BSSR Lecture Series: Virtual Patients, Cross-Cultural Research in Four Languages and Adaptive Trials


Uploaded by NIHOD on 07.06.2012

Transcript:
STUDIES AND ONE PREVAILING
COMMENT THAT I GOT AFTER THAT
WAS, GEE, I DIDN'T KNOW NIH WAS
INTERESTED IN MIXED METHODS
RESEARCH, WHICH I THINK WAS
PRETTY TELLING.
AND FOR THOSE OF YOU WHO HAVE
GRANT PORTFOLIOS, I THINK YOU
KNOW IT MAY BE A SMALL PORTION
OF THE NIH GRANT PORTFOLIO.
CERTAINLY WE HAVE BEEN SEE ING
INCREASING INTEREST AND
INCREASING NUMBER OF APPLICANTS
USING MIXED METHODS APPROACHES
IN THEIR RESEARCH.
AND I HAD THE HONOR TO HEAR
DR. FEDDERS GIVE A PLENARY TALK
THAT THE CONFERENCE AND I
THOUGHT IT WOULD BE A GREAT
START TO ASK HIM TO COME HERE
AND TALK TO THE NIH COMMUNITY.
WE HAVE ALSO, LBSSR HAS BEEN
WORKING TO DEVELOP BEST
PRACTICES֜ FOR APPLICATION IN
REVIEW OF MIXED METHODS STUDIES.
DR. FEDDERS HAS PARTICIPATED IN
THAT AS WELL AND WE ARE HOPING
WE WILL LAUNCH THAT NEXT MONTH
ON THE OBSSR WEBSITE.
SO STAY TUNED FOR THAT. ç
SO, I WOULD LIKE TO INTRODUCE
DR. MICHAEL FEDDERS.
HE IS A FAMILY MEDICINE
RESEARCHER AND ASSOCIATE
PROFESSOR IN THE DEPARTMENT OF
FAMILY HEADS AT THE UNIVERSITY
MICHIGAN IN ANN ARBOR.
HE SAY LONG-STANDING INTEREST IN
MEDICAL ETHICS AND THE INFLUENCE
OF CULTURE ON MEDICAL
DECISION-MAKING AS WELL AS
APPLICATIONS OF MIXED METHODS
RESEARCH.
HE IS BILINGUAL IN JAPANESE AND
ENGLISH AND FOUNDED AND DIRECTED
THE UNIVERSITY MICHIGAN'S
JAPANESE FAMILY HEALTH PROGRAM.
HE RECEIVED HIS MEDICAL DEGREE
AT THE OSU, OHIO STATE
UNIVERSITY AND COMPLETED HIS
FAMILY MEDICINE RESIDENCY
TRAINING IN CLINICAL
EPIDEMIOLOGY DURING THE ROBERT
WOOD JOHNSON CLINICAL SCHOLAR AS
PROGRAM AT THE UNIVERSITY OF
NORTH CAROLINA.
AT MICHIGAN STATE UNIVERSITY, HE
STUDIED APPLICATIONS OF
QUALITATIVE METHODS IN BIOETHICS
RESEARCH.
DR. FEDDERS CONDUCTED NUMEROUS
RESEARCH PROJECTS AND CO-LED
MIXED METHODS WORKSHOPS.
HE SERVES AS AN ASSOCIATE EDITOR
OF THE MEDICAL STUDIES AND THE
JOURNAL OF MIXED METHODS
RESEARCH.
SO PLEASE JOIN ME IN WELCOMING
DR. FEDDERS.
[APPLAUSE]
>> THANK YOU FOR THAT VERY WARM
DISCUSSION.
I SEE MY SKYPE IS SHOWING UP.
IT'S A GREAT HON HORR TO BE HERE
TODAY.
THANK YOU FOR TUNNING OUT.
A WONDERFUL PRESENTATION.
IT'S A CALL ORDER FOR ME T
HELPED TO SET THE BAR VERY HIGH.
I WILL TRY TO MAKE THIS WORTH
YOUR WHILE TO HAVE COME.
I WILL JUST ACKNOWLEDGE THE MANY
PROJECT COLLABORATORS THEY
WORKED WITH OVER THE YEARS THAT
HAVE INFLUENCED MY OWN THINKING
AND THESE PRESENTATIONS.
NONE OF THESE THINKS NAP A
VACUUM.
DO WE NEED THE INTERNET PLUGGED
IN IT I'M GOING TO TOUCH BRIEFLY
MY OWN BACKGROUND AND JUST
EMPHASIZE A COUPLE OF THINGS AND
THEN TACKLE AN ELEPHANT IN THE
ROOM, MAYBE AN OBVIOUS ELEPHANT
AND MAYBE NOT.
JUST ILLUSTRATE SEVERAL MIXED
METHODS PROJECTS IN THE HEALTH
SCIENCES WE HAVE BEEN WORKING
ON.
TRYING TO TOUCH ON DIFFERENT
AREAS WE HAVE BEEN WORKING ON
INTO JUST BRIEFLY TOUCH AGAIN ON
SOME CHALLENGES OF DOING HEALTH
SCIENCES MIXED METHOD RESEARCH.
SO, I HAD WORKED IN JAPANESE
STUDIES AND WAS REALLY EXPOSED
TO CULTURE BEFORE GOING INTO
MEDICINE AND THEN GETTING
QUANTITATIVE EXPOSURE THROUGH
CLINICAL EM DEEMOLOGY AND MORE
QUALITATIVE EXPOSURE.
AND THE KEY POINT IS THAT A LOT
OF THE GRADUATE STUDENTS AND
JUNIOR RESEARCHERS THAT I'M
ENCOUNTERING NOW ARE SPENDING
TIME STUDYING BOTH OF THESE
AREAS AND THEN SAYING, HOW DO WE
COMBINE THESE THINGS TOGETHER?
SO I RELATE TO YOU AND HAVE
WORKED ON THAT.
AND IT WAS FUN ADDING UP JUST
THE NUMBER OF MIXED METHOD
PROJECTS I HAVE BEEN ON FOR
THIS.
SO I THINK IT COMES BACK ALSO TO
THE POINT THAT HELEN WAS MAKING
THAT, NOT ONLY IS NIH, BUT OTHER
INSTITUTIONS AS WELL, VERY
RESPECTABLE INSTITUTIONS ARE
FUNDING THESE PROJECTS.
JUST PUTTING IN A SELFLESS PLUG
HERE FOR YOU TO CONSIDER
PUBLISHING YOUR WORK IN THE
JOURNAL OF MIXED METHODS
RESEARCH AND ALSO CONSIDER TO BE
A REVIEWER FOR THE JOURNAL OF
MIXED METHODS RESEARCH.
AND AS HELEN MENTIONED, I WAS
FORTUNATE ENOUGH TO BE A
PARTICIPANT IN THE BEST
PRACTICES FOR MIXED METHODSÖ+œ
RESEARCH PANEL RECENTLY AND I
THINK ALL OF YOU WILL FIND THE
OUTCOME OF THAT TO BE QUITE
INTERESTING IF YOU'RE INTERESTED
IN MIXED METHODS RESEARCH.
SO, IN HEALTH SCIENCES AND MIXED
METHOD, THERE SAY MIX OF FIELDS
THAT ARE REPRESENTATIVE AMONG
THE ç RESEARCHERS, EDUCATION,
PSYCHOLOGY, SOCIOLOGY, BUSINESS
AND MANY OTHER AND INCREASINGLY
A LOT OF INTEREST IN THE HEALTH
SCIENCES FIELD AS WELL.
SO I LIKE THIS CARTOON FOR LIKE
SOCCER IS THE NEW KID ON THE
BLOCK COMPARED TO FOOTBALL.
I'M THINKING MAYBE I NEED TO
SWITCH THAT OUT FOR LACROSSE,
ALSO SEEMS TO GO GROWING.
IT'S FAIR TO START OUT WITH THE
DEFINITION TO MAKE SURE WE ARE
TRYING TO GET ON THE SAME PAGE.
AND THIS IS JUST ONE DEFINITION.
THERE ARE A NUMBER OUT THERE.
MIXED METHOD RESEARCH IS AN
APPROACH IN WHICH THE RESEARCHER
COLLECTS, ANALYZES AND INTEGRATE
OR MIXES BOTH QUANTITATE AND I
HAVE QUALITATIVE DAVEA --
DATA IN A SINGLE STUDY OR
MULTIPLE STUDY IN A SUSTAINED
PROGRAM OR INQUIRY.
THE PURPOSE OF THIS FORM OF
RESEARCH IS BOTH EQUALITATE AND
I HAVE QUANTITATIVE METHODS, IN
COMBINATION, PROVIDE A BETTER
UNDERRING OF A RESEARCH PROBLEM
OR ISSUE THAT EITHER METHOD
WOULD ALONE.
SO I JUST WANTED TO DO A QUICK
SURVEY OF YOU IN THE AUDIENCE.
HOW MANY OF YOU EVER
PARTICIPATED IN A HEALTH
SCIENCES MIXED METHOD STUDY?
SO A LITTLE MORE THAN HALF.
AND THOSE WERE FUNDED PROJECTS?
AND THE UNIVERSITY WE END UP
DOING A LOT OF UNFUNDED ONES
WITH MEDICAL STUDENTS.
SO WHAT ABOUT REVIEW OF MIXED
METHOD STUDY PANEL?
OR SERVED AS AN SRO OF MIXED
METHOD PROJECT?
OKAY.
JUST HELPS TO KNOW THE AUDIENCE
A LITTLE BIT MORE.
ANY WAY, GOALS IN HEALTH
SCIENCES ARE PROMOTION OF
HIGH-QUALITY LIVING AND
REDUCTION OF HUMAN SUFFERING.
FACTORS INFLUENCING THESE
OUTCOMES AS YOU'RE AWARE ARE
EXTREMELY COMPLEX.
SO, HEALTH SCIENCES RESEARCHERS
NEED ROBUST RESEARCH TOOLS AND
COLLABORATORS TO ACHIEVE THESE
ENDS.
THE ISSUE THAT I HAVE RUN INTO A
NUMBER OF TIMES IS THAT HEALTH
RESEARCHERS ARE VERY
KNOWLEDGEABLE BUT THEY ARE NOT
ALWAYS WISE IN TERMS OF
RECOGNIZING THE LIMITATIONS OF
THEIR RESEARCH METHODS.
SO, THIS IS WHERE THE ELEPHANT
IN THE ROOM COMES IN.
I WANT TO BRING UP THIS STORY OF
WHICH MANY ARE FAMILIAR WITH
ABOUT THE FIVE BLIND MEN AND THE
ELEPHANT AND I THOUGHT IT WAS
APPROPRIATE GIVEN MY JAPANESE
INTEREST TO BRING IN A WOOD
BLOCK PRINT.
THIS POEM WAS WRITTEN BY JOHN
GOD FREE SAX.
SO, THE BLIND MAN IN
THE
ELEPHANT.
[READING:
[READING POEM]
[READING POEM]֜
SO, FOR ME THE ISSUE IS, ALL OF
US AS METHODOLOGISTS HAVE
LIMITATION NO, SIR WHAT WE DO.
THAT WAS A QUALITATIVE ç TAKE.
I THOUGHT IT WOULD BE FUN TO GO
THROUGH A QUANTITATIVE
ASSESSMENT ABOUT HOW YOU MEASURE
AN ELEPHANT, HOW MUCH DOES ONE
WEIGH?
WE SEE ONE ON SCALES, HOW TALL
IS AN ELEPHANT?
WHAT IS THE GIRTH AND LENGTH OF
AN ELEPHANT?
HOW MANY TEETH DOES AN ELEPHANT
HAVE?
WHAT IS THE GESTATIONAL DUR
NATION I'M IN MY 18th MONTH
NOW.
THAT'S A LONG TIME.
OR OF COURSE THE CLASSIC
QUESTION, HOW MANY ELEPHANTS
DOES IT TAKE TO SCREW IN A
LIGHTBULB?
SO THE ELEPHANT IN THE ROOM IS
THE RESEARCHER WHO DOES NOT
RECOGNIZE ALL METHOD VS
LIMITATIONS, IS BLIND AND NOT
WORTH HIS SALT.
AND ALMOST INTEGRATING MULTIPLE
SOURCES OF INFORMATION WILL
PROVIDE A BETTER UNDERSTANDING
OF ELEPHANT PHENOMENON, A LARGE
PHENOMENON, USING ANALOGY THERE,
THAN A SINGLE APPROACH ALONE.
SO THAT IS WHERE WE WANT TO GO
TO THE DOG AND PONY SHOW AS I
SAY.
YOU SEE THE DOG ON TOP OF THE
PONY HERE.
JUST TALKING ABOUT THE FUN
PROJECTS THAT WE HAVE BEEN DOING
IN MIXED METHOD RESEARCH IN THE
BEHAVIORAL AND SOCIAL SCIENCES
AREA.
I'M GOING TO THWART A PROJECT
CALLED MODELING PROFESSIONAL
ATTITUDES AND TEACHING
COMMUNICATION AND VIRTUAL
REALITY.
IT'S A PROJECT I'M A CO-PI ON.
AND OUR GOAL IN THIS PROJECT IS
TO UNDERSTAND HOW NEW MEDIA CAN
BE USED TO DEVELOP BREAKING BAD
NEWS PROTOTYPE FEE TERRING A
ONE-ON-ONE INTERACTION WITH A
VIRTUAL HUMAN PATIENTS.
AND THIS IS THE OVERVIEW OF THE
METHODS AND ONE OF THE ISSUE
THAT IS COMES UP IN MIXED METHOD
RESEARCH IS THEY ARE COMPLEX.
AND NEED TO HAVE GOOD TWICE
PRESENT YOUR INFORMATION,
PARTICULARLY IN APPLICATIONS AND
I'LL TALK ABOUT THAT A LITTLE
BIT MORE.
BUT AT THE TOP, WE HAVE OUR
DESIGN.
WE HAVE A BLUEPRINT FOR
DEVELOPMENT, AND BUILDING THE
PROTOTYPE AND ASSESSING THE
PROTOTYPE AND SEAT PROCESSES
ALONG THE LEFT, PROCESSES AND
PROCEDURES AND OUTCOMES AND YOU
CAN SEE THIS ELEMENT IN TERMS OF
DEVELOPING PROTOTYPE COMPONENTS
AND BRING INFORMATIVE FEEDBACK.
I'M NOT GOING TO GO THROUGH THIS
IN DETAIL IN THE INTEREST OF
TIME BUT I DID WANT TO JUST
POINT OUT HOW THIS OVERVIEW
ILLUSTRATES HOW WE ARE USING THE
COMBINATION OF BOTH QUANTITATE
AND I HAVE QUALITATIVE THINGS.
I'M GOING TO GO INTO THAT MORE
AIM BY AIM AND SO THE FIRST AIM
BEING TO DESIGN A BLUEPRINT FOR
THIS PROTOTYPE.
THIS INVOLVES SOME THINGS
DEVELOPING CRITERIA FOR
ASSESSING USER PERFORMANCE,
DRAFTING A SCRIPT, DESIGNING
VIRTUAL PATIENT, DESIGNING
VIRTUAL REALITY ENVIRONMENT AND
PERFORMING A FORMATIVE
EVALUATION OF THE SCRIPT,
CHARACTER AND INTERFACE
ENVIRONMENT.
SHEAR WHERE WE ARE BRINGING IN
DATA TO ASSESS THIS NEW MEDIA
THAT WE ARE DEVELOPING.
AND THIS INVOLVES DESIGNING A
VIRTUAL PATIENT CHARACTER AND
GETTING FEEDBACK FROM
PROFESSIONALS WHO WOULD BE USING
THIS AND MEDICAL STUDENTS WHO
WOULD BE USING IT AND THEN IN
THE SECOND AIM BUILDING THE
PROTOTYPE, RECORDING SCRIPT,
CREATING DIALOGUE, PREPARING
REFERENCE VIDEOTAPE, COMPLETING
CHARACTER READING, ANIMATING THE
VIRTUAL PATIENT.
, DEVELOPING USEESH ENGINE AND
INTERFACE --
AND THIS IS THE EXAMPLES IN
TERMS OF APPLYING DATA POINTS
ACCORDING TO AREAS THAT I THINK
MANY OF US ARE NOT AS FAMILIAR
WITH.
SO THE ACTUAL EXPERIENCE THIS
LEADS TO IS WHAT WE CALL THE VR
EXPERIENCE AND A USER WILL WEAR
HEAD PHONES WITH A MICROPHONE IN
ORDER TO INTERACT WITH THE
VIRTUAL PATIENT.
A SUBJECT WILL CLICK ON THE ç ICON
TO START THE PROGRAM.
SELECT THE GENDER TO HAVE PROPER
VOICE RECOGNITION AND THEN
CHOOSE FROM CHOICES THAT ARE
SPOKEN INTO THE MICROPHONE THAT
ARE PRESENTED.
SO IS THERE AN INTERACTION.
YOU CHOOSE FROM SPECIFIC ç
CHOICES.
AND THESE OPTIONS INCLUDE WHAT
IS BAD, BETTER AND BEST WITH
DIFFERENT POINT VALUES BEING
ASSIGNED FOR EACH SO YOU CAN
EVALUATE HOW SOMEONE
PERFORMANCE.
SO HERE YOU ARE INTERACTING WITH
THE VIRTUAL PATIENT ON A
COMPUTER, ROBIN PRESENTS WITH AN
UNSTOPPABLE NOSE BLEED.
YOU JUST FOUND OUT THAT HER LAB
DEMONSTRATES SHE HAS A SEVERE
FORM OF LEUKEMIA AND YOUR JOB AS
THE PLAYER OF THIS NEW MEDIA IS
TO DISCLOSE HER SHE HAS CANCER.
WE ARE GOING TO GO PART WAY INTO
THIS.
YOU JUST FOUND THOUGHT
INFORMATION AND TRYING TO
DISCLOSE THIS AND SHE HAS
DISBELIEF AND ANGER.
THIS IS HER RESPONSE TO YOU
INTERACTING WITH YOU.
>> I'M FLOTTRYING TO BE A JERK.
I JUST --
I NEED --
THOSE TESTS HAVE TO BE WRONG.
>> SO, VERY SHORT CLIP,
HOPEFULLY YOU CAUGHT IT.
BUT I THINK YOU CAN SEE THAT
THIS IS A PRETTY COMPELLING
PIECE WITH A VIRTUAL PATIENT AND
YOU'RE PROBABLY USED TO VIDEO
GAMES THAT MAYBE YOU PLAY
YOURSELF, THE DEMOGRAPHICS OF
SERIOUS GAME PLACERS GROWING OR
THE GAMES AND THE ANIMATION YOU
SEE WITH YOUR CHILDREN.
THIS WAS THEM WITH AN SBIR PHASE
1.
SO, TAKING THAT INTO ACCOUNT, WE
ARE VERY HAPPY WITH HOW IT
TURNED OUT AND THIS IS LEADING
TO DATA THAT WE HAVE BEEN USING
TO CONDUCT A ASSESSMENT OF THE
EMOTIONAL IMPACT AND EFFICACY OF
THIS PROTOTYPE WITH MEDICAL
STUDENTS, MEDICAL EDUCATION
EXPERTS.
AND WHAT WE ARE USING IS PART OF
THE MIXED METHODS COM OPPONENT
IS QUANTITATIVE SCORES FROM THE
PROTOCOL SOFTWARE, SURVEY DATA
THAT HAVE EQUALITATE AND I HAVE
QUANTITATIVE MEASURES AND
IN-DEPTH INTERVIEW DATA AND
QUALITATIVE INTEGRATION IS
FOCUSED AROUND THE QUALITATIVE
ANALYSIS BEING INFORMED BY THE
SCORES OF THE PROTOTYPE
THEMSELVES.
AND THIS IS MY TRUSTED COLLEAGUE
DR. CONE, THE EARLIER VERSION.
I'M GOING SWITCH GEARS.
I SAID IT WAS A DOG AND PONY
SHOW.
MAYBE SOME OF YOU ARE
INTERESTED] CROSS-CULTURAL
ISSUES MOVING OUT OF THE HEALTH
SCIENCES AND EDUCATION AREA AND
CANCER AND NOW WE'LL TALK A
LITTLE BIT ABOUT THE WORK THAT
WE HAVE BEEN DOING IN QATAR.
JUST LITERALLY GOT BACK.
THIS SAY PROJECT FUNDED BY THE
NATIONAL RESOURCE PRIORITIES
PROGRAM IN QATAR AND THE PROJECT
IS THE QATAR CONSUMER ASSESSMENT
HEALTH SURVEY.
MANY WILL PROBABLY RECOGNIZE THE
CONSUMER ASSESSMENT HEALTH PLAN
SURVEY AS AN ARC TOOL.
WHAT WE ARE TRYING TO DO IS
ADAPT THIS&INSTRUMENT FOR QATAR.
THE TITLE OF OUR PROJECT IS
PROVIDING CULTURALLY APPROPRIATE
HEALTH CARE SERVICES IN QATAR,
DEVELOPMENT OF A MULTILINGUAL
PATIENT CULTURAL ASSESSMENT
SURVEY AND BASICALLY, I'LL TELL
YOU MORE ABOUT QATAR, BUT
DEVELOPING THIS INSTRUMENT IN
THE FOUR MOST COMMONLY USED
LANGUAGES IN THE HOSPITAL.
SO, WHAT ABOUT QATAR?
IT'S A SMALL STATE IN THE
ARABIAN GULF KNOWNAZ FOR CAM
BREEDING, FISHING AND DIVING FOR
PEARLS AND THEN THE DISCOVERY OF
OIL AND THE WORLD'S LARGEST
NATURAL GAS FIELD FUELED THIS
AMAZING LEAP INTO THE 21st
CENTURY.
AND CURRENTLY DEPENDING ON WHICH
GROUP YOU FOLLOW, QATAR HAS THE
HIGHEST PER CAPITA INCOME IN THE
WORLD.
THIS IS JUST DEMONSTRATING THE
ARABIAN GULF AND THEN CASTAR
THIS LITTLE TINY LUMP DOWN HERE
IN THE֜ BOTTOM.
MULTICULTURALISM QATAR STYLE.
THERE IS AN UNPRECEDENTED
ECONOMIC GROWTH IN AN INFLUX OF
PATRIOT WORKERS WITH EXTREME
CULTURAL VARIATION ECHOED IN 190 ç
LANGUAGES USED AMONG THE
EXPATRIOTS.
YOU'RE TALKING ABOUT ONE CITY,
190 LANGUAGES.
PEOPLE TOGETHER ALL THE TIME
TALKING TRYING TO% COMMUNICATE
WITH EACH OTHER.
IN THE HEALTH CARE SETTING, WE
COINED THIS WORD, INCIDENTAL
INTERPRETERS.
IT MEANS THE JANITOR THAT IS
THERE, THE NURSE, THE MEDICAL
STUDENT, ANYBODY THAT IS THERE
BECOMES THE INTERPRETER.
SO INCIDENTAL IN INTERPRETER, IS
WORK THAT WE HAVE COINED TO
DESCRIBE THIS PHENOMENA.
WE ALSO NOW DESCRIBE THIS AREA
AS AN EXTREMELY HIGH DENSITY,
MULTI-COLLATERALE POPULATION
BECAUSE THERE ARESOME OTHER
PEOPLE IN ONE
APPLIES - MULTICULTURAL.
WITH ALL THESE LANGUAGES AND
CULTURES, PEOPLE OFTEN LACK
SPLICE THEIR HEALTH CARE.
SO, AGAIN I WON'T TRY AND GO
INTO ALL THE DETAILS OF THIS BUT
THIS IS AN OVERVIEW OF OUR MIXED
METHODS PROJECT AND YOU'RE
GETTING A SENSE HERE THAT YOU
NEED TABLES TO REALLY PORTRAY
THESE COMPLEX PROCESSES.
WE HAVE THE STEPS OF THE PROJECT
ON THE LEFT AND THEN THE --
THAT'S IN THE GREEN.
AND THEN OUR PROCEDURES FOR DATA
COLLECTION IN THE PURPOSEEL AND
THEN THE ACTUAL PRODUCTS THAT
WE'RE PRODUCING TO THE RIGHT.
AND THOSE STEPS BEING
TRANSLATING INSTRUMENT AND
OBTAINING ASSESSMENTS, ASSESSING
VALIDITY AND THAT.
BECAUSE THE STICKS SMALL, I'M
GOING TO GO INTO THESE A LITTLE
BIT MORE ONE BY ONE.
SO THE FIRST AIM GOING TRANSLATE
THE EXISTING CAP INSTRUMENT INTO
ARABIC, HINDY AND IRD.
AND IDENTIFY TRANSLATION
DILEMMAS TO THEN INFORM PHRASES
AND CONCEPTS THAT WOULD BE
VALUABLE FOR US TO EXPLORE IN
TERMS OF MAKING A CULTURAL
ADAPTATION OF THE INSTRUMENT.
IT'S HARD TO TRANSLATE BUT MUST
MEAN THERE IS SOMETHING GOING
ON.
SO, THIS JUST DEMONSTRATES HOW
WE TOOK THE EXISTING INSTRUMENT
AND TRANSLATE TODAY INTO ARABIC,
INDY AND IRDU AND THEN USED
THESE TRANSLATION DILEMS TO HELP
INFORM OUR QUALITATIVE INTERVIEW
GUIDE, WHICH WAS WHAT WE ARE
DEVELOPING IN STEP TWO,
EXPLORING PATIENT'S ASSESSMENTS
OF THE TRANSLATION DILEMMAS AND
THE QUALITY OF THEIR VISITS
BASED ON THEIR OWN CULTURAL
CONTEXT AND PREFERRED LANGUAGES.
ONE OF MY COLLABORATORS WITH ONE
OF THE FIRST MEDICAL
INTERPRETERS IN THE MIDDLE
THERE.
SO THIS IS STEP TWO.
HERE WE SEE THIS PROJECT BEING
INFORMED FIRST BY LITERATURE
REVIEW WHICH IDENTIFIED FOR US
AS BEING IMPORTANT IN THIS
CULTURE, GENDER, DIET TRACKS
ADDITIONAL AND ARABIC MEDICINE.
WE ALSO USE CULTURAL
CONSTRUCTION OF CLINICAL REALITY
MODEL TO INFORM OUR INTERVIEW
GUIDE AND ALSO USE THE
TRANSLATION DILEMMAS WE
IDENTIFIED IN THE PREVIOUS STEP.
SO THIS ALLOWED US TO PRODUCE AN
ENGLISH QUALITATIVE INTERVIEW
INSTRUMENT THEN TRANSLATED INTO
ARABIC, HINDY AND IRDU.
GOING ACROSS THE WAY, WE HAVE
JUST COMPLETED THE 85 INTERVIEWS
IN THOSE FOUR LANGUAGES AND WE
ARE NOW USING THOSE QUALITATIVE
DATE TO INFORM DEVELOPMENT OF A
QUANTITATIVE MEASURE.
NOT REALLY DEVELOPING BUT ADDING
TO AND MAKING A CULTURALLY
ADAPTED QUALITY ASSESSMENT
INSTRUMENT FOR THE CAPS.
SO WHY DID WE DO THE INTRODUCE?
WE WANTED TO IDENTIFY THE --
INTERVIEWS.
WE WANTED TO IDENTIFY THE CODES
THAT PATIENTS USE, PHRASES, IN
ORDER DEVELOP A
CULTURALLY-ADAPTED CAPS
INSTRUMENT.
AND OF COURSE THE BEST ITEMS IN
AN INSTRUMENT ARE THINGS THAT
WERE DEVELOPED FROM REAL WORLD
UTERANCES AND PHRASES FROM REAL
PEOPLE ANDyM REFLECTING THE
LANGUAGE THEY USE AND IT HELPS
TO REFLECT THE ISSUE THAT IS ARE
OF INTEREST TO THEM AND USES
CATCHPHRASES THAT ARE
UNDERSTANDABLE TO THEM.
WE ARE GETTING BACK --
LITERALLY JUST GOT BACK FROM
QATAR LAST FRIDAY.
SOME OF THE THINGS WE ARE
FINDING THAT WE ARE NOT REALLY
AS WELL REPRESENTED IN THE
EXISTING CAPS INTEREST THAT --
INSTRUMENT THAT NEEDS TO BE
THERE, WAITING TIMES ARE REALLY
SIGNIFICANT, INCLUDING PHARMACY
WAIT TIMES, COMMUNICATION
MEDICAL SUPPLIES, USE OF
ALTERNATIVE CARE, RELIGIOUS
CONSIDERATIONS, NASHINALY AND
CULTURAL CONSIDERATIONS, AND
CONCERNS ABOUT FAIR TREATMENT.
MOVING FORWARD, WE'RE GOING TO
BE DEVELOPING THESE INTO NEW
ITEMS TO ADD INTO THE CAPS.
AND THEN WE'LL BE FIELD TESTING
IT AND THIS IS WHAT SOME OF
QATAR LOOKS LIKE.
BUT A LOT TVs GROWING INTO
TALL BUILDINGS.
AND ULTIMATELY, WE INTEND TO
GENERATE A USER GUIDE TO EXPLAIN
HOW TO INTERPRET THIS LINGUISTIC
AND CULTURAL INFLUENCE ON HEALTH
CARE QUALITY.
WE ARE WORKING ON TRANSLATING
INSTRUMENTS INCLUDING DEVELOPING
OUR OWN CONSULTERATION
INSTRUMENT WHICH IS MAIQ LOOKING
AT THE SOCIOCULTURAL DILEMS AND
DOING FIELD TESTING AND
PROBLEMATIC AREAS.
WE ARE IN THE PROCESSu CURRENTLY
OF DOING COGNITIVE TESTING OF
THE ITEMS IN THE FOUR LANGUAGE
AND DEVELOPING SURVEY ITEMS AND
MORE TO COME.
I THOUGHT THIS PHOTO WAS SORT OF
TELL BEING QATAR.
GASOLINE CHEAPER THAN WATER.
SO THE FLOWERS OUTDOORS, THE
GREENERY OUTDOORS, IT'S COMING
AT A VERY DIFFERENT COMPOSITE
DIFFERENT MIND-SET THAN WHAT WE
HAVE HERE.
OUR LAST PROJECT I WANT TO TOUCH
ON S A PROJECT CALLED
ACCELERATING DRUG AND EVALUATION
THROUGH INNOVATIVE CLINICAL
TRIAL DESIGN AND THE CO-PIS ON
THAT ARE:
AND THIS IS SUPPORTED BY A UL1
MECHANISM FROM THE NIH COMMON
FUND.
AND IN THIS PROJECT, VERY LARGE
PROJECT, ON THE MIXED METHOD
TEAM WITH MY COLLEAGUES.
I'M GOING TO THANK YOU VERY MUCH
ON THE OVERALL GRANT THROUGH A
COLLABORATIVE PROCESS, DESIGN
AND IMPLEMENT CLINICAL TRIALS.
MOST LIKELY TO YIELD RESULTS
THAT WILL IMPROVE OUTCOMES OF
PATIENTS WHO HAVE ACUTE
NEUROLOGICAL ILLNESS AND INJURY.
AND USING THIS MIXED METHODS
APPROACH SO THE AIM IS TO
ACTUALLY DESIGN THESE FOUR
INNOVATIVE ADAPTIVE CLIN CAN
CALL TRIALS FOR EVALUATIONS OF
RIGS AND DEVICES USED IN THE
CARE OF PATIENTS WHO HAVE ACUTE
NEUROLOGICAL ILLNESS OR INJURIES
AND THE ADAPTIST METHODS INCLUDE
FREQUENT ANALYSIS,
PROBABILITY-BASED DECISION
OUTCOMES AND RULES AND
LONGITUDINAL MODELING AND
RESPONSE TO RANDOMIZATION.
THIS IS VERY CUTTING-EDGE TYPE
OF TRIALS WHICH MAY OR MAY NOT
BE FAMILIAR.
WE ARE INTERESTED IN MY PART IN
TERMS OF IDENTIFYING
QUALITATIVELY, CHARACTERIZING
KEY STEPS AND BARRIERS RELATED
TO THE ACCEPTANCE AND
IMPLEMENTATION OF ADAPTIVE
CLINICAL TRIALS.
THE IDEA THAT ONE CAN
DOITERRATIVE TRIALS COMPARED TO
CLASSIVE VIEWS ABOUT KNEW IN A
RANDOMIZED CONTROL TRIAL IS VERY
NEW AND NOT SOu! STRAIGHTFORWARD.
STAKEHOLDERS AND PART OF THAT
PROCESS IS SAYING WHO ARE THE
STEAK HOLDERS AND MAKING SURE WE
GET THE VOICE OF THE
STAKEHOLDERS.
THAT IS FDA, ç NIH, THE
RESEARCHERS THEMSELVES.
THE GRANT REVIEWERS, PIER
REVIEWERS, CLINICIAN USERS.
SO IT'S A LOT.
AGAIN, I'LL APOLOGIZE FOR ALL
THE DETAILS.
IT'S MORE JUST THE IDEA OF HOW
THESE STUDIES ARE VERY COMPLEX.
YOU NEED TO BE VERY ORGANIZED
AND PRESENTING THEM IN
APPLICATIONS IN ORDER TO
ILLUSTRATE THE KIND OF
METHODOLOGIES THAT ARE BEING
USED, BUT THE POINT HERE BEING
TO DEMONSTRATE IN OUR DATA
COLLECTION PROCEDURES IS THERE A
WHOLE HOST OF WAY THAT IS WE ARE
COLLECTING BOTH QUANTITATE AND I
HAVE QUALITATIVE DATA AND
INTEGRATING THAT TOGETHER.
AND THIS IS JUST SHOWING A
LITTLE BIT MORE TRUNCATED WAY
GOING BACK TO THE ELEPHANT PUN,
PERHAPS, HOW WE ARE COLLECTING
PREMEETING SURVEY ATTITUDES
ABOUT TRADITIONAL ADAPTIVE
CLINICAL TRIALS USING VISUAL
ANALOGUE STYLES GET A
QUANTITATIVE ASSESSMENT OF WHERE
PEOPLE ARE STARTING OUT WITH
THEIR INTRODUCE SOME OF THESE
ISSUES, THE USE OF MANY FOCUS
GROUP INTERVIEWS, CONDUCTING
FIELD OBSERVATIONS AND DOING
POST MEETING PROCESS WELL
EVALUATION SURVEYS.
THE RETAILS ARE NOT AS
IMPORTANT --
DETAILS ARE NOT AS IMPORTANT.
THERE ARE MULTIPLE WAYS WE ARE
INTEGRATING THE EQUALITATE AND I
HAVE QUANTITATIVE DATA AND THAT
IN DOING THIS WORK, YOU HAVE TO
BE ORGANIZED IN PRESENTING WHERE
SOMEONE HAS A LITTLE MORE TIME
IN A BIG FORUM LIKE THIS, TO
REAL GE THROUGH THE DETAILS AND
UNDERSTAND IT.
SO JUST A COMMENT WHERE WE ARE
IN THIS PROJECT IT'S REALLY ONLY
STARTED IN THE LAST SEVERAL
MONTHS BUT WE HAVE INITIAL
VISUAL ANALOGUE SCALE RESPONSES
AND WE ARE INTEGRATING THOSE WHO
OUR QUALITATIVE, OPEN-ENDED,
TRANSFER RESPONSES.
AND THEN ALSO LINKING THAT TO
QUALITATIVE INTERVIEWS THAT WERE
DONE THROUGH A GROUP PROCESS,
MANY FOCUS GROUPS AND THROUGH
SOME KEY INFORMING INTERVIEWS.
AND THIS HAS BEEN IMPORTANT FOR
DEFINING WHERE THE STAKEHOLDERS
STAND ON USING THE ADAPTIVE
DESIGNS PROPOSED.
AND ADDRESSING HELEN'S QUESTION.
THE REASON I WANTED TO PRESENT
THIS TRIAL, EVEN THOUGH WE ARE
JUST GETTING STARTED, THERE IS
NOW INTEREST IN NIH SUPPORT FOR
USING MIXED METHODS AND
UNDERSTANDING HOW TRIAL
DEVELOPMENT ACTUALLY OCCURS.
SO, SOME CHALLENGES IN MIXED
METHOD PROJECTS AND HEALTH
SCIENCES, TEAM DEVELOPMENT
REALLY CRITICAL.
WE HAVE A PAPER FORTHCOMING AND
IN WHICH THE LEAD AUTHOR IS
LESLIE CURRY.
IT'S NOT EXACTLY FORTHCOMING YET
BUT ACCEPTED WITH MINOR
REVISIONS.
IS WORN OF THE BIGGEST
CHALLENGES ARE THOSE WHO HAVE
DONE ONLY QUANTITATIVE WORK,
UNDERSTANDING THE COMPLEXITIES
OF WHAT IS HAPPENING AND BUT
GOES BOTH WAYS IN TERMS OF EACH
GROUP COMING FROM VERY DIFFERENT
TRADITIONS.
OFTEN PHILOSOPHICAL POSITIONS
AND BEING ABLE TO HAVE A
DIALOGUE AMONG THE MULTIPLE
MEMBERS OF THE TEAM IS QUITE
CHALLENGES.
ANYONE DOING EQUAL DATIVE
RESEARCH KNOWS THERE ARE JUST
VOLUMES OF DATA TO FIGURE OUT
HOW TO INTEGRATE THAT DATA
TOGETHER A REAL CHALLENGE.
AND ALSO, SIGNIFICANT ISSUE IS
JUST HOW ARE YOU GOING TO
PUBLISH YOUR WORK?
WHO WILL BE YOUR AUDIENCE?
ARE YOU GOING TO BE ABLE TO GET
YOUR MIXED METHOD PAPERS INTO
JOURNALS THAT TACET 2,500 WORDS
WHICH IS WHAT MOST OF֜ THE
JOURNALS IN MY CLINICAL
DISCIPLINE HAVE.
NOW THE JOURNAL OF MIXED METHOD
RESEARCH, I'LL PUT A PLUG BACK
IN.
WE TAKE MANUSCRIPTS UP TO 10,000
WORDS.
WE WANT TO KNOW THE DETAILS.
AND MOST OF THOSE ç 25 HELPED WORD
PAPERS YOU'RE TRUNCATING THE
METHODS TO THE EXCEPT YOU CAN IN
ORDER TO GET YOUR RESULTS OUT
THERE I - 2,500.
WE ARE A PLACE THAT CELEBRATES
YOUR METHODOLOGY.
WE WELCOME YOU AND IF YOU'RE
INTERESTED IN LEARNING MORE
ABOUT METHODS, IT'S A GOOD FLIES
REVIEW.
AS FOR CHALLENGES AND CROSS
CULTURAL AND CROSS LINGUAL MIXED
METHODS RESEARCH, DEVELOPING IN
FRA STRUCTURE WHERE THERE HASN'T
BEEN ANY IS REALLY QUITE
CHALLENGING.
CONDUCTING THE SOCIAL CULTURE
ADAPTATION INSTRUMENTS
SIMULTANEOUSLY ACROSS MULTIPLE
CULLURES AND ACROSS MULTIPLE
LANGUAGES HAS PROVED TO BE
INCREDIBLY INTERESTING AND ALSO
COMPLEX AND CHALLENGING AND I
CAN'T SPEAK ENOUGH TO THE
LEADERSHIP AND THE COLLABORATORS
THAT I HAVE IN QATAR.
THERE IS ALL KINDS OF ISSUE THAT
IS COME OUT IN TERMS OF
TRANSLATION AND QUALITY
CONTROLS.
AND THEN ACTUALLY THE ANALYSIS
PROCEDURES AND ALL THESE
LANGUAGES.
WE WANT TO JUST END WITH A PEARL
OF THE DAY AND I HAVE BEEN
ALLUDING THIS AS I SPOKE BUT
HAVING AN IMPLEMENTATION MATRIX
IS REALLY IMPORTANT FOR
CONVEYING THE COMPLEXITY OF THE
DESIGNS AND ORGANIZING GRANT
WRITING, DEMONSTRATING HOW THE
DIFFERENT AIMS AND FAITH IS
BUILT ON PREVIOUS RESULTS OR HOW
THEY ARE GOING TO BE INTEGRATED.
IT REALLY PROVIDES A VISUAL THAT
ILLUSTRATES WHEN AND HOW
EQUALITATE AND I HAVE
QUANTITATIVE DATA WILL BE MIXED.
IT BECOMES A GREAT WAY TO SELL
THE PROJECT TO REVIEWERS.
AND ALSO YOU CAN SAY THAT IS
WHAT WE NEED TO WORK ON.
IN CONCLUSION, THE RESEARCH THAT
WE ARE ALL DOING IN HEALTH
SCIENCE SYSTEMS EXTREMELY
COMPLEX.
AND COLLABORATION ARE NECESSARY
IN ORDER FOR STUDIES TO ADDRESS
HEALTH SCIENCES RESEARCH.
THERE IS REALLY JUST A GROWING
DEMAND FOR COLLABORATORS,
PARTICULARLY FOR THOSE WHO HAVE
QUALITATIVE EXPERTISE AND CAN
UNDERSTAND TRADITIONAL
QUANTITATIVE STUDIES.
THAT'S WHY I LIKE THIS CARTOON.
NO WEAK HEART.
YOU HAVE TO BE ABLE TO
UNDERSTAND BOTH METHODOLOGIES.
THERE ARE BASIC SCIENCES,
BIOLOGY, CLINICAL CARE,
BEHAVIORAL, EPIDEMIOLOGICAL AND
EVEN PHILOSOPHICAL SOURCES, SO
LIKE THE BIOLOGICAL DATA, THIS
IS AN AREA THAT NONE OF THE
OTHER FIELDS SIGNIFICANTLY DEAL
WITH.
AND THAT'S AN AREA OF PARTICULAR
INTEREST IN TERMS OF MIXED
METHOD RESEARCH.
WHAT ABOUT HUMAN GLOBIN A1CS AND
DIABETICS AND WHAT I ARE DOING
MIGHT WANT TO BRING INTO PLAY
MIXED METHOD ANALYSIS.
WE THINK THAT HEALTH SCIENCES
ARE REALLY FERTILE GROUND FOR
SCATTERING THE SEEDS OF THIS
EMERGING MIXED METHOD APPROACH
AND EXAMINING THE RESULTS OF
THIS CROSS-POLLINATION OF USING
QUALITATIVE AND QUANTITATIVE
METHODS.
SO, I DON'T KNOW HOW TO DO THIS
ON TIME, BUT I'LL BE HAPPY TO
ENTERTAIN QUESTIONS.
I HOPE I֜ DIDN'T GO TOO FAST
TRYING TO GET THROUGH MATERIALS.
MOSTLY TRYING TO BE MORE
CONCEPTUAL, AGAIN KIND OF A DOG
AND PONY SHOW, TO SOME EXTENT,
TO SAY THESE ARE DIFFERENT WAYS
THAT MIXED METHODS ç PROJECTS HAVE
BEEN FUNDED AND MAYBE GIVE
MUUMUU IDEAS ABOUT WHAT YOU
MIGHT DO IN YOUR OWN PROJECTS
AND THINKING MORE ABOUT HOW
YOU'RE GOING TO ORGANIZE
YOURSELF WHEN DOING YOUR MIXED
METHODS PROJECTS.
[APPLAUSE]
--
OFF MIKE.
CONCEPTUALLY I GET IT.
I CAN SEE WHERE IF YOU'RE ONLY
EXAMINING SOMETHING WITH ONE
TOOL, YOU'RE GOING TO BE LIMITED
IN WHAT YOU CAN LEARN.
SO HOW DO I GO ABOUT PREPARING
MYSELF TO REALLY UNDERSTAND
THESE METH APOLOGIES.
SO, I THINK ONE --
METHODOLOGIES.
ONE ISSUE IS MENTORSHIP.
THAT'S ALL VERY HELPFUL.
YOU NEED TO KNOW REALLY
ESSENTIALS OF BOTH
METHOLOGYITIES SOME DEGREE.
I THINK IT MAY MEAN DOING TWO
MASTERS OR DOING A Ph.D. IN
ONE AREA AND MAKING SURE YOU
HAVE SOME SUPPLEMENTAL TRAINING
AS PART OF THAT.
I DON'T THINK THERE IS REALLY
ONE PATHWAY YET.
CERTAINLY A PASSION FOR DOING IT
IS REALLY IMPORTANT.
I THINK THE SOONER SOMEONE'S
JUNIOR CAN GET INVOLVED IN A
MIXED METHODS STUDY TO START
SEEING WHAT THE ISSUES ARE, THAT
THAT WILL BE REALLY IMPORTANT.
WE HAVE TREMENDOUS DEMAND AND
DIFFICULTY FINDING PEOPLE THAT
ARE COMFORTABLE WITH QUALITATIVE
ANALYTIC SOFTWARE.
YOU SEE ON ANY NIH PROPOSAL
SIGNIFICANT FUNDING FOR THE
BIOSTATISTICIAN, THESE ARE VERY
FEW NIH PROPOSALS THAT WOULD GO
THROUGH WITHOUT A
BIOSTATISTICIAN.
SO IS THERE A WHOLE FIELD OF
BIOSTATISTICS.
S THERE ARE MORE LIMITATIONS AND
NOT AS MUCH APPLIED EXPERIENCE,
I THINK, IN TERMS OF HAVING VERY
HIGH LEVELS OF OF INDIVIDUALS
WHO CAN INTERACT AND WORK WITH
CLINICIANS AROUND THE
QUALITATIVE ASPECTS THAT ALSO
SPEAK THE LANGUAGE OF
QUANTITATIVE METHOLOGISTS.
SOCIETY MORE TOWNS YOU HAVE TO
LEARN ABOUT --
SO THE MORE TONIGHT YOU HAVE TO
LEARN ABOUT BOTHS --
THERE ARE COURSES.
FOR EXAMPLE, THE INTERNATIONAL
MIXED METHODS CONFERENCE, EVERY
YEAR HAS A MIXED METHODS COURSE.
WE ALSO, WITH MY COLLEAGUE,
PIERRE, WE RUN A MIXED METHODS
WORKSHOP AT NORTH AMERICAN
PRIMARY CARE RESEARCH GROUP.
WE HAVE DONE THAT FOR THE LAST
FEW YEARS AND SUBMITTED A
PROMISE PROPOSAL TO DO ONE AGAIN
THIS YEAR.
YOU YOU'RE NOT GOING TO LEARN
MIXED METHOD IN A WEEKEND
WORKSHOP.
I DON'T KNOW THAT IS THERE A
GOOD ANSWER FOR THAT YET.
I THINK AS IN ANY FIELD OF
RESEARCH, HAVING GOOD MENTORING
AND A GOOD GRASP OF THE
FUNDAMENTALS ç IS CRITICAL.
>> SO THAT'S GETTING INTO AREAS
OUTSIDE OF MY EXPERTISE.
THAT'S REALLY MORE THE WORK THAT
THEY ARE DOING WITHIN THE TRIALS
THEMSELVES.
AND SO I CAN'T REALLY SPEAK TO
THAT.
I'M --
MY PIECE OF THE PROJECT IS MORE
LOOKING AT THE PROCESS BY WHICH
THEY ARE DEVELOPING THESE
TRIALS.
AND HAVING THE FIRST VIEWS FROM
THE DIFFERENT DISCIPLINE THAT IS
HAVE TO WORK TOGETHER TO CONDUCT
THIS KIND OF A TRIAL.
SO, ONE OF THE ISSUE SYSTEMS,
THERE IS A LOT OF MODELING
REQUIRED IN SETTING UP AND
RUNNING ADAPTIVE CLINICAL
TRIALS.
BEYOND THAT I COULDN'T SPEAK TO
THE ISSUE MORE THAN THAT.
[OFF MIC]
>> YOU LIKE ME TO GO THROUGH ONE
MORE MORE DETAIL?
SURE.
SO WHAT THIS IS DOING TIEING THE
SPECIFIC STEPS OF THE PROJECT TO
THE LEFT AND AGAIN, I'M SORRY I
WENT THROUGH THIS VERY QUICKLY.
THERE IS MORE OF WHAT IS THERE.
REALLY STARTING OUT LOOKING AT
HOW THIS SPECIFIC AIM AND THE
STEPS PROFIT JECT ARE GOING TO
TIE TO SPECIFIC PROCEDURES.
AND PRODUCE SPECIFIC PRODUCTS.
SO IF YOU LOOK IN THE FIRST
STEP, TRANSLATING THE CAPS
SURVEY --
THE POINTER TAKES A WHILE TO
SHOW UP HERE.
SO, THE FIRST STEP WAS
TRANSLATING CAPS INTO ARABIC,
HINDY AND IRD.
AND IDENTIFYING THE TRANSLATION
DILEMS AND THE PROCEDURES OF
THAT WERE THAT WE HAD THREE
TRANSLATION TEAMS DEVELOP THE
CAR GET LANGUAGE DRAFTS AND THEN
DOCUMENT THE ACTUAL TRANSLATION
DILEMMAS THAT CAME UP.
FROM THOSE TRANSLATION DILEMMAS,
WE THENnd WHAT WERE PHRASES
AND CONCEPTS DIFFICULT TO
TRANSPOLICE STATION THEN THIS
BECAME THE MATERIAL FOR EVALUATE
THEM DURING THE CULTURAL
CONSTRUCTS, QUALITATIVE
INTERVIEWS.
SO THIS BEING THE PRODUCT OF
THAT FIRST STEP.
SO THIS THEN LED TO THIS.
WHICH WAS NOW THAT WE KNEW WHAT
IT WAS WE NEEDED TO LOOK AT, WE
NEEDED TO OBTAIN PATIENT
ASSESSMENT OF QUALITY OF
AMBULATORY CARE VISITS BESIDES
THESE TRANSLATION DILEMMAS AND
ALSO THE INFORMATION WE BROUGHT
IN FROM OUR LITERATURE REVIEW
AND FROM OUR CONCEPTUAL MODEL.
SO THAT STEP INVOLVES CONDUCTING
40 CULTURAL CONSTRUCTS,
QUALITATIVE INTERVIEWS AND WE
INCREASED TO 20 PER LANGUAGE, OR
20-25 WITH ALL FOUR OF THE
LINGUISTIC GROUPS AND NOW WE ARE
BRINGING THOSE IDEAS INTO THE
INSTRUMENT.
AND THAT IS THEN GOING TO LEAD
TO CULTURAL ISSUES THAT ARE
OCCURRING IN QATAR THAT ARE
NEEDED FOR A QUALITY ASSESSMENT
INSTRUMENT.
THEN THE OTHER NIECE IS A
PRODUCT OF THAT STEP IS GETTING
PATIENT FEEDBACK ON THE
TRANSLATION DILEMMAS.
SO, YOU HAVE A GROUP OF
TRANSLATERS WHO SAY THESE ARE ç
THE THINGS WE ARE HAVING TROUBLE
WITH.
HOW WILL WE TRY TO CONVEY THESE
THINGS IRDU OR HINDY OR ARABIC?
SO YOU THEN GET FEEDBACK FROM
PATIENTS IN SAY, WHAT DOES IT
MEAN?
WHAT DOES ç A PERSONAL DOCTOR MEAN
TO YOU?
HOW WOULD YOU THREATS IDEA OF
THE DOCTOR THAT YOU GO SEE, WILL
YOU HAVE A COMMON PROBLEM?
NOT NECESSARILY AN EASY PROBLEM
BUT YOU HAVE A COMMON PROBLEM.
SAY LIKE DIABETES.
WHAT IS THE NAME OF THE DOCTOR
THAT YOU SEE ON A REGULAR BASIS.
AS YOU MAY OR MAY NOT BE
SURPRISED TO KNOW, THERE IS A
WHOLE VARIETY OF WAY THAT IS
PEOPLE TALK ABOUT THEIR DOCTOR
WITH SOME JUST SAYING, I GO SO
MY DOCTOR AND THEY DON'T REALLY
KNOWLEDGE ABOUT THE SUB
SPECIALIST OR THE SPECIALIST IN
THE WAY THAT WE CONCEPTUALIZE
IT.
SO THAT IS ONE OF OUR MOST
CHALLENGING PROBLEMS HOW TO
IDENTIFY THE DOCTOR THAT SOMEONE
SEES ON A REGULAR WAY.
FROM THIS, THEN, WE CAN THEN GO
TO OUR NEXT STEP WHICH WILL BE
ASSESS THE VALIDITY OF THESE NEW
ITEMS AND DEVELOPING A REVISED
CULTURALLY ADAPTED INSTRUMENT.
THAT WILL THEN INVOLVE TESTING
OF OUR INSTRUMENT THROUGH
COGNITIVE INTERVIEWS, MAKING
SURE PEOPLE UNDERSTAND THE
CONTENT THAT IS THERE AS WE
INTEND TODAY TO BE.
AND DOING IT IN ALL OF THE
LANGUAGES AND THAT'S ALL LAID
OUT HERE IN THIS STEP.
SO SOMEONE CAN SEE IT SORT OF AT
A GLANCE.
AND THEN WE FINALLY COME UP WITH
A CULTURAL AND LINGUISTICALLY
ADAPTED PRELIMINARY TEST BECAUSE
THEN WE NEED TO GO THROUGH AND
DO OUR VALIDATION STUDIES AND
THAT'S WHAT THE FOURTH STEP S
YOU CAN SEE HOW LINE BYLINE WE
ARE SAYING WHAT IS THE STEP?
WHAT ARE THE PROCEDURES WE'RE
GOING TO BE USE SOMETHING HOW
MANY PEOPLE ARE GOING TO BE
INVOLVED SIMILAR THE DETAILS?
AND WHAT IS THE PRODUCT GOING TO
BE FROM THAT?
SO I WON'T GO FURTHER GIVEN
THE --
WHERE WE ARE AT.
BUT I THINK YOU CAN SEE HOW THE
MATRIX THEN SHOWS YOU HOW YOU
CAN GO THROUGH AND REALLY
DISPLAY ALL OF THESE PROCEDURE
THAT IS ARE INVOLVED, DISPLAY
HOW YOU'RE USING QUALITATIVE
DATA AND HOW YOU'RE USING
QUANTITATIVE DATA AND WHAT SORT
OF SPECIFIC OUTCOME YOU'RE GOING
TO GET FROM THAT?
THESE PROJECTS ARE REALLY HARD
TO CONVEY TO IRBs N A TRIAL,
YOU SAY HOW MANY PEOPLE ARE YOU
GOING TO EN SNOW WE'LL ENROLL
600 PEOPLE AND THESE ARE
INCLUSION CRITERIA AND THESE ARE
EXCLUSION CRITERIA.
THESE ARE PROJECTS THAT HAVE 4
AND 5 STEPS T MAY CHANGE FROM
STEP TO STEP.
WITH A QUALITATIVE STUDY, YOU
CAN'T DICTATE NECESSARILY HOW
MANY SUBJECTS YOU'RE GOING TO
NEED UPFRONT.
AND SO, PUTTING ALL OF THIS INTO
ONE TABLE, YOU CAN GO THROUGH
AND EVEN FOR YOUR YOURSELF ADD
UP SOME OF THE FRUSTRATION I
HAVE HAD IN SITTING ON REVIEW
PANELS IS, YOU'RE READING
THROUGH THE TEXT AND FINDING
SOMETHING THAT SEEMS TO
CONTRADICT SOMETHING YOU'RE
SEEING SOMEWHERE ELSE AND
NUMBERS AREN'T ALL ADDING UP.
SO, WE ACTUALLY IN THE MOST
RECENT PROPOSAL WE WROTE, I
SAID, WE ARE NOT GOING TO WRITE
ANY TEXT UNTIL WE PUT IT IN A
TABLE AND DECIDE WHAT WE ARE
DOING.
WE ALL GOT TO BE ON THE SAME
PAGE, MAKE SURE WE ARE ALL
AGREEING ON WHAT IT IS WE ARE
DOING, OTHERWISE YOU ARE REALLY
SPINNING YOUR WHEELS DIVIDE UP
WHO IS WRITING WHAT PARTS.
AND SOMEONE CHANGES THE NUMBER
THAT THEY ARE WORKING ON.
LIKE NO, THIS IS OUR BLUEPRINT
FOREVER HOW WE ARE GOING TO WORK
ON THIS PROJECT SO THAT
EVERYBODY CAN REALLY SEE THIS IS
WHERE WE ARE GOING THINGS.
AND IT'S A PRACTICAL TIP SORT OF֜
THING FOR OUR IRB SECTION, THE
HUMAN SUBJECT SECTION, BOTH OF
THE PROPOSALS BUT ALSO IN OUR
IRB APPLICATIONS TO OUR
INSTITUTIONS, WE ARE DIVIDING UP
INTO THESE STEPS AND SAYING,
SPECIFICALLY, THIS IS THE NUMBER
OF ç HUMAN SUBJECTS IN THIS STEP.
AND THIS IS THE INCLUSION AND
EXCLUSION CRY YEAR BESIDES
GENDER OR WHATEVER OTHER
CRITERIA YOU'RE USING.
SO REALLY HELPS TO SEGMENT THE
DIFFERENT SECTION BECAUSE
ULTIMATELY, THE FINAL
APPLICATION IS, HOW MANY
SECRETARIES ARE YOU ENROLL
SOMETHING HOW MANY MEN AND
WOMEN --
HOW MANY SUBJECTS.
WHAT IS YOUR DISTRIBUTION OF
UNDER REPRESENTED MINORITIES AND
GROUPS?
SO IF YOU'RE NOT USED TO THESE
KINDS OF STUDIES AS A REVIEWER,
IT CAN BE VERY OVERWOMENNING AND
SO WE WANT TO MAKE OUR STUDY
PALATABLE TO THE REVIEWERS SO
THAT THEY CAN REALLY LOOK AND
SEE IF THEY ARE REEDING
ASPECTION SAYING, I DON'T
UNDERSTAND WHAT GOING TO HERE.
WE DON'T HAVE ALL THE TEXT HERE
OBVIOUSLY IN A GRID LIKE THIS
BUT YOU DO HAVE THE ESSENTIAL
ELEMENTS OF HOW MANY INTERVIEWS
ARE BEING DONE AND WHAT IS THE
PURPOSE OF DOING THOSE
INTERVIEWS?
WHAT IS THAT GOING TO LEAD TO IN
TERMS OF ANOTHER STEP?
AND I READ SOMEWHERE THAT THERE
WERE GOING TO BE 10 BUT NOW
YOU'RE TELLING ME THERE IS 40.
YOU CAN GO SMEAR SAY FOR
COGNITIVE TESTING, MAYBE YOU
ONLY 1910 INTERVIEWS AND THAT'S
FINE DOES. THAT HELP?
[OFF MIC]
>> THAT'S A REALLY GREAT
QUESTION.
SPELL DOING CROSS-CULTURAL WORK.
SO FOR EXAMPLE, IN AWE STUDY
HERE YOU MIGHT WANT TO DO A
GROUP INTERVIEW OR FOCUS GROUP
INTERVIEW.
IT MIGHT BE YOUR CHOICE.
YOU REALLY DON'T KNOW HOW MANY
OTHER CULTURES WOULD REACT TO
BEING IN A SETTING WITH OTHERS
AND EXPRESSING THEIR OPINION.
SOME OF THE ASSUMPTION THAT IS
GO INTO A GOOD QUALITY FOCUS
GROUP, A GROUP INTERVIEW, ARE
THAT THIS IS JUST DON'T
NECESSARILY KNOW EACH OTHER OR
THEY DON'T KNOW EACH OTHER AND
BUT THERE IS SOME COMMON
DEMOGRAPHICS SO THEY CAN SEE AND
RELATE AND THEY WILL RESPOND TO
AN ISSUE.
WE DON'T KNOW HOW THAT PLAYS OUT
IN SOME EXPERIENCE.
PEOPLE WERE LOOKING TO SEE WHO
WAS THE SENIOR MOST PERSON?
WHO WAS THE PERSON WHO HAD THE
HIGHEST STATUS?
AND THEN, TO SOME EXTENT,
DEFERRING TO THEIR OPINIONS
ABOUT THINGS.
AND SO, WHAT MIGHT BE CONSTRUED
AS AN APPROPRIATE METHODOLOGY OF
ONE CULTURE CAN BE NOT VERY GOOD
IN ANOTHER CULTURE OR NOT PROVEN
SO MAYBE HOW MUCH CAN YOU ASSUME
THAT'S GOING TO TRANSLATE ACROSS
CULTURAL BOUNDARIES.
THAT IS JUST ONE FACET OF YOUR
QUESTION.
A WHOLE OTHER REQUEST IS, HOW
MUCH WOULD PEOPLE BE WILLING TO
DISCLOSE A GROUP AS OPPOSED TO
AN INDIVIDUAL INTERVIEW.
WHEN YOU'RE TALKING ABOUT SOME
VERY SENSITIVE TOPICS, SAY,
DOMESTIC VIOLENCE, THAT'S A
TOPIC OF INTEREST, WOULD WOMEN
FEEL MORE EMPOWERED TO BE
TALKING IN A GROUP SETTING?
OR WOULD ç THEY FEEL MORE EM FORD
SPEAK IN A PRIVATE SETTING?
THESE KINDS OF THINGS MAY WEIGH
IN TO AND SHOULD WEIGH INTO
WHICH SPECIFIC METHODS YOU'RE
USING.
AND ALSO YOU MAY COME TO ç THE
CONCLUSION THAT ONE METH ALONE
DOESN'T SUFFICE.
SO FOR EXAMPLE, IN THE THIRD
PROJECT IN WHICH WE ARE
EVALUATING THE PROCESS, IT'S
VERY FUNNY BECAUSE I TOLD THE P.
THEY WE WERE GOING TO MAKE
OBSERVATIONS AND I SAID, YOU
NEED TO DO THIS, YOU NEED TO
OBSERVE WHAT IS GOING ON BECAUSE
YOU NEVER KNOW WHAT IS TO
HAPPEN.
THE FIRE ALARM MIGHT GO OFF.
LOW AND BEHOLD, AND I DIDN'T DO
THIS.
I SWEAR I DID NOT.
THE FIRE ALARM WENT OFF IN THE
MIDDLE OF THE MEETING.
AND IT WAS AMAZING BECAUSE WHAT
HAD BEEN A RELATIVELY LONG
TRADITIONAL KIND OF PRESENTATION
WHICH IS, PEOPLE TALKING SORT OF
ONE BY ONE GOING THROUGH STEPS,
AND PEOPLE LISTENING VERY
INTENTLY WITH THE FIRE ALARM,
EVERYBODY HAD TO GO OUTSIDE THE
HOTEL.
WE WERE TRUDGING ALONG AS
OBSERVERS.
YOU WOULDN'T BELIEVE THE
CONVERSATION THAT IS WERE GOING
ON.
EVERYBODY HAD SO MUCH SAY.
BUT THE FORUM WASN'T REALLY
ACCOMMODATING THAT.
SO IF WE HAD JUST TAKEN THE
TRANSCRIPT OF THE PRESENTATION,
OR WE JUST USED THE INFORMATION
FROM THE INSTRUMENTS THAT PEOPLE
FILLED OUT, WE WOULDN'T HAVE HAD
A MECHANISM TO RECORD THIS
FRENZY OF CONVERSATION THAT
HAPPENED BECAUSE THE FIRE ALARM
WENT OFF.
AND THE PI CAME OUT AND SAID,
THAT WAS GREAT!
DID YOU SEE THE FIRE ALARM WENT
OFF?
YOU SAID IT WAS GOING TO HAPPEN!
IT WAS JUST --
YOU KNOW, THESE THINGS HAPPEN.
THINGS YOU CAN NOT ANTICIPATE
WILL HAPPEN THAT DO.
WE ALSO LOOKED AT A SEATING
CONFIGURATION SEE WHERE PEOPLE
WERE MOVING AND WHAT SORT OF
MINICONVERSATIONS WERE
DEVELOPING DURING BREAKS BECAUSE
WHEN IT HIT BREAK, CERTAIN
GROUPS FORMED TO TALK ABOUT --
DISCUSSING WHATEVER THEY WERE
INTERESTED IN.
IT WAS INTERESTING TO SEE SO IS
LOGICALLY WHICH GROUPS WERE
FORMING TOGETHER --
SOCIOLOGICALLY --
THE SHREW THINKING ABOUT WHAT
SORTS OF QUALITATIVE DATA OR
QUANTITATIVE DATA HOLDS BOTH
WAYS, WHAT SORTS OF MECHANISMS
DO YOU HAVE FOR COLLECTING DATA?
SO IS THIS A NIECE YOU SPEND A
LOT OF TIME IN AND WORKSHOPS WE
DO TO SAY FIRST OF ALL, WHAT ARE
THE SOURCES OF DATA THAT ARE
ACCESSIBLE TO YOU?
AND THEN, IN WHAT WHAT WAY WOULD
THOSE DATA INFORM YOUR
UNDERSTANDING OF WHATEVER
PHENOMENA THAT YOU'RE INTERESTED
IN LOOKING AT?
AND SO, FOR EXAMPLE, THE
OBSERVATIONS ARE GOING TO GIVE
US THINGS THAT WE WOULDN'T HAVE
OTHERWISE KNOWN.
SO, ONE OF THE THINGS I DID WHEN
I WAS A GRADUATE STUDENT, I WAS
TRYING TO LEARN ABOUT AS MANY OF
THE METHODOLOGIES AS I COULD.
AND I REMEMBER CONSCIOUSLY
MAKING AN EFFORT ARE.
I WAS NAIVE.
I WANTED TO USE EVERY DATE
COLLECTION STRATEGY WHILE I'M A
FELLOW.
IT'S A NAIVE THOUGHT AT THE
TIME.
BUT IF YOU WANT TO DO
MULTIMETHOD OR MIXED METHOD
RESEARCH, THE MORE EXPOSURE YOU
CAN GET WHEN YOU'RE STILL IN A
RELATIVELY JUNIOR STAT US AND
CAN GO TO DIFFERENT MENTORS AND
TRY DIFFERENT THINGS AND IT IS
STILL SAFE TOzV FAIL, AND IT'S NOT
AS HIGH-STAKES, I THINK IT'S A
GREAT TIME TO EXPERIMENT.
THAT WOULD BE MY VIEW.
I SUPPOSE SOME SAY YOU NEED STAY
ON THE CLOCK AND ç MAKE SURE YOU
GETS BY SUCH AND SUCH A 78
FINISH THIS UP AND I'M NOT SURE
HOW MUCH FLEXIBILITY AND SUCH
THERE IS FOR SOMEONE AS JUNIOR
IN TRAINING NOW.
BUT FOR ME, IT WAS FIRST OF ALL
REALLY FUN.
IT WAS SO MUCH FUN TRYING
DIFFERENT THINGS USING DIFFERENT
METHOLOGY SPEC WORKING WITH
DIFFERENT POPULATIONS.
IT WAS A BLAST.
IT IS A LONG-WINDED ANSWER.
ABSOLUTELY.
THINK IT'S LARD TO DO.
REALLY GOOD COMMUNITY-BASED
PARTICIPATORY RESEARCH WITHOUT
SOME ELEMENT OF MIXED METHODS.
IEST MICHIGAN IS FORT NOT HAVE
JUST OUTSTANDING CLASS OF
GENERAL SCHOLARS THROUGH THE
ROBERT WOOD JOHNSON FOUNDATION
IS THERE A REAL EMPHASIS ON
COMMUNITY-BASED PARANTICIPATORY
RESEARCH PROJECTS.
AND IT SEEMS LIKE I DON'T HAVE
EXACT NUMBERS BUT IT SEEMS LIKE
VIRTUALLY EVERYONE IS INVOLVED
OR ENGAGED AT SOME LEVEL IN
EMPLOYING MIXED METHOD STUDIES.
AGAIN, BECAUSE IT GOES BACK TO A
VERY COMPLEXIZATION YOU'RE
TRYING TO DO SNAG WILL BE
MEANINGFUL.
YOU NEED TO UNDERSTAND WHAT THE
STAKEHOLDERS VIEWS ARE AND IN
SOME WAYS IT MIGHT BE BETTER
COLLECTING SOME SORT OF
QUANTITATIVE DATA JOUST SAY
WHERE ARE THEY STARTING SNAT
THROUGH AN INTERVIEW PROCESS YOU
MAY BE ABLE TO FIND OUT THEIR
CONCERNS OR WORRIES ARE OR MAYBE
TO UNDERSTAND WHAT THEIR
UNDERSTANDING OF AN ISSUE IS BUT
WHERE THEY REALLY STAND AND HOW
MIGHT YOU COMPARE TO OTHERS.
OR, THERE IS LOTS OF DIFFERENT
EXAMPLES.
I FIND IT HARD --
FOR ME, THE PROJECTS THAT I DO
IN HEALTH SCIENCES AND THE
BEHAVIORALLY-BASED PROJECTS,
IT'S HARD FOR ME TO IMAGINE ANY
PROJECT THAT COULD BE DONE
REALLY WELL WITH JUST ONE METHOD
ALONE.
ONE ISSUE THAT ALWAYS COMES UP
OF COURSE IS WHAT IS THE
FEASIBILITY IN TERMS OF FUNDING?
THEY ARE EXPENSIVE.
AND SPELL QUALITATIVE RESEARCH,
IT'S VERY INTENSE.
I KEEP N-TERMS OF WRITING
PROPOSALS, I'M THINKING, BECAUSE
OUR GRANTS ADMINISTRATOR SAYS
HOW MUCH TIME DO YOU NEED?
MY QUESTION RECENTLY HAS BEEN,
HOW MUCH TIME ARE WE PUTTING ON
FOR THE BIOSTAT PERSON AND
MULTIPLYING IT BETWEEN 3 AND 4?
THEY THINK MAY NOT BE ENOUGH.
JUST BECAUSE THE WHOLE PROCESS
OF GOING THROUGH THE DATA IS SO
LONG, IT IS JUST A LOT OF WORK.
SO, SOME OF THE ISSUE THAT IS
COME BACK, ALL RIGHT, WHICH
METHODOLOGIES ARE YOU GOING TO
USE?
WHICH QUANTITATE AND I HAVE
QUALITATIVE METHODS?
IT'S GOING TO COME BACK TO WHAT
IS FEASIBLE.
NOT JUST, WE COULD COLLECT THIS
INFORMATION.
THAT WOULD BE GREAT.
ARE YOU GOING TO BE ABLE TO PAY
TO HAVE THAT WORK DONE?
ARE YOU GOING TO HAVE THE MONEY
TO ANALYZE THE DATA WHEN IT
COMES BACK IN?
BUT I KIND OF WENT ON A LONG
COURSE THERE.
BUT I THINK YOU'RE DEALING WITH
LOTS OF DIFFERENT CULTURAL
ISSUES, MAYBE CROSS-CULTURAL
ISSUES.
MAYBE WITHIN OUR OWN DOMINANT
CULTURE, MAYBE MULTILINGUAL.
I JUST CAN'T IMAGINE DOING A
SOPHISTICATED PROJECT WHEN YOU
DON'T HAVE SOME COMPONENT OF
MIXED METHODS.
BUT I'M VERYzV BIASED.
THANK YOU ALL VERY MUCH.
[APPLAUSE]
THANK YOU FOR HAVING ME.