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 Heidegger • Descriptive (realist) – • Interpretative Transcendental • Epistemological • Ontological • ‘What do we know…’ (about • ‘What is the nature and the world) meaning of ‘being in the world’ • Bracketing – suspending belief • 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? - 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. DIAGNOSIS Figure 1: - Forge constructive relationships with potential participants. ‘An organisational-change action research cycle’. Clarify and validate problem/s with potential participants. Adapted from: Whitehead D et al. (2003) Action research in - Possible pilot study to investigate validity of action research Health Promotion Health Education Journal 62 : 1. (with kind activity and to highlight the most appropriate participants for permission from Health Education Journal ) main study. - Investigate ethical considerations / constraints. - Participants decide if further interventions are required, either PLANNING - Establish the nature and range of as an extension of the existing FURTHER the most appropriate data programme or as a separate add- ACTION DATA collection methods. on programme. COLLECTION - - Determine documentation and Further action becomes part of a recording methods. continuous cycle of reflexive practice. - Programme may ‘complete’ here - Initial interpretation of collected with the consent of participants. data occurs. - Collaborative analysis and - measurement of outcomes takes The dissemination and DISSEMINATION place. publication of outcomes to RESEARCH DATA - Validation of problem/s against relevant local / national PARTICIPANTS ANALYSIS analysed data. audiences occurs. AND - Data analysis informs draft ORGANISATION action-change programme. - Effectiveness of programme is measured against agreed outcomes, targets and - Collaborative discussion and success criteria. examination of data outcomes leads to - Methods and approaches are agreement on draft and final change reviewed for validity and REFLECTION / programme. reliability. EVALUATION - Change targets and outcomes are - Critical reflections of agreed. participants are collated. - Individual commitment to change process and roles are agreed, whilst parameters of ‘ownership’ are - The programme is communicated and established. implemented according to agreed protocols. FEEDBACK - Intentions / interventions are discussed - Participants are supported and developed in ACTION with relevant stakeholders. Any their change-management role. necessary systems / policy changes are - Progress is recorded at regular intervals. formalised. - All changes are monitored and recorded.
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
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