A Critical Evaluation of a Qualitative and a Quantitative - Research Paper Example

? A Critical Evaluation of a Qualitative and a Quantitative Research Study School or Introduction Defining the differences between qualitative and quantitative research is relatively simple: quantitative research involves large samples and is objective, with acceptable statistical outcomes, based on the size of sample. Generally, it is desired that this will have a 95% confidence level with a margin error of 5% as stated by GEO (2006, p.1). Qualitative research reflects data compiled by personal observations of people and what they say and do, and in the case of diagnosed schizophrenia, what stigmas are attached, as indicated by Knight et al. (2003, p. 209). As a consequence, it is more subjective because of the interpretation of interviewers in focus groups and interviews where respondents’ opinions and perceptions play a large role in responding to questions (GEO 2006; Rathus 1996). Another way to put this is that quantitative research is about verified science while qualitative research is more personal, more about what people think and feel about things. This paper endeavours to show these evaluations through two different research studies that follow, using CASP forms as guidance for the evaluations (CASPqual 2013; CASPquan 2013). The questions within each CASP tool provides the direction for presenting information about the research study within the review being conducted. Each question is answered within the framework of the reviews although not necessarily by numerical order of the CASP tool. Both CASP tools are provided in Appendix A and Appendix B. Both studies concern the subject of schizophrenia, with the qualitative study showing the personal side of negative effects on patients within their social and physical environment (Liu et al. 2012), and the quantitative study presenting the use of Minocycline, which is tested for alleviating negative effects in early onset of diagnosed schizophrenia (Chaudhry et al. 2012). As a chronic and disabling psychiatric disorder, often perceived as challenging to manage, both studies contribute exponentially to this field in mental health (Knight et al. 2003, p. 209; Kantowitz et al. 1991). Qualitative Research-Part I The qualitative research study involved for review is “What Do Psychotic Experiences Mean to Chinese Schizophrenia Patients?” by Liang Liu, Xiquan Ma and Xudong Zhao (2012), published in the journal of Qualitative Health Research. A critical appraisal skills programme (CASP) tool for qualitative studies was used as part of the evaluation for this study (CASPqual 2013). A clear statement was made for the aim of this phenomenological research study by Liu et al. (2012), as proposed by Hicks (2004). which was to discover how Chinese patients, who were diagnosed with schizophrenia, viewed their daily lives and how their treatments, mental state and social-family relationships were affected by their psychotic episodes, as also evidenced in studies by Caqueo-Urizar et al. (2009) and Teferra et al. (2013) (Mestdagh & Hansen 2013; Sternberg 1998; Yanos et al. 2010; Switaj et al. 2012). The use of the qualitative interview design of thematic development in research and analysis, as recommended by Mitchell & Jolley (1996, p. 84), was appropriate in understanding the personal side of the respondents’ experiences of what was happening to them as they attempted to live normal lives within their social environment which, in China, there is a cultural stigma against schizophrenia (Liu et al. 2012; Mestdagh & Hansen 2013). The recruitment process for the study was explained very well by distinctly outlining the inclusion and exclusion criteria for patients to be part of the study. As part of methodology, patients had to have been officially diagnosed according to the International Classification of Diseases (ICD), promoted by the World Health Organization (WHO) of 1993, had been hospitalized, and were receiving medication accordingly. They also had to be deemed sufficiently competent to understand the purposes of the study and to give informed consent (Liu et al. 2012). This criteria structure provided validity and strength to final results, as proposed by Kantowitz et al. (1991, p. 264). There were a final total of 16 patients who were presented by their psychiatrists, with ages between 21 and 52, and five of whom were men and 11 were women. The variables of marital status, employment and psychotic episodes were also detailed (Liu et al. 2012; Kannappan 2009). The first two authors of the study, Liu and Ma, specialized in psychiatry and worked together in conducting all the interviews. Each researcher had worked in a hospital for three years or more as a psychiatrist and none had ever had personal experiences of psychosis. Ma worked at the hospital where the respondents were recruited while Liu worked in a different mental health hospital located in Shanghai (Liu et al. 2012). Before conducting interviews, the researchers first reviewed each other’s assumptions and past clinical experiences to reduce subjective impact on future analysis. Two psychologists were also retained to oversee the crosschecking of results and to provide comments and suggestions. In order to prevent bias as much as possible, each researcher coded the transcripts of recordings independently, then met for discussion in order to consolidate the data into categorical themes as well as uncover any discrepancies, as recommended by Mitchell & Jolley (1996, p. 72). Strengths of the study design, at this point, show that strict criteria was used in selecting the respondents in order to ensure data validity, and that the researchers went to great lengths in avoiding observer bias by reviewing the coding process and consolidating data down into recognizable themes for analysis. The one weakness was the small size of the sample used, compared to what Mitchell & Jolley (1996, p. 461) suggested as normal. By research design and methodology, information was obtained from individual interviews, which consisted of open-ended questions, that lasted from 45 to 90 minutes and was conducted in a private office or consulting room at an outpatient psychiatric clinic. The study detailed the process of data gathering by the researchers. Each interview was conducted by one interviewer while the other took notes and provided assistance (Liu and Ma) and all the interviews were recorded by tape after receiving permission to do so, in order to ensure confidentiality. All participants spoke Mandarin and therefore, no translation was needed during and after the interview process when the tapes were transcribed and cross-checked (Liu et al. 2012). There were progressive levels of coding done and several themes developed which were later integrated into more centralized themes for analysis purposes, and used to describe respondents’ experiences (Liu et al. 2012; Hsieh & Shannon 2005). The study was explicit in presenting the three main themes and the sub-themes by consolidating content, as suggested by Wagner et al. (2011, p. 1). In analysis for the data, this study did not provide any technical methods of analysis, such as using Microsoft Excel or IBM’s SPSS, for example, although means were provided in ages of the respondents and for the lengths of the interviews. However, the researchers, as noted in the previous section, had determined several themes from the overall collection of data by consolidated smaller themes into larger, more encompassing themes (Liu et al. 2012; Gale et al. 2013). While the process of analysis was based on putting information into themes, only the top three major themes were addressed. Those themes are: negative experiences, a sense of powerlessness, and an ambivalent therapeutic relationship. There were a number of subthemes under each major theme. Unwilling experiences of hospitalization and confused past experience were put under the negative experience theme. Changes in self, pessimism about the future and a sense of being controlled went under the sense of powerlessness theme (Liu et al. 2012; Wagner et al. 2011). Different understandings of mental illness and boundary were put under the theme of ambivalent therapeutic relationship. The examples of findings within the thematic structure were pretty explicit and, as noted in the previous section, these theme were developed by both researchers (Liu and Ma) after continued review initially during the data collection process (Liu et al. 2012; Wagner et al. 2011). The researchers were also clear in demonstrating that these findings were also relevant to other research studies as part of their literature research, which was fairly extensive. The dataset was rather small with only 16 respondents, as noted by the researchers (Mitchell & Jolley 1996). They also felt that, because of their position as psychiatrists, this may have also affected their interpretation of the data to be more negative and concentrated on the responders’ complaints and symptoms. Overlying all of this is the Chinese cultural stigmatic viewpoint of those who are diagnosed as schizophrenic, which played a part in the patients’ experiences (Liu et al. 2012). The study did present relevant findings in that the researchers found that the psychiatrist-client relationship needed to be more directed on encouragement and developing coping strategies for their patients, thus providing a more sensitive and effective intervention for the patient (Liu et al. 2012). Finding showed that all the respondents felt intimidated, hopeless and fearful at present about their surroundings and the people they engaged with, including their doctors. In retrospect, however, the researchers could have done a pre-test to determine whether more specific questions could be developed for the interview process, as it appeared that the study may have been too open-ended with its initial statement of purpose. The other aspect to note is that the sample could have been obtained from more than two sources in order to get a more divergent return in data content, as presented by Mitchell & Jolley (1996, p. 462), in reference to sampling bias. Quantitative Research-Part II In this quantitative study, conducted by Chaudhry et al. (2012), a clear hypothesis was given and the testing is done as a randomized double-blind placebo-controlled clinical trial, using the antibiotic drug, minocycline. As a heavily data-based design for the research study, the objective was to test whether the drug would reduce onset of schizophrenic symptoms, such as apathy, emotional blunting and social withdrawal as compared to a placebo group with the same initial diagnosis (Chaudhry et al. 2012; Miyaoka 2012). This research study will follow the CASP form for Random Controlled Trials (RCT) as part of quantitative studies, in order to explore the component infrastructure of this research study, as proposed by Hicks (2004) (CASPquan 2013). The research study was very clear about criteria for inclusion into the study and protecting the test subjects through physical monitoring and also providing the option to leave the research study. There were 144 respondents starting out who were randomized within a select population, as presented by Kantowitz et al. (1991, p. 82), for receiving treatment as usual (TAU) along with Minocycline or placebo. The study took place over a three-year span in both Brazil and Pakistan, and those participating had to be within one to five years of having been diagnosed under the Diagnostic and Statistical Manual-IV (DSM-IV) schizophrenia, schizoaffective disorder, unspecified psychosis, or schizophreniform disorder. Inclusion also requested ages between 18 and 65, ability to provide informed consent and with a witness present, stability in medication at four weeks before the testing began, and also willing (for females) to use adequate contraceptive precautions. Out of the initial group, 94 completed the trial and the results showed the minocycline group at 9.2 improvement as opposed to the placebo group of 4.7, with an adjusted difference of 3.53 (s.e. 1.01) 95% CI: 1.55, 5.51; p < 0.001, for both countries (Chaudhry et al. 2012). Specific exclusion criteria were also given such as drug addiction, pregnancy, among a few details, and patients also had provision for discontinuing the testing for several reasons. The study gives very specific details on both inclusion and exclusion. The study design was clearly appropriate for this type of scientific discovery, as suggested by Mitchell & Jolley (1996) for clinical testing. Polgar and Thomas (2001) also present that RCT, within the quantitative design and methodology structure, provides the most rigorous levels of effectiveness in an intervention. The testing was done according to the hypothesis developed, which presented that as there was a loss of grey brain within the first years of actual diagnosis which contributed to cognitive decline and negative symptoms within the patient, the use of Minocycline could help reduce grey matter shrinkage. Therefore, Minocycline was considered to be a drug that would regress such negative outcomes and also help stabilize the effects of any supporting antipsychotic prescribed drugs (Chaudhry et al. 2012). However, the testing did not clearly address or note interaction of Minocycline with any antipsychotic drugs by specific levels, except in the cases where there were direct reactions from Minocycline itself. Most of the researchers are connected with universities such as the Universities of Manchester, Sao Paulo, Manchester Metropolitan University, Sheffield Hallam University and University of Alberta. Only one is connected to the Institute of Psychiatry in Rawalpindi, Pakistan, one of the testing sites (Chaudhry et al. 2012). There was not enough information given about the background of the researchers other than where they were located. It would have been important to note professional experience besides being a professor at a university. Yet, it was clear from the design and methodology of the research study that they all had knowledge of appropriates tests that should be conducted on patients to monitor and collect data for further analysis, as determined by Kntowitz et al. (1991). Testing was done on a computerized random basis for each group and medicines were distributed by a designated pharmacy in each country (Chaudhry et al. 2012). All members of the research study, including medical staff, were blind as to who were getting the medicine or the placebo, as suggested by Kantowitz et al. (1991) and Kannappan (2009). After a sample selection was made, according to the specific inclusion and exclusion criteria, which obtained in and out-patients from psychiatric units, who also provided informed consent, there were 71 patients assigned to take the Minocycline and a further 73 were allocated the placebo within a total of four groups, one for each place of testing. At end of the study, 94 patients, overall, had fully completed the full testing, with 46 taking the medicine and 48 taking the placebo (Chaudhry et al. 2012). The following tests were essential for registering reactions and developments, specific to schizophrenia and the application of Minocycline over a period of time (Rathus 1996; Kantowitz et al. 2001). The 30-item/7-point Positive and Negative Syndrome Scale (PANSS) tool was used within the registration trials and ratings were made during semi-structured clinical interviews in the primary data gathering sections. In the secondary data gathering section, the Clinical Global Impression (CGI) scale, the Global Assessment of Function (GAF) scale, and the Abnormal Involuntary Movement Scale (AIMS), were applied (Chaudhry et al. 2012; Torrey & Davis 2012). Other secondary tests were done as well, and different clinical, functional and neurocognitive assessments were conducted at different designated intervals during the three year period. The study indicates clearly the precise times for conducting the different tests and also how long these tests took in hours and sequential visits (Chaudhry et al. 2012). At all times, the patients were monitored for body/organ functions and for any side effects. This design and methodology in conducting these tests under rigid scientific conditions, provided a great deal of strength to the study and subsequent data analysis of the returns, as suggested by Kantowitz et al. (2001) and Mitchel and Jolley (1996). The analysis methodology showed that there were no differences in variables concerning age, gender, economic or educational status, and treatment-by-country statistics did not show any statistical significances. The statistical software program, Stata v. 11, was used for data analyses and covariance (ANCOVA) was applied for time, country (each at two levels) and beginning PANSS as the covariates (NIHR 2012). Treatment dropouts were also examined for patterns and potential missing data outcome. The study is very specific as to how the data was analysed and with which variables under different conditions were looked at for information. Missing assessment data was also noted. Results for each of the analysis tests done, were clearly outlined, along with corresponding graphs and table outputs (Chaudhry et al. 2012; Watabe et al. 2013). Any side effects were also detailed in the study, noting those who left the study because of side effects from Minocycline. The largest limitation of note which also was not studied during testing was the control of antipsychotic drugs being taken by the patients, and it was not clear whether Minocycline reacts differently with different antipsychotic drugs, and at different levels of prescribed dosages. Biomarker measures of blood cytokine assays and structural brain imaging were also not conducted and the researchers themselves, noted the limitation in this area (Chaudhry et al. 2012). Results of the test were clearly outlined, particularly through statistical analyses, and it was determined that, generally, the drug Minocycline was effective and beneficial when applied in early stage diagnosis and that the variables of age, gender, country, and other descriptive information, did not have any effect on data returns and analysis process. This test also verified another Israeli RCT study (Levkovitz et al. 2010; Chaudhry et al. 2012) using much the same research design, and it was noted that the first year in the study, there were no deterioration levels observed when Minocycline was applied. Conclusion and Summary In the second research study, following the RCT outline for this research study, the trial had a very clearly focused issue, that of finding out if Minocycline would help reduce negative effects of schizophrenia, which it did in the majority of respondents who finished the trial (Chaudhry et al. 2012). The scientific numbers-based study was randomized and all the staff and patients, including those who dropped out, were clearly accounted for and documented, by the end of the research study. All of the respondents fit the inclusion criteria requested for this study and differences in age, gender, economic status, did not affect the results of this test and all were treated equally other than receiving a placebo or Minocycline (Chaudhry et al. 2012). Concise analysis description and methodology was provided in the research report, including graphs and tables, and the results could also be applicable to any in the population who had been diagnosed with early stages of schizophrenia or similar issues, as suggested by Hicks (2004). Clinically important outcomes were addressed although limitations were observed, such as not measuring effects of Minocycline on prescribed psychotic drugs (Clinical Trials 2013) and also establishing biomarkers on various assessments, as noted in the Limitations section. Certainly, it appears that Minocycline is deemed effective enough for people to try it, just so long as they are also carefully monitored and assessed by their doctors for any possible reactions and for results, and this was clearly detailed (Chaudhry et al. 2012). Both research studies were professionally done according to guidelines and rules of ethics as required by scientific and ethical medical standards. The qualitative research study first reviewed could have provided a better understanding of how smaller themes were arrived at first and then incorporated into the three main themes as a result of coding and compilation of the data, as recommended by Kantowitz et al. (1991) and Sternberg (1998, p. A-11). The qualitative process allows for a certain leeway in interpretation of the data which is more subjective to the researchers’ experience and knowledge of the subject matter. In contrast, the quantitative study provides a very rigid infrastructure for each step of the process and there is a set goal, or hypothesis, for which the research is being conducted and that requires an answer. Statistical analysis is also very structured, objective, and looks for specific returns, providing an added layer into the overall statistical result, as recommended by Hicks (2004) (Chaudhry et al. 2012; Rathus 1996). As an added note in closing, there are also research studies being conducted now which address whether Minocycline has an effect on psychiatric drugs and how those may differ from one drug to the next. This will add a far greater dimension on the use of Minocycline with psychiatric drugs which may also need to be dosage-adjusted for better compatibility. Added in with this is the advanced research, using markers which determine changes in brain size in early stage schizophrenia diagnoses. Appendix A: CASP Qualitative Evaluation Form Title of Study Paper Design Qualitative Appraisal Tool CASP for Qualitative 1.-Was there a clear statement of the aims of the research? 2.-Is a qualitative methodology appropriate? 3.-Was the research design appropriate to address the aims of the research? 4.-Was the recruitment strategy appropriate to the aims of the research? 5.-Were the data collected in a way that addressed the research issue? 6.-Has the relationship between researcher and participants been adequately considered? 7.-Have ethical issues been taken into consideration? 8.-Was the data analysis sufficiently rigorous? 9.-Is there a clear statement of findings? 10.-How valuable is the research? Appendix B: CASP Quantitative Evaluation Form Title of Paper Paper Design RCT Appraisal Tool CASP for RCT 1.-Did the trial address a clearly focused issue? 2.-Was the assignment of patients to treatments randomized? 3.-Were all of the patients who entered the trial properly accounted for at its conclusion? 4.-Were patients, health workers and study personnel ‘blind’ to treatment? 5.-Were the groups similar at the start of the trial? 6.-Aside from the experimental intervention, were the groups treated equally? 7.-How large was the treatment effect? 8.-How precise was the estimate of the treatment effect? 9.-Can the results be applied to the local population? 10.-Were all clinically important outcomes considered? 11.-Are the benefits worth the harm and risks? Resources Caqueo-Urizar, A, Gutierrez-Maldonado, J & Miranda-Castillo, C 2009, ‘Quality of life in caregivers of patients with schizophrenia: A literature review’, Health and Quality of Life Outcomes, vol. 7, no. 84. 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Rathus, SA 1996, Psychology in the New Millennium, Harcourt Brace Publishers, Fort Worth, TX. Sternberg, RJ 1998, In Search of the Human Mind, 2nd edn, Harcourt Brace Publishers, Fort Worth, TX. Switaj, P, Anczewska, M, Chrostek, A, Sabariego, C, Cieza, A, Bickenback, J & Chatterji, S 2012, ‘Disability and schizophrenia: a systematic review of experienced psychosocial difficulties’, BMC Psychiatry, vol. 12, no. 193. Available from: [12 November 2013]. Teferra, S, Hanlon, C, Beyero, T, Jacobsson, L & Shibre, T 2013, ‘Perspectives on reasons for non-adherence to medication in persons with schizophrenia in Ethiopia: a qualitative study of patients, caregivers and health workers’, BMC Psychiatry, vol. 13, no. 168. Available from: [13 November 2013]. Torrey, EF & Davis, JM 2012, ‘Adjunct Treatments for Schizophrenia and Bipolar Disorder: What to Try When You Are Out of Ideas’, Stanley Medical Research Institute (SMRI) Online. Available from: [20 November 2013]. Wagner, LC, Torres-Gonzalez, F, Geidel, AR & King, MB 2011, ‘Existential questions in schizophrenia: Perception of patients and caregivers’, Revista de Saude Publica, vol. 45, no. 2, pp. 1-6. Available from: [14 November 2013]. Watabe, M, Kato, TA, Tsuboi, S, Ishikawa, K, Hashiya, K, Monji, A, Utsumi, H & Kanba, S 2013, ‘Minocycline, a microglial inhibitor, reduces ‘honey trap’ risk in human economic exchange’, Scientific Reports, vol. 3, no. 1685. Available from: [20 November 2013]. Yanos, PT, Roe, D & Lysaker, PH 2010, ‘The Impact of Illness Identity on Recovery from Severe Mental Illness’, American Journal of Psychiatric Rehabilitation, vol. 13, no. 2, pp. 73-93. Available from: [15 November 2013]. Read More