Anna Madill

Objectivity and reliability in qualitative analysis: realist, contextualist and radical constructionist epistemologies.

The effect of the individual analyst on research findings can create a credibility problem for qualitative approaches from the perspective of evaluative criteria utilized in quantitative psychology. This paper explicates the ways in which objectivity and reliability are understood in qualitative analysis conducted from within three distinct epistemological frameworks: realism, contextual constructionism, and radical constructionism. It is argued that quality criteria utilized in quantitative psychology are appropriate to the evaluation of qualitative analysis only to the extent that it is conducted within a naive or scientific realist framework. The discussion is illustrated with reference to the comparison of two independent grounded theory analyses of identical material. An implication of this illustration is to identify the potential to develop a radical constructionist strand of grounded theory.

Qualitative Research and Its Place in Psychological Science

In discussing the place of diverse qualitative research within psychological science, the authors highlight the potential permeability of the quantitative-qualitative boundary and identify different ways of increasing communication between researchers specializing in different methods. Explicating diversity within qualitative research is facilitated, initially, through documenting the range of qualitative data collection and analytic methods available. The authors then consider the notion of paradigmatic frame and review debates on the current and future positioning of qualitative research within psychological science. In so doing, the authors argue that the different ways in which the concept of paradigm can be interpreted allow them to challenge the idea that diverse research paradigms are prima facie incommensurate. Further, reviewing the ways in which proponents of qualitative research are seeking to reconfigure the links between paradigms helps the authors to envisage how communication between research communities can be enhanced. This critical review allows the authors to systematize possible configurations for research practice in psychology on a continuum of paradigm integration and to specify associated criteria for judging intermethod coherence.

Dissociation, Trauma, and the Role of Lived Experience: Toward a New Conceptualization of Voice Hearing

Voice hearing (VH) is often regarded as pathognomic for schizophrenia. The purpose of this article is to review and integrate historical, clinical, epidemiological, and phenomenological evidence in order to suggest that VH may be more appropriately understood as a dissociative rather than a psychotic phenomenon. First, we discuss the lifetime prevalence of VH in the general population, which is estimated to range between 1% and 16% for adult nonclinical populations and 2% and 41% in healthy adolescent samples. Second, we demonstrate how the ubiquity of VH phenomenology, including variables like voice location, content, and frequency, limits its diagnostic and prognostic utility for differentiating psychotic from trauma-spectrum and nonclinical populations. Finally, we report on the empirical associations between VH, measures of dissociation, and trauma particularly (though not exclusively) childhood sexual abuse. There are 2 main conclusions from this review. First, we argue that available evidence suggests that VH experiences, including those in the context of psychotic disorders, can be most appropriately understood as dissociated or disowned components of the self (or self-other relationships) that result from trauma, loss, or other interpersonal stressors. Second, we provide a rationale for clinicians to use psychotherapeutic methods for integrating life events as precipitating and/or maintaining factors for distressing voices. Potential mechanisms for the relationship between trauma, dissociation, VH, and clinical diagnosis are described, including the relevance of literature from the field of attachment in providing a diathesis for dissociation. Suggestions for future research are also discussed.

A Metasynthesis of the Self-Management of Type 2 Diabetes

Type 2 diabetes is a metabolic disorder characterized by chronically elevated blood glucose and high risk of comorbidities. In this article we report a metasynthesis of the 21st-Century qualitative research concerning the self-management of type 2 diabetes. We identified 38 relevant articles (sample size range 6 to 175), which were synthesized through a process of iterative reading and theory development. In this literature, authors argued and assumed that diabetes management is influenced by multiple, complex, competing factors, including interpersonal relations, gender, and sociocultural context. Conversely, self-management was sometimes construed as a facet of individual agency and was accepted uncritically, placing accountability for health with patients themselves. We conclude that a satisfactory account of diabetes care would pay attention to the “inner” world, while acknowledging the social and political conditions in which diabetes-related experiences unfold.

The meanings of organ donation: Muslims of Pakistani origin and white English nationals living in North England

This study explores the meanings of organ donation, with emphasis on donating eyes and hearts, comparing people across gender and across two ethnic groups. Four focus group interviews were conducted with people living in the North of England: (1) five Muslim women of Pakistani origin, (2) five Muslim men of Pakistani origin, (3) nine white English women, and (4) eight white English men. The focus group interviews were analysed using grounded theory and a conceptual micro-model created for each group. The main finding was that the act of organ donation can be perceived as involving a personal cost. The Muslims of Pakistani origin related costs with their religious beliefs. In contrast, the white English associated costs with their distrust of the medical system. Women were concerned about the transmission of disease or of personality, whereas the white English men highlighted their personal rights. We conclude that the meaning of organ donation is more than about being and having a body. It is bound up in metaphors of embodiment, religious considerations, and moral judgement of scientific and medical conduct.

The Potential of Conversation Analysis for Psychotherapy Research

An illustrative analysis is offered demonstrating the potential of conversation analysis for psychotherapy research. Extracts are presented from an unresolved problematic theme selected from an unsuccessful eight-session psychodynamic-interpersonal therapy of a female client presenting with a major depressive episode. The authors identify descriptive devices and communicative skills on which the client and therapist draw in the process of problem formulation. They demonstrate the way in which differing versions of the client’s problems were presented and how the client and therapist pursued differing attributional projects. Specifically, the authors examine how internal and external accounts of the client’s underlying problems were accomplished and warranted and how the therapist attempted the transformation of problems. The quality criteria pertaining to conversation analysis are indicated, the implications for therapeutic practice explored, and the relationship between the present findings and previous research discussed.

Communications skills in dental education: a systematic research review

Communication is an essential element of the relationship between patient and dentist. Dental schools are required to ensure that undergraduates are adequately trained in communication skills yet little evidence exists to suggest what constitutes appropriate training and how competency can be assessed. This review aimed to explore the scope and quality of evidence relating to communication skills training for dental students. Eleven papers fitted the inclusion criteria. The review found extensive use amongst studies of didactic learning and clinical role-play using simulated patients. Reported assessment methods focus mainly on observer evaluation of student interactions at consultation. Patient involvement in training appears to be minimal. This review recommends that several areas of methodology be addressed in future studies, the scope of research extended to include intra-operative communication, and that the role of real patients in the development of communication skills be active rather than passive.

Fear of devaluation: understanding the experience of intersexed women with androgen insensitivity syndrome.

OBJECTIVES We aim to provide an understanding of the psychological sequela of androgen insensitivity syndrome (AIS) in phenotypic females in order to begin to inform psychosocial health care services. DESIGN Eight adult women with AIS were recruited through the Androgen Insensitivity Syndrome Support Group-United Kingdom (AISSG-UK). Data was collected via two semi-structured interviews with each woman. METHODS Transcripts were analysed using grounded theory and a conceptual model was developed which suggests a way of understanding the AIS distress experienced by the participants. RESULTS The pivotal concept is a womans fear of devaluation. This is connected to her level of adaptation and perception of having a compromised womanhood. These, in turn, are related to her medical management and involvement with others via a support group and in talking about AIS. CONCLUSIONS Participants showed a clear preference for open communication about their condition throughout the process of medical management. We recommend sensitive, pacing of information to allow young women and their families to make informed decisions about treatment and a realistic adaptation to life with AIS.

What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors.

With the recognition of health-related quality of life (HRQL) as an important and relevant outcome in pressure ulceration, it is important to gain better understanding of the complex relationship among the various factors that affect it. A problem with existing literature in this area is that the impact of having a pressure ulcer on HRQL is combined conceptually with contributory factors which may influence outcome. This study identified contributory factors affecting pressure ulcer-related HRQL and explored interrelationships between factors based on views of adults with pressure ulcers. We obtained patient-reported qualitative data through semi-structured interviews with 30 patients with pressure ulcers recruited from hospital and community settings around England and Northern Ireland. Patients described how pressure ulcers affected their lives by recounting specific relevant events. Events (patient-reported issues) were sorted into categories and data framework analysed to produce a taxonomy of contributory factors. Inter-rater reliability established the extent of agreement between two independent raters. We identified 16 contributory factors, into two theme taxonomy: experience-of-care and individual-patient factors, defined by descriptive components. Our taxonomy is a comprehensive theoretical model of factors that contribute to pressure ulcer-related HRQL. We have also identified further research priorities to inform clinical practice.

The air's got to be far cleaner here: a discursive analysis of place-identity threat.

That talk is never disinterested complicates the relationship between the environment and the claims people make about it. Talk about place, and ones self in it, is particularly complex when the environment poses risk or is otherwise problematized. This study, a secondary analysis of interview data, seeks to extend discursive work on place-identity by examining the ways in which 14 residents of a small English village talk about themselves and their locale. The locale accommodates an active quarry, and many residents had lodged complaints to the quarry about dust, noise and vibrations from blasting. Attention to the interactional context of the interviews illustrates the ways in which (simply) interviewing people about their locale can threaten self- and place-identity. When asked about life in the village, interviewees oriented to two main dilemmas in protecting self- and place-identity: (1) how to justify continued residence in a challenging environment and (2) how to complain about the locale whilst maintaining positive place-identity. Discursive responses to these dilemmas drew upon typical identity processes, such as self- and place distinctiveness and the formulation of out-groups, as well as upon constructions of localized power-sharing and morally obligated tolerance of risk. We suggest that research on problematical places, and of environmental risk, needs to be sensitized to how it may constitute a threat to self- and place-identity, and how this may mediate formulations self and place, as well as of environmental risk.