Bernadette Bartlam

Saturation in qualitative research: exploring its conceptualization and operationalization

Saturation has attained widespread acceptance as a methodological principle in qualitative research. It is commonly taken to indicate that, on the basis of the data that have been collected or analysed hitherto, further data collection and/or analysis are unnecessary. However, there appears to be uncertainty as to how saturation should be conceptualized, and inconsistencies in its use. In this paper, we look to clarify the nature, purposes and uses of saturation, and in doing so add to theoretical debate on the role of saturation across different methodologies. We identify four distinct approaches to saturation, which differ in terms of the extent to which an inductive or a deductive logic is adopted, and the relative emphasis on data collection, data analysis, and theorizing. We explore the purposes saturation might serve in relation to these different approaches, and the implications for how and when saturation will be sought. In examining these issues, we highlight the uncertain logic underlying saturation—as essentially a predictive statement about the unobserved based on the observed, a judgement that, we argue, results in equivocation, and may in part explain the confusion surrounding its use. We conclude that saturation should be operationalized in a way that is consistent with the research question(s), and the theoretical position and analytic framework adopted, but also that there should be some limit to its scope, so as not to risk saturation losing its coherence and potency if its conceptualization and uses are stretched too widely.

New lifestyles in old age: Health, identity and well-being in Berryhill Retirement Village

A day in the life of a retirement-community resident Retirement communities: the context Developing a retirement-community lifestyle: participation and involvement Health and well-being Growing older: age and identity Conclusions.

Health literacy, associated lifestyle and demographic factors in adult population of an English city: a cross-sectional survey

Lower health literacy is a public health issue that follows a social gradient, potentially reinforcing existing health inequalities. However, levels of health literacy in particular populations can be unclear and are a key to identifying effective public health interventions. This research examined health literacy levels in Stoke‐on‐Trent, where 31.2% of the population live in areas classified amongst the 10% most deprived in England.

Then and now: evolving community in the context of a retirement village

ABSTRACT There is currently much debate in the United Kingdom policy and practice literature about how best to respond to the care and accommodation needs of people as they retire and grow older. Against a policy background which espouses the benefits of ‘lifetime homes and lifetime neighbourhoods’, the growth of purpose-built segregated retirement villages looks somewhat contradictory and is set to transform the housing scene. Whilst there has been considerable research into these environments in countries like the United States of America and Australia, we know comparatively little about what it is like to live in British retirement communities, how they evolve over time and whether they enhance peoples lifestyle aspirations and quality of life. This paper examines these issues through the lens of ‘community’ and in the context of Denham Garden Village: a purpose-built retirement village in Buckinghamshire. Drawing on a range of qualitative data (from individual and group interviews, diaries and directives), we focus on how ‘community’ was conceptualised, experienced and understood both ‘then’ (in the early days of the village) and ‘now’ (subsequent to its redevelopment). The findings enable us to examine the extent to which ‘community’ evolves over time and raise important questions about how socially cohesive, or not, such retirement villages are.

Exploring the age-friendliness of purpose-built retirement communities: evidence from England

ABSTRACT This article contributes to emerging debates around age-friendly environments, providing empirical evidence concerning the relative age-friendliness of purpose-built retirement communities. Adopting a new definition – ‘underpinned by a commitment to respect and social inclusion, an age-friendly community is engaged in a strategic and ongoing process to facilitate active ageing by optimising the communitys physical and social environments and its supporting infrastructure’ – the article analyses the age-friendliness of one retirement community in England. The Longitudinal Study of Ageing in a Retirement Community (LARC) encompassed two waves of a survey with residents, interviews and focus groups with stakeholders involved in staffing, managing and designing the community, and other qualitative data collected from residents. Reviewing the different data sources, the article argues that purpose-built retirement communities have the potential to be age-friendly settings but might better involve residents in a regular cycle of planning, implementation, evaluation and continual improvement if they are to facilitate active ageing. In addition, more clarity is needed on how such developments can better fit with the age-friendly agenda, particularly in terms of their capacity to support ageing in place, the accessibility of the wider neighbourhood, opportunities for intergenerational interactions, and the training of staff to work with older people.

Infertility Counselling: the ISSUE experience of setting up a telephone counselling service

This paper explores the role of telephone counselling for people experiencing fertility problems. It examines the first nine months of the evening telephone counselling service offered by ISSUE (The National Fertility Association). Records of the service were analysed for number, duration and nature of calls. The results suggest that there is significant demand for such a service and that this demand has grown in line with availability. All counsellors working on the service were interviewed. Qualitative analysis of the interviews generated key themes concerning gender and culture, supervision and training, counselling process issues, boundaries and managerial issues. In addition, specific issues about counselling in the field of reproductive medicine were highlighted. Findings are discussed in relation to implications for service provision in this area of health care.

Home From Home? A Mixed-Methods Study of Relocation Within a Purpose-Built Retirement Community

Moving from a location where one has intimate knowledge of the physical and social aspects of space, with established daily routines, social networks, and attachment to place, can present challenges in later life. The literature supports the optimality of aging in place, and several studies point to the potentially detrimental effects of disruption, particularly in cases of involuntary relocation. Using both qualitative and quantitative data, this exploratory study aimed to examine the experiences and effects of relocation as part of a redevelopment of a community housing older people. Thirty-five interviews were completed with 17 participants across stages of the relocation process. Quantitative indicators of well-being were also compared between residents who had moved and those who had not over this period. No significant differences were found between movers and non-movers in the quantitative data. However, the qualitative data suggested that the relationship with the environment is more nuanced than the duality of optimal and detrimental. Individuals’ agency in relation to their environment was found to be mediated by such factors as lifestyle and daily routine, bereavement, sociospatial factors, and access to nature. The effects of relocation appear to be complex and mediated by a variety of individual and social factors.

Keele Aches and Pains Study protocol: validity, acceptability, and feasibility of the Keele STarT MSK tool for subgrouping musculoskeletal patients in primary care

Musculoskeletal conditions represent a considerable burden worldwide, and are predominantly managed in primary care. Evidence suggests that many musculoskeletal conditions share similar prognostic factors. Systematically assessing patient’s prognosis and matching treatments based on prognostic subgroups (stratified care) has been shown to be both clinically effective and cost-effective. This study (Keele Aches and Pains Study) aims to refine and examine the validity of a brief questionnaire (Keele STarT MSK tool) designed to enable risk stratification of primary care patients with the five most common musculoskeletal pain presentations. We also describe the subgroups of patients, and explore the acceptability and feasibility of using the tool and how the tool is best implemented in clinical practice. The study design is mixed methods: a prospective, quantitative observational cohort study with a linked qualitative focus group and interview study. Patients who have consulted their GP or health care practitioner about a relevant musculoskeletal condition will be recruited from general practice. Participating patients will complete a baseline questionnaire (shortly after consultation), plus questionnaires 2 and 6 months later. A subsample of patients, along with participating GPs and health care practitioners, will be invited to take part in qualitative focus groups and interviews. The Keele STarT MSK tool will be refined based on face, discriminant, construct, and predictive validity at baseline and 2 months, and validated using data from 6-month follow-up. Patient and clinician perspectives about using the tool will be explored. This study will provide a validated prognostic tool (Keele STarT MSK) with established cutoff points to stratify patients with the five most common musculoskeletal presentations into low-, medium-, and high-risk subgroups. The qualitative analysis of patient and health care perspectives will inform practitioners on how to embed the tool into clinical practice using established general practice IT systems and clinician-support packages.

Physical Therapists' Views and Experiences of Pregnancy-Related Low Back Pain and the Role of Acupuncture: Qualitative Exploration

Background Low back pain is often accepted as a “normal” part of pregnancy. Despite research suggesting that quality of life for women who are pregnant is adversely affected, most are advised to self-manage. Although the use of acupuncture for the management of persistent nonspecific low back pain has been recommended in recent UK national guidelines, its use in the management of pregnancy-related low back pain remains limited. Objectives This study aimed to explore the perceptions and experiences of physical therapists involved in treating women who are pregnant and have low back pain with the objective of informing the pretrial training program for a pilot randomized trial (Evaluating Acupuncture and Standard care for pregnant womEn with Back pain [EASE Back]). Design A qualitative phenomenological method with purposive sampling was used in the study. Methods Three focus groups and 3 individual semistructured interviews were undertaken, and an iterative exploratory thematic analysis was performed. To ensure transparency of the research process and the decisions made, an audit trail was created. Results Twenty-one physical therapists participated, and emergent issues included: a lack of experience in treating pregnancy-related complaints, mixed messages from previous acupuncture education, a mistrust of the current evidence for acupuncture safety and effectiveness, and personal and professional fear of causing harm. Conclusions The findings suggest that UK physical therapists are reluctant to use acupuncture in the management of pregnancy-related low back pain. The explanations for these findings include perceived lack of knowledge and confidence, as well as a pervasive professional culture of caution, particularly fears of inducing early labor and of litigation. These findings have been key to informing the content of the training program for physical therapists delivering acupuncture within the pilot EASE Back trial.

Identifying vulnerability in grief: psychometric properties of the Adult Attitude to Grief Scale

AbstractPurpose Grief is a reaction to a significant loss that can profoundly affect all aspects of life and capacity to function well. The consequences can vary from severe psychological distress through to physical disturbances and significant social problems. This study sought to identify a measure of vulnerability in grief, by examining the psychometric properties of the Adult Attitude to Grief (AAG) scale in a sample of 168 people seeking help in their bereavement. Methods The factor structure of the scale, its internal consistency, its construct validity and optimum classification cutoffs were tested. Results Confirmatory factor analysis broadly supported the factor structure of the AAG, but identified one item that could profitably be reworded. Internal consistency of the three subscales was acceptable. Construct validity and discriminative validity were supported by correlations with allied constructs (depression and anxiety) and a significant difference between scores for clients with Prolonged Grief Disorder and those without. A correlation with counsellors’ own clinical ratings of vulnerability demonstrated criterion-related validity of the AAG. Using receiver operating characteristic methods, optimum cutoff scores on the scale were identified for the classification of different levels of vulnerability. Conclusion The AAG was found to be a psychometrically promising tool for identifying vulnerability in grief.