Jackie Waterfield

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.

Validity, reliability and responsiveness in the assessment of pain

This paper examines some methodological issues in the assessment of pain, with particular reference to validity, reliability and responsiveness. These issues are illustrated with reference to various measures of pain, in particular the visual analogue scale (VAS). Pain is a complex experience which has sensory, affective, evaluative, cognitive and behavioural dimensions. While the essentially private nature of the pain experience poses problems for criterion-related validity, establishing the content validity of pain assessments is both feasible and necessary to reflect the multidimensional nature of pain. Prescriptive validity is also of importance in clinical contexts. The reliability of most methods of pain assessment is good, but in the case of measures such as the VAS, reliability may be purchased at the cost of content validity. High levels of reliability depend upon careful instruction and standardisation of application. Responsiveness is the ability of an instrument to detect change, and is import...

Effectiveness of Specific Neck Stabilization Exercises or a General Neck Exercise Program for Chronic Neck Disorders: A Randomized Controlled Trial

Objective. In a cohort of primary care patients with chronic neck pain, to determine whether specific neck stabilization exercises, in addition to general neck advice and exercise, provide better clinical outcome at 6 weeks than general neck advice and exercise alone. Methods. This was a multicenter randomized controlled trial in 4 physical therapy departments. Seventy-four participants (mean age 51.3 yrs) were randomized to specific neck stabilization exercises with a general neck advice and exercise program (n = 37) or a general neck advice and exercise program alone (n = 37). They attended a 1-hour clinical examination, followed by a maximum of 4 treatment sessions. Assessments were undertaken at baseline, 6 weeks, and 6 months. The primary outcome was the Neck Pain and Disability Scale (NPDS). Analysis was by intention to treat. Results. Seventy-one (96%) participants received their allocated intervention. There was 91% followup at 6 weeks and 92% followup at 6 months. The mean (SD) 6-week improvement (reduction) in NPDS score was 10.6 (20.2) for the specific exercise program and 9.3 (15.7) for the general exercise program. There were no significant between-group differences in the NPDS at either 6 weeks or 6 months. For secondary outcomes, participants in the specific exercise group were less likely to be taking pain medication at 6-week followup (p = 0.02). There were no other significant between-group differences. Conclusion. Adding specific neck stabilization exercises to a general neck advice and exercise program did not provide better clinical outcome overall in the physical therapy treatment of chronic neck pain.

An Exploration of Physiotherapy Students’ Perceptions of Older Adult Rehabilitation

ABSTRACT Research suggests that healthcare professionals, including students, can demonstrate negative attitudes toward older patients. Effective education is proposed as the way to change negative attitudes, but evidence is conflicting. This study explored physiotherapy students’ perceptions of older people and their rehabilitation. Data were collected utilizing semistructured, focus group interviews with the United Kingdoms physiotherapy students aged between 20 and 40 years. A thematic analysis was undertaken. Two themes from the main study pertinent to clinical education are presented. Issues identified as adversely affecting care for older adults included organizational intransigence, lack of resources, lack of motivation and activity on wards, and stereotypical attitudes. These findings suggest that clinical placements clearly influenced participants’ perceptions. While more negative experiences had the potential to adversely influence perceptions, they engendered in the participants a sense of injustice and increased their determination to be proactive in the rehabilitation of older people.

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.

Perineal resuturing versus expectant management following vaginal delivery complicated by a dehisced wound (PREVIEW): a nested qualitative study

Objective To explore womens lived experiences of a dehisced perineal wound following childbirth and how they felt participating in a pilot and feasibility randomised controlled trial (RCT). Design A nested qualitative study using semistructured interviews, underpinned by descriptive phenomenology. Participants and setting A purposive sample of six women at 6–9 months postnatal who participated in the RCT were interviewed in their own homes. Results Following Giorgis analytical framework the verbatim transcripts were analysed for key themes. Womens lived experiences revealed 4 emerging themes: (1) Physical impact, with sub-themes focusing upon avoiding infection, perineal pain and the impact of the wound dehiscence upon daily activities; (2) Psychosocial impact, with sub-themes of denial, sense of failure or self-blame, fear, isolation and altered body image; (3) Sexual impact; and (4) Satisfaction with wound healing. A fifth theme ‘participating in the RCT’ was ‘a priori’ with sub-themes centred upon understanding the randomisation process, completing the trial questionnaires, attending for hospital appointments and acceptability of the treatment options. Conclusions To the best of our knowledge, this is the first qualitative study to grant women the opportunity to voice their personal experiences of a dehisced perineal wound and their views on the management offered. The powerful testimonies presented disclose the extent of morbidity experienced while also revealing a strong preference for a treatment option. Trial registration number ISRCTN05754020; results.

Can sample size in qualitative research be determined a priori

ABSTRACT There has been considerable recent interest in methods of determining sample size for qualitative research a priori, rather than through an adaptive approach such as saturation. Extending previous literature in this area, we identify four distinct approaches to determining sample size in this way: rules of thumb, conceptual models, numerical guidelines derived from empirical studies, and statistical formulae. Through critical discussion of these approaches, we argue that each embodies one or more questionable philosophical or methodological assumptions, namely: a naïve realist ontology; a focus on themes as enumerable ‘instances’, rather than in more conceptual terms; an incompatibility with an inductive approach to analysis; inappropriate statistical assumptions in the use of formulae; and an unwarranted assumption of generality across qualitative methods. We conclude that, whilst meeting certain practical demands, determining qualitative sample size a priori is an inherently problematic approach, especially in more interpretive models of qualitative research.

The sample size debate: response to Norman Blaikie

ABSTRACT In his detailed response to our paper on sample size in qualitative research, Norman Blaikie raises important issues concerning conceptual definitions and taxonomy. In particular, he points out the problems associated with a loose, generic application of adjectives such as ‘qualitative’ or ‘inductive’. We endorse this concern, though we suggest that in some specific contexts a broad categorization may be more appropriate than a more nuanced distinction – provided that it is clear in which sense the terms are employed. However, other concepts, such as saturation, do not lend themselves to generic use, and require a more detailed conceptualization. Blaikie’s analysis also makes it clear that meaningful discussion of sample size in qualitative research cannot occur with reference to an undifferentiated conception of the nature of qualitative research; clear distinctions need to be made within this approach in terms of methodology, ontological and epistemological assumptions and broader research paradigms.

Summer book review supplement

Hamilton and Whitneys Nutrition — Concepts and Controversies (6th edn) The Primary Prevention of Rheumatic Diseases Clinics in Physical Therapy — Physical Therapy of the Low Back (2nd edn) Groupwork in Occupational Therapy The Hong Kong Conductive Education Source Book Office Orthopaedics for Primary Care: Diagnosis and Treatment Paediatric Respiratory Care — a Guide for Physiotherapists and Health Professionals Clinics in Physical Therapy —Physical Therapy of the Cervical and Thoracic Spine (2nd edn) Neals Common Foot Disorders, Diagnosis and Management (4th edn) Simons Nursing Assessment: For the Care of Older People with Dementia Childrens Orthopaedics and Fractures