Lisa Gibbs

Generating best evidence from qualitative research : the role of data analysis

Objective: To outline the importance of the clarity of data analysis in the doing and reporting of interview‐based qualitative research.

Parent-proxy and child self-reported health-related quality of life: using qualitative methods to explain the discordance

BackgroundAlthough parent-proxy reports of health-related quality of life (HRQOL) are only moderately correlated with child reported HRQOL, it remains unknown why these scores differ. The aim of this study was to use a qualitative methodology to examine why parents and children report different levels of HRQOL.MethodThe sample consisted of 15 parent–child pairs. A think-aloud technique was used where parents and children were given a generic HRQOL instrument (KIDSCREEN) and instructed to share their thoughts with the interviewer. Qualitative analyses were conducted to assess whether parents and children base their answer on different experiences or reasoning, have different response styles, or interpret the items differently.ResultsThere was discordance between parents and children, in terms of rating scale and in terms of the reasoning for their answer. Children tended to have different response styles to parents, where for example, children tended to provide extreme scores (highest or lowest score) and base their response on one single example, more than parents. Parents and children interpreted the meaning of the items very similarly.DiscussionThis study provides evidence to suggest that discordance among parent-child pairs on KIDSCREEN scores may be as a result of different reasoning and different response styles, rather than interpretation of items. These findings have important implications when parent-proxy reported HRQOL is used to guide clinical/treatment decisions.

Increasing school playground physical activity: A mixed methods study combining environmental measures and children's perspectives

Schools are integral settings in which children can participate in moderate and vigorous physical activity. This study reports on the relationship between playground characteristics and child activity levels using a combination of quantitative and qualitative methods. The aim of the study is to increase understanding of how children respond to their school playground environments. Twenty-three primary schools located in a predominantly low socio-economic area of Melbourne, Australia were involved. SOPLAY (System for Observing Play and Leisure Activity in Youth) was administered in all 23 schools to measure the levels of student physical activity and playground environmental factors such as equipment provision. In 12 of the 23 schools, a sample of 9-11-year-old students participated in focus group discussions exploring perceptions of their school playgrounds using a photo ordering technique. A larger proportion of students participated in VPA when loose equipment (60% vs. 52%; p<0.001) and teacher supervision (62% vs. 52%; p<0.001) were present in activity settings, compared to when they were unavailable. Fixed play equipment and bitumen with court/play-line markings were seen by children as settings inviting active play but only had the greatest impact on moderate activity (fixed play equipment: 35% vs. 20%, p<0.001; court markings/goals: 62% vs. 52%, p<0.001; play-line markings: 25% vs. 20%, p=0.04). The mixed method design provided a greater understanding of the potential influence of environmental characteristics on childrens lunch time activity levels and their perceptions of play areas. The findings indicate that relatively simple changes such as the provision of loose equipment, painting of court and play-line markings, and increased teacher presence on the playground, are likely to provide opportunities for increased physical activity.

What have sampling and data collection got to do with good qualitative research

Objective: To highlight the importance of sampling and data collection processes in qualitative interview studies, and to discuss the contribution of these processes to determining the strength of the evidence generated and thereby to decisions for public health practice and policy.

Expanding Children's Food Experiences: The Impact of a School-Based Kitchen Garden Program

OBJECTIVE Evaluate achievement of the Stephanie Alexander Kitchen Garden Program in increasing child appreciation of diverse, healthy foods. DESIGN Comparative 2-year study. SETTING Six program and 6 comparison primary schools in rural and metropolitan Victoria, Australia, matched for socioeconomic status and size. PARTICIPANTS A total of 764 children in grades 3 to 6 (8-12 years of age) and 562 parents recruited. Retention rates at follow-up included 85% children and 75% parents. INTERVENTION Each week of the school year, children spent 45 to 60 minutes in a garden class and 90 minutes in a kitchen class. PHENOMENON OF INTEREST Program impact on childrens willingness to try new foods, capacity to describe foods, and healthy eating. ANALYSIS Qualitative data analyzed using inductive thematic analysis. Quantitative data analyzed using random-effects linear regressions adjusted for school clustering. RESULTS Child and parent qualitative and quantitative measures (if never tried before, odds ratio 2.0; confidence interval, 1.06-3.58) showed increases in childrens reported willingness to try new foods. No differences in articulation of food descriptions (program vs comparison groups). Qualitative evidence showed that the program extended its influence to healthy eating, but this was not reflected in the quantitative evidence. CONCLUSIONS AND IMPLICATIONS Findings indicate program success in achieving its primary objective, meriting further program research.

Accessing maternal and child health services in Melbourne, Australia: Reflections from refugee families and service providers

BackgroundOften new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH) service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0–6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers.MethodsWe used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7 years in Australia (range one month-18 years). Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers.ResultsFour themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making phone bookings. Service users and providers reported that continuity of nurse and interpreter is preferred for increasing client-provider trust and ongoing engagement.ConclusionsAlthough participants who had children born in Melbourne had good initial access to, and experience of, using MCH services, significant barriers remain. A systems-oriented, culturally competent approach to service provision would improve the service utilisation experience for parents and providers, including formalising links and notifications between settlement services and MCH services.

Double disadvantage : the influence of ethnicity over socioeconomic position on childhood overweight and obesity: findings from an inner urban population of primary school children

OBJECTIVE To examine the relationship between overweight/obesity in children, socioeconomic status and ethnicity/cultural background. DESIGN Cross-sectional survey of children aged 4-13 years. SETTING A total of 23 primary (elementary) schools in an inner urban municipality of Melbourne, Australia. Participants. A total of 2685 children aged 4-13 years and their parents. MAIN EXPOSURE MEASURES Ethnicity/cultural background - maternal region of birth; socioeconomic position (SEP) indicators - maternal and paternal educational attainment, family employment status, possession of a healthcare card, ability to buy food, indicator of disadvantage (Socioeconomic Index for Areas, SEIFA) score for school; parental weight status. Main outcome measure. Prevalence of overweight/obesity. RESULTS Prevalence of overweight/obesity approached 1 in 3 (31%) in this sample. Prevalence of overweight/obesity was greater for children of both North Africa and Middle Eastern background and children of Southern, South Eastern and Eastern European background compared with children of Australian background. This difference remained after adjusting for age, sex, height, clustering by school, SEP indicators and parental weight status; odds ratio, OR=1.57 (95% confidence interval, CI 1.12-2.19) and 1.88 (95%CI 1.24-2.85), respectively. CONCLUSIONS There is a clear independent effect of ethnicity above and beyond the effect of socioeconomic status on overweight and obesity in children. Further research is required to explore the mediators of this gradient.

The essential role of social theory in qualitative public health research

Objective: To define the role of social theory and examine how research studies using qualitative methods can use social theory to generalise their results beyond the setting of the study or to other social groups.

Growing Community: The Impact of the Stephanie Alexander Kitchen Garden Program on the Social and Learning Environment in Primary Schools

This article presents results from a mixed-method evaluation of a structured cooking and gardening program in Australian primary schools, focusing on program impacts on the social and learning environment of the school. In particular, we address the Stephanie Alexander Kitchen Garden Program objective of providing a pleasurable experience that has a positive impact on student engagement, social connections, and confidence within and beyond the school gates. Primary evidence for the research question came from qualitative data collected from students, parents, teachers, volunteers, school principals, and specialist staff through interviews, focus groups, and participant observations. This was supported by analyses of quantitative data on child quality of life, cooperative behaviors, teacher perceptions of the school environment, and school-level educational outcome and absenteeism data. Results showed that some of the program attributes valued most highly by study participants included increased student engagement and confidence, opportunities for experiential and integrated learning, teamwork, building social skills, and connections and links between schools and their communities. In this analysis, quantitative findings failed to support findings from the primary analysis. Limitations as well as benefits of a mixed-methods approach to evaluation of complex community interventions are discussed.

Government food service policies and guidelines do not create healthy school canteens

Objective