Qualitative Research Methodology

Unstructured Observations

Unstructured observation involves spontaneously observing and recording what one sees with a minimum of planning. Although unstructured observations give the observer freedom, there is a risk that the observer may lose objectivity or may not remember all of the details of the event. If possible, the researcher should take notes during the observation periods. If this is not possible, the researcher needs to record the observations soon afterward. You may even find it useful to photograph or videotape the observation period so that you can examine it extensively at a later time (Harrison, 2002; Mullhall, 2002).

Unstructured observations are not unsystematic or sloppy as the term might suggest. Rather, unstructured means that the researcher has few predetermined notions as to what he or she might observe. What notions the researcher does have may change over time as data are collected. As Mulhall (2003) pointed out:

Hamilton and Manias (2007) studied the observational methods of psychiatric nurses and their invisibility in an acute inpatient setting. This excellent study not only gives you as reader a clear understanding of the careful observation conducted during this study, but it also enables you to understand how detailed observation must be in a qualitative study and gives you a chance to think about how you might conduct your own observations. Hamilton and Manias (2007) described their study as follows.

The authors concluded the following:

Unstructured Interviews

Unstructured interviews are used primarily in descriptive quantitative and qualitative studies. According to market research, in-depth interviews provide more quality data for less money than do focus groups (Palmerino, 1999). However, the interviewer seeks information from a number of individuals, whereas the focus group strategy is designed to obtain the perspective of the normative group, not individual perspectives.

Focus Groups

Focus groups were designed to obtain the participants’ perceptions in a focused area in a setting that is permissive and nonthreatening. One of the assumptions underlying the use of focus groups is that group dynamics can help people to express and clarify their views in ways that are less likely to occur in a one-to-one interview. The group may give a sense of “safety in numbers” to those wary of researchers or those who are anxious.

Focus groups are a relatively recent strategy that was used initially in nursing studies in the late 1980s. However, they have been used in other fields for a long time. The idea of focus groups emerged in the 1920s as an approach for examining the effectiveness of marketing strategies. The concept reemerged during World War II with efforts to determine ways to improve the morale of the troops. The technique serves a variety of purposes in nursing research. It has been used to perform qualitative studies (Twinn, 1998), make policy analyses (Straw & Smith, 1995), assess consumer satisfaction, evaluate the quality of care (Beaudin & Pelletier, 1996), examine the effectiveness of public health programs, assist in professional decision making (Bulmer, 1998; Southern et al., 1999), develop instruments, explore patient care problems and strategies for developing effective interventions, develop education programs (Halloran & Grimes, 1995), and study various patient populations (Disney & May, 1998; Goss, 1998; Quine & Cameron, 1995; Reed & Payton, 1997). It has also been employed as a data collection strategy in participatory research. A focus group study might include from 6 to 50 groups.

The following assumptions underlie focus groups (Morrison & Peoples, 1999):

The effective use of focus groups requires careful planning. Questions that must be addressed include the following:

Many different communication forms are used in focus groups, including teasing, arguing, joking, anecdotes, and nonverbal approaches such as gesturing, facial expressions, and other body language. Kitzinger (1995, pp. 299–300) has suggested that

Recruiting appropriate participants for each of the focus groups is critical, because recruitment is the most common source of failure. Each focus group should include 6 to 10 participants. If there are fewer participants, the discussion tends to be inadequate. In most cases, participants are expected to be unknown to each other. However, when targeting professional groups such as clinical nurses or nurse educators, such anonymity usually is not possible. You may use purposive sampling to seek out individuals known to have the desired expertise. In other cases, you may look for participants through the media, posters, or advertisements. A single contact with an individual who agrees to attend a focus group does not ensure that this person will attend the group session. You will need to make repeated phone calls and remind the candidates by mail. Inform them at the time of consent that you will be calling to remind them of the group and to verify that the phone number they gave you is the best number to call. You may need to offer incentives. Cash payments are, of course, the most effective if the resources are available through funding. Other incentives include refreshments at the focus group meeting, T-shirts, coffee mugs, gift certificates, or coupons. Overrecruiting may be necessary; a good rule is to invite two more potential participants than you need for the group (Morgan, 1995).

Segmentation is the process of sorting participants into focus groups with common characteristics. Selecting participants who are similar to each other in lifestyle or experiences, views, and characteristics facilitates more open discussion. And you can increase the group’s validity by conducting multiple focus groups and placing participants with differing characteristics into separate groups. These characteristics might be age, gender, social class, ethnicity, culture, lifestyle, or health status. Strickland (1999) pointed out the problems that could occur if differing cultural groups are included in the same focus group. Communication patterns, roles, relationships, and traditions might interfere with the interactions within the focus group. In some cases, groups may occur naturally such as those who work together. Be cautious about bringing together participants with considerable variation in social standing, education, or authority because some group members may hesitate to participate fully, whereas others may discount the input of those with perceived lower standing (Kitzinger, 1995; Morgan, 1995).

Establish a setting for your focus group that is relaxed. There should be space for participants to sit comfortably in a circle or U-shape and maintain eye contact with all participants. Ensure that the acoustics of the room will allow you to obtain a quality tape recording of the sessions. As with the one-on-one interview discussed earlier, place your tape or video recorders unobtrusively, and use batteries rather than plugging your equipment into a power source as this is less invasive. Use a highly sensitive microphone. However, it may be necessary for the moderator or assistant moderator to take notes when the speaker’s voice is soft or when several individuals are speaking at once. Making notes on the dynamics of the group is also useful. Note how group members interact with one another. Sessions will usually last 1 to 2 hours, although some may extend to an entire afternoon or continue as part of a series of meetings.

It is important for the researcher to clarify the aims of the focus groups and communicate these aims to the moderators and the participants before the group session. Instruct participants that all points of view are valid and helpful and that speakers should not have to defend their positions. Make clear to the group that the facilitator’s role is to moderate the discussion, not to contribute. Carefully plan the questions that are to be asked during the focus group, and, if time permits, pilot-test them. Limit the number of questions to those most essential so that sufficient time is left for discussion. You may elect to give participants some of the questions before the group meeting to enable them to give careful thought to their responses. Questions should be posed in such a way that group members can build on the responses of others in the group, raise their own questions, and question each other. Probes can be used to elicit richer details using questions such as “How would that make a difference?” or “What makes you think that?” “Why” questions are not good because they tend to push a participant toward taking a stand and defending it. Then it is difficult to move away from the stand if the group begins moving toward some consensus. The act of questioning or challenging ideas offers a stimulating learning experience for group members. Their thinking may be supported or tested, and participants may be presented with new ways of thinking about a problem (Hollis Openshaw, & Goble, 2002).

A common problem in focus groups is to dive right into the topic of interest to the researcher with little emphasis on the interests of the participants. Early in the session, provide opportunities for participants to express their views on the topic of discussion. Next, proceed with the questions. Use probes if the discussion wanders too far. A good facilitator will weave questions into the discussion naturally. The facilitator’s role is to clarify, paraphrase, and reflect back what group members have said. These discussions tend to express group norms, and individual voices of dissent may be stifled. However, when the discussion is on sensitive topics, the group may actively facilitate the discussion because less inhibited members break the ice for those who are more reticent. Participants may also provide group support for expressing feelings, opinions, or experiences. Late in the session, the moderator may encourage group members to go beyond the current discussion or debate and discuss inconsistencies among participants and within their own thinking. The moderator can use disagreements among group members to encourage participants to state their points of view more clearly and provide a rationale for their position (Kitzinger, 1995).

Collecting Stories

During observation and interviewing, the researcher may record stories shared by participants. Banks-Wallace (1998) described a story as “an event or series of events, encompassed by temporal or spatial boundaries, that are shared with others using an oral medium or sign language. Storytelling is the process or interaction used to share stories. People sharing a story (storytellers) and those listening to a story (storytakers) are the main elements of storytelling” (p. 17). Stories can help researchers to understand a phenomenon of interest. In some qualitative studies, the focus of the research may be the gathering of stories. Gathering of stories can enable health care providers to develop storytelling as a powerful means to increase insight and promote health behavior in clients. For example, Nwoga (1997, 2000) studied how African-American mothers use storytelling to guide their adolescent daughters regarding sexuality. The stories could assist other mothers who are struggling to help their daughters deal with sexuality issues.

Coffey and Atkinson (1996) discussed the importance of capturing stories in qualitative studies.

Mattingly and Lawlor (2000) described their research in which they solicit “illness stories.” These authors skillfully guide you in interpreting the process of the story, identifying key turning points as the story progresses.

Constructing Life Stories

A life story is designed to reconstruct and interpret the life of an ordinary person. The methodology, which emerged from history, from anthropology, and more recently from phenomenology, has been described by a number of scholars (Bateson, 1989; Bertaux, 1981; Frank, 1979; Gergen & Gergen, 1983; Josselson & Lieblich, 1995; Linde, 1993; Mattingly & Garro, 1994; Polkinghorne, 1988; Sarbin, 1986; Tanner et al., 1993; Ventres, 1994). The life story can be used to clarify the meanings of various states of health, chronic illness, and disability in the lives of patients, their families, and other caregivers. These stories can help us understand the meaning to patients of their health behavior, lifestyles, illnesses, or impairments; the meaning of symptoms; their experiences of treatment; how they adapt; and their hopes and possibilities of reconstructing their lives. Interviews are tape-recorded and transcribed. Notes from observations may be important, and personal documents such as diaries or historical records may be used. Analysis involves more than just stringing events together; events should be linked in an interpretation through which the researcher can create theoretical sense. Materials are organized and analyzed according to theoretical interests. Constructing a life story often requires a long-term contact and extensive collaboration with the participant (Frank, 1996; Larson & Fanchiang, 1996; Mallinson, Kielhofner, & Mattingly, 1996).

Roesler (2006) provided a life story of Herr Bittner in an article describing a narratological methodology for identifying archetypal story patterns in autobiographical narratives. The article is translated from German.

Case Studies

A case study examines a single unit within the context of its real-life environment. The unit may be a person, a family, a nursing unit, or an organization. In the early twentieth century, the most common nursing study was a case study. Medical case studies were also common. Nursing case studies were published in the American Journal of Nursing and initiated a variety of nursing studies of patient care. As nursing research began to use more rigorous methods, the case study fell into disrepute. However, the importance of information from case studies is again being recognized. Case studies can use quantitative, qualitative, or mixed methods of data collection. It is important for the researcher to consider the multiple aspects that affect a particular case and to include this essential information in the plan for data collection and analysis.

Research questions, as well as the qualitative method chosen for the study, guide the data collection. However, as with most qualitative studies, as an understanding of the situation begins to emerge, other questions arise and new data may be gathered to address the new question. A researcher might want to understand the multiplicity of factors that affect patient care, all of the elements that affect the emotional state of a person with a particular illness, or the factors that affect learning from a particular approach to patient education. Factors might include the social and political environment in which care is being provided. Thus, identifying all of the variables to be examined is a critical component to planning the study. Multiple sources of information for as many of the variables as possible give the study greater validity. This is referred to as data triangulation. A field diary is also useful because insights can be recorded as they occur. The researcher might also recognize new variables that need to be examined. Personal response to events should also be recorded. If the case is a person, multiple interviews may need to be conducted, requiring a strong commitment from the respondent. Documentary evidence is also a valuable source of details related to the case. Analysis focuses on providing a rich, in-depth description of the case. Generalization, as with many qualitative studies, is not possible. However, comparisons with similar situations are sometimes possible.

Benderix and Sivberg (2007) provided an example of a case study.

Using the Computer for Qualitative Analysis

Traditionally, qualitative data collection and analysis were performed manually. The researcher recorded the data on small bits of paper or note cards, which were then carefully coded, organized, and filed at the end of a day. Manual analysis requires cross-checking each bit of data with all the other bits of data on little pieces of paper. It is easy to lose data in the mass of paper. Keeping track of connections between various bits of data requires meticulous record keeping. This method was developed because it was important for the qualitative researcher to maintain a close link with—or become immersed in—the data being analyzed.

Some qualitative researchers believe that using the computer can make analysis of qualitative data quicker and easier without the researcher losing touch with the data (Anderson, 1987; Miles & Huberman, 1994; Pateman, 1998; St John & Johnson, 2000; Taft, 1993). Taft has suggested that because of the ease of coding and recoding, the researcher feels more free to play with the data and experiment with alternative ways of coding. This freedom fosters analytical insight and thus facilitates data analysis. Researchers can also search for codes that tend to occur together. Also, easy access to the data facilitates team research. Pateman (1998; full text available in Nursing Collection) suggested that “some would argue that scientific, mathematically-minded people are more computer literate than those with more artistic, humanistic interests, in which case affinity with computing may have something to do with personal traits.… Some of the … arguments [by qualitative researchers against using computers] could simply be rationalisation by computer-phobic researchers.” However, Taft expressed concern about the dark side of computer technology for qualitative researchers. The researcher may be tempted to study larger samples and sacrifice depth for breadth. Meaningful understanding of the data may also be sacrificed. Sandelowski (1995a) expressed concern that the use of computers will alter the aesthetics of qualitative research and suggested that the key motivation for using computer technology in qualitative research is to legitimize the claim that qualitative researchers are doing science. She stated, “computer technology permits qualitative researchers to have computer printouts of data (with the veneer of objectivity they confer) comparable to their quantitative counterparts whose claims to doing science are often not questioned. Even so-called soft data can become hard when produced by hardware. Qualitative work can now have the look and feel, or aesthetic features, of science” (p. 205).

The computer can assist researchers in activities such as processing, storage, retrieval, cataloging, and sorting and leaves the analysis activities up to the researcher. Anderson (1987) pointed out that “the computer does not perform the thinking, reviewing, interpretative, and analytic functions that the researcher must do for himself or herself. Rather, the computer makes the researcher more efficient and effective in those high-level functions, and eases some of the tedious ‘mindless’ tasks that otherwise consume so much time and energy” (pp. 629–630). However, Sandelowski (1995a) has argued that replacing and streamlining the cutting and pasting activities may be seen as desirable by some because they are uncomfortably reminiscent of childhood play. She argued against the claim that machine technology saves human labor and suggested that it may actually increase labor because more data are stored and retrieved and once the data are stored, one has more of a sense that it must all be accounted for in the report of results.

Computer use has several advantages over the more traditional methods of recording and storing data. Multiple copies can be made with ease, and files can be copied onto backup disks and stored at another site without the need for a large amount of storage space. Blocks of data can also be moved around in the file or copied to another file when data are being sorted by category. The same block of data could be inserted within several categories, if desired. At the same time, interviews or descriptions of observations can be kept intact for reference as needed. In addition, most word processing programs can perform sort operations and can search throughout a text file for a selected word or a string of words. Many of these activities can be performed with a traditional word processing program (Burnard, 1998). Files in a word processing program can be transferred to a database spreadsheet such as Excel, dBase, or Lotus 1–2–3 to organize the data into matrices.

A number of computer programs have been developed specifically to perform qualitative analyses. Podolefsky and McCarty (1983) described one of the earliest attempts. This program, Computer Assisted Topical Sorting (CATS), allowed users to insert codes, designated as numbers, into a text file. A mainframe text editor gave users the capacity to search for strings of characters such as words or phrases. St John and Johnson (2000) explored the pros and cons of various data analysis software for qualitative research.

Transcribing Interviews

Tape-recorded interviews are generally transcribed word for word. Field and Morse (1985) provided the following instructions for transcribing a tape-recorded interview.

Sandelowski (1994) indicated that the researcher must choose which features about the interview to preserve in print. These choices directly influence the nature and direction of the analysis. Once the interview has been transcribed, the transcript takes on an independent reality and becomes the researcher’s raw data. Sandelowski suggested that the process of transcription alters reality. The text is “many transformations removed from the so-called unadulterated reality it was intended to represent” (p. 312). She recommended asking the following questions regarding transcription:

Sandelowski pointed out that transcriptions require about 3.5 hours for each 1 hour of interview time. The cost for this work may be $20/hour for an experienced typist.

Hutchinson (2005) has developed an innovative method of data analysis that uses audio-editing software to save selected audio bytes from digital audio recordings. The data are never transcribed but remain in audio form. A database is used to code and manage the linked audio files and generate detailed and summary reports. Although the system is time consuming to set up, it negates the need for expensive and time-intensive transcription of recorded data.

Listen to the tape recordings as soon after the interview as possible. Listen carefully to voice tone, inflection, and pauses of the researcher and the participant, as well as the content. These features may indicate that the topic is very emotional or very important. While you are listening, read the written transcript of the tape. Make notations of your observations on the transcript.

Ayers and Poirier (1996) pointed out that “qualitative analysis results from the recontextualization of chunks of data, always with the caveat that the new context must in some way be faithful to its origins. Narrative data are meaningless without context” (p. 164). Using the reader response theory emerging from the work of Iser (1980) and Kermode (1983), Ayers and Poirier indicated that “the meaning of a text arises from the interaction of the mind (including the personal history) of the reader with the content of the text (which in turn arose from the mind and personal history of the interview respondent)” (p. 164). Reading the text results in an interaction between the mind and personal history of the respondent and the mind and personal history of the researcher. This interaction results in the emergence of a “virtual text,” which is the entity being interpreted. Thus, there is no real objective, authentic information from which only one correct interpretation can be made. The text does not explain everything. “Motives, histories, antecedents, and causal links, sometimes entire subplots are left to the reader, to the researcher, to infer” (Ayers & Poirier, 1996, p. 165). The process of interpretation occurs in the mind of the reader. The virtual text grows in size and complexity as the researcher reads and rereads. Throughout the process of analysis, the virtual text develops and evolves. Although multiple valid interpretations may occur if different researchers examine the text, all findings must remain trustworthy to the data. This trustworthiness applies to the unspoken meanings emerging from the totality of the data, not just the written words of the text.

Immersion in the Data

Data collected during a qualitative study may be narrative descriptions of observations, transcripts from tape recordings of interviews, entries in the researcher’s diary reflecting on the dynamics of the setting, or notes taken while reading written documents. In the initial phases of data analysis, you need to become familiar with the data as you gather them. This process may involve reading and rereading notes and transcripts, recalling observations and experiences, listening to tapes, and viewing videotapes until you have become immersed in the data. Tapes contain more than words; they contain feeling, emphasis, and nonverbal communications. These aspects are at least as important to the communication as the words are. In phenomenology, this immersion in the data is referred to as dwelling with the data.

Data Reduction

Because of the volumes of data acquired in a qualitative study, initial efforts at analysis focus on reducing the volume of data so that the researcher can more effectively examine them, a process referred to as data reduction. During data reduction, you begin attaching meaning to elements in your data. You will discover classes of things, persons, and events and detect properties that characterize things, persons, and events. You will also note regularities in the setting or the people. These discoveries will lead to classifying elements in your data. In some cases, you may apply the classification scheme used by participants or authors. In other cases, you may wish to construct your own classification scheme.

According to Sandelowski (1995b),

Data Analysis

The following is a description of some of the techniques qualitative researchers use during the process of data analysis and interpretation. These techniques include coding, reflective remarks, marginal remarks, memoing, and developing propositions.

Multimedia Analysis

The purpose of any sort of analysis of transcripts is to ascertain meaning. The type of meaning sought may vary. However, meaning in an interaction is not conveyed totally through the words that are used. The way in which the words were expressed may be critical to the meaning being conveyed. In addition, approximately 70% of communication is nonverbal. As Burnard (1995) wisely pointed out, “often the words used are not particularly relevant or are not ‘registered’ by the parties involved in a conversation. We do not, after all, usually pick our words very carefully when we speak, nor do we continually ‘check each other’ to ascertain that understanding has occurred. And yet we do understand one another, most of the time” (full text available in Nursing Collection). In some cases, the words used have little or no meaning. They are used to convey unstated meanings. The meanings are behind the words. It may be impossible to capture this meaning by analyzing transcripts. The participant, asked for an exact interpretation of what was meant, may not be able to explain the meaning. Sometimes,

One way to address this problem is to use multiple data collection methods. Interviews might be videotaped as well as audiotaped. The researcher might strengthen his or her analysis by simultaneously reviewing video and audio transmissions while reviewing the transcript. Parse (1990) referred to this process as immersion in the data. Multimedia computers are now available in which text, video, graphical media, and sound can be used for such immersion. Burnard (1995) foresees a time when CD-ROM disks might be used to store these multimedia data sets. This type of integrated and triangulated approach to analysis would provide a richer understanding of meaning.

Analysis of Focus Group Data

Historically, content analysis has been used to analyze focus group data. However, data from focus groups are complex in that analysis is required at both the individual level and at the group level, considering interactions among individuals and the group, and making comparisons across groups. It is important to attend to the amount of consensus and interest in topics generated in the discussion. Analysis of deviance and minority opinions is important. Attending to the context within which statements were made is critical to the analysis (Morgan, 1995).

Carey (1995) made the following suggestions regarding analyzing focus group data.

It is important in analyzing the data to determine who said what. If only tape-recording is available, this may be a problem. Video recording can help you to obtain this information; if this is not feasible, the cofacilitator can take notes that may provide some information that will help you to make this determination. One useful analysis strategy is to examine all the input of a particular individual and the extent to which this individual’s comments influenced the position of other group members. Nonverbal interaction should also be noted. Dominant members of the group may suppress dissonant views that increase the richness of the data. According to Sim (1998):

Generalization from Focus Group Analysis

The common view of focus groups was that they were representative of a target population and thus generalization to the target group was acceptable. However, participants are not obtained using probability sampling, and one is on shaky ground justifying generalization using this argument. The type of person likely to agree to participate in a focus group is probably different from those who decline. The focus group is a carefully constructed environment, with the setting designed to facilitate the group dynamics so that data are generated. The contrived social situation is not a natural one. What a person says in the focus group cannot be assumed to be what the person would say in other settings. Sim (1998) concluded that “it is not clear that any process of analysis can meaningfully separate out from the data the social factors which operate within the context of a focus group—indeed, the very idea of a context-neutral perspective may not even make sense within this sort of epistemological framework” (p. 350). Rather than considering empirical generalization, Sim (1998) recommended theoretical generalization, based on commonalities of the focus group participants with other groups. Different degrees of generalization may be possible based on the extent of commonality.

Displaying Data for Analysis and Presentation

Displays contain highly condensed versions of the outcomes of qualitative research. They are equivalent to the summary tables of statistical outcomes developed in quantitative research and allow the researcher to get the main ideas of the research across succinctly. Strategies for achieving displays are limited only by the researcher’s imagination. Some suggested ideas follow. It is relatively easy to develop displays by using computer spreadsheets, graphics programs, or desktop publishing programs. Miles and Huberman (1994) provided helpful guidelines for developing displays of qualitative data. Williamson and Long (2005) described techniques of qualitative data analysis using data displays, including the use of computer packages for making displays.

Drawing and Verifying Conclusions

Unlike the case in quantitative research, conclusions are formed throughout the data analysis process. Conclusions are similar to the findings in a quantitative study. Miles and Huberman (1994) identified 12 tactics used to draw and verify conclusions.

Building a Logical Chain of Evidence

At first glance, this step would seem to be the same activity described earlier that resulted in the development of a tentative theory; however, this activity assumes the prior development of a tentative theory. Building a logical chain of evidence involves testing that theory. The researcher must go back and carefully trace evidence from the data through development of the tentative theory; the elements, relationships, and propositions of the theory are then tested against new data. The researcher looks for cases that closely fit the theory and for those that clearly do not fit the theory. The theory may then be modified.

This process is referred to as analytical induction and uses two interlocking cycles. The first cycle is enumerative induction, in which a number and variety of instances are collected that verify the model. The second cycle, eliminative induction, requires that the hypothesis be tested against alternatives. The researcher is required to check carefully for limits to generalizability of the theory. The process of constant comparisons used in grounded theory is related to eliminative induction (Miles & Huberman, 1994).

Making Conceptual/Theoretical Coherence

The previous steps have described a gradual move from empirical data to a conceptual overview of the findings. Inferences have been made as the analysis moved from the concrete to the more abstract. The steps then moved from metaphors to interrelationships, then to constructs, and from there to theories. The theory must now be connected with existing theories in the body of knowledge. To accomplish this step, you must become familiar with a wide variety of theories that could explain the current phenomenon. If you can connect the new theory with other theories, it further strengthens the present theoretical explanation (Miles & Huberman, 1994).

Content Analysis

Content analysis is designed to classify the words in a text into a few categories chosen because of their theoretical importance. Because content analysis uses counting, many qualitative researchers do not consider it to be a qualitative analysis technique. Content analysis is frequently used in historical research. It is the primary approach to analysis used by Kalisch and Kalisch (1977); Kalisch, Kalisch, and Belcher (1985); Kalisch, Kalisch, and Young (1983); and Kalisch, Kalisch, and Clinton, J. (1982) in their series of studies examining the image of nursing as reflected in news media and primetime television.

The technique provides a systematic means of measuring the frequency, order, or intensity of the occurrence of words, phrases, or sentences. Initially, the specific characteristics of the content to be measured must be defined, and then the researcher develops rules for identifying and recording these characteristics. The researcher first selects a specific unit of analysis, which may be individual words, word combinations, or themes. This unit of analysis is considered a symbolic entity and often indicates an abstract concept. Downe-Wamboldt (1992, p. 314) pointed out that “content analysis is more than a counting game; it is concerned with meanings, intentions, consequences, and context. To describe the occurrences of words, phrases, or sentences without consideration of the contextual environment of the data is inappropriate and inadequate.”

To perform content analysis, text is divided into units of meaning (idea categories). These units are then quantified according to specific rules. Idea categories are constructed and words considered representative of these idea categories are selected; this is a crucial phase of content analysis. In more complex studies, more than one categorizing scheme may be used. One common approach to categorization is the use of a dictionary to identify terms and delineate their meaning (Kelly & Sime, 1990).

In some studies, the researcher is searching for latent meaning within the text. In these studies, the text cannot be analyzed by directly observing or identifying specific terms. The researcher may have to infer meaning by more indirect means, such as by looking for relationships among ideas, reality, and language (Kelly & Sime, 1990).

Narrative Analysis

Narrative analysis is a qualitative means of formally analyzing text including stories. When stories are analyzed, the researcher “unpacks” the structure of the story. A story includes a sequence of events with a beginning, a middle, and an end. Stories have their own logic and are temporal (Coffey & Atkinson, 1996; Denzin, 1989). The structures can also be used to determine how people tell stories, how they give shape to the events that they describe, how they make a point, how they “package” events and react to them, and how they communicate their stories to audiences. The structure used for narrative analysis as identified by Coffey and Atkinson (1996, p. 58) is as follows:

The abstract initiates the narrative by summarizing the point of the story or by giving a statement of the proposition that the narrative will illustrate. Orientation provides an introduction to the major events central to the story. Complication continues the narrative by describing complications in the event that make it a story; it takes the form “And then what happened?” Evaluation is the point of the narrative, followed by the result, which gives the outcome or resolution of events. The coda ends the story and is a transition point at which talk may revert to other topics.

The narrative analysis can focus on social action embedded in the text or examine the effect of the story. Stories serve a purpose. They may make a point or be moralistic. They may be success stories or may be a reminder of what not to do or how not to be, with guidance on how to avoid the fate described in the story. The purpose of the story can be the starting point for a more extensive narrative analysis. Narrative analysis may examine multiple stories of key life events and gain greater understanding of the impact of these key events; it may help to explain the relationship between social processes and personal lives; and it may be used to elucidate the cultural values, meanings, and personal experiences. Issues related to power, dominance, and opposition can be examined. Through stories, silenced groups can be given voice (Coffey & Atkinson, 1996). You could perform a narrative analysis of Barbara’s story under Collecting Stories.

Coding is not used in narrative analysis. Coding breaks data up into separate segments and is not useful in analyzing a story; the researcher can lose the sense that informants are providing an account or narrative of events.

Qualitative researchers may choose to communicate the findings of their study as a story. A story can be a powerful way to make a point. Stories can be presented to readers from a variety of perspectives: chronological order, the order in which the story was originally presented, progressive focusing, focusing only on a critical or key event in the story, describing the plot and characters as one would stage a play, following an analytical framework, providing versions of an event from the stories of several viewers, or presenting the story as one would write a mystery and thus appealing to problem solvers.

Reporting Results

In any qualitative study, the first section of a research report should be a detailed description of the participants, the setting, and observing and experiencing the environment in which the data were gathered. This description should be so vivid that the readers or listeners will feel that they are there with you. To accomplish this goal, the qualitative author must go beyond the skills required for technical writing to creative writing skills. Many qualitative authors suggest that researchers are so eager to get right into the results of data analysis, such as those described in this section, that they pay only brief attention to writing the description. The final part of a qualitative research report should express the theoretical ideas emerging from the data analysis.

Phenomenological Research Methods

In phenomenological studies, the researcher can use several strategies for data collection, and it is possible to use combinations of strategies. To conduct these data collection strategies, you will involve your personality and use intuiting. Intuiting is the process of actually looking at the phenomenon. During intuiting, you will focus all awareness and energy on the subject of interest to allow an increase in insight. Thus, this process requires absolute concentration and complete absorption with the experience being studied. Intuiting is a strange idea to those of us in the Western world. It is a more common practice in Eastern thought and is related to meditation practices and the directing of personal energy forces.

Grounded Theory Methodology

Data collection for a grounded theory study is referred to as fieldwork. Participant observation is a commonly used technique. Observation focuses on social interactions within the phenomenon of interest. Interviews may also be conducted to obtain the perceptions of participants. Data are coded in preparation for analysis, which begins with data collection. Stern (1980) and Turner (1981) described the methodology used for grounded theory analysis.

Zoffmann and Kirkevold (2007) conducted a grounded theory study of relationships and their potential for change developed in difficult type 1 diabetes. The abstract of the study is provided here.

Ethnographical Methodology

Historical Research Methodology

The methodology of historical research consists of the following steps: (1) formulating an idea, (2) developing research questions, (3) developing an inventory of sources, (4) clarifying the validity and reliability of data, (5) developing a research outline, and (6) conducting data collection and analysis.

Philosophical Studies

The purpose of philosophical research is to clarify meanings, make values manifest, identify ethics, and study the nature of knowledge (Ellis, 1983). A philosophical researcher is expected to consider a philosophical question from all perspectives by examining conceptual meaning, raising further questions, proposing answers, and suggesting the implications of those answers. The data source for most philosophical studies is written material and verbally expressed ideas relevant to the topic of interest. The researcher critically examines the text or the ideas for flaws in logic. A key element of the analysis is the posing of philosophical questions. The data are then searched for information relevant to the question. Ideas or values implied in the text are an important source of information because many philosophical analyses address abstract topics. The researcher attempts to maintain an objective distance from perspectives in the data so that the logic of the idea can be abstractly examined. Ideas, questions, answers, and consequences are often explored, debated, or both with colleagues during the analysis phase.

Three types of philosophical studies are foundational inquiry, philosophical analyses, and ethical analyses.

Critical Social Theory Methodology

Three means of collecting data for a critical social theory study may be used: verbal or written questions posed to individuals or groups, observation, or use of written documents. Data may be quantitative or qualitative and include numbers and stories. Methods are selected that are expected to yield the most compelling evidence, which is most likely to be a combination of stories and numbers. This strategy may use one of three basic approaches:

The research process of critical social theory requires that researchers use oppositional thinking to perform a critique of the social situation under study by applying the following four steps: (1) critical examination of the implicit rules and assumptions of the situation under study in a historical, cultural, and political context; (2) use of reflection to identify the conditions that would make uncoerced knowledge and action possible; (3) analysis of the constraints on communication and human action to develop a theoretical framework that uses causal relationships to explain distortions in communications and repression, the theoretical framework is then tested against individual cases (Hedin, 1986); and, finally, (4) participation in dialogue with those oppressed individuals within the social situation. Dialogue raises the collective consciousness and identifies ways to take action against oppressive forces. The action for change must come from the groups and communities rather than from the researcher. The groups and communities must consider “(a) their common interests; (b) the risks they are willing to undergo; (c) the consequences they can expect; and (d) their knowledge of the circumstances of their own lives” (Hedin, 1986, p. 146).

As with most qualitative research methodologies, it is difficult to separate the steps. Dialogue is used both to collect and to interpret the data, and researchers constantly move back and forth between collection and interpretation. Dialogue, which uses some of the techniques of phenomenology, includes conversations between the researcher and persons within the society and requires a relationship of equality and active reciprocity. In addition, by reflection and insight, the researcher dialogues with the data while collecting, analyzing, and interpreting it. “New meanings emerge, and phrases that have always been ignored suddenly come alive and demand explanation” (Thompson, 1987, p. 33). The process “exposes ways in which the self has been formed (or deformed) through the influence of coercive power relations. The work of critical scholarship is to make these power relations transparent, for these relations lose power when they become transparent” (Thompson, 1987, p. 33). Knowledge is created, and this knowledge furthers autonomy and responsibility by enlightening individuals about how they may rationally act to realize their own best interests (Holter, 1988).

Theoretical Frameworks

It has been the position of qualitative researchers that they do not use theoretical frameworks as do quantitative researchers. In some cases, theory was developed as an emerging part of the analysis process. Two recent texts are changing that stance by arguing that atheoretical research is impossible. Flinders and Mills (1993), in their text Theory and Concepts in Qualitative Research, first addressed the issue saying, “Few of us now claim that we enter the field tabula rasa, unencumbered by notions of the phenomena we seek to understand” (p. xi). Anfara and Mertz (2006) in their text Theoretical Frameworks in Qualitative Research, stated that “no comprehensive discussion of theoretical frameworks exists to assist those engaged in qualitative research” (p. xiii). Their goal is to describe what a theoretical framework is and how it is used in qualitative research as well as the effects it has on the qualitative research process. Each chapter in their text offers the framework of a qualitative researcher as a guide for qualitative researchers as they develop frameworks.

The framework development process for qualitative studies is not unlike that described in Chapter 7 of this text. The role that theory plays in qualitative research will likely differ from that of quantitative research. Some qualitative researchers may refer to a theoretical stance, whereas others may not be quite ready to take the leap to frameworks. Strategies for using frameworks to guide the development of qualitative studies, and in the interpretation of results, are not yet clear. It will be interesting to see how the move to frameworks in qualitative research plays out over the next few years.

Researcher-Participant Relationships

One of the important differences between quantitative and qualitative research is the nature of relationships between the researcher and the individuals being studied. The nature of these relationships has an impact on the data collected and their interpretation. In many qualitative studies, the researcher observes social behavior and may participate in social interactions with those being studied. Four types of participant observation are commonly distinguished: (1) complete participation, in which the observer becomes a member of the group and conceals the researcher role; (2) participant as observer, in which participants are aware of the dual roles of the researcher; (3) observer as participant, in which most of the researcher’s time is spent observing and interviewing and less in the participation role; and (4) complete observer, in which the researcher is passive and has no direct social interaction in the setting. You must carefully consider the type(s) of researcher-participant relationships that you will use in your study and specify them when describing your methodology.

In varying degrees, the researcher influences the individuals being studied and, in turn, is influenced by them. The mere presence of the researcher may alter behavior in the setting. Although this involvement is considered a source of bias in quantitative research, qualitative researchers consider it to be a natural and necessary element of the research process. The researcher’s personality is a key factor in qualitative research as skills in empathy and intuition are cultivated. You will need to become closely involved in the subject’s experience to interpret it. It is necessary to be open to the perceptions of the participants rather than attaching your own meaning to the experience. Individuals being studied often participate in determining research questions, guiding data collection, and interpreting results. Watts (2006) described challenges in feminist research when researching women who do not identify with feminist aims. She discussed the impact the insider researcher role has on “truth telling.” She pointed out that there is a fine line between empathy and exploitation. Dickson-Swift, James, Kippen, and Liamputtong (2006) conducted a study examining the blurring of boundaries between the researcher and the participants. Many researchers conducting research in sensitive areas found themselves becoming friends with the participants. Poor boundary management adds stress to research work. A number of researchers described emotional exhaustion and feeling overwhelmed. The authors recommend that you develop protocols for studies of sensitive areas before initiating the study. Training is also recommended for managing boundary issues before commencing such studies.

The interface between the participant-observer role and the nurse role of the researcher is a concern. Because of the possible impact of the nursing role on the study, Robinson and Thorne (1988) claimed that the nurse researcher has an obligation to explain in the study report the influence that his or her professional perspective had on the process and outcomes of the study. In some studies, the researcher is expected to interact with participants but to stay in the role of researcher and avoid relating to participants as a nurse. Some insist that the nurse researcher must always relate first as a nurse and second as a researcher (Cooper, 1988; Fowler, 1988). Connors (1988) suggested that qualitative researchers must be authentic and engaged as a whole person rather than just as a researcher or as a nurse. Colbourne and Sque (2005) pointed out that nurse researchers, while in the role of qualitative researcher, “may offer the participant a mechanism for reflection, greater self-awareness, finding a voice, obtaining information, and venting repressed emotions.” Positive and negative aspects of this therapeutic component are explored along with cautions that the nurse researcher think carefully about the stance taken in the field.

In addition to the role you will take in the relationship, carefully consider the expectations of your study. Munhall (1988) pointed out that ethically, it is essential that the qualitative researcher think through both the aims and the means of the study and determine whether these aims and means are consistent with those of the participants. For example, if your desire as a researcher is to change the behavior of the participants, the participants need to share this goal. During the study, a level of trust develops between the researcher and the participant, who may provide information labeled as secret. Establishing relationships with participants, however, can cause harm. Participant observation requires a close relationship that invades the privacy of the individual. Although participants may experience confidence, commitment, and friendship from the encounter, they may also experience disappointment, perceived betrayal, and desertion as the researcher functions in the researcher role and then leaves (Munhall, 1988). The relationship can also harm the researcher. Cowles (1988) described emotional pain and difficulty sleeping as she collected data from family members of murdered individuals. She frequently required support and opportunities to explore her feelings with colleagues during the process. Draucker (1999) cautioned that little is known about the effects on participants in studies of sexual violence.

Reflexivity

Qualitative researchers need to critically think through the dynamic interaction between the self and the data occurring during analysis. This interaction occurs whether the data are communicated person to person or through the written word. The critical thinking used to examine this interaction is referred to as reflexive thought or reflexivity (Lamb & Huttlinger, 1989). During this process, the researcher explores personal feelings and experiences that may influence the study and integrates this understanding into the study. The process requires a conscious awareness of self.

Drew (1989), in a paper recounting her experience conducting a phenomenological study of caregiving behavior, demonstrated reflexivity as she described the impact of relationships on her study.

In some phenomenological research, this critical thinking leads to bracketing, which researchers use to avoid misinterpreting the phenomenon as the individual experiences it. Bracketing is suspending or laying aside what is known about the experience being studied (Oiler, 1982). Researchers using the Husserl interpretation of phenomenology most commonly use bracketing. Other phenomenologists, especially those using Heideggerian phenomenology, do not believe bracketing is possible. However, they do identify beliefs, assumptions, and preconceptions about the research topic, which are put in writing at the beginning of the study for self-reflection and external review. These procedures are intended to facilitate openness and new insight.

Most researchers inexperienced in qualitative research require mentoring in reflexive thought. Part of this mentoring is developing a plan for reflexive thought during the conduct of the study. Dialogue with the mentor(s) during the study about the researcher’s experiences and reactions during the study and their implications are also critical. Walsh and Downe (2006), in developing criteria for appraising the quality of qualitative research, developed the following criteria for judging reflexivity. These criteria are especially helpful for students who seem to have difficulty grasping the idea of reflexivity.

Auditability

The larger scientific community has in some cases seriously questioned the credibility of qualitative data analysis. The concerns relate to the inability to replicate the outcomes of a study, even when using the same data set. Miles and Huberman (1994) described the problem as follows.

To respond to this concern, some qualitative researchers have attempted to develop strategies by which other researchers, using the same data, can follow the logic of the original researcher and arrive at the same conclusions. Guba and Lincoln (1982) referred to this strategy as auditability.

Auditability requires that the researcher establish decision rules for categorizing data, arriving at ratings, or making judgments. A decision rule might say, for example, that a datum would be placed in a specific category if it met specified criteria. Another decision rule might say that an observed interaction would be considered an instance of an emerging theoretical explanation if it met specific criteria. A record is kept of all decision rules used in the data analysis. All raw data are stored so that they are available for review if requested. As the analysis progresses, the researcher documents the data and the decision rules on which each decision was based and the reasoning that entered into each decision. Thus, evidence is retained to support the study conclusions and the emerging theory and is made available on request (Burns, 1989). Marshall (1984, 1985), however, cautioned against undermining the strengths of qualitative research by overly mechanistic data analysis. Marshall and Rossman (1989, p. 113) expressed concern that efforts to increase validity will “filter out the unusual, the serendipitous—the puzzle that if tended to and pursued would provide a recasting of the entire research endeavor.”

If you intend to use auditability strategies, plan for auditability before you begin collecting data, because analysis is initiated at that point. You should include these plans in your research proposal.

Appraisal of Qualitative Studies

Synthesis of studies in preparation for evidence-based practice has, until recently, focused entirely on quantitative research. Qualitative research has been left out of the equation, not considered sufficiently relevant to evidence-based practice to be included. This decision has serious implications for the contribution of qualitative knowledge to clinical practice. Funding of studies, funding of educational programs, and valuing of qualitative knowledge is determined by the inclusion of these studies in the evidence base for practice. A small group of qualitative scholars have been working to persuade those in decision-making positions to include qualitative research in the studies examined for inclusion in evidence-based practice reports. A book describing their work, Handbook for Synthesizing Qualitative Research (Sandelowski & Barroso, 2007), is an excellent guide for qualitative researchers working in the teams to synthesize qualitative studies for inclusion of the evidence base. Of particular interest to a broader group of users, faculty, and students interested in qualitative research is a chapter titled “Appraising Reports of Qualitative Studies.” This chapter provides a detailed guide to the appraisal of individual qualitative studies and to the comparative appraisal of qualitative studies. This book takes the art of writing a qualitative research report and the application of findings well beyond auditability to a whole new level of analysis. We recommend it to students, faculty, and researchers who are invested in qualitative research.

• Qualitative data analysis occurs concurrently with data collection rather than sequentially as is true in quantitative research.

• Methods of data collection include unstructured observations, unstructured interviews, focus groups, collecting stories, constructing life stories, and case studies.

• Some qualitative researchers use the computer for data analysis, whereas others perform their analysis manually.

• Data are often transcribed from tape recordings to typed manuscripts before analyses.

• After the analyses, a variety of methods are used to display data for analyses and presentation, including critical incident charts, causal networks, and cognitive mapping.

• Methods of analyzing the data may include content analysis and narrative analysis.

• Six research methodologies for qualitative studies are described: phenomenological, grounded theory, ethnographical, historical, philosophical, and critical social theory including feminist approaches.

• Although theoretical frameworks have not traditionally been used in qualitative studies, some researchers are beginning to include frameworks in their studies.

• Research-participant relationships are critical to the effective conduct of qualitative studies and are explored in the chapter.

• Participatory research, which began in ethnographical studies, is emerging as an important approach in both qualitative and quantitative studies.

• Reflexivity, in which the qualitative researcher critically thinks through the dynamic interaction between the self and the data, is an important element of qualitative studies.

• Auditability requires the researcher to establish decision rules for categorizing data, arriving at ratings, and making judgments so that another qualitative researcher, using the same data, can follow the logic of the first researcher and arrive at similar conclusions.

• Appraisal of qualitative studies is a newly developing strategy that provides methods to synthesize relevant qualitative studies so that qualitative findings can be included in evidence-based practice documents.

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