Qualitative Research Methodologies for Occupational Science and Therapy

Shoba Nayar, Mandy Stanley, Shoba Nayar, Mandy Stanley

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781134088904
• Edition: 1
• Topic: Medizin
• Subtopic: Beschäftigungstherapie

The push for evidence-based practice has increased the demand for high-quality occupational science and occupational therapy research from conceptualisation of the study through to publication. This invaluable collection explores how to produce rigorous qualitative research by presenting and discussing a range of methodologies and methods that can be used in the fields of occupational science and therapy.

Each chapter, written by an experienced researcher in the relevant methodology, includes examples of research, foundational knowledge and therapeutic applications. Including new and cutting-edge methodologies, the book covers:

• 
  
  

• Qualitative Descriptive
• Grounded Theory
• Phenomenology
• Narrative
• Ethnography
• Action Research
• Case Study
• Critical Discourse Analysis
• Visual Methodologies
• Metasynthesis
• Appreciative Inquiry
• Critical Theory and Philosophy

Designed for occupational science and occupational therapy researchers, this book develops the reader's ability to produce and critique high quality qualitative research that is epistemologically sound and rigorous.

1 Beginning conversations

Shoba Nayar and Mandy Stanley

Our story

The idea for this book came from a number of conversations that we have had over time. At various points over the past few years, when we came together from our homes in Australia and Aotearoa New Zealand at conferences or meetings, we would have a conversation about qualitative research. We often lamented that the quality of some of the published qualitative research within occupational science and occupational therapy was not what it could and should be. The publishing of studies of low methodological quality raised particular areas of concern.

First, we questioned whether the studies demonstrated the appropriate level of respect for participants who volunteer time and allow researchers access to aspects of their personal lives. Such studies, we believe, do not do justice to those volunteers and may be a poor reflection on the occupational science discipline or the occupational therapy profession. Second, with the growing demand for evidence-based practice, we were concerned about the quality of evidence. Already, researchers and practitioners who subscribe to a hierarchy of evidence based on understanding causation do not rate qualitative research highly; and it certainly will not be well regarded if it is not quality work. But further, if the profession at large wants occupational therapy practice to be based on research evidence, then it must be quality evidence to inform practice. If practitioners are drawing on published studies that are of low quality, then it will not be the best evidence for quality occupational therapy practice and good outcomes for clients.

The third concern centered on how the profession’s body of knowledge would be judged by other researchers and practitioners, based on their reading of the published literature if the quality is low. To be taken seriously by service funders and other professions, occupational science and occupational therapy researchers must show that they can produce and disseminate quality studies. Given our shared concerns we came to the decision that instead of lamenting the situation, we should do something more positive and make an active contribution to remedying the situation as we perceive it.

We are both occupational scientists and occupational therapists, as well as qualitative researchers with experience as university academics. We use qualitative approaches within our own work and in our supervision of research students, and we have experience teaching qualitative methodologies. We review for a number of occupational therapy and health-related journals and are associate editors for the Journal of Occupational Science. But rather than laying out our curriculum vitae at this point, we prefer to convey our passion in relation to both occupational science and occupational therapy and qualitative research.

Our shared interests and experience, and commitment to positive contributions, led us to writing a paper together for an occupational therapy audience about improving the quality of qualitative research. While writing that paper, we came to the realization that our ideas could be expanded and perhaps it would make a better book than a journal article. So once we finished the paper we worked on the book proposal. While working on the proposal we facilitated a workshop at a New Zealand Association Occupational Therapy national conference, which was based on our manuscript and some of our emerging ideas. We had a positive response to that workshop, from both novice and experienced researchers, which reinforced to us the need for this book. In developing the book proposal we canvassed existing texts which supported our claim, as it appeared that this was the first time a methodological text was being mooted that brought together occupational science and occupational therapy and that had a specific methodological focus on researching occupation. Occupational science and occupational therapy have reached a stage of maturity in discipline and professional growth warranting the publication of occupation-focused research texts. Despite the explicit focus on occupational science and occupational therapy, researchers from other disciplines may well find something useful and relevant in this book.

Without making claims to know it all, we have set out to create a text that might provide some guidance to students and novice researchers or to experienced researchers who want to extend their knowledge and skills into methodologies less familiar to them. We offer that guidance with humility and recognize our limitations, so it is not the definitive text, rather we put it forward as a contribution. Our intent right from the beginning was to have a strong international flavor. Thus, a key feature of this book is the inclusion of chapter contributions from leading occupational science and occupational therapy researchers from across the globe, bringing variety, depth, and breadth.

Focus of the book

Qualitative research approaches have been used in both occupational science and occupational therapy research for some time. So what do we mean when we the use term qualitative research? Nkwi, Nyamongo and Ryan (2001) stated that “Qualitative research involves any research that uses data that do not indicate ordinal values” (p. 1). This is deliberately a broad and all-encompassing definition. While still maintaining the breadth, Denzin and Lincoln (2005) offered a somewhat more refined definition, “Qualitative researchers study things in their natural settings, attempting to make sense of, or to interpret, phenomena in terms of the meanings people bring to them” (p. 3). In this book, and in our practice, we conceptualize qualitative research as a process of conversation either with oneself and/or with others, be they individuals or groups or dialoguing with texts. As conversations vary, so too do different approaches within qualitative research. Some are descriptive, some are more in-depth, some are designed with a specific purpose to understand or get behind a topic and so on. Essentially, we believe, as with any good conversation, qualitative research is about authentic engagement with the context within which one is situated, for the purpose of advancing understandings in the topic of interest. To fully develop those understandings, the conversation requires thought and planning, as well as a commitment to ensuring a rigorous process, which is not without its challenges. Thus, in choosing to undertake qualitative research, one should not underestimate the demand or the effort required to do it well.

To produce rigorous qualitative research, that is credible both within academic scholarship and the wider community of health professionals, occupational scientists and occupational therapists need to have a solid understanding of the match between topic, question, methodology, and methods. Without these understandings translated into good research practice, there is a risk that the discipline and profession fail to produce quality evidence that can be taken seriously and used judiciously by those who hold and sit outside of an occupational perspective. Hence, the purpose of this book is to explore a range of qualitative research methodologies and related methods that can be used in the fields of occupational science and therapy.

At this point, it is important to acknowledge that while the focus of this text is very clearly on qualitative research, it is not to say that we do not value quantitative research. In our view, approaches to research form a continuum with quantitative and qualitative at opposite ends and mixed methodology claiming middle ground. We certainly do not want to perpetuate any debates of quantitative versus qualitative work as each has its own value and purpose. For us it is about choosing the right approach for the research question. Currently, the questions in occupational science and occupational therapy that energize us and call to be answered are best served by a qualitative methodology.

In the occupational therapy practice arena, there is a strong push from funders and clients to have practice that is evidence based. Evidence-based practice, developed out of evidence-based medicine, is defined as practice that is informed by a combination of client preference, practitioner expertise, and the research evidence (Sackett, Strauss, Richardson, Rosenberg, & Haynes, 2000). In our experience that definition, which emphasizes the combination of the three areas, is played out with the research evidence trumping practitioner experience and expertise. Furthermore the research evidence is then classified into a hierarchy by eminent governing bodies of research such as the National Institute of Health (United States) and National Health and Medical Research Council (Australia). In those evidence hierarchies, qualitative research ranks quite low in the hierarchy.

When it comes to single studies examining questions about effectiveness of interventions, randomized controlled trials, often considered to be the gold standard, will provide the best research evidence. There has been a concerted push for robust trials and systematic reviews; however, in many areas of occupational therapy, evidence from randomized controlled trials just does not exist. Much of what occupational therapists do in practice is difficult to reduce to discrete variables that can be measured and controlled, in large part due to the complexity of occupational engagement, the diversity of individuals and environments, and the nature of the relationship between the occupational therapist and the client.

Other authors have critiqued the philosophical fit between occupational therapy and evidence-based practice (Gustafson, Molineux, & Bennet, 2014), but it would be remiss of us not to address the issue in this text. The need for evidence for practice is not being questioned; what we are questioning is the place of qualitative research within that evidence. For questions related to the client’s view of a particular intervention, use of a qualitative methodology will provide the best research evidence. Qualitative research methodologies can account for the complexity of occupational engagement situated in context. As such, Tomlin and Borgetto (2011) have proposed an alternative hierarchy of evidence which is a three-dimensional pyramid with three sides and a base. One of the sides is the hierarchy of qualitative evidence with qualitative studies utilizing one source of data at the lowest rank on the hierarchy and meta-syntheses which combine a number of related qualitative studies at the top. The authors acknowledge that there are some limitations to their proposed model; however, it is worthy of consideration.

As a contribution to building research capacity, to generate the research evidence for occupational therapy, we see this book as a first stop for occupational scientists or occupational therapists interested in undertaking qualitative research with an explicit occupational focus, but do not believe that it is the only stop. Within the chapters, authors have directed readers to other quality resources for more in-depth consideration of the chosen methodology. We encourage readers to explore these resources and further readings, while knowing they can always return to this text that it is ‘grounded in occupation’.

The intended audience is primarily graduate students in the fields of occupational science and occupational therapy with a basic understanding of qualitative research approaches; however, graduate students and researchers from other health disciplines may also benefit.

A key feature of this book is the inclusion of chapters that thus far have not been considered in other occupational therapy texts. These chapters address new and cutting edge research methodologies including meta-synthesis, visual methodologies, and critical theory.

The chapters

Each chapter is written by an occupational scientist/therapist who has experience in the particular methodological approach. Throughout the chapters, examples of research pertaining to occupation, in terms of both foundational knowledge (occupational science) and therapeutic applications (occupational therapy), are used to showcase the application of the methodological approach. The aim is to develop the reader’s ability to produce high-quality qualitative research that is epistemologically sound and rigorous and to be a skilled critical reader of qualitative research.

Having introduced ourselves as editors, sharing the story of how we came to be writing this book and declaring our intent, we turn in Chapter 2 to consider a brief history of qualitative research within occupational science and occupational therapy and to set forth some shared understandings that underpin the qualitative methodologies explicated in the following chapters.

The specific methodology chapters begin with Chapter 3 on qualitative descriptive. Mandy Stanley draws on her experience of conducting research with a team to explore older Australians’ perspectives on loneliness, while in Chapter 4, Shoba Nayar utilizes her work related to Indian immigrant women settling in New Zealand to reveal the process of grounded theory methodology.

Chapter 5 on phenomenology has been written by New Zealand researcher Valerie Wright-St Clair. In this chapter, Valerie relates her experience of becoming a phenomenologist and the value of the methodology in revealing the ordinary in the everyday. Multiple examples from her reflective journal and data are used to explicate the art of phenomenology.

Researchers from Sweden and Norway, Staffan Josephsson and Sissel Alsaker, respond to the call for an elaborated and sensitive qualitative inquiry within occupational science and occupational therapy through their exploration of narrative methodology and argue that narrative moves beyond solely ‘words’. Next we travel to Canada, where Suzanne Huot captures the essence of ethnography in Chapter 7 through her personal descriptions of the Francophone community in Canada. Suzanne’s experience is a powerful reminder of how qualitative research can be a changing experience for both researchers and participants. Noteworthy here is her innovate use of occupational mapping as a data collection approach.

Australian researchers Clare Wilding and Danika Galvin draw on two different action research studies in Chapter 8 to demonstrate the transformative power of action research methodology for studying phenomena in context and embedding occupational science concepts into occupational science practice. In Chapter 9, New Zealand researchers Margaret Jones and Clare Hocking explicate case study methodology and demonstrate the thought and planning that is required in order to produce quality case study research. Their chapter highlights the strength of qualitative research in studying the complexity of occupational engagement, and they use a unique multilayered approach to analyze data both literally and figuratively.

Chapters 10 and 11 are brought to us by a group of international researchers from Canada, Sweden, and Germany. Chapter 10 draws on two Canadian studies by Debbie Laliberte Rudman and Silke Denhardt to introduce readers to critical discourse as a qualitative methodology that uses analysis of texts to address issues of power. Power is also forefronted in Chapter 11 through a visual medium as Eric Asaba, Debbie Laliberte Rudman, Margarita Mondaca, and Melissa Park introduce us to the potential of photovoice as an emerging methodology used in two Swedish and Canadian studies.

Chapter 12 is an insightful discussion of the proc...