Qualitative Methods in the World of Health Care

College of Health ProfessionsTexas State University

October 25, 2012

(Please do not cite without the permission of the author/presenter)

Joseph A. Kotarba, Ph.D.

Professor of SociologyDirector,

Center for Social InquiryTexas State University-San Marcos

jk54@txstate.edu

Our Plan

• Define qualitative methods• Explain relevant theory• Explain varieties of qualitative methods• Present examples of qualitative studies

Qualitative Methods

• Seek an understanding of social phenomena in everyday life

• People assemble meaning for events collectively

Social Theory

• Symbolic Interaction (Herbert Blumer)

–Situation–Self–Interaction–Culture

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Social Theory

• Dramaturgy (Irving Goffman)

–Theater of everyday life–Presented self–Actors–Scripts

Social Theory

• Phenomenology (David Locker)

–Natural attitude–Common sense–Cognition / consciousness–Community

Social Theory

• Ethnomethodology (Aaron Cicourel)

–Society: language community–Talk–Power / inequality–Reflexivity / indexicality

Social Theory

• Existential Social Theory (Joe Kotarba)

–Existential self–Crisis of self–Culture / media–Affect

Social Theory

• Postmodernism (Norman Denzin)

–Society <-> mass media–Master Narrative / Grand Theory: out–Simulacrum–Hyperrreality

Methods

• Data: words, symbols, images, ideas

• Mixed methods: desirable

• Labor intensive

Methods

• Ethnography: total description

• Participant observation: membership

• Interviews: all kinds

Methods

• Observations: visual and video

• Performance

• Content analysis

American Acupuncturists

• Kotarba (1975)

• Symbolic interaction: situation

• Participant observation

American Acupuncturists

• Typology: Patients

– Hopeful (70%) in pain

– Curious (20%) fashion

– Indifferent (10%) instrumental

American Acupuncturists

• Typology: Practitioners

– American (allopathic)

– Asian (holistic)

Aerospace Medicine

• Kotarba (1983)

• Interviews and observations

• NASA / Johnson Space Center

Aerospace Medicine

• Metaphor: holistic health care

–sharing the health / healing experience–family care–total care –perfect patients / prevention

Aids Hospice

• Kotarba and Hurt (1995)

• Process analysis: how accomplished

• Participant observation: volunteering

Aids Hospice

• Organizational level of analysis

–Everyday staff practices• Touch•Managing stress•Commonsense

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Aids Hospice

• Typology: Relationships

–Caring relationships–Pastoral relationships–Intimate relationships

Aids Hospice

• Metaphor-to-concept development

–Organizational pastiche

Battlefield Medicine

• Kotarba (2012)

• Theory development

• Comparable field studies

• Visual

Battlefield Medicine

• Definition: Battlefield medicine is health care delivered to sick or injured patients that is intended to get them back to work as soon as possible.

Battlefield Medicine

• Multi-method / historical

• Visual

• Policy-oriented

Battlefield Medicine

• Professional athletics

• Typology: quality of care by social class

–Executive (major leagues)–Middle-class (minor leagues)–Working class (part-time)

Battlefield Medicine

• Typology: quality of care by gender

– Men: good, employer-based

– Women: poor, community-based

Battlefield Medicine

• Hurricane Katrina

• Process: returning evacuees to functional poverty

• Visual ethnography

Battlefield Medicine

• Music Festivals

• Visual and audio ethnography

• Returning fans to the show

Translational Science Research

• Contemporary health care

• Contemporary science

• Contemporary health bureaucracy

Translational Science Research

• Federally-funded (NIH / CTSA)

• Bureaucratic—and how!

• Evaluation research

The Culture of Translational Research:

A Qualitative Evaluation

Research Questions

• What is the traditional culture of research at UTMB?

• What is the emerging culture of translational research at UTMB?

• How can CTSA participants enhance the emerging translational research culture at UTMB?

Sensitizing Theory: Symbolic Interaction

• Organizational life is a process of interaction/ communication among people in order to arrive at shared meanings (e.g., values, rules, and goals) and unified course of action;

• Organizations are simultaneously formal and informal, stable and fluid;

• The individual’s primary objective for entering into organizational activity is to simultaneously fit the self into that activity while enhancing the experience of self through the activity.

Second Sensitizing Theory:Action Theory

• Action theory is popular among researchers studying complex organizations such a hospitals, schools and governmental agencies.

• Action theory is problem/solution/change oriented.

• Action theory welcomes the respondent into the research and problem-solving process.

Methodology

• Qualitative data• Thirty-seven executive interviews with

members of the UTMB and CTSA in leadership positions

• Focus group interviews with 22 graduate and postgraduate students

• Respondents were asked to speak for their team members as well as for themselves (“expert witnesses”)

CTSA Stories

• Symbolic Interaction argues that respondents’ understanding of the organization can be retrieved through stories they author and relay.

• These stories are the dynamic culture of the organization.

• Qualitative interviews to date suggest a model of translational research consisting of two fundamental features of this complex interactional work: dilemmas and significant symbols.

Stories: Dilemmas

• Dilemmas refer to problems organizational members face in doing their work.

• Dilemmas in and of themselves are common and expected features of any group activity.

• We can define dilemma as a situation which requires the actor to decide how to proceed (cf. Maines 2001). Individual and group activity, whether in terms of establishing an organization, equipping a lab or designing a study, is not automatic or necessarily obvious.

Routine and Tradition vs. Experiment and Innovation

Commitment vs. Time Constraints

Mentoring vs. Freedom

Discovery vs. Application

P.I. vs. Team

Recovery from Ike vs. Organizational Growth

Organizational vs. Scientific Expertise

Vision vs. Design

Significant Symbols

• “My Lab”

• “The meeting”

• “The scientist”