Ensuring quality in the research process

For any research project to be valuable, it is crucial to demonstrate the quality and the integrity of the entire research process. Qualitative researches are often criticised as lacking scientific rigour and justification of the methods; mostly they are considered to produce anecdotal evidence, are biased by the researcher`s predispositions and it generally lacks generalisability (Sandelowski, 1993; Rolfe, 2006; Pope and Mays, 2013). What constitutes rigour or quality in qualitative research has been a subject of debate amongst scholars and as such, there is no consensus regarding the standards by which the quality of qualitative researches is judged (Cutcliffe and McKenna, 2004; Rolfe, 2006; Parahoo, 2014). Silverman and Marvasti (2008) argue that the quality of any research should be assessed using criteria

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which are considered appropriate and that the perception of the credibility of a research comes from those judgements that are made using such criteria. The criteria will vary according to the different approaches such as phenomenology, critical theory, ethnography, grounded theory, and feminist inquiry (Silverman, 2017).

The term “rigour” which denotes quality in research process was replaced by the term “trustworthiness” for judging naturalistic inquiry (Lincoln and Guba, 1985). Although no definitive criteria exist for the evaluation of quality in qualitative research, the use of clear evaluative criteria enhances the transparency of the entire research process, the critical thoughts undertaken in the research and the personal values of the researcher (Patton, 2014). This research established trustworthiness through the concepts of credibility (internal validity), dependability (reliability), confirmability (objectivity or reliability), and transferability (external validity or generalisability) (Box 5).

Box 5: Criteria for the assessment of the quality of naturalistic inquiry (Lincoln and Guba, 1985)

Credibility Refers to the truth or believability of the research findings

Dependability Demonstrating that the findings of the study are consistent and could be repeated

Confirmability Refers to the extent to which the findings of the research are shaped by the participants` and not the researcher`s interest or motivation

Transferability Demonstrating that the findings can be applied in other settings similar to those of the study

In this study credibility was achieved through rigorous in-depth field work, the truth of the participants responses gathered overtime using repeated measures allowing confirmation and changes in opinions and experiences to be captured. Primary interview data was supported by collating patient clinical indicators as a measure of adequate dialysis. The researcher ‘self’ within the research was acknowledged at the outset through a critical self- reflection and reflexivity which continued throughout the period of data collection (Patton, 2014), having a Nigerian background facilitated a deeper understanding of the embedded culture. Dependability describes the constancy of the research data over a similar condition (Tobin and Begley, 2004; Polit and Beck, 2012), addressed through a robust audit trail using Halpern`s (1983) categories for reporting information (Box 6). All the methodological and analytical decisions made during the entire research process were clearly documented giving

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a transparent account of the research steps taken and the rationale for taking the steps; from the commencement of the research project to the development and reporting of the research findings. The accuracy of the interview transcriptions was considered essential and checked by reading the transcripts whilst listening to the interviews.

Box 6: Audit trail of essential information

Category Audit trail

Raw data All audio recordings, interview transcripts, field notes, journal excerpts, and copies of documented information from the participants` hospital files were stored securely and available for external scrutiny. All the interview data were anonymised before the storage.

Data reduction and analysis products

The steps taken in coding each interview transcripts and the synthesised findings are stored in a secure computer whereas the hard copies of word documents are available for examination and some are attached at the appropriate appendix section of the research report.

Data

reconstruction and synthesis products

The process of theme development, the relationships between the themes and the existing literature, the findings of the research, the conclusions, the final report and its connection to exiting literature are all stored securely electronically as Word documents readily available for examination. Process notes All the decisions made were recorded in the form of field notes, in a

reflexive journal used as part of the data set, alongside research supervision forms and the research report.

Materials relating to intentions and dispositions

Copies of ethical approvals for the research, participant information sheets which contain details of the proposed research are included in the

appendices. The research proposal is available on request, and a copy held by the Ethics and Research Committee of the University.

Instrument development information

All the forms and guides used in the conduct if this research is included in the appendices section of the research report.

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Confirmability refers to the extent to which the findings of the research were shaped by participants` and not the researcher`s interest or motivation. To enhance the confirmability of the research I maintained a reflective diary throughout the period of the study, had constant critical discussions with my supervisory team, and most importantly validated the research findings using QLR with the participants themselves, where possible. The interpretations of the findings and the conclusions will be discussed in Chapter 6; rich quotes of the participants` responses to the interview questions and the extracts from my reflexive journal will be included to demonstrate how each theme was derived (Cope, 2014). These confirm the authenticity of the research and the relevance of the new knowledge generated in enhancing clinical practice. No previous other study has explored the experiences of ESKD patients receiving dialysis services in healthcare systems with unequal access to healthcare. Therefore, the findings of this study are unique and invaluable to ESKD patients, the healthcare providers and the government in shaping the healthcare policy in the country.

Transferability refers to findings that can be applied in other settings or groups like those of the study (Polit and Beck, 2012; Houghton, Casey, Shaw and Murphy, 2013). It replaces the concept of generalisability or external validity which is associated with the positivist paradigm. This is perhaps more difficult to achieve in qualitative research as the focus in not on generalising findings. However, the similar themes across individual accounts (discussed in the following chapters) reinforces the transferability and applicability of the findings to other ESKD patients, the healthcare setting and the wider Nigerian context.