MODULE 1

INTRODUCTION TO RESEARCH METHODS

Research methods is broadly defined as the application of theories, concepts and

techniques of research activities to perform scientific research works. This module is developed
to harmonize the teaching of research methods course to students. It is primarily developed using
the existing curricula for post graduate programs in the health science field. The main focus of
this module is to provide postgraduate students with the skills needed to conduct research of
sufficient quality and rigour that enables it to be useful for evidence based decision-making.

The reader will also have the skills of assessing the quality of information to view other
people’s research with a critical eye. The Module introduces principles, methods, and elements
of the research process within the context of quantitative, qualitative, and mixed design
approaches. Learners will use these theoretical underpinnings to critically understand how to
define a research problem, how to develop research questions, how to do research, how to write a
thesis report or manuscript, and how to critically appraise research outputs so as to use them for
evidence based decision making.

The module sessions included in the module are introduction to research and literature
review, Quantitative research methods, Research ethics, Introduction to qualitative research,
Qualitative research methods, Research proposal and thesis report writing, and manuscript
writing. Purpose of the Module This module is prepared to standardize the teaching of research
methods course mainly for MPH/MSc and other postgraduate health sciences students. It can
also be used as a resource for anyone who is interested in research.

Module Learning Outcomes

After studying this module, students will be able to:

 Identify a problem to be researched
 Write a thesis/research proposal
 Conduct research
 Write a thesis report
 Write a manuscript
 Critical appraise evidence
Session One:

This session begins by describing about the term ‘research’. Different scholars define
Research differently. In 2002 Oxford English Dictionary define research as “the systematic study
of materials and sources in order to establish facts and reach new conclusions.” According to
McMillan and Schumacher (1997) define research as “a systematic process of collecting and
analyzing information (data) for some purpose.”

Discussions then move on to critical literature review steps and recognise its importance
in research work. Having provided this information, the session then focuses on the theoretical
considerations involved in the first stage of the research process: formulating the research
problem and research questions, hypotheses or objectives.

Session Learning Outcomes

By the end of the session, students should be able to:

 Discuss what is meant by the term ‘research’ and describe the stages of the research process
 Identify and formulate a research problem using literature review as sources of information
 Access resources and use the proper citations and references
 Formulate and write research questions or hypotheses and research objectives
 Construct reliable research tools for data collection on the basis of other researchers

1. Definition and Types of Research

1.1. Research defined
We can define research as an activity of systematic enquiry that seeks answers to a
problem. Research experiences in our everyday lives. In our daily lives we all encounter
research. The results of research are presented to us in different form such as articles, books,
newspaper, reports, and media programmes. For example, Poverty and health are presented to
the public through television news reports and some other political issues are also very popular
with magazines as well as television programmes. Thus, through different medias the public
become familiar to reading and hearing about this issues and although people may not be aware
of it, we used to making our own judgments about research findings. If we take the example of
poverty and health, many of us have taken into consideration information that has been presented
on ‘effect of poverty on health of 8 individuals within the context of our country.

We assess the information what has been presented, create an opinion as to the relevance
and validity of the research ideas, and reach to our own conclusions based on the following
considerations:
  why the research was conducted
 what we understand is the question to answered
 how the findings are presented
 what we know about who conducted the research
 what other people think about the information
 how the research findings relate to us

We may choose to overlook the information, if we don’t understand what the findings
mean, we may disagree, or agree with the findings and either to adjust our contribution to curb
the problem or decide that we would have other computing priority agendas. In other words, you
may not be aware of it, but you already have some understanding of the research process, the
role of research, research concepts, and research evaluation.

1.2 Characteristics of Research

Research is a process of collecting, analyzing and interpreting information to answer
questions. But to qualify as research, the process must have certain characteristics: it must, as far
as possible, be controlled, rigorous, systematic, valid and verifiable, empirical and critical.

Characteristics of Research
Activities to Qualify as Research Criteria for good research Descriptions Controlled 
Exploring causality in relation to two variables, set the study to minimizes the effects of other
factors affecting the relationship Rigorous  you must be meticulous in ensuring procedures
followed to find answers to questions are relevant, appropriate and justified. Systematic 
procedure adopted to undertake an investigation follow a certain logical sequence  different
steps cannot be taken in a haphazard way  Some procedures must follow others Valid and
verifiable  Implies that whatever you conclude on the basis of your findings is correct and can
be verified by you and others. Empirical  Any conclusion drawn are based upon hard evidence
gathered from information collected from real life experiences or observations. Critical  critical
scrutiny of the procedures used and the methods employed is crucial to a research enquiry.  The
process of investigation must be foolproof and free from drawbacks.  The process adopted and
the procedures used must be able to withstand critical scrutiny. Remarks: For a process to be
called research, it is imperative that it has the above characteristics. 2. Research Types Based on
purposes Research differ accordingly. There are three major research types such as application,
objectives, inquiry mode, and sometimes may be use as mixed method research. 2.1 Application
(Pure and Applied Research) Applied research is "hands-on", which means that researcher is
actually working with the topic while conducting the research. Generally, applied research
focuses on 10 "practical problems" such as public health issues/ clinical issues in order to come
up with solutions to better or improve an existing condition. Basic research is often called "pure"
research and is considered the foundation for applied research. It is often considered researching
to increase knowledge as opposed to applied research truly is intended to solve a problem. 2.2
Objectives (Descriptive, Co-relational, Exploratory and Explanatory)  Descriptive research
(statistical research): The idea behind this type of research is to study frequencies, averages, and
other statistical calculations. The main goal of this type of research is to describe the data and
characteristics about what is being studied.  Correlation research : measures the relationship
between two or more variables or gives an indication of how one variable may predict another. 
Exploratory research is a type of research conducted because a problem has not been clearly
defined. Exploratory research helps determine the best research design, data collection methods,
and selection of subjects. Given that it is fundamental in nature, exploratory research often
concludes that a perceived problem does not actually exist.  Explanatory research explores
"why," and attempts to explain as the purposes of explanatory research. It builds on exploratory
and descriptive research and further identifies the reasons for something that occurs. It looks for
causes and reasons. 2.3 Inquiry mode (qualitative and quantitative): From the process adopted to
find answer to research questions – the two approaches are:  Structured approach 
Unstructured approach  Unstructured approach (qualitative): The unstructured approach to
inquiry is usually classified as qualitative research. This approach allows flexibility in all aspects
of the research process. It is more appropriate to explore the nature of a problem, issue or
phenomenon without quantifying it. Main objective is to describe the variation in a phenomenon,
situation or attitude. E.g., description of an observed situation, the historical enumeration of
events, an account of different opinions different people have about an issue, description of
working condition in a particular industry.  Structured approach (quantitative): quantitative
research is usually classified as structured approach to inquiry. Here everything that forms the
research process includes objectives, design, sample, and the questions that you plan to ask of
respondents is predetermined. It is more appropriate to determine the extent of a 11 problem,
issue or phenomenon by quantifying the variation. For example it is deals with measurement of
attitudes, behaviors and perceptions of study subjects. In short quantitative research address the
following issues:  Means the data is analyzed in terms of numbers.  Involves the collection of
numerical data.  Predicts and explains data in the form of statistical analysis.  Uses the
numerical method to analysis and interpret the results.  Finds out the relationship among
quantifiable variables and the results are inferred. learning activity 1.1 The Instructor can ask the
students to think and plan for doing research as their graduation requirement on different public
health research topics such as factors affecting increasing early childhood mortality, factors
increasing maternal mortality. Suppose that the instructor asks students to plan for doing research
on factors affecting increasing mortality on early childhood in certain locality, the instructor
would give directions and set the limits for this planning. For example: you have one million
Ethiopian birr to do this research and you can do this research in one year period; and you have
to spend all the money but cannot over spend. You research design could be prospective or
retrospective follow up . Now ask the students to think of their personal and research context,
research outcomes and policy implications and limitations etc. and ask them to rationally plan
the process. Give them ten minutes to plan. Comment 1.1  Now ask them how they planned it.
As some of the students share how they planned it, through this discussion establish that the
planning involves a complete research process. One has to see the problem and objectives. One
has to do literature review by gathering information from different literatures and discuss with
their colleagues those who have the expertises. The process also involves research methodology.
For instance, some students will directly go to the literature review and understand what is
already know about their research questions and what is unknown in the subject matter. Ask
them in the same way how they would analyze gathered information collected from the literature
review they have done and share that it is their data analysis that leads to their conclusions and
decision making. 12 Learning Activity 1.2: Identify the Research Types from the Following 
After the introductory lecture on types of research, the instructor will provide the participants
with a worksheet which contains the following statements: 1. If you are going to study the
relationship between job satisfaction and career development of health professionals working at
the university of Gondar, this is an example of _____________________________. 2. If you are
going to find out reasons of staff turnover in the Hospital, this is an example of
_______________. The instructor ask the students to fill in the blanks with appropriate
statements about the types of research. Comment 1.2 1. Correlation research 2. Explanatory
research 3. Research as a process Research process as impression of linearity: Research can be
seen as a series of linked activities moving from a beginning to an end. Research usually begins
with the identification of a problem followed by formulation of research questions or objectives.
Proceeding from this the researcher determines how best to answer these questions and so
decides what information to collect, how it will be collected, and how it will be analyzed in order
to answer the research question. At each operational step in the research process you are required
to choose from a multiplicity of methods, procedures and models of research methodology which
will help you to best achieve your objectives. 3.1 Steps in linearity Research Process: 
Formulating the Research Problem  Extensive Literature Review  Developing the objectives 
Preparing the Research Design including Sample Design  Collecting the Data  Analysis of
Data  Generalization and Interpretation Cyclical or iterative Research Process: On the other
hand, research process is often an iterative process whereby the process of conducting the
research will give rise to new ideas which, in turn, feed back into the data collection and analysis
stage. Decisions made early in the research process are often revisited in the light of new insights
or practical problems encountered along the way. 13 Figure 2 cyclical or iterative Research
Process Sources: 1. Through the process of designing your research, consideration of both
practical and conceptual issues may force to reconsider original research question. 2. Difficulties
with access to research sites or participants may cause to reconsider questions or methods. 3.
Issues arising during data collection may suggest that additional data are required or reveal
problems with the original research question. 4. Problems or new questions arising from analysis
of data collected so far may result in a need to collect more data, sample elsewhere or employ a
different technique. 5. Finally you progress to the report writing stage. Regardless of the route
taken subsequently, research should start with the problem and the research questions. If the
intention of research is to answer your questions, it follows that choice of method should develop
from question: choose the method that can best provide the information you need to answer your
research question given the resources available to you. This is one reason why it is very
important to be clear as to what you are asking. As you can see there are numerous choices to be
made within the research process. Planning your research involves the consideration of four
overlapping themes.  The conceptual approach – the philosophical underpinnings of research 14
 Research design – how data collection is organized  Data collection techniques – how data are
collected  Sampling – from whom data are collected These aspects of research planning can be
represented as forming different layers of a research ‘onion’. Figure 3: The ‘onion’ diagram of
research choices Each layer of the onion presents a different set of choices regarding research
philosophy, research approach, method and so on. All research involves choices at all these
levels, though these choices are not always made explicit. Choices further into the centre of the
onion are often, but not always, contingent on those made further out. Other Considerations
Choices in research planning must also take into account the following:  The types of
information outputs required – who needs the information and for what purposes  Research
resources – time, funds, facilities, staff, and access  Ethical considerations – for example, within
the research plan is it possible to obtain informed consent from all participants, does the plan 15
involve any risks to the safety of the researcher, can the researchers assure the confidentiality of
all information given? 4. From Research Idea to Researchable Problem 4.1 Sources of research
ideas Ideas for research problems or topics can arise from a range of different potential sources
such as personal or professional experience, a theory, the media, or other research studies. 1.
Personal professional experience Our daily personal or professional experience lead to identify a
problem that we would like to have a solution. Alternatively, we may encounter a question or
questions that we would like to try and answer. For example, on a personal level, you may prefer
the taste of organically produced vegetables and thus you may speculate if people general in
Ethiopia prefer the taste of organically produced vegetables to those produced non-organically.
The research topic is a study into taste preferences and the question ‘do people in general in
Ethiopia prefer the taste of organically produced vegetables to those produced nonorganically?’
2. Theory Theories are ideas about how things relate to each other. Theories may be general,
commonly held beliefs (such as, man is mortal, therefore Abebe is Mortal ) or more technical
ideas (for example, that global warming is causing a change to the timing of the seasonal
responses of the change of cultivation in Ethiopia). There are many ways of expressing theories,
some are very formal, others are informal. Here are some examples:  The idea that distance
learners have different needs than on-campus students is a theory.  Theories may be useful in
suggesting interesting questions and generally guiding fieldwork, but should not restrict us from
exploring alternative explanations. The end result of the research process is knowledge. 3.
Literature and Media There are many sources of literature, such as journal articles, books, and
newspapers. When searching and reading literature it is possible to encounter gaps in information
and knowledge, and problems for which there is currently no solution. These may provide a good
basis for research. We are also flooded with information presented by the media, such as
television, which again might give rise to research ideas. 16 Considerations in Selecting a
Research Problem These help to ensure that your study will remain manageable and that you will
remain motivated. 1. Interest: a research endeavour is usually time consuming, and involves hard
work and possibly unforeseen problems. One should select topic of great interest to sustain the
required motivation. 2. Magnitude: It is extremely important to select a topic that you can
manage within the time and resources at your disposal. Narrow the topic down to something
manageable, specific and clear. 3. Measurement of concepts: Make sure that you are clear about
the indicators and measurement of concepts (if used) in your study. 4. Level of expertise: Make
sure that you have adequate level of expertise for the task you are proposing since you need to do
the work yourself. 5. Relevance: Ensure that your study adds to the existing body of knowledge,
bridges current gaps and is useful in policy formulation. This will help you to sustain interest in
the study. 6. Availability of data: Before finalizing the topic, make sure that data are available. 7.
Ethical issues: How ethical issues can affect the study population and how ethical problems can
be overcome should be thoroughly examined at the problem formulating stage. 4.2 Formulating
the research problem Once the general topic or problem has been identified, this should then be
stated as a clear research problem, that is, taken from just a statement about a problematic
situation to a clearly defined researchable problem that identifies the issues you are trying to
address. It is not always easy to formulate the research problem simply and clearly. In some
areas of scientific research the investigator might spend years exploring, thinking, and
researching before they are clear about what research questions they are seeking to answer.
Many topics may prove too wide-ranging to provide a researchable problem. Choosing to study,
for instance a Public health issue such as maternal mortality ratio, does not in itself provide a
researchable problem at particular district level. The problem is too wide-ranging for one
researcher to address because it required large denominator. Therefore it will be time and other
resources unfeasible and the results from such a study would consequently lack depth and focus.
17 Steps in formulation of a research problem : Working through these steps presupposes a
reasonable level of knowledge in the broad subject area within which the study is to be
undertaken. Without such knowledge it is difficult to clearly and adequately ‘dissect’ a subject
area. Table : Show Steps in formulation of a research problem Steps Descriptions Step 1 Identify
a broad field or subject area of interest to you Step 2 Dissect the broad area into sub areas. Step 3
Select what is of most interest to you. Step 4 Raise research questions. Step 5 Formulate
objectives. Step 6 Assess your objectives. Step 7 Double check your research question 4.3
Statement of Research Problem An adequate statement of the research problem is one of the
most important parts of the research. Different researchers are likely to generate a variety of
researchable problems from the same situation since there are many research issues that can arise
out of a general problem situation. Your research will be able to pursue only one in depth. For a
problem statement to be effective in the planning of applied research it should have the following
characteristics. 1. The problem reflects felt needs 2. The problem is non-hypothetical, i.e. it must
be based on factual evidence 3. It should suggest meaningful and testable hypotheses – to avoid
answers that are of little or no use to the alleviation of the problem 4. The problems should be
relevant and manageable Formulating the research problem allows you to make clear, both to
yourself and the reader, what the purpose of your research is. Subsequent elaboration of method
should be oriented to providing information to address that problem. The problem statement is
therefore a very important device for keeping you on track with your research. It is also one
means by which your research will be evaluated – does the research address the problem as
stated. 5. Literature Review Literature review is an important part of any research. It gives a
foundation for the research by enlightening the researcher about the process. You need to
provide evidence that you are aware of the current trends and issues in your area of interest and
cognizant of the current state of knowledge on the subject. 18 5.1 Literature review as sources of
information Any research, no matter the scope of the research, requires reading about:  what
other people have done in the area of your interest,  how they have done it,  what are the gaps
in the research in that area Any new generation of knowledge is based on previous and existing
knowledge. To write about your findings you need to have information either to support or refute
your arguments. Ideally this reading should form the basis for choosing your research
methodology. Reading continues and spills over into the stage of data collection and analysis.
Some reading is naturally required at the stage of interpretation of the qualitative or quantitative
data to embed your research in its settings. Moreover, every new articles you read will have a
cumulative effect on the existing body of knowledge in your mind, pushing to you reinterpret or
rethink some of your previous assumptions or ideas. But there is a limit to the changes you can
make in your literature review. The best way is to prepare a first draft and then polish it at the
stage of data interpretation when you will be reading your literature review again to present your
analysis in a coherent manner with cross-references related to your literature review. 5.2
Important Reasons to review literature Some reasons for including a literature review in your
research paper/thesis are:  Essential preliminary task in order to acquaint yourself with the
available body of knowledge in your area of interest.  Literature review is integral part of entire
research process and makes valuable contribution to every operational step. Reviewing literature
can be time-consuming, daunting and frustrating, but is also rewarding. Its functions are: 19
Summary points of functions of Literature review Reason for Literature review Descriptions
Bring clarity and focus to research problem  Better understand the subject area  To
conceptualize research problem clearly and precisely  To understand the relationship between
research problem and the body of knowledge in the area  Contextualization shows awareness of
the work going on in field and identifies the niche to occupy Improve your methodology  If
similar procedures and methods others used to the ones that you are proposing,  to learn what
procedures and methods have worked well for them, what problems they have faced with them. 
To select a methodology that is capable of providing valid answer to your research questions
Broaden your knowledge  It ensures to read widely around the subject area to conduct the study
 As you are expected to be an expert in your area of study, it helps fulfill this expectation.  It
also helps to understand how the findings of the study fit into the existing body of knowledge.
Contextualize your findings  How do your answer research questions compare with what others
have found?  What contribution have been able to make in to the existing body of knowledge? 
How your findings different from those of others?  To answer these questions go back to
literature review  It is important to place findings in the context of what is already known in
field of enquiry. 5.3 Procedure for reviewing the literature: 1. Search for existing literature in
your area of study; 2. Review the literature selected; 3. Develop a theoretical framework; 4.
Develop a conceptual framework. 5.4 Sources of literature review Search for existing literature:
To effectively search for literature in your field of enquiry, it is imperative that you have in mind
at least some idea of broad subject area and of the problem you wish to investigate, in order to
set parameters for your search. 20  Articles in Journals  Books  Internet  Research Reports 
Government Documents  Abstracts  Reviews  Unpublished Theses  Electronic Research
Information Center/Social Sciences Citation  Index/Dissertation Abstracts Index Most of this
material is now available on the Internet. Libraries in established higher education institutions
are another rich resource for locating the required materials. 5.5 Review the literature selected:
After identifying books and articles as useful, the next step is to start reading them critically to
pull together themes and issues that are associated. If you do not have a theoretical framework of
themes in mind to start with, use separate sheets of paper for each article or book. Once you
develop a rough framework, slot the findings from the material so far reviewed into that
framework, using a separate sheet of paper for each theme of that framework. As you read
further, go on slotting the information where it logically belongs under the theme so far
developed. You may need to add more themes as you go. Read critically with particular
reference to the following aspects:  Note whether the knowledge relevant to your theoretical
framework is confirmed beyond doubt.  Note the theories put forward, the criticisms of these
and their basis, the methodologies adopted and the criticisms of them.  Examine to what extent
the findings can be generalized to other situations.  Ascertain the areas in which little or nothing
is known-the gaps that exist in the body of knowledge. 5.6 Writing up the literature reviewed In
order to comply with the first function of literature review i.e. to provide theoretical background
to your study: List the main themes that have emerged while reading literature  Convert them
into subheadings. These subheadings should be precise, descriptive of the theme in question, and
follow a logical progression. 21  Now, under each subheading, record the main findings with
respect to the theme in question, highlighting the reasons for and against an argument if they
exist, and identify gaps and issues.  In order to comply with the second function of literature
review i.e. contextualizing the findings of your study requires you to very systematically
compare your findings with those made by others. Quote from these studies to show how your
findings contradict, confirm or add to them. It places your findings in the context of what others
have found out. This function is undertaken when writing about your findings i.e. after analysis
of your data 5.7 Presenting the Literature Review Literature review is specific piece of writing
designed to inform readers of a topic, establish credibility as a researcher, and argue the need for,
and relevance of the research work. Most find it difficult task that takes patience, practice, drafts,
and redrafts (O’Leary, 2004:84) O’ Leary’s quote encapsulates the essence of the literature
review. You have to be certain that the review is adequate and sufficient. The literature review
should have a definite structure based on the arguments that you want to make or the task that
you want to accomplish through it. Prepare a blue print of the structure of your research. This
can be revised as your thinking evolves but a basic outline would help you to begin writing. You
can also use it to fill in the bits and pieces as your reading advances or your theoretical
perspectives develop. Use empirical evidence to substantiate your argument (Gay, 2000). This
will authenticate your carriage. Be judicious in the selection of relevant literature and avoid the
temptation to include every single source that you have accessed. Moreover, be careful to be
recent and up to date in citing. With the internet revolution, the pace of knowledge generation
and meaning making has multiplied manifold and access to the internet is also within reach. One
valid suggestion for writing a good literature review is to read a few well written literature
reviews. Because it will give an idea about how to go about it. Finally, literature review is an
ongoing process that overlaps other stages of your research. It will then support your arguments
and contribute to your analysis and interpretation of the data. In public health, literature review is
usually a separate chapter. Sometimes it is built into the introduction section. However, in
sciences, the literature review is usually part of the introduction. The role of literature remains
the same both in sciences and public health. 22 5.8 Sample Literature Review If you are doing
action research, a good way to begin your literature review would be to define what it is. Action
Research Action research can be defined as the process of studying a public health situation to
understand and improve the quality of public health services…. It is a systematic and orderly
way for public health experts to observe their practice or to explore a problem and a possible
course of action…. Action research is also a type of inquiry that is pre-planned, organized, and
can be shared with other public health experts. The world average infant mortality rate is about
42/1000 live births; and it varies from 3/1000 live births in some highly developed countries
such as Japan and Sweden to about 182/1000 live births in least developed countries such as
Afghanistan and Sierra Leone ( UN Inter-agency Group, 2011, Jupitor,2008). Some of the world
highest rates of infant mortality are found in sub-Saharan Africa, especially in West and Central
Africa where 92 deaths per 1,000 live births in 2009 ( UN Inter-agency Group,2011). In Eastern
and Southern Africa, infant mortality has fallen 33 per cent since 1990, from 103 deaths per
1,000 in 1990 to 69 per 1,000 in 2009. Table 1 summarizes the reduction of infant mortality rates
between the years 1990 and 2009 in different regions of the world. The development has been
slowest in subSaharan Africa as compared to other regions of the world. Moreover, the declines
of infant and Perinatal mortality were not uniform and varied greatly in size, timing, and pace in
this region. Table - Reduction of infant mortality rate (IMR) during 1990-2009 in the world
Region Reduction of IMR /1000 live births Sub- Saharan Africa 109 to 81/1000 West and
Central Africa 118 to 92/1000 Eastern and Southern Africa 103 to 69/1000 Middle East and
North Africa 57 to 32/1000 South Asia 89 to 55/1000 East Asia and the Pacific 40 to 21/1000
Latin Americans the Caribbean 41 to 19/1000 Central and Eastern Europe 42 to 19/100
Industrialized countries 8 to 5/1000 The world 62 to 42/1000 Source: Child Mortality report inter
agency group 2011 23 In Ethiopia, infant and Perinatal mortality rates remain high compared to
some eastern African countries. National level infant and Perinatal mortality rate was estimated
59 /1000 live births and 46/1000 births respectively (EDHS, 2011). Substantial variations in
infant mortality rates were also observed across the regional states in the country. Learning
Activity 1.3 After the delivered the lecture, if possible, take the students to the e-library; if not
possible, arrange 5 to 6 Published Articles. Make each of these Journal articles should be related
to one general theme. Use 5-6 themes such as women empowerment and higher education in
Ethiopia, gender equality issues, primary education, and socioeconomic issues and women
empowerment in Ethiopia. Give these sets of research ideas to different groups. Ask each
students to develop a research topic for himself/herself and then do a brief literature review using
the set of literatures provided to his or her group. Comment 1.3: Please read related literature to
the topics given above and synthesis literature part of your research topic. please follow steps
given in the main body of the literature to prepare your literature review. 5.9 Conceptual
frameworks Conceptual frameworks are sometimes called “research” or “theoretical”
frameworks. Conceptual frameworks take a broad view of the program itself in order to clarify
the relationship of its activities and its main goals to the context in which it operates. It is also a
useful tool for identifying and illustrating a wide variety of factors and relationships that may
affect program success. The design should show the interrelationships between all factors that
are relevant to achieving the program’s goals. These factors can be systems, organizations,
government or institutional policies, infrastructure, population characteristics, or other features
of the operational landscape that may help or hinder the program’s success. Constructing a
conceptual framework clarifies your assumptions about the causal relationships between
significant features of the program context, clarifying aspects that your planned intervention may
affect as well as other factors beyond your control. Identifying the variables that factor into
program performance, and organizing the explicit ways they interact with each other sets the
stage for outlining the objective results you can reasonably expect from your program activities.
Clarifying all of these issues is a critical step toward designing valid measures for analyzing, or
evaluating, the success of those interventions. A common tactic here is to ‘unpack’ your idea or
problem thus generating a range of possibilities before narrowing down on one or two themes.
Following the suggestions of Punch (1998) steps could be: 24 1. write down the all the concepts
involved, and all the sub-questions you can think of pertaining to the issue. Reading around your
research idea will help to generate questions and information and to identify themes and potential
information sources 2. subdivide your questions where possible; split wide general questions into
smaller ones 3. begin to order questions and develop focus: group questions together under
common themes, separate general and specific questions 4. start to trim by selecting those
questions that you wish to deal with, consider the resources that will be available to you 5.
collate these thoughts within a loose conceptual framework this shows how questions and themes
are related and may help guide your thinking at a later stage. This process of thinking wide and
then focusing and delimiting your questions, should result in a handful of research questions that
you wish to investigate. These may still need further modification to render them answerable;
they may need to be operationalize. Note: there are no right or wrong answers in such an
exercise; the purpose is to get you thinking about as many facets of your research idea as
possible. It should also cause you to question some of the concepts you might previously have
accepted as given. Learning activity 1.4 Develop conceptual framework for Get into groups of 4
or 5 students. • Develop conceptual framework for utilization of family planning/maternal and
child health services. • Identify factors that influence health service utilization • Arrange factors
into a conceptual framework • After 30 minutes, a member of each group will share the
framework with all participants Comment 1.4: See conceptual framework annexed at the end of
this module. 6.0 Managing the literature The bibliography/reference at the end of a recent article
or book can provide you with an adequate reading list of most relevant materials related to the
topic. Once 25 the relevant literature has been located and found through the sources suggested,
the next step is to manage it. This requires efficient and selective reading. Once you try locating
the relevant literature, you will discover that it is available in vast quantities. Now the primary
task is to pick out the material that is actually related and relevant to your research area. This
requires you to be a proficient reader who can get the gist of things quickly as you will have to
go through a lot of reading. In an article published in a journal, the first thing to do is look at the
abstract or summary of the article. This will give you an idea whether it is relevant for you. In
the case of a book you should look at the list of contents, the blurb, the summaries usually given
at the end of the chapters and the introduction. This will tell you quickly if any part is pertinent
for you. The next step is to follow a clear system of keeping track of your reading references.
You need to create a management system that will incorporate your sources with all relevant
details including a note about where you found that article or book. This means that you put
down that the article/book was on the shelf or in the library you have created. A number of
computer programs like Endnote, Procite, or Reference Manager are available to keep track of
your references. This will save a lot of hassle and futile finger biting at the end when you
desperately need a page number for a quote and cannot remember where you had found the
material. These programs can automatically format references in any number of styles once the
basic details have been entered. It is also useful to annotate your references. You can write brief
notes on the Index Cards. This will provide you with a methodical and organized review of
materials that you have read. It is a record of the accuracy, relevance, and quality of the sources
you have consulted. Your critical comment, that is your informed and considered evaluation, can
also be added. These annotations can be varying in length and content depending on the
pertinence of the material reviewed. It will minimize the time when you have to incorporate them
in your writing. 7. Formulating Research Questions, Hypotheses, And Objectives Research
questions If you have gone through the ‘brainstorming’ process described above you will
probably have a number of questions which are close to your requirements as research questions
they appeal to your interests and are likely to be answerable within your time and resource
constraints. Phrase your questions so that they are simple and clear. It is usually best to pose only
one or two questions. Do not pose more than three questions at a time because it leads to much
larger research project. Start questions with terms like, how, who, what, why, and when.
Questions should be specific, not vague. Example research questions  What factors determine
the quality of laboratory services? 26  Is there a relationship between the training of laboratory
personnel and the quality of their diagnosis?  Is the quality of laboratory diagnosis influenced
by high workload on laboratory personnel? The questions above represent wide differences in
scope and complexity and hence will make very different demands on research resources. Some
of these questions might later need to be modified to fit resources (abilities, time, finance,
equipment) while still addressing research problem. Research hypotheses What is a hypothesis?
A hypothesis is a tentative answer to a research problem that is advanced so that it can be tested.
When do we use a hypothesis? It is appropriate to use a hypothesis when you are testing a
theory. Definition of theory is very broad – it could be ‘an idea about how things relate to each
other’. If you have an expectation of how your research question will be answered (the outcome)
then it is fair to say you have a theory in mind. If you ask of your research question ‘What is the
expected outcome?’ and have an answer, you can ask why? What is my thinking behind this
prediction? This is essentially the theory that you will be testing. If you are not able to predict the
answer to your question then your approach is not one of theory testing and you should not
proceed with developing hypotheses to test. Your research questions remain as such. This will be
the case if your research is descriptive or exploratory in nature. Developing a hypothesis from a
research question Developing hypotheses requires that you identify one character, variable of a
sampling unit that causes, affects, or has an influence on, another character, variable of the same
or other sampling units. The character, variable that affects other variables or sampling units is
called the independent variable. The character, variable which is affected by the independent
variable is called the dependent variable or response variable. Note that although for the
purposes of research methodology some variables may be called ‘dependent’ when investigating
their relationship with other ‘independent’ variables, this does not imply the existence of a causal
(as compared with associative) relationship unless strict rules of research design are followed.
This issue is discussed in more detail later in the module. 27 Good hypotheses There are two
criteria for good hypotheses. One, hypotheses are statements about relationships between
variables. Two, hypotheses carry clear implications for testing the stated relationships. These
criteria mean, then, that hypothesis statements contain two or more variables that are measurable
or potentially measurable and that they specify how the variables are related. Research without
hypotheses In exploratory research our base knowledge of a subject may be so low that we
cannot formulate meaningful hypotheses. Nonetheless, exploratory research should be guided by
a clear sense of purpose. Instead of hypotheses, the design for the exploratory study should state
its purpose, or research objectives as well as criteria by which the exploration will be judged
successful. For example, if we would like to start and encourage mothers to make use of family
planning services, we may first need to know the social norms or cultural issues of the
community before we begin making meaningful hypotheses. We can state that our exploratory
study would have the purpose of generating hypotheses about personal characteristics which
correlate with the adoption/rejection of use of family planning services, the composition of the
decision-making unit, and the factors which influence the decision either to adopt or reject.
Success would be measured in terms of generating testable hypotheses. Interpretative research,
which seeks to develop knowledge through understanding meaning, does not usually proceed
with hypotheses. Research objective(s) What are the research objectives? In general, research
objectives describe what we expect to achieve by a project. Research objectives may be linked
with a hypothesis or used as a statement of purpose in a study that does not have a hypothesis.
Even if the nature of the research has not been clear to the layperson from the hypotheses, s/he
should be able to understand the research from the objectives. A statement of research objectives
can serve to guide the activities of research. Consider the following examples.  Objective: To
describe what factors mother take into account in making such decisions as whether to use a new
family planning services or not.  Objective: To develop a budget for reducing pollution by a
particular enterprise. In the above examples the intent of the research is largely descriptive.  In
the case of the first example, the research will end the study by being able to specify factors
which emerged in mothers decision. 28  In the second, the result will be the specification of a
pollution reduction budget. These observations might prompt researchers to formulate
hypotheses which could be tested in another piece of research. So long as the aim of the research
is exploratory, ie to describe what is, rather than to test an explanation for what is, a research
objective will provide an adequate guide to the research. Examples of research statements
Session summary In this introductory session of the module, you have learned about the different
definitions of research, why research is done, where it is conducted and what researchers use. At
the end of the section, you have acquired basic knowledge about research methods and skills
based on your educational background and professional experiences. You can easily differentiate
among perspectives on and approaches for classifying different research types. The classification
will help you understand different concepts related to research described in later sessions. In the
literature review, you have learned what a literature review is, and why review of literature is
necessary for any research. You have also been introduced to various sources for conducting
literature review. It is also discussed how literature review can be managed well. To facilitate
learning, a brief sample of annotation and a sample literature review are also provided. 29
Learning activity 1.5 Learning activity 1.5.1 Match the research types with the following
descriptions Learning activity 1.5.2: Assessment would be done through the outcome of the
activity of writing literature review as provided in the example above for your thesis desertions.
Learning activity 1.5.3: Identify the independent and dependant variables in the following
situation: A university teacher is interested in determining the best way to teach introductory
technology course, and ensure that her students have learned the material. Learning activity
1.5.4: Formulate hypotheses for the following two situations:  Situation 1: What effects does
viewing violence on television have on boys? 30  Situation 2: A sanitation department is nearby
and the smell is coming from the same direction.  The sanitation department does a series of
steps to process the sewage and wastewater.  Hypothesis: If
__________________________then___________________________. 31 Session two:
Quantitative Research Methods Session introduction This session describes how researchers
shall collect, organize and analyze data that are relevant to the purpose of the study. There is a
need to organize the methods section into logical subsections that illustrate the steps to be
followed during collection, organization and analysis of data. During proposal development, you
need to describe what you want to do using future tense. Original methods shall be described in
detail otherwise give references if you want to apply standard methods. When writing the
methods section, selection of the study design appropriate for the study objectives is usually the
initial task. The design itself guides how you should proceed with data collection, management,
and analysis. Mechanisms of maintaining the quality of data shall be considered from the
inception of the research project to the final write up of a scientific paper. If the methods section
of a proposal is carefully written, there will be little work later on during the write up of a thesis
report or manuscript because usually it is a matter of changing to past tense. Learning outcomes
When you have studied this session, you should be able to:  Identify the study design(s)
appropriate for different research objectives  Describe to which population groups study
findings could be generalized  Describe the minimum number of study units required for
different studies and how they can be selected  Describe the variables of a study and how they
can be measured  Describe the different data collection technique(s)  Develop a questionnaire
for data collection  Describe what issues need to be considered during the analysis of data 
Describe the mechanisms of maintaining the quality of data 2.1 Choosing study design Study
design is a logical model that guides the investigator in the various stages of the research
process. Once the researchers identify the study design, they will know how to proceed
conducting that research. There are different quantitative and qualitative study designs with their
own advantages and limitations. Selecting the appropriate study design shall be the first task of
the researchers after they know their objectives. This session will not present the details of the
different study designs. The learner shall refer the Epidemiology module to learn about the 32
quantitative research designs. Additionally, it is good if you refer other modules on qualitative
research to learn about the qualitative study designs. But, Session five of this module also
includes qualitative methods where there is slight touch of qualitative designs The following
criteria may be considered during selection of study design(s) 1) Research problem 2) Personal
experience 3) Resources available for the study 1) Research problem This is the major criteria
that should be considered during selection of study designs. For example quantitative designs
would be appropriate if the interest is:  estimating the prevalence of a specific condition in a
specific locality  assessing associations between the different independent variables and a
dependent variable  Assessing the effectiveness of a new drug, vaccine etc.... Major quantitative
designs include Cross sectional, Case control, Cohort, and Intervention studies. On the other
hand qualitative designs would be appropriate when: • the topic is new • the topic has never been
addressed with a certain sample or group of people, and • existing theories do not apply with the
particular sample or group under study Qualitative approaches allow room to be innovative and
to work more within researcher-designed frameworks. They allow more creative, literary-style
writing. The major qualitative study designs include ethnography, phenomenology, grounded
theory, participatory action research, and case study. 33 A mixed methods design is useful when
either the quantitative or qualitative approach by itself is inadequate to best understand a research
problem. Mixed methods are becoming popular. The integration of quantitative and qualitative
methods permits a more complete and synergistic utilization of data than do separate quantitative
and qualitative data collection and analysis The problems addressed by social & health science
researchers are complex. The interdisciplinary nature of research calls for mixed methods.
Formation of research teams with individuals having diverse methodological interests and
approaches is required. Mixed Methods Research Designs can be used for the following
purposes: 1) Validate findings using quantitative and qualitative data sources. 2) Use qualitative
data to explore quantitative findings. 3) Develop survey instruments. 4) Use qualitative data to
augment a quantitative outcomes study. 2) Personal experience Researcher’s personal training
and experience influence the choice of design. For example, an individual trained in technical,
scientific writing, statistics, and computer statistical programs and familiar with quantitative
journals would most likely choose the quantitative design. On the other hand, individuals who
enjoy writing in a literary way or conducting personal interviews, or making up-close
observations may prefer qualitative approach. The mixed methods researcher is an individual
familiar with both quantitative and qualitative research 3) Resources available for the study Diff.
types of study design are not considered equal in the strength of evidence they provide.
Investigators may not be able to select the design that gives a high level of evidence. The design
that gives a high level of evidence may not be feasible to do or ethical to do. For example
conducting prospective cohort study produces more valid data than cross sectional study or the
traditional type of case control study. Since conducting prospective cohort study is time
consuming and costly, researchers with 34 limited time and money may opt to apply study
designs which can be completed within short time period and minimal cost 2.2 Population In
epidemiological research, measurements are taken from few people and estimates are derived
from these measurements. All kinds of errors prior, during and after the study can be responsible
for bias in the final results. This bias can be caused by measurement errors, as well as through
poorly chosen source and study populations. Bias can also be introduced during the sampling
procedure. Given that epidemiological research is generally carried out with a limited number of
people, the generalizability of the results could be limited by these types of bias. A good sample
from a well-described study population is therefore very important. When planning research,
researchers need to consider the different groups of people ranging from target population to
sample population. Target population refers to the entire group of individuals or objects to which
researchers are interested to generalize the conclusions. But, because of practicalities, entire
target population often cannot be studied. The target population usually has varying
characteristics and it is also known as the theoretical population. The target population consists
of all the individuals at large, for example in Ethiopia, with the same characteristics as the actual
sample that will be included in the study. Sometimes target population is interchangeably used
with source population. Source population is the underlying population from which the subjects
will be drawn. E.g patient population of a hospital. Study population is the population to which
the researchers can apply their conclusions. This population is a subset of the target/source
population and is also known as the accessible population. It is from this accessible population
that researchers draw their samples. E.g Female patients who are older than 50 years admitted
with a diagnosis of diabetes mellitus. Sample population is a population selected and included in
the study. Samples are subsets of study populations used in research because often not every
member of study population can be measured. However, the results drawn from the investigation
of the sample are interpreted and applied directly to the study population. 35 2.3 sampling
techniques &Sample size determination 2.3.1 Research and Sample The term sampling refers to
strategies that enable us to pick a subgroup from a larger group and then use this subgroup as a
basis for making inferences about the larger group. The researcher's goal is always to generalize
about the population based on observations from the sample. Sampling strategies not only make
it possible to collect data from a smaller number of respondents, but these strategies also make it
possible to go into greater depth with this smaller number by asking more and deeper questions
or by following up the structured questions with more open-ended or qualitative questions than
would be possible with a larger group of respondents. When using such a subgroup to make
decisions about the larger group, the subgroup must be as closely representative of the larger
group as possible. Sampling techniques are useful when we want to know how a large group
would be described with regard to several variables, but there would be major added costs,
narrow restrictions on the number of questions that could be asked, or some other difficulty in
administering the data collection procedure to every member of the target population. If we
wanted to find out how many graduate students in entire university were interested in taking a
certain advanced course next semester, it would be difficult and expensive to ask every graduate
student this question. Even if we had a list of all their names, it would be difficult to get them all
to reply to a questionnaire. Finally, we would probably have time to ask only one question, and it
would be unlikely that we would be able to uncover the qualitative reasons behind interest or
lack of interest in the course. Similarly, if we wanted to know how many number of patients
showed progress after taking a certain drug in Ethiopia, we would find it a lot more convenient to
administer our test to a sample of patients than to interview every patients. This will bring us to
sampling 2.3.2 Sampling Strategy The manner in which a sample is drawn is an important factor
in determining how useful the sample will be for making inferences about the population from
which it is drawn. It is quite possible to have a very large sample upon which no sound decision
can be based. This occurs because the respondents in the sample are not really similar to the
population about which we want to make generalizations. To be useful, the sample must be
representative of the population about which we wish to make generalizations. 36 2.3.2.1 What is
Sampling? Sampling is the act, process, or technique of selecting a suitable sample, or a
representative part of a population for the purpose of determining parameters or characteristics of
the whole population. When dealing with people, it can be defined as a set of respondents
(people) selected from a larger population for the purpose of a survey. The purpose of sampling
is to draw conclusions about populations from samples, we must use inferential statistics which
enables us to determine a population`s characteristics by directly observing only a portion (or
sample) of the population. We obtain a sample rather than a complete enumeration (a census ) of
the population for many reasons. Obviously, it is cheaper to observe a part rather than the whole,
but we should prepare ourselves to cope with the dangers of using samples. There would be
difficulties to measure the whole populations because:  The large size of many populations 
Inaccessibility of some of the population: some populations are so difficult to get access to that
only a sample can be used. E.g. prisoners, people with severe mental illness, disaster survivors
and so on. The inaccessibility may be associated with cost or time or just access. 
Destructiveness of the observation: sometimes the very act of observing the desired characteristic
of the product destroys it for the intended use. Good examples of this occur in quality control.
For instance, to determine the quality of a fuse and whether it is defective, it must be destroyed.
Therefore if you tested all the fuses, all would be destroyed.  Accuracy and sampling: A sample
may be more accurate than the total study population. A badly identified population can provide
less reliable information than a carefully obtained sample. 37 Figure 1.1: Schematic presentation
of the process of sampling 2.3.2.2 Steps in Sampling Design There are steps that we need to
follow to get in to the respondents . The steps that we need to do are that:  What is the target
population? Define the target population and study population.  What are the parameters of
interest? Define the parameters of interest of the study.  What is the sampling frame? Select the
sampling frame.  What is the appropriate sampling method? Determine which sampling method
we are going to use depending on the setting of the population and the purpose of the study. 
Plan procedures to select the sampling unit  Determine the size of the sample which will be
selected from the population.  Select actual sampling unite  Conduct field work What you want
to talk Population Sample Sampling Frame Sampling Process What you actually observe in the
data Inference 38 2.3.3 Advantage and Disadvantage of Sampling Advantage of Sampling 
Sampling is a must in some situations: to diagnosis the patient for a certain diseases we don't
need to take the whole blood of the patient. In addition, if we want to inspect eggs, bullets and
missiles, we don't need to test all. This is possible only in sample study. Thus sampling is
essential when the units under study are destroyed.  It saves time: Research without sampling
might be too time consuming.  The population to be studied may be too large or unlimited that
it is almost impossible to reach all of them. Sampling makes possible this kinds of study. 
Sampling reduces the study population to a reasonable size that expense are greatly reduced. 
Sometimes the experiments are done on sample basis. The fertilizers, the seeds and the
medicines are initially tested on samples and if found useful, then they are applied on large scale.
Most of the research work is done on the samples.  Sampling saves the source of data from
being all consumed.  Sample data is also used to check the accuracy of the census data.
Disadvantage of Sampling  If sampling is biased, or not representative or too small the
conclusion may not be valid and reliable  In research the respondents of the study must have a
common characteristics which is that basis of the study  If the population is very large and there
are many sections and subsections, the sampling procedure becomes very complicated  If the
researcher does not possess the necessary skill and technical knowhow in sampling procedure,
then the outcome will be devastated. 2.3.4 Types of Sampling There are many methods of
sampling when doing research. One of the most important decisions that any researcher makes is
how to obtain the type of participants needed for the study. The sample that we draw for our
study determines the generalizability of our findings. As we have seen before, in most situations,
it is impossible to study an entire population. We typically study a subset of people drawn from a
larger population and use inferential statistics to make an inference from the sample back to the
population. The validity of that inference depends on how representative the sample or subset is
of the population from which it is drawn. Our goal, as researchers, is to 39 obtain the most
representative sample that we can. Some sampling strategies can get us pretty close to the
population, others have problems that might result in a biased sample. As we learn about
different sampling strategies, let's use the population drawn below as our starting point. When
we draw our sample, we want to have a good representation of all of the kinds of people in the
population. In General there are two methods of sampling: 1. Probability Sampling Method 2.
Non-Probability Sampling Method 2.3.4.1 Probability Sampling Method Probability sampling
strategies typically use a random or chance process, although there are important exceptions to
this rule. Random sampling is a strategy for selecting study participants in which each and every
person has an equal and independent chance of being selected. What does it mean to be
independent? The researchers select each person for the study separately. Let us say you were
asked to participate in an experiment, enjoyed it, and told your friends to contact the researcher
to volunteer for the study. This would be an example of non-independent sampling. We assume
that friends share similar values and by recruiting your friends to be in the study, the sample
might represent you and your friends but not the whole population of interest. The "equal
chance" and "independent" components of random sampling are what makes us confident that
the sample has a reasonable chance of representing the population. Where do we start? When we
use probability sampling, we begin by defining our population. Once we have done this, we must
have some sort of record or directory to use to select individual participants from the target
population. The sampling frame is the population as it is defined and available through records.
There are a number of probability sampling techniques that can be used depending on the types
of the population complexity we want to study. 40 Figure 2: Schematic presentation of
probability sampling methods A. Simple Random Sampling Simple random sampling is the most
straightforward of the random sampling strategies. We use this strategy when we believe that the
population is relatively homogeneous for the characteristic of interest. This sampling method has
the following properties.  The population consists of N homogeneous subjects.  There is frame
for the population  The sample consists of n subjects or objects.  All possible samples of n
subjects are equally likely to occur Procedures to select the sample How do we actually take a
random sample? The specific procedures that you follow may vary depending on your resources,
but all involve some type of random process. Depending on the complexity of the population, we
can use different tools to select n samples from the frame. These are lottery method, table of
random number (they are available in the appendix of many research methods and statistics
textbooks) or computer generated random number.  Lottery method is appropriate if the total
population is not too large, otherwise if the population is too large then it will be very difficult to
use lottery method. Sampling Methods Probability Sampling Techniques Nonprobability
Sampling Techniques Simple Random Sampling Systematic Sampling Stratified Sampling
Cluster Sampling Multistage sampling 41  Table of random number or computer generated
random number is the feasible method to be used. If computer is accessible, it will be very easy
to use computer generated random number to select the sample. What you need to do is that
specify the total population(N), the sample size (n) and the range of the frame (minimum and
maximum number.) At the end the computer will display the randomly selected list of numbers
according to the sample you specified. That will be your sample. There are a number of
computer programs which can generate the list of the sample for simple random sampling. Of
this, openepi is one of the free software that we can access from the web. The required
information to use this program are: lowest value, highest value, and the sample size you want to
draw. Figure 3: OpenEpi software to generate random numbers Example 1: Consider the
following condition. The total number of patients who visit Gondar University Hospital for the
last six months in the year 2015 were N. We want to see the proportion of TB among those
patients who visited the hospital. So if we thing that those patients who visited the hospital
within the specified time period are homogeneous with respect to the variable of interest and list
of the patients are available, then we can use simple random sampling to select the sample, n. B.
Systematic Random Sampling A method of selecting sample members from a larger population
according to a random starting point and a fixed, periodic interval. We use this sampling method
when the population is homogenous and frame is not available. 42 Typically, every nth member
is selected from the total population for inclusion in the sample population. Systematic sampling
is still thought of as being random, as long as the periodic interval is determined beforehand and
the starting point is random. It is frequently chosen by researchers for its simplicity and its
periodic quality. The procedure involved in systematic random sampling is very easy and can be
done manually and the results are representative of the population unless certain characteristics
of the population are repeated for every nth individual which is highly unlikely. Hence, in the
absence of frame, this method will be the appropriate choice. Steps in systematic sampling: 
Define the population  Determine the desired sample  List the population from 1 to N 
Determine K, where k = N/n  Select a random number between 1 and k, let us denote this
number by a  Starting at a, take every Kth number on the list until the desired sample is
obtained. Then the selected list will be a, a + k, a + 2k, a + 3k, …., Note that:  Since systematic
random sampling is a type of probability sampling, the researcher must ensure that all the
members of the population have equal chances of being selected as the starting point or the initial
subject.  The researcher must be certain that the chosen constant interval between subjects do
not reflect a certain pattern of traits present in the population. If a pattern in the population exists
and it coincides with the interval set by the researcher, randomness of the sampling technique is
compromised. C. Stratified Random Sampling Stratified random sampling is used when we have
subgroups in our population that are likely to differ substantially in their responses or behavior
(i.e if the population is heterogeneous). In stratified random sampling, the population is first
divided into a number of parts or 'strata' according to some characteristic, chosen to be related to
the major variables being studied. For example, you are interested in visual-spatial reasoning and
previous research suggests that men and women will perform differently on these types of task.
So, you divide your sample into male and female members and randomly select equal numbers
within each subgroup (or "stratum"). With this technique, you are guaranteed to have enough of
each subgroup for 43 meaningful analysis. Often we used simple random sampling to select a
sample from each strata after stratification. Figure 3: Characteristics of population and sample
for stratified sampling Steps involve in stratified sampling method:  Define the population 
Determine the desired sample size  Identify the variable and subgroups (strata) for which you
want to guarantee appropriate representation (either proportional or equal)  Classify all
members of the population as a member of one of the identified subgroups  Randomly select
(using simple random sampling) an appropriate number of individuals from each subgroup. Then
the total sample size will be the sum of all samples from each subgroup. There are two methods
to get the study subject from each subgroup, proportional allocation or equal allocation. We use
proportional allocation technique when our subgroups vary dramatically in size in our
population. For example, we are interested in risk taking among college students and suspect that
risk taking might differ between smokers and nonsmokers. Given increasing societal pressures
against smoking, there are many fewer smokers on campus than nonsmokers. Rather than take
equal numbers of smokers and nonsmokers, we want each group represented in their proportions
in the population. The subsample which will be taken from each subgroup can be determined by:
Let N be total population and N1, N2, …, Nk be the subtotal population for strata 1, 2, …, k
respectively. Moreover, let n be the total sample size and n1, n2, …, nk be the subsample for
strata 1, 2, …, k respectively in which: N = N1 + N + 2+, …,+NK n = n1 + n2+,…, +nk Then the
subsample ni which will be selected from subgroup Ni can be allocated equally or
proportionally. Proportional allocation cab ne done: 44 N nxN n i i  Where i = 1, 2, 3,…, k
Figure 4: Schematic presentation of the distribution of sample size for each strata The higher the
population in the subgroup, the higher the sample size will be. However, equal allocation will be
used if the total population from each subgroup is approximately equal. Advantage of stratified
sampling over simple random sampling:  It can provide greater precision than a simple random
sample of the same size.  Because it provides greater precision, a stratified sample often
requires a smaller sample, which saves money.  A stratified sample can guard against an
"unrepresentative" sample  We can ensure that we obtain sufficient sample points to support a
separate analysis of any subgroup. The main disadvantage of a stratified sample is that it may
require more administrative effort than a simple random sample. 45 D. Cluster Random
Sampling Cluster sampling is useful when it would be impossible or impractical to identify every
person in the sample. If the study covers wide geographical area, using the other methods will be
too costly. The idea is, divided the total population in to different clusters and then the unit of
selection will be cluster. Therefore, total population in the selected cluster will be taken as the
sample. Figure 5: Characteristics of population and sample for cluster sampling Steps in cluster
sampling are:  Define the population  Determine the desired sample size  Identify and define
a logical cluster (can be kebele, Got, residence, and so on)  Make a list of all clusters in the
population  Estimate the average number of population number per cluster  Determine the
number of clusters needed by dividing the sample size by the estimated size of the cluster 
Randomly select the required number of clusters (using table of random number as the total
number of clusters is manageable)  Include in the sample all population in the selected cluster.
46 There are different classification of cluster sampling; Figure 6: Illustration of cluster random
sampling. The main advantage of cluster sampling is that it saves time and money and hence it is
advisable to use this method if the study covers wide geographical area. Consider the following
graphical display: E. Multistage Random Sampling This is the most complex sampling strategy.
The researcher combines simpler sampling methods to address sampling needs in the most
effective way possible. For example, the administrator might begin with a cluster sample of all
schools in the district. Then he might set up a stratified sampling process within clusters. Within
schools, the administrator could conduct a simple random sample of classes or grades. By
combining various methods, researchers achieve a rich variety of results useful in different
contexts. 2.3.4.2 Non-Probability Sampling Method Most probability sampling strategies have a
random or chance component, though there are some important exceptions. It is this random
component that gives us confidence that our sample is a reasonably good representation of the
population. This random component can be time-consuming and expensive. Hence, in the
presence of constraints, the alternative sampling method is nonprobability sampling method.
Nonprobability sampling strategies are used when it is practically impossible to use probability
sampling strategies. This typically occurs because of time and expense constraints and the lack
of an adequate sampling frame. 47 Nonprobability sampling is also used when the frequency of
the behavior or characteristic of interest is so low in the population that a more targeted strategy
is needed to find sufficient numbers of participants for the research. Figure 7: Schematic
presentation of non-probability sampling methods A. Purposive Sampling Purposive sampling
targets a particular group of people. When the desired population for the study is rare or very
difficult to locate and recruit for a study, purposive sampling may be the only option. For
example, you are interested in studying cognitive processing speed of young adults who have
suffered closed head brain injuries in automobile accidents. This would be a difficult population
to find. Figure 8: Schematic presentation of purposive sampling Purposive sampling
Conveniences sampling Quota Sampling Snowball Sampling Nonprobability Sampling
Techniques 48 The major problem with purposive sampling is that the type of people who are
available for study may be different from those in the population who can't be located and this
might introduce a source of bias. B. Convenience Sampling Convenience sampling selects a
particular group of people but it does not come close to sampling all of a population. The sample
would generalize only to similar programs in similar cities. Convenience sampling is widely used
in student research projects. Students contact professors that they know and ask if they can use
their classes to recruit research subjects. Convenience sampling looks just like cluster sampling.
The major difference is that the clusters of research participants are selected by convenience
rather than by a random process. C. Judgment Sampling The researcher selects the sample based
on judgment. This is usually and extension of convenience sampling. For example, a researcher
may decide to draw the entire sample from one "representative" city, even though the population
includes all cities. When using this method, the researcher must be confident that the chosen
sample is truly representative of the entire population. D. Quota sampling It is the nonprobability
equivalent of stratified sampling. Like stratified sampling, the researcher first identifies the
stratums and their proportions as they are represented in the population. Then convenience or
judgment sampling is used to select the required number of subjects from each stratum. This
differs from stratified sampling, where the stratums are filled by random sampling. E. Snowball
sampling It is a special nonprobability method used when the desired sample characteristic is
rare. It may be extremely difficult or cost prohibitive to locate respondents in these situations.
Snowball sampling relies on referrals from initial subjects to generate additional subjects. While
this technique can dramatically lower search costs, it comes at the expense of introducing bias
because the technique itself reduces the likelihood that the sample will represent a good cross
section from the population. What we need to do in case of snowball sampling is that first
identify someone who meets the criteria and then let him/her bring the other he/she knew. 2.3.5
Sample size determination Determining the sample size for a study is a crucial component of
study design. The goal is to include sufficient numbers of subjects so that statistically significant
49 results can be detected. Statistically inconclusive findings make it difficult to determine
whether a particular treatment or intervention was effective and to identify directions for future
studies. Studies with insufficient subjects also may result in potentially important research
advances that go undetected. In statistical language, these studies are referred to as "under-
powered." That is, the probability that they will detect an existing treatment effect is lower than
optimal. Among the questions that a researcher should ask when planning a survey or study is
that "How large a sample do i need?". The answer will depend on the aims, nature and scope of
the study and on the expected result. All of which should be carefully considered at the planning
stage. In general, sample size depends on:  The type of data analysis to be performed  The
desired precision of the estimates one wishes to achieve  The kind and number of comparisons
that will be made  The number of variables that have to be examined simultaneously  How
heterogeneous the sampled population is The type of outcome variable under study should also
be taken in to account. There are three possible categories of outcome variables. The first is
where the variable of interest has only two alternatives response: yes/no, dead/alive,
vaccinated/not vaccinated and so on. The second category covers those outcome variable with
multiple, mutually exclusive alternatives responses, such as marital status, religion, blood group
and so on. For these two categories of outcome variables, the data are generally express as
percentages or rates. So we can use percentage to compute the sample size. The third category
covers continuous response variables such as birth weight, age at first marriage, blood pressure
and cerium uric acid level, for which numerical measurement are usually made. In this case the
data are summarize in the form of means and standard deviations or their derivatives. The
statistical method appropriate for sample size determination will depend on which of these types
of outcome variables the investigator is interested in. Deciding on a sample size for qualitative
inquiry can be even more difficult than quantitative because there are no definite rules to be
followed in qualitative study. It will depend on what you want to know, the purpose of the
inquiry, what is at stake, what will be useful, what will have credibility and what can be done
with available time and resources. You can choose to study one specific phenomenon in depth
with a smaller sample size or a bigger sample size when seeking breadth. 2.3.5.1 Sample Size for
Single Population Mean This is the condition in which the research question is about mean
(continuous variable). Three questions must be answered to determine the sample size: 50 1.
Standard deviation of the population: It is rare that a researcher knows the exact standard
deviation of the population. Typically, the standard deviation of the population is estimated: a.
from the results of a previous survey, b. from a pilot study, c. from secondary data, d. from
judgment of the researcher. 2. Maximum acceptable difference: This is the maximum amount of
error that you are willing to accept. That is, it is the maximum difference that the sample mean
can deviate from the true population mean before you call the difference significant. 3. Desired
confidence level : The confidence level is your level of certainty that the sample mean does not
differ from the true population mean by more than the maximum acceptable difference.
Commonly we use a 95% confidence level. Then the sample size determination formula for
single population mean is defined as: 2 2 2 2 ( )  Z  n  Where  n is the sample size for
single mean  α=The level of significance which can be obtain as 1-confidence level. 
σ=Standard deviation of the population  w=Maximum acceptable difference  Zα/2=The value
under standard normal table for the given value of confidence level 2.3.5.2 Sample Size for
Single Population Proportion This is the situation in which the variable of interest is categorical.
Three questions must be answered to determine the sample size for single population proportion:
1. Best estimate of population proportion of the variable of interest : Make your best estimate of
what the actual percent of the survey characteristic is. The possible source of this proportion are:
a. From the results of a previous study, b. From a pilot study, c. Judgment of the researcher. 51 d.
Simply taking 50% 2. Maximum acceptable difference: This is the maximum percent difference
that you are willing to accept between the true population rate and the sample rate. Commonly
we use a difference of 5 percent. That is, if your survey finds that 25 percent of the sample has a
certain characteristic, the actual rate in the population may be between 20 and 30 percent. 3.
Desired confidence level: How confident must you be that the true population rate falls within
the acceptable difference. This is the same as the confidence that you want to have in your
findings. If you want 95 percent confidence, you should enter 95. This means that if you took a
hundred samples from the population, five of those samples would have a rate that exceeded the
difference you specified in the previous question. 52 Then the formula for the sample size of
single population proportion is defined as: 2 2 2 ( ) (1 )  Z p p n   Where  n is the sample
size for single mean  α=The level of significance which can be obtain as 1-confidence level. 
p= Best estimate of population proportion  w=Margin of error or maximum acceptable
difference - The margin of error (w) measures the precision of the estimate - Small value of w
indicates high precision - It lies in the interval (0%; 5%] - For p close to 50%, w is assumed to be
close to 5% - For smaller value of p, w is assumed to be lower than 5%  Zα/2=The value under
standard normal table for the given value of confidence level - For α = 0.05 the Z0.025 = 1.96 -
For α= 0.1 the Z0.05 = 1.645 and so on Note that: The reason behind taking 50% proportion for
the variable of interest is that this is the value which gives the maximum product when we
compute the sample size. Hence try to find all possible effort to get the estimated proportion
from previous study. Example: A survey is being planned to determine what proportion of
families in a certain area are medically indigent. It is believed that the proportion cannot be
greater than 0.35. A 95% confidence interval is desired with w= 0.05. What sample size should
be selected for the study? Solution: 350 (0.05) (1.96) 0.35 (1 0.35) ( ) (1 ) 2 2 2 2 2      x x
Z p p n   The size 350 is not the final sample for the study. There are conditions that we have
to account. Different Some Considerations 53 The final sample size should consider the
following conditions:  Nonresponse, lost to follow up, lack of compliance and so on. Depending
on the sensitivity of the research problem, up to 15% nonresponse can be accounted.  Consider
the total size of the population (N): if N < 10000 then finite population correction formula can be
used which is defined by: N n n nf 0 0 1  Where nf=final sample size, n0=sample size from
the above formula and N=total population.  Design effect: Is a correction of bias in the variance
introduced in the sampling design, by selecting subjects due to the use of clusters. The design
effect can be calculated after study completion, but should be accounted for at the design stage. It
compares the variance of simple random sampling and variance of cluster sampling; n P P Var
SRS (1 ) ( )   ( 1) ( ) ( ) 2     k k p P Var Cluster i Then Design effect can be computed as
Var SRS Var cluster Design ( ( ) Effect  Where  p=global proportion,  pi=proportion of the
ith cluster,  n=number of subjects  k=number of strata The design effect is 1 (no design effect)
when taking a simple random sample. The design effect varies using cluster sampling; it is
usually estimated that the design effect is 2 in cluster sampling. 54 2.3.5.3 Sample size for two
population Equal Sample size for the Difference of proportions Here the objective of the study is
to check whether there is significant difference between two proportions coming from two
different population. The sample size to be taken from each group is assumed to be equal. Thus
the sample size which will be randomly taken from each group can be determined by: 2 2 1 2 1 1
2 2 1 / 2 ( ) ( )( ) (each group) p p p q p q Z Z n       Where:  p1 =current estimate of
population proportion P1 (Non-exposed or control group)  q1 = 1-p1  p2 = current estimate of
population proportion P2 (exposed or treated group)  q2 = 1- p2  Zα/2=the Z value
corresponding to the alpha error. This is the value at two tailed.  Zβ=the Z value corresponding
to the beta error. The Z value for beta is always based on one tailed test. So if beta is 0.05, 0.1,
0.2, or 0.3, then the corresponding z values are 1.65, 1.28, 0.85 and 0.52 respectively Example :
An investigator wants to determine if the fatality rate among cancer patients undergoing standard
therapy differs from the case fatality rate in cancer patients receiving new treatment. The case-
fatality rate among cancer patients undergoing standard therapy is 0.80, and is 0.60 for cancer
patients receiving a new treatment. Find the required sample size to test a hypothesis that the
case-fatality rate differed between groups at the stated level of significance, alpha = 0.05, and
desired power of the test, 0.90. Solution: From the given information, - p1 =0.60 - q1 = 1-
0.60=0.40 - p2 = 0.80 - q2 = 1- 0.80=0.20 - Zα/2 = 1.96 55 - Zβ = 1.28 388.4 (0.8 0.7) (0.7 0.3
0.8 0.2)(1.96 1.28) ( ) ( )( ) (each group) 2 2 2 2 1 2 1 1 2 2 1 / 2           x x p p p q p
q Z Z n   T hus, 389 standard treatment users and 389 new treatment users needed for the
study 2.3.5.4 Sample Size using Statistical Software As an alternative method, statistical
softwares calculate the sample size required for the study. There are many softwares which can
be used to determine sample size including Openepi, and EPI-Info. These are commonly used in
area of health because of their simplicity to use and understand easily. 56 2.4 Variables of the
study & operational definition A variable is defined as a characteristic of a person, object or
phenomenon, which can take on different values. When one tries to assess associations between
variables, there is a need to identify dependent and independent variables. Response (dependent,
outcome) variable is a variable which can be affected by explanatory/independent variables. On
the other hand, explanatory (independent, predictor) variable is a variable that explain the
response variable. Many variables can easily be measured but for some variables it is sometimes
not possible to find meaningful categories unless the variables are made operational with one or
more indicators. Operationalizing variables means that you make them measureable. For
example, if a researcher reported that 60% of the women are knowledgeable on family planning
methods, readers may have different understanding on this report unless there is standard
definition for it or operationally defined. Knowledge is not usually assessed by asking only a
single question. There is a need to develop a series of questions. The answers to these questions
form an indicator of someone’s knowledge on the issue which can then be categorized. For
example, if 10 questions were asked, you might decide that the knowledge of those with 0 to 3
correct answers is poor; 4 to 6 correct answers is satisfactory; and 7 to 10 correct answers is
good. 2.5 Data collection methods/techniques The commonly used data collection
techniques/methods include: • Using available information (Document review) • Observation •
Interviewing (face-to-face) • Administering written questionnaires • Focus group discussions
2.5.1 Using available information (Document review) Analysis of the information routinely
collected by health facilities is very useful for identifying problems. Researchers can also
identify other sources of available data like newspapers, published case histories etc. The major
advantage of available data is that collection is inexpensive. But, as a limitation, it is sometimes
difficult to gain access to records or reports. Additionally, data may not always be complete and
precise enough, or is too disorganized. 57 2.5.2 Observation Observation is a technique that
involves systematically selecting, watching and recording behavior and characteristics of living
beings, objects or phenomena Observation of human behavior can be undertaken in different
ways: A) Participant observation. Observer takes part in the situation he or she observes Eg. A
nurse hospitalized with fracture who now observes patient care practices in the ward she is
admitted B) Non-participant observation. Observer watches the situation, openly or concealed,
but does not participate Observation can give additional, more accurate information on behavior
of people than interviews or questionnaires. As observations are time consuming, they are most
often used in small scale studies. Observations can also be made on objects like observing the
presence or absence of latrines and the state of cleanliness 2.5.3 Interviewing It involves oral
questioning of respondents, either individually or as a group. Answers can be recorded by
writing them down, tape-recording, or a combination of both. Interviews can be structured,
unstructured, or semi-structured Structured interviews (standardized interviews). This type of
interview is often used in quantitative research. There is low degree of flexibility during the
conduct of interview. The same sets of questions are asked, in the same order, using the same
words, to different interviewees. Unstructured interviews These are interviews without
predetermined set of questions. It is often used in combination with observation Researchers and
interviewees talk freely. Interview is flexible and highly responsive to individual differences and
emerging new information. Researchers have to generate relevant questions based on their
interaction with the interviewees Semi-structured interviews (Guided Interview) In this type of
interview, researchers prepare interview guides that consist of a set of questions to initiate
discussion. Researchers generate other questions in interesting areas of inquiry during the
interviews. It is widely used as the qualitative interview method Qualitative Interview (In-depth
interview) Advantages of in-depth interview • Usually yield richest data • Permit face-to-face
contact with respondents • Provide opportunity to explore topics in depth 58 • Flexible according
to particular individuals or circumstances - allow explaining or clarifying questions
Disadvantages of in-depth interview • Expensive and time-consuming • Need well-qualified
(highly trained) interviewers • Interviewee may distort information due to the desire to please
interviewer • Flexibility can result in inconsistencies across interviews • Volume of information
too large; may be difficult to transcribe and reduce data 2.5.4 Administering written
questionnaires (self-administered questionnaire) Written questions are presented that are to be
answered by the respondents in written form. A written questionnaire can be administered in
different ways, such as by sending questionnaires by mail; gathering all or part of the
respondents in one place at one time, giving oral or written instructions, and letting them fill out
the questionnaires; and hand delivering questionnaires to respondents and collecting them later
Advantages of self-administered questionnaire • less expensive • permits anonymity & may
result in more honest responses • does not require research assistants • eliminates bias due to
phrasing questions differently with different respondents Disadvantages of self-administered
questionnaire • Cannot be used with illiterates • there is often a low rate of response • questions
may be misunderstood 2.5.5 Focus Group Discussion (FGD) One or two researchers and several
participants meet as a group to discuss a given research topic. This discussion is considered as
focused because it is guided by a set of specific topics (questions). Participants need to be
generally homogenous on particular characteristics of relevance to the topic. FGD encourages
group interaction where participants can influence and be influenced by others. FGD can be used
to complement other methods. It is important to develop culturally relevant questionnaire. The
number of participants in FGD should be small enough for everyone to have a chance to talk and
large enough to provide diversity of opinions (Usually 8-12 participants in one group) FGD is
preferable to that of in-depth interview when: 59 • Group interaction will help address the
research question. It bring out diverse points of view • Breadth of data is more important than
depth • Topic is not sensitive Advantages of FGD • Do not discriminate against people who
cannot read and write • Encourages participants reluctant to be interviewed • Participant
interaction helps weed out false and extreme views • Help researcher to know expressions and
slang Disadvantages of FGD • The results are more subject to interpretive bias and error •
Analysis process is more time-consuming • Investigator risks getting too much unnecessary
information 60 2.6 Questionnaire design A questionnaire is a research instrument consisting of a
series of questions for the purpose of gathering information from respondents. Researchers need
to consider two important procedures at the outset of constructing a questionnaire. These are
planning and piloting. Planning During planning, it is important to:  list the topics of interest in
relation to the aims of the study  collect appropriate and tested questions and scales  list
additional items and response formats that need to be developed Piloting The developed
questionnaire should be pretested on a sample of about 30-50 people depending on the
complexity of the items. The following issues need to be addressed in the pilot study/pretest • Is
each question measuring what it is intending to measure? • Is the wording understood by all
respondents • Are the instructions on self-administered questionnaires understood by all
respondents? • For closed questions, is an appropriate response available for each respondent? •
Are any questions systematically or frequently missed, or do some questions regularly elicit un-
interpretable answers? • Do the responses suggest that the researcher has included all the relevant
issues in the questionnaire? Questionnaire layout The questionnaire should be visually easy to
read and comprehend. The first few lines of a questionnaire usually include: • the label
‘confidential’, • the respondent’s serial (identification) number (to preserve anonymity), 61 • the
title of the study • a brief introduction Lower case letters should be used for texts. The
instructions for the respondent or interviewer should also be given clearly at the beginning for
example, whether answers are to be ticked, circled, written in or combinations. A thank you
statement should be given at the end of the questionnaire. Any filter questions that do not apply
to some respondents must be clearly labeled and all interviewers and respondents must
understand which question to go to next. Instructions about filter questions/skips are usually
printed for interviewers in the right-hand margin of the questionnaire. The following are
examples of filter question and skip 1a. Have you ever chewed chat? Yes__ No__ GO TO
QUESTION 2 1b. are you currently chewing chat? Yes__ No__ Question numbering and topic
ordering Questions must be numbered (1,2 etc), and sub-questions clearly labeled (e.g 1a, 1b
etc). A question and its responses should never be split over two pages, as this can lead to
confusion. The order of questions is very important that questions should not skip backward and
forward between topics. Each section of the questionnaire should form a module and be topic
based (e.g questions should be grouped together by subject). Provide linking sentences when
moving to new section/modules on the questionnaire for example, the next questions ask about
some personal behaviors Question forms Question form refers to format of the question (closed
or open-ended), and type of measuring instrument (e.g single items, batteries of single items or
scales). The comprehensiveness of response choices for closed questions is important. Closed
questions can be dichotomized (e.g yes/no response choices), multiple response (no restrictions
on the number of responses that can be ticked) or scaled (with one response code per response
frame permitted). 62 Structured interviews involve the use of fixed questions, batteries of
questions and/or scales which are presented to respondents in the same way, with no variation in
question wording and with closed qes (pre-coded response choices). Some structured
questionnaires will also include open-ended questions, to enable respondents to reply in their
own words. The more structured approach is only suitable for topics where sufficient knowledge
exists for largely pre-coded response formats to be developed Semi-structured interviews include
fixed questions but with no, or few, response codes, and are used flexibly, often in no fixed
order, to enable respondents to raise other relevant issues not covered by the interview schedule
Unstructured interviews are comprised of a checklist of topics, rather than fixed questions, and
there are no pre-codes Open questions Open-ended questions are essential where replies are
unknown, too complex or too numerous to pre-code. They are also recommended for developing
questions and measurement scales. The information collected is only limited by the respondent’s
willingness to provide it. It can be very informative as a method, but demanding for the
respondents. Most interview questionnaires include a combination of open & closed questions.
Open questions following closed questions are useful for probing for clarification of reasons and
explanations. Closed questions following open questions are of value on topics about which little
is known and where people are likely to be uncritical or influenced by social desirability bias if
presented too soon with response choices Disadvantages of open questions • replies can be
distorted by the coding process back in the office • They can be time consuming and difficult to
analyze • require more skilled interviewers and coders Closed questions Closed questions are
preferable for topics about which much is known. They are quicker and cheaper to analyze. Self
administered (e-g postal) questionnaire should be restricted to closed question because most
respondents will not bother to write their replies to open-ended questions. Pre-coded responses
always carry the risk that respondents’ replies are forced into inappropriate categories. Care is
needed when one is choosing the response choices for closed ended questions. There should be a
category to fit every possible response, plus include ‘other (specify)’ category if it is 63 felt that
there may be some unknown responses. Pre-coded numbers such as age groups need to be
mutually exclusive, comprehensive and unambiguous Form and under-reporting Pre-coded
response choices may be helpful if under-reporting is likely to be a problem. The list of
alternatives must be comprehensive to prevent under-reporting. With questions asking about
knowledge, open-ended questions are preferable to the provision of response choices in order to
minimize successful guessing. Postal questions should also be avoided when asking questions
about knowledge as they give respondents the opportunity to consult others, or to look up the
answers Question items, batteries and scales Single item questions Single item measures use a
single question to measure the concept of interest. Single item questions are imperfect indices of
attitudes or behaviors, as responses to one question can only be partly reflective of the area of
interest. Responses can also be affected by other factors, including question wording, social
desirability bias and interviewer bias, all of which can lead to measurement error Batteries
Batteries of questions are a series of single questions, each relating to the same variable of
interest. Each item is analyzed and presented individually, not summed together Scales Scales
involve a series of items about a specific domain that can be summed (sometimes weighted) to
yield a score. A more valid measure than a single item questions or batteries of single items is
obtained, because any individual item error or bias tends to be cancelled out across the items
when averaged or summed. Items on the scale should differ in content i.e they should all express
a different belief about the area of interest, or different aspects of the behavior so that they will
not all be limited by the same types of errors or question bias. Scales also permit more rigorous
statistical analysis. Researchers usually aim to provide single score, partly because they are
easier to analyze and apply. The simplest method of combining scale items is to add the item
response scores. For knowledge questions each correct answer can be given a value of 1 and
each incorrect answer allocated 0, and the items added to form a score. With scaled responses a
numerical value can be attached to each class, such as strongly agree=4, agree=3, disagree=2,
strongly 64 disagree=1. Many investigators allocate a middle scale value to ‘no opinion’ (e.g
‘neither agree nor disagree) responses, as in Likert Scale. In this case, the scale values would be:
strongly agree=5, agree=4, neither agree nor disagree = 3, disagree=2, strongly disagree=1. The
crude addition of scores, which results in all items contributing equally to the multi-item scale
score, makes the assumption that all items are of equal importance. If some items are regarded as
more important than others, they should be weighted accordingly (their scores are multiplied by
X to enable them to count more) Likert scale Likert scales are the most popular for the
measurement of attitude. It contains a series of ‘opinion’ statements about an issue. The person’s
attitude is the extent to which he or she agrees or disagrees with each statement, usually on a
five-point scale. It is conventional for high numbers to signify favorable evaluation. Scoring is
reversed where necessary. The total attitude score is the sum of the responses 65 2.7 Planning
data analysis & choosing statistical techniques 2.7.1 Data processing Data processing refers data
entry into a computer, data checks and correction, variable coding, and data cleaning. The aim of
this process is to produce a relatively clean dataset. Data Entry Data entry concerns the transfer
of data from a questionnaire to a computer file. It is converting data into a form that can be read
and manipulated by computers used in quantitative data analysis. The collected data should be
entered in to a data entry form which is prepared in one of the software. It is possible to enter
data in almost all statistical softwars. However, some of these softwars do not have controlling
mechanism for mistakes during when we create data entry template. Softwars like EPI-Info and
EpiData have the feature of mistake controlling mechanism, whereas SPSS, STATA, R or SAS
are powerful for analysis. Thus, it is advisable to use one of this software for data entry and then
export the data to other software for analysis. Before analysis, data must be checked for errors,
outlying observation, missing observation, and data that needs coding must be coded. If there are
outlying or/and missing observations, handling mechanism should be used. Deleting such
observation before formal statistical test will introduce bias. Data coding In general computers
are at their best with numbers. Some statistical packages cannot analyze alphabetic codes, some
cannot understand open ended responses. We must translate variables through coding. Coding is
assigning a separate (nonoverlapping) numerical code for separate answers and missing values.
For instance, instead of using male and female for the variable gender, it can be indicate by
number 1=Male and 2=Female. Numerical variables can be also transformed in to categorical
variable through coding. When you transform numerical variable to categorical, the choice of the
cutoff value should not be arbitrary. Rather, the cutoff values need reference and scientific
justifications. Data Cleaning No matter how carefully the data have been entered some errors are
inevitable. Data cleaning is need after data entry process is completed. The aim of this process is
to produce a clean set of data for statistical analysis. 66 2.7.2 Plan for analysis Data analysis plan
is critical because it tells the reader what analysis will be conducted to examine each of the
research question. In the data plan, cleaning, transformations, and assumptions of the analyses
should be addressed, in addition to the actual analytic strategy selected. We do data analysis to
get answer for the research question we plan answer. The study may have more than one
research question which can be stated as: - Primary research question - Secondary research
question The appropriate methods of data analysis are determined by your data types and
variables of interest, the actual distribution of the variables, and the number of cases. Different
analyses of the same dataset may reflect or represent different aspects of the underlying data
structure. Plan of Data analysis could contain any combination of the following types of data
analysis strategies: • Exploratory data analysis: This type of data analysis often occurs when a
program is new, and it is unclear what to expect from the data. • Descriptive data analysis: The
most common type of data analysis, this approach will summarize your findings and describe the
sample. • Inferential: Inferential statistics allow us to draw conclusions about the larger
population from which the sample is drawn. These powerful techniques may be able demonstrate
if a change has occurred as a result of your program. The purpose of analyzing data is to obtain
usable and useful information. The analysis, regardless of whether the data is qualitative or
quantitative, may: • Describe and summarize the data. • Compare variables • Identify
relationships between variables. • Forecast outcomes 2.7.2.1 Descriptive statistics When data
have been clean and checked, the next explanatory step is to examine the distribution of each
variable. The distribution of each variable should be explored where distribution refers to the
way data are distributed, in order to draw conclusions about a set of data. With continuous
variables, the aim is to determine whether or not normality may be assumed. If not we may wish
to consider transforming the variable, or may wish to categorize the variable for analysis (e.g.
age groups). With categorical variables, we obtain the frequency distribution of each variable.
Based on the distribution, we may wish to amalgamate certain categories for analysis. The
probability distribution of a categorical variable tells us with what probability the variable will
take on the different possible values. 67 The characteristics of categorical variables can be
described by charts or frequency table. There are variables which need to be described by charts
and there are variables which are appropriately described using table. Table 1: Nutritional status
of Adult people living with HIV/AIDS on ART at Achefer Woreda,June 2015,(N=315). Variable
Frequency % BMI(kg/m2) =50 10 19 1.84(0.84, 4.024) 2.326(1.016,5.32 4) INH Prophylaxis
Yes 3 30 2.27(0.712,7.22) * No 64 259 1 WHO clinical T staging at switch I/II 20 107 1 III 29
143 0.845(0.47,1.49) 0.96(0 .52, 1.745) IV 18 39 1.59(0.83, 3.04) 2.58(1.297, 5.14) CD4 cell
count =100cells/mm3 20 114 1 NRTI at first line ART start D4T 29 104 1 AZT 15 137
0.86(0 .5,1.47) * TDF 13 48 1.8(0.916, 3.56) * 78 Note that: The covariate age, WHO stage, and
CD4 cell counts were significant predictors of treatment failure. 2.3 Data quality assurance The
term quality refers to being fit for the purpose. Data quality assurance includes all those planned
and systematic actions necessary to provide adequate confidence that a data product will satisfy a
given set of quality requirements. Many aspects of data collection can impact the quality of the
data, including completeness and clarity of questionnaires, the interviewer's delivery, the
accuracy of mechanical instruments, and technicians' measurement techniques. Other errors can
be introduced into the data after the data are collected, during transcription, at data entry, and
data manipulation for analysis. Minimizing all of these potential sources of error is very
important the planning and implementation of any study. Quality assurance Quality assurance
consists of those activities undertaken prior to data collection to ensure that the data are of the
highest possible quality at the time they are collected. These activities include the development
of the study protocol, development of the data entry and data management systems, training of
data collection personnel, and testing of data collection procedures. The major component of
quality assurance is the development of the study protocol and the creation of manuals
documenting the protocol. Careful design of data collection instruments, including content,
format, and step-by-step instructions for completion of the instrument are necessary. Procedures
should be designed to ensure that the data being produced are reliable and valid. Limitations of
various types of instruments should be considered during development so that potential problems
can be identified and mitigated. All aspects of the protocol must be documented in a manual of
operations. This document should be viewed as the official study reference document for data
collection staff and should contain all details of data collection procedures. Collection of
accurate data is only the first step. It is equally important that errors are not introduced in the
process of converting the data to electronic format. For some forms it may be desirable to have
the form reviewed and edited before data entry. The purpose of this review would be to ascertain
that the form was complete, that skip patterns were followed, and that any data values that
seemed inconsistent or looked like possible errors were checked before being entered. Double-
data entry is one strategy to catch and correct any data entry errors from the original entry. 79
Once all protocols have been developed and documented, the next step is to train study personnel
to implement the procedures. Training result in standardization and can lead to reduced costs
over time. The final step in the quality assurance process is to test all procedures that have been
developed. This is often done by means of a pilot study in which the entire protocol is performed
on volunteers who are similar demographically to the anticipated study subjects. The pilot study
should encompass all aspects of the protocol Quality control Once data collection begins, the
quality control procedures developed as part of the quality assurance process must be
implemented. The goal of these quality control procedures is to identify and correct errors in the
data both during and after data collection. The quality assurance procedures developed during the
planning phase for monitoring performance must be implemented. Frequently, studies establish
procedures for identifying problems but fail to establish adequate procedures for ensuring that
the problems are resolved. Items to monitor may include the following: 1) Recruitment.
Coordinating person or group shall check whether enrolled participants meet all eligibility
criteria (e.g., gender, education status etc). 2) Performance of data collectors. Data should be
analyzed regularly to assess the performance of data collectors. Evidence that a specific data
collector’s data deviate significantly from the group as a whole should be reported and
investigated by the quality control coordinator/supervisor. 3) Data clean-up. Data should be
analyzed routinely for problems such as extreme or inconsistent values. In longitudinal studies,
for example, if a participant's weight is entered as 60 kg one year and 98 kg the next, it is likely
that one of these values is an error which should be checked. 4) Replicate measures. Multiple
measures taken at one point in time can be used both to identify possible data errors and to
calculate more accurate measures. For example, multiple blood pressures are often taken during
one study visit and averaged in order to give a more accurate value of the participant's blood
pressure. Combining multiple measurements by averaging serves to provide more accurate
estimates of true data values and to minimize measurement error. 80 Session summary Research
methods section of a protocol is the section which shall describe how researchers collect,
organize and analyze data that are relevant to the purpose of the study. When writing the
methods section, selection of the study design appropriate for the study objectives is usually the
initial task. Selection of a specific study design depends on the research problem, personal
experience, and resources available for the study. Research problem is the major criteria that
should be considered during selection of study designs. Quantitative study designs would be
appropriate when the interest is quantifying the occurrence of a problem and assessing
associations between dependent and independent variables. On the other hand, qualitative
designs would be appropriate when the topic is new or has never been addressed with the
particular group under study. A mixed methods design is useful when either the quantitative or
qualitative approach by itself is inadequate to best understand a research problem. Researcher’s
personal training and experience also influence the choice of design. An individual trained in
technical, scientific writing, statistics, and computer statistical programs and familiar with
quantitative journals would most likely choose the quantitative design. On the other hand,
individuals who enjoy writing in a literary way or conducting personal interviews, or making
upclose observations may prefer qualitative approach. Investigators may not be able to select the
design that gives a high level of evidence. The design that gives a high level of evidence may not
be feasible to do or ethical to do. The population to be included in the study should be carefully
selected so that as far as possible it should be able to generalize the study findings to a bigger
population i.e target (source) population. Selection of adequate sample by probability sampling
techniques would enable to generalize the findings to the source population. Sample size should
be large enough to address the different objectives of the study. When one tries to assess
associations between variables, there is a need to identify dependent and independent variables.
For some variables which can’t be easily measured, for example by asking a single question,
operational definition is necessary. You need also to identify a data collection technique which is
appropriate for your study purpose and provide more valid data. The commonly used data
collection techniques include document review, observation, interviewing, self administered
questionnaire, and focus group discussion. The most commonly used data collection tool is
questionnaire. Questionnaires need to be carefully prepared and pre-tested/piloted. A variable
can be measured by using single item question, batteries of questions, or scales. The plan for data
management shall reflect issues like which software packages will be used for data entry and
analysis, what will be analyzed, which statistical tests will be used, which measures of
association will be computed, what methods will be applied to control confounding etc. You
should also describe how you will be assuring the quality of data. The activities applied for
quality assurance include careful development of the study protocol, development of the data
entry and data 81 management systems, training of data collection personnel, and testing of data
collection procedures/tools. 82 Learning activities for session 2, Part 1 Read the following thesis
proposal carefully and answer the questions that follow. Some parts of the proposal are
deliberately omitted for the sake of the exercise Research proposal title: Determinants of Non-
adherence to Antiretroviral Therapy Among HIV- Infected Adults In Aksum Town, Northern
Ethiopia: Unmatched Case – Control Study Objectives: To identify determinants of non-
adherence to Antiretroviral Therapy among HIV infected adults on ART. METHODS AND
MATERIALS Study design: Institution based unmatched case control study design will be
carried out. Source Population: Source population will be HIV/AIDS positive adults who are on
ART in Aksum town. Study Population: The study population will be HIV/AIDS positive adults
who are on ART in Aksum town during the study period. Sample size calculation: The sample
size will be computed by Kelsey formula in Epi Info version7 StatCalc for un-matched case
control study. 5% type I error, 80% power and 1:2 ratio of non-adherent cases to adherent
controls will be used. From previous studies, percent of controls exposed, Odds Ratio and
percent of cases exposed to determinant of non-adherence to ART will be employed to carry out
sample size based on table-1 below.

QUALITATIVE RESEARCH METHOD Session Four: INTRODUCTION TO QUALITATIVE

RESEARCH INTRODUCTION One of the objectives of the CMHS is “to carry out relevant
basic and applied researches for the advancement of knowledge and improvement of health care
system of the country”. This is also emphasized in the educational principles of the college that
“Providing curricula and teaching programs that are Community Oriented that enable a graduate
to identify health problems of the community and to improve patterns of health care”, which
could not be practical without performing researches. Based on this principle many basic and
applied researches had been and are being performed by the academic staff and students.
Majority of the researches follow that of quantitative methods rather than qualitative methods. It
is high time to produce a learning material that will enable staff and students to develop
knowledge and skill on qualitative research method. This session is meant to contribute towards
the development and improving the status of researchers in qualitative research. Qualitative
research nowadays is growing and applied in many basic and applied researches. Many texts are
produced on how to go about it. This session is mainly focuses on the introduction of qualitative
research in particularly focusing on the scope, principles and characteristics. LEARNING
OUTCOMES At the end of this session, you should be able to: 4.1. Understand the extent,
purpose or intention of qualitative research in conducting research, 4.2. Identify the rules or
beliefs governing a qualitative research, 4.3. Identify the feature/quality/typical nature of a
qualitative research. 97 4.1. THE SCOPE OR THE EXTENT OF QUALITATIVE RESEARCH.
Qualitative research provides an in-depth understanding of human behavior and the explanation
behind it. It also explores using the why and how questions. It is a method of naturalistic enquiry
aiming to study people in their natural social settings and to collect naturally occurring data. The
focus is on the meanings the participants in the study setting (i.e. in the field in their natural
settings), attach to their social world. Qualitative research describes in words rather than
numbers the qualities of social phenomena through different methods such as observation,
interviews, diary methods, biography, focus group discussions, etc. Qualitative research methods
allow the researcher to work with the primary and secondary data (transcribed from interviews,
observational notes, and documents), to explore the nature of the stories people tell or the way
they behave to look at the different perspectives, understandings and interpretations that social
beings bring to each social situation in which they participate. The researcher’s role is to listen,
observe, theory test (in the case of interviews), and then interpret or make sense of what she/he
sees and hears. As the extent and nature of the data cannot be known before they are collected,
the process of collecting and analyzing qualitative data often intermingle. The collection of some
data from perhaps a small number of in-depth interviews may be followed by analysis, which
then helps the researcher to identify further data that are needed to test out or develop his/her
preliminary interpretations. The researcher is in close touch with the real situations of the data,
close to the ground. HISTORY Short history of the development of qualitative research:  Until
the 1970’s used only to refer to a discipline of anthropology and sociology.  During the 1970s
and 1980s Qualitative Research began to be used in other disciplines, such as studies of
educational, social works, management, political sciences, health services, etc.  In the late
1980s and 1990s new methods of Qualitative Research evolved, to address the perceived
problems with reliability and imprecise modes of data analysis.  In the last thirty years the
acceptance of Qualitative Research by journal publishers and editors has been growing. 
Original meanings: qualitative originated from a Latin word Qualitas which means consistency,
nature, feature, attribute, and condition. Qual describes 98 as observable condition, composition
of systems, processes and their features. It is expressed as language. DEFINITION OF
QUALITATIVE RESEARCH Different scholars on the field define qualitative research in many
ways.  It is a study, which is conducted in a natural setting where the researcher, an instrument
of data collection, gathers words or pictures, analyzes them inductively, focuses on the meaning
of participants, and describes a process that is both expressive and persuasive (=sound reasoning)
in language.  It aims to gather an in-depth understanding of human behavior and the reasons
that govern such behavior.  It is needed to provide insights to people’s life style, behavior, their
knowledge, their feelings and attitudes, their opinions and experience.  The Qualitative
Research method investigates the why, what, and how of decision making, not just how
much/many , where, when, and how often.  Qualitative research methods are methods for
collection, analysis, and interpretation of data on phenomena that are not easily reduced to
numbers or that might be destroyed by an attempt to do so THE AIMS OF QUALITATIVE
RESEARCH Qualitative Research - Helps to discover the range, psychological nature, motives,
behavior, rather than measuring their incidence or rationalized opinions. - Allows people to
contribute and share their views and feelings in a conversational format. - Is a method of
naturalistic enquiry; - Aims to study people in their natural social settings and to collect naturally
occurring data; - Describes in wards rather than numbers; - Is multi-methods in focus; - In
general, it enables us to make sense of reality, describes and explains the social world, and
develops explanatory models and theories. Essential Features of Qualitative Research The central
ideas guiding qualitative research are different from those in quantitative research. The essential
features of qualitative research are the correct choice of appropriate methods and theories; the
recognition and analysis of different 99 perspectives; the researchers' reflections on their research
as part of the process of knowledge production; and the variety of approaches and methods.
Preliminary lists of Qualitative Research Features are: • Appropriateness of methods and theories
- The object under study is the determining factor for choosing a method and not the other way
round. - qualitative research's central criteria depend on whether findings are grounded in
empirical material or whether the methods are appropriately selected and applied, as well as the
relevance of findings and the reflexivity of proceedings • Perspectives of the participants and
their diversity. • Reflexivity of the researcher and the research. • Variety of approaches and
methods in qualitative research. WHY AND WHEN TO USE QUALITATIVE RESEARCH?
The following Reasons could call for a Qualitative Inquiry: • Topics that need to be explored:
This is a situation where variables cannot be easily identified; theories are not available to
explain behavior of participants/their population of study. • Need to present a detailed view of
the topic. • Not enough to present answers to the problem. • Need to study individuals in their
natural setting. • Need to write in a literary style: This is where the writer engages a story telling
form of narration. • Where there is sufficient time and resources on the extensive data collection
in the field and detailed data analysis, • The nature of research question: In a qualitative study,
the research questions often starts with a how or a what; and The Roles of Qualitative Research
in Public Health A. Understand success or failure of a program Read the following published
research paper entitled “If you want to know, Ask Them: A Modern Fable” (Fable= a short story
that teaches a lesson or truth) and answer the questions below. 100 QUESTIONS ON
EXERCISE I. If You Want to Know, Ask Them: A Modern Fable 1. What was the main
problem/s that induced the researcher to conduct this research? Exercise I. If You Want to Know,
Ask Them: A Modern Fable A country plagued with high rates of STI and low condom use
invited a team of experts to introduce a new contraceptive option: the female condom. This new
barrier device, they argued, was an effective alternative to the male condom and would at last
give women the control they needed to protect themselves or their partners against infection.
Working with local counterparts, the team initiated a program to strengthen STI prevention and
treatment services, inform people about the female condom, train providers in its use, stock the
shelves of clinics and dispensaries, and recruit lay outreach workers to carry the message to
women in the communities. Six months later, encouraging results showed that rates of infection
had dropped; women and men were indeed seeking treatment for STI symptoms. Twelve months
later, treatment rates were still up, but rates of new infection were not declining as expected. The
team was forced to conclude that introduction of the female condom was not a cost-effective
strategy because it had little sustained impact on the incidence of STI. The team leader, however,
began to suspect that there might be more to the story. She invited a social scientist with
qualitative research skills to investigate further the failure of the female condom to lower STI
rates. This researcher designed a follow-up study that used in-depth interviews, focus groups,
and clinic observation to explore the meaning of the new device to different community groups.
He and his trained interviewers soon learned that clinicians were not distributing the female
condom because they feared being accused of lacing the condoms with HIV virus – a rumor that
was circulating in the community. Data from providers about the popular belief that the female
condom could carry HIV were reinforced by comments from women in the communities.
Talking with women revealed that most women knew about the method but did not ask for it,
believing that providers who rarely suggested it) either did not have it or thought it was
ineffective or even dangerous. In both men’s and women’s focus groups, participants discussed
what the female condom meant to them. Men were candid in their criticism of giving women
control over pregnancy and therefore license to engage in extramarital affairs. They surprised the
researchers with their anger at a program that “encouraged promiscuity” while claiming to
promote reproductive health. Some even questioned the motives of women “who would want to
collect a man’s semen” in a condom. Against a backdrop of cultural beliefs in the power of
witchcraft to bring harm to one’s enemies, men’s anxiety concerning illicit use of female
condom was a serious and understandable obstacle to the program. Women felt caught between
program messages urging them to try the female condom and partner resistance. Although most
were attracted to the idea of independent protection, they also understood that control carried it’s
on risks. By accepting the female condom, they possibly would trade the risk of infection for the
risk of abandonment by partners who could them of infidelity. Listening to people tell how they
made their decisions gave program developers the information they needed to understand and
address specific social and cultural issues in female condom promotion. But even more important
was the realization that the forces motivating sexual and reproductive decisions are complex and
often more powerful than competing health promotion messages. We may not know why some
programs succeed and others fail, but the simple lesson from this situation is that if you want to
understand how and why people make the decisions they do, ask them. 101 2. What was the first
strategy did the researcher used? 3. What were the activities performed to implement the first
strategy? 4. How was the result? 5. Why was the female condom not a cost-effective strategy? 6.
What action did the researcher took after the first result? 7. What research design implemented
by the new team? 8. What were the new findings? 9. Why do people not use the health facility?
10. Why has the female condom not the same success of the male condom? 11. What is the
recommendation of the researcher? B. Prepare the Implementation of a Programme (informs
actions) C. Refine the Implementation of a Programme - Enhances decision making. D.
Additional applications: - Identify attributes to be included in a questionnaire. - Explain results
from quantitative research. 4.2. The Principles that govern in the utilization of qualitative
research. Key features of qualitative methodology Qualitative research is humanistic because it
focuses on the personal, subjective, and experiential basis of knowledge and practice. It is
holistic because it seeks to situate the meaning of particular behaviors and ways of doing things
in a given context. READING ASSIGNMENT I. Read the Published Research Paper entitled as
Maternal health care professionals' perspectives on the provision and use of antenatal and
delivery care: a qualitative descriptive study in rural Vietnam on Page 75. 102 Qualitative
researchers are constantly trying to make sense of what they see and hear in a specific context;
their approach to understanding what is going on is interpretive, in other words, their aim is more
often to explain rather than to merely describe. How the data gathered on people’s experiences
are interpreted depends much on the researcher’s theoretical presuppositions and background.
Qualitative researchers, more than quantitative researchers, generally adopt a reflexive position
vis-à-vis their research, in other words, they are explicit about how their personal history and
biography shape the questions asked, the framing of the research and the presentation of data.
These four characteristics of qualitative research require a different methodological approach.
Methods in qualitative research are generally open-ended and in-depth, and naturalistic, that is,
they attempt to study things, people and events in a natural (non-experimental) setting. The
methodology is flexible because it may use multiple methods to examine the same question or
area (‘triangulation’) and iterative, refers to questions or studies that are repeated over time with
the same informant or group of informants. This is feasible when a researcher has access to the
same informant over the course of a study, and is useful when new questions arise, or the
researcher wants to go back and check some of the data s/he has analyzed. The Nature of
Qualitative Research Qualitative research is the main method used by anthropologists in
participant observations and/or qualitative interviewing of members of a culture (ethnography),
and by social scientists whose approach is rooted in a phenomenological perspective. It
originates in social anthropology and mainly concerned with developing explanations of the
social world. In opposition to positivist thinking which dominates quantitative research, it
predicted upon the socially constructed nature of reality. The two main paradigms in the social
sciences are Naturalism that provides the theoretical basis for qualitative approaches and
Positivism that provides the theoretical basis for quantitative approaches. The Main Features of
Naturalism  Social world should be studied in its natural state.  World cannot be understood as
a set of causal relationships because human actions are based on meanings.  Getting close/ focus
on the micro – about sharing life of those being studied to share people’s interpretations of their
world.  Theory generating or emphasis on induction. Researcher does not describe the
phenomena using pre-determined categories. Inductive reasoning begins with observations and
builds up general statements and hypotheses from them for testing. A holistic approach – open to
gathering any data that will shed light on the problem. The natural scientist systematically
observes and measures the behaviour of matter and the 103 results of these investigations are
regarded as ‘facts’; these are believed to be undistorted by the value judgement of the scientist.
The Main Features of Positivism The method of investigation used depends on the investigator’s
assumptions about society. A considerable body of social science is directed by research methods
drawn from the natural science. This approach is known as positivism. Positivism aims to
discover laws using quantitative methods and emphasizes positive facts. Thus, positivism
assumes that there is a single objective reality, which can be ascertained by the senses, and tested
subject to the laws of the scientific method. Positivism in social science assumes that human
behavior is a reaction to external stimuli and that is possible to observe and measure social
phenomena, using the principles of the natural scientists, and the hypothetical-deductive method,
and thereby to establish a reliable and valid body of knowledge about its operations based on
empiricism (actual evidence gathered through use of senses, i.e. observed). Deductive reasoning
means that the investigator starts with general ideas and develops specific theories and
hypothesis from them, which are then tested by collecting and analyzing data. Positivists are not
concerned with measuring the meaning of situations to people because they cannot be measured
in a scientific and objective manner.  Belief in objective nature of reality that can be studied and
understood.  Experimental design is the model for social research.  Emphasis on the
quantification of observations using neutral/standardized language.  Discounts subjective
understandings and intentions of humans.  Theory testing. 4.3. CHARACTERISTICS OF A
QUALITATIVE RESEARCH The eight characteristics of qualitative research, which are
important to consider are: 4.3.1. AN EXPLORATORY AND DESCRIPTIVE FOCUS Research
studies are qualitative and designed to discover what can be learned about some phenomenon of
interest, particularly social phenomena where people are participants or subjects. Qualitative
researchers develop a general ‘focus of inquiry’ that helps to guide the discovery of what is to be
known about some social phenomenon. Researchers are interested in investigating and
responding to exploratory and descriptive questions such as ‘In what ways do people in this rural
town build informal social networks?’ ‘How do people who work in this place think the physical
environment could be improved?’ The outcome of any of these studied is not the generalization
of results, but a deep understanding of experience from the perspectives of the participants
selected for study. 104 4.3.2. EMERGENT DESIGN Important leads are identified in the early
phases of data analysis and pursued by asking new questions, observing new situations or
previous situations with a slightly different lens, or examining previously unimportant
documents. This broadening or narrowing of what is important to study (i.e., the focus of
inquiry) and the consequent sampling of new people and settings is anticipated and planned for,
as best one can, in qualitative research designs. 4.3.3. A PURPOSIVE SAMPLE In qualitative
research, participants or settings are carefully selected for inclusion, based on the possibility that
each participant or setting will expand the variability of the sample. Purposive sampling
increases the likelihood that variability common in any social phenomenon will be represented in
the data, in contrast to quantitative research random sampling which tries to achieve variation
through the use of random selection and large sample size. 4.3.4. DATA COLLECTION IN THE
NATURAL SETTING Qualitative researchers are interested in understanding people’s
experience in context. The natural setting is the place where the researcher is most likely to
discover, or uncover, what is to be known about the phenomenon of interest. Extended amounts
of time with people in the places they inhabit is a critical feature of indwelling, fostering the
development of both explicit and tacit knowledge. 4.3.5. EMPHASIS ON ‘HUMAN-AS-
INSTRUMENT’ The qualitative researcher has the added responsibility of being both the
collector of relevant data – data whose relevance changes as the study proceeds – and the culler
of meaning from the data, which most often is in the form of people’s words and actions. It is
possible to include other formal instruments, such as questionnaires or tests, in a qualitative
study. 4.3.6. QUALITATIVE METHODS OF DATA COLLECTION The data of qualitative
inquiry is most often people’s words and actions, and thus requires methods that allow the
researcher to capture language and behavior. The most useful ways of gathering these forms of
data are participant observation, indepth interviews, group interviews, and the collection of
relevant documents. The researcher in the form of field notes collects observation and interview
data and audiotape interviews, which are later transcribed for use in data analysis. There is also
some qualitative research being done with photographs and videotaped observations as primary
sources of data. 105 4.3.7. EARLY AND ONGOING INDUCTIVE DATA ANALYSIS The
characteristics of qualitative research described so far point to two important characteristics of
qualitative data analysis: a/. It is an going research activity, in contrast to an end stage, when the
design is emergent; b/. It is primarily inductive. Analysis begins when one has accumulated a
subset of the data, providing an opportunity for the salient aspects of the phenomenon under
study to begin to emerge. Pursuing the relevant persons, settings, follows these initial leads or
documents that will help illuminate the phenomenon of interest. In other words, there is a
broadening or narrowing of the focus of inquiry as the data suggest it. What is important is not
predetermined by the researcher. Within the broad boundaries of the researcher’s focus of
inquiry, the data studied for what is meaningful to the participants in the study or ‘participant
perspectives’. The outcomes of the research study evolve from the systematic building of
homogeneous categories of meaning inductively derived from the data. 4.3.8. A CASE STUDY
APPROACH TO REPORTING RESEARCH OUTCOMES The results of a qualitative research
study are most effectively presented with a rich narrative, sometimes referred to as a case study.
The number of cases varies with each study, from one case to several. With book length reports,
the researcher has an opportunity to provide many excerpts from the actual data that let the
participants speak for themselves – in word or action – thereby giving the reader sufficient
information for understanding the research outcomes. In article length reports, the researcher by
necessity is briefer, using a modified case-study mode of reporting. A qualitative research report
characterized by rich description should provide the reader with enough information to determine
whether the findings of the study possibly apply to other people or settings. 106 Figure1.
Showing Characteristics of Qualitative Research Emergent Design Focus of Inquiry
INDICATES NEED SUGGESTS TO REFINE Early and ongoing Emphasis on Purposive
Sample inductive data analysis human-as-instrument Yield data for Explored through Qualitative
methods of data collection in natural settings Research outcomes presented using a case study
approach (Adapted from ‘Beginning Qualitative Research, A philosophic and Practical Guide’.
Pamela M. 107 and Richard M.). Exercise II. Instruction 1. Observe the following picture and list
down what you have seen/watched. 2. How do you relate this exercise with a qualitative
research? 108 SUMMARY QUALITATIVE RESEARCH  It is useful to gain an in-depth and
first-hand understanding of a problem to inform for further development of a quantitative study.
 It helps for further explanation to provide insight into the results of a quantitative study.  It
helps to understand the differences among groups or categories beliefs, opinions, and behaviors.
 It helps to gain insight into what influences/hinders people’s decision – making practices and
behaviors on different issues.  Audiences are receptive to qualitative research. 109 Self-
Assessment Questions (SAQs) for Study Session 4 Now that you have completed this study
session, you can access how well you have achieved its Learning Outcomes by answering these
questions. You can check your answers with the Notes on the Self-Assessment Questions at the
end of this Module. Exercise III. Instruction: Identify the following as related to either
Qualitative or Quantitative Research. 1. A study which the researcher carefully designs all
aspects of the study before actually collecting any data;_____________ 2. You know in advance
what you are looking for; _________ 3. The design emerges as the study
unfolds;_____________ 4. “How do teachers in special education classes react to distance
learning?”______ 5. The Researcher deals with data in the form of words; ____________ 6. List
at least three methods for the application of Qualitative Research? 7. Show at least three
differences between Qualitative and Quantitative Researches? 8. Can we use both Qualitative
and Quantitative Research designs/ approaches in a research? Yes___ No___ 9. Which of the
two aims to generate hypothesis and to describe rather than testing hypothesis and generalizing?
Qualitative _______ Quantitative_____ 10. Which favors counting rather than natural
observation? Qualitative _______ Quantitative_____ 110 SESSION FIVE: QUALITATIVE
RESEARCH METHODS Introduction A method is a particular procedure for accomplishing or
approaching something and order lines of thought or behavior which is originated from Greek
word methodos which means pursuit of knowledge, (Concise Oxford Dictionary-10th Edition).
In applied research, qualitative methods have become very important tools, because they provide
in-depth or insights into the local perspectives of study populations. The great contribution of
qualitative research is the culturally specific and contextually rich data it produces. Such data are
proving critical in the design of comprehensive solutions to public health problems in developing
countries. As a qualitative researcher, it is mandatory to know the different methods of
qualitative research and when to use them based on the area of inquiry. In general, qualitative
research is multi-methods in focus. The investigator has the responsibility of selecting the best
method/s based his/her problem to address because each method has its own advantages and
disadvantages. Choosing a method depends on the subject under investigation, researcher’s
preferences, time and money available, and funders and/or audience preferences. What questions
can qualitative methods in applied research investigate?  Contextual: identifying the form and
nature of what exists: - What are the dimensions of attitudes/ perceptions that are held? - What is
the nature of people’s experiences? - What needs does the population of the study have? 
Diagnostic: examining the reasons for, or causes of, what exists? - What factors underlie
particular attitudes or perceptions? - Why are decisions or actions taken, or not taken? - Why do
particular needs arise?  Evaluative: appraising the effectiveness of what exists - How are
objectives achieved? - What affects the successful delivery of programmes or services? - How do
experiences affect subsequent behaviors?  Strategic: identifying new theories, policies, plans
and actions - What types of services are required to meet needs? - What actions are needed to
make services more effective? - How can systems be improved? - What strategies are required to
overcome identified problems? 111 LEARNING OUTCOMES 5.1. Understand the various Steps
to be followed and when to use Qualitative Research. 5.2. Review literature for generating
qualitative research ideas. 5.3. Develop relevant skills in conducting Qualitative Research. 5.4.
Recognize when and where to use qualitative research methods. 5.5. Formulate qualitative
research questions. 5.6. Develop and apply basic study instruments for collection of qualitative
data 5.7. Record and manage qualitative data 5.8. Prepare qualitative data for analysis. 5.9.
Assess/evaluate the Quality of Qualitative Research. 5.10. Distinguish between quantitative and
qualitative approaches. 5.11. Examine when to use combination of qualitative and quantitative
research approaches. 5.1. CHOOSING STUDY DESIGN/PROCESS FOR QUALITATIVE
RESEARCH. The process of designing a qualitative study is not liner. 5.1.1 Identify the general
area of inquiry/investigation Choose the topic something a researcher wants to know more about.
Most applied researches are drawn to an area of inquiry out of personal interest or experience, or
a desire to help solve a problem, or in a response to a request from a stakeholder/donor. In PH,
areas of inquiry might be, e.g. the need for dental care, introduction of a new method for cancer
prevention, prevalence of HIV, etc. The chose is rooted in values and expectations that the
inquiry will in some way benefit society. 5.1.2. Specify the purpose of the research Define the
broad area in terms of specific issues that will form the core of the study. 5.1.3. Define the
research problem Identify the problem/issue of interest that guides the entire project. A research
problem may also come from earlier studies, perhaps a query as to why or under what
circumstances a finding has occur. Understand the depth and parameters of the problem:
literature review, other people’s views. Conduct a literature review: Investigate prior research
findings, identify gaps in literature and explain how your study will address the gaps. In general,
this will indicate the style of research design, the data collection techniques and even the
presentation of the findings. 112 5.1.4. Develop the larger conceptual framework Conceptual
Framework is:  One way to keep your design centered on the research problem is to take the
time to develop a Conceptual Framework.  A set of related ideas behind the research design. 
Simple list of concepts and their possible associations.  An elaborate schematic diagram of key
influences, presumed relationships, and possible outcomes of the research problem.  A map of
your ideas. What is conceptual framework good for? It helps to outline the research question,
provides a context in which others will be able to understand the research, and it is the
“springboard” from which you are studying. 5.1.5. Phrase questions that will address the
research problem. Generate research question concerning the problem. The research problem
will determine whether your design should focus on people’s experiences, actions and behaviors,
on their opinions and values, on their feelings or emotional responses, or what they know or
believe. A. Experience or behavior questions • How did people in this area controlled malaria?
B. Opinion or value questions • What is your opinion on Health Extension Program? C. Feeling
questions • How do you feel when unknown guest comes to visit you at the office? D.
Knowledge questions • What are the different methods of HIV/AIDS transmission? Formulate
overall research questions: a. Address what the researcher wants to know more about. b. Identify
the significance of the study. c. Explain why it is important to study the topic. Choose an
appropriate type of qualitative research to address the research question. Exercise IV: Develop a
conceptual framework on the following topic. “Decision to enroll in a Voluntary Health
Insurance” 113 Type of Qualitative Research Purpose  Phenomenology - Focuses on the lived
experience of participants.  Grounded Theory - To inductively generate a theory merging from
the data that describe and explain the phenomena.  Ethnography - Examines cultures (language,
practices, ideas, beliefs) and the cultural characteristics of a group of people.  Case Study - To
provide an in-depth description of one or more cases.  Qualitative Context Analysis - To
explore the underlying meaning of messages or phenomena. It may also be used in evaluation.
Questions can be developed during the research design plan, any more questions will be
generated during the initial survey phase of field work. It is not fixed, may be dropped as
irrelevant, some may be modified or new questions may be added as the study proceeds. 5.1.6.
Select Data Collection methods that will best address the research questions. Match the research
questions with the methods and techniques that can yield the richest information. The major
methodological strategies are observation, study of existing documents, in-depth interview, and
focus group discussions. 5.1.7. Define participants, select a sampling strategy In qualitative
research selecting criteria may change as the study progresses. This will allow the researcher to
follow new leads with information from new Exercise V: Develop questions based on the
following research problem. From Research Problem to Research Question. Research Problem:
“To assess the feasibility of introducing dual-method use (DMU), the use of condoms with
another contraceptive method, among couples at risk of pregnancy and STIs”. READING
ASSIGNMENT II Read the example on questions designed for qualitative research on page 91.
114 sources. Participant Selection Researchers will use purposeful sampling to choose
participants who can offer the fullest and most relevant information about the topic under study.
It establishes the criteria/conditions necessary to be included the study, i.e. choose a case/cases
that match these criteria. Several Types of Participant Selection  Typical A case is chosen
because it is taught to be like the majority. The Researcher may be interested in data on typical
facilities, not services that are extremely good or extremely poor.  Extreme/deviant Selects
extreme cases in order to highlight and understand characteristics of typical situations. After the
norm for a typical case is established, the researcher may want to explore extreme cases in order
to make a comparison. E.g. A study of RH provider effectiveness selected two clinics known for
high levels of clients and two with a poor reputation in the local community. Methods:
observation of services, interviews with clients. Comprehensive A situation in which all the
cases in a sample can be examined.  Unique-case selection: Selection is based on unique or rare
attributes.  Reputation-case selection A case is chosen on the recommendation of experienced
experts, based on its reputation (=trusted or admired).  Comparable-case selection Selecting
cases on the same relevant characteristics over a period of time in order to compare results for
replication.  Critical-case selection: One case that makes the point dramatic.  Convenience
sample: The case/cases that can be studied most easily, cheaply, or quickly. Other sampling
techniques are: Snowball sampling • Technique to identify informants with special
understanding. • Investigator starts with one selected participant. • Investigator asks each
participant to suggest others with similar ability to address the issues, “who knows a lot
about….?” 115 • Valuable when researcher does not know the field. Homogenous sampling
When looking for differences in a group which is apparently similar. For studying a group in
depth (often used in FDGs). E.G.– Exploring the impact of an AIDS prevention programme on
male truckers at risk of HIV. Initial formative phase to establish criteria that determine the risk
and selective representatives that meet all these criteria. Heterogeneous sampling When looking
for a common compound in apparently different people. E.g. Explore a common factor for
family planning. Selection of rural, urban and suburban family clinics serving different
socioeconomic groups. Intensity/Maximum variation sampling It focuses on excellent but not
necessary extreme examples of a phenomenon. Samples are small and rich in information but not
unusual. E.g. Study about how health deliver can be sensitive to the particular needs of women,
selection of womencentered RH services. Opportunistic sampling On the spot decision to take
advantage of unforeseen opportunities after fieldwork has begun. E.g. Study on contraceptive use
was started in clinics A group of women who met the researchers outside in a village where
spontaneously included. 5.1.8. Data Collection Some of the actual processes of collecting data
include observation, interviewing, filming, photography, and record review.  Identify how you
will collect your data.  Discuss how you will recruit your sample. 5.1.9. Define how data
collectors will be trained and monitored.  Describe the type of data to be collected, the number
of participants and why.  Describe your sample and settings: Address the parameter of your
sample (inclusion and exclusion criteria). 5.1.10. Define ethical standards that will assure the
protection of study participates. All human research should begin with the informed consent of
participants. It means that study participants understand the following:  Possible risks and
benefits, 116  Voluntary participation,  Assurances of confidentiality  The purpose of the
research,  How they were chosen to participate,  Data collection procedures, and  Whom to
contact with questions and concerns. 5.1.11. Define methods of Data Analysis It is the process of
systematically organizing the field notes, interview transcripts, and other materials until you
understand them. Data analysis dependent on what type of qualitative research you are pursuing.
Each method and methodologies has their own views on how to analyze the data. 5.1.12. Decide
how results will be disseminated 5.1.13. Report Writing/Write Up It is highly essential that the
report needs to include the following: a. To interpret and to present the data according to the data
analysis technique. b. Using quotes as evidence to support your themes and sub-themes. c.
Compare and contrast the results of your study to the literature in the discussion. d. State the
studies’ limitations. e. Make recommendations for future research. Generally report writing takes
the form of long narratives, sometimes combined with pictorial presentations. Many formats to
choose from and needs to have a Beginning, Middle and an end. The Beginning should include a
general background to help readers understand the focus of your paper. The introduction often
concludes with a description of the design of the rest of the paper. The description should include
 a discussion of the research methods and techniques used,  the time and length of the study, 
the number of settings and subjects,  the nature of the data,  where and how the documents
were located,  researcher-subject relations,  check on the data, and other information that
might help the reader to evaluate the soundness of your study. The Middle makes up the bulk of
the work, argue your thesis, present your theme and illuminate your topic. Use the most salient
quotations you can find to illustrate the main points of the thesis. 117 The End should be written
as a conclusion, often the focus is decisively restated, the arguments reviewed, and the
implications elaborated. 5.2. APPROACHES TO COLLECTION OF QUALITATIVE DATA.
What are Research Methods? Research methods are the techniques used by researchers to
structure a study, gather and analyze relevant to the research question. Qualitative Research
Methods: - Are methods for collection, analysis and interpretation of data on phenomena that are
not easily reduced to numbers or that might be destroyed by an attempt to do so; e.g. love, health,
etc. - Allow the researcher to work with primary and secondary data. The researcher's role is to
listen, observe, and then interpret/make sense of what she/he sees and hears. Types of Data
collection tools in Qualitative Research  Interviews: are typically conducted one-to-one. They
seek to understand participants’ personal perspectives and on an issue, or event, or situation. This
may include: in-depth interview, Key informant interview.  Focus Groups: are used to
understand a groups’ opinions, ideas, or attitude about a product, issue, or event.  Participant
Observation: Involves living among or observing a group of people over the causes of a long
period of time and participatory in their daily activities to provide insight to their cultural
practices.  Field Notes: these are notes that researchers take during the course of data collection.
 Archrivals Texts: Important texts (policy, brief, paper, or book) that provide information
relevant to the research topic.  Open ended responses on a survey or questionnaire: Short
answer questions. They are used to supplement quantitative information. The most common tools
for data collection in qualitative research methods are presented as follows (Observation,
Interview, FGD, and Document Review). 1. OBSERVATION Observation techniques are
methods by which an individual or individuals gather firsthand data on programs, processes, or
behaviors being studied. It is a research method in which the investigator systematically watches,
listens to the records the phenomenon of interest. 118 Observation is not limited to ‘watching’
but extends to the direct gathering of information by the investigator using the senses, generally
both sight and hearing. It is the oldest and most basic tool, involved in any kind of research
(quantitative, qualitative) and learning. The data to be collected during observation are body
language, facial expression, behavior, other non-verbal expressions of meanings, movements,
etc. observation method provide researchers /evaluators with an opportunity: - To collect data on
a wide range of behaviors, - To capture a great variety of interactions, and - To openly explore
research/evaluation topic. By directly observing operations and activities, the
researcher/evaluators can develop a holistic perspective, i.e. an understanding of the context
within which the research/project operates. Observation of behaviors, actions, activities and
interactions is a tool for understanding more than what people say about situations, and can help
to understand these complex situations more fully. This approach also allows the
researcher/evaluator to learn about things the participants/staff may be unaware of or that they
are unwilling/unable to discuss in an interview/focus group. Observations can be useful during
both formative and summative phases of evaluation. It can be descriptive or analytical and
observations are carried out using a carefully developed set of steps and instruments. It is usually
are guided by a structured protocol. The protocol should prompt the observer to: Describing the
setting: where the observation took place and what the physical setting was like; Identify the
people who participated in those activities, i.e. characteristics of those who were present;
Describe the content of the intervention, i.e. actual activities and messages that were delivered;
Document the interactions between implementation staff and project participants; Describe and
assess the quality of the delivery of the intervention; and Be alert to unanticipated events that
might require refocusing one or more evaluation questions. Field Notes are frequently used to
provide more in-depth background or to help the observer remember salient events if a form is
not completed at the time of observation. Field Notes contain the description of what has been
observed. The descriptions must be factual, accurate, and through without being judgmental. The
date and time of the observation should be recorded, and everything that the observer believes to
be worth noting should be included. No information should be trusted to future recall. 119
Informed consent must be obtained from participants before any observational data are gathered.
The issues of Privacy and Access need to be considered. Outside or Inside Perspective
Observation method can be Participatory: Concealed/Covert, or Non-participatory or
Structured/Unstructured. 1. Participant Observation Researchers typically become/involved to be
member of a culture, group, or setting, and adopt roles to conform to that setting. The aim is for
the researcher to gain a closer insight into the culture's practices, motivations, and emotions.
Events are observed and recorded, together with the interpretation and explanation. It is the best
method for understanding the experiences of people and the meanings they attach to them.
Participant Observation are two types: Concealed Participant Observation and Covert Participant
Observation. A. Concealed Participant Observation The participant observer may be honest
about his/her role in the group, or may conceal/ hide the investigation and pretend to be a normal
member of the group. Concealment does raise ethical questions in relation to the lack of
informed consent. It also leads to a great deal of emotional stress on the part of the observer. 120
Exercise VI: Read the article on Covert observation of psychiatric hospitals and answer the
questions followed. (Source: Rosenhan D.L. (1973) ‘On being sane in insane places’, Science,
179; 250-8. Rosenhan was interested in how reliable and valid diagnostic measures of ‘sanity’
were and whether psychiatric staffs were able to distinguish the sane and inane. He devised an
experiment in which eight ‘normal’ people got themselves admitted to US Psychiatric Hospitals
by claiming to hear voices that said ‘hollow’ ‘empty’ or ‘thud’ but by other ways presenting their
‘real’ medical and social histories to admission clinic staff. All were admitted with a diagnosis of
schizophrenia except one with a diagnosis of manic depressive psychosis. On admission,
researchers behaves normally and cooperated with hospital routines, given that they spent
considerable time in the hospitals waiting to be discharged their undercover status provided an
opportunity for covert observation. Rosenhan’s paper reports on their experiences of being
hospitalized and the ways in which the diagnostic label they had received at admission shaped
the interpretation of their behavior by staff. None of the researchers were identified as sane
pseudo-patients by staff; although interestingly many other patients challenged them assuming
that they were undercover journalists or researchers. In general, they were discharged with
diagnosis of ‘Schizophrenia in remission’. Rosenhan’s findings were important. Not only did he
contribute to the debate around the social construction of labels as such as schizophrenia, but the
reports of his pseudo-patients were an important contribution to our understanding of the effects
of both hospitalization and labeling. Labeling someone as mentally ill shapes the interpretation
of all their behavior. As patients with a diagnosis, the everyday behaviors of the researchers,
such as writing notes or being anxious in the new hospital environment, were seen as symptoms
of their diseases. Rosenhan’s decryption of many aspects of hospitalization, such as the low level
of interaction between staff and patients, the occasional abuse of patients and lack of privacy,
were a significant development in our understanding of how institution lead to depersonalization
and may contribute to mental health, rather than cure it. With other studies of long-term
institutions, this pseudo-patients study was an influence in the gradual policy shift in many
countries away from asylums and towards other forms of care for those with mental health
problems. However, the design of the study raises a number of ethical questions. First, there are
the problems of deceit. Except in one case, neither the hospital staff nor other patients knew that
they were participants in the research (though some patients did guess), and had not consented to
the part. Rosenhan defends the concealment (though he does admit it is distasteful) on the basis
that it was necessary. It was the only way that these data could have been gathered. If hospitals
were warned that researchers would try to get themselves aditted there would be no way of
knowing whether the process of admission and expenses on the wards were typical or not. The
hospitals and staff are not named in the report. Rosenhan’s is not interested in exposing poor
practice (as an undercover journalist might) but rather in generalizing from his data to say
something about the ways in which mental illness is dealt with in American health care system.
The defense against breaching normal expectations of informed participation is thus a public
interest one, based on utilization principles. In short, the ends (furthering public knowledge with
the aim of improving services for some of the most marginalized people in society) could be said
to justify the means. Arguably, though Rosenhan’s study ‘spoils the pitch’ for future researchers
attempting to study psychiatric services in more open ways, making mental health professionals
defensive and less willing to consider change. If these disadvantages are taken in to account, the
benefit in terms of the service improvements may be less likely. A final ethical consideration is
the safety of the research team. Once admitted to the hospitals, most of the researchers wanted to
leave very quickly, as they were unpleasant places to be. It is, however, difficult to get
discharged at short notice, and they spent between 7 and 52 days as patients. This expense may
be distressing, and there was also the danger of having to take unnecessary medications.
Reference: Qualitative Methods for Health Research, Judith Green and Nicki Thorogood, Second
Edition, 2009. 121 Meanings of selected words from the above study: - Sane= not mad - Insane=
very foolish, serious mentally ill. - Deceit= deception (deceive). Question on the article on
Covert Observation of Psychiatric Hospitals 1. What was the aim/purpose/problem of the study?
2. What actions did the researcher took to address the above problem? 3. What were the
findings? 4. What were the results? 5. What was the main problem with such a method? 6. What
was the remark made by the researcher? Application of Participant Observation It will help to
investigate complex behaviors that cannot be easily explained or understood from outside. Its
limitations may require more time than outside observation, adaptation is not always possible
and researcher is sometimes clearly outside the study population, e.g. male researcher studying
females, non-drug user researcher studying drug users, cross-cultural studies, etc. Key
Informants in Participant Observation Key Informants are insiders with special knowledge,
status, or communication skills, speak on behalf of others, may be suggested by population under
study or in advance by the researcher and lay investigator having better access to community
under study. Limitations of Key Informant are data collected is “second hand” information,
control about bias of key informant d may engender jealously or suspicion in the group under
study. B. Overt/ Non-Participant Observation Researcher collects data without interacting with
participants’ activity. It shows how something happens rather than how people perceive it
happening. The researcher gather information with his/her own eyes instead of with participants’
eyes. It can be descriptive or analytic. Observation and participant observation may be done or
shown openly/ publicly (overt). There may be suspicious about academics and their motives
among local communities. Time must be spent to form links and explanation should be 122
offered about how the study can be mutually advantageous. Access is usually obtained through
negotiations with a ‘gatekeeper’ (e.g. head of an organization). The first step is writing to the
heads of the organizations about the aims, nature and confidentiality of the study and its potential
value. This permission is often given without consulting the members being studied and the
investigator needs to be aware of this. Application of Non-Participatory Observation To validate
interview data (e.g. did the provider really give the information that he claimed to give during
counseling according to an interview?). Limitations: Interpretation may be biased by researcher's
cultural and social background. Qualitative observations are frequently referred to as
Ethnography. It is a description and interpretation of a cultural/social group/system (Creswell,
1998). In such a study, the researcher examines the group’s observable and learned patterns of
behavior, customs, and ways of life. Here, the researcher becomes a participant observer, and
gets immersed in the day-to-day lives of people or through one-on-one interviews with members
of the group. The researcher focuses on the meanings of behavior, language, and interactions of
the culture-sharing group. Structured Observation The researcher has to begin with a conceptual
definition, what is to be observed and standardized with a validated measurement instruments,
and the proceeds to make the observations in order to test the theory. The contents are - The
Setting: What is the physical environment like? What is the context? Etc… - The participants:
Describe who is in the setting? How many people and their roles? Etc… - Activities and
Interactions: What is going on? Is there a definable sequence of activities? Etc… - Frequency
and Duration: When did the situation being observed begin? How long does it last? Etc… - Data
Collection Tools: Eyes and other senses, watch, scales, microscope, check-list, etc. Advantages
of Observation Methods It is to gain access to behavior of which individuals themselves may
provide biased accounts, or indeed be unaware. It provides direct information about behavior of
individuals and groups. It permits researcher/evaluator to enter into and understand
situation/context. It gives more detailed and context related information. 123 It provides good
opportunities for identifying unanticipated outcomes. It permits collection of information on
facts not mentioned in an interview. It permits tests of reliability of responses to questionnaires.
It exists in natural, unstructured, and flexible setting. Disadvantages of Observation Methods -
Ethical issues concerning confidentiality or privacy may arise. - Observer bias: selective
perception of observer may distort/affect the investigation. - The impossibility of observing a
large random sample of people, organizations or other units of study. - Rich data but may be hard
to quantify/replicate. - Expensive and time consuming. - May affect behavior of participants. -
Investigator has little control over situation. - Need well qualified, highly trained observers; may
need to be content experts. 2. INTERVIEW It is designed to allow the respondent to tell their
story in their own ways. It also allows the subject matter to be explored in some depth. The use
of the interview as a data collection method begins with the assumption that the participants’
perspectives are meaningful, knowable, and able to be made explicit (clear, detail), and that their
perspectives affect the success of the research/project. An interview is selected when
interpersonal contact is important and when opportunities for follow up of interesting comments
are needed. There are different types of interview such as Structured, Semi-structured, In-depth
(Unstructured/Focused) and In-depth or Semi-Structured. - In-depth (unstructured/Focused) is
not fixed order. - In-depth or Semi-Structured: It is a conversation between the researcher and the
subject about the researcher area/topic. - Individual In-depth Interview is detailed information
obtained from individuals. It is One-to-one and reliable for highly personal, sensitive or
confidential topics. Interviewee can be either “key informants” or “ordinary READING
ASSIGNMENT III and IV. READ THE EXAMPLES ON STRUCTURED AND
SEMISTRUCTURED QUESTIONNAIRES ON PAGE 92 and 95. 124 people”. It is valuable for
searching busy people, probing deeper into individual attitudes, lasts for 30-90 minutes, and
minimum sample size 10-30. - In-depth Interviews is a dialogue between a skilled interviewer
and an interviewee. Its goal is to elicit rich, detailed material that can be used in analysis
(Lofland and Lofland, 1995). It is best conducted face to face, although in some situations
telephone interviewing can be successful. The interviewer does not follow a rigid form; and seek
to encourage free and open responses. It also encourages capturing of respondents’ perceptions
in their own words and characterized by extensive probing and open-ended questions. Usually iIt
needs the preparation of an Interview Guide. It - Includes a list of questions or issues that are to
be explored for following up on key topics, - Helps the interviewer to remember the points to
cover; - Suggests ways of approaching and talking about topics; - Helps the interviewer pace the
interview and make interviewing more systematic and comprehensive. - Reminds the interviewer
about probes (= to search & examine carefully & thoroughly) and ways of asking questions. -
Ensures that the interviewer covers all the topics; - Gives a possible order of topics; and - Helps
the interviewer to enable people to talk in their own ways, and fully as possible. - Includes an
introduction and way of ending the interview. It needs to have a Beginning, a Body and an End.
Beginning: Put the respondent at ease and help them to begin to talk, ask them to describe their
situation or something that has happened to them and give them clearer ideas of the nature of the
interview. Body: Moves to the areas of particular interest to the researcher. As progressed more
detailed or sensitive areas may be discussed. The researcher must be prepared to be 125 flexible
and to come back to explore in more depth areas that have been mentioned but not developed by
the respondent. End: As the interview draws to its close, the researcher moves on to less sensitive
and more general matters. Remind again that the interview is confidential. Reading the
Interview: In-depth interviews are usually recorded and then transcribed. The interviewer must
be familiar with the tape recorders and other accessories. Types of In-depth Interview  In-depth
(unstructured/Focused): No fixed order.  In-depth or Semi-Structured: It is a conversation
between the researcher and the subject about the researcher area/topic. 126 TIPS ON IN-DEPTH
INTERVIEWING  The key to being a good interviewer is to be a good listener & questioner.
 Remember the interview is a conversation, not an interrogation.  Don’t assume that you
understand what the respondent means - ask - Can you tell me more about that?, Can you tell me
how you feel about that?, In what way was that a good/bad experience?  Try to sit an angle to
the respondent and maintain eye contact.  Don’t be thrown if they say something which shocks
or surprise you.  Look expectant and encouragingly say “that is interesting!”  Use probes to
encourage people to tell you more: - “What happened next?”, Can you tell me more about…?” -
“You said earlier that… could we talk a bit more about that?” - “What do you mean?”, “In what
way?”  Embarrassing situations and sensitive issues may be tackled by: - “What about you?
How do you feel about that?” - “Some people say that…what do you think about that?”  Avoid
double questions, E.g. “How do you feel about going there with other people and having what
they want to do?”  Avoid leading questions, E.g. “Don’t you think it would be better if…?” 
Don’t sum up what people say: rather, say: “Am I right in thinking that you…?” Don’t interrupt
the flow if they don’t immediately answer the question, but don’t let them stray too far away
from the topic- gently bring them back! “That’s very interesting; I wonder if we could now move
on to talk about..?” 127 Potential Pitfalls/Problems when considering In-depth Interviews 1.
There may be substantial variation in the interview setting. These limit the interviewer’s control
over the environment and the interviewer may have to be contend with disruptions and other
problems. 2. There may be a large gap between the respondent’s knowledge and that of the
interviewer; interviews are often conducted with knowledgeable respondents, yet administered
by less knowledgeable interviewers, or by interviewers not completely familiar with the pertinent
social, political, or cultural context. The solution is not only to employ highly trained and
knowledgeable staff, but also to use interviewers with special skills for specific types of
respondents. The researcher to conduct the interviews, if this can be done without introducing or
appearing to introduce bias. Factors to consider in determining the setting for In-depth Interviews
and FG: Select a setting that provides privacy for participants: Select a location where there are
no distractions and it is easy to hear respondents speak, a comfortable location, a no threatening
environment, a location that is easily accessible for respondents’, and a facility equipped for
audio or video recording. Stop telephone or visitor interruptions to respondents interviewed in
their office or homes; and provide seating arrangements that encourage involvement and
interaction. Recording Interview Data It can be recorded on tape, with the permission of the
participants, and/or summarized in notes. Detailed recording is a necessary component of
interviews since it forms the basis for analyzing the data. Three Procedures for Recording the
Data: First approach:  The interviewer/transcriber listens to the tapes and writes a verbatim
account of everything that was said. - Transcription of the raw data includes word-for-word
quotations of the participant’s responses as well as the interviewer’s descriptions of participant’s
characteristics, enthusiasm, body language, and overall mood during the interview. 128  It is
essential that the participants have been informed that their answers are being recorded, that they
are assured confidentiality, and that their permission has been obtained. A Second possible
procedure for recording interviews draws less on the word-byword record and more on the notes
taken by the interviewer or assigned note taker. This method is called “note expansion.”  As
soon as possible after the interview, the interviewer listens to the tape to clarify certain issues
and to confirm that all the main points have been included in the notes.  The note expansion
approach saves time & retains all the essential points for the discussion.  A disadvantage is that
the interviewer may be more selective or biased in what he/she writes. In the third approach, the
interviewer use no tape recording, but instead takes detail notes during the interview and draws
on memory to expand and clarify the notes immediately after the interview.  This approach is
useful if time is short, the results are needed quickly & the questions are simple.  The
interviewer must frequently talk and write at the same time, a skill that is hard for some to
achieve. The data collection tools for In-depth Interviews are Interview Guide, Check-list,
Questionnaires, and tape recorder. Semi-structured Interview (Interview Guide) List of topics to
be covered has to be prepared and the interview decides sequence and wording of questions.
Strengths: Interviews remain fairly conversational and situational. It ensures similar basic lines.
Weakness: It lacks flexibility in sequencing and wording and can result in different responses
reducing the comparability. Informal Interview 129 Questions emerge out of the context/follow
the natural flow. There is no predetermined of questions topics or wording. Strengths: There is
maximum flexibility, people feel more open, and useful at initial stage of research. Weakness:
Different information collected from different people with different questions. Advantages of In-
depth Interview - Usually yield richest data, details, new insights; - Permit face-to-face contact
with the respondents; - Provide opportunity to explore topics in depth; - Permits clarification of
questions. - Affordability to experience the affective as well as cognitive aspects of responses; -
Allow interviewer to explain or help clarify questions, increasing the likelihood of useful
responses. - Suitable for use with both literates & illiterates. - Has higher responses rate than
written questionnaires. - Allow the interviewer to be flexible in administrating interview to
particular individuals or circumstances. Disadvantages of In-depth Interview - Expensive and
time consuming; - Need well qualified, highly trained interviewers; - Interviewee may distort
information through recall error, selective perceptions, - Presence of interviewer can influence,
desire to please interviewer; - Flexibility can result in inconsistencies across interviews; and -
Volume of information too large, may be difficult to transcribe and reduce data. - Reports of
events may be less complete than information gained through observation. 130 EXERCISE VII:
INTERVIEW Class Work 1. Organize students in Group: 5 students in each group. 2. Select a
topic for each group. 3. The interviewer has to develop relevant questions for the interview,
4/5/or more based on the given topic. 4. When one interviews the other group members will
observe and evaluate the way how the interview is being conducted. Take notes on the positive
and negative aspects. The focus areas could be: - Greetings/Self-presentation/Introduction, body
Language, questioning, follow up/Probing, closing, etc. 5. The Observer group will reflect the
positive and negative aspects to the class. 131 Sample Format: It has to be used by the Observer
Group Issues Positive Aspects Negative Aspects Greetings/ Self-presentation/ Introduction Body
Language Questioning Follow-up/ Probing Closing 3. FOCUS GROUP DISCUSSION (FGD)
FGDs are used as a research method to find out what groups of people think and how they
discuss ideas together. It attempts to create a natural phenomenon a group of people with
something in common discussing an issue/event and is not used to find out what each individual
thinks or has experienced but rather how the group discusses the topic being researched (group
dynamics). The hallmark of focus groups is the explicit use of the group interaction to generate
data and insights that would be unlikely to emerge without interaction found in a group. The
technique inherently allows observation of group dynamics, discussion, and firsthand insights
into the respondents’ behaviors, attitudes, language, etc. Hence, it combines elements of both
interviewing and participant observation. The group discussion is then structured to allow the
group to discuss the issue before moving on to complete the task. Interviewer is a moderator that
facilitates the group process. The facilitator prepares a guide to help in structuring the discussion
while allowing the interaction between the members of the group to develop. It relies on
interview guide/topic guide. 132 One Moderator who guides and facilitates the group (starts to
ask questions), keep the discussion focused, keeps the discussion moving, handles emotions,
encourages all participants to speak. S/he must be experienced and knowledgeable and important
to be ethnic and culturally appropriate One Note Taker whose tasks are limited. S/he takes care
of tape recording, and takes notes. Time limited: not longer than 2 hours. Respondents’ social
class, level of expertise, age, cultural background, and sex should be considered. They need to be
paid for attendance and provided with refreshments and are typically asked to reflect on the
questions asked by the moderator. They are permitted to hear each other’s responses and to make
additional comments. It is not necessary for the group to reach any kind of consensus, it is
necessary for people to disagree. One/two persons should not dominate. Informed consent is
necessary and confidentiality should be assured. FGD has a beginning, middle, and an end. At
the Beginning let the people get talking and share relating experiences and ideas. In the Middle
part help people to focus by asking more specific questions and at the End complete the group
task. TIPS ON FGDS A Focus Group  Is a group discussion, i.e. group discusses views with
each other;  are a gathering of 8 – 12 people who share some characteristics relevant to the
research (has members who have something in common); homogenous group;  Focused on a
particular topic;  Sitting in a circle; Although FGs and in-depth interviews share many
characteristics, they should not be used interchangeably. 133 Preparation of FDGs • Collect brief
profiles of each participant, i.e. education, occupation, marital status, family size, age, etc. This
will help analyzing the data later. Profiles should include only information that may be relevant
to the study question. • Keep sensitive issues of the profiles/background information confidential
(i.e. age at first pregnancy, use of contraception, etc…) and define demographics variables that
you think will have an impact on the study (i.e. sex, age, education, parent/non-parent,
rural/urban). • Collect the background information with informed consent of participants,
individually – not in the group. • Use code numbers – not the names of the participants to link
background information to the answers given during the FDG. Conducting a FGD • Requires a
high level of interpersonal skill of the moderator: create a group of conversational partners, be
able to listen with non-judgmental interest, show real interest, curiosity, empathy, and
encouragement, must be flexible, creative, able to comment to each person's unique response,
and stay with his topic guide. • Do not use microphones passed around. • For some sensitive
topics, sex and cultural background should match between moderator and participants. • Note
taker should take notes who said what, even if the discussion is tape recorded. • Explain the
purpose of the meeting to participants. • Assure participants that tapes will not be shared outside
the research team and that their names will not appear. • Participants should understand that there
is no right or wrong answer. • Moderator should explain ground rules: speaking one at a time, not
interrupting each other, have fun, you may end the discussion with some refreshments for the
participants, payment or not??? Before Leaving for the Site: Review notes, study protocols and
topic guide, Gather materials, prepare tape recorder (extra), sufficient cassettes, batteries (extra),
notepads, pens, labels, name tags, topic guides, gifts/travel, other relevant materials and test tape
recorder. At the site before Discussion Begins  Set up the room (Refreshment, arrange chairs in
a circle)  Test the tape recorder and label the cassette with the date and group identification
code; load and test it. 134  Greet the participants and collect socio-demographic data
informally.  Make labels with numbers corresponding to data sheets if you are using them to
identify individual speakers during recording and note taking. Starting the Discussion 
Introduce yourself and invite participants to introduce themselves.  Summarize the purpose of
the study.  Describe the FGD process. Emphasize - There is no right or wrong answers; - All
should participate and respect the opinion of others; - Help to keep the discussion on track; -
Describe the use of the tape recorder; - Remind the participants that notes will be taken; - Inform
the discussion will last approximately 1 ½ hours; - Invite questions. Conduct the Discussion 
Begin with warm-up questions.  Be aware of who is talking and who is not. - Do not allow
one/two individuals to dominate; - Bring silent participants into the discussion.  Use broad,
open-ended questions and avoid yes/no or short-answer questions  Frame the discussion with
more general questions and encourage participants to raise issues that are important to them. 
Always probe: Probing does not mean suggesting a more interesting answer. Probes that suggest
answers are leading probes and must be avoided. Following are examples of leading probes NOT
to use: - Do you mean……? - Are you saying that….? - Is that the only thing you can think of? -
You do not mean that …? 135 Good non-leading probes are usually general inquires such as the
following: - How do you mean? - In what way? - What other methods (means of) do you know?
- There is no hurry, take a moment to think about it and tell me all that comes to your mind. 
Do not hesitate to use silence and non-verbal prompts (nodding, raising the eyebrows, etc…); 
Note any questions that the group does not seem to understand, as well as questions that
stimulate good discussion.  Record body language and other nonverbal communications. - An
idea stated forcefully or even angrily might emphasize the strength of a participant’s convictions.
- A hesitant manner might suggest the participant is not sure about the idea.  Use the guidelines
flexibly; return to topics that were not fully discussed or that need more thought. End of
Discussion  Thank the participants.  Explain how the discussion information will be used. 
Remunerate: e.g. travel expense, gifts, etc…  Collect everything and check the cassettes After
the Discussion Expand your notes in outline form. The note taker and moderator should do
together immediately following the session, if possible at least on the same day. Record in
writing any nonverbal data. Transcribe the tapes; develop the system; Review the transcribed
notes and add the researcher’s comments in parenthesis, include observations about the group,
remarks to probe in latter discussions, or methodological problems. Then translate. Advantages
of FGD  May encourage people to participate who otherwise may not want to,  May be able
to generate more ideas,  Quick information at less cost,  Obtaining data from illiterate
communities,  Good at exploring attitudes and opinions,  Researcher can be present at
session, 136 Disadvantages of FGD  Some topics may be too sensitive and too personal, 
Deviant views may be inhibited,  Moderator may influence participants,  Errors if there is no
homogeneity,  Results are harder to analyze & interpret. Data Collection Tools that are
necessary for FGD are FGD guide, Tape recorders, and Hand notes. EXERCISE VIII. FGD I
Class Work Instruction: Conduct FGDs based on the given/developing your own topics.  Select
one PI/Moderator and one Observer  Present your findings to the class  Use your mobile phone
for recording  Cigarette Smoking - Is smoking bad? - Why shouldn’t you smoke? - Who
smokes? - What are the risks of smoking? - What should be done to stop smoking?  Healthy
Lifestyles Program - How do you define healthy lifestyles? - You have been in the program for
five months, what do you think so far of the program? 137 4. DOCUMENTARY EVIDENCE 
Independent evidence, e.g. medical records  Only totally uninfluenced way of data collection.
 May provide an historical context (allows to acquire historical perspective and knowledge). 
Useful for subjects difficult to study.  Material you are examining has been collected by others.
Data Collection Tools for Documentary Evidence are check-lists, data compilation forms.
Records, newspaper article, handwritten documents, letters, other articles, epidemiological
surveys, demographic and health survey, pictures, posters, radio and TV shows, billboards,
songs, diaries, etc… Applications of Documentary Evidence: - Secondary transcription from
interviews of FGDs. - To address government policy as presented in the press or radio. - To
address gender bias in health care, radio dramas/comedies. - To understand context: cultural
norms, values, beliefs, peoples hope, fear, triumphs. Advantages It is inexpensive, saves money,
and permits observation of trends over the past. It is very informative. EXERCISE IX. FGD II
Class work Instruction: Develop questions based on the following topics and conduct FGD: 
HIV/AIDS,  STIs,  Air Pollution,  TB,  Personal Hygiene. 138 Disadvantages Data is not
always easily accessible, Ethical issues concerning confidentiality, Information may be imprecise
or incomplete, Words and behaviors may have different meanings at the time the document was
created. Exercise X. Select the best method Instruction In pairs consider the following scenarios
and consider how you would conduct some qualitative research with group and the pros and cons
of using Interviews, Observation, or Focus Group Discussion with each. Select the Best method
and justify. 1. Children’s experiences of Asthma clinics. 2. Women’s experiences of undergoing
cervical smear tests. 139 5.3. ANALYSIS OF QUALITATIVE RESEARCH DATA (using
different methods and computer assisted methods such as open code software) Introduction In
qualitative research data collection and data analysis are interwoven. The analysis begins as soon
as the first data are collected and analytic notes are recorded during data collection. It is systemic
but not rigid and this has the advantage of following the researcher to go back and refine
questions, develop hypothesis, and pursue emerging avenues of inquiry in further depth. It relies
on cutting, sorting and pasting. Principles of Qualitative Data Analysis 1. Reality is subjective
Respondent’s view may differ from researcher’s view and reality depends on the researcher
view. Description of a situation depends on the perspective. Picture 1 Picture 2. Principles of
qualitative data analysis What do you see here? Exercise XI. Instruction 1. Observe the following
two pictures and list down what you have seen/watched. 2. How do you relate these exercises
with the above principle of a qualitative research? 140 Therefore, during data collection and
analysis learn to recognize, and become aware of your own perspective, check your perceptions
against the raw data. You need to be open to surprising findings but do not immediately interpret
them and actively seek for alternative explanations. The more precise and neutrality you
collected your data, the better and easier will be your analysis. 2. A Phenomenon cannot be
understood without its context. You need to aware the physical setting (of a behavior, disease, or
process), historical, social, political climate, organizational and individual characteristics.
Qualitative Researchers consider how informant’s stories are shaped. 3. Theory guides and
results from qualitative research Theory “a set of interrelated concepts, definitions, and
proportions that presents a systematic view of events/situations by specifying relations among
variables” 4. Exceptional cases may yield insight into a problem Although analysis aims to seek
common patterns, it is important to understand exceptions. Why and how do individuals differ
from the group? Individuals that appear exceptional may in fact represent a large group that was
not investigated yet. 5. Understanding of human behavior emerges slowly and nonlinearly. 141
Approach may take numerous rounds of questioning, reflecting, rephrasing; why and how do
individuals differ from the group? Analysis should begin in the field to have time for additional
data collection. QUALITATIVE RESEARCH TECHNIQUES 1. Interpretive Techniques Expert
observes, examine the data, interpret it via forming an impression and report their impression in
a structured and sometimes quantitative form. 2. Coding It is an interpretive technique that both
organizes the data and provides a means to introduce the interpretations of it into certain
quantitative methods. Most coding requires the analyst to read the data and demarcate segments
within it. Each segment is labeled with a “code”- usually a word or short phrase that suggests
how the associated data segments inform the research objectives. When coding is complete, the
analyst prepares reports via a mix of: - summarizing the prevalence of codes, - discussing
similarities and differences in related codes across distinct original sources/contexts, or
comparing the relationship between one or more codes. 3. Recursive Abstraction Some
qualitative dataset are analyzed without coding. A common method here is recursive abstraction,
where dataset are summarized; those summaries are then further summarized, and so on. The end
result is a more compact summary that would have been difficult to accurately discern without
the preceding steps of distillation. 4. Mechanical Techniques Some techniques rely on leveraging
computers to scan and sort large sets of qualitative data. One such scenario is for datasets that are
simply too large for a human to effectively analyze or where analysis of them would be cost
prohibitive relative to the value of information they contain. A frequent criticism of Mechanical
Technique is the absence of a human interpreter. Define Methods for Data Analysis  Who will
conduct the data analysis? What level of detail will be needed to respond to your research
question?  Will the analysis be computer-assisted or manual?  If a computer will be used,
decide about the software package.  Will the whole team be involved or will specific team
members be responsible for different aspects of investigation?  Will team members work
separately and then meet to share the findings? 142 Methods for Qualitative Data Analysis The
methods of qualitative data analysis that are frequently being used are:  Thematic content
analysis  Grounded Theory  Framework analysis  Narrative analysis Approaches Aim
Descriptive:  Thematic Analysis  Framework Analysis  Narrative Descriptive summary by
pre-determined themes or framework Analytical:  Grounded Theory Abstract level: 
Conceptual issues  Insight to new knowledge  Theory generation 143 5.3.1. THEMATIC
CONTENT ANALYSIS (TCA) Picture 1. Picture 2. Exercise XII. Instruction 1. Observe the
following pictures and list down what you have seen/watched of each picture. 2. How do you
relate these exercises with Thematic Content Analysis? 144 Picture 2 What are the common
themes in the four pictures below? THEMATIC CONTENT ANALYSIS • Is a descriptive
presentation of qualitative data. • A satisfactory TCA portrays the thematic content of interview
transcripts by identifying common themes in the text provided for analysis. • Categorize
recurrent or common ‘themes’ (frequently recurring issues), • Most common approached used in
health journals, • Aims to present the key elements of respondent's accounts, • May be applied
for texts, interview notes, notes from observation, images, • Tools for thematic analysis: coding,
indexing Coding is the process of attaching labels to lines of the text so that the researcher can
group and compare similar pieces of information. 145 Indexing is the process that generates a
word list comprising all the substantive words and their locations within the text. STEPS IN
THEMATIC CONTENT ANALYSIS (1) Reading (2) Coding I. In the Field Questioning (5)
Interpreting Verifying II. At your Desk (4) Reducing (3) Displaying 1. Reading: Read, Read,
Read • Read for Content: Did you get the information you intend to collect? Begin to identify
emerging themes and develop tentative explanations • Read for Quality: How were data
obtained? Where notes recorded? Were interview questions neutral? • Read for Language • Read
word by word 2. Coding Attach labels (codes) to parts of the text that represent those themes •
According to meaning of words, to emotions represented by some words, to decision making, to
individuals attitudes or attitudes of the environment and according to behavior . 3. Displaying
Make an inventory of the information by clustering the codes. Identify principal theme in each
block of material, and identify sub-themes in each block of material. Look for evidence that
supports or denies each theme and sub-theme, and look at what language is used to express ideas.
Record emergent ideas as memos and look for link between themes. 146 4. Reducing -
Clustering of similar themes according to their volume or frequency; how often it was
mentioned? How it was emphasized by respondents? - Distilling the information to make visible
the most essential concepts and relationships. - Separate essentials from non-essentials. - Use
visual approaches for data reduction such as matrixes, diagrams. 5. Interpretation: the act of
identifying and explaining the core meaning. - Explain the main clues to the reader. - must
provide answers to your research question and be relevant to the topic. - should develop
credibility and trustworthiness. The other approaches for data analysis are: Framework analysis:
practical and quicker Grounded Theory: more theoretical, sociological and extensive. 5.3.2.
FRAMEWORK ANALYSIS It is used to analyze in-depth and focus group data. It facilitates
systematic analysis and involves summarizing & classifying data within a thematic framework
(code book). It relies on the skills of the analyst. The Five stage of Framework Analysis Stage I:
Familiarization: Read, listen to tapes, reread notes. Stage II: Identifying a thematic framework:
Develop coding scheme, themes become labels. Stage III: Indexing: Based on comparison within
and between cases. EXAMPLE ON DISPLAYING Main theme: health seeking behavior =>
peoples’ access to health services is poor. Sub-theme: different factors hamper access to services.
Evidence: list evidence for each factor in text of interviews. Emergent ideas………………. Link
between themes: health care seeking behavior linked to quality of care…to poverty…to culture,
etc. 147 Stage IV: Charting: Rearranging data according to content (table, matrix, diagram). And
sorted by themes or by case. Stage V: Classifying and interpreting qualitative data. 5.3.3
GROUNDED THEORY It is developing a theory directly from empirical data. It emphasizes the
cycling process of data collection, analysis and interpretation until a point of saturation is
reached (no new information). It involves constant comparison (moving forward and back
between data and interpretation). It is founded in intense coding of early data to generate many
potential codes as possible. Follows Open Coding: codes are continuously modified and
improved, and Theoretical sampling: sampling goes on after first round of analysis based on
findings. Grounded Theory (other definitions) - is a method for discovering theories, concepts,
hypothesis and propositions directly from data, rather than from prior assumptions, other
research, or existing theoretical frameworks. - is a theory that is inductively derived from the
study of the phenomena it represents rather than deductive. - Encourages the initiation of
research without any preconceived theoretical ideas about the topic being researched. - The point
of Grounded Theory is to encourage the researcher to be as flexible as possible when interpreting
the findings of the research. 148 Stages of conducting Grounded Theory Analysis Stage I: Open
Sampling and Open Coding • Sampling is about the explicit generation of information to refine
and develop theory rather than the notion of randomness/representation. • Saturation of the
theory is when no new categories are found which relate to the central issue/process being
researched. Stage II: Purposive Sampling and Axial Coding • Purposive Sampling is about
locating more data to confirm/elaborate categories, identifying relationships or suggest limits to
their applicability. • Coding: The process of making the data manageable by classifying into
topics and sub-topics and attaching labels to concepts and themes that appear in the data. Stage
III: Discrimination Sampling and Selective Analysis • Deliberate and directed selection of
further data from persons, sites or documents to confirm that the theoretical accounts is saturated.
5.3.4. NARRATIVE ANALYSIS It is telling a story for transferring a message, for illustrating
complex issues. The story is the topic of the analysis like let the patient tell his/her story.
Narrative should contain six elements: - Abstract: which summarizes the story? - Background:
information setting the context, cast list, orientates the listener. - Complicating action: (i.e. ‘then
I collapsed’, I was completely lost). - Resolution: what happened at the end of the sequence or
moral of the study? - Evaluation - Coda: ‘so that’s my story’. COMMON TYPES OF
QUALITATIVE RESEARCH DESIGN A research design is a logical model that guides the
investigator through the research process. The major qualitative research designs include: 
Grounded theory: theory (what happens? and why?)  Phenomenology: event  Ethnography:
person  Case study: describing experience 149 Qualitative methods approaches: illustrations
using breast cancer Grounded theory What are the coping strategies adapted by women while
living with breast cancer? Phenomenology What are the commonly held views about breast
cancer? Ethnography What is the lived experience of women having breast cancer in different
social contexts? Case Study /Narrative analysis How do a typical woman with breast cancer get
health care ? GROUNDED THEORY A qualitative research that add to the existing body of
knowledge – developing new theories about a phenomenon. Theory is a set of well-developed
categories that are systematically interrelated to form a theoretical framework that explains the
phenomenon. PHENOMENOLOGY It describes things that are part of the world in which we
live: events, situations, experiences or concepts. Phenomenological research investigates
individuals’ lived experience of events – for example the experience of caring for someone with
AIDS/terminal cancer: meaning of caring in that context, the components of caring, the impact of
caring: negative and positive. It is philosophical belief that, unlike matter, humans have a
consciousness. They interpret and experience the world in terms of meanings and actively
construct an individual social reality. ETHNOGRAPHY It is the study of people in naturally
occurring settings or ‘fields’ by means of methods which capture their social meanings and
ordinary activities, involving the researcher participating directly in the setting, if not also the
activities, in order to collect data in a systematic manner but without meaning being imposed on
them externally. Ethnography routinely builds in triangulation of method because it involves the
use of multiple methods of data collection. In its most characteristic form...[ethnography]
involves the ethnographer  participating, overtly or covertly, in people’s daily lives for an
extended period of time,  watching what happens, 150  listening to what is said,  asking
questions, and  collecting whatever data are available to throw light on the issues that are the
focus of the research’ (Hammersley and Atkinson, 1995:1). The goal is to tell the whole story of
a group’s daily life, to identify the cultural meanings, beliefs and patterns of the group. Studies
culture of organizations, programmes and groups of people with common social problems such
as smoking and drug addiction (shared experience). Ethnography helps to develop cultural
awareness and sensitivity and enhances the coverage and quality of services. Ethnography is a
written description of a particular culture - the customs, beliefs, and behavior - based on
information collected through fieldwork." --Marvin Harris and Orna Johnson, 2000.
"Ethnography is the art and science of describing a group or culture. The description may be of a
small tribal group in an exotic land or a classroom in middle-class suburbia." --David M.
Fetterman, 1998. Typical ethnographic research employs three kinds of data collection:
interviews, observation, and documents. This in turn produces three kinds of data, quotations,
descriptions, and excerpts of documents, resulting in one product narrative description. This
narrative often includes charts, diagrams and additional artifacts that help to tell “the story“
(Hammersley, 1990). When to use ethnography? Ethnography is most appropriately used for
inquiry that requires: • In-depth understanding, • Rich narratives (if using qualitative interviews),
• Social phenomena being studied over a period of time, • An understanding of the social
meanings constructed by individuals’ themselves, • Topics not easily accessible through simple
face-to-face interviews, and • Topics which involve examining processes of change, examining
negotiated lived experiences, topics which see culture as constructed and reconstructed through
actors’ participation’ are especially suited to participant observation and ethnography’ (O’Reilly,
2005: 29) Challenges of Ethnography • Very time consuming, • Completely reliant on the
individual researcher (or a small team), • Difficult to gain full access, • Difficult to achieve
objective distance and the danger of ‘going native’, • Reporting findings and the role of
interpretation, and • Ethical dilemmas of participation. CASE STUDIES 151 Case studies are in-
depth investigations of a single or small number of units. Case study may offer rich and depth of
information not usually offered by other methods. Ranges in complexity: from the simplest:
description of a single event or occurrence to a complex: analysis of a social situation over a
period of time. Exercise XIII. Class/Take-Home Exercise: Design a Qualitative Study
Instruction: This can be exercised in the class as a group or takehome assignment as an
individual work. 1. The class will divide in groups 2. Each group will decide about a general area
of inquiry. 3. Each group will design a qualitative study to address their study by addressing the
following: a. Define the research problem b. Prepare a conceptual framework to guide your study
c. Develop a methodology (which tools do you use for data collection) d. Develop a sampling
strategy (who would you interview and why?) e. Reflect on the field implications: How will you
contact people and who will interview them. f. List themes you wish to address in the interview
g. Prepare 2 – 5 sample questions to each theme h. Consider the ethical implications of your
study 4. Prepare a presentation of your study design (flip chart). 152 5.3.4. COMPUTER
BASED SOFTWARE FOR QUALITATIVE ANALYSIS