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5.5.3.1 Preparing the data

The audio-recorded focus groups and interviews were transcribed into Microsoft

Word (2010) documents. I undertook the majority of the transcription as this is

suggested to help with the process of familiarising and immersing oneself in the data. Some interviews were transcribed by a research secretary who similarly transcribed the interviews verbatim. As the audio recordings were transcribed, they were made anonymous by replacing names with participant numbers.

5.5.3.2 Coding the data

We made a decision to inductively code several of the transcripts and develop a hierarchical, iteratively refined, list with which the remaining transcripts could be coded. Transcripts were coded using QSR International’s NVivo 10 (2012) software before moving on to manage and analyse the data using the Framework Analysis approach. Using the ‘Framework Matrix’ function in NVivo 10 had the benefit of enabling me to retain an electronic link between the original data and thematically-organised summaries of the data, as shown in Figure 1. The

inductive sub-themes were organised under the deductively produced research questions, used as headings.

5.5.3.3 Framework Analysis in NVivo

Framework Analysis (Ritchie and Spencer, 1994) has gained popularity in healthcare research since its conception at the UK National Centre for Social research. Framework Analysis is a method of qualitative data management and analysis whereby data is summarised in a matrix and analysed thematically (i.e. a table). This involves a process of developing a hierarchical thematic framework which is used to categorise data by key themes and subthemes. Each source of data (e.g. a focus group or interview transcript) is represented as an individual case in the matrix. Cases are set out in rows. Themes and subthemes, deductively or inductively identified, are set out in columns.

The Framework approach can be used in both a deductive and inductive manner (Gale et al., 2013). In this study, the research questions deductively guided the

development of themes and determined the organisation of the Framework matrices. Transcripts were coded inductively, allowing unanticipated themes to emerge. These unanticipated themes were organised as subthemes, under relevant overarching deductive research questions.

Data relating to each case and subtheme are summarised in the corresponding matrix cells. Once complete, it is possible to look across the entire matrix for patterns within the data, associations between themes and cases, and explanations.

A link is retained between the summaries and raw data. The link means an audit trail is created that can be followed from the beginning of the analysis to the end. This allows for a degree of transparency, which is beneficial for ensuring the quality of the research, as findings can be easily linked back to raw data. This is shown in the screenshot in Figure 5.4.

Figure 5.4- Screenshot of the electronic link between summaries (left) and the original source material (right)

The Framework approach lends itself well to the healthcare domain where substantial evaluation projects can involve multiple researchers and the emphasis is on rigorous research to inform evidence-based care (Ritchie & Spencer, 1994).

The retention of the link between original transcripts and the summarisations reduces the risk of the analysis becoming overly subjective and eases the process of reworking ideas.

An additional benefit of having the summarised data charted in a matrix is that it adds an additional step to the process of analysis, compared to thematic analysis, bringing the researcher ‘closer’ to the data by compelling them to digest the data into summaries. The matrix summaries support comparisons between and within individual cases or groups of cases allowing in this study, for example, the comparison of DHSW responses from different regions and the comparison of DHSW and coordinator responses.

We chose to use NVivo 10 software to aid the data management and analysis.

NVivo 10 has a ‘Framework Matrices’ tool incorporated into the program. This was

beneficial because the raw data and matrices can be stored in one file and the links between the raw data in the focus group transcripts and the matrix summaries are maintained by the software.

The key stages of the Framework Analysis undertaken are detailed in Table 5.3; however, in summary, a matrix was created for each research question. The example in Table 5.3 shows the summaries for three cases and three subthemes explored in one matrix under the research question ‘how is tailoring implemented?’ By organising the data by this method, we were able to compare and contrast participant responses across regions of Scotland, and between professional groups, by viewing the summaries contained within each matrix.

We followed the five key stages of Framework Analysis as described by Ritchie and Spencer (1994). These stages are detailed in Table 5.4. Stages 1-2 were carried out with transcripts printed in hard copy. Stages 3-5 were carried out using QSR International’s NVivo 10 (2012) software.

Stages 1-4 were carried out as the data collection was ongoing. This meant that we were able to use early findings to inform my approach to subsequent sessions. We were able, therefore, to ask new groups and interviewees about issues that had been pertinent to previous ones. In this manner I occasionally brought

additional topics of discussion, which were not generated organically, to some sessions (Kreuger and Casey, 2000).

After completing Stage 5 of the Framework Analysis I began to summarise and write up the findings under the overarching higher level themes. Through this process, the themes and content were further refined. A theme development diagram for all the final themes can be found in Appendix 14.

Table 5.3- Extract from a framework matrix

Research Question: How do DHSWs deliver the right level and type of support?

Preparedness for

change Developing relationship Communication strategies

DHSWs East May need to work on_{parents’ oral health}

before the child – parent may be in pain, have dental phobia/anxiety or take time to see oral health as priority

Working long term with some families Gaining parent’s trust with first visit, then coming back Phoning after 6 months to check –in

Phone, letter, cold call to house

Use resources where appropriate

Wheel of Needs

Coordinators East

May just mention one message and not go into detail. Depends on family circumstances

Allow family to ask questions

Important to get to know family first

Using phone calls, texts, sending out letters

Using resources to get family to focus or occupy child

Programme managers

Consider what will be effective long term

May not be immediate goal to get them to dentist

Talk to someone about what they want to talk about first- building rapport

Not necessarily waiting to make an appointment with a family but taking advantage of any opportunity to get the messages across when meeting the parents

Table 5.4- Stages of framework analysis

Stage of Analysis

Description

1. Familiarisation I became immersed in the data and gained a _{comprehensive overview of the material by listening}

to audio recordings of focus groups and interviews, transcribing them myself, where time allowed, and reading through the transcripts. Some of the sessions were transcribed by a research secretary.

2. Identifying a thematic framework

I examined each line of each transcript and noted the key concepts or themes mentioned in each phrase or section. A hierarchical coding map began to emerge with themes and sub-themes relating to each research question.

3. Indexing I applied the coding map to the transcripts in a systematic way, reading every part of each transcript and annotating with the corresponding codes.

4. Charting I developed Framework matrices for each research question. The themes relating to each research question are charted as column headings and each focus group or ‘case’ is represented in a row. In each available cell in the matrix, I summarized the pre- coded data corresponding to each theme-case pair.

5. Mapping and

interpretation I examined themes across the matrix in order to compare and contrast the data in relation to the research questions. My aim was to establish whether any relationship existed between concepts. This process resulted in the emergence of higher level themes which addressed the research questions.