Interpretive Description

Qualitative Research for Applied Practice

Sally Thorne

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9781629582986
• eBook ISBN: 9781134820566
• Edition: 2
• Topic: Social Sciences
• Subtopic: Social Science Research & Methodology
• Index: Social Sciences

The first edition of Interpretive Description established itself as the key resource for novice and intermediate level researchers in applied settings for conducting a qualitative research project with practical outcomes. In the second edition, leading qualitative researcher Sally Thorne retains the clear, straightforward guidance for researchers and students in health, social service, mental health, and related fields. This new edition includes additional material on knowledge synthesis and integration, evidence-based practice, and data analysis. In addition, this book

• takes the reader through the qualitative research process, from research design through fieldwork, analysis, interpretation, and application of the results;
• provides numerous examples from a variety of applied fields to show research in action;
• uses an accessible style and affordable price to be the ideal book for teaching qualitative research in clinical and applied disciplines.

Part I Interpretive Description in Theory

Qualitative Research in the Applied Disciplines

DOI: 10.4324/9781315545196-1

Theorizing and Application

Many years ago I had the experience of engaging in a week-long intensive workshop with a group of academics, composed roughly equally of social scientists and health professional researchers. Although everyone was highly enthusiastic about the topic of discussion (as it happened, the confluence of genetics and ethics), fundamental schisms began to form quite early in the week between the two groups, such that by the end of our time together there seemed an insurmountable barrier to understanding. Essentially, for the clinician researchers, the entire point of questing for knowledge was to apply it to real human beings caught in complex and difficult human health problems so that their quality of life could be improved in some manner. For the social scientists, the point of knowledge development was theorizing, and it was anathema to them that people would put their ideas to use prematurely. While I fully recognize that many clinicians theorize and many social scientists do applied work, it seemed that the extreme situation of working together so closely on this particular topic had revealed a polarizing tendency that I had not previously appreciated in its full blossom. While that singular episode is not representative of so many of the vibrant interdisciplinary collaborations I have been party to before or since, the underlying problem stayed with me, and the insights arising from it began to feature in my own applications of research method.

In the context of our interprofessional, multidisciplinary health research world, especially within the qualitative research community, it becomes easy to forget that we represent different disciplines with highly distinctive origins and intellectual objectives. After all, we are all friends, working together on projects that are of common interest, and we are all trying to make a better world. We all think of ourselves as enlightened individuals, freethinkers capable of drawing on the ideas and insights derived from a universe of disciplinary traditions. However, that early rather extreme example humbled me into what felt like a more fulsome understanding of the extent to which we are what we study, complete with a profound sense of the depth with which the disciplinary traditions into which we are educated, especially in the applied disciplines, shape the angle of vision we take into all of our multidisciplinary activities.

Much of the fine tradition of qualitative health research method we have available today derives from the historical context of what we collectively refer to as the “social” sciences. Auguste Compte’s understanding in the early nineteenth century that authentic knowledge derives from personal experience and not simply from theological or metaphysical foundations led to a search for laws of social life that might mirror the natural laws of the physical sciences (Pascale, 2011). However, strong critique for Compte’s brand of positivism led some scholars to reject hypothetico-deductive reasoning as the appropriate foundation of all social knowledge (Bohman, Hiley, & Shusterman, 1991). On this basis, a range of approaches to rigorously work with nonobjective data in order to study human behavior and try to understand the reasons that govern it started to emerge within the social sciences (Jovanović, 2011). As a result of these historical tensions, it has been observed that the mainstream social sciences have a lingering skepticism of inquiry methods that seem bound to the scientific and evidentiary discourses (Alasuutari, 2010; Pascale, 2011).

Over the course of time, social sciences such as anthropology, sociology, and psychology generated a range of methods we now recognize as ethnography, grounded theory, and phenomenology to advance their disciplinary projects (Hamilton, 1994; Vidich & Lyman, 1994). Because these methods were the ones that dominated the field by the time the applied disciplines began to take serious interest in qualitative inquiry, it is instructive for the applied disciplinary world to remember that the intended trajectory of new knowledge for the methodological originators was enacted primarily through careful theorizing (Berger & Luckman, 1966; Chenail, 1992; Durrenberger & Thu, 1999; Porter & Ryan, 1996). Simplistically stated (with apologies), anthropology’s mandate was to document and interpret human variations toward enhancing our grasp of what may be universal about being human. Sociology concerned itself with working out the way human nature is manifest in social behavior. And psychology sought to understand the workings of the human mind, with the social psychology element particularly interested in ways in which that human mind shapes the ways we engage with one another. Although each of these disciplines now includes subspecialties working in applied “real-world” contexts such as health, its origins within human philosophical curiosity ensures that its scholarship remains quite solidly grounded in theoretical and empirical rather than practical problems (Reason, 1996; Reason & Torbert, 2001; Thorne, 2001). As such, the formal methodological traditions that derived from these disciplines continue to carry with them some of what we in the applied world may encounter as “theoretical baggage” (Thorne, 2014).

Applied to the study of health issues, then, the fundamental point of social science research is not to solve everyday problems of patients, but rather to capitalize on health phenomena to answer problems of a more elemental nature related to understanding how social groups behave and what constitutes the core nature of human experience (Alasuutari, 2010). To illustrate, there exists a strong sociological tradition of studying epilepsy as a prototypical lens through which to learn more about the workings of social stigma (Goffman, 1968; Scambler & Hopkins, 1990; Schneider & Conrad, 1980). While such work constitutes fine social theorizing and can inform us about the “nonclinical” world in which health and illness are played out, health care professionals and planners would clearly be remiss in assuming this constitutes evidence that epilepsy produces more problematic social disclosure issues than do other chronic diseases.

In direct contrast, applied science within the health disciplines draws its lifeblood directly from the world of clinical realities (Chenail, 1992; Hall, 2013; Miller & Crabtree, 1994). Certainly the applied health disciplines theorize, and often brilliantly so, but when they do, they tend to do so in the hopes that theorizing will facilitate better application. Essentially, it is in the nature of the clinically trained mind to “see” the prototypical human client at the end of the theorizing—to recognize a practically relevant knowledge gap out there in the world and to strive as purposefully as possible toward meeting it. In contrast, it is in the nature of the social scientist to see the theorizing as a legitimate and worthy goal in and of itself, and sometimes to see the human being and his or her plight as an opportunity to advance that theorizing. In the interpretive (antifoundationalist, antinaturalist) world of nonapplied disciplines, the existence of some form of reality and its relationships to various truth claims is contested ground. As Shusterman puts it: “Having abandoned the ideal of reaching a naked, rock-bottom, unmediated God’s-eye-view of reality, we seem impelled to embrace the opposite position—that we see everything through an interpretive veil or from an interpretive angle” (1991, p. 103). Taking this perspective, what social scientists know about a phenomenon depends more upon the theoretical lens they bring to understanding it than to any immutable properties it may possess. By extension then, the competing theoretical positionings social science brings to the study of a thing become the intellectual standpoints from which to debate it, with no pretense that one will have better truth value than another because the real world upon which a truth claim must be grounded is itself simply an idea.

I unabashedly admit that, in saying this, I am expressing this distinction as an extreme polarity that undoubtedly overlooks a multitude of exceptions. (As Mark Twain’s oft-cited adage reminds us, All generalizations are false, including this one.) However, I do this intentionally because I believe that the difference is vitally important when it comes to grasping why it is that conventional social science methods cannot advance clinical knowledge in quite the manner that the applied health disciplines require, and therefore why variant approaches to discovery are sometimes needed.

The Nursing Example

For those who are not members of the tribe, nursing is a complex and “messy” discipline, having been born of the universal practical requirement to care for the sick within society and growing to maturity in close partnership with its more science-minded cousins in clinical medicine. It has weathered the storms of gender bias and economic disadvantage, and come through a period of political awakening in which it has emerged from a sense of being an oppressed group within professional society and into an awareness of the power of public trust. It has grappled with identity politics (is it a quasi-religious “calling,” an occupational entity, or a full profession?), whether it does or does not possess a distinctive scientific basis apart from that of medicine and other health sciences. Further, for much of its modern history, it has attempted to resolve these matters through theorizing, an activity that has often seemed an uncomfortable bedfellow with its practice aims.

However frustratingly problematic the nursing discipline may be, it is also exquisite in its complexity and its purity of purpose (Sellman, 2011). And it is these properties that are important in understanding why nursing’s need for knowledge would drive a quest for new methodological options (Dzurek, 1989; Morse, 2012; Reed, 1995; Sidani, Epstein, & Moritz, 2003; Thompson, 1985; Watson, 1995). Nursing always and inherently requires knowledge about patterns and themes within people in general so that it can better inform the care of the unique and distinct individual. From a nursing standpoint, knowledge always evolves through dialectic processes (Risjord, 2010). The care of any individual patient inherently involves examination of the interplay between objective and subjective information, such that technical detail about the hip replacement procedure that is about to take place is carefully tempered by the distinctive humanity of the person who is entering that surgical experience. As you discover things about an individual patient, these inform your interpretation and uptake of the available knowledge, which includes not only formal evidence but also shared clinical wisdom, pattern recognition, established practice, ethical knowledge, and the “how to” craft of artfully aligning all of those together into competent and compassionate practical application (Johnson & Ratner, 1977; Liaschenko, 1997). Nurses draw upon an amazing array of diverse knowledge sources, sorting and organizing available knowledge options according to an internalized conceptual framework that derives from the philosophical understanding of why we nurse; on the basis of that organized knowledge nurses create applications tailored to the specific patient we find before us today. Even if we are applying a standardized intervention for a health problem we have encountered hundreds or thousands of times before, nursing holds dear the conviction that this particular individual may be the one who requires a new twist in the standard scheme, a new adaptation to the typical approach, in order to achieve his or her optimal level of health at this time and in these circumstances. And this marvelous tension between the general and the particular characterizes the inherent complexity of nursing’s intimate relationship with knowledge development (Thorne & Sawatzky, 2014).

Of course, nursing’s praxis orientation—that dialectic between practice and knowledge—is not unique, and other applied disciplines certainly share many of the same qualities and draw upon many of the same historical thought traditions (Maxwell, 1997). However, nursing is so utterly steeped in them, and they are so central to the core business of the discipline, that knowledge forms capable of shedding light on that dialectic between conceptualization and action have tremendous value within the everyday practice world (Hall, 2013). Thus, nursing’s comfort within the world of complexity and contradiction, its enthusiasm for ways of thinking that acknowledge the messiness of the everyday practice world, and its fascination for both pattern and diversity help explain why it would have taken a leading role in what has become a generation of methodological development within the applied qualitative health research field.

Methodological Ancestry

Interpretive description is an approach to knowledge generation that straddles the chasm between objective neutrality and abject theorizing, extending a form of understanding that is of practical importance to the applied disciplines within the context of their distinctive social mandates. It responds to the imperative for informed action within the admittedly imperfect scientific foundation that is the lot of the human sciences.

The methodological approach that grew into what is now called interpretive description arose from the necessity to find a way to do the kind of applied qualitative research that could generate the kinds of understandings of complex experiential clinical phenomena that would be optimally relevant and useful to the practice of nursing and other professional disciplines concerned with questions “from the field.” Disentangling methodological strategies and techniques from the theoretical assumptions inherent in the original social science disciplinary projects for which the conventional qualitative research approaches were originally intended, the idea of interpretive description was to retain the coherence and integrity of a theoretically driven approach to knowledge development while supporting defensible design variations according to the specific features of context, situation, and intent. In so doing, it emphasized a design logic and organizing framework consistent with the epistemological integrity of the discipline as a hallmark of excellent qualitative accounts of the phenomena of concern to the health and applied professions.

My first attempt to write about the possibility of an alternative to the conventional qualitative approaches for applied health research was published in 1991. At that time, qualitative researchers in the health field were still quite defensive about the quality of their contributions and tended to rely quite heavily on “established methods” from the social sciences in order to lend credibility to their empirical contributions. Not only did it seem requisite to “locate” oneself within a particular methodological tradition, naming the particular theorists upon whose work one was building, but also one was expected to follow the associated rule structure meticulously (Bartolomé, 1994; Janesick, 1994). However, consideration of the disciplinary projects from which the available methodologica...

Table of contents

• Cover Page
• Half Title Page
• Series
• Title Page
• Copyright Page
• Contents
• List of Boxes
• Preface
• Foreword to the First Edition
• Part I Interpretive Description in Theory
• Chapter 1 Qualitative Research in the Applied Disciplines
• Chapter 2 Cultivating Questions in the Applied Practice Field
• Chapter 3 Scaffolding a Study
• Chapter 4 Framing a Study Design
• Chapter 5 Strategizing a Creditable Study
• PART II Interpretive Description in Process
• Chapter 6 Entering the Field
• Chapter 7 Constructing Data
• Chapter 8 Working Data
• Chapter 9 Transforming Data
• Chapter 10 Writing Findings
• Part III Interpretive Description in Context
• Chapter 11 Interpreting Meaning
• Chapter 12 Enhancing Credibility
• Chapter 13 Disseminating Findings
• Chapter 14 Advancing Evidence with Interpretive Description
• Chapter 15 Building, Aggregating, and Synthesizing
• Chapter 16 Knowledge Integration
• References
• Index