Document content analysis process

My second form of data analysis was content analysis of the collected documents. Bryman (2004) defines document content analysis as a “systematic procedure for

searching out underlying themes in reviewing or evaluating documents” (p.392). He asserts that, like other analytical methods in qualitative research, this analysis requires that data be examined and interpreted in order to elicit meaning and

understanding. Furthermore, the aim of document content analysis is to be systematic and analytic but not rigid (Altheide 1996, p.16). Bowen (2009) maintains that

documents which contain text (words) and images have been recorded or published without a researcher’s intervention. What I understand this to mean is that I was not involved in the construction of the documents – as opposed to my construction of the interview questions and my part in the co-construction of data from the interviews – allowing for some distance. However, as I was actively involved in the interpretation and analysis of these data, I still played a part in the construction of my findings although to a lesser degree.

Atkinson and Coffey (1997) refer to documents as ‘social facts’, which are produced, shared, and used in socially organised ways (p.47). As a midwife and child health nurse, I assumed that the documents or ‘social facts’ that I gained access to would be in the form of printed sheets of information, booklets compiled for various areas of perinatal education, manuals, policies, protocols, books, event programmes, lesson plans, education syllabi, specific forms used in clinical work (such as clinical pathways and psychoassessment tools), and the like. I originally considered restricting my collection of data mainly to lesson plans (assuming there were any) and parenting curricula (again assuming they were in existence) as, initially, I was solely interested in antenatal classes and child health anticipatory guidance. However, in order to gain a thorough understanding of the role of mental health promotion in the perinatal period, as opposed to early detection, prevention or onward referral, I needed to look at as many materials as possible, and so a large collection of data was sought.

Furthermore, I was mindful of Bowen’s (2009) discussion regarding an absence of sufficient detail in most studies in reviewed literature, regarding the procedure followed and the outcomes of the analyses of documents. By ‘casting a wide net’ for the data collection, I hoped to gain as much information as possible in order to be representative of the services I examined. Atkinson and Coffey (1997; 2004) advise researchers to consider carefully whether and how documents can serve particular

research purposes. Therefore, it was important not only to be meticulous in my collection procedures, analysis and interpretation of the data, but also to ensure that the recommendations from the study be reported back to WACS and CHAPS for any changes (should any be necessary) that could be important for parents’ wellbeing. In doing so, I would also be remaining congruent to my critical ethnographic approach of ensuring that my work not only explored my research question, but that the findings translated into supporting parental rights to mental wellbeing.

Although documents can be a rich source of data, it is important not to treat them as “necessarily precise, accurate, or complete recordings of events that have occurred” (Bowen 2009, p.6). His comments cautioned me to ensure that I did not simply ‘lift’ words and passages from available documents but that I established the meaning of the document and its contribution to the research aim being explored (p.4). It was also important to determine the relevance of documents to my research question and aim (Bryman 2004) and that I “ascertained whether the content of the documents fitted the conceptual framework of my study” (Bowen 2009, p.4). In doing so I determined the authenticity, credibility, accuracy, and representativeness of all the selected documents I collected.

In my document analysis process, I was guided by a number of studies; firstly by Altheide (2004) whose approach to ethnographic content analysis advocates for a familiarisation with the context within which the documents were generated, then to becoming familiar with a small number of documents, and finally to generating some categories (using similar terms to those in my literature review). In this study, the document content analysis was an iterative process that combined elements of content analysis and the thematic analysis that was applied in the interview analysis process.

Firstly, the documents I collected were assessed for completeness, in the sense of being comprehensive (covering the topic completely or broadly) or selective

(covering only some aspects of the topic) (Bowen 2009). Once I had completed this, I determined whether the documents were even (balanced) or uneven (containing great detail on some aspects of the subject and little or nothing on other aspects). Further steps in the process, which I recorded in an excel spreadsheet, included the

need for me to consider the original purpose of the document, that is the reason it was produced and its target audience. It was also important for reasons of context and authenticity to know information about the author of the document and the original sources of information from which the documents were constructed. Overall, although I cast a wide net, there was not a large amount of data to collect.

Documents related, mainly, to protocols that the midwives and child health nurses used in their day to day practice. Once I had started analysing each protocol (e.g. clinical pathway, databases records, assessment tools) for mental health promotional content, I found that there were some absences or sparseness of content, which Bowen (2009) maintains could be suggestive of something significant to note about mental health promotional information or the health professionals involved or even the context in which they find themselves. Furthermore, this absence or dearth of information may have been suggestive that certain matters had been given little attention or that certain voices have not been heard (p.8).

One of the other purposes of document analysis that was important to recognise was what Bowen (2009) calls a document’s ability to provide context. By this he means how documents can ‘bear witness’ to past events and provide background

information as well as historical insight. In keeping with my study’s critical

ethnographic lens, this information and insight helped me to understand the historical roots of the documents I collected and indicated past conditions that impinged upon how mental health promotion was or wasn’t included in early parenting. Lastly, as documents can provide a means of tracking change and development, Bowen (2009) advises that where various drafts of a particular document could be accessible, that I compare them to identify the changes as even subtle changes in a draft can be reflective of substantive developments in the area.

In summary, my second form of data was documents that I collected from the WACS and CHAPS. In my analysis process I related the process to my research question

“what creates mental health?” noting any form of mental health promotional content within all documents available. The findings from this analysis process is presented and discussed in the second combined findings/discussion chapter regarding a default mental illness framework in practice, entitled ‘The elephant in the boa constrictor’.