The use of qualitative methods to inform program development and assure that interventions are understood and well received by their intended audiences is considered an important component of behavioral intervention research supported by the National Institutes of Health (NIH). In the last decade, we have seen growing recognition that in order for interventions to be successful, they must be relevant to the individuals and communities they are intended to benefit. All too often, the best laid plans for improving public health have failed because of ill-informed assumptions by researchers about the values and priorities of the target population. Qualitative strategies have gained momentum with researchers as a critical step in developing effective interventions by providing a more in-depth understanding of the complex socio-cultural context in which health and disease occur.
In 2001, the Office of Behavioral and Social Sciences Research published a document, Qualitative Methods in Health, to assist investigators using qualitative methods with submitting competitive applications for support from NIH (see http://obssr.od.nih.gov/publications/archives/archives.aspx). These methods have become widely used in the formative phase of behavioral intervention studies. As evidence of their increased acceptance, NIH has issued Funding Opportunity Announcements (FOAs) for behavioral research that specify qualitative research methods as an appropriate approach, including more than two dozen FOAs in the past decade for Community-Based Participatory Research alone (see http://obssr.od.nih.gov/scientific_areas/methodology/community_based_participatory_research/index.aspx).
The article by Ayala and Elder provides a basic introduction to the use of qualitative methods, specifically for assessing the acceptability of health interventions to the target population. Not explicitly stated in the article, but important to consider, is the fact that qualitative methods can be used alone or together with quantitative methods to investigate behavioral and social phenomena in all phases of health research (e.g., from theory development to evaluation and dissemination of interventions). An emerging trend in health intervention research incorporates the use of mixed methods, that is, research in which the investigator integrates qualitative research and quantitative research in a single study (1). In a review of funding trends for health-based mixed methods, Plano Clark(2) shows an increase in funding for mixed methods studies by NIH and other US agencies. This is encouraging, given the potential of mixed methods for providing insights about health and illness that go beyond what either quantitative or qualitative research approaches can accomplish separately.
I think it is worth echoing Ayala and Elder's encouragement to investigators new to qualitative or mixed methods research to seek out collaborations with experts in the methodology who understand the nuances of data collection and analysis. Different research questions warrant different methodological approaches – each with their own strengths and limitations. Understanding and appropriate application of these methods is a critical step to successful development of interventions that are able to effectively address the most pressing health problems.