Peter Callery

Enhancing the Rigor of Grounded Theory: Incorporating Reflexivity and Relationality

Some proponents of the grounded theory method appear to treat interview and participant observation data as though they mirror informants’ realities. Others claim that grounded theory incorporates reflexivity. It is claimed in this article that the principal texts on grounded theory do not attend to the effects of interactions between researchers and participants in interview and participant observation contexts. Descriptions of the effects of interactions on interview data and attention to relationships between interviewers and interviewees are necessary for attending to the rigor of grounded theory findings. Therefore, it is argued that reflexivity and relationality, which are defined as attending to the effects of researcher-participant interactions on the construction of data and to power and trust relationships between researchers and participants, should be incorporated into grounded theory.

MOMENT -- Management of Otitis Media with Effusion in Cleft Palate: protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey

BackgroundCleft palate (CP) has an incidence of approximately 1 in 700. Children with CP are also susceptible to otitis media with effusion (OME), with approximately 90% experiencing nontrivial OME. There are several approaches to the management of OME in children with CP. The Management of Otitis Media with Effusion in Children with Cleft Palate (MOMENT) study is a feasibility study that includes the development of a core outcome set for use in future trials of the management of OME in children with CP.Methods/DesignThe MOMENT study will include a systematic review of the literature to identify a list of outcomes that have previously been reported. This list of outcomes will be used in a Delphi study with cleft clinicians. The Delphi study is anticipated to include three rounds. The first round will ask clinicians to score the outcome list and to add any outcomes they think are relevant. The second round involves presentation of scores according to stakeholder group and the opportunity for participants to rescore outcomes. To ensure that the opinion of parents and children are sought, qualitative interviews will be completed with a purposive sample in parallel. In the final round of the Delphi process, participants will be shown the distribution of scores, for each outcome, for all stakeholder groups separately as well as a summary of the results concerning outcomes from the qualitative interviews with parents. A final consensus meeting will be held with all stakeholders, including parents and children, to review outcomes.DiscussionA core outcome set represents the minimum that should be measured in a clinical trial for a particular condition. The MOMENT study will aim to identify a core outcome set that can be used in future trials of the management of OME, improving the consistency of research in this clinical area.

The importance of integration of stakeholder views in core outcome set development : otitis media with effusion in children with cleft palate

Background Approximately 75% of children with cleft palate (CP) have Otitis Media with Effusion (OME) histories. Evidence for the effective management of OME in these children is lacking. The inconsistency in outcome measurement in previous studies has led to a call for the development of a Core Outcome Set (COS). Despite the increase in the number of published COS, involvement of patients in the COS development process, and methods to integrate the views of patients and health professionals, to date have been limited. Methods and Findings A list of outcomes measured in previous research was identified through reviewing the literature. Opinion on the importance of each of these outcomes was then sought from key stakeholders: Ear, Nose and Throat (ENT) surgeons, audiologists, cleft surgeons, speech and language therapists, specialist cleft nurses, psychologists, parents and children. The opinion of health professionals was sought in a three round Delphi survey where participants were asked to score each outcome using a bespoke online system. Parents and children were also asked to score outcomes in a survey and provided an in-depth insight into having OME through semi-structured interviews. The results of the Delphi survey, interviews and parent/patient survey were brought together in a final consensus meeting with representation from all stakeholders. A final set of eleven outcomes reached the definition of “consensus in” to form the recommended COS: hearing; chronic otitis media (COM); OME; receptive language skills; speech development; psycho social development; acute otitis media (AOM); cholesteatoma; side effects of treatment; listening skills; otalgia. Conclusions We have produced a recommendation about the outcomes that should be measured, as a minimum, in studies of the management of OME in children with CP. The development process included input from key stakeholders and used novel methodology to integrate the opinion of healthcare professionals, parents and children.

The effectiveness of self-care support interventions for children and young people with long-term conditions: A systematic review

Childrens health policy has highlighted the need to develop self-care programmes. However, there is a lack of evidence on which to base the development of such programmes. This paper reviews the published research on the effectiveness of self-care support interventions for children and young people with asthma, cystic fibrosis and diabetes. A systematic search was conducted of a range of electronic databases, supplemented by searching the reference lists of retrieved papers and published reviews. Retrieved studies were assessed against quality and eligibility criteria by two independent reviewers. The results were narratively synthesized to examine the effectiveness of self-care support interventions on health status, psycho-social well-being, condition-related knowledge, health service use and participant satisfaction. The search strategy identified 4261 papers which were screened against the review inclusion criteria. A total of 194 papers were assessed as being potentially eligible for inclusion with 15 papers being judged as adequate to include in the review. There is strong evidence of the effectiveness of interventions that target children/young people; use e-health or group-based methods; that are delivered in community settings. There is no evidence that interventions that focus on parents alone or are delivered only in hospital settings are effective. While there is some evidence to inform the development of self-care support programmes, there is a need for well-designed trials of interventions that are feasible to transfer into real-life settings and which involve parents and children in their development.

The use of qualitative methods to inform Delphi surveys in core outcome set development

BackgroundCore outcome sets (COS) help to minimise bias in trials and facilitate evidence synthesis. Delphi surveys are increasingly being used as part of a wider process to reach consensus about what outcomes should be included in a COS. Qualitative research can be used to inform the development of Delphi surveys. This is an advance in the field of COS development and one which is potentially valuable; however, little guidance exists for COS developers on how best to use qualitative methods and what the challenges are. This paper aims to provide early guidance on the potential role and contribution of qualitative research in this area. We hope the ideas we present will be challenged, critiqued and built upon by others exploring the role of qualitative research in COS development.This paper draws upon the experiences of using qualitative methods in the pre-Delphi stage of the development of three different COS. Using these studies as examples, we identify some of the ways that qualitative research might contribute to COS development, the challenges in using such methods and areas where future research is required.ResultsQualitative research can help to identify what outcomes are important to stakeholders; facilitate understanding of why some outcomes may be more important than others, determine the scope of outcomes; identify appropriate language for use in the Delphi survey and inform comparisons between stakeholder data and other sources, such as systematic reviews. Developers need to consider a number of methodological points when using qualitative research: specifically, which stakeholders to involve, how to sample participants, which data collection methods are most appropriate, how to consider outcomes with stakeholders and how to analyse these data. A number of areas for future research are identified.ConclusionsQualitative research has the potential to increase the research community’s confidence in COS, although this will be dependent upon using rigorous and appropriate methodology. We have begun to identify some issues for COS developers to consider in using qualitative methods to inform the development of Delphi surveys in this article.

Topicality and the structure of interactive talk in face‐to‐face seminar discussions: implications for research in distributed learning media

This article examines the structure of topic movement within face‐to‐face postgraduate university seminar discussion forums through a conversation analytic approach. The analysis of 12 audio recordings of seminars showed that in spite of clear differences in the management style of sessions by seminar leaders there were important consistencies in their normative structure of participation. Previous research has shown that the turn‐taking procedures used as a basic organisational feature of the talk have been seen to result in a regular change of topic within seminars. Although the research here supports these findings, the data showed that topic change was only one aspect of the topic negotiation process. The analysis in this article illustrates that topic negotiation was an ever‐present feature of the talk and that, in addition to frequent ‘successful’ changes of topic, there were also innumerable ‘unsuccessful’ topical interjections. One prominent source of such failure was the presence of overlap in th...

The Digital Revolution in Qualitative Research: Working with Digital Audio Data Through Atlas.Ti

Modern versions of Computer Assisted Qualitative Data Analysis Software (CAQDAS) are enabling the analysis of audio sound files instead of relying solely on text-based analysis. Along with other developments in computer technologies such as the proliferation of digital recording devices and the potential for using streamed media in online academic publication, this innovation is increasing the possibilities of systematically using media-rich, naturalistic data in place of transcribed ‘de-naturalised’ forms. This paper reports on a project assessing online learning materials that used Atlas.ti software to analyse sound files, and it describes the problems faced in gathering, analysing and using this data for report writing. It concludes that there are still serious barriers to the full and effective integration of audio data into qualitative research: the absence of ‘industry standard’ recording technology, the underdevelopment of audio interfaces in Atlas.ti (as a key CAQDAS package), and the conventional approach to data use in many online publication formats all place serious restrictions on the integrated use of this data. Nonetheless, it is argued here that there are clear benefits in pushing for resolutions to these problems as the use of this naturalistic data through digital formats may help qualitative researchers to overcome some long-standing methodological issues: in particular, the ability to overcome the reliance on data transcription rather than ‘natural’ data, and the possibility of implementing research reports that facilitate a more transparent use of ‘reusable’ data, are both real possibilities when using these digital technologies, which could substantially change the shape of qualitative research practice.

Developing an intervention to promote young people’s participation in asthma review consultations with practice nurses

AIM The article is a report of a study to develop an evidence-based pre-consultation guide for young people to use prior to an asthma review with a practice nurse. BACKGROUND The participation of young people aged 13-19 in consultations with health professionals can be limited by the lack of opportunity to learn the appropriate skills in triadic consultations. Evidence-based interventions to promote participation of adults in consultations have been developed but young peoples needs have not been specifically addressed. DESIGN Multiple methods design informed by guidelines for the development of complex interventions. METHODS A pre-consultation guide for young people was developed in 2007 by application of a model of health behaviour change, development of criteria by an expert panel and in consultation with young people using a nominal group technique. RESULTS The concepts of the Health Action Process Approach model were applied to the development of criteria underpinning the pre-consultation guide. In the nominal groups young people agreed that they had different needs to other children and adults. The consensus was that the preconsultation guide should include disease-specific information, realistic photographs rather than Clip Art, consistent styles of fonts, bullet points and colours, short words and mature language. Statements and example questions written by young people were included in the evidence-based guide. CONCLUSION Young peoples views can contribute to the development of interventions designed to promote communication in consultations with nurses. There is potential for this approach to be used to develop interventions in primary and secondary care of a range of long-term conditions.

Young People's Preferences for Emotional Well-Being Support in High School—A Focus Group Study

PROBLEM Schools have been identified as a suitable setting for the delivery of emotional well-being (EWB) support, but in the United Kingdom there is little empirical evidence from young people that can inform the development of appropriate school-based interventions. METHODS Fifty-four students (11-16 years) from three U.K. high schools discussed the content, delivery, and evaluation of acceptable, school-based, EWB support. Focus group methods were matched to the school setting and sensitive topic. FINDINGS Participants identified emotional difficulties in school, home, and with peer relationships. They said that some problems were too sensitive for them to seek help in school setting. They valued confidentiality, support, and effective help that were offered by people they experienced as friendly, trustworthy, and skilled. Teachers and peer mentors were not thought to fit these criteria, although trusted adults in mentor roles could meet their criteria. Participants recognized that they could hide their emotions, so their EWB would be difficult to assess. They described how the effect of emotional distress on their behavior is idiosyncratic, and therefore their EWB should not be judged simply on their behavior. CONCLUSION The way in which EWB support is delivered in school is an important aspect of the role of practitioners and educators attempting to provide it. Because young people are sensitive to the personal qualities and skills of people offering them help, programs to train school staff in emotional support roles are important to ensure trust and an environment open to students seeking assistance. Interventions for school-based EWB support need to consider subjective well-being as well as behavioral change.

Transition in endocrinology: The challenge of maintaining continuity

Transition from child to adult status is a crucial stage in young peoples lives. It is important that young people continue to receive appropriate endocrine care throughout and following transfer from paediatric to adult services. This study examined indicators of patient loss to follow‐up at initial transfer from paediatric care to identify implications for transitional care practice and research.