S UPPORTING 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 June 2017 Yale Global Health Leadership Institute
Collaborators 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
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
Positive deviance The Positive Deviance Method Positive deviants are members of community who find solutions to a problem despite facing similar challenges and having POSITI the same resources or VE knowledge as peers DEVIAN CE Premise: local wisdom can be generalized within that community to solve problems
Identify ‘ positive deviants ’ Positive deviance to Qualitative study to generate hypotheses improve organizational Test hypotheses quantitatively performance Disseminate with partners Evaluate uptake Bradley et al., Impl Sci 2011 and impact Krumholz et al., Am Heart J 2011
The qualitative component
Strengths Limitations of the qualitative of the qualitative component component Measurement Resource intensive Requires deep Hypothesis expertise and generation collaboration
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
Triangulation (of methods, data sources, researchers) to determine convergence and corroboration across datasets Credibility (internal validity) Sample to the point of theoretical saturation Participant confirmation or member checking Degree to which findings explain phenomenon or cohere Interviewer techniques to encourage candor with what is known Search for negative or deviant cases
Maintenance of audit trail External audit by independent Dependability researcher (skeptical, (reliability) independent peer review) Degree to which researchers account for and describe changing circumstances
Explicit statement of research aims and specific rationale for qualitative methods Transferability (external validity) Thorough, sufficiently detailed description of study context Thorough description of Degree to which findings can procedures for sampling, data be transferred to other collection and analysis settings, contexts, or populations as determined by the reader
Bracketing (make explicit and hold in abeyance biases through memos or external debriefs ) Confirmability Reflexivity (acknowledging the effect of researchers on process, (objectivity) using multiple researchers, journaling and reporting) Triangulation (see above) Degree to which findings are shaped by respondents rather Search for negative or deviant than researcher bias, cases (see above) motivation or interest
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
References 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 outcomes 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.
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