On Twitter @CalvinMoorley @JoBardi01

I have recently been collecting data for a research project on life after stroke funded under the Mary Seacole award for Leadership in Nursing. The data collection method is semi structured indepth interviewing and by its given nature is qualitative research (Robson 2011). My project investigates the lived experience of stroke carers within the family setting; it seeks to identify to what extent care giving in life after stroke is influenced by culture. I also had a conversation with one of my MSc Public Health students Josephine Bardi (co-author of this blog) on how qualitative research can help us to understand maternal mortality. In this conversation we discussed what we already know about qualitative research and how it can help us to deliver better primary care and ultimately public health services.

What do we know about qualitative research for health?

• Qualitative research is robust despite what its critics say for example Tong et al. 2007 have provided a set of criteria for qualitative research http://intqhc.oxfordjournals.org/content/19/6/349.full.pdfh
• Qualitative research is based on the subjective and allows the researcher an insider look into the lives of participants or certain groups.
• In health care qualitative research can be described as interviews and focus groups (Soafer 2002) and explores complex phenomena experienced by health care workers and clinicians qualitative research
• Using qualitative research in health care can help us unravel and make sense of the participants experiences.

An example

In my area of research, life after stroke I have found that qualitative research can also help to support quantitative findings (Moorley, 2012) a researcher can use the technique following a thread O’Cathain et al. 2008. For example in my work I found that African Caribbean women reported higher abilities to perform of activity of daily living compared to their other ethnic counterparts in my quantitative data analysis (Moorley et al. 2014). I followed this up in interview questioning to understand the lived experience of this group which was different from what they reported to the health practitioner. Here qualitative research helped me to understand why African Caribbean women over reported their abilities and I was able to make recommendations to the stroke rehabilitation team based on the qualitative findings.

Can qualitative research help us understand maternal health?

Millennium Development Goal (MDGs number 5) states

“In recent years, there has been increased recognition that reducing maternal mortality is not just an issue of development, but also an issue of human rights”. (United Nations Populations Fund, 2010).

What is known about maternal death?

Maternal deathis the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes (World Health Organisation, 2014).

Almost all maternal deaths (99%) occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia (World Health Organisation, 2014). Sub-Saharan Africa still had high maternal morbidity and mortality rates (Rogo et al., 2006; Alvarez et al., 2009).

What contributes to maternal deaths?

According to the WHO (2014) maternal mortality occur due to the following reasons:

• Poor access health
• Severe bleeding (mostly bleeding after childbirth)
• Infections (usually after childbirth)
• High blood pressure during pregnancy (pre-eclampsia and eclampsia)
• Complications from delivery
• Unsafe abortion.

Maternal mortality ratio in developing regions continues to be 14 times higher than in the developed regions (United Nations, undated).

How can Qualitative research help us to understand maternal health and mortality?

Qualitative research may help to explain the experience of bereaved families before and after the death of a mother, daughter, child or both.

For instance, it is useful to find out how a mother-in-law, husband and children felt after the death of a wife and mother or what practices may have led to the death and explore these. What does a community, bereaved family and, looked after children think is the reason for maternal deaths? What is their experience of maternal mortality and to what extent does cultural practices contribute to maternal health and mortality?

The role of qualitative research in delivering primary care services

There is role for using qualitative research that can help in delivering primary and public health care services, firstly qualitative research can help to contextualise quantitative finding and strengthen a study. By undertaking qualitative research we can understand why individuals do not adhere to medications regimens and attribute causes other than pathophysiological for disease (Moorley, 2012). By using qualitative research health practitioners can understand why patients take certain actions, qualitative research opens up a space for discussion with service provider and user, which can ultimately lead to benefits for both groups. Using a qualitative approach such as case study or phenomenological research can help to answer some of the questions we posed in this blog (pertaining to our research), which can in turn be used to deliver primary care services that will contribute to reducing maternal mortality , improved stroke aftercare and better access of public health services.

Questions for the #EBNJC

1. Can you think of a time when qualitative research would have helped you to do your job better?

2. How can we ensure we embed qualitative methods in health research?

3. What benefits can qualitative research bring to primary care delivery?

4. How can qualitative research help in delivering the wider public health agenda and meet needs of local communities?

5. Can we reduce maternal mortality through qualitative research findings?

The next EBN Twitter Journal Chat #EBNJC will take place on Wednesday 9th July 2014 8-9 pm (UK time) and focus how can qualitative research help us to deliver primary care services.

Participating in the EBN Twitter Journal Chat

1 To participate in the EBN twitter chat, if you do not already have one, you require a Twitter account; you can create an account at www.twitter.com. Once you have a Twitter account contributing is straightforward:

2 You can follow the discussion by searching for links to #ebnjc or @EBNursingBMJ in Twitter
Or contribute to the discussion by sending a tweet starting with @EBNursingBMJ and ending with #ebnjc (the EBN chat hashtag).
3 NB not including #ebnjc means people following the chat won’t be able to see your contribution.

References

Alvarez, L. J., Gil, R., Hernández, V., and Gil, A, (2009) ‘Factors associated with maternal mortality in Sub-Saharan Africa: an ecological study’, BMC Public Health, 9, pp. 462-469, Academic Search Complete: EBSCOhost. Available at: http://search.ebsco.com [Accessed: 3 July 2014].

Moorley, C. 2012 Life after stroke: Personal, Social and Cultural Factors – An Inner City Afro-Caribbean Experience. PhD Thesis University of East London.

Moorley C, Tunariu., A, Cahill., S, Scott O. (20140 Impact of stroke, a functional, psychosocial report of an inner city multiracial population Journal of Primary Care 24(4) 26-34

Partnership for Maternal, New born and Child Health (2011) Commission on information and accountability for women’s and Children’s Health [Online]. Available at: WHO. http://www.who.int/pmnch/media/news/2011/20110620_commission_on_accountability/en/ [Accessed: 5 July 2014].

Rogo, K. O., Oucho, J. and Mwalali, P. (2006) Maternal Mortality. In: Jamison DT, Feachem RG, Makgoba MW, et al., editors. Disease and Mortality in Sub-Saharan Africa. 2nd edition. Washington (DC): World Bank; 2006. Chapter 16. Available at: http://www.ncbi.nlm.nih.gov/books/NBK2288/ [Accessed: 4 July 2014].

Robson., C. 2011 Real World Reserch London Sage

Sofaer., S. Qualitative research methods. Int J Qual Health Care 2002;14:329–36.

Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349-357.

United Nations (undated) Goal 5: improve maternal health [Online]. Available at: UN. http://www.un.org/millenniumgoals/maternal.shtml [Accessed: 4 July 2014].

United Nations Populations Fund (2010) Reducing maternal mortality the contribution of the right to the highest attainable standard of health [Online]. Available at: http://www.unfpa.org/public/publications/pid/4968 [Accessed: 5 July 2014].

World Health Organisation (2014) Maternal mortality [Online]. Available at: WHO. http://www.who.int/mediacentre/factsheets/fs348/en/ [Accessed: 5/7/2014].