Critical appraisal of qualitative research in clinical journals challenged

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Critical appraisal of qualitative research in
clinical journals challenged
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For qualitative work to pass muster, the authors
must still demonstrate

• a clear aim for their project, not just an
  attempt to gather masses of data and then impose
  some "order" on it
• choice of an appropriate methodology
• justification for who was and who was not
  included, and some discussion of the effect of
  drop outs and non-responders. It may be more
  important to employ purposive sampling to gather
  the whole range of possible opinions and
  experiences, rather than random sampling to
  produce a representative study group.
• And must also address a new question, more
  pertinent to qualitative work
• The relationship between investigators and
  subjects and any bias this may have introduced

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• Essentially, you must still pose and answer the
  three questions
• what is the message?
• can I believe it?
• can I generalize it?

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• The appearance of qualitative research in
  clinical journals has been increasing over the
  last 20 years as evidenced by the number of
  citations in online databases.
• A quick search using the keyword qualitative
  research in Medline (the word only became a MESH
  term in 2003) yielded 5 hits in 1983 and 792 hits
  in 2003.

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• Unfortunately, based on one authors (JS)
  experience with several qualitative manuscripts
  in circulation, editorial review boards appear to
  be lagging in their ability to appropriately
  critically appraise articles of a qualitative
  nature.

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Why?

• It is acknowledged that the need for critical
  appraisal criteria in qualitative research is
  controversial partly because there are no
  universal criteria furthermore, there is much
  debate about criteria proposed between, and
  within, various qualitative traditions. What is
  not disputed is that critical appraisal criteria
  differ for qualitative and quantitative research,
  and that these criteria have little to do with
  reliability and validity . While we are not
  arguing for, or against, specific critical
  appraisal criteria applied to qualitative
  research, there are common elements to these
  criteria that need to be presented for the
  integrity and status of qualitative research to
  be promoted in the clinical realm.

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transferability

• The term generalizability as it is typically
  understood does not exist in qualitative
  research. Qualitative researchers refer to terms
  such as transferability, (the ability to
  transfer findings from one context to another,
  or theoretical generalization, (the ability to
  produce theoretical explanations about a
  phenomenon or the ability to contribute to a
  theory.

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sampling procedures

• In qualitative research, decisions around sample
  size and sampling procedures concern the data
  collected, not the participants involved in the
  study there is little emphasis on
  generalizability based on the demographics of the
  participants.

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literature review

• The role of the literature review varies in
  qualitative research. In some traditions, such as
  phenomenology, it is acceptable to conduct the
  literature review before and/or after data are
  collected and analyzed.

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researchers

• Qualitative researchers are not viewed as
  detached, objective entities but as individuals
  who actively participate in, and shape, the
  research findings .

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• Although clinical journals pay lip service to
  being receptive to qualitative papers, review
  boards of these journals appear to be lacking in
  qualitative membership and reviewers continue to
  apply inappropriate critical appraisal to these
  studies. Unfortunately for qualitative
  researchers, the impact factor of journals
  dedicated to qualitative research is low or
  nonexistent, which means that qualitative
  research is still considered a second-class
  citizen in the clinical realm.

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• It is time for qualitative researchers to be more
  proactive about addressing these, and other,
  critical appraisal challenges so that they are
  more successful in their submissions to clinical
  journals.

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appropriate criteria for critical appraisal of
qualitative research

• there is a great deal of disagreement and debate
  about the appropriate criteria for critical
  appraisal of qualitative research, and the ones
  given here are likely to be modified in the
  future.

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• Question 1 Did the paper describe an important
  clinical problem addressed via a clearly
  question?
• Question 2 Was a qualitative approach
  appropriate?
• Question 3 How were the setting and the subjects
  selected?
• Question 4 What was the researcher's
  perspective, and has this been taken into
  account?

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• Question 5 What methods did the researcher use
  for collecting dataand are these described in
  enough detail?

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• Question 6 What methods did the researcher use
  to analyze the dataand what quality control
  measures were implemented?
• The researcher must find a systematic way of
  analyzing his or her data, and, in particular,
  must seek examples of cases which appear to
  contradict or challenge the theories derived from
  the majority.
• the data (or at least, a sample of them) will
  have been analyzed by more than one researcher to
  confirm that they are both assigning the same
  meaning to them, although in practice this is
  often difficult to achieve.

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• Question 7 Are the results credible, and if so,
  are they clinically important?
• The results should be independently and
  objectively verifiable (quotes and examples)

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• Question 8 What conclusions were drawn, and are
  they justified by the results ?
• how well does this analysis explain why people
  behave in the way they do?
• how comprehensible would this explanation be to a
  thoughtful participant in the setting?
• how well does the explanation cohere with what
  we already know?

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• Question 9 Are the findings of the study
  transferable to other clinical settings?

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