Appraising and Incorporating Qualitative Research in Evidence-Based Practice

Journal of Physical Therapy Education, Winter 2004 by Henderson, Roberta, Rheault, Wendy

DECISION RULES

We suggest four Decision Rules for including qualitative research studies in EBP (Table 2). First, qualitative studies must satisfy assumptions for inclusion in EBP. Second, qualitative studies must meet screening criteria that are based on the definition and ethical principles of qualitative research. Third, the level of evidence for a study must be determined with the Rosalind Franklin-Qualitative Research Appraisal Instrument (RF-QRA), that assesses the four aspects of trustworthiness (credibility, transferability, dependability, confirmability) in Cuba's Model of Trustworthiness of Qualitative Research.1819 Finally, a grade of recommendation, based on the qualitative level of evidence, must be assigned considering the available evidence.

Decision 1: Assumptions

There are two assumptions for inclusion of a qualitative research study in EBP. The first assumption is that qualitative research study is peer reviewed, and the second is that the problem researched is important to the EBP question.

Decision 2: Qualitative Screens

Qualitative screens for inclusion of qualitative studies in EBP require that the research involves observation of social or human problems in the natural setting and interprets observations. Simply describing or reporting is not sufficient. Furthermore, the research should tie observed phenomena to understanding, explanation, or development of theory, and must adhere to ethical principles including risk/benefit analysis and privacy.

Decision 3: Levels of Evidence

The qualitative levels of evidence resemble Sackett's five levels (Table 2); however, they are defined using Cuba's four aspects of trustworthiness of qualitative research. A Level I study would demonstrate an affirmative response to all four aspects without any relevant problems, while a Level II study demonstrates affirmative responses in three aspects and relevant problem (s) in one aspect, and so on, to Level V studies, which demonstrate relevant problems in all of Cuba's four aspects.

Decision 4: Grades of Recommendation

Grades of recommendation are as stated by Sackett (Table 2), but are based on the qualitative levels of evidence as defined by the RF-QRA. Grade A recommendations are made for outcomes supported by at least one, and preferably more than one, Level I study. Grade B recommendations are made for outcomes supported by at least one Level II study, and Grade C recommendations are supported by Level III, IV, or V studies.

ROSALIND FRANKLIN-QUALITATIVE RESEARCH APPRAISAL INSTRUMENT

The Rosalind Franklin Qualitative Research Appraisal Instrument (RF-QRA) (Table 3) was based upon Cuba's Model18 and assesses the "trustworthiness" of qualitative data. It translates rigor of a qualitative study to a categorical ranking of level of evidence. Cuba's four aspects of trustworthiness are listed and described below; the equivalent concept for quantitative research follows in parentheses.

* Credibility (Internal Validity)

* Transferability (External Validity)

* Dependability (Reliability)