Docent: Dr. Gijs Hesselink/Dr. Marianne Dees. Docent: Dr. Marieke Groot. Docent: Drs. Jeanette Heldens

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1 Reqder 17 qpri! 2Ol4

2 Prgrmm dnderdglt pril 2014 Cre Onderzekschldg ver kwl ittief nderzek Lktie: De Mulin A, rute 124 Ochtendprgrdmm: uur Anlyse met behulp vn mteril diepte-interviews Dcent: Dr. Gijs Hesselink/Dr. Mrinne Dees Tutr: Drs. Jsper vn Riet Pp Ll-.00 uur uur Kffie Criteri vr berdeling publictie vn (kw littief) nderzeks rti ke! Anlyse pzet rtikel met behulp vn criteri Dcent: Dr. Mrieke Grt Tutr: Drs. Jsper vn Riet Pp uur Lunch in resturnt de Hrdt Middgprgrmm: uur!nterviewtrining Dcent: Drs. Jenette Heldens Tutr: Drs. Jsper vn Riet Pp uur uur Thee Evlutie en slt

3 Literqtuur l7 qpri I v.rlt. Lcey, Luff: Qulittive Dt Anlysis (2007l. Wester: Anlyse vn kwlittief nderzeksmteril (2004) RATS guidelines: Clrk JP. Hw t peer review qulittive mnuscript. ln Peer Review in Helth Sciences. Secnd editin. Edited by Gdlee F, Jeffersn T. Lndn: BMJ Bks; 2003:2L Tng, Sinsbury nd Crig: Cnslidted criteri fr reprting qulittive reserch (CORfQ): 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;1L:

4 IVf,ftrnl ínsfffr"rf,e f,rrr ËÍetrtfr fr[eserrh The NIHR ffierench Derign Serwice fsr 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 tne 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, 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 S1 4DP Hrvrd Peditric Helth Services 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 University f Nttinghm University Prk Nttinghm NG7 2RD Tel: 01 í www. rds+stm id l nds. n i h r.c. u k Leicester: enquiries-ln R@rds+stmid lnds.rq. u k Nttinghm: enquiries-n DL@rds-estmid lnds.rs. u k The NIHR RDS fr Yrkshire & the Humber ScHARR The University f Sheffield Regent Curt 30 Regent Street Sheffïeld S1 4DA Tel: Sheffield: rds-vh@sheffield.c.uk Leeds: rds-vh@leeds.c.uk rds-vh@vrk.c.uk Gpyright f The NIHR RDS Elf,, Ytl (2e) The N HR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

6 Tble f Gntents Pge 1. lntrductin Wht is Qulittive Dt? 5 3. Theries nd Methds in Qulittive Dt Anlysis... I 4. Stges in Qulittive Dt Anlysis Ensuring Rigur Prcticlities... 3í 7. Sftwre Pckges Summry 37 References Glssry 39 Appendix í - Smple Trnscript (Derek) 41 Appendix 2 - Smple Trnscript (Sue) 45 The N HR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

7 í. lntrductin 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 e044. 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..: T:.dÍedus.. ómè f th,è'théretiöl mödels'within whièh qulittive dticn be nlysed, nd select the mst pprprite ne fr prticulr piece f resercé. T understnd the stges invlved in qulittive dt nlysis, nd gin sme experience in cding nd develping ctegries. r ïö àssëss hw rlgur cn bè miimïsèd in quàlitàtive dàt nlysis,. T ppl, prcticl slutins t the prcess f qulittive dt nlysis. Thè NIHR RDS Ír the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

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. 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 fllwing: Trnscipts f individul interuiews with members f stff in the deprtment Fcus grup trnscripts Field ntes frm bservtin f stff meetings Cpr'es f diry entries tht stff members hve been sked t cmplete ech dy Criticl incident recrdings frm specific episdes f vilence r buse Resercher mems nd reflectins 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 fí the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

9 2.í Wht d we men by nlysis? euntittive 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 tbullins nd clculting mens nd stndrd devitins. Further nlysis wuld blild n these initil finàings, 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/ftive 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 wéich f the myrid sttisticl tests vilble t use t nlyse numericl àt, 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 exércise, 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. Furthermre, 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 Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

10 . Cding (my be clled indexing) ldentifictin f themes. Re-cding. Develpment f prvisinl ctegries Explrtin f re ltinsh i ps between ctegries. ReÍinement 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. r 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 t 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 OUALITATIVE DATA ANALYSIS

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 nàlysing yur dt but depressin being sscited with perceived lss f 'nrmlr 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 iinoing. 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 N HR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

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 i;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 iime 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 inirduce 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, int fretps 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 whè 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 NIHR RDS fr the Est Midlnds / Yrkshire & the Humber 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, ttre 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 ieltinships' (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 bód, 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 untilthey 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 óf grunded thery is cumultive nd cn invlve frequent revisiting f dt in the iight f the new nlyticl ides tht emerge s dt cllectin nd resses:. pen cding (initilfmiliristin with the dt). delinetin f emergent cncepts cflc 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 qt lqqfl 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 N HR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

14 1990:44). 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 lemt 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 / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSTS

15 ndtrnscribed.trnscriptinsftheinterviews wàre ànrysed using the cnstnt cmprtive methd (Glser, 1976, 1993; Glser nó Struss,lS6Z;. Dt nlysis ws itertive with dt cllectin. Dt were nlysed s they were cllected thrugh the prcess f cding. Thrugh pen cdihg, cmmn themes f everydy life were identified nd exmined in reltin t tée 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 fllectin, leding t further cnceptulistin f the dt nd refinement f the cding schemes.-as prt f the nlysis, similrities nd differences but the cmpíed 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 psychólgicl prblem (r cre vrible) nd the bsic scil prcess emerged. Thereticàl 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 luring 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 Í 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 findings reflected their experience.' (Kendll 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 explreà in tf,e 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 génerlly chnging the wy tht qulittive nlysis is undertken. Mst pprèhes t qulitíve 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 2OOg QUALITATIVE DATA ANALYSIS 12

16 Further Re unded Thery ln Gerrish K nd Lcey A (2006) Ihe Reserch Prcess in Nursing Oxfrd: Blckwell. Kendll, J (1gg8)'Ouflsting disruptin: the prcess f reinvestment in fmilies with ADHD children' Qutittive Helth Reserch 9:2' ' Glser, B nd Struss, A (1967) The Discvery f Grunded Thery' Lndn: Weidenfield & Niclsn. Gtser, B (1978) Theretict sensitivity. clifrni: scilgy Press. Struss, A (1987) Qutittive Antysis fr Scil ScrenÍlsfs. New Yrk: Cmbridge University Press. Struss, A nd Crbin, J (1990) Bsrbs f Qulittive Reserch: Grunded Thery Prcedures nd Techniques. Lndn: Sge' 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, 1gg4). ln cntrst t grunded thery, Frmewrk Anlysis ws explicitly deveíped in the cntexi f pplied plicy reserch. Applied reserch ims t meet speciflc 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 às emergent cncepts, fr exmple in cding. This cn be imprtnt 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 theréfre 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

17 Fmiliristin: whle r prtil trnscriptin nd reding f the dt. ldentifying themtic frmewrk: this is the initil cding frmewrk which is Oevétpéd 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 numericàl 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). Chrting: using hedings frm the themtic frmewrk t crete chrts f yur dtà s tht yu cn esily red crss the whle dtset. Chrts cn be éitner themtic fi ech theme crss ll respndents (cses) r by cse fr ech respndent crss ll themes. Exmples: Themtic Ghrt Cse 1 Cse 2 Cse 3 etc Theme Cse Chrt Theme 1 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 texi, íhere re pge nd line references t id esy retrieve f the riginl dt in the trnscripts: The N HR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

18 Exmple Gse Chrt Theme: Seryice rtinle Theme: Rle f cmplementry theries 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 ersn (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'(í994:186). 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 vióully 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 N HR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 OUALITATIVE DATA ANALYSIS

19 Need mre efficcy prf l, 5,6,3,4 9,7 Prf suíficient 18, 2, 10, 8, 15, 1 I GPs 9 8,2, 10 18, 15 7, 12, l, 5, 6,3, 4 Need mre cst-effectiveness The digrm seemed t cnfirm ur ides, rruhich 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: ichie, J nd Spencer, L (1994), 'Qulittive dt nlysis fr pplied plicy ', in Brymn nd Burgess, eds., Anlysing Qu/iftive Dt, Lndn: Rutledge, p Miles, MB nd Hubermn, AM (1994) Qulittive Dt Anlysis; An expnded surcebk. Lndn: Sge. The NIHR RDS fr the Est Midlnds / Yrkshire & the HumbeÍ 2009 QUALITATIVE OATA ANALYSIS

20 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 piimry 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 stríing pinis suggósíed (eg specified smple) fr the reserch beynd the ut-plient settin.- Such study culd esity be cncerned with generting thery but nn-ttendnce behviur, which culd then be ÍesÍed crss rngó f settings cncemed with DNA ptterns. lt culd prvide hypthesis fr subsequent deductive pprches s wel/. 2. Frmewrk ntysis seems mst pprprite here. The questin is specffic nd suggesfs pre-de signed smple (prfessinl prticipnís) s well s sme prirí rssues (rgnistin nd integrtin), which will need t be explicitly ddressed. The stidy 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

21 yu hve chsen ne f the nlysis pprches fr the reserch prjects bve. Nw cnsider hw yu wuld g but ech f the studies, given the nlysis pprch yu re using: 1. The prblem f nn-ttendnce in ut-ptients. yu culd begin in severl wys. Yu might fr exmple wnt t tlk first t hspitl dctrs, nurses nd receptinrbfs Í get their perceptins f resns fr'nn-ttendnce. Yu might try nd cntct peple wh hve nt ttended directty r insted sk the generl pubtic fr their views, fr exmple in fcus grups. Grunded thery nlysis f yur first stge f fieldwrk dt shuld then determine where yu decide t lk next nd the methds yu emply. As yur reserch prgresses, yu will be cnstntly cmpring the cncepts. nd ctegies emerging frm ech stge f the nlysis until yu feel sfrcfi'ed íht yu hie cvered the questin s fully s pssrb/e, in ther wrds tht yu hve reched thereticl sturtin. tn develping nd testing yur emerging thery but why peple d nt ttend sc;heduled ppintments with hspitl dctrs, yu will ls wnt t bring in existing reserch evidence in the re nd cnsider the scil rgnistin f hspitls. 2. A study t explre the rgnistin nd integrtin f n cupuncture service within primry cre tem frm the perspective f prfessinl prticipnts.. Yu re tikety t hve lredy identified the primry cre tem in questin, but if nt yu wóuld need t find tem which ffers n cupuncture setvice wh re willing t prticipte.. yu wuld then identify wh were the relevnt prfessinl ptticipnts (GP/s, cupuncturist/s, prctice nurse/s etc) nd think but hw yu might ccess their perceptins. lnterviews seem n bvius chice f methd, but yu might ls cnsider fcus grups r bservtin insted f, r s well s, interviewing. Yu might develóp semi-structured interview schedule bsed n existing literture in the re nd the priri rgnistin nd integrtin issues.. Yu wuld then pilt the schedule with similr prfessin/s if t llpssrb/e. Thè NIHR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

22 Deperdlrg the cnstrints n yur priect (time etc) yu wuld then im t d smeànlysis ", s the interviews prgress r yu my cnduct ll the dt cllectin befre undeftking the nlysis. yur initil fmiliristin nd cding síges wutd drw n the pririissues s well s identifying emergent themes frm the dt. As yu mve thrugh Íhe síges f Frimiwrk Alntysis, yu will devetp Íhese themes by chrting nd màpping exercrses, s well s referring bck t the riginl trnscripts. The utput frm yur nlysis might be lrgety descriptive piece..n. the sevice, but wilt pibbly im t ffer interprettin f the key rcsge9 tht hve emerqed s thi the reóerch cn infrm future develpments f this kind. 4. Stges in Qulittive AnlYsis Hving lked t the generl principles f qulittive nlysis (Secti.n 1) -nd then til specific ppràcfres (Sectin 2), we nw turn t the prcticlities. Wht prcticl picesses re invlved in ctully crrying ut qulittive dt nlysis? Hw lng des it ll tke? The NIHR RDS fr the Est Midlnds / Yrkshire & the Humber 2OO9 QUALITATTVE DATA ANALYSIS í9

23 The nswer t the lst questin is prbbly 'hw lng hve yu gt?' As discussed in Sectin 2, frmewrk nlysis pprch is much mre suited t limited time frme thn grunded thery pprch. But there's n denying tht ny qulittive nlysis is very time cnsuming nd demnding prcess. ln this seótin we will tke yu thrugh sme f the erly stges in qulittive nlysis, fllwing generl themtic nlysis pprch. We will ls highlight pints where frmewrk nlysis nd grunded thery wuld tke seprte rute. 4.1 Trnscriptin Almst ll qulittive reserch studies invlve sme degree f trnscriptin - the dt my be tpe recrded interviews, fcus grups, vide recrdings, r hndwritten field ntes. lt is nt pprprite, usully, t write up summry ntes frm tpe recrding - unless the wrds re trnscribed verbtim, the resercher is likely t bis the trnscriptin by nly including thse sectins tht seem relevnt r interesting t them. Mny reserchers wuld ls include sme nn-verbl cues in the trnscript - silence my cmmunicte embrrssment r emtinl distress, r simply puse fr thught. Wrds such s 'well... er. '.... I suppse... re imprtnt elements f cnverstin nd shuld nt be ignred. Lughter r gestures my ls give dded mening t the spken wrd. li smene eée is trnscribing yur mteril, it is imprtnt t tell them hw much f this nn-verbl mtter t include. lí yu hve never trnscribed mteril, it is useful exercise t d little yurself. The N HR RDS fr the Est Midlnds / Yrkshire & the Humber 2OO9 QUALITATIVE DATA ANALYSIS 20

24 Find willing vlunteer - perhps member f yur fmily, r friend r cllegue. As1 them t tke prt in n infrml interview with yu, lsting perhps ten minutes. Yu culd chse t sk them but their definitin f helthy persn, then try nd prbe wht it is fr them tht mkes tht persn helthy. Tpe recrd the interview, then trnscribe it int wrd prcessing pckge in yur wn time, including s much nn-verbl mteril s yu cn.. Hw lng did the trnscriptin tke yu, cmpred with the riginl interview? Unless yu're very skilled typist nd hve prticully cler tpe, it is likely tht the trnscribing prcess tk t lest fur times s lng s the interview. lt my hve tken evt:en lnger. Yu wilt prbbly hve fund tht yur first ttempt t {rnscribing ws mzingly time cnsuming. Hwever yu will be pretty fmilir with the dt by the time yu finished! Highlight the nn-verbl cmmunictin yu were ble t include. Wht des it tell yu, in dditin t the wrds yu hve recrded? Depending n the fluency r theruise f yur vlunteer, yu will prbbly hve few 'er's ànd 'um's, but this dds t the relism nd credibility f yur dt, s well s giving clues s t hw the respndent ws feeling. Recrding lughter, mvements ànd 'sides' /s helps t mke the dt live when yu re-red it severl dys r weeks lter.. Lk t the questins yu sked, nd ny cmments yu mde. Hve yu led the respndent in ny wy, r missed imprtnt clues tht they gve yu? Yu my well find yu hve interrupted yur respndent, r sked n inpprpite questin; trnscriptin is slutry experience in evluting yur wn interview tech niques.. Listen t the tpe gin, with the trnscript in frnt f yu. Hve yu chnged ny f the wrds frm the tpe, perhps just t mke sentence mre grmmticlly crrect? Hve yu trnscribed everything ccurtely? Chnging wrds r phrses t mke them grmmticlly crrect is nt necessry, nd my indveríentty chnge fhe sense f wht ws sid lf necessry, cttquiàlisms nd dd usge f lnguge cn be explined in the ccmpnying text when yu cme t write reprt. The NIHR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

25 4.2 Orgnising yur Dt After trnscriptin, it is necessry t rgnise yur dt int esily retrievble sectins. Yu my wish t give ech interview number r cde, r t brek up field ntes int sectins identified by dte, r by cntext. lnterviewees will need t be given pseudnyms r referred t by cde number. A secure file will be neeóed tht links pseudnyms nd cde numbers t the riginl infrmnts, but s with ny reseich this file is cnfidentil nd wuld usully be destryed fter cmpletin f the prject. Similrly nmes nd ther identifible mteril shuld be remved frm the trnscripts. Nrrtive dt needs t be numbered using line r prgrph numbers, s tht ny unit f text yu use cn be trced bck t its riginl cntext. lf yu re using sftwre pckge t d the nlysis, this my be dne fr yu utmticlly by the cmputer, but yu my need t decide upn yur unit f nlysis - whether yu wish ech wrd, ech line, ech sentence r ech prgrph t be numbered. lf yu re wrking with 'hrd' cpies (i.e. type r hnd writtén sheets) yu wuld be well dvised t mke severl cpies f ech t this pint, t vid lsing dt when the nlysis stges begin. Similrly wrd prcessed files shuld be bcked up nd stred independently. 4.3 Fmiliristin The bve prcedures will hve begun the prcess f fmiliristin. By this we men the resercher listening t tpes nd wtching vide mteril, reding nd re-reding the dt, mking mems nd summries befre the frml nlysis begins. Ínis is n essentil stge, nd is prticulrly imprtnt if the min resercher hs nt gthered llthe dt themselves. 4.4 Cding Befre we strt this sectin, it wuld be helpful if yu red thrugh the smple interview trnscripts t Appendix 1 nd 2. They re excerpts frm series f interviews crried ut with peple wh hd experienced hert ttck yer previusly, t explre perceptins f helth nd f their wn recvery. lnterviews tk plce in the respndents' hme, nd lsted but n hur' After fmiliristin with the mteril, we need t d sme preliminry cding (this wuld be clled pen cding in grunded thery). Lets ssume we re interested in ides f hw the respndents cnceptulise the hert ttck, its cuse nd its impct n their lives. Certin ides crp up in the trnscript redily, nd we cn give these preliminry cde. Fr exmple, in Sectin 1 f Derek's interview, he tlks but the 'shck' f hving hert ttck. The NIHR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE OATA ANALYSIS

26 H,ghlight thse lines in Derek's interview which refer t the shck f hving hert ttck. yu shuld hve fund tw instnces where Derek used this wrd (lines 14 nd 16), nd tw frm the interuiewer (line 19). Hwever there re ther phrses tht Dérek uses fhí cutd ls be interpreted s refening t the shck f the dignsis. Fr exmple, yu my wnt t highlight 'l were ne f them peple thl never thught it culd hppen' (line 14) s ls expressing s yu nw hve yur first prvisinl cde, clled 'shck'. lt is likely t be mdified lter, but servés t begin the prcess f ctegrising nd nlysing the dt. Cdes cn be identified by 'in viv' terms tht the respndents themselves use. Fr exmple 'just pld n; (lines 28 nd 159) typifies Derek's descriptin f his ttempts t live with his disbility. Or cdes my be nmed by the resercher, t include vriety f wys tht respndents express n underlying cncept. An exmple f this frm Derek's interview might be 'cnfusin', cde tht wuld include Derek's cmment 'ljust cn't wrk it ut smetimes' (line 75). lf yu re using frmewrk nlysis, yu my t this stge hve priri cncepts yu wish t usè s cdes. Yu my wnt t knw, fr instnce, but hw peple wh hve hd hert ttck cnceptulise the cuses f the ttck. Frm existing literture, yu my knw tht these cn be divided int physicl cuses, psych-lgicl cuóes, ides f luck, genetic inheritnce nd s n. Yu culd ihén serch the dt fr mteril tht culd be cded under these hedings.. Using highlighter pens f different clurs, r cdes in the mrgin, red thrugh the rest f Derek's trnscript, develping cdes frm the dt.. D the sme with Sue's interview, nting which ides re similr t thse in Derek's interview, nd which yu hve t develp new cdes fr. yu witt hve fund sme cdes tht cn be pplied t ides in bth interviews. 'Fer' crps up in bth, prticutrty in the cntext f hving nther hert ttck. Bth interviewees tlk but nt tking enugh exercise, nd hving t cut dwn n wrk ctivity. Bth discuss /ifesfyle chnges they hve mde since the hert ttck. But yu will hve fund sme ides in ech tht re nt mirrred in the ther. Derek ttks buf chesí pin, nd tking medictin fr it. Sue desnï mentin pin t ll, but des mentin medictin. Yu my well hve nticed difference in the wy the tw respndents tlk but their médictin - Sue sees it s wy f ctively cntrlling her disese nd prmting helth, Derek sees his ngin Spry s lst resrt, t be used if he cn't màge ny ther wy. ln lking t these differences, yu re beginning t refine yuródes - fter using 'medictin' s preliminry cde, we culd nw begin i nlyse this cncepts further. Mybe we decide t plce the cde The NIHR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS 23

27 ,medictin' int ctegry clled 'mnging the symptms" 'tking cntrl f the disese', r'cping with chest pin'. Hwever yu my then ntice tht ther dt ls flls int these new revised ctegrieó. 'Mnging the symptms' culd ls includes Derek's cmment's rn-s the pinlmes n tstp...l dn't mess but'(line 62) S9:9me degree f re-cding nw needs t be dne, nd mny units f dt will fll int mre thn ne ctegry.. f-f thrugh the dt gin, with the ide f frming these brder ctegries. Write dwn, n Seprte piece f pper, fur r five brder ides nd, undemeth ech, list f cdes tht culd cntribute t ech. One such ctegry culd be'cping with returning t wrk'. Cdes tht cntribute t tht my be: Tking mre time 'l'll d them tmrrw'. Struggling with PhYsiclwrk Cutting dwn n stres{hevy wplk 4.5 Themes Yu hve nw begun t identify themes r emergent cncepts, nd will engge in re-cding t develp mre well defined ctegries. One f these ctegries culd be 'physicl cuses f the hert ttck'. Bth respndents discusó this t vrius pints, but this ctegry culd ls hve been identified pririfrm the literture in frmewrk nlysis' L""k th*.gh y"* list f cdes, nd identify thse tht wuld infrm this ctegry f,perceivàd pfrysicl cuses'. Then lk bck thrugh the interviews nd see if theie re ny ther references tht yu hve missed. Derek expresses bewilderment tht he shuld hve hd hert ttck t ll, given hii physicl fitness nd ctivity (ine )..H..e wnders whether óhnge t'móre mechnistin t wrk my hve precipitted tht ttck, s he ws lulking /ess. Sue expresses her betieí tht she is nw fitter tht she ws t the time {her hert ttck (tines 82-83), nd sííes tht she ws nt tking ny exercise in the yers befre she hd her herí ttck. She /s sfresses the lrge wrkld she ws in her ir The N HR ROS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

28 With frmewrk pprch, it wuld be likely tht sme f the themes emerging frm the dt wuld ls be the identified issues with which yu begn yur reserch. Yur dt wuld cnflrm their imprtnce, in this cse, nd enble yu t explre them further. lf, n the ther hnd, yu re tking grunded thery pprch, yu wuld try t ensure tht ll the emergent themes were generted frm the dt itself, lthugh yu might lter incrprte ther thereticl ides in yur nlysis. A grund]ed-therypprch wuld ls be prepred t test ides generted in erly dt nlysis in further dt cllectin. Hw O the tw respndents cnceptulise 'helth'? Wht theries but ly perceptins f helth culd yu test further in lter dt cllectin? ln lines Sue expresses smething but being helthy despite hving dignsis f heft drsese. She /s defines helth s hving blnce between wík nd rest (tines ). Derek defines helth in functinl terms, being ble t climb hiils withut symptms (line 111). Mybe the differences re relted t gender - re wmen mre tikely t define helth in cmplex, hlistic terms, whéres men relte it mre t physict functining? Yu culd test ut this ide in future interviews with bth Obviusly we cnnt g very fr with the prcess f nlysis with the smple trnscripis prvided here. Nrmlly yu wuld hve much mre dt t nlyse, nd the prcesses described bve wuld generte mny themes nd ctegries, which wuld need refining nd develping. Using grunded thery, erly dt wuld be subjected t preliminry nlysis, then emerging thery testód in subsequent dt cllectin. Cllectin f dt wuld cntinue, idelly, until 'sturtin' is reched - i.e. n new themes re emerging, nd thereticl ides hve been tested stisfctrily. Using frmewrk nlysis, indexing wuld be fllwed by mpping nd chrting. ln prctice, reserch studies re ften bund by cnstrints f time nd resurces, nd nlysis hs t be brught t clse wéen specific questins hve been nswered. Frmewrk nlysis is n pprch mie suited t reserch sking specific questins nd with limited timescles thn grunded thery. The N HR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

29 5. Ensuring Rigur Relibility nd vlidity re imprtnt issues in ll reserch including qulittive reserch. Demnstràting tht yur qulittive dt nlysis is rigrus is especilly imprtnt given cmmn criticism (frm thse less fvurble t qulittivl reserch) iht qulittive results re necdtl. lncresingly, jurnl editrs nd funders re using 'checklists' f criteri r questins fr ssessing the relibility nd vlidity f qulittive reserch sent t them (see fr exmple, the British Medicl Jurnl guidelines fr qulittive reserch n On mny levels then, it is imprtnt t ddress these issues in yur nlysis. ln this sectin, we will discuss the issues f relibility nd vlidity in the cntext f qulittive dt nlysis. lf yu re fmilir with quntittive reserch, yu will see tht these terms re interpreted smewht differently nd hve different implictins in qulittive reserch. We will then lk t ther wys f demnstrting the rbustness f qulittive nlysis, nmely tringultin nd respndent vlidtin. 5.í Relibility ln terms f ssessing qulittive reserch the emphsis is n the relibility f the methds emplyed, Vu need t demnstrte t the reder tht the methds yu hve used re reprducible nd cnsistent. Hwever, unlike in quntittive reserch, externl replictin my nt be the mst pprprite mesure. lnsted, in demnstrting the relibility f yur nlysis yu wuld need t cnsider the fllwing:. Describing the pprch t nd prcedures fr dt nlysis. Justifying why these re pprprite within the cntext f yur study. Clerly dcumenting the prcess f generting themes, cncepts r theries frm the dt udit tril. Referring t externl evidence, including previus qulittive nd quntittive studies, t test the cnclusins frm yur nlysis s pprprite The N HR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 OUALITATIVE DATA ANALYSIS

30 5.2 Vlidity Here the emphsis is n the vlidity f the interprettin. The bility f the findings t represent the 'truth' my nt be pprprite if we ccept the existence nd imprtnce f multiple 'truths'. Rther, vlidity will be judged by the extent t which n ccunt seems t firly nd ccurtely represent the dt cllected. ln terms f presenting the nlysis then, reflectin is required n: The impct f yur reserch design nd pprch t nlysis n the results yu present.. The cnsistency f yur findings, fr exmple hs nlysis been undertken by mre thn ne resercher (ften referred t s inter-rter relibility). The extent t which yu represented ll relevnt views, fr exmple checking fr'negtive' r devint cses t test yur interprettins.. Adequte nd systemtic use f the riginl dt (fr exmple using quttins, nd nt ll frm the sme persn!) in the presenttin f yur nlysis s tht reders re cnvinced tht yur interprettins relte t the dt gthered. 5.3 Other wys f demnstrting relibility nd vlidity Tringultin Evidence tht the qulittive resercher hs undertken 'tringultin' is frequently seen s demnstrting rigur. Tringultin mens gthering nd nlysing dt frm mre thn ne surce t gin fuller perspective n the situtin yu re investigting. This my be mre r less imprtnt, r pssible, depending n yur reserch questin nd setting. Fr exmple, cnsider the hyptheticl study f n cupuncture service in primry cre, discussed in Sectin 3. ln this study, tringultin might men tht yu cnduct bservtin f the pertin f the service nd review f service recrds in dditin t semistructured interviews, S wy f gining different insights int the Sme situtin. Hwever, tringulted dt shuld nt be simply used t 'check' the cnclusins frm ne dt surce ginst nther. Often the dt frm ne surce will cntrdict r questin the findings frm nther. This is nt necessrily filure f the reserch in itself, s 'rel' life reserch situtins re inevitbly cmplex. lndeed key strength f tringultin is the pssibility f uncvering this cmplexity nd f finding different views. The cntrdictins nd differences within the dt cllected shuld spur the resercher n t further nlysis, nd smetimes, t further investigtin until sme 'sense' cn be mde f wht is hppening. Evidence tht the nlyst hs used tringultin in this wy nd hs effectively drwn the nlysis f different frms f dt tgether demnstrtes rigur, rther thn simply the use f different surces. The NIHR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

31 Resercher perspective Feminist reserchers such s Reinhz (1992) hve highlighted the necessity t mke cler the perspectives f the resercher themselves in demnstrting the vlidity (they wuld cll it credibility) f the reserch. Becuse qulittive nlysis is n interpiettive prcess, the precnceptins, ssumptins nd 'wrldview' f the resercher re likely t influence the prcess nd ny emerging thery, despite use f rigrus pprches such s we hve described. This needs cknwledging, by mking the resercher mre 'visible' in the nlysis prcess. Other writels óll this reflexivity', A reflexive ccunt is n hnest ttempt by the resercher t declre their cnceptuljurney thrugh the reserch, perhps by including sectins f their wn reflective diries s they undertk the reserch. Respndent Vlidtin Qulittive reserchers frequently feed bck the findings frm their reserch t their prticipnts in sme wy. The rnge f feedbck t respndents vries. ln sme cses trnscripts r quttins my be sent bck simply t check ccurcy r cnsent fr use, in ther cses respndents my be sked t cmment n the interprettin r drfts f the reprt. Feedbck t respndents hs been seen s imprtnt in invlving prticipnts in the reserch prcess nd, fr sme criticl scil scientists, in ddressing cncerns but the resercher hving sle pwer f interprettin. Mny funders nd reviewers cnsider 'respndent vlidtin' f qulittive reserch t be mrk f qulity, nd evidence f respndent vlidtin' f findings is incresingly seen s wy f demnstrting rigur. Hwever, the decisin t invlve respndents in feedbck r vlidtin my legitimtely vry frm study t study. lt might be mre helpful in terms f ssessing rigur t cncentrte n evidence tht the reserchers hve:. Cnsidered the issue f feedbck t respndents. Prvided resns fr their decisin t prvide feedbck r nt. Explined hw they hve gne but ny feedbck, the type f feedbck prvided, nd why Explined hw ny feedbck frm respndents hs been used in the nlysis nd interprettin. Respndent feedbck genertes imprtnt issues fr the nlyst t cnsider, nt lest wht t d but cmpeting interprettins. lt is imprtnt t cnsider tht, fr resns f cnfidentility, individul respndents my nt hve ccess t the full rnge f views tht the resercher hs fund; tht respndents my hve cmpetíng perspectives (fr exmple, dctrs nd receptinists my view the sme situtin differently); nd tht they my hve prticulr persnl, prfessinl r pliticl resns fr disliking the reserchers interprettins, hwever legitimte these interprettins my be. lt is imprtnt t cnsider hw fr it is the reserchers' jb t questin 'tken fr grnted' ssumptins r prticulr views, even when this my be unppulr with Sme respndents. The N HR RDS fr the Est Midlnds / Yrkshire & the Humber 2009 QUALITATIVE DATA ANALYSIS

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