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A quantitative analysis of qualitative studies in clinical journals for the 2000 publishing year

Forum Qualitative Sozialforschung / Forum: Qualitative Social Research

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Another example of the use of mixed methods was research done by Willms and Wilson and their colleagues [ 5 - 7 ] on smoking cessation. They found the meanings that patients who smoked attributed to their cigarettes peer acceptance, coping during a time of stress and feeling out of control, feeling more like an adult, and smoking as more glamorous, tough, and rebellious had more influence on cessation than did such external conditions as nicotine gum or counseling.

Until the complex issues of why individuals smoke were dealt with, few were motivated to change their attitudes towards smoking and thus stop smoking. Another effective example of integrated qualitative ethnography and quantitative epidemiology methods was a study done by Borkan and colleagues [ 8 ] to determine predictors of recovery after hip fracture in elderly patients.

Traditional predictors such as age, type of break, and comorbidity, were collected by using standard questionnaires. In-depth interviews were used to collect injury narratives focusing on internal explanations of the fracture, sense of disability, and view of the future after hip fracture.

None of the epidemiology factors predicted successful outcomes but those who perceived their fracture as more external or mechanical as opposed to an internal or organic problem e. Persons who perceived their disability in the context of autonomy, independence, and connection with the outside world also showed better ambulation at 3 and 6 months than persons with a more narrow and confined view of the fracture and its resulting disability.

Donovan and colleagues [ 9 ] used mixed methods to study prostate cancer screening and treatment choices to determine why study recruitment was lower than expected. Rousseau and Eccles and their colleagues [ 10 , 11 ] used qualitative methods case interviews to explain the limited use of computerized guidelines for asthma and angina in a primary care study done in the United Kingdom.

Many other examples exist; Creswell and colleagues describe 5 additional mixed methods studies in primary care as well as provide criteria for evaluating mixed methods studies [ 2 ]. We postulate that qualitative studies, either stand-alone reports or studies with mixed methods, are occurring more frequently in health care.

This paper was done to describe the publishing of qualitative studies in 1 year of clinical literature, document and present the range of content and techniques in these studies, and establish a baseline for subsequent studies.

We defined our sample to include all articles published in a set of major general medical, mental health, or nursing journals during We determined how many qualitative studies were published and in which journals, and extracted design methods and healthcare content, and how often studies used mixed methods and analyses.

Because the nursing literature published a higher proportion of qualitative studies in our sample we also compared studies published in nursing journals with other journals to ascertain if quantitative differences exist across disciplines in the use of qualitative methods. Our analysis is a quantitative review of qualitative studies in health care in Their purpose is to provide enhanced abstracts and commentaries on important high-quality original studies and review articles for their respective clinical audiences.

To identify these studies and review articles, 6 research staff read major clinical journals to ascertain if articles were in 1 or more categories of therapy, diagnosis, prognosis, etiology, economics, clinical prediction guides, differential diagnosis, and qualitative studies and if so, did each meet predefined methodology criteria for study quality[ 12 ]. One hundred and seventy journals provided data for this article. The staff of the Health Information Research Unit has established quality criteria for the 8 categories of clinical literature that must be met before articles are judged appropriate for clinical application and publication in an abstract journal.

Qualitative studies have 3 criteria:. For this paper, KAM, one of the readers, analyzed the qualitative studies. Qualitative systematic reviews were excluded leaving only reports of original studies.

These were assessed to extract journal title, qualitative study type, data collection methods, research question, persons studied, setting, and disease or health condition considered.

In addition, studies with mixed methods were further analyzed although we did not use stringent criteria for assessing the quality [ 2 ] of the combination of methods. We identified mixed methods articles using a loose criterion of "some numerical or statistical analysis of quantitative data or qualitative data that had been turned into quantitative data".

An example of quantifying qualitative data is the study done by Borkan and colleagues [ 8 ] on hip fracture. The analysis had to be fairly substantial—for example, a simple descriptive analysis of baseline demographics of the participants was not sufficient to be included as a mixed methods article. In addition, Giacomini and Cook [ 14 , 15 ], as part of the Evidence-Based Working Group in the Users' Guides to the Medical Literature, describe attributes that they have identified as belonging to high-quality qualitative studies: These aspects were also extracted for analysis in this report.

Data were taken from article abstracts and if needed, the full text was reviewed. Methodologies assessed were phenomenology, grounded theory, ethnography, case studies, narrative analysis, participant action, critical incident techniques, and discourse analysis.

Author descriptions were used and if an additional methodology was found it was added to the list of types using definitions and descriptions from the Handbook of Qualitative Analysis, 2 nd edition by Denzin and Lincoln [ 16 ]. Data collection and sampling procedures were also extracted. Multiple designations were allowed. Twelve systematic reviews were excluded leaving qualitative studies for assessment.

The reproducibility of the categorization was measured by kappa chance adjusted agreement: Agreement was low for participant selection methods kappa 0. The qualitative studies appeared in 48 journals mean 7. Most of the qualitative studies were published in nursing journals: Few qualitative studies were published in the high-circulation, general healthcare journals.

These 4 journals published 15 qualitative studies with BMJ publishing The highest-ranking journal with qualitative studies was Annals of Internal Medicine , ranked number 6. JAMA , ranked number 2, published articles about qualitative studies in [ 14 , 15 ] but did not publish any qualitative studies.

Social Science and Medicine published 10 of these mixed methodology studies—the most of any title studied. Many studies dealt with a range of participants and settings. Many uncommon issues were also assessed. For example, Tongprateep [ 17 ] reports a phenomenology study designed to help nurses better understand essential elements of spirituality and health among rural Thai elders.

The mixed methods studies did not included participatory action research, critical incident technique, or discourse analysis studies, methods that could be difficult to combine with quantitative studies. These methods are major data gathering techniques in qualitative studies. Nursing studies did not differ for data gathering techniques. Sampling is important in all studies—often no single right way exists for a study question.

Purposive, snowball, and theoretical sampling are often used in qualitative studies and random and consecutive sampling for quantitative studies. All methods were represented in this analysis but the breakdowns are not reported because of low inter-rater agreements for categorization and missing author information.

Most of the qualitative studies were in nursing journals although some medical journals such as BMJ and Annals of Internal Medicine also published several.

This is likely a reflection on the emphasis on a positivist, numerical approach that many of these journals embrace. The difference in proportion of qualitative studiers published in nursing journals is probably because of two historical, but linked factors. Qualitative studies have roots in women's studies and the nursing profession has always dealt with the patient as much more of a whole person rather than basic sciences facts and numbers.

Both of these factors lead to more emphasis on understanding and embracing qualitative methods for research and practice. In general, these mixed methods studies were similar to the single methodology studies except they did more assessments of physicians and relied more on questionnaires to gather data for analysis.

The presence of these mixed methods or multipardigmatic studies as described by Miller and Crabtree [ 1 ] and Creswell [ 18 ] is encouraging for those who espouse harnessing methodologies appropriate for exploring, explaining, and interpreting the complexities and ranges of issues in health care practice and research. It is also interesting comparing qualitative studies in Nursing and non-Nursing journals.

Regardless of the differences in proportion of qualitative studies published, from a content point of view few differences exist between the Nursing and non-Nursing journals except that more physicians were studied in the non-Nursing journals and fewer studies were done in clinical settings—not unsurprising findings.

This indicates that the content and methods of qualitative studies seem to be similar across disciplines or if the methods are combined with quantitative methods.

This review of the publication of qualitative studies is limited in several ways. The proportion of journals studied was very low in relation to the total number of journals published.

MEDLINE indexes over journals and this number is still a relatively small proportion of all journals that deal with health care. In addition, all of the journals searched were published in English so we do not know about qualitative studies in other languages. Although our criteria were relatively strict for including qualitative studies, our criteria for mixed methods studies could certainly have been stronger.

We did not count the number of high-quality quantitative studies that could have included some qualitative analyses. We studied only 1 year of publishing; much could have changed since Qualitative studies provide insight into social, emotional, and experiential aspects of health and health care and as such, they have an important place in understanding health and health care. Hopefully more studies will be published and more will be published in the high impact high circulation journals.

This paper provides a basis for measuring increases. Qualitative studies are being done and are published in a wide range of healthcare journals. These journals however are not the highest impact journals. Iltis, Wake Forest University. Narrative Inquiry in Bioethics. Also of Interest Twentieth-Century China. Journal of Chinese Religions.

Progress in Community Health Partnerships: Research, Education, and Action. Kennedy Institute of Ethics Journal. Journal of the History of Philosophy.

Perspectives in Biology and Medicine. Journal of Health Care for the Poor and Underserved. American Journal of Mathematics.

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Qualitative Research Journal (QRJ) is an international journal devoted to the communication of the theory and practice of qualitative research in the human sciences. It is interdisciplinary and eclectic, covering all methodologies that can be described as qualitative. Journal of Ethnographic & Qualitative Research (JEQR) is a quarterly, peer-reviewed periodical, publishing scholarly articles that address topics relating directly to empirical qualitative research and conceptual articles addressing topics related to qualitative. .