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Qualitative methodology – a tool for studying meaning and culture in medicine

Julia Szymczak explains how qualitative research methods can be used to collect information regarding AMS and what the pros and cons of this are.
Hi, everyone. My name is Julia Szymczak. And I’m an assistant professor at the University of Pennsylvania’s Perelman School of Medicine. So I’ll start by saying I have nothing to disclose in relation to what I’ll be presenting to you today. We can use qualitative methodology, which is really a fabulous tool for studying meaning and culture in medicine. And when we think about the kinds of research that we do and what is the point of research, research is about generating knowledge about the world, about some phenomenon. And when we conduct research, we are stating a claim about knowledge.
We make claims about what reality is, how we know what we know, the values that go into it, how we write about it and the process that we take to study something. And at the heart of qualitative methodology is this distinction, the etic versus the emic approach to knowledge generation. The etic account is this idea that if we are going to research something, we might research it from the categories that the research community might use using the concepts, the words, the phrases, the ideas, and terminology to apprehend knowledge about a phenomena.
And this is juxtaposed with the emic account, which is a description of a phenomenon in terms that are meaningful to the people who are experiencing that phenomenon, whether they’re in a particular culture, profession, or some kind of exposure. And so to demonstrate this, I want to show you two pieces of research on the same topic, antimicrobial use in paediatric surgery. So here we can see the excerpt of an abstract of a paper that uses epidemiological methods to study how antibiotics are used in paediatric surgical patients. And you can contrast that with this excerpt, which is an interview that I conducted with a surgeon.
So these two pieces of research are about the same topic, but they tell us something very different about the phenomenon. And I juxtapose the two to suggest that we need them both, because they both tell us something different about this issue that we need in order to tackle it. And so qualitative research is really focused on eliciting the meaning that people attach to their worlds, to their events, their relationships, the things that they’re dealing with. It’s focused on understanding the explanations that people give, why they do what they do. It’s a way to think about how social norms and these hidden rules or these implicit rules dictate behaviour.
It’s also a way to uncover information about the social processes and mechanisms that might underlie observed quantitative associations. And so I think this is a really exciting part of mixed methods work that takes quantitative observations and utilises qualitative methodology to provide a nuanced picture of what kind of mechanisms might have produced that association. And again, it’s a way to explore a phenomenon in a natural setting in a way that is experienced by the individual who you’re trying to understand and not necessarily from the standpoint of the researcher.
There are many types of qualitative methodology that have been fruitfully used to study antimicrobial overuse and the implementation of stewardship interventions, everything from ethnography, to a variety of different approaches of interviewing, to focus groups. And each method has an entire body of literature and approaches that you use to do it. But they’re all very robust and rigorous methodological disciplines that you can think about using in your own work. Now, a lot of people have a misperception of qualitative research methods as lacking in rigour. And I think what’s important to remember is that these research methodologies have a long history and have a body of work that demonstrates how it should be done systematically.
Just to give you some tips about how we might demonstrate rigour
and qualitative research, some key concepts are: keeping meticulous records of all the decisions that you make, like a lab notebook, being aware and mitigating wherever possible the impact and influence of bias on the research. We experience bias in all kinds of work, and we always need to be aware of it. And qualitative research has particular kinds of bias that might need to be addressed. When we present our research, we want to include rich verbatim descriptions of participants accounts so that the person who is reading the work can really evaluate the validity of the interpretation. You can analyse data in a team.
You can also engage in member checking and respondent validation of findings, which is where you actually bring the findings of your research back to the subject of your study to give you a sense of whether or not you know you’ve gotten it right. And then finally, and I think most importantly and most powerfully, and I really think we’ve seen this in the research literature on antimicrobial use, really powerfully is this idea of data triangulation. So if you want to study a phenomenon, you don’t just use one method. You use multiple approaches to get a holistic picture of that issue. And so you need qualitative work, you need quantitative work, and you need different kinds of qualitative work.
So you need the focus group, you need the interview, you need the ethnography to show a different viewpoint. And you need to combine all these methods to get a better picture of what we’re observing in one method alone. So to conclude, I’ve tried to show you that qualitative research methods in particular can generate valuable knowledge about these social, behavioural, and cultural drivers of antibiotic use that you really can’t get at in any other way and that this information is valuable and can help us in our efforts to improve the use of antibiotics. So thank you so much for your time and your attention.

In this video Julia Szymczak talks about the use of qualitative methods of research, and how they can be used to generate valuable knowledge that can be used in antimicrobial stewardship.

Key features of qualitative research methodology include:

  • Adopting a flexible and iterative research strategy – there is an openness to refine methods as the research is happening.

    • For example, if you begin to uncover a theme or pattern that you didn’t know to ask about, your interview guide can be changed in order to ask about it.
  • Using data collection methods involves close contact between the researcher and what is being researched.

  • Data which is detailed, information rich and extensive.

  • Gaining a deeper understanding of the social and material circumstances, experiences, perspectives and histories of the research subject.

  • Viewing human behaviour and social life in terms of processes rather than static terms.

  • Subjects that are small in scale (especially in comparison to quantitative work) and purposefully selected.

Pros and Cons

There are positive and negative aspects to qualitative research, and it is important to take both sides into account.

Pros Cons
Allows investigation of topics that are difficult to operationalise quantitatively. Takes a large amount of time.
Allows discovery of unanticipated phenomena. There is limited generalisability (often due to small samples).
Information gathered can inform subsequent investigations and intervention design. Very labour intensive.
Data are compelling to multiple audiences. Can be hard to publish in medical literature.
Can be used to uncover mechanisms to explain why an intervention did or didn’t work. There is scepticism about scientific worthiness and validity of approach – although this is changing.

Now that you have listened to the presentation please see below under see more for further reading on recent studies that have applied social science research to tackling AMR. This will provide further insight into the empirical contribution qualitative methods can make to understanding how we can develop contextually fit and sustainable programmes in different settings.

Please find a pdf of the PowerPoint slides in the downloads section below.

In the comments below please let us know:

  • Your view on the use of qualitative research
  • How might you use qualitative research in your own practice?
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Tackling Antimicrobial Resistance: A Social Science Approach

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