Use of the Vignette Technique in a Qualitative Study of Health Disparities
Background: Evidence of racial disparities in health care is remarkably consistent across a range of illnesses and health care services (IOM, 2002). Although health outcome and treatment differences persist after controlling for socioeconomic status, little is known about how middle-class African-Americans perceive the healthcare encounter (van Ryn & Burke, 2000).
Studying this group, and the potentially discriminatory treatment they face, is methodologically difficult. The vignette technique, in which participants are asked to respond to a hypothetical situation, may illuminate respondents’ opinions in instances in which they may be reticent to divulge deeply held or controversial feelings or instances in which they may not have a fully formed opinion about an issue. Used in conjunction with other qualitative data collection methods, i.e., in-depth interviews, observation, focus groups, the vignette technique may strengthen data interpretation. This may be particularly beneficial in the context of discussions of discrimination in which participants may not have considered certain elements of their own experience but may respond to the hypothetical situation presented in the vignette. In this manner, vignettes provide an additional mechanism through which the connection between perceptions and actions is further clarified.
Study Design: The study uses in-depth interviews, the vignette technique, and focus groups to explore the healthcare experiences of black middle-class women. Each study participant responded to four hypothetical healthcare situations in which certain strategies used to mitigate racial and gender discrimination in healthcare settings were explored.
Population Studied: Thirty African American women between 38 and 67 in a large urban area. The women are defined as middle-class based on either education, income, profession, or home ownership.
Results: Participant responses to the vignettes corroborated findings from the in-depth interviews and focus groups. Specifically, women endorsed the idea that positive self-presentation is an important strategy for mitigating potentially discriminatory treatment in healthcare settings.
Implications:
The vignette technique is an important data collection method in qualitative studies. Although vignettes are more generally used in quantitative studies with large samples, vignettes used in conjunction with other qualitative data collection methods provide an additional mechanism through which the connection between perception and action may be explored. Comparing responses to questions in an in-depth interview and the hypothetical situation of the vignette, likely provides additional information from which to analyze the robustness of the findings. In this manner, use of the vignette technique provides an excellent check of qualitative data.