Donor deferral: a qualitative approach.

Arjuna PonnampalamTransfusion Medicine Fellow

December 20th, 2011

Objectives

• Introduction to Qualitative research methodology

• Understanding the meaning of permanent deferral for blood donors – Whittaker et al.

• Critical appraisal of literature

Quantitative

Which?How much?

Quantitative

Which?How much?

Qualitative

What?Why?How?

Qualitative

What?Why?How?

“How many parents would consult their GP when their child has a mild temperature?”“How many parents would consult their GP when their child has a mild temperature?”

“Why do parents worry so much about their children’s temperature?”“Why do parents worry so much about their children’s temperature?”

“What proportion of smokers have tried to give up?”“What proportion of smokers have tried to give up?”

“What stops people giving up smoking?”“What stops people giving up smoking?”

• Qualitative– Multiple versions of

reality– Exploratory, explanatory– Inductive– Naturalistic– Subjective– Holistic

• Quantitative– One reality that can be

measured– Confirmatory– Deductive– Experimental– Objective– Particularistic

• Fundamental principles:

• Perspective of participants

• Interpretive and inductive

• Naturalistic setting

methodology

PhenomenologyPhenomenology

Grounded theory

Grounded theory

Case studyCase study

EthnographyEthnography

methods

Interviews and focus

groups

Interviews and focus

groups

Document review

Document review

Participant observationParticipant observation

samplesample

Data collection

Data collection AnalysisAnalysis

Saturation:a) Datab) Theoretical

Saturation:a) Datab) Theoretical

• Critical appraisal:

• Is a structured check list universally applicable?• Encourage mechanistic and protocol-driven approach.

– How to read a paper, 4th edition, Trisha Greenhalgh– JAMA – Users’ guide to the medical literature, Giacomini– Qualitative research in transfusion medicine, Arnold

• Critical appraisal:

• Hallmarks of a rigorous qualitative study:– Appropriate research design– Systematic data collection– Thorough and thoughtful analysis– Good knowledge translation

• Critical appraisal:

• Did the paper describe an important clinical problem addressed via a clearly formulated question?

what is the question?

• What is the experience of blood donors who receive postdonation notification of permanent deferral?

• What are the important issues to consider when developing an effective process for notifying donors?

• What is the best practice for notifying donors of permanent deferral?

• Critical appraisal:

• Was a qualitative approach appropriate?

methodology

Grounded theory

Grounded theory

• Critical appraisal:

• How were the setting and the subjects selected? Were participants relevant to the research question and was their selection well reasoned?

6767

2020

4747

1717

3030

22

2828

• Critical appraisal:

• What methods did the researcher use for collecting data – and are these described in enough detail? Was there an adequate paper trail?• Was the data collection comprehensive enough to

support rich and robust descriptions of the observed events?

• Data collection• Constant comparison method• Telephone interviews• Semi structured interview guide• Open ended questions (30-45 mins)• Audiotaped and fully transcribed• Imported into quality data management software

program

• Critical appraisal:

• What was the researcher’s perspective and has this been taken into account? Was a multidisciplinary approach undertaken?

• Critical appraisal:

• What methods did the researcher use to analyze the data – and what quality control measures were implemented? • Did they employ triangulation? • Was there validation by participants?

• Data analysis• Team analysis approach• Inductive and iterative process feedback• Open -> Axial -> Selective coding

• Key findings validated via triangulation method– Multidisciplinary team consensus– Audit trial, multiple data sources– Member checking– Comparison of study findings with published lit.

• Critical appraisal:

• Are the results credible, and if so, are they clinically important? • Were deviant occurrences described and discussed?

• Results• 28 agreed to participate• 2.5 mos. between notification and interview• No difference between first time and repeat donors• Data analyzed in two groups:

– A) positive , B) negative/indeterminate

• Motivation for donation– Altruism– Awareness of need for blood

1

2

3

4

5

• Critical appraisal:

• What conclusions were drawn, and are they justified by the results?

• Author conclusions:• Holistic understanding• Majority of donors are extremely distressed• Confusion• 35% contact CBS, 75% contact family physician• Family physician education• CBS acknowledgement• Retesting/re-entry process• Majority not reconciled at 3 months

• Critical appraisal:

• Are the findings of the study transferable to other settings?

• my critique:• Clearly defined rationale• Thoughtfully framed questions• Appropriate methodology and methods to answer

posed questions• Developed a sensible theoretical model• Exhaustive inquiry which translates into transferable

themes to other populations

Questions?