Collaborators Amanda Brewster PhD, Yale School of Public Health - - PowerPoint PPT Presentation

SUPPORTING RIGOR IN THE QUALITATIVE

COMPONENTS OF A POSITIVE DEVIANCE STUDY

Leslie Curry, PhD, MPH

Senior Research Scientist, Yale School of Public Health Core Faculty, Yale Global Health Leadership Institute Lecturer, Yale College Yale Global Health Leadership Institute June 2017

Amanda Brewster PhD, Yale School of Public Health Kelly Devers PhD, NORC at the University of Chicago James Burgess PhD, Boston University School of Public Health

Collaborators

Overview

 Review one model of positive deviance  Address 5 common misconceptions about qualitative

methods in positive deviance studies

 Discuss strategies for increasing rigor in the

qualitative component

Positive deviance and organizational performance in health care

POSITI VE DEVIAN CE

The Positive Deviance Method

Positive deviance

 Positive deviants are members

• f community who find solutions

to a problem despite facing similar challenges and having the same resources or knowledge as peers

 Premise: local wisdom can be

generalized within that community to solve problems

Qualitative study to generate hypotheses Test hypotheses quantitatively Disseminate with partners Identify ‘positive deviants’ Evaluate uptake and impact

Bradley et al., Impl Sci 2011 Krumholz et al., Am Heart J 2011

Positive deviance to improve

• rganizational

performance

The qualitative component

Strengths

• f the qualitative

component Limitations

• f the qualitative

component

Measurement Hypothesis generation Requires deep expertise and collaboration Resource intensive

Five common misconceptions

Misconception #1

Distinctions between positive and negative deviants are straightforward and easy to identify

Misconception #2

Positive deviance studies require teams with primarily qualitative expertise

Misconception #3

Both positive and negative deviants are always required in order to identify factors contributing to exceptionally high performance No consensus on this one!

Misconception #4

Determining sample sizes for sites and respondents using theoretical saturation is not feasible in practice

Misconception #5

The qualitative component of positive deviance studies is quick, easy and inexpensive

Strategies for increasing rigor of the qualitative component

Credibility (internal validity)

Degree to which findings explain phenomenon or cohere with what is known

Triangulation (of methods, data sources, researchers) to determine convergence and corroboration across datasets Sample to the point of theoretical saturation Participant confirmation or member checking Interviewer techniques to encourage candor Search for negative or deviant cases

Dependability (reliability)

Degree to which researchers account for and describe changing circumstances

Maintenance of audit trail External audit by independent researcher (skeptical, independent peer review)

Transferability (external validity)

Degree to which findings can be transferred to other settings, contexts, or populations as determined by the reader

Explicit statement of research aims and specific rationale for qualitative methods Thorough, sufficiently detailed description of study context Thorough description of procedures for sampling, data collection and analysis

Confirmability (objectivity)

Degree to which findings are shaped by respondents rather than researcher bias, motivation or interest

Bracketing (make explicit and hold in abeyance biases through memos or external debriefs) Reflexivity (acknowledging the effect of researchers on process, using multiple researchers, journaling and reporting) Triangulation (see above) Search for negative or deviant cases (see above)

Summary points

 Positive deviance is becoming popular in health services research  Substantial potential for improving performance, quality and outcomes  Requires expertise in quantitative, qualitative and mixed methods  Ensuring rigor of qualitative component is essential, using well established techniques

THANK YOU!

Leslie Curry, PhD, MPH Senior Research Scientist Yale Global Health Leadership Institute Yale University leslie.curry@yale.edu http://ghli.yale.edu @lesliecyale, @YaleGH YaleGlobalHealth

Barbour, R. S. (2001). Checklists for improving rigour in qualitative research: A case of the tail wagging the dog. Bristish Medical Journal, 322, 1115–1117. Curry L, Nembhard I, Bradley E. Qualitative and mixed methods provide unique contributions to

• utcomes research. Circulation, 2009; 119:1442-1452. PMID:19289649.

Mays N. & Pope C. (1995) Rigour and qualitative research. British Medical Journal 311 , 109–112. Mays N. & Pope C. (2000a) Assessing quality in qualitative research. British Medical Journal 320 , 50– 52. Bradley E, Curry L, Ramanadhan S, Rowe L, Nembhard I, Krumholz H. Research in Action: Using positive deviance to improve quality of health care. Implementation Science, 2009; 4:25. Devers K.J. (1999) How will we know ‘good’ qualitative research when we see it? Beginning the dialogue in health services research. Health Services Research 34 (5), 1153–1188. Giacomini M.K. & Cook D.J. (2000) Users’ guides to the medical literature, XXIII. Qualitative research in health care, A. Are the results of the study valid? Journal of the American Medical Association 284 , 357–362.

References