Commentary

By Bahareh Kardeh & Ben Mortenson

In our day-to-day conversations, we are usually exchanging two types of information: objective and subjective. You might ask your friend how their sports team scored in the last match, to which they will give you an objective answer: numbers. But you might also ask them what they thought of the match. In that case, you are expecting to hear their personal perspective and experience. The data that researchers collect can be broadly categorized in a similar fashion. The first type of inquiry involving objective data collection is considered quantitative research, and the latter, which is focused on subjective personal experiences, is qualitative research. In practice, most researchers usually have a preference for either of these two types of research depending on their discipline and expertise.

Before starting my Master’s degree in Rehabilitation Sciences program at the University of British Columbia, I completed my studies in medicine and collaborated on several quantitative research projects. Therefore, I was comfortable with quantitative research but had no prior knowledge of qualitative research. My thesis was part of a larger mixed-methods study (i.e., a study including both quantitative and qualitative components), which explored the access to and use of assistive devices among people with disabilities and related barriers and facilitators. To address some of our research questions, it was necessary to interview participants to understand their personal experiences. Therefore, I took an advanced qualitative research course to conduct and analyse the qualitative portion as well. This course turned out to be a real challenge for me. While most other students were actively engaged in class discussions and shared their already-in-progress qualitative projects, I felt like an alien. I even had trouble understanding their “language”. Our first assignment was to choose three qualitative papers on a similar topic and compare them. I remember asking the professor about trying to find the equivalent of variables in these papers but was reminded that there was no such thing in qualitative research. Overall, going through this course was an intimidating experience and, in retrospect, I became resistant. I subconsciously thought that qualitative research does not seem like real research after all. Here, I discuss the reasons for my initial negative attitude and how it has changed.

The Struggle

I believe I struggled for four main reasons:

1. Having a bias towards past research experience:

My previous research was purely quantitative. Therefore, I would say I was not a blank slate to begin with. I was inculcated to look for abstract numbers and have outcome measures when writing a proposal. I was used to the idea that research was supposed to be a primarily objective process. This background created a bias, which made it difficult for me to make room for qualitative research. It might have been different if I were just beginning to do research.

2. Distinguishing the purpose of clinical vs. qualitative interviews:

Another challenge for me was that I was accustomed to the idea of interviewing only within a clinical setting. Although one aspect of a good patient-centered medical interview is to explore the patients’ stories and experiences of their illnesses, physicians need to guide them to elaborate on significant areas of their health histories and clarify the attributes of their symptoms (1). Depending on the context, this focus might be more or less prominent; however, the main goal is to gather information that is relevant for a diagnosis (2), especially as some physicians might not have sufficient time with their patients (3). In contrast, a good qualitative interviewer encourages participants to open up and share their stories, experiences, and personal perspectives.

I had to realize that the relevance of a participant’s answers to qualitative interview questions is not as black and white as in a clinical interview setting. It is not always practical to expect a very direct answer to a particular question. For instance, if the participant is asked about the problems they have in using an assistive device, they might continue to also talk about issues with insurance coverage. While this topic does not seem related to the question on a surface level, it does have inherent value, such as by providing context for the interviewer with regards to another interview question or even prompting them to design another study to investigate the topic. In addition, asking the participant to get back “on track” might discourage them from giving elaborate answers and make them feel rushed, which hurts the quality of data. To tackle this, the interviewer should show reasonable patience and appreciation for shared answers and remember that there will be enough time to categorize the information when it comes to analysis. This skill might take some time to develop for a novice qualitative researcher, such as myself, who was predominantly used to doing clinical interviews.

3. Distinguishing the role of the professional vs. interviewer:

Role perception was another hindering difficulty for me. In a professional-patient relationship, the professional is typically the expert. However, in a good qualitative interview, the interviewer takes the role of a non-expert regardless of their level of familiarity with the topic and acknowledges the participant as an expert, who has unique insights. The interviewer is eager and patient to “learn” from the participant. This shift of mindset may not be very easy for a clinician. This required me to refrain from any comments that could potentially lead the participant to think that I have any assumptions about their experiences or that I am looking for “correct” answers. For instance, in my research project on the use of assistive devices, if a participant mentioned they preferred using a power wheelchair most of the time even though they could use a cane instead, it is not the right time and place for the interviewer, regardless of credentials and expertise, to try to express their opinion or provide advice.

4. Going beyond objective data:

Finally, my personal information-taking and decision-making preferences was another reason for my struggle. While I was personally more focused on the importance of objective data, I found out others might more easily recognize the value of participants’ feelings and perspectives, which can be significant for various stages of healthcare delivery.

Furthermore, in contrast to quantitative research, qualitative researchers are an integral part of data interpretation. I could not grasp the idea of the researcher being part of the data and its analysis. This was contradictory to the objective definition of data that I had embraced. For this reason, I was skeptical about how researcher-interpreted data obtained from a limited number of participants could have broader implications (e.g., inform policies).

An Opportunity for Growth

My biggest motivations to take the course were to understand qualitative research, as an emerging methodology in the health sciences, and to gain some experience even if I decided it was not something that I would like to pursue in my research career. Given these struggles, I was relieved when I passed the course.

Since then, I have had the opportunity to conduct and analyze a number of qualitative interviews as part of my responsibilities on several mixed-methods research projects. It has been an eye-opening experience. The wealth of information that can be simply obtained through open-ended questions was beyond what I had expected. The expertise of the participant is evident and humbling when they tell you things that you did not know or even know that you did not know. Things that might not have been included in a quantitative questionnaire or be understood in statistically significant differences between variables.

I had to realize that the relevance of a participant’s answers to qualitative interview questions is not as black and white as in a clinical interview setting. 

The Resolution

When reading a qualitative paper, it is hard to picture the raw data and the analysis process. Of course, the authors describe trustworthiness strategies and support their observations with quotes; however, not all readers are confident trusting these kinds of assertions. Now, after having been involved in the process, I can understand that it is not the point. Qualitative research does not seek to reveal a single reality in a totally objective and unbiased way. Instead, the purpose is to shed light on the less familiar sides of a real issue. Its value is in being somewhat subjective, unpredictable, unexpected, and messy. It can answer research questions that we were not even aware of. It can give us direction by showing how and why something works or doesn’t work and what solutions would appeal most to those involved (e.g., patients).

Individuals seeking rehabilitation care are usually dealing with chronic conditions affecting various aspects of their lives. As the goal of rehabilitation is to improve patients’ independence in activities of daily living and quality of life through patient-centered plans (4), it is crucial to understand their perspectives. Qualitative research provides the means to do this. Patients’ lived experiences might be far from our perceptions as clinicians are mainly concerned with objective outcomes. Reflecting on my journey with qualitative research, I see that it was not easy but absolutely worthwhile. Similar to the way that learning new languages has allowed me to tap into new worlds of wisdom, I believe qualitative research has opened my eyes to layers of information that I would have otherwise missed out on. I feel more confident as a researcher with another strong tool in my wheelhouse to communicate with my participants, and more importantly, they deserve to be heard and understood in qualitative ways as well.

Acknowledgements

Featured illustration by Joshua Koentjoro for rehabINK.

To refer to this article, it can be cited as:

Kardeh, B, Mortenson, B. Dear Qualitative Research, forgive me! rehabINK. Issue 12. Available from: https://rehabinkmag.com

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References

1. Bickley L, Szilagyi PG. Bates’ guide to physical examination and history-taking. Lippincott Williams & Wilkins; 2012.
2. Keifenheim KE, Teufel M, Ip J, Speiser N, Leehr EJ, Zipfel S, Herrmann-Werner A. Teaching history taking to medical students: a systematic review. BMC medical education. 2015;15(1):159.
3. Barrier PA, Li JT, Jensen NM. Two words to improve physician-patient communication: what else? Mayo Clinic Proceedings. 2003;78(2):211-214
4. What is Physical Medicine and Rehabilitation? American Academy of Physical Medicine and Rehabilitation. Accessed October 26, 2020. https://www.aapmr.org/about-physiatry/about-physical-medicine-rehabilitation