Michelle O’Reilly

‘Unsatisfactory Saturation’: a critical exploration of the notion of saturated sample sizes in qualitative research

Measuring quality in qualitative research is a contentious issue with diverse opinions and various frameworks available within the evidence base. One important and somewhat neglected argument within this field relates to the increasingly ubiquitous discourse of data saturation. While originally developed within grounded theory, theoretical saturation, and later termed data/thematic saturation for other qualitative methods, the meaning has evolved and become transformed. Problematically this temporal drift has been treated as unproblematic and saturation as a marker for sampling adequacy is becoming increasingly accepted and expected. In this article we challenge the unquestioned acceptance of the concept of saturation and consider its plausibility and transferability across all qualitative approaches. By considering issues of transparency and epistemology we argue that adopting saturation as a generic quality marker is inappropriate. The aim of this article is to highlight the pertinent issues and encourage the research community to engage with and contribute to this important area.

'This doctor, I not trust him, I'm not safe': the perceptions of mental health and services by unaccompanied refugee adolescents.

Background: Unaccompanied refugee adolescents are a small but clinically significant group. This group is vulnerable with physical and psychiatric needs which are often not met. There are several barriers to providing care for this group, originating with the refugees but also due to service provision. Aims: The aim of this research is to appreciate the views and perceptions that unaccompanied minors hold about mental health and services. Method: Fifteen unaccompanied adolescents engaged with mental health services were interviewed, and thematic analysis was employed to explore relevant issues. Discussion: Their views reflected a range of opinions on mental health and the treatments they received, but many held negative attitudes toward mental health and had a lack of trust in services. This could be explained by their descriptions of their experiences within their home country of psychiatric care, their experiences of being a refugee/asylum-seeker or cultural differences. Conclusion: We argue it is important to engage this group in the development of policy and practice in child mental health, and in developing services.

‘Gossiping’ as a social action in family therapy: The pseudo-absence and pseudo-presence of children

Family therapists face a number of challenges in their work. When children are present in family therapy they can and do make fleeting contributions. We draw upon naturally occurring family therapy sessions to explore the ‘pseudo-presence’ and ‘pseudo-absence’ of children and the institutional ‘gossiping’ quality these interactions have. Our findings illustrate that a core characteristic of gossiping is its functional role in building alignments’ which in this institutional context is utilized as a way of managing accountability. Our findings have a number of implications for clinical professionals and highlight the value of discourse and conversation analysis techniques for exploring therapeutic interactions.

Should children be seen and not heard? An examination of how children’s interruptions are treated in family therapy

This work adds to the growing literature on children’s talk and the extensive research on interruptions by combining the two. I investigate children in the institutional context of family therapy and their interactions with the parents and therapist. Drawing upon 22 hours of natural family therapy data and four families, I use a discursive approach. I note that children are not attended to when they try to interrupt unless they persist and then the acknowledgement is negative. I show that when the main topic is about extremes of behaviour the child’s none relevant interruption is ignored. There are occasions however when the child interrupts with a topic relevant issue and these are usually attended to. This research has wider implications for therapeutic practice and children’s role in therapy. There is a need for further study of children’s interruptive discourse practice as research in this area is limited.

Is Evidence-Based Practice a Threat to the Progress of the Qualitative Community? Arguments From the Bottom of the Pyramid

Although scholars have gone to great lengths to illustrate the value of qualitative research and ensure that it is well represented in all areas of academic life, there remains a gap of equality when compared with quantitative research, which is still viewed by many as superior, specifically in applied fields such as health. This has become particularly true as the evidence-based movement has continued to find its way into discussions around the legitimacy of qualitative research. In this article, we argue that the evidence-based movement, particularly in medicine and health, continues to pose challenges for us as a qualitative community—challenges that we will need to grapple with in the coming years.

The risk of secondary traumatic stress in the qualitative transcription process: a research note:

It is recognised that transcribing is not merely a neutral and mechanical process, but is active and requires careful engagement with the qualitative data. Whether the researcher transcribes their own data or employs professional transcriptionists the process requires repeated listening to participants’ personal narratives. This repetition has a cumulative effect on the transcriptionist and hearing the participants’ personal narratives of a sensitive or distressing nature, can have an emotional impact. However, this potential emotional impact is often not something which is accounted for in the planning stages of research. In this article we critically discuss the importance of considering the effects on transcriptionists who engage with qualitative data.

Discourse/Conversation Analysis and Autism Spectrum Disorder

Qualitative research focused on autism spectrum disorders (ASD) is important, as it can refine understandings of particular issues related to ASD and be practically relevant provided that quality criteria are applied (Bolte 2014). Employing qualitative methods for the study of ASD is an important way of giving a ‘voice’ to participants and can be particularly useful for empowering vulnerable or disadvantaged people groups (Peters 2010). The field of mental health and disability generally is one that is mediated through language (Brown et al. 1996) and qualitative methods tend to focus on language use, specifically those using discourse or conversation analysis approaches. Quantitative evidence, whatever its form, provides important and valuable evidence about ASD. However, it is crucial that the field does not solely rely on a relatively narrow range of methodologies and forms of knowledge to inform us about such a complex and diverse condition. Qualitative methods are able to go beyond establishing the likelihood of associations between variables, towards understanding the nature of such associations and the complex processes that they may be interpreted to represent. More specifically, qualitative methods are able to go beyond what works to show how and why a particular practice is effective (Rhodes 2011), particularly when taking into account established quality criteria. In this special section, we focus specifically on discourse analysis and conversation analysis, which are languageoriented qualitative approaches that analyse what people actually do and say, as opposed to what they report that they do or say (McCabe 2006). The five included articles use discourse or conversation analysis in varying ways, and highlight how these analytic methods pursue robust validation procedures and focus on identifying systematic patterns of interaction grounded in natural data (McCabe et al. 2002) with built in quality criteria. Typically researchers applying discourse or conversation analysis use extensive corpora of audioor video-recordings of social interactions collected in natural settings (e.g., clinic, therapy session). Analysis then involves a close, inductive examination of the interactions of all the participants in that setting. Although discourse analysis and conversation analysis are similar approaches, and both fall broadly within the landscape of qualitative research in that they treat language as their central focus (Bryman 2008), there are some important practical and epistemological differences which dictate the nature of the questions asked and the specific analytic methods used. Conversation analysis (CA) is a qualitative approach that focuses on the study of interaction. The core aim of this approach is to examine the social organisation of activities that are produced in interaction through talk (Hutchby and Wooffitt 2008). In other words, CA aims to interrogate how people use language to perform certain social actions, such as excusing, inviting, complaining, & Michelle O’Reilly mjo14@leicester.ac.uk; mjo14@le.ac.uk

Assessing interprofessional competence using a prospective reflective portfolio.

Abstract The assessment of interprofessional competence or capability following interprofessional education (IPE) remains essential if we are to ensure future practitioners who are able to work in teams and collaborate for improved health outcomes. Any IPE curriculum must design and describe its theoretical stance and this also applies to how learning will be assessed. This article reports on a study of the use of an IPE portfolio by students across 10 professions as a flexible framework for students to demonstrate their learning. Using a qualitative approach, the completed portfolios of a proportion of students from medicine, social work, and speech and language therapy were read, and a sub-set of students were interviewed to gain their perceptions of this assessment process. The findings are discussed in the light of the value of reflection for learning to consolidate interprofessional understanding. The study highlights how emotional and cognitive learning triggers lead to new understandings for collaborative practice reached only because students were able to reflect on their experiences. The portfolio is now summative and includes other assessment components.

Either/or questions in child psychiatric assessments: The effect of the seriousness and order of the alternatives

Mental health practitioners, assessing children for possible psychiatric conditions, need to probe sensitive matters. We examine practitioners’ use of questions which try to clarify a given issue by offering alternative descriptions of how things are: one bland, and the other clearly undesirable in some way. The undesirable states of affairs can be described in serious terms (e.g. the child wanting to kill themselves) or, while still undesirable, in less serious ones (e.g. the child feeling temporarily upset). We find that if an undesirable state of affairs is described in seriously negative terms, it tends to be put as the first item in the pair of alternatives. We argue that this version of the familiar ‘optimistic questioning’ practice ensures that were the negative case to be chosen, it would be in spite of it being the more interactionally difficult answer to give. That makes the answer diagnostically more reliable. We discuss the pros and cons use of this practice in the environment of triage.

Should Autism Be Classified as a Mental Illness/Disability? Evidence from Empirical Work

Is autism a disability? Fundamentally, this question also raises additional questions, including: What is a disability? Who makes the definition valid? What function does such a label serve within society? The answers are perhaps dependent upon varied points of view and affiliations with particular theoretical frameworks. Indeed, there has been inconsistency regarding the terminology that has been utilised, with this terminology continuing to evolve. In the latest incarnation of autism in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), autism has been defined as Autism Spectrum Disorder (ASD) (American Psychiatric Association, 2013), while other terms are still used within the International Classification of Diseases (ICD). Controversially, the diagnostic label of ‘Asperger’s Syndrome’ has been removed from DSM-5.