Incident reports contain descriptions of errors and harms that occurred during clinical care delivery. Few observational studies have characterised incidents from general practice, and none of these have been from the England and Wales National Reporting and Learning System. This study aims to describe incidents reported from a general practice care setting. A general practice patient safety incident classification will be developed to characterise patient safety incidents. A weighted-random sample of 12 500 incidents describing no harm, low harm and moderate harm of patients, and all incidents describing severe harm and death of patients will be classified. Insights from exploratory descriptive statistics and thematic analysis will be combined to identify priority areas for future interventions. The need for ethical approval was waivered by the Aneurin Bevan University Health Board research risk review committee given the anonymised nature of data (ABHB R&D Ref number: SA/410/13). The authors will submit the results of the study to relevant journals and undertake national and international oral presentations to researchers, clinicians and policymakers.

Introduces and traces the history of the methodological paradigm wars and brings readers up to the state of affairs (albeit, 1998). Discuss the ‘warring’ positions and the evolution of thinking regarding pragmatism and the development of mixed methods approaches to social science research.

fter eras of “blaming” parents for their children’s disabilities and relying on biomedical labels as both correct and sufficient to explain and name various conditions, research and practice today recognize the significance of the meaning and understanding of disabilities held by family members and children themselves. What do teens with disabilities believe about their circumstances, and what do they understand to be the causes, correlates, and consequences of their conditions? Elicited explanatory models from adolescents with varied cognitive disabilities and delay to better understand their personal experiences

A Framework—the “agreement concept”—is developed to study the use of Cohen's kappa as well as alternative measures of chance-corrected agreement in a unified manner for qualitative and mixed methods research. Focusing on intrarater consistency it is demonstrated that for 2 × 2 tables an adequate choice between different measures of chance-corrected agreement can be made only if the characteristics of the observational setting are taken into account. In particular, a naive use of Cohen's kappa may lead to strinkingly overoptimistic estimates of chance-corrected agreement. Such bias can be overcome by more elaborate study designs that allow for an unrestricted estimation of the probabilities at issue. When Cohen's kappa is appropriately applied as a measure of chance-corrected agreement, its values prove to be a linear—and not a parabolic—function of true prevalence. It is further shown how the validity of ratings is influenced by lack of consistency. Depending on the design of a validity study, this may lead, on purely formal grounds, to prevalence-dependent estimates of sensitivity and specificity. Proposed formulas for “chance-corrected” validity indexes fail to adjust for this phenomenon. It is common practice to assess consistency of diagnostic ratings in terms of 'agreement beyond chance'. To explore the interpretation of such a term we consider relevant statistical techniques such as Cohen's kappa and log-linear models for agreement on nominal ratings. We relate these approaches to a special latent class concept that decomposes observed ratings into a class of systematically consistent and a class of fortuitous ratings. This decomposition provides a common framework in which the specific premises of Cohen's kappa and of log-linear models can be identified and put into perspective. As a result it is shown that Cohen's kappa may be an inadequate and biased index of chance-corrected agreement in studies of intra-observer as well as inter-observer consistency. We suggest a more critical use and interpretation of measures gauging observer reliability by the amount of agreement beyond chance.

After eras of “blaming” parents for their children’s disabilities and relying on biomedical labels as both correct and sufficient to explain and name various conditions, research and practice today recognize the significance of the meaning and understanding of disabilities held by family members and children themselves. Elicited explanatory models from adolescents with varied cognitive disabilities and delay to better understand their personal experiences.

One of the key elements in qualitative data analysis is the systematic coding of text (Strauss and Corbin, 1990; Miles and Huberman 1994:56). Codes are the building blocks for theory or model building and the foundation on which the analyst’s arguments rest. Implicitly or explicitly, they embody the assumptions underlying the analysis. Given the context of the interdisciplinary nature of research at the Centers for Disease Control and Prevention (CDC), we have sought to develop explicit guidelines for all aspects of qualitative data analysis, including codebook development. On the one hand, we must often explain basic methods such as this in clear terms to a wide range of scientists who have little or no experience with qualitative research and who may express a deep skepticism of the validity of our results. On the other, our codebook development strategy must be responsive to the teamwork approach that typifies the projects we undertake at CDC, where coding is generally done by two or more persons who may be located at widely dispersed sites. We generally use multiple coders so that we can assess the reliability and validity of the coded data through intercoder agreement measures (e.g., Carey et al. 1996) and, for some projects, as the only reasonable way to handle the sheer volume of data generated. The standardized structure and dynamic process used in our codebook development strategy reflects these concerns. This paper describes (1) how a structured codebook provides a stable frame for the dynamic analysis of textual data; (2) how specific codebook features can improve intercoder agreement among multiple researchers; and (3) the value of team-based codebook development and coding. Origins of the Codebook Format Our codebook format evolved over the course of several years and a variety of projects. The conceptual origins took shape in 1993 during work on the CDC-funded Prevention of HIV in Women and Infants Project (WIDP) (Cotton et al. 1998), which generated approximately 600 transcribed semistructured interviews. One research question pursued was whether women’s narratives about their own heterosexual behavior could help us understand general processes of change in condom use behavior (Milstein et al. 1998). The researchers decided to use the processes of change (POC) constructs from the Transtheoretical Model (Prochaska 1984; DiClemente and Prochaska 1985) as a framework for the text analysis. However, the validity of the POC constructs for condom-use behavior was unknown, and a credible and rigorous text coding strategy was needed to establish their applicability and relevance for this context. To do this, the analysts had to synthesize all that was known about each POC construct, define what it was, what it was not, and, most importantly, learn how to recognize one in natural language. Several years earlier, O’Connell (1989) had confronted a similar problem while examining POCs in transcripts of psychotherapy sessions. Recognizing that "coding processes of change often requires that the coder infer from the statement and its context what the intention of the speaker was," O’Connell (1989:106) developed a coding manual that included a section for each code titled "Differentiating (blank) from Other Processes." Milstein and colleagues used O’Connell’s "differentiation" section in a modified format in their analysis of condom behavior change narratives. They conceptualized the "differentiation" component as "exclusion criteria," which complemented the standard code definitions (which then became known as "inclusion criteria"). To facilitate on-line coding with the software program Tally (Bowyer 1991; Trotter 1993), components were added for the code mnemonic and a brief definition, as well as illustrative examples. Thus, the final version of the analysis codebook contained five parts: the code mnemonic, a brief definition, a full definition of inclusion criteria, a full definition of exclusion criteria to explain how the code differed from others, and example passages that illustrated how the code concept might appear in natural language. During the code application phase, information in each of these sections was supplemented and clarified (often with citations and detailed descriptions of earlier work), but the basic structure of the codebook guidelines remained stable.

Great discussion and illustration of issues and strategy for establishing reliability in inter-rater coding. Intercoder reliability is a measure of agreement among multiple coders for how they apply codes to text data. Intercoder reliability can be used as a proxy for the validity of constructs that emerge from the data.

Introduction and discussion of various sampling approaches

Introduces a framework for developing sampling designs in mixed methods research. Discusses sample frames, recommended sample sizes, a typology for classification of strategies, guidance for sampling decisions, and issues related to how sampling decisions impact generalization.

Practical guide to study design with good attention to taxonomy of research approaches by purpose and sampling issues.