Sally Thorne

Data analysis in qualitative research

Unquestionably, data analysis is the most complex and mysterious of all of the phases of a qualitative project, and the one that receives the least thoughtful discussion in the literature. For neophyte nurse researchers, many of the data collection strategies involved in a qualitative project may feel familiar and comfortable. After all, nurses have always based their clinical practice on learning as much as possible about the people they work with, and detecting commonalities and variations among and between them in order to provide individualised care. However, creating a database is not sufficient to conduct a qualitative study. In order to generate findings that transform raw data into new knowledge, a qualitative researcher must engage in active and demanding analytic processes throughout all phases of the research. Understanding these processes is therefore an important aspect not only of doing qualitative research, but also of reading, understanding, and interpreting it. For readers of qualitative studies, the language of analysis can be confusing. It is sometimes difficult to know what the researchers actually did during this phase and to understand how their findings evolved out of the data that were collected or constructed. Furthermore, in describing their processes, some authors use language that accentuates this sense of mystery and magic. For example, they may claim that their conceptual categories “emerged” from the data1—almost as if they left the raw data out overnight and awoke to find that the data analysis fairies had organised the data into a coherent new structure that explained everything! In this EBN notebook, I will try to help readers make sense of some of the assertions that are made about qualitative data analysis so that they can develop a critical eye for when an analytical claim is convincing and when it is not. Qualitative data come …

The Analytic Challenge in Interpretive Description

The past decade has witnessed remarkable evolution within qualitative health research as scholars have moved beyond initial adherence to the specific methods of phenomenology, grounded theory, and ethnography to develop methods more responsive to the experience-based questions of interest to a practice-based discipline. Interpretive description (Thorne, Reimer Kirkham, & MacDonald-Emes, 1997) is an inductive analytic approaches designed to create ways of understanding clinical phenomena that yield applications implications. In this article, we further develop our understanding of this methodological alternative by elaborating on the objective and mechanisms of its analytic processes and by expanding our consideration of its interpretive products.

Qualitative Metasynthesis: Reflections on Methodological Orientation and Ideological Agenda:

In an era of pressure toward evidence-based health care, we are witnessing a new enthusiasm for qualitative metasynthesis as an enterprise distinct from conventional literature reviews, secondary analyses, and the many other scholarly endeavors with which it is sometimes confused. This article represents the reflections of five scholars, each ofwhom has authored a distinct qualitative metasynthesis strategy. By providing the reader a glimpse into the tradition of their various qualitative metasynthesis projects, these authors offer a finely nuanced examination of the tensions between comparison and integration, deconstruction and synthesis, and reporting and integration within the metasynthesis endeavor. In so doing, they account for many of the current confusions about representation and generalization within the products of these inquiries. Through understanding the bases of their unique angles of vision, the reader is invited to engage in their commitment to scholarly integrity and intellectual credibility in this emerging methodological challenge.

The Structure of Everyday Self-Care Decision Making in Chronic Illness

As health care reform strategists increasingly recognize the critically important potential of effective everyday self-care decision making for reducing the burden of illness and the strain on health service systems, wemust find ways to understand and support it. In this study, the authors investigate persons with expertise in self-care management of type 2 diabetes,HIV/AIDS, and multiple sclerosis to understand how everyday self-care decision making is learned and experienced. They used interview, think-aloud, and focus groups to construct an account of how persons affected by these chronic diseases make decisions in relation to the choices in their everyday lives and learn to manage the untoward effects of these conditions accordingto their unique contexts and values. The findings form a conceptual foundation for ongoing inquiry into this complex phenomenon and provide insights that might assist clinicians to understand more fully the responses and attitudes of those they serve.

Attitudes toward patient expertise in chronic illness

Although it has become an accepted standard to acknowledge the patient as a full partner in health care decisions, replacing traditional authoritative relationships with those based on an emancipatory model, the experiences of persons living with chronic illness confirm that this paradigm shift is not yet apparent in many health care relationships. In this paper, the authors present a qualitative secondary analysis of combined data sets from their research into chronic illness experience with two quite different chronic diseases - Type I Diabetes (a socially legitimized chronic disease) and Environmental Sensitivities (a disease which is currently treated with considerable scepticism). Comparing the experiences of individuals with diseases that are quite differently socially constructed, it becomes possible to detect common underlying health professional values and attitudes that powerfully influence the experience of living with and negotiating health care for a chronic illness. In the discussion of findings from this study, the authors examine the implications of the spiral of behaviors that fuels mutual alienation in chronic illness care relationships if professionals are unable to value patient expertise.

Living with Diabetes as a Transformational Experience

The construct of transformation has been presented in many research studies as the epitome of living with a chronic illness. Because it has been inadequately defined, however, many other concepts (e.g., hope, meaning, control) are used in ways that suggest considerable overlap and correspondence with transformation. This article represents an attempt to explicate the structures and processes of transformation as they were revealed in a qualitative inquiry into the experience of individuals with Type I diabetes. In the accounts constructed with participants in this study, the process of personal transformation was significant in the attainment of healthy outcomes. The authors describe this transformation and examine its relationship to control and to the valued outcomes of intensified sense of self, meaning, and mastery.

Complementary/alternative medicine in chronic illness as informed self-care decision making

The reasons that persons with chronic illness explore complementary and alternative medicine (CAM) have not been well understood. Using data from a study of self-care decision making in chronic illness, we conducted a qualitative secondary analysis to interpret the rationale underlying decisions to experiment with and use various CAM practices and products. The findings confirm that CAM use can be understood as a critical component of self-care management in general, and not as a rejection of conventional medicine or an unrealistic search for cure. In contrast, it represents personal responsibility for health, reframing the measures by which therapeutics are evaluated, and adopting a pragmatic approach to living as well as possible in the context of a chronic condition.

Chronic Illness Experience: Insights from a Metastudy

Concurrent with the recent enthusiasm for qualitative research in the health fields, an energetic call for methods by which to synthesize the knowledge has been generated on various substantive topics. Although there is an emerging literature on meta-analysis and meta-synthesis, many authors overestimate the simplicity of such approaches and erroneously assume that useful knowledge can be synthesized from limited collections of study reports without a thorough analysis of their theoretical, methodological, and contextual foundations and features. In this article, the authors report some of the insights obtained from an extensive and exhaustive metastudy of qualitative studies of chronic illness experience. Their findings reveal the complexities inherent not only in any phenomenon of interest to health researchers but also in the study of how we have come to know what we think we know about it.

Health Care Communication Issues in Multiple Sclerosis: An Interpretive Description

Communication between persons with chronic illness and their professional health care providers is a critical element of appropriate health care. As the field of health care communication evolves, it becomes apparent that aspects of the illness experience shared by those affected by specific diseases might be a source of particular insight into what constitutes effective or appropriate communications. This interpretive description of health care communication issues in multiple sclerosis was based on qualitative secondary analysis of a set of in-depth interviews and focus groups conducted with 12 persons with longstanding MS experience. Analysis of their accounts illustrates an intricate interplay between common features within the disease trajectory and the communications that are perceived as helpful or unhelpful to living well with this chronic illness. From the analysis of these findings, the authors draw interpretations regarding what might be considered communication competencies for those who care for patients with this disease.

The experience of dyspnea in late-stage cancer. Patients' and nurses' perspectives.

We examined the phenomenon of dyspnea during the last weeks of life as it is experienced by patients with cancer and understood by the nurses providing their care. The literature on late-stage cancer suggests a discrepancy between the prevalence of this symptom and the degree to which it is considered clinically significant. Using a range of descriptive and interpretive approaches, we sought to interpret that discrepancy through an understanding of how patients and nurses interpret the nature and meaning of this serious and distressing symptom. Data sources included a pencil-and-paper survey of late-stage cancer patients, chart audit of a population of late-stage cancer patients in a metropolitan home-care hospice program, and intensive interviews with selected patients and nurses. The findings showed that although dyspnea seems to be a significant clinical problem for patients in late-stage cancer, and although effective intervention and management strategies are available, dyspnea often goes unreported by patients and unnoticed by healthcare professionals.