Critical Evaluation of a Qualitative Research - Article Example

Critical Evaluation of a Qualitative Research Article CRITICAL EVALUATION OF A QUALITATIVE RESEARCH ARTICLE Introduction In the article, “What Perceptions do patients have of Decision Making (DM)? Toward an Integrative Patient-Centred Care Model: A Qualitative Study Using Focus-Group Interviews”, Moreau et al. (2012: p206) set out to investigate the perception of patients about decision-making, as well as to identify the different relationships among the three models of decision-making. To do this, the researchers carried out a qualitative study in which they used four focus group interviews made up of elderly persons, rural inhabitants, students, and users of health support groups. These participants were investigated using written clinical scenarios about prostate cancer, breast cancer, and hypertension with analysis based on grounded theory principles (Moreau et al., 2012: p207). Critical Evaluation Statement of Research Aims This research study sought to answer two main research questions about patient’s perceptions of decision making are and how these perceptions contribute to the discussions about conceptual definitions and interactions between Charles’ three models (Moreau et al., 2012: p207). The research questions, while including the broad definition of the population to be studied, did not focus on the particular groups of patients that would be studied as indicated in the introductory part. In this case, these were students, elderly persons, rural inhabitants, and users of health support groups. There was also no mention of the interventions given or what the patients were exposed to in order to answer the questions. However, the research questions did consider the outcomes given in that the perceptions of the patients would be used in understanding the relationships between Charles’ three models of paternalistic care, the consumerist informative model, and the shared decision making model. Ratner (2010: p29) contends that, a research question must be complex, concise, focused, clear, and arguable. The research question from this article fulfils these criteria by clearly focusing the research on investigating the topic, while it is complex enough to necessitate research and analysis and cannot be answered by a simple yes or no. In addition, it is also arguable since the researchers could contend that the perceptions of the patient about DM are either relevant or irrelevant to conceptual definitions and interactions between the three models. Appropriateness of Qualitative Methodology The type of study used, i.e. a qualitative research study, can be considered as being relevant to the research question and objectives of the study. The research question that seeks to find out perceptions of patients is clearly seeking to utilize the qualitative paradigm because non-numerical data is to be collected, especially since the researchers are seeking to investigate the feelings and thoughts of the participants. This makes it impossible to utilize the quantitative paradigm through collection of numerical data. Maanen (2013: p38) contends that qualitative research seeks to collect in-depth information and achieve in-depth understanding concerning the behaviour of humans, as well as the reasons that govern human behaviour. This research article is especially interested in investigating; the how and why of participant decision-making, which renders the qualitative paradigm as the best type of study to assess the objectives. Smith (2009: p56) also posits that qualitative studies are best used when researchers are seeking to come up with information regarding only the specific case that they are studying, while any more information gathered is only used to make informed assertions. Owing to the intensive nature of the research question, the researchers will be seeking only to elicit information about participant perceptions of decision-making, which, in turn, will be used to understand relationships between Charles’ three models. There are various advantages to using a qualitative study in this research study. To begin with, it will provide detail and depth through recording the behaviours, feelings, and attitudes of the participants about DM. It can also encourage the participants to expound on their answers, which could open up areas of the topic that the researchers were not considering in the first place (Strauss & Corbin, 2010: p46). In addition, the researchers can achieve a more detailed picture about why the participants act in a specific manner, as well as their feelings concerning their actions in the healthcare setting. Finally, although not used in this study, if it was used alongside quantitative collection of data, the researchers would have a clearer picture about why the participants gave particular responses. However, using a qualitative study also portended various disadvantages to the researchers. One of the drawbacks was that they studied fewer people because qualitative studies normally involve more time and costs, which necessitates a smaller participant group. Also, they should have found it more difficult to make generalizations due to the small number of participants studied, meaning that they could not generalize their results to the entire population (Strauss & Corbin, 2010: p62). Moreover, Moreau et al. would have found it difficult to come up with systematic comparisons if the participants gave highly subjective and widely differing responses to their questions. Research Design This qualitative study used focus groups. It turned out to be the most appropriate design for the researchers to understand why the participants held specific beliefs and perceptions about decision making in the healthcare setting. Morgan (2008: p49) defines focus groups as interactive individual groups that possess common characteristics that are held together by moderators who utilize the groups and how they interact to attain information concerning a focused or specific issue. From this explanation, it becomes clearer why the researchers chose focus groups since the researchers could create a nurturing and interactive environment that allows them to elicit different viewpoints and perceptions to answer their research questions. In addition, by using different focus groups, they can identify patterns and trends concerning decision making perceptions across different patient ranges (Morgan, 2008: p51). In addition, by using focus groups, the researchers could conduct a systematic and careful analysis to provide insights and clues about how healthcare services can integrate the three models of decision-making. There are several advantages to using focusing groups in addressing the research question posed by Moreau et al. This design can elicit information from illiterate individuals in any setting, while it also has high face validity that will allow the participants to interact with another and influence each other (Litosseliti, 2013: p60). Because qualitative studies are expensive, the researchers can lower costs by assembling groups, rather than interviewing individuals separately. The researchers were also able to interact more directly with the participants, enhancing the capacity to probe further for clarification of answers and ask follow-up questions. In addition, due to the wide range of individuals who seek healthcare, focus groups allowed the researchers more flexibility in selecting the most representative sample. However, the researchers may also have had to contend with less control over their groups, as well as the information that was to be produced (Krueger & Casey, 2010: p51). In addition, data making is also relatively chaotic, which may have made their data analysis more difficult. Finally, it is also possible that members with opinionated and dominant views will have biased the results. Recruitment Strategy The researchers utilized purposive sampling as part of their recruitment strategy, which, according to Henry (2010: p41), is reliant on the researcher’s judgment about selection of the sample units that will be studied. In this circumstance, the researchers decided that the attitudes of patients towards decision-making might vary according to the residential context, health promotion activism, and age, which resulted in recruitment of elderly individuals, activist users of a support group, students, and rural residents. These samples were further differentiated according to their ages, i.e. >65, 35-65, 20-25, and 40-50 years of age respectively (Moreau et al., 2012: p207). This recruitment strategy was appropriate due to the small sample being investigated as a result of using a qualitative study. It was suitable for answering the research question because it focuses on specific characteristics of the population that were of interest to the researchers, especially due to the importance in assessing whether the phenomenon they were investigated existed across a wide range of potential participants. In addition, it enables the researchers to ensure strict eligibility criteria due to their use of focus groups, while it also fits in with grounded theory analysis as it allows for the researchers to recruit participants with characteristics of interest (Henry, 2010: p49). Purposive sampling gave the researchers several advantages, including allowing for proper representation of patients as they will have enhanced knowledge about what decision making is like across a wider range of groups (Thompson, 2012: p33). It also avoids irrelevant and unnecessary items from being included in the sample, while also allowing for a more intensive study of the item under study. In addition, since the researchers are using a qualitative study, it enables them to be more economical by reducing time and costs expended in the study. Finally, it also gives more results that are accurate since the researchers are able to make sound judgment and keenly observe the participants and their responses. However, this recruitment technique also has disadvantages, such as personal bias as the researchers may have relied on prejudiced judgment in selecting the sample (Kothari, 2012: p28), while the chances of including all items required were not equal because of the judgmental nature of recruitment. Data Collection Methods Data was collected using interviews given to the focus groups and were moderated by a general practitioner with focus group experience, as well as a department of general medicine associate professor. The answers to the interview were recorded using audio devices and note taking. This method was appropriate for answering the research question. Scruggs, & Mastropieri (2006: p90) contends that, interviewing’s suitability is totally dependent on the specific research question. Since the research question in this study seeks to elicit the perceptions of the participants, the in-depth interviews will allow the participants to give accounts of their feelings and experiences. In addition, because the information will be used to understand conceptual definitions and interactions of the three models of DM, the additional space given by the in-depth interviews will allow the participants to expand on their answers, offering more information since the answers are not re-categorized. Moreover, since in-depth interviews do not presume advance knowledge of most of the topics investigated, they can be used in an exploratory manner (Scruggs, & Mastropieri, 2006: p92). Finally, this data collection method is aimed at understanding and interpreting the why and how of a phenomenon, in this case decision making perceptions. Advantages of using in-depth interviews to answer the research question, especially since it seeks to elicit perceptions, are that the participants can answer with as much detail as they would want (Ratner, 2010: p29). It also elicits additional valid information concerning the opinions, values, and attitudes of the participants, especially how they contextualize the issues. It is also possible to encourage honesty and openness among the participants, while it is possible for the researchers to change direction and adjust the questions according to the atmosphere of the focus group. However, due to the long periods taken by the in-depth interview, it can be time consuming, while it is also difficult to compare results directly because of the uniqueness of each interview (Ratner, 2010: p32). Finally, data collection and analysis is also time-consuming. Data Analysis According to Schreiber & Stern (2011: p44), the approach taken in a research study usually has a significant influence on the research analysis, which means that the research analysis will enable the audience to tell how the researchers implemented their research proposals and answered their research questions. In this case, Moreau et al., used the grounded theory analysis design by first collecting information from their participants, followed by marking the key points of the gathered information with codes like UFG, RFG, and RFG (Moreau et al., 2012: p207). They followed this up by grouping the codes into similar concepts followed by categories and then created a theory from the categories. This design was appropriate because it allowed the researchers to determine the explanation about participant perceptions of decision, especially by analyzing the information collected about decision making using the stated process. In addition, grounded theory allowed the research to generate a theory that tells about the why and how of decision making among the participant (Glaser & Strauss, 2011: p50). In addition, since there is no use of figures and statistical methods in the research, the design is appropriate. However, it did not follow the classical grounded theory design since it started by making a hypothesis, which should not be the case as grounded design begins by collecting data. The research showed significant rigor as the researchers used some of the actual words of the participants in the theory as proposed by Glaser & Strauss (2011: p52), used some of their personal insights and views concerning the perceptions of decision making and relationships between the three models of decision making, and specified why and how participants were selected. However, they did not describe the relationship of literature to each emergent category in the theory. Using grounded theory had several advantages for this research study, especially because it provides sequential and explicit guidelines in conducting a qualitative research study. Grounded theory design offers particular strategies for the handling of analytic inquiry phase of the study, while it also streamlines the information collection and analysis stages and integrates them (Gerrish & Lacey, 2011: p23). In addition, it also enabled the researchers to advance a conceptual analysis about the qualitative data they collected from the participants. Finally, as well as providing rich and detailed data from the participants involved, this design also enhanced the researcher’s potential ability to carry out a rigorous and systematic procedure. However, for this research study, the grounded design came with several disadvantages. First, the information they collected through the interviews was too subjective, which made the establishment of validity and reliability of information and procedures difficult. It also opened up the research to researcher-induced bias because it becomes difficult to prevent or even detect the bias as posited by Gerrish & Lacey (2011: p23). Finally, the highly qualitative nature of derived information and results is not directly usable by health practitioners. References Gerrish, K., & Lacey, A. (2011). The research process in nursing. Oxford, Blackwell Pub. Glaser, B. G., & Strauss, A. L. (2011). The discovery of grounded theory: strategies for qualitative research. Chicago, Aldine Pub. Co. Henry, G. T. (2010). Practical sampling. Newbury Park, Sage Publications. Kothari, C. R. (2012). Research methodology methods & techniques. New Delhi, New Age International Krueger, R. A., & Casey, M. A. (2010). Focus groups: a practical guide for applied research. Thousand Oaks, Calif, Sage Publications. Litosseliti, L. (2013). Using focus groups in research. London, Continuum. Maanen, J. (2013). Qualitative methodology. Beverly Hills, Sage. Moreau, A., Carol, L., Dedianne, M., Dupraz, C., Perdrix, C., Laine, X., & Souweine, G. (2012). What perceptions do patients have of decision making (DM)? Toward an integrative patient-centred care model. A qualitative study using focus-group interviews. Patient Education and Counselling. 87(2), 206-211. Morgan, D. L. (2008). Focus groups as qualitative research. Newbury Park, Calif, Sage Publications. Ratner, C. (2010). Cultural psychology and qualitative methodology: theoretical and empirical considerations. New York, Plenum Press. Schreiber, R. S., & Stern, P. N. (2011). Using grounded theory in nursing. New York, Springer Pub. Co. Scruggs, T. E., & Mastropieri, M. A. (2006). Applications of research methodology. Amsterdam, Elsevier JAI. Smith, M. (2009). 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