It is no secret that implementation science (IS) is a challenging field, given the complexity of interventions, implementations, and implementation sites, which involve interpersonal processes and multiple levels of context that influence the effort. Adding to the challenge is the real-world, dynamic nature of implementation research marked by changes in interventions, implementation strategies, and settings over time. Qualitative methods are well suited to help us sort out this complexity and, in tandem with quantitative methods, render mixed methods a powerful tool for understanding implementation efforts and outcomes.
The use of qualitative methods in IS, however, has not been without its problems. Traditionally, qualitative research involves long-term, labor-intensive engagement of the researcher in a research setting. Implementation science, however is action-oriented, requiring flexible, adaptive methods, frequently in compressed timeframes. Adapting qualitative methods to the contingencies of implementation science while maintaining methodological rigor and integrity can be difficult. A comprehensive discussion specifically focused on qualitative methods in IS is necessary, but has not yet formally or systematically occurred. To remedy this, NCI’s Implementation Science Team has organized a workgroup to catalyze this discussion, the QUALRIS (QUALitative Research in Implementation Science) group. The group is included on the Research to Reality website as one of its learning communities.
QUALRIS includes thought leaders in IS science, qualitative methods, or both. Its members are Deborah Cohen (OHSU), Benjamin F. Crabtree (RWJMS), Laura Damschroder (Ann Arbor VA), Alison B. Hamilton (Los Angeles VA), Suzanne Heurtin-Roberts (NCI), Jennifer Leeman (UNC Chapel Hill), Deborah K. Padgett (NYU), Lawrence Palinkas (USC), Borsika Rabin (UC San Diego), and Heather Schacht Reisinger (Iowa VA).
The group has been writing a white paper examining some of the challenges involved in using qualitative methods in implementation science and offering guidance in meeting those challenges. The paper is intended for implementation researchers with limited to no experience in qualitative methodology, orienting readers to qualitative methods, and relating how the methods have been used thus far and for what purposes. Using qualitative methods in IS can be challenging for the most experienced researcher, and we anticipate that these researchers will also find the paper helpful.
QUALRIS is planning to meet in December of this year, just after the 10th annual D&I conference, to put finishing touches on a near-final draft of the paper. We plan to release the paper on NCI’s IS Team website early in 2018. In the meantime, we can share some thoughts on using qualitative methods rigorously and appropriately in IS. They have drafted guidance in the following domains:
1) Employ qualitative methods relevant to research questions rather than methods commonly used as “defaults” such as “focus groups” or “semi-structured interviews;”
2) Give increased attention to procedures designed to achieve qualitative analogs to validity and reliability, such as “trustworthiness,” “transferability,” and “auditability.” Providing documentation of adherence to those procedures;
3) Provide rationales for form and content of interview and focus group guides;
4) Document and explain data analysis logic and procedures;
5) Improve presentation of qualitative findings in IS publications.
The group also recommends increased qualitative expertise on research teams and increased training in qualitative methods for IS researchers.
Raising the bar for the use of qualitative methods in IS serves to strengthen the field. It can also expand our understanding of the implementation process, as qualitative inquiry frequently leads to discovery of new phenomena and to new questions we hadn’t previously thought to ask. Strong methods, both qualitative and quantitative, will lead us to a stronger implementation science.
We would love to hear about your experiences in using qualitative methods in implementation research. What has worked well for you? What problems have you faced? How did you address those problems? What are your thoughts about maintaining rigor in qualitative methods while engaged in frequently fast-paced and complex implementation studies? What questions do you have? Please join in our QUALRIS conversation on R2R!
Cohen, D.J. and Crabtree, B.F. (2008) Evaluative criteria for qualitative research in health care: controversies and recommendations. Annals of Family Medicine 6:331-339.
Palinkas, L. A. (2014) Qualitative and mixed methods in mental health services and implementation research. Journal of Clinical Child and Adolescent Psychology 43(6): 851-861.
Sandelowski, M., & Leeman, J. (2012) Writing usable qualitative health research findings. Qualitative Health Research 22(10), 1404-1413.
Southam-Gerow, M. A. and S. Dorsey, S. (2014). Qualitative and mixed methods research in dissemination and implementation science: introduction to the special issue. Journal of Clinical Child & Adolescent Psychology 43(6): 845-850.