RESNA 27th International Annual Confence
The Relevance of Qualitative Research to AT Outcome Research Goals
Interest in and use of qualitative research in outcomes research in health care has significantly increased during the past decade (1). Qualitative research consists of a broad array of techniques, methodologies, and theories, many of which complement quantitative techniques and aims. This study identifies qualitative tools applicable to the goals of assistive technology (AT) outcomes researchers. Discussion focuses on how qualitative and quantitative techniques may be combined to produce more accurate and effective outcomes measures and concepts.
Qualitative research, quantitative research, outcomes, disability, assistive technology
As a general methodology, outcomes research is most often assumed to be quantitative in nature. That is, research questions and results are tabulated and/or manipulated so that they are expressed in a numerical format. It is further assumed that these numerical values present an objective profile of the subject under study. However, classificatory schemes, which form the basis of those underlying methodologies and instruments, contain an array of assumptions, attitudes, and values about disability and technology. Pragmatically, the results of outcomes research rest on the assumed integrity and utility of its classifications and categories. Outcomes results necessarily presuppose that the aggregate data produced correctly represent the individuals' experiences on which they were originally based. Qualitative research, used in conjunction with quantitative methods, highlights underlying biases and allows for better quantitative models and enhanced reporting of results.
Mol (2) provides a clear example in her discussion of laboratory test norms. She places established quantitative norms within a qualitative analytic framework. In so doing, Mol shows how cultural and professional biases have formed quantitative values. These values, in turn, form the justification for diagnostic acts and treatment modalities within healthcare practices. This is similarly reinforced in Mol (3) discussion of different treatments for arterial deterioration. Here quantitatively derived conclusions are deconstructed to show, among other things, how specific modalities, presumed to be objectively measurable, were in fact wholly biased by external elements such as the training and schools attended by personnel, available funding, patience and self-confidence of the therapist.
In these examples, the critical issue is that categories that appear commonsensical and authoritative must themselves be investigated as ways of perceiving and organizing the world. Diagnostic procedures and questions may reflect more about how a branch of scientific research organizes its own knowledge practices, and less about the phenomena under study.
Within outcomes research, we may consider the recently modified World Health Organization's International Classification System (ICF) nomenclature related to disability (4). For example, the ICF identified the construct “participation.” Researchers generally regard an increase in this category as an obvious outcome goal. However it contains many assumptions about the nature and desirability of societal, work, and familial relationships that may or may not be realistic, desirable, or applicable across all disability types and contexts. These contexts need to be uncovered so that researchers can develop instruments that accurately assess subjects' multiple complexities and uses.
The objective of this study is to suggest complementary strategies and methodologies that can be successfully integrated into future outcomes projects. Specifically, focus groups, interviews, participant observation, and analytic methods will be discussed as relevant qualitative tools when establishing a quantitatively oriented research program. Differences between qualitative and quantitative research processes also will be noted, as will the various uses and strengths of qualitative research strategies in terms of the kinds of information and analyses they may support.
A review of qualitative research literature in the social sciences was performed with respect to disability issues and, specifically, assistive technology. Scanned social sciences included anthropology, sociology, psychology, political science, and economics. In addition, substantial qualitative research relevant to assistive technology issues was found in the fields of education, nursing, and occupational therapy.
Three methodologies were identified as being potentially useful to outcomes researchers: focus groups, interviews, and participant/observation.
Focus groups and interviews are fairly well-known qualitative research techniques within disability research. Focus group research involves organized discussions among a selected group of individuals in order to generate opinions, views, and experiences on a specific theme (5). Although underused in social research, focus groups have a long history in market research and, more recently, in medical research. A chief strength of this research strategy is the insight it provides into a group's shared understandings of everyday life and the ways in which individuals are influenced by others in group situations.
Interviews are very often used within qualitative research to examine disability topics (6). Types of interviews may include, for example, open-ended, semi-structured, unstructured, formal, conversational, and phenomenological. They may be given once or multiple times. Interviews are conducted with individuals (as opposed to groups). They provide in-depth knowledge about individual experiences. Interviews, as with focus groups, must be analyzed for common themes and emergent concepts and can be used to enlarge, verify, or create new categories.
Participant-observation is a third methodological strategy (7). Historically, it is employed by anthropologists and ethnographers. Unlike the first two methods that focus on what people say they feel, think, or do, participant observation also relies on observing behaviors for a prolonged period of time within a natural context. The participant-observer's perception of people's actions contributes an added dimension to self-report measures. As with focus groups and interviews, participant-observation data is analyzed for patterns, themes and concepts from the variety of accumulated texts (which may include verbatim notes, transcribed recordings, videotapes, jotted notes, “field notes” of observations, diaries or journals).
Qualitative research methodologies can provide several levels of novel and complementary utility for AT outcomes researchers. Some of these methods are in use today in outcomes research, but lack the sophistication that a connection to their theoretical contexts can provide. Executed properly and appropriately, the iterative, organic, formalized program of data collection and analysis can clarify, create, and refine, existing categories and concepts and their relationships among each other for organizations, individuals, technologies, economies, and connections. They also can provide information that illuminates assumptions in existing quantitative instruments constructs. The innovative outcome of this complementary approach can produce better quantitative information and a context through which a broad audience of researchers, end-users, and policy analysts and decision-makers can access and comprehend the power and expertise of outcomes work. Quantitative and qualitative methods should be viewed as complementary spheres for modeling and analyzing the vital questions arising in and out of outcomes research in assistive technology.
This study was funded by The Langeloth Foundation and the National Institute on Disability and Rehabilitation Research, grant number H133A010403. The opinions contained in this study are those of the grantee and do not necessarily reflect those of the NIDRR and the U.S. Department of Education.
Frances H. Harris, PhD,
Center for Rehabilitation Technology,
Helen Hayes Hospital ,
West Haverstraw , NY 10993.