Karina Kielmann Fabian Cataldo Janet Seeley
Introduction to QualitativeResearch Methodology:A Training ManualKarina KielmannFabian CataldoJanet Seeley
Karina KielmannSenior Lecturer in International HealthInstitute for International Health & DevelopmentQueen Margaret UniversityEdinburgh, Scotland EH21 6UUE-mail: kkielmann@qmu.ac.ukFabian CataldoResearch Director - MalawiDignitas InternationalP.O. Box 1071 Zomba; MalawiE-mail: f.cataldo@dignitasinternational.orgJanet SeeleyPlease reference this manual as:Kielmann, K., Cataldo, F. and Seeley, J. (2012).Introduction to Qualitative Research Methodology:A Training Manual, produced with the support of theDepartment for International Development (DfID), UK,under the Evidence for Action Research ProgrammeConsortium on HIV Treatment and Care (2006-2011).This manual is also available on the net t.aspxProfessor of International DevelopmentSchool of International DevelopmentUniversity of East Anglia, Norwich, NR4 7TJ, UKE-mail: j.seeley@uea.ac.ukandHead of the Social Science ProgrammeMRC/UVRI Uganda Research Unit on AIDSP.O. Box 49, Entebbe, UgandaE-mail: janet.seeley@mrcuganda.orgEdited and Designed by Write-Arm(www.write-arm.com) December 2012II
ContentsC H A P T E R 1 .6The Qualitative LensC H A P T E R 2 .12The Quantitative - Qualitative ContinuumC H A P T E R 3 .18Issues in the Design of Qualitative ResearchC H A P T E R 4 .24InterviewsC H A P T E R 5 .Contents32Group InterviewsC H A P T E R 6 .40ObservationC H A P T E R 7 .46FieldworkC H A P T E R 8 .52Ethics and Logistics of Data CollectionC H A P T E R 9 .64Steps Towards Data AnalysisNext Steps .70End Notes .71Feedback on Exercises .72Optional Exercises .76Qualitative Research Methods - A List of Useful References .79About the Authors .81Acknowledgements .82Appendix A - Example of a Focus Group Discussion Guide .83Appendix B - Example of a Guide for a .Semi-Structured Interview84III
PrefacePurpose of the manualThe manual can be used as a stand-alone,self-learning tool by individuals new to theuse of social science methods in healthresearch; it can also be used by socialscientists tasked with conducting short-termtraining in qualitative research methods forapplied health research.About the manualThis manual is based on a courseentitled ‘Qualitative Research Methodsfor Non-Social Scientists’ which wasdeveloped by the authors, and run inEntebbe, Uganda, in March 2010. The coursewas part of the capacity building effortsof the Evidence for Action ResearchProgramme Consortium, funded by theDepartment for International Development,UK1. The participants came from Zambia,Malawi and Uganda, most with clinicalbackgrounds in HIV. Their high levelsof motivation and enthusiasm for the courseand their desire to build on what theyhad learnt led to the idea of this manual.Aimed primarily at non-social scientists,the manual is also accessible to a wideraudience. It introduces qualitative methodsin an interesting and hands-on way to provideyou with an understanding of key conceptsand methods in qualitative research asapplied to the field of health.The authors have drawn extensively on theirown experiences of teaching and usingqualitative research methods, but they havealso tried to synthesise many importantinsights gained from teachers, colleagues,and scholars, some of whom have beenacknowledged at the end of the manual.There are, of course, many excellent manualsand websites providing introductions toqualitative methods. The objective here is tocomplement these more in-depth sources withan overview that introduces the user to thetopic and approach. If you would like moreinformation on the different topics covered,an annotated list of other useful referencesis provided on page 79.All three authors are trained anthropologistswho have been working in health anddevelopment for many years. They haveconducted research, taught, and built capacityfor qualitative and applied anthropologicalresearch in different types of health settingsin a variety of countries.IV
Learning objectives Third, to enable you to process the textualdata obtained through these methods,and to undertake preliminary steps towardsanalysis of qualitative data (Chapters 7to 9)As you go through this manual, you willlearn how to: Understand and describe theoretical andmethodological assumptions underlyingqualitative research Distinguish between quantitative andqualitative approaches to research and data Formulate qualitative research questions Recognise when and where to usequalitative research methods Make practical and logistic decisions inpreparation for undertaking qualitativeresearch Develop and apply basic study instrumentsfor collection of qualitative data Record and manage qualitative data Prepare qualitative data for analysisWe emphasise throughout the manual - butparticularly in Chapter 8 - that qualitativeresearch is not just about applying a differentset of tools to gain knowledge, but rather,involves a fundamental shift in the approach toresearch, and description of reality.To aid learning, we combine short texts thatintroduce key concepts with examples to helpyou understand the ideas and reflect on theirapplication. The chapters are also interspersedwith Boxes, Examples, and Exercises toenhance your learning. Exercises will not onlycheck your understanding of the concepts,but also encourage you to apply some ofthe gained skills yourself. Feedback on theexercises is provided at the end of the manualso that you can check that you are on theright track.Structure of the manualThe manual is organised around three maingoals:We hope you enjoy working with thesematerials. While we cannot provide distancelearning support we would very much welcomeany comments you might have on thismanual. You can send your comments toQualitative.research.manual@gmail.com First, to introduce you to qualitativethinking and a qualitative approach inresearch (Chapters 1 and 2) Second, to equip you with knowledge tobe able to plan and conduct selectedqualitative research methods(Chapters 3 to 6)5V
C H A P TE R 1The Qualitative LensC H A P TE R 1The Qualitative LensLearning objectivesThis chapter will help you to: Understand how theory influences methodology Distinguish qualitative from quantitativeresearch on the basis of key features Adopt a qualitative lens to health-related questionsKey words:positivism; constructivism; meaning; context; humanism; holism;interpretive; reflexive; naturalistic; iterativeIntroductionB.What is reality? How do we make sense ofit? Research in all fields of study focuses onfinding and validating new ways to investigateand understand reality. The methods adoptedto define and measure aspects of the natural,material, and social worlds depend very much onthe individual researcher’s background, training,interests, and familiarity with the subject. At thesame time, researchers may have fundamentallydifferent ways of thinking (theories) aboutthe social and material world around them. Inthis chapter we begin to appreciate the waysin which a qualitative research approach differsfrom a quantitative research approach; we alsosee the ways in which the two methodologicalapproaches complement each other.E X A M P L EC.3 “Poverty is like living in jail, living under bondage,waiting to be free.” — a saying from Jamaica “If you want to do something and have no power todo it, it is talauchi (poverty).” — a proverb fromNigeria “For a poor person everything is terrible - illness,humiliation, shame. We are cripples; we are afraid ofeverything; we depend on everyone. No one needsus. We are like garbage that everyone wants to getrid of.”— a blind woman from Tiraspol, MoldovaE X A M P L EConsider the following three descriptions of‘poverty’. What does each of them tell you aboutpoverty and how does it do so?A.“Rural poverty in Tanzania has been halved in theperiod from 1985 to 2001. At present about 38 per centof people living in rural areas are classified as poor.This progress is reflected in the United NationsDevelopment Programme’s Human Development Indexfor Tanzania, which rose from 0.3 in 1991 to 0.4in 2002.”21. How did each of the three examplesdescribe or explain poverty?2. What made the second and third examplesso different from the first?3. Which description did you find mostconvincing? Why?6
C H A P TE R 1Theory and methodThe Qualitative Lensmethods themselves are not neutral but arealways influenced by the assumptions you makeabout your subject of study. Your use of theoryis related to your training, your reading of therelevant literature, your political positioningand so on – in short, what you hold to be avalid picture or explanation for the phenomenonunder study. Theory shapes the questions youthink are worth asking, which in turn determinea research strategy. The strategy (study design)helps you choose appropriate methods. Particularmethods yield data sets which you analyseand which may lead to further questions. Inturn, new and unexpected data help to refinetheoretical assumptions. This cyclical process isdepicted in Figure 1.You will most probably agree that all threedepictions of poverty constitute valid formsof representing poverty. However, (A) usesnumbers to quantify poverty, that is, to providean absolute numerical value or assessment ofthe magnitude in poverty levels in a specificsetting. These numbers are produced by usingquantitative methods that prioritise a particulardefinition of poverty through socio-economicindicators. In contrast, the photo in (B) andquotes in (C) are derived through the applicationof qualitative methods – they suggest thatmeasuring poverty is only meaningful whenrepresented in subjective ways, that is, in wordsor images that show us what it means to bepoor. These also broaden our understanding ofpoverty, as they tell us that being financiallybadly off may also translate into feelings ofinferiority and shame, and experiences of illnessand powerlessness.Quantitative and qualitative approaches can alsobe understood by contrasting the differencesbetween two philosophical positions about thestate of reality: positivism and constructivism.Quantitative research, in general, holds amore positivist view of the world; it suggeststhat reality is something tangible that canbe objectively measured with the help ofobservational and experimental methods.Thinking about the differences in thesethree depictions of poverty introduces us tothe idea that the reality of a given socialphenomenon has different dimensions, andthat these dimensions can be captured throughdifferent lenses. By lens, we mean here theways in which a researcher frames what s/heis looking for with the help of a theory andtheoretical assumptions. These assumptions, inturn, shape the choice of methods that generatewhat is considered valid data.Qualitative research generally adheres (althoughnot always) to a constructivist view of theworld, one that suggests that reality is in theeye of the beholder; in other words, that thereis no single reality for a given phenomenon, butmultiple, relative dimensions of reality whichcan only be partially captured using subjective,naturalistic methods.Research of any type is a cyclical rather thana linear process; methodological choices andFigure 1: The relationship between theory and methodTHEORYFURTHER DATA COLLECTIONHYPOTHESIS / QUESTIONSINTERPRETATION / ANALYSISRESEARCH STRATEGYMETHODOLOGY /DATA COLLECTION7
C H A P TE R 1The Qualitative LensQualitative insights inhealth and illnessabout and experience health and illness. You willfocus, for example, on:Quantitative methods provide a broad picturewhen used to collect data on health, risk,illness, and health-seeking behaviour. They helpto answer descriptive questions such as: Whatis going on? What is the scope of the problem?How is the problem changing over time? They arealso used to assess similarities, differences, andassociations (for example, of a risk factor witha given illness) in the data through statisticalanalysis. It is important to recognize thatthe quantitative researcher has to make fixeddecisions about what s/he is going to measureand compare. Experiences of illness, or of interactionswith different health care providers.Listening to people’s experiences providesstories or ‘narratives’, which are the dataneeded to understand the nature andcomplexity of illness and health-seekingepisodes and the factors affecting them Knowledge and understanding of agiven issue, for example people’sunderstanding of the body and health ina certain cultural context, which influencestheir interpretation of an illness and howit was caused, and also the course of actionthey have taken to treat the illnessQualitative research on the other hand, does nottake categories of health, risk, and illness forgranted. Instead the qualitative researcher triesto ascertain how people who experience theseconditions themselves define what they are goingthrough, when they decide to seek treatment,what happens when they seek treatment, howtheir experience of illness impinges on theirlives and so on. Meanings derived by people based ontheir knowledge and experience.People attach meaning to things, events,relationships and the world at large tomake sense of their lives and theirexperiences. For example, if they arediagnosed as HIV-positive, they are likelyto attach a great deal of meaningto this, based on the ways in which HIVis conceptualised in their particularsetting: they may feel that life is not worthpursuing any more, that they have failedtheir close relatives, or that they aresomehow impure and that their social statushas collapsed; or they may reconstruct theirself image - it can give them new meaningand purpose in lifeThese differences in the research ‘lens’ andmethodology can be crudely contrasted in theways epidemiologists and anthropologists studyhealth, risk, and illness (see Box 1).As a qualitative researcher working in healthyou will pay close attention to the subject’ssocial reality – social ties, ‘culture’, economicand environmental conditions etc. – and howthis reality shapes the ways in which people talkBOX 1: CONTRASTING EPIDEMIOLOGICAL AND ANTHROPOLOGICALRESEARCH ON ILLNESSEPIDEMIOLOGYANTHROPOLOGYHow much disease is there?How is illness recognized and classified?What risk factors areassociated with the disease?What do risk factors meanin a context?What is the measurable risk ofobtaining specific outcomes?How do people interpret, respondand cope with risk and illness?8
C H A P TE R 1The Qualitative LensKey features ofqualitative methodology Explanations and rationale given bypeople to justify their decisionsand actions - the ‘whys’ and ‘hows’ ofpeople’s actions and responses to eventsthat affect them. For example a person withdiabetes may have frequent experiences ofhypoglycaemia following his/her regulardaily activities, which means s/he decidesto maintain a higher blood sugar thanrecommended at the clinic, for safetyand to avoid the nuisance of low bloodsugar. This is a rational decision from thepatient’s point of view. People explaintheir decisions and course of action asbeing beneficial and ‘making sense’ in theireveryday life contextAs suggested above, qualitative research ishumanistic because it focuses on the personal,subjective, and experiential basis of knowledgeand practice. It is holistic because it seeks tosituate the meaning of particular behavioursand ways of doing things in a given context(as opposed to isolating these as a quantitativeresearcher would). These features influence twoother characteristics of the qualitative approach.Qualitative researchers are constantly trying tomake sense of what they see and hear in a specificcontext; their approach to understanding whatis going on is interpretive, in other words,their aim is more often to explain rather than tomerely describe. Finally, as we have already said,how the data gathered on people’s experiencesare interpreted depends much on the researcher’stheoretical presuppositions and background.Qualitative researchers, more than quantitativeresearchers, generally adopt a reflexive positionvis-à-vis their research, in other words, theyare explicit about how their personal historyand biography shape the questions asked, theframing of the research and the presentation ofdata. Social institutions (norms and rules)thatgovern people’s lives and dictateexpectations and behavioural norms canalso be derived from qualitative data.For example, in most societies there are‘rules’ about courtship, marriage andchildbirth that people are expected toadhere to, for example: no sex beforemarriage; seeking the father’s permissionfor marriage; payment of dowry orbride-wealth; the importance placed onhaving children to sustain the kinship line;the expectation that wives shouldmeet the sexual demands of their husbands,and so on. Of course these ‘rules’ arenot always followed – people have sexbefore marriage and outside marriage,they may not pay bride-wealth. However,norms still influence their own lives andhow they judge others who deviate fromthe normsAs we will see in later chapters, these fourcharacteristics of qualitative research require adifferent methodological approach. Methods inqualitative research are generally open-endedand in-depth, and naturalistic, that is, theyattempt to study things, people and events in anatural (non-experimental) setting.The methodology is flexible because it mayuse multiple methods to examine the samequestion or area (‘triangulation’, discussed inChapter 2), and iterative. Iteration refers toquestions or studies that are repeated over timewith the same informant or group of informants.This is feasible when a researcher has access tothe same informant over the course of a study,and is useful when new questions arise, or theresearcher wants to go back and check some ofthe data s/he has analysed. Social processes, that involve how peoplecommunicate and interact to fulfil socialgoals, for example, how people negotiate,bargain and make decisions within ahousehold - decisions about where totake a child for treatment, or decisionsabout how to allocate money to differentpriorities. Also, there are questionsabout how and when people choose to actcollectively based on what they experienceas a shared condition, for example, in ashow of solidarity, or in the form of aself-help group, or as a way to moreeffectively access support or resources9
C H A P TE R 1The Qualitative LensIterative methods are also useful when a subjectis relatively unexplored o
Janet Seeley Professor of International Development School of International Development University of East Anglia, Norwich, NR4 7TJ, UK E-mail: j.seeley@uea.ac.uk and Head of the Social Science Programme MRC/UVRI Uganda Research Unit on AIDS P.O. Box 49, Entebbe, Uganda E-mail: janet.seeley
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