey questions
Partially open response
Require specific, short answers
Do not encourage free expression.
Are a compromise between closed response and open
response forms.
Provide an Other category where a person can provide
additional information.
Semantic differential questions

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 Phrasing Questions
1. Clarity/specificity
Avoid nonspecific response options,
Often? Sometimes? Regularly?

2. Neutrality
Avoid loaded questions, arguable statements, and
judgmental words/phrases

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 Phrasing Questions
3. Simplicity
Avoid complex or technical phrasing.
Use complete but short sentences
Avoid double negatives and redundancy between question
stem and response options

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 Phrasing Questions (cont)
4.Sensitivity
Encourage unorthodox and socially undesirable"
responses (depersonalization)
Everybody does it
How many times
Many experts say
Discourage over reporting of socially desirable responses
Did you happen to
Many people have trouble remembering
Allow for either agreement or disagreement in question

Funnelling questions to introduce sensitive topics

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 Funelling questions
Please tell me whether or not you think it should be
possible for a pregnant woman to obtain a legal abortion
if: the woman wants it for any reason?
1. Yes
2. No
3. Don't know

Please tell me whether or not you think it should be

possible for a pregnant woman to obtain a legal abortion
if: there is a strong chance of a serious defect in the baby?
1. Yes
2. No
3. Don't know 64
 Phrasing Questions (cont)
5. One topic per question
Avoid double-barreled questions
Do African-Americans and Latinos suffer from
6. Specify an appropriate time frame
Typical/usual versus maximal/minimal
7. Improving recall
Aided recall (memory cues, prompts)
Bounded recall (time window)
Records or diaries

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 Phrasing Questions (cont)
8. Mutually exclusive and exhaustive response options
Use of other fields

9. Consider question polarity and sequence (survey as

conversation)
Avoid yea-saying patterns but maintain
consistency when possible
10. Check for technical accuracy
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 Scaling Responses
Visual analogue (thermometer) scales
Frequency-weighted multi-symptom indices
IPSS score
Multi-symptom checklists
Charlson/Elixhauser comorbidity lists
Grading or ranking
Likert scale

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 Questionnaire Format
As short as possible
Visually attractive
Readable (consider font size)
Uncluttered
Broken into logical sections if possible
Clear skip patterns for contingency questions
Clear spaces for respondents to mark answers
Boxes
Parentheses (X)
Or numbers to circle 123
Avoid lines to put check___
Amount of space provided for open-ended questions will
determine amount respondent will write.
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 Instructions to Respondents

General instructions should be provided at the

beginning of the self-administered survey
Brief explanation includes:
Purpose
Significance of the answers
How to answer the questions
Stress: CONFIDENTIALITY OF RESPONSES

Provide specific instructions to questions as needed

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 Question Order

Be attentive
Initial questions affect answers to subsequent ones
Start with easy, salient, non-threatening
questions near the end.
Cluster questions addressing the same topic or
concept together.
Avoid redundancy.
 Response Options
Should reflect concepts you are trying to measure,
and fit with the wording of the question
Avoid simple yes or no answers and attempt to
measure intensity if possible
Mutually exclusive (select only one answer)
Exhaustive (all possible answers are listed, including
other or not applicable or dont know)
How much bodily pain have you generally had during the past
4 weeks?
(Circle one)
None.1
Very mild.2
Mild.3
Moderate.4
Severe.5
Very Severe.6
 Pre-test (pilot)
Be sure to pilot test the survey instrument before actual
administration
If it is a new instrument that you constructed or has not
been used previously in your population of interest.
Use a similar population or identical population you will
be measuring.
Revise instrument as needed
Repeat pre-test
Ideally with some of original pre-test respondents and new
respondents
 Pre-test (pilot)
Testing:
Question clarity
Failure to answer?
Multiple answers?
Other answers and how to handle them in data
entry
Qualified answers
Questionnaire format
Instructions?
Flow?
Layout?
Variance in responses
Consistency in responses among respondents
 Pilot study
Interview Questioning Behavior
1. Reads questions exacty as worded
2. Reads questions with minor changes
3. Reads questions so that meaning is altering

Respondent Behaviors
1. Interrupt question reading
2. Asks for clarification of question
3. Gives adequate answer
4. Gives answer qualifies about accuracy
5. Gives answer inadequate for questions
6. Answers dont know
7. Refuses to answer 78
 Points to note
Self-administered survey should include:
Cover letter
On letterhead
Signed by PI or most significant person possible
Brief explanation of
Purpose
How results will be used
Why respondent was selected
Why answers are important
Emphasize confidentiality (if applicable)
Provide contact information for questions
Describe/explain any incentives for participation
or consequences or not for non-participation
 Points to note
Mail survey should include:
Survey instrument
Return envelope
Self-addressed and stamped
 Monitor survey returns
Open surveys as they are returned
Assign unique ID number (if not already assigned)
Stamp date on survey
Track number returns daily
Used to inform timing of follow-up reminders
Optimal response occurs with 2 reminders
Timing
Based on returns (1-2 weeks after original)
Materials (mail survey)
Reminder card to have new survey sent or
Send entire packet again
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