Approach

6.1.1 Phenomenology

Interpretative phenomenology is a version of phenomenological research methods concerned with hermeneutics and is an ideographic approach (Langdridge 2007; Willig 2008) enabling the researcher to explore participants’ experiences3_{, gain insight into, and} understanding of, the ways in which people perceive, interpret and explain their world (Stenner et al 2017). It is concerned with how people make sense of and draw meaning from those experiences. The intention is that, as far as possible, experiences are articulated in their own terms, not in relation to predefined categories. Participants are experts on their own experiences, providing researchers with understandings through their accounts of these (Smith et al 2009). As noted in Chapter 5, with the research being framed by phenomenology, interviews were used as an appropriate way to access and describe participants’ ‘life worlds’ (Koro-Ljungberg et al 2009). Description of things “in their appearing” (Finlay 2009,6) was at the core of the research with a focus on the lived

3 _{Ideographic - focused on the particular and on detail: involving deeper analysis, aiming to enable}

understanding of how a particular experience is understood from the perspective of a particular person in a particular context.

89 experience (Gee 2011) of participants’ habitus and field and their attempts to make

meanings of these (Langdridge 2007; Smith, Flowers and Larkin 2009).

Hermeneutics is concerned with interpretation. In this study, there was a double hermeneutic: the researcher interpreting the participant’s interpretation of their experience. This hermeneutic circle enabled exploration of the dynamic relationship between the part and the whole at a range of levels, trying to understand the phenomena that emerged along with interpretation of practice (Koro-Ljungberg et al 2009, Stenner et al 2017). This iterative approach facilitated exploration of different perspectives in relation to meanings within the data. The aim was to have an insider perspective but also to be able to look at the participant from another position (Smith et al 2009), so acknowledging the active role of the interpreter (Gardiner 1999) and that within this approach all

interpretation is a ‘view from somewhere’ (Kinsella 2006).

6.1.2 Critical hermeneutics

The phenomenological approach was useful in guiding the analysis, however, due to the nature of the data emerging from the interviews, it became evident that insights offered by critical perspectives, which can be used to inform hermeneutic enquiry, would be helpful in understandings in this study. Some of the issues of interest concerned power, language and the acknowledgement of ‘the fix we are in’ (Kearney 2003, Kinsella 2006) in relation to the apparently unchanging state of affairs a propos support of disabled students. This approach allowed a more critical interrogation of the participants’ accounts to gain further insight into “its nature, meaning and origin” (Willig 2008,63) particularly in relation to how the accounts were shaped by field, capital, habitus and doxa.

Interpretation was iterative in nature; the critical lens providing an alternative but complementary way through which to view the data. This second level of interpretation aimed to position initial description within cultural, social and sometimes theoretical contexts, asking critical questions of participants’ accounts and exploring their personal ‘sense-making’ activities (Smith and Osborn, 2008). I acknowledge that this critical

hermeneutic interpretation is more tentative and speculative than the earlier empathic and descriptive level so providing an opportunity to “think about ‘what it means’ for the

participants to have made these claims, and to have expressed these feelings and concerns in this particular situation” (Larkin, Watts and Clifton 2006,104). Whilst this approach enriched the analysis and generated new insights and a deeper understanding of

90 participants’ experience, it was crucial to be reflexive about the presentation of an

alternative narrative which differed from the participant’s own account of what was going on (Willig and Stainton Rogers 2008).

This level of interpretation proved to be a good ‘fit’ with participants’ accounts of their practice in relation to their experiences and the frameworks of power in which they worked.

6.1.3 Thoughts from critical disability studies

As noted during reflection on the developing analysis, a critical perspective was felt to be appropriate in informing the enquiry. Critical theories:

“produce and convey critical knowledge that enables human beings to emancipate themselves from forms of domination through self-reflection” (Wodak and Meyer 2009,7).

Ideas from critical disability studies were useful in illuminating the relationship between the role of discourse and the (re)production of dominance (van Dijk 2009). Arguably the exercise of social power by institutions and groups (i.e. the NHS, HEIs and professionals working within these fields) may result in inequalities in relation to the position of disabled students within those fields. Possibly, the participants themselves, being part of the NHS environment, experienced inequality because of the macro-notion of institutional power (Lukes 2005).

While the participants probably would not consider themselves in need of emancipation, perhaps the often-reductive biomedical systems in which they were embedded had a dominant effect on their thinking, attitudes and behaviour. In the case of both disabled students and practice educators, the inequality experienced because of powerful

institutional discourses could be viewed as being jointly produced: the dominated groups being persuaded that the dominance is natural and legitimate leading to a situation in which ‘bottom up’ challenge and resistance is not considered or thought to be appropriate (van Dijk 1993). The powerful effects of discourses such as the medical model cannot necessarily be “interpreted as conscious and manipulative in intent” (Jager and Maier 2009, 39). Arguably, they are so ingrained within society and healthcare that they become accepted unquestioningly as doxa. Exploring these issues was helpful in the analysis; the critical lens providing a more socio-political stance. It became important to analyse

91 participants’ narratives in the light of broader social frameworks and to “relate properties of discourse with these underlying, socially shared, representations, which group members use as a resource to talk about members of other groups” (van Djik 2009,78). The process was reflexive, involving much conscious thought and discussion about what participants meant and why they said what they did. I hope that the outcomes of this might contribute in some way to providing a platform to affect change in physiotherapy practice through critical understanding.

I think that it is important to acknowledge the development of my understandings as I moved through the different elements of the study, from initial conceptualisation, to fieldwork, analysis and throughout the writing up period, with a focus on the deployment of Bourdieu’s social theory of practice in the consideration of my participants’ accounts.