Qualitative Methods in Public Health: A Field Guide for Applied Research / Edition 1

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Qualitative Methods in Public Health: A Field Guide for Applied Research presents practical strategies and methods for using qualitative research and offers basic logic and rationale for qualitative research decisions. It reveals the complexities, advantages, and limitations of qualitative methods, and leads the researcher through every phase of research from theory to study design, data collection, analysis, interpretation, and dissemination.

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Editorial Reviews

Doody's Review Service
Reviewer: J. Thomas Pierce, MBBS PhD(Navy Environmental Health Center)
Description: In this book on qualitative research, the authors include eight chapters that stretch from an invitation to join the field to plans for dissemination of findings. Major chapters also speak to study design, collecting qualitative data, logistical concerns and data analysis and reporting techniques. The short list of chapters is buttressed by more than 14 appendixes that can help even a beginning researcher understand important issues (oral consent forms, focus group guidelines, and appraisal skills, among others).
Purpose: The authors state that the purpose is to make the methods of qualitative science more accessible to researchers and practitioners challenged by problems that affect the public's health. There is perhaps an important statement made by Dean Alan Steckler in the foreword that "qualitative methods fill a gap in the public health toolbox, (helping) to understand underlying behaviors, attitudes, perceptions and culture." My reading of this book is that its purpose includes an implied recommendation for the utility of qualitative research methods.
Audience: Given the resurgence in popularity of narrative medicine and associated qualitative research techniques, this book may find a broad readership. While its core audience may consist of qualitative method researchers, particularly those in the reproduction and infectious disease fields, I believe it merits a broader audience. It is important to note the title indicates Qualitative Methods in Public Health as opposed to a narrower categorization.
Features: In addition to its eight chapters, the book includes 14 useful appendixes that provide critical items such as samples of conceptual frameworks, examples of consent forms, and sample budgets. These are indispensable items! Although materials such as the Critical Appraisal Skill checklist in Appendix Nine are copyrighted, they can save time and expense.
Assessment: The authors have been generous in citing everything from general textbooks, all the way through data management sources, and even extending to list-serve recommendations. Thus, I see this book as an important reference. The book is generous in permitting note taking along its two inch outer margins. I particularly admire the authors' decision to include an example of qualitative-quantitative research design. Both the authors and contributors are distinguished on a global scale.

4 Stars! from Doody
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Product Details

  • ISBN-13: 9780787976347
  • Publisher: Wiley
  • Publication date: 10/22/2004
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 344
  • Sales rank: 562,003
  • Product dimensions: 8.46 (w) x 11.08 (h) x 1.02 (d)

Meet the Author

Priscilla R. Ulin is a senior research scientist in theBehavioral and Social Sciences Research Division of Family HealthInternational, Research Triangle Park, North Carolina.

Elizabeth T. Robinson is director of theInformation Programs Division of Family Health International,Research Triangle Park, North Carolina.

Elizabeth E. Tolley is a senior research associate in theBehavioral and Social Sciences Research Division of Family HealthInternational, Research Triangle Park, North Carolina.

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Table of Contents

List of Boxes.

List of Field Perspectives.




Chapter 1: Invitation to Explore.

Chapter 2: The Language and Logic of Qualitative Research.

Chapter 3: Designing the Study.

Chapter 4: Collecting Qualitative Data: The Science and theArt.

Chapter 5: Logistics in the Field.

Chapter 6: Qualitative Data Analysis.

Chapter 7: Putting It into Words: Reporting Qualitative ResearchResults.

Chapter 8: Disseminating Qualitative Research.

Appendix 1: Samples of Behavioral Frameworks.

Appendix 2: Examples of Oral Consent Forms.

Appendix 3: Example of a Qualitative-Quantitative ResearchDesign.

Appendix 4: Procedural Guidelines for Managing Focus GroupDiscussions.

Appendix 5: Sample Budget Categories for Planning Focus GroupDiscussions.

Appendix 6: Topic Guides for Focus Group Discussions onReproductive Health.

Appendix 7: Sample Interviewer Training Program Agenda.

Appendix 8: Common Errors in Moderating Focus Groups.

Appendix 9: Critical Appraisal Skills Programme (CASP): TenQuestions to Help You Make Sense of Qualitative Research.

Appendix 10: Where to Publish.

Appendix 11: Sample Research Brief on the Female Condom.

Appendix 12: Who Is an Author?

Appendix 13: Sample Brochure to Share Qualitative Study Findingswith Participating Communities.

Appendix 14: Making Study Findings Accessible to OtherResearchers.

Suggested Readings and Selected Internet Resources.


The Authors.

The Contributors.


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First Chapter

Qualitative Methods in Public Health

A Field Guide for Applied Research
By Priscilla R. Ulin Elizabeth T. Robinson Elizabeth E. Tolley

John Wiley & Sons

ISBN: 0-7879-7634-2

Chapter One

Invitation to Explore

Why do some programs succeed and others fail? Why are screening programs underused? Why does chronic disease go untreated? Why do countless couples know how to protect themselves from sexually transmitted infection but do not do so? How does a community mobilize itself to solve a persistent health problem? Questions like these may be all too familiar to readers of this field guide-public health practitioners, researchers, and program planners, many of whom have worked for years to protect health and prevent disease in highly vulnerable populations.

Advances in the biomedical and population sciences have brought the means to better health within reach of people around the world. Yet evidence of escalating disease and inadequate health resources in many countries tell us that there is still much we do not know. How do women and men understand and actually use the technical information they receive to make critical decisions that affect their lives and their children's lives? By opening windows on cultural understandings of health and disease, methods of qualitative research can help us comprehend some of these old problems in new ways.

Our Purpose

The purpose of this book is to make the methods of qualitative science more accessible to researchers and practitioners challenged by problems that affect the public's health. The reader will observe that many of our illustrations are taken from the field of sexual and reproductive health-family planning, risk associated with sexually transmitted infection (STI) including HIV/AIDS, issues in adolescent pregnancy, and numerous instances of related decision making about health, sometimes in highly sensitive contexts. The first edition of this book, published under the title Qualitative Methods: A Field Guide for Applied Research in Sexual and Reproductive Health (Ulin and others 2002), was developed by staff at Family Health International, a nonprofit international public health organization, for developing country researchers in maternal and child health, health education, community medicine, nursing, and the applied social sciences. Our many years of experience with colleagues in these countries, working to understand the critical problems they face in AIDS prevention and reproductive health, showed clearly the need for a practical but comprehensive field guide for qualitative exploration. Since then, readers from other fields of public health and other parts of the world have told us that many of the principles and problems inherent in reproductive decisions and STI prevention also apply to their research and practice in other areas. Some have contributed examples from their own experience with qualitative methods, further expanding the applicability of this edition to a wide range of social and behavioral health problems.

We write not only for the qualitative researcher but for applied social scientists, epidemiologists, health providers, health educators, program managers, and others whose training and experience may be predominantly in quantitative methods. Our readers will be students as well as seasoned professionals looking for ways to probe more deeply the whys and hows of questions they may partially have answered in terms of how much and how many. They will want to know what qualitative methods can offer to improve their practice or strengthen their research findings. And many of our readers will be training others to ask the same kinds of questions, to listen, and to observe.

Numerous disciplines have contributed to the phenomenal growth of public health. Sociology, anthropology, psychology, economics, demography, medicine, and nursing, among others, have brought their unique perspectives and methods to a multidisciplinary understanding of health and wellness. Parallel advances in these disciplines have resulted in different ways of conceptualizing and addressing issues as diverse as health decision making, health promotion, child survival, compliance, substance abuse, adolescent sexuality, domestic violence, and gender relations. Similar progress in service delivery research and evaluation have given us a broader understanding of providers' knowledge and values, client-provider communication, and issues related to the accessibility and quality of health care for populations at risk.

Much of this work has focused on objective questions, such as numbers of births, patterns of contraceptive use, trends in disease prevalence, and numerous factors that predict health behavioral outcomes. Research designs traditionally have been quantitative, describing measurable phenomena, projecting trends, and sometimes discovering causal relationships. Psychological research in health behavior has developed primarily from a quantitative perspective, contributing useful rating scales and behavioral indicators, along with case study methods and tools for observation. Anthropologists and qualitative sociologists have approached some of the same problems from different perspectives, focusing on cultural norms and relationships that influence how people interact and act on everyday experiences (Bernard 1995; Knodel 1997). Their methods rely primarily on techniques of observation, participation, guided discussion, in-depth interviewing, life histories, and secondary analysis of documentary data.

Yet there is much overlap among different disciplinary approaches. Quantitative researchers at times use qualitative methods to guide a sampling design or to develop a sensitive data collection tool. Anthropologists and qualitative sociologists turn to quantitative methods when they want to describe a population or measure some tendency they may have observed qualitatively. Quantitative research with representative samples can produce hard, factual, reliable outcome data that usually are generalizable to wider populations (Steckler and others 1992). But most quantitative studies lack contextual detail and reflect a limited range of responses (Carey 1993). On the other hand, qualitative methods elicit rich, contextual data, but their small samples and flexible design usually are not appropriate if the study objective is to describe larger populations with statistical accuracy (Patton 1990). As a result, researchers increasingly are exploring creative new ways to combine techniques, letting the strengths of one method compensate for the limitations of another to yield a more powerful methodology (Wolff and others 1991).

We have written this guide not to promote one methodology over another, but because many quantitatively trained health professionals, policymakers, and researchers are looking for ways to expand their methodological options with new tools for answering difficult questions.

In searching the literature on qualitative research, we found it divided between manuals that summarize specific techniques for designing and conducting health-related studies (Yoddumnern-Attig and others 1993; Hudelson 1996; Campbell and others 1999) and more comprehensive texts for general academic audiences (Denzin and Lincoln 2000; Patton 1990; Rossman and Rallis 1998). Missing from most manuals was a theoretical basis for qualitative decisions, and few texts included strategies to address practical health research issues and problems that arise in the field. Nor did we find clear guidelines for dealing with the large volume of transcripts that qualitative data collection on sensitive topics often generates. Another gap in the literature was the lack of direction for writing and disseminating qualitative results. Our intent, therefore, is to show first how qualitative methods can shed new light on perplexing questions and second to provide basic skills to design, conduct, and disseminate the research.

What Is Qualitative Research?

A challenge to the author of any book on qualitative research is to answer the commonsense question: What is it? Although there is no short, comprehensive definition, the unique organizing framework is a theoretical and methodological focus on complex relations between (1) personal and social meanings, (2) individual and cultural practices, and (3) the material environment or context. Similarly, there is no universal blueprint for doing qualitative research, but the availability of rigorous methods for qualitative inquiry can take us down many rewarding paths to understanding life in ways that consider the perspectives and experiences of people who live it. Note that although qualitative analysis can answer questions about how people make sense of the world, it also can address many objective dimensions of human action and interaction, relating these findings to the contexts in which they occur.

Many problems central to public health research and practice are deeply embedded in their cultural contexts. People in communities confront decisions and challenges that are conditioned by membership in multiple social groups-whether or not to use contraception, how to get through pregnancy and childbirth safely, where to go for help in times of illness, and how to give young people the skills and confidence they will need for healthy adulthood. Contradictions and competing priorities can make many seemingly commonplace decisions difficult: Spend money on prescription drugs or save for retirement? Protect oneself from sexually transmitted infection and risk losing the attention and economic support of a sexual partner or accept the risk of disease? Running through the fabric of economic, sexual, and reproductive lives is the pervasive influence of gender, a theme that resonates in the voices of the women and men in our research.

The fact that people differ in the ways they interpret-and consequently act on-ordinary situations has profound implications for health research. If it is true that what people define as real is real in its consequences (Thomas and Thomas 1929), then applied behavioral research in public health must have the capacity to uncover multiple perspectives and understand their implications for health decision making. Qualitative researchers have taken seriously this charge, with the result that we now have at our disposal powerful techniques for "hearing data" (Rubin and Rubin 1995, p. 12), listening to what people are saying about their own lives in their own words.

Qualitative researchers know that there are always at least two key players: the participant who contributes the information and the researcher who, as learner and co-interpreter, guides the process toward the understanding that both seek to articulate. Together they form a partnership for exploring different social understandings of reality. Creating a qualitative research partnership requires a high level of skill. It also carries with it profound ethical obligations, because the relationship is based on trust and mutual understanding of a common goal.

Application of Research to Action

We have chosen to focus on applied research because it informs action and enhances decision making on practical issues, unlike basic research, which is conducted to generate theory and produces knowledge for its own end. Although applied research can add immeasurably to our understanding of human behavior, its outcomes are "judged by their effectiveness in helping policymakers, practitioners, and the participants themselves make decisions and act to improve the human condition" (Rossman and Rallis 1998, p. 6). Most well-designed qualitative studies have elements of both the basic and the applied, because rigorous applied research has a theoretical base, and scholars ground their theory in concrete findings. Unfortunately, however, too many examples of hastily constructed qualitative research attempt to apply faulty findings to policy or program issues. Such studies often have an inadequate theoretical base or use data collection techniques that are inappropriate to the purpose of the research. These misguided efforts do not constitute science and seldom contribute significantly to solutions to problems.

At least three important developments are fueling the demand for qualitative expertise in the international health arena:

Advances in cross-cultural understanding of health and health-related behavior

Global health patterns

Increased awareness of issues in human rights

Discussion of these items follows.


Sophisticated quantitative methods have produced an extensive base of knowledge for understanding such phenomena as population growth, disease patterns, and many aspects of human behavior that are determinants of health and sickness. But each new finding leads to more questions and new research problems that often require a different approach to data collection and analysis. For example, knowing the contraceptive prevalence rate in a population leads us to ask why fertility is still high in some sectors. Or with the wide availability of primary health care services, we must ask why so many potentially serious diseases continue to go undetected in their early stages. Qualitative methods are adding a new dimension to the ongoing search for answers to these and other complex questions.

Designs for quantitative surveys increasingly are incorporating qualitative techniques in an effort to improve the validity of interview tools through better understanding of the language and perspectives of study populations. Hearing participants' customary language for sexual issues helps the survey researcher compose standardized items in familiar words or prestructure response categories from actual experience. Program planners too are finding that participation of local people in collecting qualitative data and analyzing local problems leads to more relevant programs and a greater sense of community ownership. In Zambia, for example, CARE International used a participatory approach to design a peer outreach program, the Partnership for Adolescent and Sexual Reproductive Health Project, to reduce sexual health risk among periurban adolescents. The active participation of young people and others in in-depth interviewing was instrumental in the design of the project and its successful implementation (Shah 1999).


Demographic and health statistics speak to the urgent need for solutions to public health problems everywhere. Growing health disparities between rich and poor countries highlight different research needs. In the United States, tobacco use, poor diet and physical inactivity, and alcohol consumption together account for roughly one-third of total deaths (Mokdad and others 2004). In the poorest areas of the world, preventable and treatable diseases, such as diarrhea, measles, and malaria, take a heavy toll on human life. In Africa alone more than 2.3 million people die from vaccine-preventable diseases annually (Carr 2004).


Excerpted from Qualitative Methods in Public Health by Priscilla R. Ulin Elizabeth T. Robinson Elizabeth E. Tolley Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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