Lioness Ayres

Qualitative research proposals--part III: sampling and data collection.

This article is the third in a series of 6 articles aimed at WOCN investigators who wish to design qualitative research proposals. The first article described problem identification, and the second offered some design options. After a problem has been identified and a qualitative research design has been selected, the researcher must make decisions about sampling and data collection. The goal of both sampling and data collection is to develop a data set that captures the phenomenon at the level of complexity appropriate for the design while at the same time keeping the study feasible in its use of resources. The following information will be useful in making and justifying sampling decisions in proposal writing.

Charting the Chart—An Exercise in Interpretation(s)

The multiauthored article is standard in the medical sciences, where the politics of the laboratory and the academy often loom larger than the singularity of the argument or grace of its execution. The following paper, however, depends upon the singularity of each of its authors and hails the individual grace of their arguments. Although collaborative, this paper is primarily collective, composed of unique readings of the same document. In its array of individual viewpoints and interpretations, it underscores the collective nature of the entries that constitute the single entity identified as the chart. As the record of one patients hospitalization is really a diverse collection of individual voices as well as professional interactions or viewpoints, so the responses of these readers are unique to each ones personal and professional backgrounds.1 —Suzanne Poirier, Ph.D., Literature2

Qualitative research proposals -- part II: conceptual models and methodological options

As pointed out by Engberg and Bliss,1 the use of a theory or conceptual framework enhances the usefulness of research by linking individual studies within the nursing knowledge base. In addition, presentation of a conceptual model early in the proposal provides evaluators with an invaluable overview of the context of the proposed research. Thus, a successful proposal, whether qualitative or quantitative, should incorporate a theory or conceptual model. Theories are defined as testable propositions about variables and the relationships among them.2 Quantitative researchers may use theory in any 1 of 3 ways: to test the theory itself, to develop a theory-based intervention, or to use a theory to identify the variables of interest in a particular study. Qualitative researchers are less likely to test theories or interventions because qualitative research is less useful at comparing groups or testing hypotheses; however, qualitative researchers both use and develop conceptual models. A conceptual model is distinguished from a theory by its level of abstraction—a conceptual model, like a theory, describes a set of relationships, but these relationships are among concepts, not variables, and as such are not testable.3 Although qualitative researchers seldom work directly with theories, nurses who are interested in studying issues relating to wounds, ostomies, or continence are likely to approach their studies with an interest in particular concepts (continence and long-term care, for instance) and may have some ideas about the relationships among those concepts. Thus, as Sandelowski points out, “Although a theoretical orientation may not be explicitly stated in a qualitative project . . . it is always implicit in the way the problem is presented [and] in the literature reviewed.”4(p213) Thus, a nurse proposing to study incontinence in midlife women may choose to explore the meaning of incontinence using such concepts as identity and stigma or to study the management of incontinence using such concepts as independence and self-care. Each of those concepts implies a different body of knowledge and a different approach to data collection and analysis, although any of them may be studied qualitatively. In addition, qualitative methods have critical concepts that must be considered in the conceptual model of the proposed research. Because of the enormous increase in the number and complexity of qualitative methods during the late 1970s and early 1980s,5 qualitative nurse researchers can now draw on a variety of paradigms, methods, and strategies. This methodological pluralism has created a range of qualitative methods and methodological variants too numerous to describe here. Instead, the author identifies 4 common qualitative research “traditions”6 and identifies the critical concepts in each.

'I'm like you': establishing and protecting a common ground in focus groups with Huntington disease caregivers... with review by Spencer L

Focus group research reflects content contributed by participants and the influence of interactions among participants. Analysis of interactions provides insights into focus group dynamics and the contextual meaning of focus group topics. The aim of this report is to analyse interactions that establish or protect a common ground in focus groups of family members caring for adults with Huntington disease (HD). HD tends to stigmatise persons with the disease, as well as their families. Thus, many of the topics in these groups were sensitive. Establishing a common ground was of paramount importance to group members. Participants used interactional processes that combined validations and challenges across assertions of knowledge or expertise, and disclosure of personally painful or socially sanctioned thoughts or feelings. Participants couched their contributions in ways that established similarity with others and when disagreements arose, group members developed processes to sustain their common ground. These behaviours served to facilitate group solidarity and may have influenced the information provided by group members. Awareness of interactions to facilitate maintenance of a common ground allows leaders to recognise the importance of such interactions for the groups functioning, and provides insights for researchers into meanings of focus group findings.

Explanations of risk in families without identified mutations for hereditary nonpolyposis colorectal cancer

PURPOSE Genetic testing for hereditary forms of cancer does not always identify a causative mutation. Little is known about personal or family response to these indeterminate results when a hereditary form of cancer is suspected. This study explored thoughts about and responses to risk for hereditary nonpolyposis colorectal cancer (HNPCC) when a family member has received indeterminate genetic test results. DESIGN In this qualitative study, data were gathered from index cases who received indeterminate genetic test results through a longitudinal study offering genetic counseling and testing for HNPCC. First-degree relatives of these indeterminate index cases were also invited to participate in the qualitative interview. METHODS Semistructured telephone interviews were conducted with index cases and their at-risk first-degree relatives. Data were analyzed using the within- and across-case method. FINDINGS The across-case analysis led to the development of the Awareness and Surveillance Trajectory, which describes individual interpretations of and responses to risk, based on personal and family history. Explanations of risk addressed the meaning of cancer in the family and provided context for individual interpretations. They were identified using within-case analysis and organized into a typology: innate, exceptional, idiosyncratic, and undeveloped explanations. CONCLUSIONS Members of families without identified HNPCC mutations vary in their explanations for, interpretations of, and responses to indeterminate genetic test results. CLINICAL RELEVANCE Explanations of family risk and interpretations of individual risk offer healthcare providers valuable information. In combination with the Awareness and Surveillance Trajectory, assessment of these beliefs can facilitate development of individualized recommendations and strategies for possible preventive actions.

Qualitative research proposals--Part I: Posing the problem.

Previously in Spotlight, members of the Center for Clinical Investigation National Advisory Board have provided excellent guidance in the design of small grants using quantitative methods, that is, research that uses experimental, quasi-experimental, descriptive, or epidemiological designs to describe phenomena in terms of their variables. A 6-part series, starting with this article, will focus on qualitative research and will be published in the 2007 “Spotlights” series in JWOCN. In quantitative studies, the research identifies selected characteristics of participants who represent the phenomenon in question, disassociates those characteristics from other attributes that are not included in the research design, and compares the selected characteristics across cases to ascertain “whether and how they exert[ed] any influence on each other.”1(p526) These research designs are ideal for comparing one treatment or group against another, for identifying potential predictors of particular outcomes, or for describing the incidence or prevalence of health conditions. Although these designs are very powerful and provide clinically useful information, they may not be appropriate to answer all of the questions proposed by wound, ostomy and continence nurse clinicians and researchers. It may be that the important sources of variation in a phenomenon are poorly understood or that no measures exist to quantify the characteristics of interest. For example, although a great deal is known about the physiologic mechanisms of incontinence in persons with spina bifida, much less is known about how adults with spina bifida decide how to manage their incontinence or about how those decisions are integrated into their daily lives. Questions about meaning and process in everyday life are best answered by qualitative research designs, and the identification of important sources of commonality and difference that can be found by a close examination of individual experience can provide the foundation for subsequent interventions and outcome measures. According to Morse,2 qualitative methods are used “when little is known about a topic, when the research context is poorly understood, when the boundaries of the domain are ill defined, when the phenomenon is not quantifiable, when the nature of the problem is murky, or when the investigator suspects that the status quo is poorly conceived and the topic needs to be reexamined.”(p833) Qualitative research methods are ideal for these situations because their flexibility permits the researcher to be guided by the data rather than by a set of fixed a priori hypotheses. Thus the aims of qualitative studies and their associated research questions look somewhat different than the aims of quantitative studies. The first step in the design of any research study is the identification of a problem. It has often been suggested that the research problem determines the method, but in practice, this causal model oversimplifies the process. Most often the researcher’s preferred approach to problemsolving is likely to influence the choice of a problem, the way that problem is understood, and the methods by which that problem will be studied. Nurses who are interested in “the whole picture,” in the way persons with wounds, incontinence, or ostomies make sense of their health or manage their lives outside institutional walls, will find qualitative questions particularly appealing because of the ability of qualitative methods to capture experience in context. At first, questions generated from these issues may seem a poor match with agency funding priorities. Like all researchers, applicants for WOCN small grants will need to look carefully at the language used by agencies to describe their mission, activities, or funding choices. For example, the management of peristomal complications might be studied through a randomized clinical trial of interventions or through interviews with patients with stomas and their family members. Each approach has inherent merits and drawbacks, and it is the responsibility

Qualitative research proposals -- part IV: data management

Qualitative data management involves transforming data from human interaction to written record. For participant observation, the investigator can transcribe field notes, but for interviews and focus groups, audiotaping and transcription are preferable. Audiotapes can include identifying information such as names and places that compromise the participants’ confidentiality; thus, it is preferable to work from transcriptions rather than recordings. Audio and videotaping equipment must be included in the grant budget. Telephone interviews, when used, also require special equipment. Digital recorders are convenient. Digital recorders have a higher capacity than analog recorders and data can easily be loaded into the computer, where it can be stored safely in compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations for protection of identifiable health information. Digital recorders are somewhat more costly, in part because they require special playback software to convert digital files to voice. If the project will use more than one data collector, each person must be supplied with equipment and batteries; sharing equipment is not recommended. Data transcription is time consuming. Generally, it takes 3-5 hours of transcription time for every hour of recorded interview, a substantial time commitment for a nurse researcher who is also engaged in practice. The alternative is professional transcription. Costs vary by region but researchers should budget for at least

A pilot study among older adults of the concordance between their self-reports to a health survey and spousal proxy reports on their behalf

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Qualitative research proposals--part V: rigor in data analysis.

20 per hour for transcription time not recorded interview time. Most transcriptionists bill by the hour. Budget estimates can be developed by multiplying the number of planned interviews by the number of hours anticipated per interview (usually 1.5-2). ■ The Rationale for Coding

Concept Analysis of Responsible Sexual Behavior in Adult Women

BackgroundProxy respondents are frequently used in health surveys, and the proxy is most often the spouse. Longstanding concerns linger, however, about the validity of using spousal proxies, especially for older adults. The purpose of this pilot study was to evaluate the concordance between self-reports and spousal proxy reports to a standard health survey in a small convenience sample of older married couples.MethodsWe used the Seniors Together in Aging Research (STAR) volunteer registry at the University of Iowa to identify and consent a cross-sectional, convenience sample of 28 married husband and wife couples. Private, personal interviews with each member of the married couple using a detailed health survey based on the 2012 Health and Retirement Study (HRS) instrument were conducted using computer assisted personal interviewing software. Within couples, each wife completed the health survey first for herself and then for her husband, and each husband completed the health survey first for himself and then for his wife. The health survey topics included health ratings, health conditions, mobility, instrumental activities of daily living (IADLs), health services use, and preventative services. Percent of agreement and prevalence and bias adjusted kappa statistics (PABAKs) were used to evaluate concordance.ResultsPABAK coefficients indicated moderate to excellent concordance (PABAKs >0.60) for most of the IADL, health condition, hospitalization, surgery, preventative service, and mobility questions, but only slight to fair concordance (PABAKs = −0.21 to 0.60) for health ratings, and physician and dental visits.ConclusionsThese results do not allay longstanding concerns about the validity of routinely using spousal proxies in health surveys to obtain health ratings or the number of physician and dental visits among older adults. Further research is needed in a nationally representative sample of older couples in which each wife completes the health survey first for herself and then for her husband, each husband completes the health survey first for himself and then for his wife, and both spouses’ Medicare claims are linked to their health survey responses to determine not just the concordance between spousal reports, but the concordance of those survey responses to the medical record.