Qualitative Research in Psychiatry: A Beginner’s Guide
Corresponding Author: Pranab Mahapatra, Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, Phone: +91 7752085533, e-mail: firstname.lastname@example.org
How to cite this article Mahapatra P, Pati S. Qualitative Research in Psychiatry: A Beginner’s Guide. Ind J Priv Psychiatry 2019;13(1):27–30.
Source of support: Nil
Conflict of interest: None
Descriptive methods of record keeping and studies have traditionally been the cornerstone of research into the study of human behavior. Quantitative research has been more prominent in current academic journals. Nevertheless, there has been a resurgence in the interest in qualitative research and the field of psychiatry provides ample opportunities for it. Qualitative research is ideally suited for research into psychological and social domains. Mental disorders are influenced by an interplay of psychological, social and anthropological elements. A qualitative approach to studying metal health conditions can thus have a wide-ranging repercussion, ranging for improving treatment methods, improving care delivery and affecting policy changes.
Keywords: Mental health, Qualitative research, Quantitative research, Research methods.
A psychiatrist in the course of his work needs to explore all aspects of a psychological phenomenon in order to diagnose an illness or plan a strategy for its management. This includes exploring all aspects of the thoughts, emotions and behavior of patients. Descriptive methods of record keeping and studies have traditionally been the cornerstone of research into the study of human behavior but of late, quantitative research have gained dominance. Quantitative research methods, being objective, having clear understanding of the processes involved in the research were considered to have a higher validity and reliability. This along with measurable components like quantity, frequency and associations between various components justified by the “p” value, favored publication of quantitative research papers in journals.
Nevertheless, the past few years have witnessed a growing interest in qualitative research as a parallel method in medical research.1 This is also observed in the recent rise of publications using qualitative methods. Even though in international purview, qualitative research is well established, in India it is yet to find its true place. One may often wonder what qualitative research entails and its know-how. We aim to familiarize the readers with the basics of qualitative research through the following paragraphs.
Qualitative research was first used by anthropologists and sociologists early in 20th century as a method of enquiry when they explored about cultures and groups. They reported by observing and talking to people about their lives. The 1960s saw a change brought about by emergent approaches to qualitative studies like the grounded theory (Glaser and Strauss, 1967). With increasing recognition of qualitative contributions to medical research, a special issue of “the Psychologist” appeared in 1995 which was dedicated to qualitative studies. Since then, the importance of this form of research has been rising steadily more so with the improvement in the approaches and methodologies of researches.
WHAT IS QUALITATIVE RESEARCH?
Qualitative research methods are usually employed early on in a research project when we know little about a phenomenon. For instance, when we want to explore the challenges faced by patients with mental disorders teaching at schools, we have less information to start with. In order to understand the condition in its entirety, we need to interview persons from among the patients, their colleagues or their family members who can give information on our study question. These interviews form a source of data (written or oral), different from the numerical data provided by quantitative studies. Qualitative studies involve seeking answers to the “what,” “when” and “how” of a phenomenon. The language data so collected by interviews are further subjected to qualitative data analysis methods. This gives a better understanding to the phenomena and frame concepts about it.
The goal of qualitative research has been defined as “the development of concepts which help us to understand social phenomena in natural (rather than experimental) settings, giving due emphasis to the meanings, experiences, and views of all the participants. The findings of a qualitative study can be a prelude to further quantitative approaches such as forming questionnaires.
HOW IS IT DIFFERENT FROM QUANTITATIVE METHODS?
All research, whether quantitative or qualitative, must involve an explicit, disciplined, systematic approach, using appropriate methods that answers the research question.
Yet, a frequent question is asked about the difference between these two methods. The first disclaimer is they both are not competitors rather they ideally should complement each other. The basic difference lies in their approaches to a phenomenon under study. This includes what they aim to achieve, their methods of data collection, the way these data are analyzed, the presentation of the results and the overall outcome of the study.2,3
To illustrate these differences, we can consider a study on stress among 10th grade high school students. A qualitative study would try to explore the different conditions leading to stress among these students and how they manage them. The study will attempt to increase our understanding of stress in these students by examining various aspects like why this is caused, what is the impact and how do these students perceive and manage it. On the contrary, a quantitative study would include an assessment of biological parameters, psychological scales and other data to find ways to measure the stress. Whereas the qualitative approach can be holistic, the quantitative approach can be reductionist in its approach.
The methods of date collection also differ in the two. Qualitative studies collect information through interviews, observations or records. These are usually “language” data. The data so collected are in the natural or “real world” settings of the participant. Differing from this, the data collection in quantitative studies are done by using measurable parameters, scales and questionnaires and these are in “numerical” form. The data is collected in structured settings. Whereas a qualitative enquiry explores for the “why” and “what” of a phenomenon, the quantitative methods look for the “frequency” of the event by asking questions like “how often” and “how many.” Through its methods, qualitative research comes up with new ideas and hypotheses regarding a phenomenon. In contrast, quantitative researchers have a hypothesis to begin with and a clear view regarding different aspects of the research before data are collected.
A qualitative research question usually seeks to study a phenomenon in a special subgroup of a population such as ethnic groups or specific patient groups. This does not inherently aim at generalizability. In contrast, by eliminating all but measurable variables, quantitative approaches attempt to generalize the findings. Besides these, the role of the researcher also differs in both forms of study. He remains detached in quantitative research as an objective observer whereas he participates in the qualitative research, influencing the process. Thus, quantitative and qualitative methods are two different modes of inquiry where one can complement the another. A study incorporating both the methods can be more comprehensive, unbiased and allows for more accurate research.
The practice of psychiatry exposes the physician to various facets of mental disorders. Besides the psychological aspects, social and anthropological aspects also influence the course of illness. Given its unique characteristics and advantages of qualitative research, it is well suited to answer many questions that intrigue a researcher in psychiatry. Examples of research areas are given below:
- Developing questionnaires. Questionnaire design begins by conducting a primary qualitative study to understand what kind of variables can influence the subject.
- Establishing diagnostic criteria. Preliminary qualitative studies lead to wider and deeper understanding of a disorder under study. Subsequent qualitative methods can help to establish diagnostic criteria for the condition.
- Examining social and anthropological dimensions influencing an illness. The process of care seeking and compliance to treatment is affected by traditional and community beliefs about the illness, socioeconomic conditions and available resources. This can be identified and addressed by studies on care seeking behavior or other such studies that consider peoples’ attitude and beliefs.
- By understanding how patients and their carers interact with the healthcare system and how the care providers deliver care, policy changes by the government can be brought about.8
The impact of qualitative research in psychiatry can be manifold, from modifying the management strategies to reinforcing the healthcare system at the community level to providing suggestions for policy changes.
KNOW-HOW OF QUALITATIVE RESEARCH
They form an important guide for the whole process of research. These questions can be more general and covering a wider area of investigation. These can be like (a) what makes a patient avoid psychiatrists or (b) what makes some patients with alcohol dependence relapse during treatment. These identify what is happening or is experienced and studies that show the relation between the events.
- Ethnography: This is a methodology for descriptive studies of cultures and peoples which influences the illness and associated conditions. This can include the culture of a region or even the culture prevailing in a hospital ward.
- Grounded theory: It is phenomenological approach where it attempts to understand how participants make sense of their experiences. From these explanations, new theories emerge. This is utilized in health and social care settings and the new theories give new approaches for intervention.
- Interpretative phenomenological analysis (IPA): IPA has two components. The phenomenological aspect where it attempts to understand how participants make sense of their experiences and the interpretative part involving the researcher. This is a popular approach used in psychology.
- Other approaches include discourse analysis, conversation analysis, content analysis and narrative analysis.13
Qualitative Data Collection Methods
These can be done in many ways, but the type of method adopted depends upon the research question. Interviews and focused group discussions (FGD) are carried out after due consent and ethical considerations. They are recorded with a digital audio recorder. The details of these have to be planned to avoid interruptions.
- Interviews: Interviews can be guided by a pre-planned, semi-structured interview guide. The questions being open-ended providing cues and prompts when needed.
- Focus groups: A good FGD can be carried out among 5–8 participants. The ground rules have to clarified. The researcher facilitates the process for smooth discussion on the topics.
- Observation: Participant observation is a common observational method where researcher is involved in the social phenomenon being studied. He identifies by observing what people actually do. For example, in a qualitative study to study the therapeutic engagement of patients with their psychiatrists, a researcher may spend time in the hospital ward as an observer.
- Other methods of data collection include, documented material such as letters, diaries, photographs, narratives, open-ended questions in questionnaires.
The main goal of sampling in qualitative research is to select participants whose responses will help answering the research question. The sampling is not intended to generalize findings to the population. The participants are identified by purposeful sampling. Examples of purposeful sampling include the use of extreme or deviant cases, typical cases or sensitive cases. Other sampling methods used are maximum variation sampling (selecting cases from diverse sociodemographic background), convenience sampling (recruiting readily available participants), and snowball sampling (where a participant identifies several others).
Analysis of data in a research project involves summarizing the mass of data collected and presenting the results in a way that communicates the most important features. It should use the data to describe a phenomenon, to show what it means and to understand it. The data collected in the form of audio recordings transcribed and if needed translated. Transcriptions in the form of digital documents are further analyzed manually or with the help of Qualitative Data Analysis software. The data or the transcripts are examined to identify codes, which denote the smallest unit of analysis and represent the idea or concept expressed within a sentence. Similar codes are sorted together looking at the emerging patterns to themes or subthemes which are further merged into categories to form the basis of theories. These categories or theories are then checked against the narratives to test the consistency of the analysis. The process of analysis of the data tends to be circular where researchers move to and fro in repetitive “loops” checking the newer narratives against the emerging theories. This has been termed an iterative process and leads to sound and fully developed theories.
There are many different approaches to analysis, these can range from quasistatistical to immersion and crystallization. In the quasistatistical approach, most frequently occurring words in a text are identified and frequency distributions calculated to develop categories. A more open-ended approach to analysis is the grounded theory. In this, a theoretical model is developed through observations from the study population after comparative analysis of social or psychological phenomena. This technique is rooted to the concept of hermeneutics, whereby the interpretation and understanding of human behavior is done from the participants’ perspective. Once the theories develop, they have to undergo a process of validation.
After following and iterative process for analysis of the data and developing theories, external validation, or transferability of the analysis, is required. This involves a qualitative research method called triangulation. Triangulation is the process by which two or more researchers compare their findings of individual analysis. It’s after their deliberations and discussions, they prepare to report the findings.
Presenting the Results
Writing a qualitative research for scientific publication is different from the usual paper. To describe the phenomena under study, details of the study setting, the participants and the process of the interviews along with field notes if any is mentioned. This is called a thick description. The goal of the write-up is to tell a story that is engaging and convincing, providing sufficient detail in a structured way. The outcome of the process of triangulation may also be included. While writing the results, the researcher conveys recurrent patterns or themes along with exceptions that do not fit. The results from in-depth interviews and FGD will be combined to propose a theoretical framework on which the hypotheses proposed is based.
With the researcher involvement being so high in all processes of the study, the risk of investigator bias is high. Triangulation, extreme case sampling and the use of topic guide for interviews are some methods that introduce rigor. Respondent validation, that is checking the themes back with the respondent for incongruency, and multiple coding by two or more researchers further enhance the rigor of the study.14,15
IMPLICATIONS FOR PSYCHIATRIC RESEARCH
Qualitative research is ideally suited for research into psychological and social domains. Mental disorders are influenced by an interplay of psychological, social and anthropological elements. A qualitative approach of studying metal health conditions can thus have a wide-ranging repercussion, ranging from improving treatment methods, improving care delivery and affecting policy changes.
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