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Qualitative research methods: Key features and insights gained from use in infection prevention research

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Infection control professionals and hospital epidemiologists are accustomed to using quantitative research. Although quantitative studies are extremely important in the field of infection control and prevention, often they cannot help us explain why certain factors affect the use of infection control practices and identify the underlying mechanisms through which they do so. Qualitative research methods, which use open-ended techniques, such as interviews, to collect data and nonstatistical techniques to analyze it, provide detailed, diverse insights of individuals, useful quotes that bring a realism to applied research, and information about how different health care settings operate. Qualitative research can illuminate the processes underlying statistical correlations, inform the development of interventions, and show how interventions work to produce observed outcomes. This article describes the key features of qualitative research and the advantages that such features add to existing quantitative research approaches in the study of infection control. We address the goal of qualitative research, the nature of the research process, sampling, data collection and analysis, validity, generalizability of findings, and presentation of findings. Health services researchers are increasingly using qualitative methods to address practical problems by uncovering interacting influences in complex health care environments. Qualitative research methods, applied with expertise and rigor, can contribute important insights to infection prevention efforts.

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Case example

TRIP involves both quantitative and qualitative approaches (so-called “mixed methods”12). In the first, quantitative phase, we surveyed infection control professionals (ICPs) at all Department of Veterans Affairs (VA) hospitals and a national random sample of nonfederal US hospitals to determine what hospitals were doing to prevent device-related infections, including catheter-associated bloodstream infections (CA-BSIs), ventilated-associated pneumonia (VAP), and catheter-associated urinary

The goal of qualitative research is discovery-oriented and holistic

Most quantitative studies conducted in the field of infection control, and health care in general, tend to use a “top-down” approach. In particular, researchers start with a theory of how specific variables may relate to one another, define how to measure these variables, use closed-ended data collection techniques (eg, fixed response surveys) to collect data, use statistical methods to test a priori hypotheses, and generalize findings through statistical inference.

In contrast, qualitative

The research process in qualitative studies is iterative and emergent

Quantitative research often is done in a sequential manner. The theory is identified, hypotheses are stated, the data collection proceeds based on previous theory and hypotheses, and data analysis commences after data are collected. Any changes to the data collection process after the start of the study may threaten the validity of findings.

In contrast, because qualitative research is a process of discovery, the research process is iterative rather than sequential. Data collection and analysis

Sampling in qualitative research is purposeful

In quantitative research, sampling is typically representative and randomized, to ensure that results can be generalized from a sample to a population and also that participants with certain characteristics are adequately represented in the sample. In contrast, sampling in qualitative studies is typically purposeful, with the goal of intentionally sampling cases that can best help the investigator understand the central problem under study. We use the word “typically” here because in a small

Qualitative data analysis is largely inductive and interpretive

The primary approach used in quantitative data analysis is to take specific numerical or categorical responses to closed-ended questions based on variables that reflect theoretical constructs and analyze these data using statistical procedures. This is largely a deductive process. In contrast, qualitative analysis generally proceeds inductively from making specific observations to identifying recurrent themes and patterns in the data. Researchers examine cases systematically, and then compare

Assessing the validity and generalizability of qualitative findings

Standards of excellence for quantitative research often are based on the validity of results, the significance of inferences drawn from results, and the generalizability of results to settings and populations. Like all research, qualitative research is a mixture of science and art, but it involves a bit more art than quantitative research. As Patton noted, “statistical analysis follows formulas while, at the core, qualitative analysis is a creative process, depending on the insights and

Qualitative findings are the products of data interpretation and can be presented in several ways

In a previous report that presented quantitative findings from the TRIP study, we gave the percentage of hospitals in a nationally representative sample that used each of several practices to prevent CA-UTIs, along with multivariable logistic regression results demonstrating associations between several independent variables and practices to prevent CA-UTIs.5 These analyses provide useful information across a large sample but do not provide deeper insight into why those associations might

Conclusion

Analysis of our quantitative survey in the TRIP study identified how many US hospitals are using certain practices to prevent device-related infections, as well as the associations between several independent variables and the use of these different practices. The use of qualitative methods added to this discussion in specific ways; it revealed processes of practice adoption and implementation that we could not uncover using quantitative methods, helped us challenge some of our assumptions,

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