Sampling data and data collection in qualitative

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Chapter

7

Sampling data and data collection in qualitative research Violeta Lopez and Dean Whitehead

Key terms

Learning outcomes

focus groups interviews observation qualitative data collection qualitative sampling questionnaires sampling criteria

After reading this chapter, you should be able to: • describe the rationale and processes for conducting qualitative sampling techniques • describe the main types of sampling in qualitative research and give examples of research for each type • explain the selection criteria in qualitative sampling • describe the different qualitative data collection approaches and note examples of research for each approach • discuss the benefits and limitations of each of the qualitative data collection approaches.

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Nursing and Midwifery Research 4e

Introduction A major part of the qualitative research process lies in determining and choosing an appropriate population (sample) for the study so that data can then be collected from that population. With qualitative research the population being studied is nearly always human, although there are some exceptions that will be discussed in this chapter. A human individual is most commonly referred to as a participant (sometimes ‘subject’) in qualitative research. A population sample is a chosen subset usually representative of a wider population. In this chapter, both sampling and data collection techniques used in qualitative research are the focus.

Sampling techniques and procedures in qualitative research The primary purpose of sampling is the selection of suitable populations (or ‘elements’) so that the focus of the study can be appropriately researched. In qualitative research, effective sample selection process is very important because inappropriate procedures may seriously affect the findings and outcomes of a study. There are a number of types of sampling procedures that can be adopted and the choice of qualitative research design will often guide that process.

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Tutorial Trigger

You want to explore the experiences of carers who care for relatives with cancer. What initial considerations might you need to identify for choosing an appropriate participant sample?

Types of sampling Sampling in qualitative research is non-probability sampling. It is unlike probability sampling used in quantitative research where researchers recruit the population with characteristics that represent a wider community. With non-probability sampling in qualitative research the researchers recruit only specific populations to investigate a specific topic or when the total population is unknown or unavailable. There are four main types of non-probability sampling:

1) convenience sampling 2) purposive sampling 3) snowball sampling 4) theoretical sampling. Convenience sampling

This is the most common form of qualitative sampling and occurs when people are invited to participate in the study because they are conveniently (opportunistically) available with regard to access, location, time and willingness. Convenience sampling is a relatively fast and easy way to achieve the sample size needed for the study. For example, Cubit and Lopez (2011) used a convenience sample of 44 newly graduated nurses who had previously practised as enrolled nurses to explore their transition experiences. These nurses were invited to participate as the researchers were able to produce a list of all newly graduated nurses from the hospital where they had to complete their one-year clinical rotation. However, the main limitation of using convenience sampling is that it could suffer from either under-representation or over-representation of particular groups within the population. It could also potentially be that the sample is unlikely to be representative of the population being studied and, therefore, limiting researchers’ ability to make generalisations of the findings to a wider population (Creswell 2007). Some would argue, however, that this is not always important in qualitative studies. Purposive (purposeful) sampling

This is also a commonly used sampling strategy, in that participants are recruited according to

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7 • Sampling data and data collection in qualitative research

pre-selected criteria relevant to a particular research question. Sometimes referred to as ‘judgment sampling’, purposive sampling is designed to provide information-rich cases for in-depth study. This is because participants are those who have the required status or experience, or are known to possess special knowledge to provide the information researchers seek. For example, Elmir et al. (2010) used a purposive sample of four Australian women to investigate their lived experience of recovering from breast cancer. The pre-selection criteria included those diagnosed with breast cancer that resulted in breast surgery, under 50 years of age and able to converse in English. Although the sample size of four participants might be regarded as small, in keeping with the aim of encouraging the detailed richness of women’s emotional experience, the sample size was deliberately kept small. There are two other types of sampling that come under the umbrella of purposive sampling. These are quota sampling and maximum variation sampling. In quota sampling, the researcher decides the number of participants and which characteristics they need to possess. The characteristics may be according to age, gender, profession, diagnosis, ethnicity and so forth. The inclusion criteria (see later) allow the recruitment of participants who would most likely experience or have experience related to the research topic. It is different from purposive sampling because quota sampling is more specific with respect to sizes and proportions of the sub-samples for each prescribed quota. For example, Chan et al. (2010) conducted a study to explore the perceptions of coronary heart disease (CHD) among Hong Kong Chinese people. The study targeted three sample groups according to their level of CHD risk factors: ‘low-risk public’, ‘multiple risk public’ and those with ‘confirmed diagnosis of myocardial infarction’ (MI). In this study, the CHD risk factor is the focus of interest in determining how people understand CHD, which is why a quota sample was used to seek an equal balance of people with low risk, multiple risk and those who had an MI. Maximum phenomena variation sampling is sometimes used to ensure that the full range and extent of the phenomena are represented. When choosing this type of sampling, the focus could be either on people (e.g. first, second and third

generation migrants), time periods (e.g. 3, 6, 12 months) or context (e.g. hospital and/or community settings). For example, Holroyd et al. (2011) conducted audio-taped interviews (see later) to examine the postnatal practices of two generations of Chinese women in Australia. This provided different data related to the fact that the participants were first-time mothers and their mothers. The study aimed to uncover whether the Chinese cultural practice of ‘doing the month’ was influenced by or had changed from one generation to the next. Snowball sampling

Also known as ‘chain referral’ or ‘networking’ sampling, snowball sampling occurs when the researcher starts gathering information from one or a few people and then relies on these people to put the researcher in touch with others who may be friends, relatives, colleagues or other significant contacts. This type of sampling is especially useful where the sample is representative of marginalised or stigmatised individuals and to find and recruit ‘hidden populations’, where individuals are not easily accessible to researchers through other sampling strategies (Green & Thorogood 2009), such as drug-users, prostitutes, AIDS/HIV sufferers, etc. As such, the potential participants may normally be reluctant to come forward without the reassurance of knowing someone who has already participated in the study. Sometimes though, research ethics committees may not grant permission for snowball sampling because of either privacy concerns, issues of consent or the potential for coercion. This is not always the case though, as with Hood et al.’s (2010) descriptive exploratory study of Western Australian midwives’ experiences of an external review (Douglas Inquiry) of obstetric services. Snowball sampling was used to invite 16 Australian midwives to participate in taperecorded interviews. Some limitations of snowball sampling are that the researcher needs to rely on referrals from initial contacts to generate additional participants. The participants, therefore, are often not considered to be representative of the overall population being studied. Theoretical sampling

This form of sampling is mostly used in grounded theory studies (see Chapter 6) but is 125


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increasingly being used to gather data from participants for theory generation (see Chapter 2). In order to identify the similarities and differences amongst the selected cases, the research starts from a homogeneous (small) sample and moves to a heterogeneous (larger) sample (Creswell 2007). It is sampling that occurs sequentially and alongside data analysis. This is when previously analysed data guides what data needs to be collected next (see Chapter 8). The first selected participants, from whom initial data are collected, are usually purposively chosen or conveniently available. For example, Utriainen et al. (2009) used theoretical sampling in their grounded theory approach to create a substantive theory of wellbeing at work among ageing hospital nurses in Northern Finland. The aim was to discover core processes of the phenomenon based on nurses’ authentic experiences. The 21 subjects of this study were nurses working at a university hospital, aged 45–55 years with at least 10 years of hospital work experience and performing three shifts per week. The material consisted of first-phase open interviews and diary entries and of second-phase interviews and open-data collection forms (see later).

Point to ponder The type of sampling chosen often depends on its ability to maximise the opportunity for producing enough ‘rich’ data to answer the chosen research question.

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Tutorial Trigger If you wanted to explore the phenomenon of client-centred care, which sampling technique would/ could you choose?

Sampling criteria In qualitative research, participants are viewed as capable individuals able to reflect upon and clearly express their experiences, values, beliefs and opinions. Different qualitative approaches have varying sampling intentions regarding participants. The selection depends on the

sampling criteria. Sampling criteria identify the characteristics of the sample population and their eligibility to be part of the study based on pre-selected inclusion and exclusion requirements. Inclusion criteria

Inclusion criteria are specific characteristics that the person or population or elements must possess, such as a certain age range or gender. For example, Jones et al. (2007) explored the training requirements of residential aged-care personal carers needed in order to understand and respond to residents with dementia and mental illness. In the study, personal carers were those who carry out all front-line nursing care tasks such as bathing, feeding, dressing, simple wound management and organising residential aged-care plans. The inclusion criteria included all personal carers enrolled in Certificate III and Certificate IV in Aged-Care and all those who worked primarily in aged-care facilities in Canberra, Australia. The chosen qualitative methodology will ‘automatically’ determine inclusion criteria. For instance, participants in phenomenological studies are mostly chosen because of their experience of the phenomenon being studied and because of their ability to express that experience. In grounded theory, because samples of events and incidents involving action or interaction relevant to the research focus are sought, participants must have been or are currently involved in those events. With ethnographic research, the researcher is in the ‘field’, observing and recording the events and behaviours of participants, so the participants have to already be in the observable location. Exclusion criteria

Exclusion criteria identify characteristics that deem a participant inappropriate for inclusion in a study, such as any person who is cognitivelyimpaired or where the conducted language of the study is the participant’s second-language. These criteria may be stated in a study or they are implied as a ‘given’. For instance, studies related to maternal care would not normally include males, unless the studies wanted to explore expectant fathers’ roles or roles of male health professionals involved in maternal services.

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Point to ponder Whatever inclusion and exclusion criteria you use, you must always provide a rationale for both the sample and the inclusion/exclusion criteria.

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Tutorial Trigger

You intend to research the perceptions of patients in a residential aged-care facility with in-dwelling urinary catheters. What might you decide in terms of inclusion/exclusion criteria?

Sample size in qualitative research Unlike quantitative approaches which aim to establish statistical significance by sampling a predetermined number of subjects or elements, qualitative researchers do not usually begin a project with a predetermined sample size. In qualitative research, there are no overall formal criteria for determining sample size and, therefore, no rules to suggest when a sample size is small or large enough for the study. Essentially, the ‘richness’ of data collected is far more important than the number of participants (Tuckett 2004). This said, the researcher still requires insight to the size most likely to achieve the purpose, context and the richness of the data collected (Patton 2002). Regarding the number of participants in qualitative studies, a common range is usually somewhere from 8 to 15 participants, but will vary widely both inside and outside this range. A number of qualitative methodologists, however, provide sample size guidelines for qualitative research designs. Creswell (2007) recommends 3–5 participants for a case study, 10 for a phenomenological study and 15–20 for grounded theory study, whereas Morse (1995) suggests a sample size ranging from six participants for a phenomenological study and 30–50 for an ethnographic study. Rarely, quite a large number of participants may be involved. For example, Crowe et al.’s (2001) New Zealand-based qualitative study accessed 131 community-based client participants in order to evaluate consumer mental health service provision. With focus groups (group interviews — see later), Krueger and Casey (2009) suggest 5–10 participants but this can also

range from as few as 4 to as many as 12. The overall number could be higher, especially where more than one group is needed for comparison between groups or in the case of program evaluation research. Cheek et al.’s (2005) South Australian study, for instance, used 14 different stakeholder focus groups to investigate factors that influenced the decisions of older people living in independent units. Within the literature, decision on the number of focus groups is often compared to the method of analysis to be used. As such, sample size should refer to the number of groups and not to the total of participants in the study (Carlsen & Glenton 2011). Small samples, however, are far more manageable because of the amount of potentially rich and detailed data that can be generated from each single participant.

Point to ponder Sample size in qualitative research should be adequate to achieve data saturation, richness of data and not too large that it is difficult to undertake in-depth, meaningful analysis.

Data collection in qualitative research The process of data collection is directly related to sampling and is best viewed as complementary to it. Data, therefore, are collected directly from the identified and selected sample population. Data collected from the sample can be either ‘direct data’ or ‘indirect data’. Direct data include recordable spoken or written words and also observable body-language, actions and interactions. Here, the interactions may be human-to-human or human responses to inanimate objects, such as a haemodialysis machine. Whatever can be observed or communicated are considered to be potential or actual data. This will occur when considering the thoughts, feelings, experiences, meaning of experience, responses, actions, interactions, language and processes of individuals and groups within their social and/or cultural setting. It is this type of data that sets the ‘context’ of qualitative studies. Indirect data are generated, in the first instance, by someone or something else, such as with documents or photographs reporting an event or an artistic rendition of an event or experience (e.g. novels, songs, paintings, 127


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poems, photographs). Turner (2005) used photographs taken by Australian youth study participants to depict their interpretations and experiences of hope. Direct data, though, are the most common form in qualitative research. Depending on the types of data required for a qualitative study, various methods of collecting data can be used singularly or in combination to obtain direct data. For direct data, these methods may include interview, observation, open-ended questionnaire, journalling (diary accounts) or ‘think aloud’ sessions. Direct data can be collected by the participant involved in a study at the request of the researcher (e.g. through writing a personal journal or diary) and then provided to the researcher. Most commonly, however, qualitative approaches acquire data primarily through interpersonal contact with participants (usually an interview) or, secondly, through the presence of the researcher in proximity to pertinent events (usually observation). This is unlike quantitative research where, frequently, there is no interpersonal contact with participants or events. Manias et al. (2005) used both interview and observational techniques to gather qualitative data concerning Australian nurses’ communication with health professionals when managing patients’ medications. Where indirect data need to be collected these are sought through a variety of methods. These may include systematically searching archives or browsing through the internet — with data collected being either in hard copy or electronic form (see Chapter 3).

Interviews Interviews are regarded as the prime method for qualitative data collection; also representing the most common method for gathering qualitative data in nursing-related research (Borbasi et al. 2005). Spoken ‘narrative’ is the basis of most qualitative data, where that narrative is most often gained through a direct encounter between the researcher and participant (or several participants) using in-depth interviews or focus group interviews. Interviews can be conducted by telephone, email and, more recently, through social media conversations (e.g. Twitter, Facebook). Interviews in qualitative research may be unstructured, semi-structured or occasionally

structured. With unstructured interviews, neither the specific questions to be asked nor the range or type of possible answers are pre-determined. The interviews are designed to be informal and conversational with the aim of encouraging participants to express themselves in a naturally unfolding manner. Unstructured interviews tend to start with single broad questions, such as ‘what is your experience of …’. The researcher, however, has an idea in mind of the general issues to be covered and may use a topic list as a reminder. Turner (2005 p 510) described his unstructured interviews with Australian youths as ‘a free-flowing conversation with a definite focal point’. Semi-structured interviews have an interview guide providing a set of questions for discussion. The questions are set to ensure the research questions or objectives are covered. However, there is freedom to ask any questions in any order, following tangents or seeking clarification of previous answers or elaboration of responses. In other words, semi-structured interviews steer the interview yet allow for flexibility. For example, Gagnon (2011) used semi-structured interviews with 11 immigrant midwives in their ethnographic study to learn the adaptations and transformations that midwives, coming from abroad into the Quebec healthcare system, needed to go through in order to integrate into practice. Using both unstructured and semistructured interviews, questions were nondirected and mainly open-ended and were designed to trigger and stimulate the participant to talk about their adaptations. Structured interviews in qualitative research are not very common and follow a list of set questions usually asked in a certain order, but these questions are still open-ended; that is, usually commencing with words like ‘how’, ‘why’, ‘where’, ‘when’ etc. This distinguishes them from structured quantitative interviews which usually only ask closed-ended questions.

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Tutorial Trigger

Prepare an interview schedule for investigating the experiences of clients who have an in-dwelling urinary catheter. What sort of questions might you want to ask of your participants?

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Conducting interviews

The structure and conduct of interviews are very important. A poor interview will produce poor quality narrative data and poor outcomes overall. Conducting interviews can be a complex and demanding skill that requires attention to process. It is unwise to conduct qualitative research interviews in terms of ‘learn as you go’. If unsure, many researchers perform ‘dry or dummy runs’ with peers and/or colleagues as a form of piloting the interview schedule. Where novice or experienced researchers are appropriately equipped to conduct interviews in the clinical setting, certain prerequisites need to be in place. The ‘rules of engagement’ need to be established early on, such as establishing and maintaining a warm and non-judgmental manner towards the participant/s, asking questions in a balanced, unbiased, nonthreatening, sensitive and clear way, and choosing a setting for the interview where it is most appropriate to ask personal questions. The majority of interviews conducted in qualitative research are audio-recorded or, less commonly, video-recorded. In Fenwick et al.’s (2005) study, they completely tape-recorded telephone interviews of a self-selected cohort of Western Australian women who had experienced childbirth. Annells (2006), however, chose to video-record interviews for her Australian hermeneutic phenomenology study on the experience of flatus incontinence by people with bowel ostomies. Both of these formats have an advantage over handwritten notes because it is often impossible to record everything the interviewer hears or to observe everything that occurs in an interview situation. In the interview process, the participant needs to be made to feel as comfortable as possible. It is necessary to ensure privacy and comfort and ensure that all items required for the encounter are available. This will likely include recording equipment, tapes, consent forms, participant information sheets, drinks and tissues. Researchers should take active steps, such as posting ‘do not disturb’ signs and disabling telephone or pager devices. This will help to ensure that interruptions are avoided. Appropriate time should be allowed for each interview. Interviews should not be hurried or stopped before they have naturally completed. If,

however, the participant wishes to stop the interview or the researcher senses that the participant is becoming too tired or distressed, then the interview can be stopped or paused at any time. This may mean setting up a new appointment for another occasion. It is, however, preferable to resume as soon as possible so that flow and recall of previous discussion is not lost. It is recommended that no single interview last more than 1–2 hours as ‘interview fatigue’ is likely to occur.

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Tutorial Trigger What might be the features of a ‘desirable’ environment for the conduct of qualitative interviews?

During an interview, the interviewer’s presence and engagement (including how they listen and attend to and end responses) is vital to the process. It should be remembered that the purpose is to gain information from the participant — and not an opportunity for the researcher to express their own thoughts and feelings. In a structured or semi-structured interview, an appropriate range of questions are asked as listed on interview schedules. The purpose of these question lists is to provide clarity and assist the participant if hesitant or confused. Questions may also be used to prompt expansion and elaboration if further detail is required. An active listening position is adopted by the researcher, concentrating on what is being said as well as being alert to other cues, particularly non-verbal cues. During the interview, some researchers find it useful to record (memoing) non-verbal aspects of the interview. Another researcher may be invited to take detailed notes (memos) during the course of the interview. The notes are later used to guide the data collected from the audio/video-taped interviews. Alongside this, the interviewer may well note and review their own thoughts and feelings about the interview and any ‘extraordinary’ situations or events that arise. The memos may then assist later data analysis (see Chapter 8). Qualitative interviews should allow the interviewee to speak freely and offer in-depth 129


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and lengthy responses through techniques used singularly or in combination. Possible techniques include those in the following list. • Funnelling — beginning the interview with general and broad (non-threatening) opening questions and then narrowing down to topic specifics as the interview progresses. • Probing — eliciting further details or seeking clarification. Price (2002) details an innovative probing technique called ‘laddered questions’. This is where appropriate questions are asked in a series leading from the least intrusive questions to the most intrusive. This technique identifies classifications of questions; questions about ‘actions’ are deemed to be the least invasive, through to questions about ‘philosophy’ (feelings/values/beliefs) as the most invasive. Story-telling, as another technique, involves asking questions in a manner which encourages story-telling and more elaborate answers; for example, ‘Tell me about when you last experienced …’ • Paraphrasing — repeating what the participant has said, without changing the meaning of what has been said, assists understanding and clarity and acts as a further prompt.

Research in brief Fernandez and Wilson (2008) examined the effectiveness of smoking cessation initiatives for Ma¯ori in New Zealand. They conducted a focus group interview, consisting of five Ma¯ori women who had stopped smoking, to ask what was more likely to influence Ma¯ori women to quit and the data were thematically analysed (see Chapter 8). Two themes were identified: (1) ‘transmission of Whanau’ (immediate and extended family) with values that included the sub-categories ‘Whanau experiences’, ‘being mothers’ and ‘role models’; and (2) ‘factors crucial in influencing change’ that included the sub-categories of ‘choices and exercising own will’, ‘a positive perception of self’ and ‘a Ma¯ori approach’. The findings provide insight for nurses into Ma¯ori women’s insights that highlight the importance of ‘Whanau’ and supportive relationships, and can be used to inform strategies to assist Ma¯ori women in smoking cessation.

When conducting interviews it is also important to consider the use of language, especially in cross-cultural settings. In qualitative research where participants are not fluent in oral or written English language, it is important that the interviewer is fluent not only in the language but is culturally understanding or representative of the participants and their environment. In multicultural societies, such as New Zealand and Australia, research is often conducted involving participants from culturally and linguistically diverse (CALD) backgrounds for the purpose of describing, understanding and clarifying their cultural ‘worldview’. As such, research in a multilingual environment poses methodological challenges (Liamputtong 2008). Appropriate strategy for data collection, when another language is used during interviews, is to include language assistants (such as bilingual researchers or professional interpreters). In the Fernandez and Wilson (2008) ‘research in brief ’ (see earlier), one of the researchers is of Ngati Tahinga descent and is also a Fellow of ‘Te Mata o te Tau’ (Academy of Māori Research & Scholarship). Benefits of interviews

Interviews provide the researcher with a valuable opportunity to enter the world of the participant and reflect on a particular event. Rapport and trust can be developed and are desirable to collect the extensive and detailed data that are needed. Interviews should develop as conversational encounters that offer opportunities to clarify issues, as well as probe for ever-deeper insight. Interviews also offer unique data, where interview outcomes will never be the same between participants. When emotional and emotive issues arise during the course of the interview session, the interviewer is able to offer appropriate support and referral to counselling if the need exists or arises. Overall, qualitative interviews potentially offer a productive, meaningful and supportive engagement that benefits both researchers and participants. Limitations of interviews

Price (2002) identifies a range of challenges when it comes to interviewing, such as securing access, making sensitive records, managing power relationships, managing ‘space’, managing communication and managing the sequence of interviews. Interviews are not so much limited

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by the techniques and methods used, but mostly by how these are applied by the researcher. Ethically, interview schedules should be challenged if there are questions which are seemingly biased, leading, unbalanced, emotive, imposing, coercive, manipulative or threatening. Therefore, the potential for an increased imbalance in the power relationship between interviewer and interviewee should be avoided. Even in research designs that are well executed, some degree of power differential will always exist in an interview situation. In order to minimise the imbalance in the power relationship, it is important for the interviewer to explain why it is in the interest of the participants to answer the questions and remain in control of the interview. A good interview is a discussion rather than a question and answer session. It is important to always treat the participants with respect and politeness. Interviews can be time-consuming and resource-intensive to establish. Although in qualitative research, estimation can be made about how many interviews may be necessary to gather a complete set of data, this is not always an exact science. Also, limiting data collection to ‘one-off ’ interviews with participants may lead to insufficient in-depth information. Another consideration is the interviewer, despite any effort to ‘bracket’ out their own experiences, ideas, prejudices and opinions prior to the interview, is always partly generating their own internalised data. The resulting data will inevitably be partly influenced by the interviewer whether this is through subtle body language or the nature of questions asked.

Focus group interviews Focus groups are useful as they help to explore, develop and refine initial research questions and interview schedules. They can also be useful as part of a developing evaluative framework to assess client needs and the outcomes of such investigation (Banning 2005). Focus groups use interview schedules but these differ in scope, nature and intention from other research interviews. This is because of the unique nature of group dynamics and insights gained from interaction between participants. Focus groups offer a collective set of values, experiences and observations of participants that are later

interpreted in context. Sometimes group ‘synergy’ or consensus (agreement) on issues occurs, but this is not always the case. If a series of focus groups are scheduled, initial interviews usually identify broad issues and perspectives related to the focus of the study, while subsequent interviews seek to prioritise and narrow down generated issues. In Fragar and Depczynski’s (2011) study of the challenges at work for older nurses and allied health workers beyond 50 years of age in rural Australia, communities were selected for focus group discussions based on size and geographical spread across the region of rural New South Wales. A convenience sample of 80 older health workers attended six focus groups. One or two items from each group were selected for further discussion by the larger group to assist other group members to contribute and/or debate on the ideas that arose from each small focus group. Such focus groups work because they include participants who are similar to each other. Homogeny (consistency) was determined by the purpose of the study and by the general inclusion criteria; that all were beyond 50 years of age, all were rurally located and all were health workers. From the methodological approach used, the results of this study provided ways to address concerns and avoid demands being placed on older healthcare workers across the rural health service. Benefits of focus group interviews

One of the main benefits of this method of data collection is that they are often less intimidating than individual interviews. The focus group method allows access to participants who may find individual interviews intimidating or inappropriate (Krueger & Casey 2009; Liamputtong 2010). They potentially offer supportive group interactions as each member is encouraged to identify, describe, analyse and resolve issues (Morgan 1997; Krueger & Casey 2009). They are particularly useful in discovering new information or obtaining different perspectives on the same topic. Focus group interviews are also useful in gaining participants’ views, beliefs, values and perceptions on why they think and feel the way they do (Litosseliti 2007). Focus group interviews are usually more economical to conduct than individual interviews. 131


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Limitations of focus group interviews

Focus groups may not explore issues as deeply as one-on-one interviews. At the same time, as they are not as intimate and private as individual interviews, they tend not to uncover sensitive or potentially embarrassing information. Researchers generally need quite high levels of interviewing expertise to conduct focus group interviews. For instance, they require ‘gatekeeping’ skills to help avoid ‘group think’ outcomes, prevent any individuals from dominating conversations as well as teasing contributions from quieter members. That said, where the focus group does not present any of these dilemmas the researchers should be mostly anonymous, often only needing to contribute to commence, prompt occasionally and finalise the session.

Point to ponder Focus groups are small, structured groups with selected participants led by a moderator. Focus groups are specialised groups in terms of purpose, size, composition and procedures. Interaction in focus groups is important with an element of flexibility and adaptability designed to obtain the best results (Litosseliti 2007).

Research in brief Paulin (2010) investigated the understanding and experience of supervision by dietitians in New Zealand. Twenty senior dietitians participated in the study. Focus group audio-taped interviews (four in each group) were conducted in a conversational style using an interview guide to ensure all topics were covered. A research assistant was also present during the interview to take notes. The study provided in-depth insight into the professional supervision practice of New Zealand dietitians which was regarded as important to ensure safe practice.

Observation Observational methods are commonly used in qualitative research designs and vary between methods. Observation is the process of watching

the daily life and behaviours of participants in their natural setting to record aspects such as social position and function, or actions and interactions. Qualitative observation is traditionally adopted by ethnographers (Borbasi et al. 2005), but can be used in other qualitative approaches. This is especially so with studies using an interpretive/constructivist approach (see Chapter 2) where exploring observed events are often used to interpret and understand behaviour (Mulhall 2003). In qualitative research, observation methods are mostly unstructured. Sometimes, however, qualitative observation may have some structure. With unstructured observation, the researcher enters the ‘field’ with no predetermined schedule as to what they may or may not see or hear. Using this approach requires an ‘observation protocol’ to record the same information collected during observations by the data collectors. For instance, observers in a ward or clinic may focus observation on a certain phenomenon of interest. Munyisia et al. (2011) undertook an observational study to see how nursing staff spent their time performing clinical activities in a 110-bed nursing home in Australia. Their study required a team of trained observers to use a predetermined classification of activities in recording the specific activity being undertaken at a particular time by nurses. Some examples of the predetermined nursing activities observed included ‘time spent in communication’, ‘medication management’, ‘direct care’, ‘indirect care’ and ‘documentation’. A total of 6538 observations were recorded over 5 days among 74 nursing staff. Process of observation

Methods of observation range across a continuum from participation to observation where four distinct roles of participation and observation can be identified. These being: complete participant; participant-as-observer; observer-as-participant; and complete observer. These roles can also be adopted in quantitative research and are further discussed in Chapter 11. Differences in observer roles depend on the degree of researcher involvement (intervention) or detachment (concealment) with participants (see Figure 7.1). With complete participation, the researcher is an accepted and established member of the

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7 • Sampling data and data collection in qualitative research Complete Participant

Participant as Observer

• Researcher is immersed in group/community (complete intervention)

• Researcher steps into and out of groups/ community (intervention)

• Research is usually concealed (covert)

• Research is known (open)

Observer as Participant • Researcher mainly observes but occasionally enters field (brief intervention) • Research is known (open)

Complete Observer • Researcher does not participate • Research is either known (open) or concealed (covert)

Figure 7.1 Different roles of the observer in observational research

community (or group or sub-group) under observation. Complete participation gives the researcher the best opportunity to observe behaviours as the researcher is part of the community. Most anthropological studies use this technique as the researcher is already a member of the community or attempts to be invited into and ultimately be accepted by the community. Often it is not known by the community that the participant observer is a researcher (a form of concealment) to avoid disruption of normal activity. In a participantas-observer role, the researcher is acting as both participant and observer with this openness allowing productive relationships to develop with other participants, and allows the researcher to step in and out of the research environment when they think it is best. With observer-asparticipant, the researcher’s role is made public and the researcher is first an observer, with participation a secondary role. The close relations of a complete participation role, however, are more difficult to establish in this role. As a complete observer, a researcher is confined to observations only and offers no interaction with participants. The research study itself may or may not be revealed. There are major ethical implications for not revealing to people that they are being observed for research purposes and so examples, not just in nursing and midwifery, are rare. Sometimes, it may be planned that participants are informed instead after the research has finished. However, this is still usually not a compelling case for ethical approval to be given. A further aspect of observation is in the ‘positioning approach’ that the observer adopts.

These are classified as single, multiple and mobile. In single positioning the observer occupies one location only. They are less likely to distract participants or be distracted. Multiple positioning allows the observer to move to different locations and view events from different angles/ perspectives. Mobile positioning is needed in situations where the observer must follow participants as they go about daily activities. Another method of conducting observational study is by the use of video-recording. Decisions on how to record observational data depends on the focus of the research question and the analytical approached proposed. A main advantage of this approach is that the researcher has the ability to play the video over and over, aiding the data analysis process and reducing personal observational bias. This method can also be effectively used for intervention studies to compare pre- and post-change in practice. For example, Mjaaland et al. (2011) video-taped (using a still camera and extended microphones) 72 doctors’ encounters with their patients before and after a communication-skills training intervention. The focus of the study was to observe if doctors responded to patients’ cues and concerns when they expressed negative emotions. The results showed that doctors tended to avoid supporting or exploring patients’ emotions. A further related method is the use of photographic observation which serves to illustrate aspects of activities that are not easily described. Researchers could, for example, take a series of 10 to 15 photographs of an activity and then describe what they see so that an account of what is happening in the activity unfolds (Kawulich 2005). 133


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Benefits of observation

Mulhall (2003) suggests that observation has several advantages for qualitative research. These being: ‘capturing data in more natural circumstances’, ‘capturing the whole social setting’ and ‘context of the environment in which people function’, and ‘informing about influences of the immediate physical environment’. Depending on the observation method used, there is opportunity to interact with participants while gaining rich data and perspectives related to participants’ values and experiences. Where the researcher is also a participant, observation allows them to reflect on and evaluate their own feelings about their experiences in the field. In this case, researchers can choose to either ‘step back from’ or ‘be immersed in’ situations.

deceived (Kawulich 2005). Table 7.1 highlights some of the overall benefits and limitations of the main qualitative data collection methods.

Research in brief Walsh (2006) used a mixture of both observeras-participant and complete observer (depending on whether he was dealing with colleagues or clients), in his ethnographic study of a free-standing birth centre. In the first instance, he would find himself informally chatting to the women and families and making field tape-recordings. In the other instance (complete observer), as he was not employed by the birth centre, he simply ‘hung out there, shadowing the staff as they went about their daily work’ (pp 229–30).

Limitations of observation

If researching from an ‘objective’ stance, it is necessary to be aware of Mulhall’s (2003) caution that observation is more prone to ‘subjective’ interpretation by the researcher than is usually the case with interview data. Field notes are likely often written up following the observation event potentially adding to the subjectivity of data. However, neither of these issues would be a primary concern if working within a constructivist paradigm of research (see Chapter 2). For example, Manias and Street (2001) state in their study that researcher/participant subjectivity was an important and positive aspect of observation. Mulhall (2003) also points to the incidence of the Hawthorne effect (reactivity) in observational research methods. This effect is a well-known phenomenon whereby people who know that they are being researched (particularly when observed) tend to behave in different ways than they would normally — either to please the researcher or to present themselves in a different and possibly more positive way (see Chapters 5 and 10 for a more detailed account of this phenomenon). To avoid participant ‘reactivity’ altogether, a practical solution is concealment of the researcher’s role from start to finish (Li 2008). The disadvantages of this approach, however, are that the researcher may lack objectivity, the group members may feel distrust when the identity of the researcher is revealed and the ethics of the situation are questionable since the group members are essentially being

6

Tutorial Trigger

Devise an observation schedule for observing chronically ill children on a paediatric ward. What type of observer/participant role/s would you employ? What might you expect to observe?

Other types of data collection Although most qualitative studies use interviews or observations for the collection of data, other data collection methods are also applied — either singularly or in relation to each other. For instance, qualitative research questionnaires can be used where a list of open-ended questions capture qualitative data. Journals can be written by participants about their experiences, decisionmaking or whatever is the focus of the study, with the journalling usually occurring soon after the event or the experience. A novel form of data collection is the ‘think-aloud’ technique. This is where participants record reflective thoughts, decision-making processes or impressions about events and incidents into, for example, a handheld audio-recorder. This occurs in a study of patients where they are making self-management decisions about their diabetes (Thorne & Paterson 2001). A long-established method of data collection is using a form of ‘systematic searching’ for

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TABLE 7.1 Summary of benefits and limitations of main qualitative data collection methods DATA COLLECTION METHODS

BENEFITS

LIMITATIONS

Individual interview

• Allows participants to express their own ideas • Allows interviewer to be responsive to individual differences and situational circumstances

• Minimal control over the order in which the topics are covered • Usually small sample size limited due to cost and time

Focus group interview

• Allows organised discussion structured in a flexible way • Provides opportunity for all to participate and give their opinions • Dominant and submissive participants can be directed and controlled • Discussion generated between participants • Large quantity of information collected in a short amount of time

• Researcher has less control over the flow of discussion • Facilitating focus group interviews requires considerable skill • Difficult to distinguish between individual view and group view • More difficult to organise and order data for analysis

Involved observation

• Allows researcher immersion and prolonged involvement with participants • Encourages free and open conversation with the participants

• Altered behaviours of observed groups by the presence of the researcher • Takes time to build trust with participants

Detached observation

• Reveals descriptions of behaviours by stepping outside the group • Allows identification of recurring patterns of behaviours that participants may be unable to recognise or reveal themselves

• Potential researcher bias in the design of a study • Sources or participants may not be equally credible • Analysis of observation can be biased

stored or displayed items of relevance (indirect data) that can later be analysed. The search may be for items of historical information (e.g. archival material, minutes of meetings, biographies, personal and organisational diaries, letters and personal documents). For instance, Kirby (2004) used government reports and professional journals to investigate nursing recruitment crises in the 1930s and 1940s — to compare how this impacted on the foundations of nursing research from 1950 to the 1970s. Such sources provide historical and contextual accounts either to back up observations and interviews, or to provide data in its own right. In the Chaboyer et al. (2004) benchmarking project, for embedding evidence-based practice into a nursing curriculum, data were drawn directly from official university documents. Similarly, Leibbrandt et al. (2005) examined the curriculum documents of 26 Australian universities to produce data for the formation

of a national curriculum evaluation framework. The systematic search process may also be used for indirect data that present as a range of literary and artistic media, including paintings, literature and photography. In this case, some qualitative researchers also ask participants to create collages, take photographs or perform other artistic processes related to the research focus of a study. For example, Turner (2005) investigated hope, from the perspective of 10 young Australian people, asking them to take photographs that reflected their experiences and interpretations of hope. Ureda et al. (2011) used ‘story-mapping’ with their focus group participants to illustrate their decision-making processes for dealing with prostate cancer. The story maps were illustrated visually by a local artist in colour and were found to increase participants’ identification of the issues surrounding prostate cancer. In addition, 135


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a discussion guide was used to assist the focus group process of how and where, in their community, participants might learn about screening for prostate cancer.

Using multiple data collection methods More and more nurse and midwifery researchers are conducting research using mixed-method/ triangulation research (see Chapter 14). One form of methodological triangulation is where the researcher uses different methods for collecting data in the same study. For instance, Henderson (2003) details a grounded theory study where she uses interviews and participant observation to investigate power imbalances between nurses and patients in Western Australia. Ray and Street (2005) use interviews and an original technique, called ‘ecomapping’, to explore the dynamic nature of social networks of Australian motor-neurone disease sufferers. Ecomapping is a form of observational technique that maps and tracks relationships, social networks and support over time and offers a visual schematic of identified connections. Research in brief Williams and Irurita (2004) report their grounded theory study to investigate Western Australian patients’ perspectives of therapeutic and non-therapeutic interpersonal interactions. Three types of data collection methods were used. Forty patients were interviewed individually; 78 hours of participant observation field notes accompanied this and patient-related documentation was also reviewed for data retrieval. ‘Emotional comfort’ and ‘emotional control’ emerged in the findings as the main factors that either prevented or promoted therapeutic relationships. Emotional comfort was found to be related to ‘level of security’, ‘level of knowing’ and ‘level of personal value’.

When have enough data been collected? Qualitative researchers often experience uncertainty when not being able to generalise their findings due to the small sample sizes often

used (Marshall 1996). However, this can be overcome when researchers ‘feel’ that they have enough information at hand or, alternatively, the emerging data becomes repetitive or uncovers nothing new. If this is the case, then researchers continue collecting data until data saturation, redundancy of data or ‘theoretical saturation’ is achieved (see Chapter 8). Saturation, therefore, is not dependent on the amount of data collected but based on the richness of the emerging data set (Tuckett 2004; Guest et al. 2006). There is some controversy, though, as to whether it is really possible to achieve true data ‘redundancy’ or saturation, because further interviews always have the potential to uncover something new or unexpected (Wray et al. 2007). Therefore, the point at which this situation seems to occur will vary with each study and cannot be predicted. However, once the researcher is reasonably satisfied that this point has potentially been achieved, data collection can then cease and the researcher can move on to the next stage in the research process — data analysis.

Point to ponder Close attention is needed when selecting data collection methods for a research study. Without effective data collection strategies, the collected data will be flawed — as will the findings and conclusions of the whole study.

Summary With qualitative research, sampling methods and methods of collecting data are a vital and closely related part of the study design (see Chapter 2). A number of different options are available which, in turn, will determine the nature and approach of the research to be conducted. So, for instance, different types of fields of observation are linked with different types of ethnographical studies. Careful attention to detail is required with both sampling and data collection processes. Errors in either are likely to severely affect overall study outcomes. The effectiveness of these processes greatly impacts on the next stage of qualitative design process, that of data analysis. Qualitative data analysis is the focus of the following chapter.

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Key points • Qualitative research uses a wide range of methods and techniques for both sampling from the appropriate population and for collecting required data from the sample. • The four main types of sampling used in qualitative research are convenience sampling, purposive sampling, snowball sampling and theoretical sampling. • Choosing a sample size and sampling scheme and collecting data from the chosen sample should be an active process of reflection which is central to qualitative research. • Qualitative research usually employs either/both interviews or observation to collect data from sample populations. Each has both its strengths and limitations.

Learning activities 1. In sampling, the inclusion criteria indicate: a) characteristics or properties of the chosen sample that the researcher would not want them to possess b) characteristics or properties of the chosen sample that the researcher would most want them to possess c) characteristics or properties of the sample that the researcher would find most attractive d) characteristics or properties of the chosen sample that the researcher would find least attractive. 2. Which group of participants below would represent a judgment sample: a) all the people working in a hospital b) specialist nurses recommending other specialist nurses c) specialist nurses working in intensive care d) all inpatients in a hospital. 3. When sampling methods are applied to data already collected, this is called: a) data sampling b) information sampling c) theoretical sampling d) non-theoretical sampling.

4. What is the most common method used for collecting qualitative data: a) questionnaire b) interview c) observation d) survey. 5. When interviewing, starting off with simple and broad questions to help ease the participant into the process is referred to as: a) nurturing b) channelling c) funnelling d) easing. 6. Observational methods can employ which of the following approaches: a) in-place participant; participant-asobserver; observer-as-participant; and absolute observer b) complete participant; participant-asobserver; observer-as-participant; and complete observer c) absolute participant; participant-asobserver; observer-as-participant; and in-place observer d) complete participant; in-place observer; in-place participant; and complete observer.

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7. Observation techniques are most commonly used in: a) phenomenology b) grounded theory c) historical research d) ethnography. 8. A qualitative researcher knows that it is not useful to collect any further data: a) when they sense that this is the case b) when the participants say that they have nothing more to say c) when data saturation/redundancy of data is reached d) when data overload is reached.

9. A form of methodological triangulation applies when: a) participants are mixed up b) different methods for collecting data are employed in the same study c) different methods for collecting data are employed in different studies d) the data collection methods are mixed up. 10. The Hawthorne effect, in observational research, is when: a) participants behave in different ways than they would normally b) participants are observed when the research is concealed from them c) the researcher becomes totally integrated into the community being researched d) there is more than one observer and observations are integrated for objectivity.

Additional resources

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Borbasi S, Jackson D, Wilkes L 2005 Fieldwork in nursing research: positions, practicalities and predicaments. Journal of Advanced Nursing 51:493–501 Higginbottom G M A 2004 Sampling issues in qualitative research. Nurse Researcher 12:7–12 Krueger R A, Casey M A 2009 Focus Groups: A Practical Guide For Applied Research, 4th edn. Sage Publications, London, UK McLafferty I 2004 Focus group interviews as a data collecting strategy. Journal of Advanced Nursing 48:187–94 Wimpenny P, Gass J 2000 Interviewing in phenomenology and grounded theory: is there a difference? Journal of Advanced Nursing 31: 1485–92

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For further content associated with this chapter visit http://evolve.elsevier.com/AU/Schneider/research/

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