Installment seven in our series on BREATHE 2 collaborators
Years ago, Dr. Barbara Bowers fought for acceptance.
“I was the only qualitative researcher in my school and in the health sciences on campus,” she said. “Qualitative research was looked down upon and I had to constantly defend it.” Many journals didn’t accept qualitative research or didn’t understand it. “It has been a really interesting evolution from ‘you’ll never get funding for it’ to being funded for 30 years. It’s a myth that took a long time to kill.”
Fortunately, things are different now. Many see the value of qualitative research in studying health and health systems issues.
Now, she is an Associate Dean for Research who serves on the editorial board of Qualitative Health Research, the Western Journal of Nursing Research and the International Journal of Older People Nursing. She is associate editor (qualitative and mixed-methods research manuscripts) for The Gerontologist and oversees Qualitative and Mixed Methods Research Resources in the Institute for Clinical and Translational Research (ICTR) at the University of Wisconsin-Madison.
When UW-CTRI earned a grant for the first Breaking Addiction to Tobacco for Health (BREATHE) study, it included both quantitative and qualitative elements. So UW-CTRI Research Director Dr. Tim Baker and UW-CTRI Director Dr. Michael Fiore reached out to Bowers via ICTR to collaborate on the qualitative aspects of the research.
Bowers worked closely with former UW-CTRI colleague Madeline Oguss, and by extension with UW-CTRI colleagues Amy Skora, Allie Gorrilla, Amy Sorce and Elana Brubaker to examine the impact of modifying the electronic health record (EHR) in primary care clinics to facilitate clinic staff referring patients to BREATHE via a 1-click referral system.
They found that clinic staff tended not to use the scripted prompts in speaking with patients, but would summarize them in their own words, often emphasizing what they felt was most appealing or relevant for their patients—especially if they knew the patient. Referral rates to the study in clinics with EHR modifications were strong compared to clinics using fax referral to quitlines. They found that, when patients had positive outcomes, it improved the chances roomers would refer patients to BREATHE. When clinic staff felt like they were part of a productive team, that also encouraged referrals to BREATHE. Most took pride in helping patients quit and found EHR referral to be effective.
“These clinic professionals took a general protocol and implemented it in the health-care environment, often tailored because they knew the patient,” Bowers said. “The question isn’t how do we get them to do it the way we want them to do it, it’s how can we get them to do the intervention in a way that works for them? For example, you might say to an older patient, ‘Here’s a way to see your grandchildren more.’”
Bowers said combining qualitative and quantitative elements into studies is useful for exploratory research to identify promising directions to take future research. “It answers, why did it work for this group and not that group. How do you explain it? Otherwise, with quantitative research only, you might say you have a result but can’t always explain why.” She said the greatest explanatory power comes from combining both qualitative and quantitative approaches.
These days, Bowers is flooded with requests for her expertise in qualitative research because it is needed to compete for grant funding.
She said one thing she has noticed over the years is that qualitative infrastructure must be included in research designs from the start, just as one would for a quantitative study. “Context and process are important.”
She has been involved with BREATHE 2 since early in the process. “I’m excited to work with the talented team,” she said. “This is an incredible group that Mike and Tim put together. I have tremendous respect for everyone involved. I couldn’t ask for anything more in academics. These are people whose work I’ve read in the past, so it’s fun being on a project with them. It’s also a very nice group of academics. They’re generous, they listen to feedback from everyone in the group, and there’s genuine collaboration.”
While BREATHE 2 has just begun, and has been slowed by the global pandemic, Bowers has examined interviews and made suggestions. The questions ask leaders of health systems and their providers about the challenges of integrating tobacco treatment into standard care.
“Hopefully, I can continue to be involved with the interview questions,” she said.
Smoking is a topic she cares deeply about, in part because she lost both her parents and her brother to it. “One died of lung cancer and two from COPD.”
The founding director of the UW School of Nursing’s Center for Aging Research and Education, Bowers advocates for nurses to quit and help their patients do the same. She sees a widespread perception that, after old age, there’s no use in quitting. “Which is not true.” She wants to change that.
She identifies as a healer. “I enjoy that.” When she’s not healing, she’s often gardening.
“We have a large terraced garden that I enjoy. It’s nice to see something tangible that you worked on grow. That’s probably why people get so excited about a manuscript, because there’s something to point to.” She plants a number of perennials and a few tomato plants. “My husband is a master gardener. Birds and butterflies are fluttering everywhere, they love it.”