D&I Study Designs for Rapid, Relevant, and Rigorous Research - - PowerPoint PPT Presentation

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Co-Hosted by the National Institutes

• f Health and AcademyHealth

D&I Study Designs for Rapid, Relevant, and Rigorous Research

Alison Hamilton, PhD, MPH VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy UCLA Dept of Psychiatry & Biobehavioral Sciences

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An epistemological ledge Qualitative scholars need to “stand out on an epistemological ledge and aggressively move qualitative thinking into the mainstream of health care scholarship.” (Hoff 2011)

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Qualitative thinking in the implementation science “mainstream”

PubMed: qualitative & implementation 1999-2009: 1704 2009-2020: 12819

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Tensions in the qualitative D&I mainstream

• Managing & reflecting time and temporality (Reynolds & Lewis 2019)
• Inquiring about power
• “Our traditional expertise with context and meaning must be supplemented with

questions of power to understand what holds these contexts and meanings in place.” (Agar 1997)

• Understanding (organizational) culture as constructed and intersubjective (Agar

1997)—not “found” or coherent (or entirely measurable)

• Being pragmatic, rapid, rigorous AND “complexity-informed,” tuned into "the

unknown, the uncertain, the unpredictable and the emergent" (Greenhalgh & Papoutsi 2018)

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Ethnography can help!

Identify “rich points” (Agar 1997)

• Surprises, problems in understanding resulting from “strips of

experience”

• Points at which your assumptions are revealed to be inadequate
• The rich point is YOUR problem to figure out

Incorporate an “ethnographic sensibility” (Pader 2006)

• How we are in, look at, and move through research settings

Reflect regularly on implementation processes (Finley et al., 2018)

• What’s happening from the insider’s viewpoint, sensemaking

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Complexity theory needs ethnography

1997: “I think complexity theory…will add potential understanding and explanation that linear cause and effect models cannot approach.” (Agar 1997) 2019: “If we are serious about understanding the ‘black box’ of complexities, then we need to take social science seriously.” (Goodwin 2019)

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“If people have cooperative intentions, and if the collaboration begins right at the beginning, adding ethnography to a project is like adding yeast to bread dough or beer. Once you see what it does, you can’t imagine why anyone would do it any other way.” (Agar 1997)

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Get comfortable out here Keep looking at/for different viewpoints Don’t worry that you can’t see or know everything Move from the rich points to deeper understanding

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Acknowledgements

Agar MH. Ethnography: an overview. Subst Use Misuse. 1997 Jul;32(9):1155-73. Finley EP, Huynh AK, Farmer MM, Bean-Mayberry B, Moin T, Oishi SM, Moreau JL, Dyer KE, Lanham HJ, Leykum L, Hamilton AB. Periodic reflections: a method of guided discussions for documenting implementation phenomena. BMC medical research methodology. 2018 Dec;18(1):153. Goodwin N. Improving Integrated Care: Can Implementation Science Unlock the 'Black Box' of Complexities? Int J Integr Care. 2019 Jul 25;19(3):12. Greenhalgh T, Papoutsi C. Studying complexity in health services research: desperately seeking an overdue paradigm shift. BMC Med. 2018 Jun 20;16(1):95. Hamilton AB, Finley EP. Qualitative methods in implementation research: An introduction. Psychiatry research. 2019 Oct 1;280:112516. Hamilton AB, Mittman BS, Campbell D, Hutchinson C, Liu H, Moss NJ, Wyatt GE. Understanding the impact of external context on community-based implementation of an evidence-based HIV risk reduction intervention. BMC health services research. 2018 Dec;18(1):11. Hoff TJ. Toward a culture of qualitative thinking in health services research. Med Care Res Rev. 2011 Feb;68(1):49-55. Pader E. Seeing with an ethnographic sensibility. Interpretation and method: Empirical research methods and the interpretive turn. 2006:161-75. Reynolds J, Lewis S. Ethnography and evaluation: temporalities of complex systems and methodological complexity. Anthropol Med. 2019 Apr;26(1):1- 17.

Works Cited

• Supported by VA QUERI (QUE 15-272, QIS 19-318), VA HSR&D (SDR 10-012, IIR 18-116), NHLBI (U01HL142109)
• Special thanks to Drs. Erin Finley and Sarah Ono for inspiring me.

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THANK YOU!

• Alison Hamilton, PhD, MPH
• VA Greater Los Angeles & UCLA

@alisonh3