Expert Answer:Multicultural Management Discussion

  

Solved by verified expert:To prepare for this Assignment, identify a research topic for your Final Paper. Choose from any of the following:
An idea from the general topics in Week 2, 4, or 6
The topic of your own Doctoral Study (if it concerns multicultural management)
The topic of your own Presentation
Gaps in the literature identified by you or your colleagues during the Discussions in Weeks 2, 4, or 6
A topic from any of the readings from Weeks 2, 4, or 6An 8- to 12-page evaluation (excluding title page and References section) of your research on multicultural management. In your evaluation, be sure to address the following: Analysis of the Field
What is your analysis of the state of the field of multicultural management? Describe important issues or current dilemmas in the field.
Research Topic
State and provide background information for your research topic.
What are the current theories and areas of debate for your topic?
Are there particular industries or technologies that will be impacted by your topic? If this impact is positive, how can it be maximized, and if negative, how can this impact be mitigated?
Future DirectionsAs a global change agent, consider the future directions of multicultural management to address the following:
Indicate specific areas of further research in this topic that would prove beneficial.
What potential impact might the topic that you have chosen have on the overall state of the field and the future directions of multicultural management research in the next 3–5 years?
What processes and strategies would you recommend that leaders in organizations employ to institute effective multicultural programs?
Use the APA Course Paper Template, Your paper should include the following headings: Analysis of the Field, Research Topic, and Future Directions. Please Note: For each page of your paper, you must include a minimum of two APA-formatted scholarly citations.
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Article
Pretesting Qualitative Data Collection Procedures to Facilitate Methodological Adherence
and Team Building in Nigeria
Samantha Hurst, PhD, MA
Department of Family and Preventive Medicine
University of California, San Diego, La Jolla, California, USA
Oyedunni S. Arulogun, PhD, MPH
Department of Health Promotion and Education
University of Ibadan, Ibadan, Nigeria
Mayowa O. Owolabi, MBBS, MSc, DM, FMCP
Department of Medicine
University of Ibadan, Ibadan, Nigeria
Rufus Akinyemi, MBBS, MSc, MWACP, FMCP
Department of Medicine
Federal Medical Center, Abeokuta, Nigeria
Ezinne Uvere, MPH
Department of Medicine
University of Ibadan, Ibadan, Nigeria
Stephanie Warth, BS
Department of Neurology and Neurosurgery
Medical University of South Carolina, Charleston, South Carolina, USA
Bruce Ovbiagele, MD, MSc, MAS
Department of Neurology and Neurosurgery
Medical University of South Carolina, Charleston, South Carolina, USA
© 2015 Hurst, Arulogun, Owolabi, Akinyemi, Uvere, Warth, and Ovbiagele. This is an Open Access article
distributed under the terms of the Creative Commons‐Attribution-NonCommercial-ShareAlike License 4.0
International (http://creativecommons.org/licenses/by-nc-sa/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly attributed, not used for commercial purposes,
and if transformed, the resulting work is redistributed under the same or similar license to this one.
53
Abstract
Qualitative methods are becoming widely used and increasingly accepted in biomedical
research involving teams formed by experts from developing and developed practice
environments. Resources are rare in offering guidance on how to surmount challenges of
team integration and resolution of complicated logistical issues in a global setting. In this
article we present a critical reflection of lessons learned and necessary steps taken to achieve
methodological coherence and international team synergy. A series of 10 pretest interviews
were conducted to assess instrumentation rigor and formulate measures to address any
limitations or threats to bias and management procedures before carrying out the formal
phase of qualitative research, contributing to an evidence-based stroke-preventive care
clinical trial study. The experience of pretesting notably helped to identify obstacles and thus
increase the methodological and social reliability central to conducting credible qualitative
research, while also ensuring both personal and professional fulfillment of our team
members.
Keywords: qualitative methods, team-based qualitative research, pretesting, instrumentation,
low- and middle-income countries
Author’s note: This research was supported by National Institute of Neurological Disorders
and Stroke (NINDS) – Award Number U01 NS079179
54
International Journal of Qualitative Methods 2015, 14
Team-based qualitative research has become increasingly common in multidisciplinary
collaborations for global biomedical research between developed and developing countries. In
contrast to the traditional use of qualitative research as an independent scholarly endeavor, the
approach of team-based qualitative research involves project designs with multiple collaborators,
complex protocols, and often complicated logistical issues affecting performance. Thus, working
as a team in a globalized setting is not without certain challenges stemming from differences in
personal backgrounds, theoretical and methodological expertise, and data collection that must be
coordinated over large geographical distances. But there are also benefits, which include
integrated study designs that strengthen health-care research capacity through cooperative
learning, shared practices, and the promotion of policy-relevant research so critically needed in
developing countries.
Despite the numerous articles and books published about conducting qualitative research, there
are limited resources outside of Guest and MacQueen’s (2008) seminal Handbook for TeamBased Qualitative Research to provide guidance for international researchers to achieve
methodological and social reliability in their work. This article is intended to add to the literature
by providing a critical reflection of “lessons learned” and practical challenges faced in conducting
international team-based qualitative research in Africa. Our purpose in this manuscript is
essentially threefold. First, we begin with a discussion on the overall strategy and practical
application of pretesting that led to modifications for facilitating the cultural and methodological
validation of data collection materials. Second, we describe the manualized training procedures
developed for instruction on qualitative research skills that were practiced in pretest trials and
revisited again prior to the main study to reinforce knowledge learned. Third, we consider the
potential benefits of practice-based training and the use of pretesting as a framework for
enhancing team dynamics. Taken collectively, all three aims resulted in an effective and reflexive
instructional strategy that was useful to forming a positive and cohesive team vision of the project
and building upon each other’s complementary knowledge and skills to establish quality
assurance for data collection and management in Phase 1 of our study. The article begins with a
brief background of our project to present the context for this discussion.
The Research Context
The ultimate aim of our formal project is to examine the impact of a tailored intervention for
reducing blood pressure in a cohort of stroke survivors in southwest Nigeria. The
conceptualization of this study evolved as a proposal for innovative research collaboration
between low- and middle- and high-income countries to address the burden of chronic
hypertension. The project design of our clinical trial focuses on evaluation of the delivery of
sustainable, effective treatment and self-care management using a patient report card, mobile
phone text messaging, and video education as features of the intervention. The first stage of the
study research design (Phase 1) used a qualitative approach, employing focus groups and
individual interviews to obtain information from stroke patients, caregivers, health-care
professionals, and hospital administrators regarding their knowledge of barriers and facilitators of
adherence to recommended guidelines for vascular risk reduction after stroke. In addition, the
interviews collected information to improve the feasibility and adaptation of the intervention for
implementation in Phase 2 of the project. It is significant to note that there are extremely few
studies that have explored patient and caregiver views in developing secondary stroke prevention
tools, and no published studies we are aware of that have incorporated the views and
recommendations of stroke patients in sub-Saharan Africa into the crafting of a tool to promote
treatment adherence.
The main study draws from four field hospital or clinical sites in southwest Nigeria. Two of the
sites are located in Ibadan, which is the capital city of the Oyo State and until 1970 was the
largest city in sub-Saharan Africa (Lloyd, Mabogunie, & Awe, 1967). The other two sites are
55
International Journal of Qualitative Methods 2015, 14
located in Abeokuta, the largest city and capital of Ogun State and approximately 78 kilometers
southwest of Ibadan. A 2-hour journey is required to reach the hospital and clinic facilities
between the two main research locations. Institutional oversight for the qualitative study of
human subjects was secured by each of the co-principal investigators both in Nigeria and the US.
Further ethical approval was obtained via the Ministry of Health in the Oyo State, Nigeria for
conducting a series of practice pretest interviews used in preparation for Phase 1 of the project.
For the purpose of pretesting data collection materials, two pretest trials of multiple interviews
were scheduled and conducted in Ibadan, but carried out at a separate state hospital facility to
avoid contamination of the sampling pool of subjects to be drawn for the intended clinical trial
study. A colleague from our research team in Nigeria trained staff from the University of Ibadan
to carry out interviews and manage the documentation of all data collection materials, which
included presentation of the informed consent, main interview script, demographic survey, and a
copy of the intervention patient report card. At the conclusion of the second pretest trial a
combined total of 10 pretest interviews were completed (three focus groups with patients, three
focus groups with caregivers, three interviews with health-care professionals, and one interview
with a hospital administrator). All focus group interviews were conducted in the Yoruba
language, and all individual interviews were carried out in English. In addition to the training for
standard data collection materials, interviewers were also instructed on writing and collecting raw
field notes of informal observations made for both the individual and focus group interviews.
Protocols for systematizing the translation and transcription of qualitative interviews and field
notes were also integrated into the pretest trials.
Pretesting Qualitative Data Collection Instruments
The practice of pretesting is highly regarded as an effective technique for improving validity in
qualitative data collection procedures and the interpretation of findings (Bowden, Fox-Rushby,
Nyandieka, & Wanjau, 2002; Brown, Lindenberger, & Bryant, 2008; Collins, 2003; Drennan,
2003; Foddy, 1998). Supported by the very nature of qualitative research as an iterative rather
than a linear process, the pretest interaction to self-correct between design and implementation
ensures the best opportunity for attaining reliability and rigor in qualitative inquiry and analysis
(Morse, Barrett, Mayan, Olson, & Spiers, 2002). By definition, pretesting involves simulating the
formal data collection process on a small scale to identify practical problems with regard to data
collection instruments, sessions, and methodology. The value of pretesting can lead to detecting
errors in cross-cultural language relevance and word ambiguity, as well as discovering possible
flaws in survey measurement variables. Pretesting can also provide advance warning about how
or why a main research project can fail by indicating where research protocols are not followed or
not feasible. A typical pretest in qualitative research involves administering the interview to a
group of individuals that have similar characteristics to the target study population, and in a
manner that replicates how the data collection session will be introduced and what type of study
materials will be administered (consent forms, demographic questionnaires, interviews, etc.) as
part of the process. Pretesting provides an opportunity to make revisions to study materials and
data collection procedures to ensure that appropriate questions are being asked and that questions
do not make respondents uncomfortable and/or confused because they combine two or more
important issues in a single question. It is vital that pretests be conducted systematically and
include practice for all personnel who will be engaged in data collection procedures for the
eventual main study.
Depending on the type of qualitative interview employed in a study, there are different roles and
tasks to be performed. For example, focus group discussions may require a moderator and a
notetaker, given the often loose and free-flowing dialogue that is challenging to direct and fully
observe. In contrast, an individual in-depth interview places a greater burden on the participants
to explain themselves to only one interviewer. In either case, the validity of the qualitative data
56
International Journal of Qualitative Methods 2015, 14
rests solely on the ability of the moderator/interviewer to produce focused amounts of data on
precisely the topic of interest within a reasonably tolerated period of discussion time. If problems
arise in the pretest interview, it is expected that similar challenges will arise in the administration
of interviews during the formal study. Projects that neglect pretesting run the risk of later
collecting invalid and incomplete data. But, completing a pretest successfully is not a guarantee
of the success of the formal data collection for the study. Although qualitative pretest findings
may offer some indication of the response patterns anticipated in the final data collection phase,
they cannot guarantee this given the lack of theoretical saturation and variation of data collected
in a pretest in comparison to recruitment projections for the design of a main study (Bowen,
2008).
The specific areas assessed during the pretests are outlined by the following categories listed
below. Some criteria were added to the final selection as a result of the outcomes and transition
from Pretest 1 to Pretest 2. The following are the main selection criteria used for review to assess
the rigor and relevance of our instruments and procedures:




Evaluating language competency and content validity of data collection materials.
Estimating time length of full interview delivery and marking periods of respondent
fatigue.
Maximizing methodological skills and achieving proficiency standards for qualitative
data collection.
Assessing the feasibility and fidelity of translation and transcription protocols in
preparation of the interview text for qualitative analysis.
Evaluating Language Competency and Content Validity of Data Collection Materials
Communication competence in the translation between two languages involves both linguistic
discourse, as well as sociolinguistic competence (Lindlof & Taylor, 2010). Sociolinguistic
competence includes the way language is used in context, including cultural norms and
expectation of words or phrases, which can greatly affect how accurately research participants are
interpreting and responding to interview questions. It has been stated many times that a study is
only as good as the data that is collected. This is especially critical in qualitative research where
the aim is to capture an in-depth comprehension of participants’ beliefs, emotions, perceptions,
and experiences.
One of the first practical considerations needing attention was the cultural relevance and
translation accuracy of our data collection materials, all of which were originally created by one
of our co-principal investigators for a U.S. study of Spanish-speaking elderly stroke patients. Our
Nigerian researchers reviewed all individual interviews with various health-care professionals and
hospital administrators for English clarity, which is also the primary language of Nigeria. They
also translated focus group scripts into Yoruba to support the common language spoken at home
by the majority of our patients and caregivers. Even when diverse cultures share a common
language, the local mind-set of each culture enables different ways of thinking and different ways
of naming and interpreting objects, causes, and events in their environment. Thus, the first pretest
was designed to determine if respondents interpreted the research questions with the same
connotative meaning as was intended in the original research. Equally important was the need to
resolve how best to stage the wording of a question if the range of responses from pretest
participants was highly variable and seemed to suggest a lack of conceptual equivalence.
A preliminary site visit was scheduled at the conclusion of the first pretest trial to provide for a
qualitative team review of pretest data collection efforts and to begin integrating team
relationships at the research site. The visit was also an excellent opportunity to familiarize the
visiting U.S. investigator with first-hand exposure to local Nigerian culture, the context of clinic
and hospital facilities, and locations where study activities would take place. Reviewing the
57
International Journal of Qualitative Methods 2015, 14
pretest interviews additionally presented a means for the U.S. investigator to assess skill levels or
experience gaps in the local Nigerian team interviewers who had carried out the pretest
interviews. The site visit also presented the opportunity for determining ways to unify and
strengthen the knowledge of our entire qualitative team before official data collection began.
Confirmation of our initial concerns relating to the cultural relevance of our interview topics
emerged in the responses of health-care professionals and hospital administrators in which they
were asked their opinion about utilizing a nurse practitioner for stroke care coordination.
Although Nurse Practitioners (NP) have been delivering primary care for nearly fifty years in the
United States (Landau, 2011), in Africa the NP movement is barely gaining ground. As it
happened, the question has little social or medical relevance to the current Nigerian nursing
profession. Rather than delete the question, our team determined to reconstruct the wording to
focus on current expectations of nurses in Nigeria and the extent to which healthcare
professionals and hospital administrators would be in support of general nurses taking on greater
responsibility in stroke care coordination. This new question was presented in the second pretest
trial, and substantive feedback was obtained to endorse the new version of the question for use in
the Phase 1 interviews.
Another question, directed to all interview participants asked about the importance of a “group
clinic” for stroke survivors. In this instance again, the westernized concept of the function of a
group clinic is not operationalized in our Nigerian study locations. In responding to the question,
caregivers and patients confused the notion of group clinic with the concept of support groups.
During both the first and second pretest trials, the patients and caregivers were unanimous in their
interest in support groups, but continued to misinterpret the activity as one that would bring them
increased contact and communication with their physicians. Much of the persistent
misunderstanding of this question was also intensified by the confusion of our Nigerian
interviewers over the semantic differences between these terms. In this case, both participants and
our Nigerian researchers were drawing upon a tacit knowledge of culture in Nigeria and these
items did not fit in their frame of reference. Once we identified the challenge, we directly sought
counsel with our co-principal investigators to explore the intended meaning of the terms, as well
as the relevance of the question to our research goals. This incident also encouraged the
qualitative team leaders to update training objectives and consider additional and more didactic
means of maximizing skills and knowledge for interviewers prior to conducting the main study
interviews.
Although there are straightforward qualitative techniques available to assist investigators in
evaluating the content validity of interviews, it was not feasible for the research team to explore
these methods during pretest trials, or integrate them during the main Phase 1 interviews. The
major concern involved the burden of time already reflected in completing the entire set of data
collection materials during the pretest trials. One technique is known as concurrent think-aloud
interviews in which respondents literally think aloud when answering questions and responses are
probed. Although the process is fairly simple, it allows interviewers to clarify meaning, decode
idiomatic words, make personal connections, question the respondent for greater detail, and
summarize what has been said. The other approach is retrospective think-aloud interviews where
respondents are asked how they arrived at their answers (Campenelli …
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