Greg Guest

Describing Mixed Methods Research: An Alternative to Typologies

Scholars have created a variety of typologies to describe and simplify mixed methods research designs. In this article, I review the rationale for using these typologies and discuss some shortcomings of the existing methods of classification. I argue that current systems of classification, although useful for simple and less fluid types of mixed methods research, are not capable of capturing the complexity and iterative nature of larger, more intricate research projects. I suggest an alternative way of viewing and describing mixed methods research for studies that resist simple classification. This alternative perspective shifts the unit of reference to the point of interface—where QUAL and QUAN data are integrated—and reduces the number of descriptive dimensions to two—the timing and the purpose of data integration.

How Many Focus Groups Are Enough? Building an Evidence Base for Nonprobability Sample Sizes:

Few empirical studies exist to guide researchers in determining the number of focus groups necessary for a research study. The analyses described here provide foundational evidence to help researchers in this regard. We conducted a thematic analysis of 40 focus groups on health-seeking behaviors of African American men in Durham, North Carolina. Our analyses revealed that more than 80% of all themes were discoverable within two to three focus groups, and 90% were discoverable within three to six focus groups. Three focus groups were also enough to identify all of the most prevalent themes within the data set. These empirically based findings suggest focus group sample sizes that differ from many of the “rule of thumb” recommendations in the existing literature. We discuss the relative generalizability of our findings to other study contexts, and we highlight some methodological questions about adequate sample sizes for focus group research.

Using the Inequitable Gender Norms Scale and Associated HIV Risk Behaviors among Men at High Risk for HIV in Ghana and Tanzania

Context: Gender norms influence unintended pregnancy, maternal health, HIV/AIDS infection, and act as barriers to reproductive health services. The Gender Equitable Men (GEM) scale has been used widely in programs and research in African settings, but it has yet to be statistically validated. Method: We examined the internal and external validity of the Inequitable Gender Norms (IGN) subscale of the GEM scale in Tanzania and Ghana using a two-step, mixed-method process. Confirmatory factor analysis tested the internal validity of the subscale and regression tests identified associations between the IGN scale and several HIV risk-related variables. Results: The IGN scale was shown to be a useful measure of gender norms in both countries. Excluding two questions that measured attitudes toward homosexuality, the scale met the hypothesized single factor structure. Furthermore, the IGN scores were significantly associated with several HIV risk variables in both samples. Conclusions: The IGN scale is a robust measure of gender norms in these African countries. However, the role of attitudes toward homosexuality as a contributor to gender norms measurement needs further exploration. Our analyses provide a basis for using the IGN scale to provide a contextualized understanding of men’s perceptions of gender norms and to evaluate programs focused more equitable gender norms. We are aware of only one other measure of gender norms that has been statistically validated in the African Context.

Evaluating Bang for the Buck A Cost-Effectiveness Comparison Between Individual Interviews and Focus Groups Based on Thematic Saturation Levels

Evaluators often use qualitative research methods, yet there is little evidence on the comparative cost-effectiveness of the two most commonly employed qualitative methods—in-depth interviews (IDIs) and focus groups (FGs). We performed an inductive thematic analysis of data from 40 IDIs and 40 FGs on the health-seeking behaviors of African American men (N = 350) in Durham, North Carolina. We used a bootstrap simulation to generate 10,000 random samples from each data set and calculated the number of data collection events necessary to reach different levels of thematic saturation. The median number of data collection events required to reach 80% and 90% saturation was 8 and 16, respectively, for IDIs and 3 and 5 for FGs. Interviews took longer but were more cost-effective at both levels. At the median, IDIs cost 20–36% less to reach thematic saturation. Evaluators can consider these empirically based cost-effectiveness data when selecting a qualitative data collection method.

Comparing focus groups and individual interviews: findings from a randomized study

Abstract Qualitative researchers often have to decide whether to collect data using focus groups or individual interviews. We systematically compare these two methods on their ability to generate two types of information: unique items in a brainstorming task and personally sensitive disclosures. Our study sample consisted of 350 African-American men living in Durham, North Carolina. Participants were randomized into either a focus group arm or individual interview arm, and were asked the same open-ended questions about their health-care seeking behavior. For the item-generating task, we compared data at two levels of analysis – the event and the individual. At the event level, focus groups and individual interviews generated similar numbers of unique items in a free-listing task. When compared on a per-person basis, however, individual interviews were more effective at generating a broad range of items. We also compared the number of data collection events in which personal, sensitive information was disclosed. We found that several types of sensitive and personal disclosures were more likely in a focus group setting, and that some sensitive themes only occurred in the focus group context. No sensitive themes emerged exclusively, or more often in, an individual interview context. Researchers may use these findings to help align their choice of qualitative data collection method with research objectives.

Public health research methods

1: Introduction to Public Health Research Methods - Greg Guest PART I: Planning and Preparing for Research 2: Designing Research - Heidi Reynolds, Greg Guest 3. Research Ethics and Working with Institutional Review Boards - Amy Corneli, David Borasky 4. Cultivating Stakeholder Involvement in Public Health Research - Dazon Dixon Diallo, Paula Frew In Focus: Community-Based Participatory Research - Karen Hacker and Greg Guest PART II. TRADITIONAL EPIDEMIOLOGIC METHODS & DESIGNS 5. Public Health Surveillance: From Data to Action - Donna Stroup, Steven Thacker 6. Outbreak Investigation - Douglas Hamilton 7. Cohort and Case Control Studies - Lee Warner, Deborah Dee 8. Designing Randomized Controlled Trials - Theresa Gamble, Danielle Haley, Niru Sista, Raymond Buck PART III. STRUCTURAL AND OPERATIONAL RESEARCH 9. Using Secondary Data - Sarah Boslaugh 10. Economics of Population Health - Emma McIntosh, Cam Donaldson, Lyndal Bond, Kenny Lawson In Focus: Cost Analysis for Interventions - Rick Homan 11. Health Services Research - Heidi Reynolds 12. Survey Design and Implementation - Jeanne Bertolli, Kathy Hageman, Travis Sanchez, Andrea Kim 13. Scale Development and Validation - Glenn Gamst, Lawrence S. Meyers, Holly McClain Burke, A. J. Guarino 14. Social Network Analysis. Methods and Applications in Public Health - Elizabeth Costenbader, Thomas Valente 15. Qualitative Research Methods - Emily Namey, Robert Trotter II 16. Randomized Controlled Trials for Psychosocial Interventions - Phyllis Solomon, Mary Cavanaugh PART IV. CROSS-CUTTING METHODS AND APPROACHES 17. Sampling: The Foundation of Good Research - Johnnie Daniel 18. Statistical Methods in Public Health Research - Mark Weaver 19. Mixed Methods Research - Greg Guest, Paul Fleming In Focus: Using Vignettes in Public Health Research - Paul Fleming, Michael Stalker 20. Geographic Information Systems (GIS) in Public Health - Candace Nykiforuk 21. Public Health 2.0. Fresh Approaches to Old Problems - Hans Ossebaard and Lisette van Gemert-Pijnen In Focus: Mobile and Digital Data Collection in the Field - Mitesh Thakkar, Nikhil Wilmink, Rachna Nag Chowdhuri, Sruthi Chandrasekaran PART V. APPLYING RESEARCH FINDINGS 22. Enhancing Research Utilization - Jeffery Peterson, Angie Funaiole 23. Implementation Science. Identifying the Path from Innovation to Impact - Temina Madon APPENDIX 1. Theories and Models in Public Health Research

When and why women might suspend PrEP use according to perceived seasons of risk: implications for PrEP-specific risk-reduction counselling

Abstract Oral pre-exposure prophylaxis (PrEP) using the antiretroviral drug emtricitabine/tenofovir disoproxil fumarate (Truvada) has been shown to dramatically reduce the risk of HIV acquisition for women at higher risk of infection if taken daily. Understanding when and why women would intentionally stop using an efficacious oral PrEP drug within the context of their ‘normal’ daily lives is essential for delivering effective PrEP risk-reduction counselling. As part of a larger study, we conducted 60 qualitative interviews with women at higher risk of HIV in Bondo, Kenya, and Pretoria, South Africa. Participants charted their sexual contacts over the previous six months, indicated whether they would have taken PrEP if available and discussed whether and why they would have suspended PrEP use. Nearly all participants said they would have used PrEP in the previous six months; half indicated they would have suspended PrEP use at some point. Participants’ reasons for an extended break from PrEP were related to partnership dynamics (e.g., perceived low risk of a stable partner) and phases of life (e.g., trying to conceive). Life events (e.g., holidays and travel) could prompt shorter breaks in PrEP use. These circumstances may or may not correspond to actual contexts of lower risk, highlighting the importance of tailored PrEP risk-reduction counselling.

Preparing for the Rollout of Pre-Exposure Prophylaxis (PrEP): A Vignette Survey to Identify Intended Sexual Behaviors among Women in Kenya and South Africa if Using PrEP

Introduction Several clinical trials have demonstrated the efficacy of pre-exposure prophylaxis (PrEP) in reducing HIV risk. One concern with introducing PrEP is whether users will engage in riskier sexual behaviors. Methods We assessed the effect that PrEP may have on sexual risk behaviors by administering a survey to 799 women in Bondo, Kenya, and Pretoria, South Africa. Participants were asked about their sexual behavior intentions twice — once as if they were taking PrEP and once as if they were not taking PrEP — within four risk situations (vignettes). They responded using a 5-point ordinal scale. We used a series of linear mixed effects models with an unstructured residual covariance matrix to estimate the between- and within-subject differences in the mean likelihood of engaging in risky sexual behavior across the PrEP and non-PrEP contexts. We also calculated the total percentage of participants who reported a greater likelihood of engaging in risky sexual behavior if taking PrEP than if not taking PrEP, by vignette. Results We found statistically significant differences in the mean likelihood of engaging in risky sexual behavior with the between-subject comparison (-0.17, p < 0.01) and with the within-subject comparison (-0.31, p < 0.001). Depending on the vignette, 27% to 40% of participants reported a greater likelihood of engaging in risky sexual behavior if taking PrEP than if not taking PrEP. Conclusions Our findings indicate that modest increases in risky sexual behavior could occur with PrEP. Although responses from the majority of participants suggest they would not be more likely to engage in risky sexual behavior if they took PrEP, a substantial proportion might. Programs rolling out PrEP should be prepared to assist similar women in making informed choices about reducing their risk of HIV and about their sexual health beyond HIV prevention.

The role of relationship types on condom use among urban men with concurrent partners in Ghana and Tanzania.

Multiple concurrent partnerships are hypothesized to be important drivers of HIV transmission. Despite the demonstrated importance of relationship type (i.e., wife, girlfriend, casual partner, sex worker) on condom use, research on concurrency has not examined how different combinations of relationship types might affect condom use. We address this gap, using survey data from a sample of men from Ghana (GH: n = 807) and Tanzania (TZ: n = 800) who have at least three sexual partners in the past three months. We found that approximately two-thirds of mens reported relationships were classified as a girlfriend. Men were more likely to use a condom with a girlfriend if their other partner was a wife compared to if their other partner was a sex worker (GH: OR 3.10, 95% CI, 1.40, 6.86; TZ: OR 2.34, 95% CI 1.35, 4.06). These findings underscore the importance of considering relationship type when designing HIV prevention strategies in these settings.

On the road again: concurrency and condom use among Uganda truck drivers.

Long-distance truck drivers have been shown to be a critical population in the spread of HIV in Africa. In 2009, surveys with 385 Ugandan long-distance truck drivers measured concurrency point prevalence with two methods; it ranged from 37.4% (calendar-method) to 50.1% (direct question). The majority (84%) of relationships reported were long-term resulting in a long duration of overlap (average of 58 months) across concurrent partnerships. Only 7% of these men reported using any condoms with their spouses during the past month. Among all non-spousal relationships, duration of relationship was the factor most strongly associated with engaging in unprotected sex in the past month in a multivariable analyses controlling for partner and relationship characteristics. Innovative intervention programs for these men and their partners are needed that address the realities of truck drivers’ lifestyles.