Qualitative Research Critique 1 Qualitative Research Critique Mark Oertel 6208623 Faculty of Nursing University of Manitoba. March 19, 2007 Nursing Research Methods NURS 3210 A03 Course Leader: Dr. Thomas Hack
Qualitative Research Critique 2 Qualitative Research Critique The research article Gendered and Cultured Relations: Exploring African Nova Scotians Perceptions and Experiences of Breast and Prostate Cancer (Evans, Butler, Etowa, Crawley, Rayson, & Bell, 2005) is examined qualitatively as part of a research methods course. The critiquing guidelines are based from our text and from recommendations from other scholarly resources. The majority of this paper will focus on the methods and research design. The phenomenon of interest is clearly stated in the title. Evans et al, (2005) describe that breast and prostate cancer are among the most frequently diagnosed cancers in North America. The authors describe there is a lack of statistical information with regards to cancer and African Canadians, and that the data obtained from the United States appears to under-represent African Americans. They introduced gender, ethnicity and culture as interacting determinants that can affect health and presented a literature review that was adequate. The authors stated no studies had examined the cancer experiences of African men and women in Canada which was corroborated by doing a literature search using PUBMED and CINAHL. This indicated that their purpose of doing a qualitative inquiry exploring culture and gender of African Canadians experiences with cancer as something that would be beneficial to nursing practice. The authors explained the significance of the findings in the conclusion of the study whereby they reiterated that these determinants (gender, ethnicity, culture) interact with one another and are important in increasing understanding and developing culturally sensitive interventions. The method used for this study was a participatory action research (PAR) approach that involved using members of the African Nova Scotian community as leaders, co-researchers, and resource people (Evans et al, 2005). There was no clear definition on what PAR involves so the reader would need to become familiar with its terminology to understand the design. In
Qualitative Research Critique 3 traditional ethnographic research, the culture and behavior of the participants is observed by the researcher in an inert way. The aim is to understand the emic (insider s) view of the world and to describe that to those viewing it from the outside (LoBiondo-Wood & Haber, 2005). Similarly, phenomenological research would have focused on understanding the lived experience of the participants, which is a passive process. In contrast, PAR is where the participants form a partnership of interaction with the researchers, thus lessening the differences between the researcher and those being researched (Fossey, Harvey, McDermott, & Davidson, 2002). This allows the participants to be involved throughout the research process which is quite different from traditional methods where participants are subjects that have little input and follow the instructions of the researcher. PAR involves participation, planning, reflection, and observation and has been found to be important to creating social change within communities (Holter & Schwart-Bartcott, 1993). The data and knowledge generated (through dynamic interaction) is used to benefit the people from which it is obtained and this has been shown to be an effective design in situations where inequalities of power exist (Fossey et al, 2002). The authors stated this as one of the reasons why they chose this type of design. From this perspective, it does make sense that this design (which is congruent with the critical research paradigm) would be used in a population that appears to be under-represented in the literature. Further justification for this design comes from the authors statements that described that through the involvement of community leaders, fears that the study was for the benefit of the white health care system were alleviated. The authors described that a research coordinator with intimate knowledge of the African Nova Scotian communities was chosen and how this was important in collaborating with other Black leaders in health networks across the province. While appropriate for this study, the implementation of this design is probably its weakest link. How
Qualitative Research Critique 4 and why two rounds of focus groups (along with time duration) were decided upon was not addressed by the researchers. From other research it has been determined that the use of focus groups when using PAR helps stimulate discussions, generates ideas, provides social support, helps determine possible themes, and is a means of validating data from participants involved (White & Verhoef, 2005). Evans et al, (2005) reported that five African Nova Scotian communities were selected in consultation with several of the communities as the source of data collection and were thought to be representative of rural and urban populations. The study used 57 individuals in two focus groups and that the majority of these participants were members of community groups. The community leaders contacted individuals with cancer directly and they decided upon the focus group composition. The first phase group was 51 participants and the second phase was 21 participants (6 new). There is no discussion on the break up of these five communities (i.e. was one community more represented than another), but it was apparent from the discussion that they varied in number and sex. Of the total, 3 men had prostate cancer, and 10 women had breast cancer. This is clearly an example of purposive sampling as the community leaders had insight in the population of interest (LoBiondo-Wood & Haber, 2005). There are no details about other variables that might be important such as participant age ranges and socioeconomic status. This would make replicating the design difficult. Another consideration is that although there is no set number as to what is best for a qualitative inquiry, there is a need to gather sufficient information to fully explore the phenomena of interest (Fossey et al, 2005). Considering that only 22.9% of the participants had prostate or breast cancer may cause some to question how much exploration into the experiences of cancer could be gathered (i.e. appropriateness of the sample), especially with regards to the men. The implementation can also be faulted by the authors own admissions that four of the participants in the focus group
Qualitative Research Critique 5 discussions were not African Nova Scotian. This poses the question as to whether the use of PAR or the lack of early preparation with the co-researchers and leaders resulted in this situation. The other problem that arose is the admission that many of the participants who attended the focus groups did not have cancer, and these participants thought they were coming for an educational presentation on breast and prostate cancer. Better preparation and foresight might have prevented this from occurring. They were included in the study by the acknowledgement that they had a family member or knew a friend with breast or prostate cancer. A criteria or set of guidelines for inclusion into the sample (i.e. appropriateness) would have been beneficial in the design as to explore more of the experiences rather than perceptions of the phenomenon of interest. One might question the usefulness of the data gathered dependent on the strength of the relationship with the individual who has cancer. Stated differently, although I may have friends who have had cancer, the data that I might provide would not be as beneficial as that from someone who actually has the disease. Ideally, the design would have wanted to draw a greater sample from those with the cancers being explored. Another criticism is from the knowledge that sampling should continue until no new data emerges (i.e. adequacy of the sample) which we have learned to be described as data saturation, which is not mentioned in the study (Fossey et al, 2005). The data collection strategies used in the first focus groups involved open ended questions that explored thoughts on masculinity, femininity, and personal experiences such as: How does cancer affect how you feel about yourself as a man/woman? The questions were a guide as the participants discussed what was important to them, which is consistent with a PAR approach. Participants had an option of using personal interviews, but none were sought. Had this been implemented, it would have been another way to gather data (i.e. triangulation) for
Qualitative Research Critique 6 comparison (Fossey et al., 2005). The data was recorded using audiotape and transcribed verbatim. There was no indication on how many were in charge of this process. Others have recommend a combination of note taking, field notes and tape recording as a good combination for obtaining data and limiting researcher bias (Fossey et al, 2005). There is no mention in the study of the use of member checking which was found to be a validation technique specifically designed for focus groups (Fossey et al, 2005). This could have been done by asking two specific questions following in the focus group and in the analysis of the data: Do these findings accurately represent your experience? and Is there anything we have missed that you feel should have been included? The second phase of the focus groups involved identifying common themes in the first round and validating them with the participants. Those discussions subsequently generated new data for collection but the number of participants is not stated. Thematic analysis was used to sort through the collected data to identify common themes. The authors described that this was done over a three day period but did not mention how many were involved in the process and how the coding of the transcripts occurred (i.e. by hand or computer). There is no mention whether this analysis was consulted with the participants to see if credibility, fittingness, and auditability were maintained, which is very important to qualitative research (LoBiondo-Wood & Haber, 2005). The results had four common themes which did appear to agree with the data. The themes included direct quotes from the participants involved. The only discrepancy was the theme Faith as anchor which did not include quotes from participants. Other research does indicate the importance of the church and faith with regards to dealing with cancer, albeit in the African American community (Figueroa, Davis, Baker, & Bunch, 2006). The results, discussion, and conclusion were well written and could easily be understood to those reading it. The authors did emphasize that the results were not
Qualitative Research Critique 7 generalizable and that this was a step in the right direction in understanding the effect these determinants have on the experience and perception of breast and prostate cancer in the African Nova Scotian community. A literature review on the subject found that many studies today are examining the differences of cancer from both cultural and scientific (genetic) origins with regards to African Americans (Couzin, 2007; Plowden, John, Vasquez, & Kimani, 2006). It was the researchers hope that this would also take place in Canada.
Qualitative Research Critique 8 References Couzin, J. (2007). Cancer research: probing the roots of race and cancer, Science, 315, 592-594. Evans, J., Butler, L, Etowa, J, Crawley, I, Rayson, D., & Bell, D.G. (2005). Gendered and cultured relations: Exploring African Nova Scotians perceptions and experiences of breast and prostate cancer, Research and Theory for Nursing Practice: An International Journal, 19 (3), 257-273. Figueroa, L.R., Davis, B., Baker, S., & Bunch, J.B. (2006). The influence of spirituality on health-care seeking behaviors among African Americans, The ABNF Journal, Spring, 82-88. Fossey, E., Harvey, C., McDermott, F., & Davidson, L. (2002). Understanding and evaluating qualitative research, Australian and New Zealand Journal of Psychiatry, 36, 717-732. Holter, I. M. & Schwartz-Barcott, D. (1993). Action research: What is it? How has it been used, and how can it be used in nursing? Journal of Advanced Nursing 18, 296-304. LoBiondo-Wood, G. & Haver, J. (2005). Nursing Research in Canada: Methods, Critical Appraisal, and Utilization. 1 st Canadian Edition. Toronto: Elsevier. Plowden, K.O., John, W., Vasquez, E., & Kimani, J. (2006). Reaching African American men: A qualitative analysis, Journal of Community Health Nursing, 23 (3), 147-158. White, M.A., & Verhoef, M.J. (2005). Toward a patient-centered approach: Incorporating principles of participatory action research into clinical studies, Integrative Cancer Therapies, 4 (1), 21-24.