Amber J. Fletcher

Using the Delphi Method for Qualitative, Participatory Action Research in Health Leadership:

Current pressures on public health systems have led to increased emphasis on restructuring, which is seen as a potential solution to crises of accessibility, quality, and funding. Leadership is an important factor in the success or failure of these initiatives. Despite its importance, health leadership evades easy articulation, and its study requires a thoughtful methodological approach. We used a modified Delphi method in a Participatory Action Research (PAR) project on health leadership in Canada. Little has been written about the combination of Delphi method with PAR. We offer a rationale for the combination and describe its usefulness in researching the role of leadership in a restructuring initiative in “real time” with the participation of health system decision makers. Recommendations are provided to researchers wishing to use the Delphi method qualitatively (i.e., without statistical consensus) in a PAR framework while protecting the confidentiality of participants who work at different levels of authority. We propose a modification of Kaisers (2009) post-interview confidentiality form to address power differentials between participants and to enhance confidentiality in the PAR process.

Applying critical realism in qualitative research: methodology meets method

Abstract Critical realism (CR) is a useful philosophical framework for social science; however, little guidance is available on which precise methods – including methods of data collection, coding, and analysis – are best suited to applied CR research. This article provides a concrete example of applied qualitative research using CR as a philosophical and methodological framework. Drawing examples from a study of Canadian farm women’s experiences with agricultural policy, I suggest a flexible deductive process of coding and data analysis that is consistent with CR ontology and epistemology. The paper follows the typical stages of qualitative research while demonstrating the application of methods informed by CR at each stage. Important considerations CR ontology and epistemology raise, such as the use of existing theory and critical engagement with participants’ knowledge and experience, are discussed throughout. Ultimately, I identify two key causal mechanisms shaping the lives of farm women and suggest a future direction for feminist political economy theory to more effectively analyze women’s work in agricultural contexts.

From “Free” Trade to Farm Women: Gender and the Neoliberal Environment

This chapter challenges the economism of contemporary macroeconomic policy through an environmental and gendered lens. It uses a feminist political economy framework to analyze newly released statistical data on international trade flows from the Food and Agriculture Organization (FAO), as well as statistics on Canadian agricultural production. The analysis moves through three levels of inquiry – macro, meso, and micro – to examine the interaction of neoliberal policy, gender, and environment. At the macro level, it questions the neoliberal discourse of “efficiency” by using trade data to illustrate the environmental inefficiencies of the current trade regime, especially the phenomenon of “trade for trade’s sake”. It links the neoliberal policy regime to its environmental consequences at the meso level of Canadian agricultural production. Finally, the gendered effects of neoliberalism are illustrated by examining the situation of Canadian farm women. Although macro-level policies are often portrayed as “gender neutral”, their unique effects on farm women’s lives are elucidated using the concept of social reproduction.

Extreme drought and excessive moisture conditions in two Canadian watersheds: comparing the perception of farmers and ranchers with the scientific record

This study compares climatological data for two climate extremes, severe drought and excessive moisture, to the experience and memories of agriculturalists based on extensive interviews with farmers and ranchers in the southern Great Plains of Canada. The climate data used were the Standardized Precipitation and Evapotranspiration Index. While differences are expected between these quantitative and qualitative sources due to the fact that there is often a gap between any extreme weather event and its impact, there was less difference than expected. However, these gaps are significant because politicians, policy makers and emergency preparedness planners do, or at least should, take into account the perceptions of those most directly affected by climate extremes and understand the instances. The findings confirm the importance of localized and experiential knowledge in climate change adaptation.

Prioritizing health leadership capabilities in Canada: Testing LEADS in a Caring Environment.

This article is the first major empirical test of LEADS in a Caring Environment, the principal leadership capability framework in Canada. The results rank the perceived salience of leadership attributes, given time and budget constraints, while implementing a major organization reform in the Saskatchewan health system. The results also indicate important differences between self-assessed leadership behaviours versus observed behaviours in other leaders that may reflect participants’ expectations of managers with designated authority.

Adaptive Strategies Building Resilience to Climate Variability in Argentina, Canada and Colombia

Many regions of the world are experiencing the impacts of climate change, which include the increasing variability of weather as well as increased drought and flood. Although many areas have had a long history of this variability and have a strong historic practice of adaptation, increasing variability has had a significant impact on adaptive strategies of agricultural producers over the last several years.

Doing Participatory Action Research in a Multicase Study A Methodological Example

In this article, we describe an approach for conducting participatory action research (PAR) in a longitudinal multicase study, with particular focus on cross-case analysis. Existing literature has documented the practice of PAR in single-case studies, but far less has been written on how to conduct PAR across multiple cases. There is also a need for instructional examples of multicase study application, particularly methods of cross-case analysis. In PAR, research methods—including data analysis methods—have the power to shape participant inclusion or exclusion, involvement or attrition, and mobilization of knowledge in real time. In response to these challenges, we discuss the analysis methods used in a PAR study of health leadership in Canada. The project, which consisted of six case studies of leadership in major health system change, involved health leaders as collaborators. We address the challenges of doing PAR with collaborators facing time limitations and suggest a project structure for involving collaborators at critical junctures. We present a detailed, two-part method for conducting cross-case data analysis. Our method involved targeted collaborator involvement in data interpretation while also ensuring faithfulness to the coded data. We describe our process for mobilizing study findings through a deliberative dialogue with health leaders.

Trading futures: Economism and gender in a changing climate

International trade is often viewed as environmentally unproblematic, even beneficial. This article challenges this view, using new trade data from the Food and Agriculture Organization to document inefficiencies in global food trade and to question the prioritization of economics over environment. It can be difficult to identify the effects of macro-level phenomena, such as trade agreements and climate change, on people’s lives at the micro-level. This article uses qualitative research conducted with farm women in the Canadian prairies to illustrate the intersection of policy, climate change, and their gendered effects in everyday life.

Reflection/Commentary on a Past Article: “Using the Delphi Method for Qualitative Research in Health Leadership”: http://journals.sagepub.com/doi/full/10.1177/160940691401300101

In 2014, we published our application of a modified Delphi method for qualitative, participatory action research (PAR) on health leadership. The lead author (Fletcher) was, at the time, a postdoctoral research fellow working in the area of research methodology. This article was one of her first peerreviewed journal publications. The second author (Marchildon) was Canada Research Chair in public policy and economic history specializing in health policy research. The article reported on a pan-Canadian research project about leadership during health system redesign, which sought to identify best practices in leadership during major health system change. Our project was one of the five regional studies across Canada, each examining a case of health system restructuring. The goal of our case study was to examine leadership practices during the onset of Shared Services—a restructuring initiative to consolidate service delivery and “back-office” functions across Saskatchewan’s 12 health regions. At the time, Shared Services was promoted as an alternative to full consolidation of the health regions. However, some of our participants wondered if Shared Services was a first step toward centralization, a suspicion confirmed years later when the province’s health regions were amalgamated into a single provincial health authority. The project methodology needed to address a policy problem (the requisite leadership capacity needed to achieve health reform/restructuring, although this could be applied to many policy management arenas outside health care), a research problem (the difficulty of defining and measuring health leadership and the contested concept of leadership), and the research design (PAR), which harnesses the knowledge and expertise of participants by integrating them as project collaborators. We faced several challenges in our methodological design. The first pertained to power and confidentiality in a study of distributed leadership. In order to best understand the experience of leading change at different levels of authority, our sample needed to consist of health system leaders at three levels: “front line” units, senior leadership below CEO level, and senior executive leadership in the ministry and health regions. To evaluate effective leadership in practice, participants needed to feel safe commenting on the leadership of those above them, which necessitated careful confidentiality provisions. The second challenge was to find an effective mechanism for sharing and validating results with both our participants and our participant collaborators (i.e., our PAR partners) while preserving confidentiality. The leaders’ busy schedules added an additional layer of difficulty; for many, the change initiative—not to mention the research project examining it—was largely being completed “off the side of their desks,” a commonly heard refrain in our findings. Our underlying challenge, therefore, was to find a method that ensured participant confidentiality while still facilitating dialogue and constant involvement of our participant collaborators. Few of the standard qualitative methods would serve this purpose alone: while in-depth interviews would provide the necessary confidentiality, interview transcripts could not be shared with the participant collaborators and would not allow for the kind of dialogue provided through group methods like focus groups or nominal group technique. Considering the power differentials and high levels of tension and uncertainty participants were experiencing during the Shared Services transition, the lack of confidentiality inherent in group activities made them a non-option. Delphi technique, in contrast, provided an opportunity for iterative dialogue on the interview themes while guarding

More than Women and Men: A Framework for Gender and Intersectionality Research on Environmental Crisis and Conflict

Over the past two decades, the important role of gender in environmental and water-related crises and conflicts has been increasingly recognized. Environmental crises occur in social contexts imbued with gender and other power relations. Existing literature in this area has examined how gender shapes issues of water access, use, governance, and adaptation to environmental crises. Gender, however, has been variously construed and theorized in this work. From essentialist to poststructuralist perspectives, the theorization of gender is key to its application in the environmental sector. In this chapter I present an overview of several major theoretical conceptualizations of sex and gender, ranging from the biological essentialist to the poststructuralist. I identify how gender has been variously used in the literature on environmental crisis and conflict. Key debates about ontology (essentialism) and representation (universalization) are highlighted. Drawing upon (and drawing together) these earlier theoretical insights and debates, I ultimately suggest a conceptual framework for doing multi-level intersectional research on environmental crisis and conflict. The framework helps to address the current tension between highly context-specific analyses and overly structural treatment of gender. The framework aims to help “scale up” the insights of intersectionality while still appropriately attending to the ongoing relevance of gender across contexts.