Quality enhancement groups: Integration of qualitative and quantitative methods in survey research of chronic disease

Although the debate surrounding the superiority of qualitative and quantitative research paradigms continues, integrating qualitative and quantitative methodologies to investigate chronic disease has become more common. A myriad of techniques exist to qualitatively develop and improve survey instruments; however, each process has unique advantages and shortcomings. Qualitative methods frequently utilize structured one-on-one or group settings to first develop survey instruments and then incorporate new participants to critique drafted measures. The purposes of this presentation are to 1) compare and contrast the similarities/differences and benefits/limitations associated with qualitative methods used to create survey instruments, 2) introduce quality enhancement groups (QEG) as methods to enhance survey instrument development, and 3) quantify the effectiveness of conducting QEG between pilot studies and grand-scale survey implementations. A survey instrument to assess risk for chronic disease was developed from a literature review, expert consensus, and focus group. After pilot-testing the instrument, a QEG was conducted with members from the initial focus group. Following predetermined QEG protocol, participant contributions resulted in substantial modifications to the survey instrument. The protocol and group dynamic created by QEG enabled participants to receive probes from the instrument, investigators, and one another. QEG members identified areas for improvement by citing ambiguous, incomplete, unclear, and non-applicable instrument items. The final instrument included the alteration of response options, elimination of an entire instrument section, and addition of two instrument scales. Psychometric property testing of data collected with the original and modified instrument scales revealed the effectiveness of QEG in chronic disease research.