priest etal_compare qualitative methods ii_02

An overview of threedifferent approaches to theinterpretation of qualitativedata. Part 2: practicalillustrationsThis paper continues the discussion of the essential features and methodsinherent within three approaches to the interpretation of qualitative datapresented in Part 1 (Priest et al 2002). Leslie Woods, Helena Priest andPaula Roberts explore the use of grounded theory, qualitative contentanalysis and narrative analysis through the use of an illustrative example

Keywords: methodological choice, qualitative methods, groundedtheory, qualitative content analysis, narrative analysis

Introduction and aimsIn Part 1 (Priest et al 2002), outlines of the philosophical bases of threequalitative approaches to data analysis (grounded theory, content analysisand narrative analysis) were presented, along with key analyticalprinciples. As previously noted, there is, in the literature, a lack of detailedguidance concerning how qualitative data should be handled andanalysed. The aim of this paper is to illustrate, using a generic interviewextract, the practical application of these three different approaches to acommon data set.

Application of the three approaches: analysis of transcription exemplarUsing the section of transcribed interview data presented in Box 1 below,we demonstrate some of the analytic procedures and techniquescharacteristic of the three approaches outlined in Part 1.

NURSE RESEARCHER VOLUME 10 NUMBER 1

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Qualitative approaches

Analysis using grounded theoryStrauss and Corbin (1998) recommend that, initially at least, the interviewmaterial should be analysed line-by-line. This would take the form ofopen coding. The potential codes that are generated by this process should


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Qualitative approachesBox 1: Transcript extract

1 Q: Can you tell me about how you have helped a patient to stop smoking.2 Nurse: One was a lady who has smoked all her life from the age of

3 17, shes in her late forties, 35 a day She wanted to use

4 Zyban, and it was a case of this is my only chance, if I dont stop smoking

5 now then I wont ever She was almost in tears. She said you have to take

6 me now or its not going to work. I thought, this lady is as motivated as

7 she is ever going to be and I have to respond to that, so I gave her an

8 appointment. I gave her a leaflet to fill in outlining 10 reasons why she wanted

9 to stop smoking and a diary of a day giving how many times she smoked.

10 When I saw her the first time I wanted to make sure she could commit to

11 attending the seven-week programme and then it was really over to her to

12 talk about motivation for why she wanted to give up smoking. At each

13 appointment we do a carbon monoxide reading which is a very good

14 motivator because that gives the opportunity to explain why smoking is a

15 problem for their health. At the second appointment we tackled the

16 potential risks of smoking. I try to apply it to her by looking at the risks that

17 are relevant to a woman of her age and the relevant length of time that she has

18 smoked

19 Q: Do you find that people are generally aware of the risks?20 Nurse: I think the general level of awareness is quite good and that instils

21 a lot of guilt in patients because they then feel guilty that they are knowingly

22 doing something that is harming them. You have to take that on board when

23 you are talking to them because that is not very helpful. She then sees me

24 at the end of the first day that she has quit as a motivator, which is useful,

25 because I do another carbon monoxide reading which is substantially less

26 than her previous reading thats a really good motivator.

reflect the main concepts that are conveyed. Looking over the first 15lines or so, there are a number of codes that can be applied to the text.For example, in lines 3-6, issues are raised to which the codesmotivation, timing and urgency (as well as others) could be generated.In fact, the code motivation can be applied to other pieces of thisinterview extract, in fact all 26 lines!

In this example, it is apparent that the same data extract can be codedunder a number of different conceptual headings. This is quite normal ingrounded theory and is merely a reflection of the way we communicatein everyday situations. That is to say that our interactions are rarelylimited to discussing discrete ideas, divorced of context; we tend tocommunicate in a complex and often haphazard way with the result thata single speech can address multiple issues.

After reading this extract several times it becomes clear that motivationis an important concept that appears to have a number of features andcharacteristics. Consequently, motivation is likely to become a categoryas opposed to a single code and, as such, it is important to identify thevarious properties or codes related to this central concept. In other words,as the analyst, once you have identified motivation as a key issue, youmight start to ask the questions such as: what factors motivate peopleto stop smoking? What factors sustain motivation? Looking at the textin response to these and other questions, a number of factors start tobecome apparent within this single transcript excerpt. For exampletiming [lines 4-7], commitment [lines 8-12], positive reinforcement [lines6-8, 12-14], health gain [lines 12-15], health risks/consequences [lines15-18], guilt [lines 20-22] and so on. It is not important that you mayhave used different terms to name these properties, but it is importantthat all codes are clearly defined and accurately reflect the meaningwithin the data. In that way, as each new instance of a defined conceptis identified, either later in the same interview or in other data, it can beadded to the coding system.

Axial codingAxial coding is used to start to make tentative connections andrelationships between the first-level open codes and categories initially


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generated. This is done following the coding paradigm (Strauss andCorbin 1998) outlined in Part 1 in this issue of Nurse Researcher (Priestet al 2002). So, in our example the central phenomenon of the model ismotivation. What led to this phenomenon was a desire to stop smoking;that is, the causal condition. The properties of a desire to stop smokinginclude codes we have generated, for example, health gain, although thisrequires further confirmation at this stage and there are likely to be othercausal conditions. The codes of timing and urgency are interveningconditions that relate to the central concept and the action/interactionalstrategies. The action/interactional strategies related to the central conceptinclude the commitment to the education programme, outlining reasonsfor stopping smoking and the prescribed treatment for the patient, as wellas the positive reinforcement of the nurse.

It should be remembered that open and axial coding are iterativeprocesses that occur concurrently with data collection. Movementbetween both phases is often not overt, and it is possible for the analystto move back and forth in one coding session without necessarily beingaware of this. The use of the grounded theory approach allows theconnection of codes and categories in the data to be established andtheoretical propositions to be developed. For example, you might arriveat a proposition that motivation to stop smoking is primarily triggered byan acknowledgement of health risks and consequences within theindividual. As an analyst and researcher, you would go back to your datato see if there was evidence to support or refute your proposition.Moreover, this might become the focus of future data collection whenyou might wish to interview patients at a smoking cessation clinic.

As stated at the outset, there are other approaches to the ways inwhich data can be analysed in qualitative research, and the next tobe discussed is content analysis.

Content analysisThe interview may have been conducted as part of an exploratory study,and therefore the main analytic categories would be known. If this was


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the case, key concepts in the interview questions would form the mastercodes, i.e. help to stop smoking and awareness of risks. Thereafter,second-level coding would follow on from these master codes. If contentanalysis was to be undertaken on text without master codes being known,the first step would involve reading the text several times to get a feel forthe master codes, from which further sub-codes would emerge. Let uspresume this is the case. If we were utilising a computerised softwarepackage the main analytic categories may be labelled: age [from lines 2& 3], quantity [line 3], medication [line 4], emotion [line 5], motivation[lines 6, 12], motivator [lines 24, 26], nursing intervention [lines 8, 9, 13,25], commitment [line 10] and risks [lines 15,16,19].

If we had text from several respondents, first-level coding would ensueacross all data sets to ascertain the master codes. Thereafter, second- andthird-level coding would ensue to ascertain core themes within each maincategory. For example, under the master code nursing intervention, second-level coding would include text under the headings of: appointment [line8], leaflet [line 8], diary [line 9] and carbon monoxide reading [line13]. If several pieces of text, either from within one text or several textspertained to the same concept they would be copied and pasted under theappropriate sub-code. Then, within each section of text, thematicinterpretation of meaning is undertaken. If several respondents use similarwords, manifest content analysis is possible; otherwise interpretation ofmeaning is facilitated through latent content analysis. To illustrate derivedthemes, respondents actual phrases may be utilised, in a reverse processof deriving evidence to support theoretically derived concepts (see Woodsand Roberts 2000). For example, for the theoretically derived conceptmotivator [lines 24, 26], evidence may readily be derived from the actualtext by reference to line numbering to illustrate the concept, for example,I do another carbon monoxide reading which is substantially less thanher previous reading thats a really good motivator. This method ofqualitative content analysis can readily be crosschecked for inter-coderreliability, and is thus a very robust form of coding.

The third and final approach to analysis of the transcript extract isdescribed below.


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Narrative analysisFollowing the principles described by McLeod and Balalmoutsou (2000),a segment of the transcript [lines 2 8] has been selected for micro-analysis. This segment can be identified as a story in that it has a beginning,middle and an end, as well as a logical temporal sequence (Riessman1993); furthermore, it is possible to identify the defining features oforientation, complicating action, evaluation, resolution and coda, as outlinedby Labov and Waletzky (1967). The transcript has been transformed intostanza form (Gee 1986, 1991), with Labov and Waletzkys (1967) keyelements identified. These features are indicated in the right-hand columnof Box 2, alongside the appropriate section of transcript.


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Qualitative approachesBox 2: Segment of transcript

Transcript extract rewritten in stanza form Defining feature

(Gee 1986,1991) (Labov & Waltzky, 1967)

A lady who has smoked all her life Orientation

From the age of 17,

Shes in her late forties,

Thirty-five a day.

She wanted to use Zyban Complicating action

And it was a case of:

This is my only chance,

If I dont stop smoking now then I wont ever

She was almost in tears.

She said: You have to take me now or its not going to work.

I just thought, EvaluationThis lady is as motivated as she is ever going to be

And I have to respond to that, Resolution

So I gave her an appointment. Coda

Having confirmed that this is indeed a story by identifying Labov andWaletzkys (1967) defining features and having deleted those words andphrases that detract from the main focus of each sentence or group ofsentences (see Emden 1998), it is now possible to identify fragments ofthemes, or sub-plots, within this story, as shown in Box 3:

By combining these sub-plots, the core story can be identified as aspecific nursing action in response to an expressed need, and this in turncan be considered in terms of its function to the teller (in this case, thenurse). Here, it could serve the function of enabling the nurse to reflecton and justify the reasons for her clinical decisions, and in particular thedecision to respond to her patients emotionally charged expression ofmotivation to change an aspect of her lifestyle. It is interesting to notethat, at this stage, the nurses response is towards the stated problem(giving her an appointment) rather than to the patients cognitive appraisalof her situation (believing this to be her last chance to change herbehaviour) or to her emotional experience (expressed by being close totears). However, it should be noted that, as one of the strengths ofnarrative analysis is its ability to retain context (Mishler 1986), the


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Box 3: Identification of sub-plots

Reduced transcript Sub-plots

A lady who had smoked 35 cigarettes a day Patients plight

all her life wanted to use Zyban

She believed it was her last chance to stop. Patients cognitive and emotional

She was almost in tears. responses to her plight

I had to respond to that [her motivation] Nurses recognition of and responseto patients readiness to change

So I gave her an appointment. Nurses action: problem-focused

rather than emotion-focused.

selection of such a short illustrative example could result in interpretationsbeing made that are out of context with the larger narrative.

As with other forms of qualitative research, data selected for narrativeanalysis are open to multiple interpretations. As Riessman (1993) hasnoted narratives are interpretive and, in turn, require interpretation: Theydo not speak for themselves. This may lead to doubt about thecredibility of analysis (Ayres and Poirier 1996). Furthermore, rules ofstory structure and grammar are culturally determined, and may not beshared between researcher and participant (McLeod 1997). Thus, despitefollowing a set procedure, individual researchers may arrive at differentconclusions regarding the structure, shape and meaning of stories.However, as Ayers and Poirier (1996) have argued, provided that theanalysis has been conducted responsibly, and remains faithful to the dataand the methods, then the conclusions drawn can be accepted as a validinterpretation. Thus, narrative analysis may be considered as a viablequalitative approach in nursing and health care research.

Conclusion This paper has provided practical exemplars to illustrate the fundamentalanalytical principles inherent within three qualitative research approacheswhich can be applied to the practical analysis of interview or other textualdata. While necessarily brief, it is hoped that this practical overview,which should be read in conjunction with Paper 1 (Priest et al 2000)introducing the background philosophies and analytical principles of thethree different approaches, will assist researchers in making informeddecisions in their approach to data handling and interpretation, and inspirethem to seek out more detailed texts.

Leslie Woods PhD, BSc(Hons), Cert Ed, RGN, DN Cert, Lecturer,University of Liverpool, EnglandHelena Priest PhD, MSc, BA, RMN, Dip N, Dip N Ed, Lecturer, KeeleUniversity, Staffordshire, EnglandPaula Roberts PhD, MA Ed Mgmt, RMN, RGN, Cert Ed, Cert HEd,ILTM, Senior Lecturer, Keele University, Staffordshire, England, andEditor, Nurse Researcher


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priest etal_compare qualitative methods ii_02

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