Qualitative approaches to research

Dr Dean Whitehead

SoNM

Why qualitative research?

The post-modernist ‘backlash’

• Post-modernism (anti-positivism)

• Different worldviews – science versus philosophy – phenomenology /existentialism

Nursing versus medicine…

How do quant/qual differ?

Qualitative - it’s all in the narrative!!

• What do people do,

think, say, believe, value, experience, observe etc…

What does it broadly do then?

• What is the most

common qualitative approach in nursing and midwifery?

Qualitative descriptive exploratory – ‘free form’

• The least theoretical

/ philosophical approach

Uses generic principles

• Usually interviews / focus groups

• Content/thematic analysis

‘Traditional methodologies’

• Phenomenology – hermeneutics

• Grounded theory

• Ethnography

How do they differ?

Different philosophers / theorists

Husserl

• Descriptive (realist) – Transcendental

• Epistemological

• ‘What do we know…’ (about the world)

• Bracketing – suspending belief

Heidegger

• Interpretative

• Ontological

• ‘What is the nature and meaning of ‘being in the world’

• Hermeneutics – moving from parts to the whole

• Gadamer

• van Manen

• Crotty

Grounded theory • For theoretical clarity

• Theory is developed

(conceptual model) – not tested

• Coding – open, axial, selective – theoretical saturation

• Blumer’s theory of Symbolic Interactionism – and objectivism

• Constructivism movement

• Corbin

• Sharmaz

Ethnography • Stems from

anthropology

• Observing cultural groups and sub-groups

• Emic / etic – insider/outsider

• Positioning – overt / covert

• Realist ethnography

• Critical ethnography

• Case studies • Auto-ethnography

• Ethnomethodology

Case study

• In-depth narrative case-studies – small numbers

• Vignettes

What’s in and out of fashion?

Historical research

Not much to say really!!

• Cycles of history

• Documentation, letters, photo’s, paintings etc - all inform a story or narrative

My original PhD topic – the origins of public health nursing in the UK

• 1890s-1960s • PRO – Kew • Royal College of

Nursing – Edinburgh/London

• Wellcome Institute

• MoH minutes / microfisch

• Nursing Times / Nursing Mirror

Feminist research

Hhhhmm – what about masculine research?

• Popular in 60s-80s

• The anomaly of

midwifery!!

• Medicalisation of normal, healthy child-birth

Critical – emancipatory paradigm – critical social theory

• Explores power

imbalances – systems, organisations, gender, ethnicity etc

• Questions the status quo of social institutions

• Seeks change and emancipation

Narrative analysis

• Concept analysis

• Discourse analysis

Concept analysis

• Rodgers

• Morse

• Walker and Avant

Discourse analysis

Jacques Derrida

Quick break!!

A criticism of qualitative research

• Can be seen as

‘wooly’, fluffy and ‘navel-gazing!!

• Rigour

• Hierarchies of evidence

I think – therefore I am…

• Rigor is the methodical commitment to experimental procedure, to the need of controlling all parameters that can affect the results of our tests.

Qualitative - Trustworthiness

• Credibility

• Transferability

• Dependability

• Confirmability

National Health and Medical Research Council - 2009

https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidenc

e_120423.pdf

Bridging the paradigmatic tension – the answer is…

Qualitative meta-synthesis

Two birds – one stone etc

Thinking outside the box… problem-solving – pragmatic…

More than one worldview…

Mixed methods – a no-brainer!

Is it qualitative?

• Hhhmmmm – third paradigm!!

Action research (AR)

Critical – emancipatory paradigm – critical social theory

• Explores power

imbalances – systems, organisations, gender, ethnicity etc

• Questions the status quo of social institutions

• Seeks change and emancipation

Term first coined by Kurt Lewin – 1946. Died 1947!! Also coined related terms – force field analysis, group dynamics & change process (unfreezing, change, refreezing)

What does it look like?

Figure 1: ‘An organisational-change action research cycle’. Adapted from: Whitehead D et al. (2003) Action research in Health Promotion Health Education Journal 62: 1. (with kind permission from Health Education Journal)

DIAGNOSIS

PLANNING FURTHER ACTION

DISSEMINATION

REFLECTION / EVALUATION

ACTION

FEEDBACK

DATA ANALYSIS

RESEARCH PARTICIPANTS AND ORGANISATION

- Identify problem/s to be addressed and proposed solutions / interventions.

- Review the associated literature for evidence-base. - Identify structural / organisational systems and processes. - Ascertain structural / organisational barriers / opportunities. - Forge constructive relationships with potential participants.

Clarify and validate problem/s with potential participants. - Possible pilot study to investigate validity of action research

activity and to highlight the most appropriate participants for main study.

- Investigate ethical considerations / constraints.

- Initial interpretation of collected data occurs.

- Collaborative analysis and measurement of outcomes takes place.

- Validation of problem/s against analysed data.

- Data analysis informs draft action-change programme.

- Collaborative discussion and examination of data outcomes leads to agreement on draft and final change programme.

- Change targets and outcomes are agreed.

- Individual commitment to change process and roles are agreed, whilst parameters of ‘ownership’ are established.

- Intentions / interventions are discussed with relevant stakeholders. Any necessary systems / policy changes are formalised.

- The programme is communicated and implemented according to agreed protocols.

- Participants are supported and developed in their change-management role.

- Progress is recorded at regular intervals. - All changes are monitored and recorded.

- Effectiveness of programme is measured against agreed outcomes, targets and success criteria.

- Methods and approaches are reviewed for validity and reliability.

- Critical reflections of participants are collated.

- The dissemination and publication of outcomes to relevant local / national audiences occurs.

- Participants decide if further interventions are required, either as an extension of the existing programme or as a separate add-on programme.

- Further action becomes part of a continuous cycle of reflexive practice.

- Programme may ‘complete’ here with the consent of participants.

DATA COLLECTION

- Establish the nature and range of the most appropriate data collection methods.

- Determine documentation and recording methods.

Advantages?

• Not research for research sake – navel-gazing or otherwise.

• It seeks organisational / community change

Delphi Technique • The Delphi is named with reference to the Ancient

Greek God Apollo, whose Delphic oracle was viewed as his most truthful and trustworthy expert informant – and who spoke to mortals from his Delphi sanctuary

Delphi technique

• The Delphi is named with reference to the Ancient Greek God Apollo, whose Delphic oracle was viewed as his most truthful and trustworthy expert informant – and who spoke to mortals from his Delphi sanctuary

Delphi Technique

• Consensus study – expert driven – where theory, research or practice is ‘sketchy’

• Classic two-round

• First-round – qualitative interviews

• Second and further rounds – quantitative - descriptive surveys

Case study / Q-methodology

Phew!!

• That’s it folks. Qualitative methodology and mixed methods in 1 hour – and 67 slides!!

Any questions