Qualitative research: quality results?

Authors


Qualitative research is undertaken in naturalistic settings and is interpretive in nature, with the collected information deriving mostly from interviews and observation (Endacott 2008). During the last quarter of a century, there has been a proliferation of qualitative research, by and large in nursing and some other socially oriented (person focused) disciplines and it has almost become the default research approach. Over this time, the quality of published qualitative research has improved in some quarters and become, in our opinion, ritualistic in others.

To make matters worse, ongoing comparisons of qualitative with quantitative research continue into the twenty-first century with the ongoing assumption that quantitative methodologies are hard/real science and the qualitative varieties distant cousins. Given the epistemological distance between positivist science (quantitative research) and interpretative methodologies, what do qualitative studies offer that quantitative methods cannot? Whether reviewing manuscripts for journals or conducting and writing up qualitative research, there are important evaluative considerations. In this Editorial, we aim to overview some of these issues.

In 1978, Carper (1978) published her ground-breaking paper on epistemologies relevant to the discipline of nursing; ‘ways of knowing’. Thirty-five years later, it seems that many nurse researchers have not yet come to grips with these fundamental differences and how each makes unique contributions to understanding human experience and therefore nursing. The intellectual premises upon which qualitative research methodologies are based are oriented towards exploring personal and/or interpersonal subtleties and shed an interpretive light on the phenomenon under study to render it explicable to those who are not participants. It is about understanding and conveying the sense people make of their life experiences, in other words endeavouring to construct or co-create human meanings (Walsh & Downe 2006, Snyder 2012).

An analytical and critical literature review is an essential foundation for qualitative research to ensure familiarization with up-to-date knowledge and perspectives in the study area: it can help clarify the research question, possibly shift the focus given extant findings, and provide a secure stepping stone in relation to both the topic and ways of researching it. In their review of qualitative research appraisal criteria, Walsh and Downe (2006, p. 117) conclude that there needs to be a ‘comprehensive…incorporation of existing literature, whether this is before the onset of the study or to contextualize the findings’. A thorough integrated use of the literature in the discussion enables the researcher/s to show how their research has added meaningful results to the nursing body of knowledge.

When planning research, the research questions, methodology and method must be congruent. Viable research begins with a research question – that is, what it is you want to find out – which has to be interrogated, discussed and honed to unequivocal clarity. Quite simply, the clear research question determines the method. Most research questions can only be truly answered via a limited range of methods.

The most common method of gaining information in qualitative studies is by interview. Apart from the type of interview to be carried out (for example, one-on-one or group) this immediately raises questions about both the interviewer/s and the interviewee/s. Other interview considerations include – whether the focus of the interviews is for specific information to confirm a pre-determined theory and conduct deductive coding (concept-driven or theoretical coding) or whether to create codes with the aim of explaining the current data to perform inductive coding (data-driven or open coding) (Fade & Swift 2011). Planning the interview involves many decisions, including ‘who to interview; how to reach them; how to establish rapport; how to word, order, and pose questions; how much personal information, if any, to divulge; whether to play the role of a naive or informed listener; how to record what is being said (tape or notes); and when to stop’ (Pawluch 2005, p. 233).

An inexperienced interviewer will be unable to draw on a repertoire of communicating, listening, re-phrasing, managing silence, prompting, keeping on track, ethically responding to distress, coping with surprises – and other flexible skills – required to ensure that rapport is developed and the question/s are addressed as fully as possible. For example, Snyder's (2012) research involved an interview schedule, which she emailed to respondents the day before; beyond the set questions, each interview involved multiple follow-up or probing questions. This reveals a thinking, clarifying, focused and persevering interviewer who aims to capture complex and detailed information.

Engagement is the key to a fruitful interview, as this is the source of unique personal knowledge that elevates qualitative research above boxed answers to standardized questions. The researcher and participants need to communicate with each other well enough to collaborate because interview responses and in situ observations are ultimately mutually generated and context specific (Graneheim & Lundman 2004). Some interviewees may feel intimidated by the role, social standing or age of the interviewer, and require more time at the outset to allow them to feel sufficiently comfortable to say what they think. Thus, the influence of researchers on information seeking (Hawthorne effect), and ensuing research processes cannot be underestimated.

Inexperienced interviewers may limit response options by asking leading questions, or reacting inappropriately to an interviewee answers creating unease or apprehension. If interviewers do not have up-to-date knowledge, especially in the clinical setting, then they are unlikely to probe at the appropriate time or be able to assess the appropriateness or relevance of responses (Sofaer 2002). Thus, broadly, qualitative research interviewer skills have to competently bridge interpersonal aptitudes and detailed knowledge of the topic under exploration.

Who is to be interviewed? Generally, a respondent who has limited language skills, is ill at ease, feels under compulsion (regardless of informed consent), who has not reflected on the topic under discussion, has a grudge to bear or a passion to speak off-topic, will be unlikely or unable to engage with the interviewer and provide authentic thoughtful insights into her/his experiences. Ethnicity, gender, religion and class may impact on interviewees' perspectives on the topic (Christensen & Jensen 2012). Given that qualitative research is seeking quality and depth, a homogenous group of participants can provide richer answers. Adding a woman/man or a few people from ethnic minorities may create thinner disparate answers and subvert information depth when collated. Other personality-related characteristics will have to handled carefully by a sensitive interviewer, for example, some interviewees may respond to perceived power inequality by supplying answers they assume are the ‘right’ ones, or those they believe the interviewer wants to hear (Snyder 2012). In summary, the interviewer, interviewee and interview processes are crucial for eliciting relevant in-depth responses, which may uncover pearls of insight during the analysis phase. Without a rich source of information, the results can only be commonplace, providing no real extension or elaboration upon existing knowledge.

As well as the interview processes, committed qualitative researchers keep a journal or notebook documenting their own hunches, intuitions and emotional responses to interviews and emergent information, and lateral questions or thoughts that arise en passant. Such self-reflections allow the researcher to trace ideas, understand their own thinking and develop further insights; it also provides a thinking-doing trail analogous to a concept map that displays researcher processes, how the project was shaped and the findings arrived at (Walsh & Downe 2006).

Researchers need to have a systematic approach to interpreting transcripts and it is important to clearly represent the subjective thoughts and feelings of respondents (Burnard 1991, Walsh & Downe 2006). Some researchers prefer to transcribe their interviews as it offers an opportunity to listen, reflect and re-examine the information, and contributes to richer contextualized results (Cope 2009). Regardless of the processes involved in analysing and interpreting qualitative information, the researcher should spend time (spread over time) immersed in and dwelling upon transcripts, and thoroughly exploring alternative understandings and re-determining codes, categories, themes and sub-themes (Walsh & Downe 2006, Snyder 2012).

Given the intense involvement with participants and the subject matter, it is inevitable that if different qualitative researchers use the same methods, interviewee responses would at least be subtly different (Salmon 2013). Data analysis involves another layer of researcher personal skills in discerning the wood from the trees, discriminating between major and minor insights and determining which ideas stand out and may become themes. Because interview material has no intrinsic structure, the qualitative data analyser has to seek threads, patterns and ultimately coherence, amongst the jumbled jigsaw pieces in an endeavour to create a clear picture (Snyder 2012). This is a matter of finding order within chaos, making sense of massed information and condensing it – not simply imposing a template upon the material. Snyder (2012) likens this to ‘fracturing’ and ‘rearranging’ data to develop coding categories. Rigour and transparency in qualitative research demand that there is some form of explicit evidence about the analytic methods used to show how themes were discerned (Walsh & Downe 2006).

When writing up qualitative studies, researchers need to be simultaneously creative and precise in the way they use language (Salmon 2013). The use of verbatim quotes to illustrate themes is now de rigueur in many journals, but these can be perfunctory and constitute ‘padding’ when what is required is a penetrating analytical and synthesizing discussion and exploration of the ideas uncovered. Nevertheless, those reading the report should be able to recognize the research method, the analytic method and the context in which it occurs and gain a greater understanding of the phenomenon under study and issues arising (Whittemore et al. 2001). In conclusion, qualitative research aims to elicit in-depth insights and real-life meanings from respondents, and if this is not evident in the final presentation, then perhaps the time and effort invested has failed the researcher, interviewees and funding/supporting bodies.

Ancillary