DATA ANALYSIS

Interviews and focus group data will be transcribed and then organised using the qualitative data analysis package NVivo (Gibbs, 2002; Bazeley, 2007). Data from both sources will be analysed together in fulfilment of data triangulation. This will enhance data trustworthiness by data convergence, enabling corroboration of views, values, preferences, reasoning and arguments across the methods. Focus group data will also be compared with individual interview data, to identify and interpret processes by which participants' views, values, preferences, reasoning and arguments emerge according to the method of data collection. There are two

aspects of data analysis for this study, i) coding, and ii) ethical analysis which, in accordance with Grounded Theory, will be undertaken concurrently (Figure 10.1).

10.6.6.1 CODING

Coding is central to Grounded Theory; it involves three stages: open coding; axial coding and selective coding (Corbin and Strauss, 2008).

In the open coding stage, categories of information are developed via line-by-line analysis of the data; examining it for concepts that appear to relate to the same phenomena. A coding framework is developed, both to facilitate analytical consistency and to reveal discursive themes and processes recurring within and across data. These categories are subsequently 'labelled' using, for example, theoretical ideas from the literature. Sub-codes are identified which represent different dimensions of the categories. For example, depending upon participants' responses, an initial label may be 'Lower priority', this may subsequently generate such sub-codes as 'responsibility', 'alternatives', 'fairness', 'blame', 'punishment' etc.

141 Figure 10.1: The process of data analysis

The second stage of coding is axial coding, in which relationships between

categories and sub-codes are explored and defined. This is done by linking codes to contexts, to consequences, to patterns of interaction, and to causes (Bryman, 2008). For example, as the potential health gain will have been (where possible) held constant within interviews and focus groups, any stated preference for

prioritising the youngest patients, the most severely ill etc. will not be combined into a category with preferences for prioritising these groups when the health gain is not predicted to be the same, as that could result in erroneous conclusions being drawn about arguments for weighting benefits.

A coding paradigm (theoretical model) that visually displays the interrelationships of these axial codings (Strauss and Corbin, 1998) is then developed (a hypothetical example is given in Figure 10.2).

The third stage of coding is selective coding which involves selecting a core category – such as 'Lower priority' in the example given above – as the central phenomenon, systematically relating it to other categories and filling in categories that need further refinement (Bryman, 2008).

CODING

ETHICAL ANALYSIS

THEORY DEVELOPMENT COMPARISON

ITERATION

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Figure. 10.2: Hypothetical example of a coding paradigm:

10.6.6.2 ETHICAL ANALYSIS

This stage of analysis will explore core categories and subject them to more detailed study of their ethical content and evidence of ethical reasoning and argumentation. A focused ethical analysis of the data will be undertaken; mapping the categories onto relevant moral theory.

To establish control over the scope of analysis (the range and complexity of theories that data could be compared against is considerable, implying a potentially limitless process of scrutiny), preliminary ethical analysis will be applied from the perspective of key ethical theories, starting with the standard bioethical approach to ethical analysis - respect for autonomy, non-maleficence, beneficence and justice, commonly referred to as the 'four principles' approach (see Chapter 5). Data will also be analysed from a consequentialist, deontological and virtue ethics

CAUSAL

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perspective. The ethical validity of arguments will be established via their adherence to a valid logical form (See Chapter 7).

Having established a practicable ethical framework, subsequent analysis will examine the process of ethical reasoning and the ways in which participants have sought to resolve both logical and ethical conflicts, inconsistencies and

contradictions in their responses. For example, are moral distinctions made between 'self-inflicted' illnesses and their influence on healthcare entitlement? Are preferences contradicted or rejected when participants are asked to consider various prioritisation strategies? Are attempts made to synthesise different ethical approaches? Are some moral concepts dominant? For example, do participants support an egalitarian account, rejecting prioritisation of healthcare on the basis of perceived responsibility for healthcare need? The extent to which broad moral concepts such as 'merit', 'responsibility' and 'social value' have been used (or inferred) to support arguments will be identified.

In acknowledgment of the need to identify coherence-focused arguments⁶¹ – in addition to the rational, logical argument structure – the links between participants' initial responses, the components of the evaluative processes applied and the conclusions will be examined.

The issue of commensurability will be explored. For example, some participants may state that their ethical priority is to ensure there is as little difference between what healthcare people receive as possible, and be consistent within this. While others might argue (or infer) that maximising health benefits is the most important approach and respond consistently within that view. However, there may be identifiable inconsistences or flaws within these arguments or there may simply be differences in what people regard as the primary ethical goal (e.g. ensuring equality, maximising benefits etc.).

All identified ethical arguments will be subjected to further descriptive analysis

highlighting, for example, issues of consensus and disagreement

To assist the supplementary validation of the findings (Strauss and Corbin, 1998), a comparative analysis of ethical arguments advanced by participants, with those

61Coherence-focused arguments are discussed in Chapter 7

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advanced in the literature regarding responsibility for ill-health as a priority-setting criterion, will be undertaken.