Qualitative Methods and Analysis

16
Peter Williams and Susan Cutler

16.1 Introduction

First in this chapter we examine what is meant by the term ‘qualitative research’. It
is an approach that seeks to understand human behaviour (i.e., what its essential
qualities are) and, in our context, health behaviour and understanding of human
health. Over recent years qualitative methods of data gathering and analysis have
gained popularity among healthcare professionals as we seek to question traditional
approaches to the delivery of healthcare. Qualitative research uses a number of dif-
ferent methods to collect the data that generate narrative or non-numerical informa-
tion; it tends to use ‘language data’: written or oral. In contrast, quantitative data
collection focuses on collecting numerical data and then employs statistical analysis
to test hypotheses. It should be remembered that similar ways of collecting data can
be employed in both qualitative and quantitative methodologies. Qualitative studies
can employ frequency counts. Language data can be used in quantitative studies.
The overall aims of a study determine the methodical approach taken. A qualitative
approach is utilised when you are asking ‘how and why’ questions rather than ‘how
often’ or ‘how many’: a quantitative approach may be more appropriate for the lat-
ter questions. A qualitative approach is used to try and gain insight into an individ-
ual’s view of their own world. It is important that a researcher does not make any
value judgements about the data collected. The focus is on the meaning and experi-
ences of individuals or groups, to analyse how and why people form associations
with other people, things, and their immediate environment.

P. Williams (*)
Department of Information Studies, University College London, London, UK
e-mail: [email protected]
S. Cutler
School of Health and Social Care, Teesside University, Middlesbrough, UK
e-mail: [email protected]

© Springer Nature Switzerland AG 2020 323

A. Ramlaul (ed.), Medical Imaging and Radiotherapy Research: Skills
and Strategies, https://doi.org/10.1007/978-3-030-37944-5_16
324 P. Williams and S. Cutler

There are two key aspects of a qualitative approach.

• We are not trying to quantify or count things by gathering interview data (except
where closed ‘survey-like’ questions are administered to a large sample of
people).
• We are interested in understanding people and how they behave or think. We
need to explore the ideas they hold in their minds as ideas are one of those things
that we cannot observe.

A qualitative approach can be beneficial in the drive to expedite the service

improvement agenda for the benefit of patients, as it seeks to explore their and prac-
titioners’ experiences of contemporary imaging and healthcare delivery. The Society
and College of Radiographers maintains that research will support change within
diagnostic imaging, radiotherapy, and oncology departments so ensuring practice
and patient-centred care becomes fully evidence based [1]. In order to change and
develop our practice for the benefit of a patient and client, we need to understand the
environment in which we live and work and a patient’s experiences and expecta-
tions. Any research we undertake must have a purpose; it would be unethical to
undertake a study that did not attempt to explore phenomena relevant to the devel-
opment of contemporary practice.

16.2 Interviews

Any project that seeks to examine the attitudes, experiences or behaviour of people,
in other words social research, will almost inevitably involve data collection by
some form of interview or survey. An interview might appear to be the easiest form
of data collection. After all, who has not sat down and had a good chat with some-
one? And you only have to turn on any form of media, be it YouTube, TV, podcasts,
or whatever, to hear an almost endless stream of interviews/conversations/
dialogues.
The first thing to say, however, is that an interview is not like a ‘chat’, despite the
fact that the best interviewers make it appear so, and even though a research inter-
view has been likened to a conversation. This distinction becomes clearer later, but
suffice to say here is that unlike a ‘chat’ or a ‘normal conversation’, in which you
may expect a roughly equal contribution from the participants, a research interview
should aim to be about 90:10 in favour of an interviewee. It is their views we are
interested in. By contrast, even the biggest pub bore would be hard-pushed to keep
up that ratio, and if he did, his audience would soon be tiptoeing out of the back
door.
What is an ‘interview’, in particular a ‘qualitative’ one, and why do we conduct
them? Let us look at a couple of definitions.

• Qualitative interviews develop a rapport between interviewer and interviewee

allowing the researcher to probe and explore complex issues [2].
16 Qualitative Methods and Analysis 325

• Qualitative interviews tend to ask about the details of [a phenomenon], how it

happened, and how the respondent felt throughout. [This] can allow researchers to
capture certain social phenomena in ways that other techniques simply cannot [3].

Also, importantly, we are interested in individual experiences: stories, insights,

things that you would not capture in questionnaire tick boxes. Patients and medical
staff were interviewed in a study [4] at various general practitioner (GP) practices
where a touch-screen information kiosk had been installed. Interviewees not only
had a wide variety of views, but ones which were totally unforeseen, and almost
unforeseeable. One interviewee thought that the kiosk merely showed a plan of the
forthcoming surgery renovation; receptionists at a large hospital said that as their
kiosk was in a booth, it had been mistaken for a toilet cubicle. Given just these two
responses, it is clear that a questionnaire could not have captured these perceptions,
unless it approximated an interview format by using questions allowing for free-text
answers.
One final point regarding the data is accrued from interviews: people often
worry about getting enough information to generalise or to make the research
‘meaningful’. Here it is useful to quote Henry Mintzberg, academic and author on
business and management, who said, in a very famous quote: ‘What is wrong with
samples of one? Why should researchers have to apologise for them? Should
Piaget apologise for studying his own children, a physicist for splitting only one
atom?’ [5]. Similarly, television documentaries often contain individuals’ descrip-
tions of a particular event and quite often the recounted experience of four or five
people gives a very rich picture, offering an insight into what was going on
beneath the surface.
As practitioners we deal with diverse and discrete client groups and their experi-
ences of imaging or oncology may be considered for inclusion in this type of study.
Interviewing of patient groups may be impractical for undergraduates owing to the
complexities of the ethical approval process. But it is an avenue of exploration for
qualified practitioners. Nevertheless, this approach can be utilised in a university
setting, with appropriate ethical approval, accessing the student body, either under-
graduate or postgraduate, employees of the organisation or the general public. For
example, you could explore the experiences of practitioners or students of working
with hearing impaired patients or patients with learning disabilities. This has the
potential to be extended to compare experiences with other health professional
groups within a university setting. Examples might be comparisons with students at
different stages of their educational programme, different academic pathways, for
example, pre-­registration undergraduate and postgraduate routes.
Using an open interviewing technique, possible questions could include the
following.

• What is your definition of hearing impairment/ learning disability?

• Could you describe any experience you have had with a hearing impaired/learn-
ing disability patient?
• How did this make you feel?
326 P. Williams and S. Cutler

• Do you think deafness awareness training would have helped?

• From your own experiences, in what way do you think a hearing-impaired
patient’s visit to the medical imaging department could be improved?
• Are you in contact with or do you have experience of learning disabilities/hear-
ing impairment outside the placement? (and follow-up with ‘could you describe
your experiences?’)
• How confident do you feel about dealing with people with learning disabilities/
hearing impairment?

These questions are by no means exhaustive, but hopefully give you a feel of how
questions could be phrased to enable participants in the study to express their opin-
ions and feelings about their experiences.

16.3 Focus Groups

Focus groups are unstructured interviews in which several participants discuss or

explore together a specific set of issues. A focus group does not set out to change
opinion or test knowledge, but like an interview, it seeks to explore participants’
experiences or attitudes. The role of a researcher is to facilitate and guide the debate
and discussion by posing a series of questions that the participants explore. This
approach can be used in its own right to explore issues. It however is often used to
complement questionnaire data or even as the preliminary tool for data collection
from which a subsequent questionnaire is developed. The scope of an undergraduate
dissertation possibly excludes utilising this multi-method approach due to the time
constraints, but can be valuable in a clinical and post-registration context to explore
in more depth issues relevant to practice.
The number of participants in a focus group varies; the general rule is to include
6–12 people. Below this number there is the potential for little stimulus or for domi-
nance of one of the participants. With too few participants, you also run the risk of
the discussion and commentary from the participants being limited. Above this
number you run the risk of having too many people talking at once and the essence
of their debate is lost in the overall chaos of conversation. Also, there is an opportu-
nity for some of the participants to hide within the larger group and therefore not
contribute. Group dynamics can be significant in the data collection as some do not
interview well in groups and others may dominate. Sometimes the public setting of
a focus group may inhibit the free flow of ideas or thoughts, which might be cap-
tured in a more intimate individual interview. Conversely the comment of one par-
ticipant may provoke profound or animated debate among the others.
This type of interview usually takes between an hour and 90 min to conduct and
can be quite demanding on a facilitator, who needs good social skills and interview
technique. As a new researcher this can be quite a daunting aspect. It is worth trying
to observe a skilled facilitator before commencing your data collection. Some of the
key attributes required of the facilitator include the following.
16 Qualitative Methods and Analysis 327

• Alertness: this refers to the attentiveness of the participants within the group; are
there individuals who are dominating or others who are keeping quiet?
• Assertiveness: this refers to making ‘demands’ of the participants to contribute
to the discussion or allow others to speak, without being overbearing.
• Confidence: this refers to having enough self-assurance to ensure the focus group
is appropriately conducted, and relevant data are collected.
• Diplomacy: this refers to the ability to diffuse any potential confrontational
situations.
• Empathy: this refers to the ability to understand and imagine the feelings of
others.
• Encouragement: this refers to gently coaxing participants to share their ideas and
thoughts.
• Interpersonal skills: this refers to the ability to establish a rapport with the
participants.
• Listening skills: this refers to listening attentively and being alert so that com-
ments can be reflected back to the group for clarification.

Before commencing a focus group, you need to take into consideration the fol-
lowing three factors: the location of the interview, the physical environment, and the
group composition.

1. The location of a focus group should be such as to prevent the participants incur-
ring any unnecessary expense.
2. The environment in which an interview takes place should be an adequate size so
as not to inhibit any interaction and enable the participants to see each other, but
not so large as to detract from the group dynamics or to prevent recording and
observing effectively. It is advisable that the location is free from distracting ele-
ments such as noise, wall furniture, and busy windows.
3. The participants’ location. Are they going to come from a disparate population
or are they going to know each other or come from the same background, such
as students in a cohort, practitioners from the same clinical department or prac-
tice area? Within the context of radiographic practice, whether therapeutic or
diagnostic, the gender of focus groups is unlikely to be representative of the
population as a whole as the profession is still predominantly female. It is
more important that focus group participants do reflect the knowledge base or
experiences required for the study.

One of the limitations of collecting data using focus groups is that only a few
questions can be addressed and are not usually explored in any detail. On the other
hand, the experiences of a larger number of participants can be captured and it is
less time-consuming than individual interviews.
It is suggested that focus group participants should be debriefed following their
interview; this may include follow-up leaflets or contact details of relevant support
groups if applicable. It is unusual for the transcription of focus group data to be sent
328 P. Williams and S. Cutler

to the participants, unlike interviews. Data produced from a focus group can be
analysed in the same way as data generated from individual interviews, and is dis-
cussed later in this chapter.
Focus groups can be used to explore patients’ experiences of healthcare.
Particular reference, for example, could be made to different client groups such
as older patients, parent perceptions of their children’s experiences and those
with special needs. Conversely practitioners, students, assistant practitioners,
and administrative staff perceptions could be expedited to give a contrasting per-
spective or to explore the context of the patients’ or practitioners’ experiences.
For example, you could explore students’ experiences of using the virtual learn-
ing environment while on placement. You could use a questionnaire to capture
the diverse experience of as many students as possible as there would have been
too many students to interview individually. You could then analyse the responses
to the questions on the questionnaire and extract themes to explore within a focus
group setting. The focus group could comprise of two groups of about six stu-
dents each and this exploration will generate rich data which will account for the
responses on the questionnaire.

16.4 Recording Your Interview or Focus Group

Recording the data can be done in three ways: voice recording using a digital
recorder, video recording, or transcription of key points by a facilitator. The fear
of doing this used to be whether it would work; the most infamous problem being
tape jams or breakages. Nowadays the problem is more about the battery life of
your device. So frustrating when you have undertaken a fantastic interview and
obtained excellent data, then discover that your mobile gave up the ghost after
10 min because you forgot to charge it before going out. Apart from making sure
this does not happen, you could be extra sure and download a battery charge
alarm app; choose carefully as most of these apps alert you when the battery is
full, not dying. They give a minority sound when it is low. Take a portable char-
ger with you.
Instead of audio-recording, you could video record an interview or focus
group. Participants may however find video recording inhibiting and become
self-­conscious. It is useful to take notes during the session; total reliance on this
method does however mean your focus is on scribing and not on the dynamics of
the focus group. As a consequence some comments may be missed and you may
misinterpret meaning. It is important to ensure the participants do not all talk at
once because data could be lost in the melee. When reviewing recorded data it
can be difficult to determine which participant was speaking on each topic. It
should be remembered that this type of data can be ‘messy’ in comparison to that
of an interview. In addition, it can be time-consuming to transcribe and analyse
the data.
16 Qualitative Methods and Analysis 329

16.5  dvantages and Disadvantages of Interviews and Focus

A
Groups

Many of the considerations for conducting an individual interview apply equally in

the context of a focus group. The advantages and disadvantages of interviews and
focus groups are highlighted below.

16.5.1 Advantages

• Participants’ own words: an interview/focus group offers an unrivalled opportu-

nity for participants (respondents) to explain, reflect, and pontificate, using their
own words and hence not being shoehorned into the words and the agenda of an
interviewer.
• Interviews/focus groups develop a rapport between interviewer and participants
allowing a researcher to probe and explore complex issues.
• Full and complete responses: participants have the opportunity to expand on
their answers, and often provide details not even considered by an interviewer.
• Observational opportunities: these manifest when interviews take place in a sub-
ject’s workplace or other location of interest to a researcher. It is amazing what
important data can be gleaned from observing someone in action, fielding phone
calls, having to break an interview to go and resolve some crisis, etc. Focus
groups are unique in that participants build on the answers of others in the group
adding to the production of rich data through social interaction. They can pro-
duce new thoughts a researcher may not have thought of, and participants encour-
age discussion of the topic collectively as a group.
• Non-verbal communication: this can also be taken into account.
• Clarification/follow-up questions: these are possible, given the synchronous and
dynamic nature of interviews. Captive subjects: as mentioned below, interview-
ees should be given the right to terminate an interview at any time. This happens
very rarely; usually because of work commitments or some unforeseen circum-
stance. Generally, the interviewee is more or less captive. Hopefully, interview-
ees will be interested enough in the topic to not think in those terms themselves,
but even if they do, they are often prisoners of their own politeness.
• Known respondent: unlike in a postal or online survey, you know who is respond-
ing as they are sitting in front of you (unless they are not who they claim to be,
which is pretty unlikely).

16.5.2 Disadvantages

It all seems so fine up to here, but of course, as with every other research method,
there are disadvantages. We provide some examples; no doubt you will be able to
find others if you think hard or cruise the internet for long enough.
330 P. Williams and S. Cutler

• Conformity to expectations: as you are right there with them, participants some-
times feel they have to say things that they assume you want them to say: people
like to be nice, and to be cooperative. It is important, therefore, to underscore that
you are not judging them and also that you are not promoting anything. In our
kiosk study we had to make it very clear we were not part of the company pro-
ducing them.
• Interviews/focus groups can be time-consuming to conduct and interviewer bias
can compromise the quality of data collected.
• The success of the interview/focus group depends upon the skill of an inter-
viewer/moderator and the articulacy of a respondent.
• Attempts to be rational: in another manifestation of the desire to conform, people
may try to be more logical than they really are. Having postulated that health
information is very important in managing chronic illness, they may feel they
cannot then say that, actually, they prefer to not think about it at all. A good
approach, instead of confronting them with questions about how much informa-
tion they need for their health, would be to simply ask how they cope, and look
out for where information crops up in their answer.
• Reticence/shyness: you may come across people who find the whole interview
process intimidating, especially a ‘research’ interview. Unless you are good at
putting them at their ease, you may find the time and expense yielding very little
return. Of course, you as an interviewer may also be somewhat introverted.
Before you decide on your project, to the extent to which you have a choice,
consider carefully if it is one in which interviews are necessary.
• In focus groups power dynamics can be problematic with some participants
domineering and others not speaking up. Some participants may withhold true
feelings so as not to create disagreement within their group. These issues can be
overcome by having a supportive environment with established ground rules.
• Time/cost: clearly, interviews are time-consuming, and costly if you have to
travel to undertake them. As noted above, the prize is usually rich, fascinating,
and very worthwhile data. However, you do need to weigh up whether you have
the resources and, if so, whether the benefits that accrue are worth all the effort.
• Data analysis is difficult: it is not easy to extract meaningful information from,
sometimes, reams of transcripts or interview notes. More on this can be found
below.
• Unrepresentative samples: sometimes, in carrying out qualitative research, there
is a tendency towards finding and relying on a few key people or, alternatively,
people who happen to have the most time to speak to you. This can be an issue
with undergraduate research when students often reciprocate participation in
studies.
• Poor articulation: depending on the group(s) you decide to interview (individu-
ally or in a focus group), there may be a problem with participants being able to
articulate their thoughts and opinions. In addition to possibly limiting the amount
of data you accrue, there is a potential problem here of an articulate individual’s
views being over-represented, simply by their ability to express them.
16 Qualitative Methods and Analysis 331

• Researcher bias: you need to be aware that your own social background
assumptions, attitudes, beliefs and behaviour can affect a research process and
should be acknowledged when writing up your project. It is important there-
fore to reflect on your own stance with regard to the research topic and acknowl-
edge that your own personal experiences have the potential to lead to bias in
the phrasing of your questions and interpretation of the data. This process of
self-­reflection is termed ‘reflexivity’. Reducing investigator bias through
admission of one’s beliefs and assumptions in this manner increases a study’s
credibility.
• Participant overload: one of the problems associated with undergraduate research
is the potential sample size being limited to the number of students studying
diagnostic or therapeutic radiography. There is a real risk that students become
exhausted by participating in a number of studies. This also means that results
are contextualised to the population and may not be extrapolated to the wider
population. As explored earlier with regard to researcher bias, there is the poten-
tial for participant bias in this context.

16.6 Other Techniques

To obviate some of the above problems, it is recommended to at least incorpo-

rate some of the following techniques to make your interview research more
robust.

• Purposive sampling: this focuses on a specific population, so the participants

have, as close as possible, the same or similar experiences of the phenomenon
you are studying. This only works, of course, if you are not interested in a wide
exploration.
• Choose deviant case: the exception proves the rule. If you can find someone who
does not seem to conform, the data gathered will put the other research into per-
spective and will give you an overall richer picture.
• Member check: this refers to going back to the participants (if possible) or their
peers and checking with them that this is what was said, and that the way you are
interpreting it is correct.
• Researcher ‘reflexivity’: this is simply acknowledging your own views and
where you fit in. Reflecting on your analysis helps you to decide whether your
own biases and pre-suppositions have ‘contaminated’ your data.
• Triangulation: this uses another data gathering method and combines the
results. This approach is often used in the study of some aspects of human
behaviour. A good idea is to combine interviews or focus groups with a
questionnaire. Much survey research actually starts with a qualitative phase
in order to tease out the main issues, around which a survey questionnaire
can be constructed. However, each approach should stand on its own merit.
332 P. Williams and S. Cutler

Using just one method of data collection provides only a limited view of the
complexities of human behaviour, so one method alone might introduce some bias.
A multi-method approach that yields the same results can increase the confidence in
those results.

16.7  ims of Your Interview, Types of Interviews,

A
and Preparation Needed

You will need, of course, ethical approval for your study, as described in Chap. 6, so
this section assumes you have done this, and the study has been approved. In terms
specifically of interview preparation, the first thing you need to do is to go back to
your original aims and objectives and determine the extent to which your interview
will address and inform these. The aims of your interview will also determine the
style with which it is undertaken. Briefly, there are three main factors involved: how
specific a topic may be; the number and type of questions, and the order of ques-
tions. At one extreme is an interview in which there are very few, if any, predeter-
mined questions and the interview is led to a great extent by the interviewee. This is
known as an ‘unstructured’ interview. This kind of interview is useful if the topic is
vague or if you as a researcher have little prior knowledge of the field.
More common is the ‘semi-structured’ interview, where a researcher has a num-
ber of issues to cover and has a loose set of questions. Here the order of questions is
not important, but a researcher tries to cover all the question areas, albeit not neces-
sarily in a given order.
There is also a ‘structured’ interview, where the questions are more specific, and
asked in a predefined order. A structured interview is often undertaken on the
telephone.
If possible, try to choose the interview location yourself. You really want to talk
to your participants in the environment of whatever it is you are studying. For exam-
ple, if you were doing a study on some aspect of the work of radiographer or prac-
titioner, it would be better to interview them actually at work so that you could see
aspects of their work that they may (or may not) mention, and the contextual factors
that may inform your study.
A very important part of your interview preparation is to look at individual ques-
tions/areas/and themes. Questions can include those seeking the following.

• Facts (e.g., age, gender, education, behaviour, experience).

• Opinion/preference/attitude/feelings.
• Motivation or intention (e.g., likeliness, willingness).

You also need to decide whether or not to record your interview. Here you need
to consider the following.

• The possible effect on interviewees. Will they be self-conscious, or as frank as

they would be if it were not recorded?
16 Qualitative Methods and Analysis 333

• Listening/transcribing time afterwards, which may be prohibitive.

• The reliability of machine/recording. A range of high-quality digital recording
devices should be used to collect data and record verbal and non-verbal commu-
nication during the interview/focus group. This ensures data are recorded on
multiple devices should a technical failure occur and data is not lost.
• Take notes. Think what a disaster it would be if the recording devices did not
record an interview. It is always best to take notes as well, partly as a fallback and
partly as orientation when playing the recording back or seeking a particular point.

16.8 Conducting an Interview

The guidance discussed below applies equally to individual and focus group inter-
views. We present a few basic rules for when you conduct your interview.

• Thank your participants. Needless to say, this is the first thing you will need to
do. Tell them how much you appreciate their time and effort in speaking to you,
whoever they are, and make them feel important. This is especially advisable
with people who may not ordinarily feel too important; frequent GP surgery
attendees, for example. Second, set the scene. Explain the why/how/where, and
for whom of the study.
• Give an idea of the question areas, and more or less in what order they will come
up (if there is a logical progression).
• Explain the ground rules. You need to lay these out anyway in the information
sheet they will have about the interview, but normally these will be that they can
decline to answer any question, as they wish; they can terminate interview at any
time; they can choose to remain anonymous if you decide to quote them in your
dissertation or report, etc.
• Ask them if they have any questions before you start.

As you can see, the resemblance of an interview to a chat is already receding.

Just to emphasis this let us compare an interview with a conversation in a pub.
Imagine, once you had got the ‘hellos’ and ‘how are yours?’ out of the way, then saying
“first, during this chat, I am going to ask you about how your day has been, with particular
reference to that bloke in your office whom you wish to strangle; then we will briefly dis-
cuss the weather, and finally I am going to lament the fact that my wife does not understand
me and my teenage son is off the rails. I have a car problem I would like to discuss also, but
that will probably have to go on the agenda for next time”.

No doubt by this stage your friend would exercise his or her right to terminate the
meeting at any time: probably doing so immediately!
Having considered a pub conversation we now return to an interview. It is com-
mon to start with basic demographic questions, which will be easy for your partici-
pants to answer; this should then make them feel comfortable. It is also pretty
standard to then continue with a general question and then funnel to the specific.
334 P. Williams and S. Cutler

16.9 Types of Questions

Types of interview questions are open, closed, probing, and leading.

• Open-ended question.
–– opening stages in a line of questioning,
–– invites opinion, general knowledge,
–– can cover areas where the interviewer’s own knowledge is lacking,
–– makes no presumption about the response.
• Closed-ended question.
–– elicits hard facts,
–– controls pace/direction of interview.
• Probing question.
–– extracts more depth,
–– maintains a line of enquiry.
• Leading question.
–– confirms an interviewee’s answer,
–– helps an interviewee, by rephrasing answer,
–– brings a line of questioning to an end (summarising).

16.10 Analysing Interview Data

This is the part that worries people the most. How do you get meaningful data from
the mass of interview transcripts or notes that you have? Although all of your inter-
viewees tell you individual and unique stories, each one is valuable in its own right,
your task will be to look for commonalities, themes, and contrasts. Most important,
of course, is to consider again your aims and objectives and to see how the interview
data inform these.
There are several methods for sorting the raw notes and transcripts into meaning-
ful research data. An approach which we favour is called ‘framework analysis’ [6].
This goes through a logical sequence which is relatively easy to follow. It consists
of five stages: familiarisation, identifying a thematic framework, indexing, charting,
and mapping and interpretation.
These are outlined below.

• Familiarisation
This is the immersion in the raw data undertaken by listening to recordings,
reading transcripts, notes, and so on, so you can just get a feel for all the different
ideas and themes that emerge.
• Identifying a thematic framework
Here you try to identify the key issues, concepts, and themes within the data.
The best way to do this is to go through each interview transcript with the aims
and objectives of your study in mind. Issues raised by the participants (respon-
dents) themselves, which may not be central to your study aims, might neverthe-
less inform the overall research. Write a word or phrase beside each issue/concept
16 Qualitative Methods and Analysis 335

elicited. By the end of this stage you will have a series of keywords and phrases,
and possibly questions, next to your main interview notes or transcripts.
• Indexing/encoding
This stage involves taking the comments, etc., grouping them into the themes
identified, and coding them, possibly adding a few notes to the codes. By index-
ing the data like this, you are categorising the original notes you made, and you
may find you see the data in a new light.
• Charting
Here you take each index entry, lift it from its original place, and paste it into
a new document, which relates to one of the specific themes that have been ite-
mised. Thus, all the text relating to a particular theme, such as ‘changes in life-
style’, will be in a single document. Before you do this, it is a good idea to use
some form of participant identification, so that you can trace back each comment
to an individual. This is a good idea because it might be that all the participants
who shared something in common, either demographically or in terms of job
status or whatever, had similar views. This will only come out where each com-
ment is attributable. There are a number of good suggestions about how to under-
take the ‘charting’ process. One such suggestion is an approach that involves
numbering each line of each transcript and printing transcripts relating to differ-
ent kinds of interviewees on different coloured paper, for example, green for
nurses, blue for doctors, and yellow for patients, etc. You can then write ‘each
question to be analysed’, or each research aim, on a large sheet of paper (prefer-
ably ‘flip-chart’ size) and you then have to go through each page of coded tran-
script and relate the indexed entries to the research questions or aims, so that the
interviewees’ comments that related to each point are all together. There may
well be other data that do not fall naturally into the predefined categories sug-
gested by the research aims or questions. This does not mean that they do not
have any value. They provide extra, perhaps contextual, data and may well sug-
gest further areas for exploration in subsequent studies.
• Mapping and interpretation
Once you have ‘charted’ the data, you are able to really get something from
what you have collected. The next, and final, stage uses the charts you have cre-
ated to map the range and nature of phenomena, create typologies, and find asso-
ciations between themes with a view to providing explanations for the findings.
The process of mapping and interpretation, just as the ‘charting’ of the previous
stage, is influenced by the original research objectives as well as by the themes
that emerged from the data. During this stage a researcher reviews the notes,
draws comparisons, and matches similarities in the perceptions and experiences
of participants, and resolves to explain these.

By the end of this stage you will have completed analysing the data and will
be ready to either take your study forward onto a quantitative (e.g., survey)
stage or make conclusions from your findings and write up your results, about
which there is more below. An analysis of an interview using this method is
described below. See also Parkinson et al., whose article describes a worked-
through analysis [7].
336 P. Williams and S. Cutler

A computer package, such as N-Vivo could be used to analyse the data. It is a

systematic process that removes subjectivity can distance the researcher from the
analysis process.

16.11 An Example of an Interview with Analysis

Below is an interview that has been transcribed. Pauses, silences, giggles, etc. have
been removed, but in some instances verbatim transcription is essential as the pauses
and hesitations enhance the data collected.
The five-stage process discussed above has been used as a guide for analysis of
the following interview.

• Familiarisation: once you have read, listened, and transcribed the interview you
start to analyse the data.
• Identifying a thematic framework: we suggest that you attempt to do this your-
self first, but you need to consider the overall aims and specific questions while
reading.
• Aim: to ascertain practitioners’ perceptions of their role as a student mentor.

The specific questions were as follows.

• What do practitioners perceive as challenges to the students’ learning in the prac-

tice setting?
• Do practitioners perceive there are any benefits of undertaking this role?
• How do practitioners perceive the students learn in the practice setting?
–– Indexing,
–– Charting,
–– Mapping and interpretation.

Here is an interview that you could practice on. Try this out yourself first. We
include some of our framework analysis later for you to look at and compare.
Depending on who is interpreting the data, some different themes can emerge. This
does not mean that you are wrong, but rather that your analysis is different.

16.11.1 T
 ranscription of an Interview with a Practitioner About
Her Role as a Mentor

It is usual practice to use italics for verbatim transcriptions of collected qualitative

data (responses of participants). We present 18 questions posed and the replies to
each question.

• Tell me about your experience of supporting learning in the clinical setting?

16 Qualitative Methods and Analysis 337

Well I have been a mentor for 3 or 4 years now. I started by coming to the university for an
induction procedure. I’ve gradually felt my way through it. I have a lot of experience so
throughout the years I have had a lot to do with students training though not always on an
official level. I’ve been a senior practitioner so I’ve always had some input into training but
it is now more formalized with appraisal. I’ve just gradually got into it and do reports on
the student’s progress and I’ve done a few sessions where I have done some practical talks
about basic views and the problems that they might encounter.

• What do you understand about the way adults learn?

I think they learn quite a lot from their co-workers or other people, in actual fact I think the
students learn from other students who are further on in the process but I think learn from
observation really and from just being there whilst it’s going on.

• Do you think that the learning needs of individuals can be met in the practice
setting?
Yes, yes I think so, it’s just a normal thing that all students are different so that you match
your teaching to what they are capable of taking in at the time. I think you have to play it by
ear as some are capable of taking in things quicker than others. Some people are more
confident and are prepared to go ahead and because they (the students) work with all of us
(practitioners) and they get a bit of something different from every person that they work
with. And here they get a good mixture of people to work with, so I think we can support
individual needs. As mentors we often discuss students together so we can highlight
strengths and weakness and put some support mechanisms in place to help students. The
site coordinator is very good and helps us with ideas of how we can help the students.

• How do you use reflective practice to support the students’ learning?

Practice can be hectic, so quite often we can’t take ‘time out’ to reflect immediately on what
has happened. It’s often when we are relaxing, having a coffee when we actually have
chance to discuss issues, but its more informal that way and we probably don’t really think
of it as reflection. But we do ask questions as we are going about practice. For example,
what about that patient who came from such and such a clinic? What did you make of the
image? Did you think it needed a lateral? Why did you think that? So, you do it amongst
yourselves. I’ve never actually sent anyone off to reflect.

• Why do you think reflection is a key aspect of professional practice?

Practitioners are not always good at documenting events but when I think about it I’ve
always reflected on my work, but not always by writing it down. We discuss things about
practice, such as CT examinations with (names a colleague), you might not put a label on
it as reflection, but it can be seen as reflection, so I do reflect all the time.

• What is important about clinical education?

It’s basically a practical occupation, you can theorise all you like, but until you’ve actually
been there and done it I don’t think you are ever quite as capable as you think you are until
you have encountered the challenges of practice. Every patient is different and they all have
different needs, so they (the students) might be taught about ageing but they don’t really
understand about the implications of that for taking an X-ray until they meet older people.
338 P. Williams and S. Cutler

• What about professional socialisation? How does the practice experience affect that?

I’m sure that is learning from example, the students need to find a good role model. I can
say they get some good examples to follow and perhaps see some examples of things that
aren’t as they should be. When I was a student, I wanted to be a professional and so tried to
exemplify that and would take my lead from whoever I thought was worthy of that niche. But
I think it takes a while to learn to work and fit in with a department, but by the time they
qualify, they know what is acceptable and what is unacceptable, we tell them if we don’t
think they are acting properly.

• What do you think are the key goals of clinical education?

Well basically it’s to have the confidence to make your own decisions and that comes from
having a lot of experience of undertaking examinations. So, they have a good base so that
they know they can cope with any event that they encounter, well they can’t do everything,
but have the practical and thinking skills to work out what they need to do. It’s about build-
ing up their knowledge so they have the confidence to make decisions about referrals and
how to examine the patient. You have to lead them through this process so they have the
confidence in the end to do this on their own.

• How do you help to develop their clinical reasoning?

I think we have to start with the basics and ask them to think about what they are going to
do before they do it. They then go and do it and afterwards think about what they have done,
what they did correctly and what they did wrong. Why did they do what they did? What
might they do next? Unfortunately, it’s time pressure really that means we don’t always
have the opportunity to discuss each case in depth as would be ideal, but over time we do
iron out any issues over a period of time.

• What do you think your role is as a mentor in the management of clinical

education?
I think it’s about giving the students the chance to try things out but ensuring that they are
doing things right the first time if possible. So sometimes it can be about saying that’s not
an appropriate examination for you to do at this stage of your training or saying it’s about
time you were doing these types of examination now. It’s about pushing them sometimes, but
also about holding them back, maybe that’s not the right term, ensuring they aren’t attempt-
ing things they aren’t currently capable of.

• How do you maximise their learning opportunities?

We do try and let them get on with what they are capable of. We do rotate them around the
department so they get a chance to see and do lots of different things. Some do make more
of their opportunities than others. In some ways I think all we can do is give them the
chance to learn, to some extent they have to take some responsibility. Some of them will
stand back and need to be encouraged all the time; others will ask ‘can I do that?’

• What about the ethical issues relating to clinical education?

Well sometimes it can be difficult to manage the learning and the patient, the students often
want to ask questions, which I might not want to answer in front of the patient. They some-
16 Qualitative Methods and Analysis 339

times might say or think that all old people are demented, but that’s not right. I try to get
them to think about what is right and wrong.

• How do you get the students to link theory with practice?

I get them to look at anatomy and pathology for example. But it can be difficult to get them
to realise that we apply theory all the time, but we don’t talk in that way every day. But when
I take an X-ray I do think about radiation protection all the time, but I might not say that
I’m doing this or that as it helps to reduce the dose.

• How do you use assessment to promote learning?

I think it’s good, as it makes them learn things, but it does scare them. They have done
things lots of times, but when you suddenly say, well this time I’m going to assess you, they
can lose the plot. When I was a student people were watching me all the time and they could
see I was progressing, I think it can be harder now as there is so much technology. I think
it’s good that they can make mistakes and can learn from them. I think assessment is good
it helps them realize what they need to know to do the job properly.

• What about feedback?

I do it informally all the time; I fill in progress forms for the students, but (names colleague)
she seems to do the more formal feedback, but I think they could do with more. But some-
times it’s hard, you don’t want to make them feel bad, but sometimes you have to be cruel
to be kind as they can be hopeless sometimes.

• How important is CPD in learning and teaching to you?

Well it’s important as you want the students to have the best experience. So, it’s important
that you are actually doing best practice yourself. I’ve always done it but haven’t always
recorded it but need to now. I need to keep up to date with my practice, so that I can help
and advise the students about what is now best practice, so in that way I’m using CPD to
inform my teaching. But I haven’t really done much about teaching as such; I’ve been on
the training courses and update days, but not much else.

• Why did you decide to become a mentor?

Well I think I have a responsibility to do it, but it’s a big responsibility. I am going to work
with these people in the future. the future, so I want to make sure they are moulded into the
right sort of person. I think you volunteer for this role, which is better than ‘pressed men’.
But that doesn’t mean you will be good at it.

• Is there anything else you would like to say?

No I don’t think so.

Thank you for taking the time to participate in the interview.

The data (responses) then had to be categorised. An example of this can be found
in Fig. 16.1.
340 P. Williams and S. Cutler

Question and answer. Issues and concepts are highlighted Words and phrases relating
to each issue/concepts
Tell me about your experience of supporting learning in the clinical setting?
1.Well I have been a mentor for 3 or 4 years now. I started
2.by coming to the University for an induction procedure.
3.I’ve gradually felt my way though it. I have a lot of 3.Gradual
4.experience so throughout the years I have had a lot to do 4.Experience
5.with students training though not always on an official 5.Unofficial
6.level. I’ve been a senior and superintendent radiographer
7.so I’ve always had some input into training but it is now
8.more formalised with appraisal. I’ve just gradually got into 8.Gradual process
9.it and do reports on the student’s progress and I’ve done
10.a few sessions where I have done some practical talks 10.Teaching
11.about basic views and the problems that they might
12.encounter.

What do you understand about the way adults learn?

13.I think they learn quite a lot from their co-workers or 13.Co-workers
14.other people, in actual fact I think the students learn from 14.Each other
15.other students who are further on in the process but I 15.Observation
16.think learn from observation really and from just being
17.there whilst it’s going on. 17.Being there

Do you think that the learning needs of individuals can be met in the practice setting?
18.Yes, yes I think so, it’s just a normal thing that all
19.students are different so that you match your teaching to 19.Different/Individualised
20.what they are capable of taking in at the time. I think you
21.have to play it by ear as some are capable of taking in 21.Pace of learning
22.things quicker than others. Some people are more
23.confident and are prepared to go ahead and because
24.they (the students) work with all of us (radiographers)
25.and they get a bit of something different from every
26.person that they work with. And here they get a good
27.mixture of people to work with, so I think we can support
28.individual needs. As mentors we often discuss students 28. Support individuals
29.together so we can highlight strengths and weakness
30.and put some support mechanisms in place to help
31.students. The site co-ordinator is very good and helps
32.us with ideas of how we can help the students.

How do you use reflective practice to support the students learning?

33.Practice can be hectic, so quite often we can’t take “time 33.Hectic
34.out” to reflect immediately on what has happened. Its
35.often when we are relaxing, having a coffee when we 35.Informal discussion
36.actually have chance to discuss issues, but its more
37.informal that way and we probably don’t really think of it
38.as reflection. But we do ask questions as we are going 38.Question practice
39.about practice, what about that patient who came from
40.such and such a clinic, what did you make of the image,
41.did you think it needed a lateral, why did you think that,
42.for example. So you do it amongst yourselves, I’ve never
43.actually sent anyone off to reflect.

Do you think reflection is an important aspect of practice?

44.I do, but I think I’m not very good at documenting all 44.Not formally recorded
45.these things, but when I think about it I’ve always
46.reflected on my work. We discuss things about practice,
47.such as barium studies with (names a colleague) you
48.might not put a label on it as reflection, but I do reflect all 48.Active reflection
49.the time.

Fig. 16.1 (a) An example of how interview data are categorised.

16 Qualitative Methods and Analysis 341

What is important about clinical education?

50.Its basically a practical occupation, you can theorise all
51.you like, but until you’ve actually been there and done it I 51.Practical
52.don’t think you are ever quite as capable as you think 52.Challenges
53.you are until you have encountered the challenges of
54.practice. Every patient is different and they all have 54.Individual needs of patients
55.different needs, so they (the students) might be taught
56.about ageing but they don’t really understand about the
57.implications of that for taking an x-ray until they meet
58.older people.

What about professional socialisation? How does the practice experience affect that?
59.I’m sure that is learning from example, the students need
60.to find a good role model. I can say they get some good 60.Role model
61.examples to follow and perhaps see some examples of 61.Good examples
62.things that aren’t as they should be. When I was a 63.Professional
63.student I wanted to be a professional and so tried to 64.Exemplify
64.exemplify that and would take my lead from who ever I
65.though was worthy of that niche. But I think it takes a
66.while to learn to work and fit in with a department, but by 66.Learning to work
67.the time they qualify, they know what is acceptable and 67.Behaviours
68.what is unacceptable, we tell them if we don’t think they
69.are acting properly.

What do you think are the key goals of clinical education?

70.Well basically it’s to have the confidence to make your 70.Autonomy
71.own decisions and that comes from having a lot of
72.experience of undertaking examinations. So they have a
73.good base so that they know they can cope with any 73.Capability
74.event that they encounter, well they can’t do everything, 74.Competence
75.but have the practical and thinking skills to work out what
76.they need to do. It’s about building up their knowledge so
77.they have the confidence to make decisions about 77.Confidence
78.referrals and how to examine the patient. You have to
79.lead them through this process so they have the
80.confidence in the end to do this on their own.

How do you help to develop their clinical reasoning?

81.I think we have to start with the basics and ask them to 81.Thinking
82.think about what they are going to do before they do it.
83.They then go and do it and afterwards think about what 83.Reflection
84.they have done, what they did correctly and what they
85.did wrong. Why did they do what they did? What might
86.they do next? Unfortunately its time pressure really that 86.Time barriers
87.means we don’t always have the opportunity to discuss
88.each case in depth as would be ideal, but over time we
89.do iron out any issues over a period of time.

What do you think your role is as a mentor in the management of clinical education?
90.I think it’s about giving the students the chance to try 90. Providing opportunities
91.things out but ensuring that they are doing things right
92.the first time of possible. So sometimes it can be about 92.Encouraging them
93.saying that’s not an appropriate examination for you to
94.do at this stage of your training, or saying it’s about time
95.you were doing these types of examination now. It’s
96.about pushing them sometimes, but also about holding
97.them back, maybe that’s not the right term, ensuring they
98.aren’t attempting things they aren’t currently capable of.

How do you maximise their learning opportunities?

99.We do try and let them get on with what they are capable 99.Encourage
100.of. We do rotate them around the department so they 100.Provide opportunities
101.get a chance to see and do lots of different things.
102.Some do make more of their opportunities than others,
103.in some ways I think all we can do is give them the
104.change to learn, to some extent they have to take some 104.Learner responsibility
105.responsibility. Some of them will stand back and need
106.to be encouraged all the time; other will ask “can I do that?”

Fig. 16.1 (continued)

342 P. Williams and S. Cutler

What about the ethical issues relating to clinical education?

107.Well sometimes it can be difficult to manage the 107.Difficult to manage
108.learning and the patient, the students often want to ask
109.questions, which I might not want to answer in front of 109.Appropriate responses
110.the patient. They sometimes might say or think that all
111.old people are demented, but that’s not right. I try to get 112.Reduce prejudice
112.them to think about what is right and wrong. Right and wrong

How do you get the students to link theory with practice?

113.I get them to look at anatomy and pathology for
114.example. But it can be difficult to get them to realise
115.that we apply theory all the time, but we don’t talk in 115.Constant use of theory
116.that way every day. But when I take an x-ray I do think
117.about radiation protection all the time, but I might not 117.Not explicit
118.say that I’m doing this or that as it helps to reduce the dose.

How do you use assessment to promote learning?

119.I think its good, as its makes them learn things, but it 119.Active tool for learning
120.does scare them. They have done things lots of times, 120.Intimidating
121.but when you suddenly say, well this time I’m going to
122.assess you, they can loose the plot. When I was a
123.student people were watching me all the time and they
124.could see I was progressing, I think it can be harder
125.now as there is so much technology. I think it’s good 125.Reflect on errors
126.that they can make mistakes, and can learn from them.
127.I think assessment is good it helps them realise what
128.they need to know to do the job properly.

What about feedback?

129.I do it informally all the time; I fill in progress forms for 129.Informally/Continuous
130.the students, but (names colleague) she seems to do
131.the more formal feedback, but I think they could do with 131.Written – formal
132.more. But sometimes it’s hard, you don’t want to make 132.Insufficient feedback
133.them feel bad, but sometimes you have to be cruel to 133.Consideration
134.be kind as they can be hopeless sometimes.

How important is CPD in leaning and teaching to you?

135.Well it’s important as you want the students to have the 135.Enhance learning experience
136.best experience. So it’s important to you yourself are
137.actually doing best practice yourself. I’ve always done it
138.but haven’t always recorded it, but need to now. I need 138.Best practice
139.to keep up to date with my practice, so that I can help 139.Responsibility
140.and advise the students about what is now best
141.practice, so in that way I’m using CPD to inform my
142.teaching. But I haven’t really done much about teaching 142.Not teaching
143.as such; I’ve been on the training courses and up date
144.days, but not much else.

Why did you decide to become a mentor?

145.Well I think I have a responsibility to do it, but it’s a big 145.Responsibility
146.responsibility. I’m going to work with these people in the 146.Future practitioners
147.future, so I want to make sure they are moulded into the
148.right sort of person. I think you to volunteer for this role, 148.Volunteers
149.which is better than “pressed men”. But that doesn’t 149.Quality of mentor
150.mean you will be good at it.

Is there anything else you would like to say?

151.No I don’t think so

152.Thank you for taking the time to participate in the interview

Fig. 16.1 (continued)

16 Qualitative Methods and Analysis 343

Thematic framework and indexing/encoding

We read the interviews and immersed ourselves in the data. We looked at the issues and concepts that
emerged from the indexing/encoding. And from these the initial themes were derived. You need to
remember that these themes and encoding arise from one interview; more may emerge from other
interviews.

Themes Charting
Mentor’s role
Reflective practice
Clinical education
Professionalism
Assessment

The next stage is charting, where the indexed/encoded items are related to the themes.

Themes Charting
Mentor’s role 3.Gradual
4.Experience
5.Unofficial
8.Gradual process
10.Teaching
90.Providing opportunities
92.Encouraging them
99.Encourage
100.Provide opportunities
115.Constant use of theory
146.Future practitioners
148.Volunteers
149.Quality of mentor
Reflective practice 35.Informal discussion
38.Question practice
44.Not formally recorded
48.Active reflection
81.Thinking
83.Reflection
86.Time barriers
104.Learner responsibility
107.Difficult to manage
Clinical education 13.Co-workers
14.Each other
16.Observation
17.Being there
19.Different/Individualised
21.Pace of learning
28.Support individuals
33.Hectic
51.Practical
52.Challenges
54.Individual needs of patients
77.Confidence
117.Not explicit

Fig. 16.1 (b) Thematic framework and indexing/encoding

344 P. Williams and S. Cutler

Professionalism 60.Role model

60.Good examples
64.Exemplify
66.Learning to work
67.Behaviours
70.Autonomy
109.Appropriate responses
112.Reduce prejudice/Right and wrong
135.Enhance learning experience
138.Best practice
138.Responsibility
142.Not teaching
145.Responsibility
Assessment 73.Capability
74.Competence
119.Active tool for learning
120.Intimidating
125.Reflect on errors
129.Informally/Continuous
131.Written – formal
132.Insufficient feedback
133.Consideration

Fig. 16.1 (continued)

16.11.2 Indexing and Thematic Framework

Included here is a copy of the interview, which demonstrates the indexing process,
and from this we developed the themes and codes. We started by reading through
the interview and thinking about the questions. We then highlighted the issues and
concepts (Fig. 16.1a). We then wrote a word or phrase against each issue and con-
cept. Look at all the words and phrases, including those highlighted in Fig. 16.1b
(these will be referred to later in the analysis). How did these match to your index-
ing? The next stage is when the original questions are reviewed, and the indexed/
encoded entries are related to the research questions.

16.11.3 Mapping and Interpretation

It is difficult with just the one interview in this example to undertake a full analysis
and interpret the findings fully. Nevertheless, we can see that some links and percep-
tions have emerged.
With regard to the question: ‘What do radiographers perceive as challenges to
students learning in the practice setting?’ The mentors indicated that assessment can
be intimidating, but they also recognised that they may have not provided sufficient
feedback. They recognised it is an active tool for learning. Observation was seen as
an important aspect of clinical education. You need to look at all of the indexing/
encoding and charting for all of your interviews and map responses to the relevant
questions. You also need to review the emerging themes. You need to be aware that
it is not always black and white; there may be overlap of categories. The numbering
helps you go back to the original location of the data to seek clarification if required.
16 Qualitative Methods and Analysis 345

16.11.4 Key Points

• Interviewing is probably the most common form of qualitative data gathering.

Remember that an interview requires good preparation and considerable skill in
conducting.
• The qualitative approach looks at the ‘how’ or ‘why’ rather than the ‘how many’
and has an emphasis on understanding.
• There are advantages and disadvantages to choosing interviews and/or focus
groups as data collection tools.
• Interviews are used to explore deeper meanings of, for example, experiences,
ideas, or attitudes and are usually conducted on a one-to-one basis.
• Focus groups usually involve the participation of several persons in a discussion
or exploration of a specific set of issues.
• Many methods can be combined to provide a rich picture of a particular
phenomenon.

16.12 Questionnaires

A questionnaire can be a useful tool to extract data from a wider population. The
field of questionnaire design is vast. The aim here is to give some basic guidance on
the development of a questionnaire that can be used in a qualitative research design.
This approach seeks to explore experiences and feelings as discussed earlier. The
design of a questionnaire thus needs to be such as to capture an individual’s percep-
tions. It is important to say that the structure of a questionnaire differs depending on
whether a study is a qualitative or quantitative design. Under certain circumstances
both methods can be used to analyse the same questionnaire. Going back to the
example of the impact of a touch-screen health information system, questions could
be asked on frequency of use, reasons for use, other information sources consulted,
etc. Here one is seeking quantitative data: how many people use the system, how
often, and for what purpose, as categorised in the survey. Their responses need only
be in the form of a tick box. However, if one is interested in individual perceptions,
ideas, and attitudes, the questions are framed differently, and the response options
might include allowing free text.
Pay attention to questionnaire structure and style. Remember that respondents
are subjects and not objects of research. Indeed, particularly in the case of research
with vulnerable groups, the term ‘participant’ has come to be used to help foster
inclusiveness [8]. Issues such as the informed consent of participants and their right
to withdraw have to be considered.
There is much debate about whether open or closed-ended questions should be
used for data collection. A problem with closed-ended questions is that they have
the potential to create false opinions: only limited options are open to a respondent.
They are often perceived as easier to answer. An open-ended question gives respon-
dents the opportunity to express their feelings and perceptions in their own words.
But as a general principle the larger the sample size the more structured, closed, and
numerical the questionnaire is likely to be. Questionnaires, particularly those that
346 P. Williams and S. Cutler

are self-administered, are used for convenience and speed rather than in-depth anal-
ysis of individual responses. ‘Depth’ is achieved by sometimes very sophisticated
statistical analysis beyond the scope of this chapter.
The method can be useful when exploring phenomena in a population that is
distributed across a wide geographical area. This means that large population sizes
are available and therefore expand the potential sample size to be included in a
study.
An example of an open question is presented below.

• How do you feel about the care you received during your examination/treatment
on your recent visit to the imaging/radiotherapy department?

Expressed in a closed-ended format it could be the following.

• How do you rate the care you received prior to your examination/treatment on
your recent visit to the imaging/radiotherapy department? Please circle one
number.
Excellent = 1
Very good = 2
Good = 3
Fair = 4
Poor = 5

16.12.1 Semi-Structured and Open-Ended Questionnaires

As we are looking primarily at language data the focus of this section is on the use
of semi-structured and open-ended questionnaires. Open questions do generate
more detailed responses from participants; as a consequence a great deal more effort
is required to encode their responses. These questions take longer to complete (so
more effort on the part of the respondents too) and this should be taken into consid-
eration when compiling a questionnaire. On the other hand, it could be considered
an economical approach in terms of the time spent distributing and collecting the
data, and has the potential to capture honest personal comments from respondents.
The wording and design of the questions do need careful consideration; this
aspect cannot be rushed and is time-consuming. Otherwise you could potentially
write unsuitable questions. Examples are presented below.

• Double-barrelled questions: these are questions that essentially ask two ques-
tions at once, therefore a respondent could answer either part of the question. An
example might be: ‘Do you think the new appointment system is easy to use and
what effect on waiting times do you think this will have?’ It would be better to
ask these questions separately as the answers given may elicit a positive answer
to the first, but a negative answer to the second.
16 Qualitative Methods and Analysis 347

• Complex questions: such as ‘Would you prefer to undertake a short programme

of study, e.g. 3 or 4 sessions, which does not carry any award, and is delivered on
a Wednesday evening each week, or a longer award bearing programme that is
designed to be undertaken during the day rather than the evening?’
• Irritating questions or instructions: such as ‘Have you ever attended a personal
tutorial during your undergraduate programme’, or ‘Have you attended any con-
tinued professional development activities during your career?’
• Ambiguous questions: this is where the words could be interpreted in different
ways, such as: ‘Do you regularly undertake self-managed study while you are on
placement?’ What do we mean by ‘regularly’? Is this once a day, once a week,
once during your placement?
• Biased and leading questions are those that are worded in such a way as to sug-
gest to a respondent that there is only one acceptable answer. An example might
be: ‘Do you prefer to plan your studies well in advance or to leave it until the
week prior to submission?’ If this was asked by your academic tutor, I think we
can guess which response you might make!

An open-ended questionnaire can be administered face-to-face or self-­

administered. Clearly if undertaken face-to-face, this can be time-consuming and
may limit potential participants. However, it does give a researcher an opportunity
to encourage participants to expand on their responses. See Sect. 16.11.1 as an
example is provided involving exploration of imaging practitioners’ perceptions of
their role as mentors. Initially interviews were carried out to get a feel of how imag-
ing practitioners perceived themselves in that role. From this data an attitudinal
questionnaire was developed. Open-ended questions regarding aspects of the men-
tor role that participants found most challenging were asked as well. Questionnaires
were used so that perceptions of a larger number of imaging practitioners could be
captured.
Radiotherapy practitioners have a role as health educators in preparing their
patients for treatment. A questionnaire could be used to explore the perceptions of
practitioners and patients of that role using open-ended questions.

16.12.2 Reliability and Validity

When using or creating a questionnaire, reliability and validity of the tool should be
considered.

–– Reliability of a tool is the ability to reproduce the results.

–– Validity is more concerned with the accuracy of the test used and asks whether it
measures what it is intended to measure.

For example, a questionnaire may be considered to be more reliable than inter-

views, as a respondent is anonymous and therefore may give more honest answers
348 P. Williams and S. Cutler

to the questions. When considering the validity and reliability of questionnaires in

particular you must think about the sample size; a small sample may skew the
results or be unrepresentative.

16.12.3 Key Points

–– Questionnaires can be a useful way to collect large amounts of data from a large
number of participants.
–– Questionnaires are versatile and can be used in both qualitative and quantitative
research designs.
–– Questionnaire structure can incorporate both open- and closed-ended questions
or a combination of both.
–– When using a questionnaire to collect data, pay attention to the criteria that may
affect the validity and reliability of a study.
–– Questionnaires are the most popular data collection tool used for cross-sectional
surveys, for student research projects.

16.13 Observation

Observation is often a preferred method or key component of case studies or action

research. It is often used to supplement other methods, such as interviews, and also
when the phenomenon we wish to study is not well known to us. Here, observation
is inductive. We begin with specific or general observations to detect patterns and
regularities. We then formulate some tentative hypotheses, and finally end up devel-
oping some general conclusions or theories.
You may be surprised to know that the apparently simple act of looking at some-
thing can be done in a great many ways. The two extreme of observational methods
are: (1) a form of participant observation where a researcher becomes one of the
people he or she is observing, and (2) to being as invisible as possible as a ‘non-­
participant’ observer. The former research is favoured by sociologists and anthro-
pologists. A ‘classic’ example is that of observers of a religious sect whose leader
had prophesied that the world would end that year. Researchers investigating the
cult pretended to be followers for a considerable time. Unlike many such ‘immer-
sion’ studies, however, they deliberately interfered with what they were observing
by suggesting to cult members that their leader might be a fraud. Observational
research in which observers try to immerse themselves in a culture or environment
is known as ‘ethnographic’. It is not however the only type of research for which
observation may be used, as some of the examples below suggest.
By contrast, the extreme non-participant observation is where an observer is as
unobtrusive as possible. A seminal example is that of a sociological study of infant
schools, in which the researcher ignored children who came to him with their work,
etc. to such an extent that eventually they learned to ignore him as much as he was
apparently ignoring them [9]. Apart from being physically present and as discreet as
16 Qualitative Methods and Analysis 349

possible, non-participant observation can be undertaken without the physical pres-

ence of a researcher (and here we generally part company with ethnography).
For example, researchers can use the following.

• Recorded behaviour, e.g., use CCTV to record footage of people’s use of a touch-­
screen health information system as one of a number of data gathering tech-
niques to look at system usage.
• Human trace behaviour, which involves examining the things people leave
behind as they go about their daily routines or undertake the activities ­researchers
are interested in. This is actually a very rare technique, the classic example of it
being a study by Rathje [10], who examined household waste. However, be sure
to consider all ethical implications of undertaking observational studies involv-
ing human participants.
• Computer log analysis, which entails observing computer usage through the
transaction logs created by the system. As users in our health kiosk study were
required to ‘log-in’ with these details, researchers were able to compare time
‘online’, pages accessed and navigational behaviour, and relate it to age and
gender.

16.13.1 Advantages and Disadvantages of Using Observation

The advantages of using observational techniques include the following.

• Capturing non-verbal behaviour, which may tell more than may be elicited from
interviews.
• Subjects do not have to do anything, except ‘act naturally’.
• Researchers do not have to ask questions and no interpretation is required by a
subject.
• Good for preparing the ground for other fieldwork, by familiarisation with a situ-
ation, process, or environment.
• Good for triangulation, i.e., for combining with other methods.
• Phenomena are studied as they occur and there is no need for the participants to
rely on memory.
• A more intimate or informal relationship is permitted, where participant observa-
tion is involved.

The disadvantages of observation include the following.

• Observation could change what is being observed. This is as true of people as it

is of subatomic particles and has been given a name: ‘the Hawthorne effect’. This
comes from a set of studies conducted in the 1920s and 1930s at the Western
Electric Hawthorne Works in Chicago, by Harvard Business School Professor
Elton Mayo, who was interested in productivity and work conditions at the
works. Mayo found that the very act of being observed made the company
350 P. Williams and S. Cutler

employees work harder [11]. The experiments led to the term ‘Hawthorne effect’
being applied to research generally where researcher observation leads to a posi-
tive change in the behaviour of those observed. Although the effects have been
questioned, it is a concept worth bearing in mind.
• An observer may pose an imagined threat. This may be particularly true in a
work context, where people may be worried about their performance.
• It is hard to track many activities at once.
• Interpretation of observations is difficult.
• Observation is time-consuming.
• A researcher can feel a bit awkward. The term ‘wallflower’ springs to mind. This
may seem a trivial point, but the work will be your study thus you will want to
do your best. You may feel that you just would not be able to do this by feeling
self-conscious or awkward.

16.13.2 Collecting Data

Having weighed up the pros and cons and decided to go ahead with some form of
observational process, you need to decide how to collect and record data. There are
several techniques, which are often relevant to both participant and non-participant
observation. The main ones, in addition to those not involving you as a direct
observer, are the following.

• Protocol analysis or ‘think aloud’ method. Here participants describe what they
are doing as you observe. This is common in looking at the usability or accessi-
bility of information technology systems.
• Take field notes; decide first on what you want to record. You can probably
make notes that equate to approximately 500 words per hour. You may wish to
record specific events, or to see what is going on generally. These can be
described as:
–– event sampling: an example might be to record communication activities
between hospital staff,
–– time sampling: this is where you record what is happening at given times dur-
ing an observational session. This was common in education at one time,
where interactions in terms of frequency of ‘teacher talk’, ‘pupil talk’,
‘silence’, and ‘confusion’ among others were analysed.

16.13.3 Recording Tips

Much observational recording is undertaken, by necessity, at the time of an observa-

tion. This is particularly true where specific instances, events, or times are being
recorded. Even where you just want to get an overall picture of an environment,
without recording chronologically, you may like to follow these recommendations.

• Record during or straight after the event otherwise you will forget the details.
• Do not start a new observation session until you have recorded the last one.
16 Qualitative Methods and Analysis 351

• Recording can take as long as actual observation if you are meticulous.

• Include everything important, or which might be important.

16.13.4 Analysing the Data

As with interviewing, people get really worried about analysing observational data.
‘What does it all mean?’ one might ask. As done with interviews (see Sect. 16.8)
consider the aims and objectives of your study, and how observation fits in with
those. We present some tips.

• Look for similarities and differences and try to explain them. You may need to
consult interview data if you have any, in this, or simply ask the people observed
to explain certain actions.
• Watch for re-occurrences. Why do the same things keep happening?
• Formulate ‘rules’ based on repeated occurrences, but look for exceptions.
• Try to explain the exceptions you find. Do they mean your rule is wrong? If so,
change it; or is the exceptional case really different in some way? If so, in what
way, and how does it inform your study?
• To systematise observations, it may be helpful to devise categories. If you did not
do this for the actual observation, doing it afterwards is still valuable, in a way
even more, as you will make the categories fit what you have observed not the
other way around. With luck patterns will emerge.
• If the observation is a preliminary ‘staking out’ of the field? Consider what ques-
tions it raises that could be incorporated in any interview or survey you may be
considering.
• There is the potential to observe practitioners or students undertaking a specific
radiographic examination or intervention to explore the variation in approaches
to techniques or tasks. It might be useful to observe how practitioners use differ-
ent approaches to a task, which may well produce a similar outcome. An exam-
ple could be a task analysis of how a lumbar spine examination is undertaken,
handwashing techniques, moving and handling of radiographic or therapeutic
equipment, observing the tools applied when evaluating images on DR or PACs
system. Task analysis is a range of techniques used by operators to describe and
evaluate interaction between humans and machines and is a way of investigating
participants’ behaviour in a specific context.
• Within a practice setting you could observe patients finding their way around the
imaging and radiotherapy departments or their interaction with staff at the recep-
tion area. Again, remember the ethical implications of studies involving human
participants.

16.13.5 Key Points

• Observational methods involve many approaches on a continuum from partici-

pant to non-participant, and the methods of data gathering, including ‘event’ and
‘time’ sampling.
352 P. Williams and S. Cutler

• Observational research methods form a key component of case studies and action
research.
• Observational research is often employed to supplement other research methods,
e.g., interviews.
• Do not forget the ‘Hawthorne effect’ during observational studies.
• When analysing data, pay careful attention to the explanations drawn from the
similarities and differences observed. In addition, participants can be asked to
explain their actions.

16.14 Case Study

A case study is where a single instance is studied in-depth and can be considered as
an approach rather than a method; several methods are employed in a case study.
Examples may include where a patient, a group of specialist practitioners, a clique,
a class, or an imaging department is studied as a unique case. A case study is used
to explore and reflect what is happening in a unique situation and allow these spe-
cific situations to be explored in greater depth, which may not be captured using
other data collection tools. One of the strengths of these studies is that they are
drawn into the context of the case itself. Case studies aim to describe ‘what it is like’
to be in a particular situation and to give a rich description of the reality. Observation
(see Sects. 16.13–16.13.5) is a frequently used tool in a case study. When will a case
study be useful?

• When a randomised approach is not appropriate.

• When it is not possible to study a particular population as a group.
• When you need to evaluate intervention outcomes over a period of time.
• When pilot information is required.

Case studies are useful as a theory generating tools. When conducting a case
study a number of factors need to be considered, such as negotiating access to peo-
ple and how the data are to be collected. Data collection tools that could be employed
in case studies include interviews using open or semi-structured questions; observa-
tions or narrative accounts. In addition, documents or diaries could be used to
explore the uniqueness of a specific situation.

16.14.1 Key Points

• A case study can be considered an approach rather than a method.

• A case can be an individual or group of patients, practitioners, a class of students,
or an imaging department.
• Case studies are used to explore a ‘happening’ in a unique situation.
• Observations are frequently used as tools to collect data in case studies.
16 Qualitative Methods and Analysis 353

16.15 Action Research

The purpose of action research is to improve understanding of practices, in a spe-

cific context, with a view to making changes for the better. It is a reflective activity.
Action research is designed to bridge the gap between research and clinical practice.
It should bring about improvement, change, and development to enable practitio-
ners to have a better understanding of their practice.
There are three basic phases to action research.

1. Look: build up a picture of a situation and the context in which it occurs, think-
ing about what the practitioners, as well as the patients, are doing.
2. Think: this process requires you to interpret a situation and explain what is hap-
pening, reflecting on what the participants have been doing, and look for any
deficiencies or issues.
3. Act: whereby actions for change are identified and put into practice.

Action research is about looking at a local issue or problem and exploring that
and making changes as well as expanding knowledge. In addition, this research
approach provides an opportunity for personal and professional development.
Methodologically it has a distinctive set of requirements. It should be the
following.

• Collaborative: participants contribute to the overall project.

• Action oriented or participatory: intervention and change are a part of the
process.
• Contextualised: it relates to a specific place, situation, or circumstance.
• Reflective: through a process of planning, action, evaluation and critique.

Action research relies on the following:

• communication of all group members,

• time to reflect on the process and outcomes of the project,
• verification of project: can it be replicated or reproduced?

It can be argued that the process of action research enhances a change process, a
key agenda in the ever changing context of healthcare; particularly in the fields of
medical imaging and radiotherapy. It is an approach that enables a researcher
actively to participate in development in their specific area or field. It is suited to
small-scale projects. Action research generates change through reflection, commu-
nication, cooperation and collaboration, and empowerment among participants.
An action research process consists of several stages, namely

• questioning existing practices and coming up with an idea,

• collaborative decision-making and planning,
354 P. Williams and S. Cutler

• action, implementing the changes with ongoing evaluation and monitoring,

• critical reflection on the intervention and the process,
• re-evaluation of the original plan based on reflections, implementation of changes
and continued monitoring,
• reflection on the knowledge generated and the reshaped practice.

The actual methodological approach employed depends upon the research ques-
tion posed. As discussed triangulation (see Sect. 16.7) is often employed to increase
validity and to identify convergence and obverse patterns. Whatever data collection
process is employed the validity and reliability of the chosen method should be
considered. There are some potential problems associated with action research.
These are the level of skill of a research facilitator and the culture of an organisation
in which the research being done.
A survey might elicit information from a patient group about waiting and chang-
ing facilities, thus the context in which this data are collected has to be taken into
consideration. The data collected must be reflected on and discussed, a plan of
action for any changes discussed and implemented. Follow-up focus groups, for
example, could be employed to determine whether the interventions did affect
change in clinical practice.

16.15.1 Key Points

• Action research is a reflective activity in which researchers aim to improve

understanding of their practice within a given context.
• The three basic phases involved in action research are: look, think, and act.
• Action research should be collaborative, action orientated, contextualised, and
reflective.
• Triangulation is often employed to increase validity and reliability of findings.

16.16 Content Analysis

Content analysis is used for studying the content of communication and documen-
tary evidence. It is a careful, detailed, and systematic examination of large amounts
of data [2]. Content analysis is used to determine the presence of certain words or
concepts within literature. The literature used can be from a variety of resources,
books, journals, research articles, professional journals, departmental or hospital
protocols, newspapers, audio of video media material, etc. Any information, whether
it is primary research or information, which is in the public domain, can be used.
Content analysis can be qualitative or quantitative and usually involves inductive
reasoning. This methodology can uncover underlying meanings within a text and
enables the content to be quantified by the use of a set reproducible method of data
extraction. Researchers quantify and analyse the presence, meanings, and relation-
ships of words and concepts within the literature. Categories and themes emerge
16 Qualitative Methods and Analysis 355

from the data. These identify the focus of the research and the extracted data are
assigned to these themes and categories as analysis of the data occurs.

16.16.1 Content Analysis Is Generally Categorised into Two Types

Two types are discussed: conceptual and relational analysis, respectively.

Conceptual analysis (a.k.a. thematic analysis) involves quantifying the existence
and frequency of words of phrases in the literature being studied. The focus is exam-
ining the occurrence of selected terms within a text or texts. The terms may be
implicit or explicit. While explicit terms are easy to identify, coding for implicit
terms and deciding their level of implication are much more complex, judgments
are based on a more subjective system. The level of implication refers to how you
have defined the words or phrases and must be kept constant throughout your analy-
sis; using the example cited earlier about what is meant by ‘regular’, you need to
define whether it means, for example, daily or weekly. To limit the subjectivity
when coding such implicit terms use can be made of specialised software packages.
These packages increase the reliability and validity of extracted data, adding rigor
to a study and its findings. However, they are time-consuming to use and are not
usually used by students because of this. Software packages are ATLAS and
MAXQDA, amongst others.

• ATLAS is software for text analysis and model building. It handles graphical,
audio, and video data files and text.
• MAXQDA works with a wide range of data types, including focus groups, sur-
veys, webpages, Twitter, and other social media. You can transcribe, analyse, and
code audio and video files in a so-called Multimedia Browser. It has a wide range
of coding features, a facility to link within documents or to external sources. You
can add variables to your data to keep track of demographic or other types of
quantitative information.

This is not an exhaustive list. Other packages available include NVivo and
Qualrus to analyse the data.
Relational analysis (a.k.a. semantic analysis) involves searching for meaningful
relationships present in a given text or set of texts. Relational analysis explores the
relationships between the concepts identified.
The difficulty with content analysis is not that of locating relevant information.
It is analysing the often vast amounts of available data. This makes the process very
time-consuming and labour-intensive. Content analysis cannot easily investigate
implied meanings and is not a useful methodology for assessing subtle meanings
within the literature.
Patient information leaflets could be selected from a number of Trusts or from
just one. These are in the public domain, and you can find them online from the
websites of a number of NHS Trusts [12]. Once you have collected your leaflets,
you could randomly select a manageable number to review. These can then be
356 P. Williams and S. Cutler

scrutinised for the type, quality, and level of language used within these texts. You
could analyse the sentence length and count the number of syllables used; you could
also ask readers to rate the readability of the information provided.
You could search historical archives of professional material looking at the
development of advanced practitioners or the development of non-traditional radio-
graphic skills such as counselling, for example. This could be a specified timeframe,
say the previous 5 or 10 years. Then you could look for articles, references or edito-
rial comments relating to counselling skills. You could also look for training and
educational programmes. You could explore whether definitions have altered, and
which areas of practice specific skills focused upon, such as ultrasound, radiother-
apy practice, or mammography services.

16.16.2 Key Points

• Content analysis involves the study of the content of communication and/or doc-
umentary evidence.
• It can be both qualitative and quantitative and usually involves inductive
reasoning.
• It can be categorised into conceptual analysis and relational analysis.
• Content analysis can be time and labour-intensive.

16.17 Critical Reviews

Critical or systematic reviewing is a research methodology that aims to review pri-

mary research evidence with rigor. High quality reviews identify all relevant studies
in a particular area of practice, assess the studies, synthesise the findings in an unbi-
ased way, and present the results in a balanced and professional manner.
Evidence-based healthcare relies on systematic reviews ensuring that healthcare
practitioners have a clear understanding of available research and ensuring that their
practice is based on the best available evidence. Healthcare professionals are turn-
ing towards current available research in order to aid in efficient clinical decision-­
making. Critical reviews contribute to evidence-based practice by using explicit
methods to select, critically appraise, and summarise large quantities of information
and literature thus aiding the decision-making process. See Chap. 12 for more
information.

16.18 The Search Strategy

Carrying out a structured search is essential and of utmost importance when

undertaking a critical review. It helps to fully understand the topic in a question.
It enables awareness of existing research in the same area and ensures the intended
project has not been undertaken before. Even if a study has been done before there
is often a need to review the latest available information and studies to ensure all
16 Qualitative Methods and Analysis 357

evidence is current. This may necessitate undertaking a review that was done pre-
viously. This is of particular importance if the new research will add knowledge
to the literature already available. The Cochrane handbook for reviewers [13] rec-
ommends that a variety of sources should be systematically searched to reduce the
risk of bias and broaden the search base. A critical review should include all avail-
able evidence. See Chaps. 3 and 12.
The identification of the best evidence and selection of research literature requires
the construction of an appropriate research question. A stepwise process named
PICO (population/participants, intervention, comparison, and outcome) has been
developed to achieve this. A research project (study) should have elements of a
population, investigation, comparative investigation, and an outcome in its question.
Formulating a question using these key components should assist in specifying the
criteria used to select studies. The importance of developing a focused research
question is crucial, ensuring it highlights the significance of the problem. Critical
reviews in radiography often use the PICO system.

16.19 Exclusion Criteria

The method used for including relative literature is undertaken in three stages.

• Stage 1: is the inclusion of studies based on their title and abstract to decide
whether they were relevant to the question posed.
• Stage 2: involves establishing if the studies met the inclusion and exclusion
criteria.
• Stage 3: assesses the methodological quality of the study and extracts the data.

Ethical implications need to be considered and addressed when undertaking any

systematic review or content analysis. Ethical release may be required from an eth-
ics committee and higher education institution (HEI). An unbiased, objective
approach should be followed, using published guidelines for critical reviews com-
bined with good reflective judgement. This ensures the answers to a research ques-
tion are based on available evidence rather than unsubstantiated claims that may
potentially produce misleading results.

16.20 Writing Up Qualitative Research

The manner in which your project should be structured and presented is explored in
Chap. 17. A number of considerations should be taken into account when writing up
your study.

• Most importantly, you must refer to the original research question/aims and
assess the extent to which your objectives have been reached.
• Try to be consistent with the data. In other words, do not try to make too much
of one quote that seems to confirm what you already think at the expense of other
data that do not.
358 P. Williams and S. Cutler

• Treat all data ‘fairly’. It is okay to say there was no apparent pattern in responses,
and also to say that ‘all the women in the sample thought X’, as long as you do
not try to imply that this suggests any generality.
• It is always good to say that ‘further research is needed to establish whether this
represents a general trend’.
• Try to include appropriate quotes in your write-up, and also some individualised
accounts/stories, etc.
• Your conclusion should include an assessment as to whether your research ques-
tions have been answered, what unforeseen results arose and, if possible, some
recommendations for further research or practical action.

Undertaking qualitative research can be both fascinating and satisfying, and that
information unearthed is often completely unexpected, and can be of immense
interest and importance. Good luck if you go down this route.

16.21 Key Points

• The aim of a critical review is to rigorously evaluate primary research evidence.

• It is important that healthcare practice is based on the best available research
evidence.
• A robust search strategy is essential when conducting a critical review (see also
Chap. 3).
• Critical reviews in radiography often use the PICO system as a useful strategy.

16.22 Conclusion

In this chapter a brief and practical definition of the term ‘qualitative’ was pre-
sented. Also covered was an extensive discussion on the many and varied methods
by which qualitative data may be obtained, recorded, and analysed. A detailed
investigation of a qualitative interview was presented. This is partly because of its
prevalence in qualitative research, either as a ‘stand-alone’ method or as one of a
suite of data gathering techniques used in action or case study research. In both your
academic and professional career you will undertake both research and other inter-
views as part of your studies or your job.
The techniques, advantages, disadvantages of other qualitative methods were
also outlined, together with the contexts within which each method would be most
appropriate to adopt. In conclusion, it is necessary to consider exactly what your
research is about and what it aims to explore before choosing to adopt a qualitative
(or any) approach. Having done so, you must think very carefully about the actual
qualitative data gathering method you decide to adopt. Hopefully, the chapter has
provided a good guide as to the application and appropriateness of each, to equip
you to make your decision.
16 Qualitative Methods and Analysis 359

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Further Reading
Smith J, Firth J. Qualitative data analysis: the framework approach. Nurse Res. 2011;18(2):52–62.