Gaby Alvarado: Telling Stories with Mixed Methods

Gaby Alvarado's first course in qualitative and mixed methods didn't start out well.

"For my master of public health degree, we had to take core courses, and I was not looking forward to Principles of Social Research. I already had my M.D. and wanted to take an advanced epidemiology class, but the schedule didn't work out. All I wanted to study was statistics, epidemiology, and 'real science'," she said.

By the end of the term, though, she was a convert.

Alvarado (cohort '19), hails from Costa Rica, where she was a practicing physician. But, she said, "Physicians sometimes have this hero complex. I got my M.D. to help people, but I felt I was doing nothing to improve the health of people in my country. Costa Rica has universal health care, but I thought the system was mismanaged. So I'd gone for my M.P.H. to fix the broken system.

"Patient experience was something I'd never stopped to think about," she said. "Social determinants of health, the culture of health, local context, the nature of hierarchies in the patient-doctor encounter — that first class opened my eyes."

Her M.P.H. thesis focused on women's medical experiences in Costa Rica, trying to understand why only 38% of women get cervical cancer screenings. She conducted field interviews, focus groups with providers and patients, and more.

"If I had tackled that question only through quantitative data, I wouldn't have had the story behind it, what was going on in people's lives. Women couldn't schedule an exam; they had to wait in line at a clinic the day they wanted it. No one has time for that. And the women knew it was important to get a pap smear, but they were getting conflicting advice and recommendations, because some doctors had older views. Yet when I asked the doctors and nurses, they said women weren't getting screened because they didn't have enough information."

After that research experience, Alvarado said, she "never looked back." She pursued a second master's degree, in anthropology, because she wanted to improve her qualitative skills.

"Public health and anthropology go hand in hand. Through my M.A. studies, I was able to fine tune my qualitative methods, ethnographic and interviewing skills, and the theory and methods behind them," she said.

Alvarado says she appreciates Pardee RAND because its curriculum allows students flexibility in pursuing goals and making progress toward what they want to study.

"For example," she said, "I wanted to improve my creative writing, to be able to share my research through narrative. Angel (O'Mahony, the academic dean) worked with me so I could take an online course at UCLA in Storytelling for Social Justice.

"I want to be able to craft something compelling, that tells a story with data and narrative from different angles."

Although she's only just finished her first year at Pardee RAND, Alvarado has already participated in several OJT projects and is also helping the school develop a community-partnered externship in Sitka, Alaska, that is set to run later this summer.

Soon after she arrived, she joined a project evaluating an effort to expand access to screening and treatment for Hepatitis C for people of color.

"I got to travel to Texas and Connecticut for focus groups with patients and providers. The nice thing about mixed methods research is getting out of the office, talking with people, and learning about their experiences. But I'm also enjoying the chance to help with the analysis — the coding as well as the data collection."

She agrees her medical degree does help with some research. "PIs like that I have a medical background. Sometimes, physicians can be hesitant with researchers. My degree lets me develop rapport. They understand that I've been there."

It also helps that Alvarado doesn't mind making cold calls. "That's important for interviewing, it's a great skill. It's also how I got involved with the Center for Qualitative and Mixed Methods," she said.

As a member of the American Anthropological Association, Alvarado wanted to organize a panel at RAND for World Anthropology Day, to show researchers you don't have to be an anthropologist to use these methods. "I was working with Casey (Bouskill) on another project, and she said I should contact (center directors) Ryan Brown and Elizabeth Petrun-Sayers."

Alvarado put together a panel of five RAND researchers — Katie Sieck, Leslie Payne, Lisa Saum-Manning, Luke Matthews, and Bill Marcellino — and had about 40 students and researchers attend in person and via videoconference.

"It was the last in-person event before the [COVID-19] lockdown began, and I was so glad it was able to go ahead. I'm even more excited to plan another one for next year," she said.

—Monica Hertzman