Graham Stew

Ready for a paradigm shift? Part 2: Introducing qualitative research methodologies and methods

This paper explores a number of commonly used methodologies and methods in qualitative research, namely grounded theory, case study, phenomenology, ethnography and narrative research. For each methodology a brief history of its development and variants is given, followed by typical methods of data collection and analysis. Examples of manual therapy qualitative research studies are highlighted for each methodology. Data collection methods are then discussed and include individual interviews, focus groups, observation and documentary analysis. A frequently used method of data analysis, thematic analysis, is briefly explained. Finally, the strategies to enhance the quality of qualitative research is explored and compared to those of quantitative research.

The phenomenon of boredom

Boredom remains a poorly understood phenomenon despite its evident association with dysfunctional behavior and mental health problems. However, little research has been devoted to the topic, and the bulk of studies have almost exclusively been quantitative in design. For this reason, a qualitative, interpretive phenomenological study was carried out, during which ten participants were asked for their accounts of the experience of boredom. These people were sampled from the general population. The aims of the study were to find out more about the antecedents to boredom, the experience itself, any stages in its development, and methods used to deal with it. Findings indicated that boredom is an extremely unpleasant and distressing experience. Situations giving rise to the sensation varied between specific external factors, to a general propensity to boredom proneness, although, according to the participants of the study, these could change throughout their lifetime. Feelings comprising the experience of boredom were almost consistently those of restlessness combined with lethargy. No stages in the development of the experience were identified. Strategies used to overcome the problem varied greatly, but generally involved trying to find interesting things to do. These strategies tended to be unsuccessful. Traditional methods of dealing with boredom have focused on increasing stimulation and choice in the environment. The authors propose that a more effective strategy might be to focus more on internal causes of boredom, such as an inability to sustain attention, although further research is required to support this interpretation of the data.

I Have Mastered the Challenge of Living With a Chronic Disease: Life Stories of People With Rheumatoid Arthritis

Our aim with this study was to explore the narrative life story of individuals diagnosed with rheumatoid arthritis. An open qualitative approach, namely narrative biographic methodology, was applied to include the life context of the participants and to deliberately exclude predefinitions of concepts. Ten people with rheumatoid arthritis who retired early because of the disease participated and were interviewed three times according to a narrative biographic interview style. The biographical data and the interview texts were analyzed both individually and in comparison to each other. Some participants regarded rheumatoid arthritis as a challenge for mastery in their lives, whereas others adapted to the disease and “made the best out of a bad situation.” Especially in countries where the medical model predominates in health care, our findings can be used to broaden the current view that some health professionals have toward patients, and stress the importance of patients being self-responsible.

Ready for a paradigm shift? Part 1: Introducing the philosophy of qualitative research

The manual therapy professions have almost exclusively focused on the use of quantitative research to help inform their practices. This paper argues that a greater use of qualitative research will help develop a more robust and comprehensive knowledge base in manual therapy. The types of knowledge used in practice and generated from the two research paradigms are explored. It is hoped that an understanding of the philosophical and theoretical underpinnings of qualitative research may encourage more manual therapists to value and use this approach to help further inform their practice; for some, this may involve a paradigm shift in thinking.

I Have a Disease But I Am Not Ill: A Narrative Study of Occupational Balance in People With Rheumatoid Arthritis

Occupational balance is a prominent concept in occupational therapy and in society at large, and could be a key concept in that it may enhance understanding of the link between occupation and health. Because there is a lack of empirical evidence, the aim of this study was to critically examine the existing assumptions regarding occupational balance. An open narrative approach was applied to include the life context of the participants and to deliberately exclude predefinitions of the concept. From 10 reconstructed life stories, which were analyzed individually, three new dimensions of occupational balance related to health and grounded in the data were developed: a balance between challenging versus relaxing occupations and activities, activities meaningful for the individual and activities meaningful in a sociocultural context, and activities intended to care for oneself and activities intended to care for others. These three dimensions of occupational balance may be key concepts for future research.

Challenge-skills and mindfulness: an exploration of the conundrum of flow process

The process of flow, a psychological state that seems to occur during optimal human experience, is currently unclear. This exploratory study examines how flow begins and what happens during and after a flow experience. A phenomenological approach was taken to examine the flow experiences of an artist, a musician, and a horticulturist. Participants kept journals and participated in semi-structured interviews. The results suggest that two phenomena, “challenge-skills” and “mindfulness,” were identified as being “flow” experiences. Challenge-skills and mindfulness had some common features. Both involved living in the present moment, not worrying, and performing activities because they were intrinsically rewarding. They were distinctly different experiences in regard to the effort involved, the perception of time, and the consequences of the experience. Understanding the process of challenge-skills and mindfulness may have implications for our understanding of the relationship between occupation, consciousness, and health and for occupational therapy practice.

Learning together in practice: A survey of interprofessional education in clinical settings in South-East England

This article describes the outcomes of a two-year project, commissioned by the Department of Health, to investigate the development of pre-registration education for the allied health professions in Kent, Surrey and Sussex. A range of data collection methods were adopted in order to identify where and how interprofessional education (IPE) was occurring in clinical settings. It was found that IPE is highly contextualized, and develops according to a variety of situational factors. The types of IPE encountered are described and their respective features, strengths and limitations are discussed.

Further Explorations into the Conundrum of Flow Process

Abstract This study builds on previous research that has aimed to clarify uncertainties regarding what happens before, during and after a ‘flow’ experience, a psychological state that appears to arise during optimal human experience. A phenomenological approach was taken to examine the flow experiences of seven participants. The method included participants keeping journals and semi‐structured interviews. The flow process seemed to vary between challenge‐skills, enjoyment, positive distraction and mindfulness experiences. These experiences had similarities, as all participants described them as positive psychological states that were a consequence of being absorbed in an occupation, but differed in relation to prior affect and the degree of challenge an occupation presented. This research has highlighted the importance of meaning and the essential role occupation may have in protecting well‐being. Occupations may lead to optimal experience when they lead to altered and ordered states of consciousness.

Patients' experience of return to work rehabilitation following traumatic brain injury: a phenomenological study

Many persons with traumatic brain injury (TBI) are young adults who, prior to their TBI, were in paid employment. Psychosocial outcome after TBI, for many, remains poor. This includes low rates of return to pre-injury work or education, among others. This qualitative study explored the experience of return to work (RTW) rehabilitation with 10 individuals who sustained TBI. Data were collected from semi-structured interviews. Transcripts were analysed using interpretative phenomenological analysis (IPA). Some of the main findings from this study included the following: Individuals find the RTW experience difficult and painful. They experience a distinct grief reaction in the process of exploring re-engagement in occupation following TBI. In view of these and other findings, changes to RTW rehabilitation should be considered to facilitate the optimal support for patients with TBI engaging in the RTW rehabilitation process.

Collaborative reflection: how far do 2:1 models of learning in the practice setting promote peer reflection?

A number of health professional groups have been looking at alternative models to the traditional 1:1 model of practice education in order to meet the increasing shortage of practice placements for pre‐registration students. One such model that has been explored recently is the 2:1 or collaborative model where one practice educator takes responsibility for the education of two or more students. This paper presents the findings of a small research study undertaken to explore facilitation of learning in 2:1 collaborative models of physiotherapy practice education, and focuses on the potential for reflection with particular emphasis on peer reflection within the collaborative model. The study adopted a qualitative approach. Semi‐structured interviews were conducted with thirteen educators and eighteen third year physiotherapy students at a number of different NHS practice sites in southeast England. Additional focus groups were held with academic tutors and students at the end of the placement period. Findings from the study indicated that learning was facilitated in a variety of ways with students benefiting from peer learning and teaching approaches. Opportunities for peer reflection appeared to be increased in the 2:1 model. However, some practice educators highlighted the need for further guidance when promoting reflective practice. Further research into the role of reflection within 2:1 models and the facilitation of reflection during clinical education placements is needed.