Tutor: Dr. Gijs Hesselink. Tutor: Drs. Jasper van Riet Paap

Transcription

1 13 nv 20 14

2 Prgrmm dnderdg 13 nvember 2Ot4 Cre Onderzekschldg ver kw littief nderzek Lktie: Mertens A, rute L22 Ochtendprgrmm: uur Anlyse met behulp vn mteril diepte-interviews Dcent: Drs. Jsper vn Riet Pp Tutr: Dr. Gijs Hesselink uur uur Kffie Criteri vr berdeling publictie vn (kw I ittief) nderzeks rti ke I Anlyse pzet rtikel met behulp vn criteri Dcent: Dr. Mrieke Grt Tutr: Drs. Jsper vn Riet Pp uur Lunch in resturnt de Hrdt (studiecentrum) Midddgprgrcrmm: l-6.30 uur lnterviewtrining Dcent: Drs. Jenette Heldens Tutr: Drs. Jsper vn Riet Pp uur L6.30 uur Thee Evlutie en slt

3 13 nv v.fî. Lcey, Luff: Qulittive Dt Anlysis (2OO7l. Wester: Anlyse vn kwlittief nderzeksmteríl (2004) RATS guidelines: Clrk JP. Hw t peer review qulittive mnuscript. ln Peer Review in Helth Scíences. Secnd editin. Edited by Gdlee F, Jeffersn T. Lndn: BMJ Bks; 2003:2L9-23s.. Tng, Sinsbury nd Crig: Cnslidted criteri fr reprting qulíttive reserch (COREQ): 32-item checklist fr interviews nd fcus grups (2007). Wry, Lindsy, Crzier, Andrews nd Leesn. Explring perceptins f psychlgicl services in children's hspice in the United Kingdm. Pllittive nd Supprtive Cre 20L3;Lt:

4 n rffit lutini Insfitr te fr HeÍtfr rllese rch The NIHR Reserch Desigrr Service fr the Est Midlnds The NIHR Reserch Design Service fr Yrkshire & the Humber Qulittive Dt Anlysis Authrs Anne Lcey Dnn Luff

5 This Resurce Pck is ne f series prduced by The NIHR RDS fr the Est Midlnds / The NIHR RDS fr Yrkshire nd the Humber. This series hs been funded by The NIHR RDS EM / YH. This Resurce Pck my be freely phtcpied nd distributed fr the benefit f reserchers. Hwever it is the cpyright f The NIHR RDS EM / YH nd the uthrs nd s such, n prt f the cntent my be ltered withut the prir permissin in writing, f the Cpyright wner. Reference s: Lcey A. nd Luff D. Qulittive Reserch Anlysis. The NIHR RDS fr the Est Midlnds / Yrkshire & the Humber,2007. Anne Lcey Dnn Luff The NIHR RDS fr the Est Midlnds / Yrkshire & the Humber lnfrmtics Cllbrtry fr the Scil Sciences (ICOSS) The University f Sheffield 219 Prtbell Sheffield 51 4DP Hrurd Peditric Helth Seruices Reserch Prgrm Children's Hspitl Bstn USA Lst updted: 2009 The NIHR RDS fr the Est Midlnds Divisin f Primry Cre, 14th Flr, Twer building U niversity f Nttinghm University Prk Nttinghm NG7 2RD Tel: www. rds-estm id l nds. n ih r.c. u k Leicester: enquiries-lnr(ards-estmidlnds.rq.uk Nttinghm : enq uiries-n DL@rds-estm id lnds.rq.u k The NIHR RDS fr Yrkshire & the Humber ScHARR The University f Sheffield Regent Curt 30 Regent Street Sheffield 51 4DA Tel: www. rds-vh. nih r.c.u k Sheffield: Leeds: Yrk: rds-vh(@sheffield.c.uk rds-vh(oleeds.c.uk Gpyright f The NIHR RDS EM / YH (2e) The NIHR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS 2

6 Tble f Gntents Pge 1. lntrductin Wht is Qulittive Dt? 5 3. Theries nd Methds in Qulittive Dt Anlysis Stges in Qulittive Dt Anlysis Ensuring Rigur Prcticlities 3t 7. Sftwre Pckges Summry 37 References 38 Glssry 39 Appendix I - Smple Trnscript (Derek) 41 Appendix 2 - Smple Trnscript (Sue) 45 The NIHR RDS fr the Est M dlnds / Yrkshire & the Humber 2009 QUALITATIVE OATA ANALYSIS 3

7 1. Intrductin This resurce pck is designed fr reserchers wrking in helth nd scil cre wh hve in mind, r hve lredy embrked upn, piece f qulittive reserch. Qulittive methds, using nrrtive nd bservtin rther thn numericl dt, re incresingly being used in helth cre settings where they re seen t'rech the prts ther methds cnnt rech' (Ppe nd Mys 2006), nd they re nw seen s prt f the minstrem f methds in helth services reserch (Hllwy 2005). Hwever, s qulittive nlysis is still new in sme fields f helth reserch, it is reltively cmmn fr the qulittive resercher t dispper under se f interview trnscripts r field ntes, with little in the wy f guidnce s t hw t prceed. Cnfusin nd de-mtivtin is the usul result! lf yu re nt lredy fmilir with the bsics f qulittive reserch, we suggest yu first red the The NIHR RDS EM / YH Resurce Pck in this series entitled 'lntrductin t Qulittive Reserch' by Beverley Hncck, Elizbeth Ocklefrd & Kte Windridge (Updted 2007), r the relevnt chpters f text n reserch methds such s Bwling (2002). We ssume yu lredy hve sme knwledge f qulittive dt cllectin methds such s prticipnt bservtin, r in-depth interviewing. Hwever beynd tht we mke n ssumptins. lf yu hve lrge pile f tpes, field ntes, r trnscripts sitting n yur desk witing t be nlysed, this pck is prbbly fr yu! Better still, if yu re still t the stge f designing sme qulittive reserch, knwledge f yur prpsed methds f nlysis will imprve the design nd sve yu lt f truble in the lter stges. After the intrductry sectins, yu will find brief thereticl review f the different wys f nlysing qulittive dt, nd yu will be encurged t decide which level f nlysis is the right ne fr yu. Then we tke yu thrugh the vrius stges f nlysis, using sme smple interview trnscripts t let yu try ut the vrius prcesses fr yurself. A discussin f prcesses tht cn help ensure rigur fllws. Finlly we ddress sme f the prcticlities f qulittive nlysis, including use f cmputer sftwre prgrmmes. LEARNING OBJECTIVES. T discuss sme f the thereticl mdels within which qulittive dt cn be nlysed, nd select the mst pprprite ne fr prticulr piece f reserch.. T understnd the stges invlved in qulittive dt nlysis, nd gin sme experience in cding nd develping ctegries. T ssess hw rigur cn be mximised in qulittive dt nlysis,. T pply prcticl slutins t the prcess f qulittive dt nlysis. The NIHR RDS fr the Est Midlnds / Yrksh re & the Humber 2009 QUALITATIVE DATA ANALYSIS 4

8 2. Wht is qulittive dt? Yu re prbbly fmilir with the bsic differences between qulittive nd quntittive reserch methds, nd their different pplictins in deling with reserch questins psed in helth cre reserch. Qulittive reserch is prticulrly gd t nswering the 'why', 'wht' r'hw' questins, such s:. Why re sme ptients with dibetes reluctnt t cmply with dietry dvice nd insulin regimes, despite their experience f dibetic cmplictins?. Wht re the perceptins f crers living with peple with lerning disbility, s regrds their wn helth needs?. Hw is the wrk f n Accident nd Emergency Deprtment ffected by frequent physicl nd verbl buse twrds stff? Ech f these questins culd be ddressed using quntittive techniques such s structured questinnires, ttitude scling, mesurement f stndrd utcmes such s mrtlity, mrbidity r stff bsence rtes. All f these cn be redily nlysed sttisticlly, nd yu will get sme srt f nswer t the questin. Fr instnce, yu my find tht lder peple re mre likely t reprt cmplince with dietry dvice thn yunger nes, r tht episdes f vilence nd stff sickness rtes re significntly crrelted. But tht wuld nly nswer prt f the questin, r my led yu t mke ssumptins but cuses nd effects tht re invlid. The prblem my be quite different frm hw we cnceptulise it. T find ut mre but the cnnectin between ge nd cmplince, r between sickness nd buse, r t relly "get int the Shes" f crer, yu will prbbly need t tlk with peple in sme depth, r bserve their behviur ver perid f time. Exercise 1 Lk t the lst reserch questin bve, but buse in n A&E deprtment. Wht kinds f qulittive dt cllectin methds culd be used t investigte this tpic? List fur different surces f dt tht culd be used by resercher. Yu hve prbbly listed sme f the fllwtng: Trnscripts f individul interuiews with members f stff in the depñment F cu s g r u p trn sc ripts Field ntes frm bserutin f stff meetings Cpies f diry entries tht stff members hve been sked t cmplete ech dy Critict incident recrdings frm specific eprsdes f vilence r buse Resercher mems nd reflectins Vide Hw d we g but mking sme sense f these srts f cllectins f dt? Qulittive dt tends t tke up mny pges f typescript, r lts f megbytes n disc! lt is usully in the frm f wrds nd nrrtives, but my include visul imges, videtpe, r ther medi. Where d we g frm here? The N HR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS 5

9 2.1 Wht d we men by nlysis? Quntittive reserch techniques generte mss f numbers tht need t be summrised, described nd nlysed. Chrcteristics f the dt my be described nd explred by drwing grphs nd chrts, ding crss tbultins nd clculting mens nd stndrd devitins. Further nlysis wuld build n these initil findings, seeking ptterns nd reltinships in the dt by perfrming multiple regressin, r n nlysis f vrince perhps. Advnced mdelling techniques my eventully be used t build sphisticted explntins f hw the dt ddresses the riginl questin. But mny quntittive reserch prjects wuld never need t g tht fr; the questin wuld be nswered by simple descriptive sttistics. S it is with Qu/rttive dt nlysis. The mss f wrds generted by interviews r bservtinl dt needs t be described nd summrised. The questin my require the reserchers t seek reltinships between vrius themes tht hve been identified, r t relte behviur r ides t bigrphicl chrcteristics f respndents such s ge r gender. lmplictins fr plicy r prctice my be derived frm the dt, r interprettin sught f puzzling findings frm previus studies. Ultimtely thery culd be develped nd tested using dvnced nlyticl techniques. There re n 'quick fix' techniques in qulittive nlysis. Just s sftwre pckge such s the Sttisticl Pckge fr the Scil Sciences (SPSS) wn't tell yu which f the myrid sttisticl tests vilble t use t nlyse numericl dt, s there re prbbly s mny different wys f nlysing qulittive dt s there re qulittive reserchers ding it! Mny wuld rgue tht this is the wy it shuld be - qulittive reserch is n interprettive nd subjective exercise, nd the resercher is intimtely invlved in the prcess, nt lf frm it (Ppe nd Mys 2006). Hwever there re sme thereticl pprches t chse frm, which will be explred in the fllwing sectin. Fudhermre, there re sme cmmn prcesses, n mtter which pprch yu tke. Anlysis f qulittive dt usully ges thrugh sme r ll f the fllwing stges (thugh the rder my vry):,'. Fmiliristin with the dt thrugh review, reding, listening etc. Trnscriptin f tpe recrded mteril. Orgnistin nd indexing f dt fr esy retrievl nd identifictin Annymising f sensitive dt The NIHR RDS fr the Est M dlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS 6

10 . Cding (my be clled indexing). ldentifictin f themes. Re-cding. Develpment f prvisinl ctegries. Explrtin f reltinships between ctegries r Refinement f themes nd ctegries. Develpment f thery nd incrprtin f pre-existing knwledge. Testing f thery ginst the dt. Reprt writing, including excerpts frm riginl dt if pprprite (eg qutes frm interviews) These stges will be explred further in Sectin 3, giving yu n pprtunity t hve g t cding nd develping themes frm the smple trnscripts yu will find in Appendix Wht d yu wnt t get ut f yur dt? It isn't lwys necessry t g thrugh ll the stges bve, just s it isn't lwys necessry t use multivrite mdelling in sttistics! Let's tke the exmple f the reserch questin but the perceived helth needs f crers. Wht re the perceptins f crers living with peple with lerning disbility, s regrds their wn helth needs? Yu my simply be interested in finding ut the cmmunity services tht shuld be prvided t meet these perceived needs. Yu might wnt t knw wht srts f services re vlued r requested by the mjrity f crers. Mybe severl respndents mentin tht they struggle with depressin nd lneliness. There re three brd levels f nlysis tht culd be pursued here: One strtegy wuld be t simply cunt the number f times prticulr wrd r cncept ccurs (eg lneliness) in nrrtive. The qulittive dt cn then be ctegrised quntittively, nd subjected t sttisticl nlysis. Plicy decisins culd be bsed n the result. This kind f nlysis (smetimes clled cntent nlysisl) is nt truly qulittive, hwever, nd will nt be discussed in ny detil in this pck. Fr themtic nlysis we wuld wnt t g deeper thn this. All units f dt (eg sentences r prgrphs) referring t lneliness culd be given prticulr cde, extrcted nd exmined in mre detil. D prticipnts tlk f being lnely even when thers re present? Are there prticulr times f dy I Hwever, plese nte tht Beverley Hncck, in the intrductry resurce pck n qulittive reserch, defines cntent nlysis mre widely. Her definitin is clser t wht we re clling themtic nlysis. The NIHR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS 7

11 r week when they experience lneliness? ln wht terms d they express lneliness? D men nd wmen tlk f lneliness in different wys? Are thse wh spek f lneliness ls thse wh experience depressin? Themes culd eventully be develped such s 'lnely but never lne' r'these fur wlls'. Fr thereticl nlysis such s grunded thery (see Sectin 2) yu wuld wnt t g further still. Perhps yu hve develped theries s yu hve been nlysing yur dt but depressin being sscited with perceived lss f 'nrml' child/spuse. The disbility my be ttributed t n ccident, r t sme filure f medicl cre, withut which the persn cred fr wuld still be 'nrml'. Yu my be ble t test this emerging thery ginst existing theries f lss in the literture, r ginst further nlysis f the dt. Yu my even serch fr'devint cses', tht is dt which seems t cntrdict yur thery, nd seek t mdify yur thery t tke ccunt f this new finding. This prcess is smetimes knwn s'nlytic inductin', nd is used t build nd test emerging thery. S sme decisins hve t be mde by the resercher s t the questins she r he is sking f the dt, nd the depth f nlysis tht is required. lt my even cme dwn t the munt f time yu hve vilble, r yur ese f ccess t dequte resurces. Certinly there is n need t d mre nlysis thn yur questin demnds, but seemingly simple questins hve hbit f becming mre cmplex lng the wy! ln the next sectin we lk t different theries nd methds used in qulittive dt nlysis. The NIHR RDS fr the Est Midlnds / Y kshire & the Humber 2009 QUALITATIVE DATA ANALYSIS 8

12 3. Theries nd methds in qulittive dt nlysis ln Sectin 1 we lked t sme cmmn fetures f qulittive nlysis. ln this sectin, we will fcus n distinct pprches t undertking qulittive nlysis. There is n ne right wy t nlyse qulittive dt, nd there re severl pprches vilble. Much qulittive nlysis flls under the generl heding f 'themtic nlysis'. The cmmn fetures f undertking themtic nlysis f qulittive dt will be utlined in Sectin 3. Hwever, there re prticulr 'schls f thught', r thereticl pprches t qulittive nlysis, which it is imprtnt t be fmilir with, bth fr designing yur wn reserch nd fr criticlly pprising qulittive reserch evidence. The prticulr pprch yu tke t ny given study will depend n mny fctrs, nt lest: the reserch questin, the time yu hve vilble nd funders' pririties. Yu will lwys need t cnsider the verll ims f the nlysis -wht d yu wnt the dt t cntribute t, fr exmple nswering specific plicy-relted questin r generting new cnceptul r thereticl understndings in prticulr re. Sme pprches t qulittive nlysis re prbbly mre fmilir t yu thn thers. Fr exmple, mny studies in the helth field, in prticulr nursing, stte tht they tke 'Grunded Thery' pprch t nlysis. The im f this sectin is t intrduce yu t tw distinct pprches t qulittive nlysis. Firstly Grunded Thery, nd secndly Frmewrk Anlysis, which is incresingly cmmnly used in helth-relted reserch. The key fetures f ech pprch will be utlined in turn. Yu will then be sked t cnsider wht pprches might be suitble fr prticulr reserch prjects nd t think but hw yur chice f nlysis might ffect hw yu g but yur reserch. 3.1 Grunded Thery Grunded Thery evlved ut f reserch by scilgists Glser nd Struss (1967). Glser nd Struss were cncerned t utline n inductive methd f qulittive reserch which wuld llw scil thery t be generted systemticlly frm dt. Tht is, theries wuld be 'grunded' in rigrus empiricl reserch, rther thn prduced in the bstrct. Wht is thery? ln this pck we tke this t men generlisble ide r cncept, glened frm dt, tht helps t understnd the scil wrld in new r mre sphisticted wy, nd tht cn be tested in different settings. Grunded Thery is methdlgy; in ther wrds, it is wy f thinking but nd cnceptulising dt. lt is n pprch t reserch s whle nd s such cn use rnge f different methds. Hwever, reserchers frequently use the nlysis prcedures utlined in grunded thery withut tking n brd the whle methdlgicl pprch t reserch design. Grunded Thery nlysis is inductive, in tht the resulting thery 'emerges' frm the dt thrugh prcess f rigrus nd structured nlysis. The N HR RDS fr the Est Midlnds / Yrkshire & the Humbe 2009 QUALITATIVE DATA ANALYSIS

13 It is imprtnt t emphsise tht wht distinguishes grunded thery frm mny ther pprches t qulittive nlysis is this emphsis n thery s the finl utput f reserch (Struss nd Crbin, 1998). Wheres ther frms f qulittive nlysis my legitimtely 'stp' t the levels f descriptin r simple interprettin, the im f grunded thery is thereticl develpment. lts fcus then is clerly n wht hs ls been clled 'nlytic inductin' Wht d grunded therists men by thery? A 'grunded thery' cnsists f 'plusible reltinships' (Struss & Crbin, 1998) mng sets f cncepts, which re directly develped frm dt nlysis. Thery, in this sense, prvides set f testble prpsitins tht help us t understnd ur scil wrld mre clerly, rther thn n bslute 'truths'. The ppel f grunded thery nlysis is the structured nd detiled prcedures fr the genertin f thery frm dt. Grunded Thery strts with cler, but ften brd, reserch questin. This questin identifies the generl re t be studied. The reserch then trditinlly prceeds in stges, with the nlysis perfrmed fter ne stge f fieldwrk determining wht r wh will be studied next nd which methds will be used. As result, qulittive nd quntittive methds cn be used within the sme study t different stges. ln terms f nlysing qulittive dt generted, t the hert f grunded thery is the ide f the cnstnt cmprtive methd. ln this methd, cncepts r ctegries emerging frm ne stge f the dt nlysis re cmpred with cncepts emerging frm the next. The resercher lks fr reltinships between these cncepts nd ctegries, by cnstntly cmpring them, t frm the bsis f the emerging thery. The resercher cntinues with this prcess f cnstnt cmprisn until they rech wht is clled 'thereticl sturtin', tht is n new significnt ctegries r cncepts re emerging. ln terms f the prcess f ding grunded thery nlysis, the resercher typiclly ges thrugh severl prcedures. These re nt liner stges, rther the prcess f grunded thery is cumultive nd cn invlve frequent revisiting f dt in the light f the new nlyticl ides tht emerge s dt cllectin nd n s resses: pen cding (initilfmiliristin with the dt). delinetin f emergent cncepts cnc ptul cding (using emergent cncepts). refinement f cnceptul cding schemes. clustering f cncepts t frm nlyticl ctegries. serching fr cre ctegries. cre ctegries led t identifictin f cre thery testing f emerging thery by reference t ther reserch nd t scil/culturl/ecnmic fctrs tht ffect the re f stud Grunded Thery nlysis requires 'thereticl sensitivity'. This is described s n bility't see the reserch situtin nd its sscited dt in new wys, nd t explre the dt's ptentil fr develping thery' (Struss nd Crbin, The NIHR RDS fr the Est M dlnds / Yrksh re & the Humber 2009 QUALITATIVE DATA ANALYSIS 10

14 199Q:44). This is cretive prcess but must be grunded in scientific pprch. ln Grunded Thery texts, there re ls discussins f hw t distnce neself frm ssumptins befre the fieldwrk nd frm the emerging nlysis, in rder t return repetedly t the dt. All thereticl develpments re t be seen s prvisinl until prven by the dt nd by vlidtin frm thers. There is strng trditin in grunded thery tht 'hw t d it' cn nly be lernt frm experience. Mentring nd wrking in tems hve been seen s imprtnt in develping reserch skills nd in ensuring rigur f nlysis nd thery genertin. An exmple f hw Grunded Thery nlysis prceeds in reserch prject is given belw. The exmple cmes frm published study (Kendll 1998) f fmilies f children with Attentin Deficit Hyperctivity Disrder (ADHD). The full reference fr the rticle is given in the reference list t the end f this sectin. ln their reprting f methdlgy, the uth(s) utline hw they went but cnducting grunded thery nlysis: The NIHR RDS fr the Est Midlnds / Yrksh re & the Humber 2009 QUALITATIVE DATA ANALYSIS 11

15 'All interviews were udi tped nd trnscribed. Trnscriptins f the interviews were nlysed using the cnstnt cmprtive methd (Glser, 1976, 1993; Glser nd Struss, 1967). Dt nlysis ws itertive with dt cllectin. Dt were nlysed s they were cllected thrugh the prcess f cding. Thrugh pen cding, cmmn themes f everydy life were identified nd exmined in reltin t the cntext, menings, nd circumstnces f living with ADHD r with n ADHD fmily member. lnterviews were cded by cnceptulising underlying ptterns in the dt. lnitil dt nlysis guided further nd mre fcused dt cllectin, leding t further cnceptulistin f the dt nd refinement f the cding schemes. As prt f the nlysis, similrities nd differences but the cmpiled cdes were clustered tgether t crete ctegries. Cnceptul sturtin ws reched when n new ctegries were generted. Thrugh the prcess f pen cding nd thereticl cding, the bsic scil psychlgicl prblem (r cre vrible) nd the bsic scil prcess emerged. Thereticl mems were written thrughut the cding prcess t trck cnceptul decisins nd ides s they were ccurring. Thereticl mems ls were cded using thereticl cding nd served s the bsis fr writing the grunded thery during the finl phse f the nlysis. A cmputer sftwre pckge, The Ethngrph 95, ws used t mnge the dt. Credibility f the dt ws estblished using the techniques f persistent bservtin (recurring bservtins f fmily members during nd between individul nd fmily interviews), peer debriefing (presenting nlyses nd cnceptul bstrctins f the dt t ther expert qulittive reserchers t explre inquirer bises nd t clrify the menings nd the bsis fr interprettins), nd member checks (presenting the nlysis f the dt t infrmnts fr their cnfirmtin r revisin) (Lincln & Gub, 1985). ln dditin, tw helth prfessinls wh Were cnsidered 'experts' n ADHD, nd wh ls hd children with ADHD, reviewed the thereticl cdes nd grunded thery nd verified tht the find s reflected their experience.' J, 1998).' There hve been mny develpments in Grunded Thery since the riginl text in lf yu re interested in pursuing Grunded Thery reserch, these cn be explred in the suggested further reding. Struss nd Crbin (1990) in prticulr hve prduced new pprches t, nd detils f, cding nd guides n hw t d grunded thery nlysis. Grunded Thery hs ls been hugely influentil in generlly chnging the wy tht qulittive nlysis is undertken. Mst pprches t qulittive nlysis, fr exmple, stress the imprtnce f interprettin being 'grunded' in detiled dt nlysis. The N HR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS 12

16 S ested Further Redin Hllwy I nd Tdres L (2006) Grunded Thery ln Gerrish K nd Lcey A (2006) Ihe Reserch Prcess in Nursing Oxfrd: Blckwell. Kendll, J (1998) 'Outlsting disruptin: the prcess f reinvestment in fmilies with ADHD children' Qulittive Helth Reserch 9:2, Glser, B nd Struss, A (1967) The Discvery f Grunded Thery. Lndn Weidenfield & Niclsn. Glser, B (1978) Thereticl Sensitivity. Clifrni: Scilgy Press. Struss, A (1987) Qulittive Anlysis fr Scil Sclenfisfs. New Yrk: Cmbridge University Press. Struss, A nd Crbin, J (1990) Bsics f Qulittive Reserch: Grunded Thery Prcedures nd Lndn 3.2 Frmewrk Anlysis A secnd, mre recent, pprch t qulittive nlysis is gining ppulrity in helth - relted reserch, nmely Frmewrk Anlysis (Ritchie nd Spencer, 1994). ln cntrst t grunded thery, Frmewrk Anlysis ws explicitly develped in the cntext f pplied plicy reserch. Applied reserch ims t meet specific infrmtin needs nd prvide utcmes r recmmendtins, ften within shrt timescle. Frmewrk Anlysis shres mny f the cmmn fetures f much qulittive nlysis which were utlined in Sectin 1, nd f wht is ften clled 'themtic nlysis'. The benefit f Frmewrk Anlysis is tht it prvides systemtic nd visible stges t the nlysis prcess, s tht funders nd thers, cn be cler but the stges by which the results hve been btined frm the dt. Als, lthugh the generl pprch in Frmewrk Anlysis is inductive, this frm f nlysis llws fr the inclusin f priri s well s emergent cncepts, fr exmple in cding. This cn be impdnt in mny pplied studies, where there re specific issues tht the funders r ther stkehlders wnt t be ddressed. Frmewrk Anlysis hs 5 key stges. These cn be undertken in liner fshin nd therefre ll dt cn be cllected befre nlysis begins, lthugh frmewrk nlysis cn eqully be used when dt cllectin nd nlysis ccur cncurrently. Key stges f Frmewrk Anlysis. Fmiliristin. ldentifying themtic frmewrk lndexing Chrting. Mpping nd lnterprettin The NIHR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS 13

17 Fmiliristin: whle r prtil trnscriptin nd reding f the dt. ldentifying themtic frmewrk: this is the initil cding frmewrk which is develped bth frm priri issues nd frm emerging issues frm the fmiliristin stge. This themtic frmewrk shuld be develped nd refined during subsequent stges. lndexing: the prcess f pplying the themtic frmewrk t the dt, using numericl r textul cdes t identify specific pieces f dt which crrespnd t differing themes (this is mre cmmnly clled cding in ther qulittive nlysis pprches -see Sectin 3). Ghrting: using hedings frm the themtic frmewrk t crete chrts f yur dt s tht yu cn esily red crss the whle dtset. Chrts cn be either themtic fr ech theme crss ll respndents (cses) r by cse fr ech respndent crss ll themes. Exmples: Themtic Chrt Cse 1 Cse 2 Cse 3 etc Theme Gse Chrt Theme I Theme 2 Theme 3 etc Cse ln the chrt bxes, yu culd put line nd pge references t relevnt pssges in the trnscripts. Yu might ls wnt t include sme text, eg key wrds r shrtened quttins s reminder f wht is being referred t. Fr exmple, the cse chrt belw is frm qulittive study f cmplementry therpy prvisin vi primry cre, which used Frmewrk Anlysis (Luff nd Thms, 1999). The themes bxes cntin bth prphrses f key issues s well s snippets f dt, t 'jg' the resercher's memry but the cntent f the themes. Alngside this text, there re pge nd line references t id esy retrieve f the riginl dt in the trnscripts: The NIHR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS 14

18 Exmple Gse Chrt Theme: Service rtinle Theme: Rle f cmplementry therpies Theme: Limits t integrtin GP Number 1 Public wnts them (2:25) Prviding chice fr ptients (4:5) Fr cnditins 'rthdx medicine fils'(5:12) Allwing ptient t tke respnsibility (5:22) 'Cnceptul differences' (7:15) Rnge f nd differences between therpies (7:31) Treting the whle persn (6:1) Mney (7:17,8:8, 9:24\ Mpping nd lnterprettin: this mens serching fr ptterns, sscitins, cncepts, nd explntins in yur dt, ided by visul displys nd plts. Ritchie nd Spencer, (1994) suggest tht t this stge, the qulittive nlyst might be iming t define cncepts, mp the rnge nd nture f phenmen, crete typlgies, find sscitins within the dt, prvide explntins r develp strtegies. They emphsis tht which f these res the nlyst chses t fcus n will depend bth n the themes tht hve emerged frm the dt nd the riginl reserch questin. Ritchie nd Spencer cknwledge tht 'this prt f the nlyticl prcess is the mst difficult t describe' (1994:186). They ffer severl exmples frm their wn reserch, including digrms they hve used t visully present their ides, t try nd demnstrte this prcess. Miles nd Hubermn (1994) ls ffer wide rnge f disply ides, which my be useful fr explring yur dt in the cntext f Frmewrk Anlysis. The centrl im f these techniques is t enble yu t visully disply ides frm the dt s n id in develping nd testing interprettins. Fr exmple, using the study f cmplementry therpy prvisin in primry cre mentined bve, we were interested t see if there were significnt differences/ptterns in ttitudes mng GPs nd cmplementry prctitiners in sme res (i.e. t lk fr sscitins between prfessinl grup nd ttitudes). The need fr, nd type f, reserch required t bck up cmplementry therpy prvisin ws ne such re f pssible sscitin which emerged frm nlysis f the dt cllected. T id us in explring this re, we visully pltted ur respndents 'psitins', using their identifictin number, n the current stte f 'prf in tw key res f reserch (efficcy nd cst-effectiveness). A shrtened versin f ur wrking digrm is presented belw: The NIHR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS t5

19 Need mre prf l, 5, 6,3, 4 9,7 t2 Prf sufficient 18,2, 10,8, 15, 1l GPs CPs 9 8,2, l0 18, 15 7,12, l, 5, 6,3, 4 l1 Need mre cst-effectiveness The digrm seemed t cnfirm ur ides, which hd develped frm ur chrts, mems nd the rw dt, tht GPs were mre likely t think tht mre reserch ws needed, prticulrly in the re f efficcy, thn cmplementry prctitiners. lt ls suggested this tendency, but within mre mixed picture, in reltin t cst-effectiveness reserch. This digrm ws used by the reserchers s strting pint t explre ther pssible ptterns r sscitins, fr exmple, were there further similrities mng the clustered GPs r CPs like ge, sex, type f generl prctice in which they wrked, ther ttitudes etc. Suggested further reding: Richie, J nd Spencer, L (1994), 'Qulittive dt nlysis fr pplied plicy reserch', in Brymn nd Burgess, eds., Anlysing Qulittive Df, Lndn Rutledge, p Miles, MB nd Hubermn, AM (1994) Qulittive Dt Anlysis; An expnded surcebk. Lndn: Sge The NIHR RDS fr the Est M dlnds / Yrksh re & the Humber 2009 QUALITATIVE OATA ANALYSIS 16

20 Exercise 1 Cnsider the fllwing reserch prject. Which f the tw pprches t nlysis might yu tke nd why? 1. The prblem f nn-ttendnce in n ut-ptient deprtment 2. A study t explre the rgnistin nd integrtin f n cupuncture service within primry cre tem frm the perspective f prfessinl prticipnts. 1. A grunded thery pprch wuld be pprprite. The reserch priect is brd nd explrtry in nture. There re few r n priri issues r necessry stfting pints suggested (eg specified smple) fr the reserch beynd the ut-ptient setting. Such study culd esily be cncerned with generting thery but nn-ttendnce behviur, which culd then be fesfed crss rnge f settings cncerned with DNA ptterns. lt culd prvide hypthesis fr subsequent deductive pprches s well. 2. Frmewrk nlysis see/ns mst pprprite here. The questin is spec/ic nd suggests pre-designed smple (prfessinl prticipnf$ s well s sme priri rssues (rgnistin nd integrtin), which will need t be explicitly ddressed. The study my generte theries tht culd be tested elsewhere, but the primry cncern ppers t be with descriptin nd interprettin f wht is hppening in specific setting. The N HR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS 17