Quantitative and Qualitative Approaches to Generalization and Replication-A Representationalist View

Generalizing from qualitative data: a case example using critical realist thematic analysis and mechanism mapping to evaluate a community health worker-led screening program in India

BACKGROUND

A central goal of implementation science is to generate insights that allow evidence-based practices to be successfully applied across diverse settings. However, challenges often arise in preserving programs' effectiveness outside the context of their intervention development. We propose that qualitative data can inform generalizability via elucidating mechanisms of an intervention. Critical realist thematic analysis provides a framework for applying qualitative data to identify causal relationships. This approach can be used to develop mechanism maps, a tool rooted in policy that has been used in health systems interventions, to explain how and why interventions work. We illustrate use of these approaches through a case example of a community health worker (CHW)-delivered gestational diabetes (GDM) screening intervention in Pune, India. CHWs successfully improved uptake of oral glucose tolerance tests (OGTT) among pregnant women, however clinical management of GDM was suboptimal.

METHODS

Qualitative interviews were conducted with 53 purposively sampled participants (pregnant women, CHWs, maternal health clinicians). Interview transcripts were reviewed using a critical realist thematic analysis approach to develop a coding scheme pertinent to our research questions: "What caused high uptake of GDM screening?" and "Why did most women with GDM referred to clinics did not receive evidence-based management?". Mechanism maps were retrospectively generated using short- and long-term outcomes as fenceposts to illustrate causal pathways of the CHW-delivered program and subsequent clinical GDM management.

RESULTS

Critical realist thematic analysis generated mechanism maps showed that CHWs facilitated GDM screening uptake through affective, cognitive and logistic pathways of influence. Lack of evidence-based treatment of GDM at clinics was caused by 1) clinicians lacking time or initiative to provide GDM counseling and 2) low perceived pre-test probability of GDM in this population of women without traditional risk factors. Mechanism mapping identified areas for adaptation to improve the intervention for future iterations.

CONCLUSIONS

Mechanism maps created by repeated engagement following the critical realist thematic analysis method can provide a retrospective framework to understand causal relationships between factors driving intervention successes or failures. This process, in turn, can inform the generalizability of health programs by identifying constituent factors and their interrelationships that are central to implementation.

Effects of long-term oxygen therapy on the mental state of patients with chronic obstructive pulmonary disease: A systematic review

OBJECTIVES

This systematic review aimed to examine the effects of long-term oxygen therapy on the mental state of patients with chronic obstructive pulmonary disease.

METHODS

Web of Science, Medline, CINAHL, EMBASE, ProQuest, and Cochrane Library were selected to search for relevant studies. We followed the Cochrane Handbook for Systematic Reviews of Interventions, adopted the Cochrane risk-of-bias tool and Risk Of Bias In Non-randomized Studies of Interventions tool, and synthesized the outcomes narratively with Grading of Recommendations, Assessment, Development and Evaluations evidence profile.

RESULTS

Six studies were included. Moderate quality of evidence supported no effects of long-term oxygen therapy on the mental state in patients with severe resting hypoxemia and moderate resting hypoxemia (or exertional desaturation) at follow-up of 6 to 12 months; however, adverse effects on mental state among patients with moderate resting or exertional desaturation were reported at the follow-up of 36 to 48 months.

DISCUSSION

Nurses should focus on the mental state of patients treated with long-term oxygen therapy, especially those who use it for a prolonged time. Due to ethical constraints in this study, a quasi-experimental study with faithful consideration of internal validity can be commenced in the future.

The Relation Between War, Starvation, and Fertility Ideals in Sub-Saharan Africa: A Life History Perspective

In this article, we examine the relations between extreme environmental harshness during childhood and personal fertility ideals in African students. The study is informed by biological models of predictive adaptive responses (PAR) for individual reproductive schedules in the context of life history theory (LHT). Following theoretical models of external and internal environmental cues, we tested whether war and starvation during childhood differentially predict African students' personal fertility ideals in terms of their desired number of children and their desired age of first parenthood. The data were collected in eight different countries from sub-Saharan Africa with an overall sample size of N = 392. Standardized effect estimates were obtained using a Bayesian approach. The results suggest that war and starvation are predictive of the desired number of children, but not of the desired age of first parenthood. Moreover, the effect estimates varied considerably between females and males, indicating possible interactions between the two independent variables depending on the students' sex. Furthermore, we found a small negative correlation between the desired number of children and the desired age of first parenthood, providing only weak support for a clustering of the two variables on a slow-fast continuum. The results are discussed in light of current models of individual life histories in humans.

Measuring mental health outcomes in Walbridge Fire 2020

In August 2020, Sonoma County experienced the Walbridge Fire (part of the Lake-Napa Unit Complex Fire). Following the repopulation of evacuated residents, the Sonoma County Department of Emergency Management circulated a Resident Experience Survey to learn from stakeholders how the fire impacted their lives, how emergency response to the fire met their needs, and to gather information to improve future disaster response activities. A total of 1,583 English and 55 Spanish surveys were completed. This paper describes a mixed-method research using survey data to understand broader mental health implications of the Walbridge Fire on residents. This study developed a quantitative Global Worry Model to explore which survey factors contributed to poorer mental health outcomes. Quantitative analytics looked at how language, loss, emergency alerts, and family size were measured for significance with a survey reported on a mental health questionnaire. Open-ended survey responses surrounding previous disaster experience, pre-existing health issues, and environmental conditions (smoke and the coronavirus disease 2019 pandemic) were contributory to responder's stress and anxiety. Final data analysis concluded that those who faced immediate loss presented with significant self-declared stress and anxiety.

Conducting and Writing Quantitative and Qualitative Research

Comprehensive knowledge of quantitative and qualitative research systematizes scholarly research and enhances the quality of research output. Scientific researchers must be familiar with them and skilled to conduct their investigation within the frames of their chosen research type. When conducting quantitative research, scientific researchers should describe an existing theory, generate a hypothesis from the theory, test their hypothesis in novel research, and re-evaluate the theory. Thereafter, they should take a deductive approach in writing the testing of the established theory based on experiments. When conducting qualitative research, scientific researchers raise a question, answer the question by performing a novel study, and propose a new theory to clarify and interpret the obtained results. After which, they should take an inductive approach to writing the formulation of concepts based on collected data. When scientific researchers combine the whole spectrum of inductive and deductive research approaches using both quantitative and qualitative research methodologies, they apply mixed-method research. Familiarity and proficiency with these research aspects facilitate the construction of novel hypotheses, development of theories, or refinement of concepts.

Rhizosphere engineering for sustainable crop production: entropy-based insights

There is a growing interest in exploring interactions at root-soil interface in natural and agricultural ecosystems, but an entropy-based understanding of these dynamic rhizosphere processes is lacking. We have developed a new conceptual model of rhizosphere regulation by localized nutrient supply using thermodynamic entropy. Increased nutrient-use efficiency is achieved by rhizosphere management based on self-organization and minimized entropy via equilibrium attractors comprising (i) optimized root strategies for nutrient acquisition and (ii) improved information exchange related to root-soil-microbe interactions. The cascading effects through different hierarchical levels amplify the underlying processes in plant-soil system. We propose a strategy for manipulating rhizosphere dynamics and improving nutrient-use efficiency by localized nutrient supply with minimization of entropy to underpin sustainable food/feed/fiber production.

Squaring the circle: From latent variables to theory-based measurement

Psychometrics builds on the fundamental premise that psychological attributes are unobservable and need to be inferred from observable behavior. Consequently, psychometric procedures consist primarily in applying latent variable modeling, which statistically relates latent variables to manifest variables. However, latent variable modeling falls short of providing a theoretically sound definition of psychological attributes. Whereas in a pragmatic interpretation of latent variable modeling latent variables cannot represent psychological attributes at all, a realist interpretation of latent variable modeling implies that latent variables are empty placeholders for unknown attributes. The authors argue that psychological attributes can only be identified if they are defined within the context of substantive formal theory. Building on the structuralist view of scientific theories, they show that any successful application of such a theory necessarily produces specific values for the theoretical terms that are defined within the theory. Therefore, substantive formal theory is both necessary and sufficient for psychological measurement.

Contextualized Measurement Scale Adaptation: A 4-Step Tutorial for Health Psychology Research

Health psychology research is inherently context specific: Different health behaviors are executed by different target groups (e.g., gender, age) in different social structures, cultures, and environments. This asks for the adaptation of research instruments to enhance specificity. For example, when using measurement scales in new contexts, translation and psychometric validation of the instruments are necessary but not sufficient if the validity of the psychological concept behind a measurement scale has not been researched. In this study, we build on existing guidelines of translation as well as psychometric validation and present four steps on how to adapt measurement scales to a new context: Step 1 asks whether the psychological concept is found in the new context. Step 2 asks whether the measurement scale and its items are understood in the new context. Step 3 asks whether a measurement scale is valid and reliable. Step 4 asks how the items of the measurement scale perform individually. Following these four steps, measurement scales are carefully translated, adapted, and validated and can therefore be transferred to very different contexts.

Future Objectivity Requires Perspective and Forward Combinatorial Meta-Analyses

This manuscript contributes to a future definition of objectivity by bringing together recent statements in epistemology and methodology. It outlines how improved objectivity can be achieved by systematically incorporating multiple perspectives, thereby improving the validity of science. The more result-biasing perspectives are known, the more a phenomenon of interest can be disentangled from these perspectives. Approaches that call for the integration of perspective into objectivity at the epistemological level or that systematically incorporate different perspectives at the statistical level already exist and are brought together in the manuscript. Recent developments in research methodology, such as transparency, reproducibility of research processes, pre-registration of studies, or free access to raw data, analysis strategies, and syntax, promote the explication of perspectives because they make the entire research process visible. How the explication of perspectives can be done practically is outlined in the manuscript. As a result, future research programs can be organized in such a way that meta-analyses and meta-meta-analyses can be conducted not only backward but forward and prospectively as a regular and thus well-prepared part of objectification and validation processes.