Advanced Qualitative research(Critique a qualitative article)

Presented byRassamee Srinon

Dang Tran Ngoc Thanh

Guidelines for critique

Element influencing believability of the research

1/Educational background of the authors- The 1st author, Moi who is a doctoral student in nursing, a lecturer at Bergen University college, and also did 3 studies in 2006, 2007, 2008 on survivors of burn injury. Therefore, the author has a clinical experience, research expertise and educational preparation that support to conduct this study. - The 2nd author, Gjengedal, who is a nursing professor at university of Bergen, so the author’s scientific background is appropriate for this study as well.

2/ Report title- The article title is not really clear because it does not highlight the methodology. However, reader can get some idea about the focus of the study on the target population and the main theme of this study.

Element influencing believability of the research (con.t)

3/Abstract The abstract offered an overview of the study, including a research purpose that wanted to describe and identify invariant meanings in the experience of life after major burn injury, a clearly stated methodology which was informed by phenomenology. However, theme in finding is not clearly stated which may cause ambiguous for reader.

4/Writing style The article is organized rather concise. However, writing style is not really well, some parts are repeated. Particularly, finding part is quite hard to understand. The references presented in a consistent format.

Element influencing robustness of the research

• PHENOMENON OF INTEREST• STUDY PURPOSE/SIGNIFICANT OF PROBLEM• LITERATURE REVIEW• STUDY DESIGN• QUALITATIVE METHODS• SAMPLE/SAMPLING• ETHICAL CONSIDERATION• DATA COLLECTION• DATA ANALYSIS• PROCEDURAL RIGOR• FINDING/DISCUSSION• CONCLUSIONS• IMPLICATION AND RECOMMENDATION

1. Is the phenomenon of the interest clearly defined/ consistent with research objective?

• The article by Moi and Gjengedal serves to inform us about adults experiencing of quality of life after major burn injury from the perspective of the patient.

• Phenomenon of study was consistent with research objective

2. Is the purpose/ research question clearly identified?

• The purpose is stated briefly in the abstract of the article, and again in more detail in the introduction.

• However, research question did not state specifically.

3. Significance of the problem of the research?

• The authors clearly indicated the significance of the problem by stating that due to the success of modern intensive care medicine, survival rates of people after major burn injury have increased. Therefore, research interest focus on optimizing the quality of life of the survivors

4. Was relevant background literature reviewed?

• A review of the literature in this article provided the relevant information from the previous researches which identifies gaps in current knowledge and research about the topic of interest.

4. Was relevant background literature reviewed? (Cont.)

• People’s lived experience after burn injury should concern both the diversity of bodily effects of the burn, as well as the large variation in terms of roles and functioning. (p.1621)

• Standardized measurements of health and quality of life are available but it might be deepened through qualitative studies assessing the survivors’ own stories. (p.1621)

• Relatively little research has addressed the experience of burn survivors using qualitative methods. (p.1622)

• Quality of life in a health perspective is a genuinely subjective phenomenon which is essentially oriented toward and open to what it is not, to the world and to the other, and it is in this openness that self-awareness arises(p.1622)

5. Does the study describe the philosophical approach?• Phenomenology was chosen as the

methodology in this study.• The authors provided some basic

information from a Husserlian phenomenological perspective which is descriptive, implying a search for the essences or the most invariant meanings that can be assigned to a phenomenon for a given context. (p.1622)

6. Is a qualitative methodology appropriate for this study?

• The aim of phenomenology in nursing research is to describe the experience of others so that those who care for these individuals may be more empathetic and understanding of the person’s experience. (Wright, 2003)

6. Is a qualitative methodology appropriate for this study? (Cont.)• The authors indicated that relatively little research has

addressed the experience of burn survivors using qualitative methods. Often, when little is known about a phenomenon, a qualitative approach, such as phenomenology is used.

(Yoder, 2005)• Speziale and Carpenter (2003) noted that because

professional nursing is enmeshed in the life experiences of individuals, phenomenology is well suited to the investigation of phenomena important to nursing

7.Have the philosophical underpinnings of the approach been explained?

• The authors also give rational why they chose phenomenological approach, not descriptive and explorative approach.

• Furthermore, the authors agreed that the concept quality of life in a health perspective is a genuinely subjective phenomenon.

• Quality of life was revealed through the burn survivors’ lived experience and what stood out as important aspects of their lives.

8. Were participants relevant to the research objective/suitable for inform?

• 14 participants having sustained and survived a burn injury at the outpatient clinic burn center in Norway were recruited, so these participant were relevant to research objective.

• A sample of 14 participants is suitable for informing research. However, the authors also considered there is nine participants were interviewed once which may affect the structures of essential meanings.

9. Was sampling method appropriate?

- A purposive sampling was used and it is appropriated for phenomenological approach

- To allow for identification of essences that cut across variations, they intentionally recruited participants of both sexes, with a broad age-span, who had experienced burns of different types, and had also received different treatments

Inclusive criteria

a) they had to be 18 years of age or older at the time of injury, and fluent in Norwegian with the capacity of verbalizing their stories

(b) having experienced a burn injury threatening survival, functioning, or appearance

(c) not having severe mental problems overshadowing the burn injury experience.

10. Was informed consent obtained?

• The authors described ethics consideration, including how informed consent was obtained, and confidentiality issues, however it was not clear enough. – Their study was approved by the Norwegian Committee

of Ethics in Medicine and registered at the Norwegian Social Science Data Service.(1622)

– The participants were informed from the invitation letter about the aims of study and procedure for the interview. Also, the author gave the participants opportunity to ask questions before they interview(1623)

– However, the researchers can not assure their participants’ anonymity; but, they can ensure confidentiality. Such assurance is provided to the participant in the consent form.

11. Data collectionMoi and Gjengedal provided the reader with a rather

good explanation of data-gathering process: – issues of gaining access to the site (not clear) – A plastic surgeon experienced in burn care and

working at the burn center selected eligible participants.

– data collection method (interview)– average 14 months post injury (range 5-35

months) but actually the author conducted from 10-35 months post injury due to obtain experience of life after the initial adaptation

11. Data collection (Cont.)

– most interviews took place the same day the burn survivors visited the outpatient clinic

– 9 participants were interviewed once, 4 were interviewed twice, and 1 participant was interviewed thrice

– the length of time spent gathering data/participant (2h10’ varying 55’-4h20’)

– the amount of data collected (20 interviews/14 participants)

11. Data collection (Cont.)

The data collection strategies was comprehensive enough to support rich descriptions:

• The first author opened the interviews by giving information about the aims of the study……….

• The participants were then asked to tell “what had happened in their lives from the time of their respective accident to the time of the interview

• Efforts were made to keep interruptions and questions to a minimum

11. Data collection (Cont.)

• The interviews were audiotaped. • Shortly after each interview, the context,

perceived atmosphere, and nonverbal communication were noted.

• The interviews were then transcribed verbatim and prepared for analysis.

• Probes were used • The participants were asked about the experience

of the interview itself

11. Data collection (Cont.)

• Overall, the researcher clearly describe the procedures used to ensure that data were recorded accurately and that data obtained is representative of the ‘whole’ picture. All source(s) of information used by the researcher was be described.

• This is important because a reader might desire to replicate this study with a different population; having clear knowledge of how the data were collected allows for ease of replication.

12. Was saturation or redundancy in data reached?

• The researchers indicated how and when the decision was reached that there was sufficient depth of information to meet the purposes of the study.

– The first author determined that the descriptions were rich and that little new information related to the main aim of this study was forthcoming.

– To decide on saturation, field notes and notes from the initial readings of transcripts were consulted

– However, the authors mentioned that it did not reach saturation (p.1629)

13. Were steps of data analysis method identified?

• Moi and Gjengedal nicely provided the 5 steps they took in the data analysis process basing on the approach of Giorgi (1985) which inform readers of the sequence in which they proceeded to take large amounts of transcribed data and pare it down into understandable themes

DATA ANALYSIS(Cont.)

5 steps of Giorgi’s (1985) phenomenological method

• First, the entire description was read to get a general impression of the whole statement. After having read all interviews, notes based on the first reading of each interview were written down.

• Second, each interview was read through once more, with the aim of discriminating units of meaning focusing on life experience after the burn injury from a quality-of-life perspective.

DATA ANALYSIS (Cont.)

• Third, the everyday expressions of the meaning units were formulated closer to the essential meaning of the phenomenon being studied

• Fourth, based on the transformed units of meaning, an individually situated consistent statement of structure of experience was synthesized for each participant

• Finally, from the convergences and divergences of the individual structures, essential meanings cutting across all interviews and participants were identified and described as an essential general structure

DATA ANALYSIS (Cont.)

• The qualitative data analysis software NVivo was used for processing and organizing the voluminous data into themes and subthemes.

• The source data consisted:– all interviews – and field notes– and a summary of the first reading of each

participant’s interview(s). • Demographic and clinical information from the

medical records were analyzed using the statistical software SPSS13.

14. Does the researcher discuss how rigor was assured?

• The authors included this important step in their report.(p.1624)

• Credibility

Dependability

Transferability

Confirmability

Goodness

(Ryan, Coughlan, & Cronin, 2007)

how rigor was assured?

• Guba (1981) suggests that credibility, depend-

ability, confirmability, and transferability be used

to support rigor in qualitative research. • Giorgi’s (1985) phenomenological analysis does

not rely on participant review or intersubjective agreement by expert judges, peer debriefing, or returning to participants to validate findings to establish qualitative rigor.

14.1 Was credibility discussed?

• Credibility involves activities that increase the probability that credible findings will be produced (Lincoln & Guba, 1985). One of the best ways to establish credibility is through prolong engagement with the subject matter– The first author, who was an experienced

intensive care nurse, conducted all interviews, took all field notes, completed all transcriptions, and performed all analyses, allowing for prolonged engagement and persistent observation.

14.2 Was dependability discussed?

• The authors also showed the dependability by the process of phenomenological reduction and through the unfolding of intentionality to identity achievement.

• The first author bracketed scientific information by writing down before starting the interviews to ensure self-awareness and open-mindedness during the research process

• The qualitative studies published on the lives of burn injury survivors were not read in detail before completing the data analysis, to increase openness in the research process

• Also, reduction was from avoid to say that an observation was what it seemed to be, and instead bringing the structures of the participants’ lifeworld to self-showing

14.3 Was transferability discussed?

• The design and result of this study had some limitations that transferability can not assured to apply to others in similar situation.– The participants were not interviewed over time– Nine of the participants were only interviewed

once– Data did not reach saturation– Heterogeneous sample of participants

14.4 Was confirmability discussed?

• Confirmability is the way one documents the findings by leaving an audit trail. An audit trail is a recording of activities over time, which can be followed by another individual (Streubert & Carpenter, 1995)– The first author conducted all

interviews….,and performed all analyses.– The second author read all interviews and

supervised the use of Giorgi’s phenomenological method and the presentation of the findings

14.4 Was confirmability discussed? (Cont.)

– The interviewing was stopped at the point where each participant felt that she or he had told their complete story, and the first author determined that the descriptions were rich and that little new information related to the main aim of this study was forthcoming.(p.1624)

– To help the researcher decide on saturation, field notes and notes from the initial readings of transcripts were consulted.(p.1624)

14.5 Was goodness discussed?

• Ryan et al. (2007) stated that goodness needs to be evident in – the philosophical background,

– study design,

– explicit explanation regarding the study context,

– data collection and management,

– the interpretation and presentation process.

• Overall, the authors did not show the goodness in some parts such as finding.

15. Were findings consistent with and reflective of data? • The authors did not show how many meaning units

in the transcribed interview, how many fomulated meaning units (constituents of the essense of quality of life of burn survivors)

• The themes that were developed by the authors were not be logically consistent and reflective of the data. So, there were an indication that data was not be appropriately assigned to themes/codes.

• Some themes of result finding was not consistent with the research objective

A striving for a regained freedom

included experiences of life with reduced or absent bodily or social restriction, a meaningful life, a life as it was before the accident and sometimes even better

Facing an extreme situation that demanded•vigilance, •appropriate action, •the need for assistance

Disrupted personal life stories•having to put significant effort into creating coherence.

Accepting the unchangeable to go through recurrent processes of •enduring, •grief, •fatalism, •comparisons with others,•new feelings of gratefulness.

Change what was changeable to achieve •personal goals, •independence, •relationships with others, •a meaningful life

16. DISCUSSION

• The report has been placed in the context of what was already known of the phenomenon “the lives of the survivors of burn injury that constitute their experience of quality of life”

• Themes from finding were discussed.

17. Are implications of finding identified?

• Some implications for burn care were stated from the result of this study.– Follow up of burn survivors should include diaries written by close

relatives or staff that cover the accident and the period of intensive care

– Family members might be significantly helped to endure the worst phases of recovery

– Burn-care staff should have an open attitude to “meaning-making,” consideration on values, beliefs, and goals of the burn patients

– Patient experiences could be further recognized and valued– Positive feelings and growth went hand-in-hand with suffering and

the many challenges involved, making the burn survivors’ experience from accident to rehabilitation

18. Are recommendations made to suggest how the research finding can be developed?

• Further study, using a more homogenous sample of participants

• Burn-care staff can be benefit from the result finding in the process of rehabilitation, when organizing and arranging burn camps, and peer support groups

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• The books, journals and other media alluded to in the study accurately referenced.

• Some cited articles and books were published long times ago but it could be classical papers.