The contribution of qualitative research to the development of tailor-made community-based interventions in primary care: a review

Abstract

Pragmatic trials seem to be oxymoronic. Although the pragmatic trial methodology establishes the effectiveness of interventions under natural, non-experimental conditions, no pragmatic fit is allowed. Qualitative research's contribution to the development of tailor-made community-based interventions lies in providing ongoing evaluations of the dilemmas faced in pragmatic trials and allowing for the development of true tailor-made interventions.

Moving From Randomized Controlled Trials to Mixed Methods Intervention Evaluations

“…A common approach to describing the use of qualitative research with RCTs is a temporal framework, which considers how qualitative research can be used before, during, or after a trial (Creswell et al, 2009;Jansen et al, 2009;Lewin et al, 2009;Sandelowski, 1996). It is worth relecting on what these authors mean by trial before exploring how qualitative research is used before during and after the trial.…”

“…In Table 23.1 we display the diferent work authors have suggested qualitative research can do before, during, and after the trial, and then we go on to explore these stages in more detail. Before the trial To "trial" the trial Sandelowski, 1996 To develop an instrument when a suitable instrument is not available to measure an outcome in a trial or select appropriate outcome measures Creswell et al, 2009;Lewin et al, 2009 To develop recruitment or consent practices, estimate recruitment or retention, and understand the burden placed on trial participants and caregivers MRC, 2000MRC, , 2008Creswell et al, 2009 To understand the context in which the trial or intervention occurs to ensure that the intervention will work in a particular context or to identify any issues that may occur Creswell et al, 2009;Jansen et al, 2009;Lewin et al, 2009 To support the need for an intervention by identifying the evidence base and identifying or developing theory and hypotheses MRC, 2000MRC, , 2008Creswell et al, 2009;Jansen et al, 2009;Lewin et al, 2009 (continued) OUP UNCORRECTED PROOF -FIRSTPROOFS, Wed Mar 04 2015, NEWGEN…”

“…To provide baseline information Creswell et al, 2009 To obtain information about the feasibility of the intervention MRC, 2000MRC, , 2008Jansen et al, 2009 To develop, pilot, and reine the intervention Jansen et al, 2009;Lewin et al, 2009 During a trial To validate trial outcomes with participant voices and to identify factors afecting trial outcome measures Creswell et al, 2009 To understand how the intervention afects participants (e.g., identifying barriers and facilitators) Creswell et al, 2009;Jansen et al, 2009;Sandelowski, 1996 To capture intended and unanticipated experiences of participants during the trial Creswell et al, 2009;Lewin et al, 2009;Sandelowski, 1996 To understand processes of change and the context in which the intervention occurs such as its afect on outcomes and alterations to the sociocultural environment. , 2000, 2008Creswell et al, 2009;Jansen et al, 2009;Lewin et al, 2009 To verify idelity of implementation of the intervention including describing the intervention as delivered, dose delivered, and dose received Sandelowski, 1996;Creswell et al, 2009;Lewin et al, 2009; To identify prospective mediators and moderators of the intervention process Creswell et al, 2009 To reine interventions for subsequent trials Jansen et al, 2009 After a trial To explore how participants interpret trial results Sandelowski, 1996;Creswell et al, 2009 To account for participant feedback in revising a treatment Creswell et al, 2009 To understand or explain the trial outcomes (e.g., variation in trial results) Sandelowski, 1996;Creswell et al, 2009;Lewin et al, 2009 To establish the long-term efects of the intervention Creswell et al, 2009…”

“…, 2000, 2008Creswell et al, 2009;Jansen et al, 2009;Lewin et al, 2009 To verify idelity of implementation of the intervention including describing the intervention as delivered, dose delivered, and dose received Sandelowski, 1996;Creswell et al, 2009;Lewin et al, 2009; To identify prospective mediators and moderators of the intervention process Creswell et al, 2009 To reine interventions for subsequent trials Jansen et al, 2009 After a trial To explore how participants interpret trial results Sandelowski, 1996;Creswell et al, 2009 To account for participant feedback in revising a treatment Creswell et al, 2009 To understand or explain the trial outcomes (e.g., variation in trial results) Sandelowski, 1996;Creswell et al, 2009;Lewin et al, 2009 To establish the long-term efects of the intervention Creswell et al, 2009 To understand the trial as an intervention in its own right Sandelowski, 1996 To understand in depth how a theoretical model worked Creswell et al, 2009;Jansen et al, 2009;Lewin et al, 2009 To verify the idelity of treatment processes Creswell et al, 2009 To consider context when comparing outcomes with baseline data Creswell et al, 2009 To generate additional hypotheses Lewin et al, 2009 (Marciel, Saiman, Quittell, Dawkins, & Quittner, 2010) was conducted in the United States using mixed methods (focus groups, interviews, survey) before an RCT to adapt a peer support group intervention for adolescents, which had previously been tested on preschool and school-age children. he aim of the intervention was to improve adherence to treatment for cystic ibrosis.…”

“…We would ideally compare a random sample of RCTs funded in different decades and measure the proportion using a mixed methods approach within each decade, showing an increase over time. his information is not available, so instead we rely on perceptions that multimethod or mixed methods intervention evaluation is common (Lewin, Glenton, & Oxman, 2009), is increasing (Grissmer et al, 2009), or is a relatively recent phenomenon (Jansen, Foets, & de Bont, 2009). Evidence that mixed methods intervention evaluations are common is available from a range of sources.…”