ENSURING RIGOUR

Rigour is an essential element of qualitative enquiry, answering challenges as to its credibility, objectivity and generalisability. Green and Thorogood (2014) have identified five elements to promote rigour, which were considered in this project:

• Transparency requires a clear and accurate description of my research process, from conception through to completion.

• Maximising validity requires a sophisticated reading of the data, considering alternative interpretations and providing sufficient contextual information for a reader to draw his or her own conclusions.

• Maximising reliability relates to replication of research and the likelihood that this would produce similar results.

• Comparison of cases within the data set is vital for producing valid and refined theories about the topic under study.

• Reflexivity involves recognising the researcher as part of the process, and identifying the potential influences thereof.

I made use of several techniques in order to improve rigour in my study. Some were ongoing throughout my research process and others took place at certain points. In order to fulfil some of the requirements of reflexivity, I actively engaged in reflective journaling. Observations of, and perspectives on, my study were recorded, and the potential influence of researcher subjectivity upon these observations was consistently scrutinised. In order to address the challenges of trustworthiness, I engaged in peer debrief with my peers and expert researchers throughout the process. This continuous dialogue served to critique certain readings or interpretations of data, proved useful for generating novel ideas and theories and afforded an opportunity to openly discuss my personal views and concerns as these occurred during the data collection phase.

Individuals from the fields of philosophy, bioethics, anthropology, psychology and sociology were consulted.

Transferability in qualitative research is similar to the notion of generalisability in the quantitative paradigm. In both forms of enquiry, this is related to sample size and participant selection. Malterud (2001) argues that even with the most scientifically stringent choice of method, study findings can never be generalised on a universal basis. Just as a quantitative researcher may base sample size and selection on an

analysis accounting for a specific degree of generalisability on the outcome, so qualitative researchers are tasked with considering the extent to which their findings will be transferable to other settings (Malterud, 2001). However, qualitative

methodologies do not aim to present findings which are valid for population groups at large, but are rather situational descriptions, recollections and observations (Malterud, 2001).

The transferability of my research hinges upon its substantial sample size, a

geographically, socio-economically and demographically diverse study population and the variety of data gathering methods used, all of which have been discussed in substantial detail in this chapter. Transferability also lends itself to internal and external validity. External validity examines the contexts in which findings can be applied. Internal validity is concerned with the study results and whether these have served to adequately address the specific study questions (Malterud, 2001). It appears from my results that some of my findings may be applicable to other developing world contexts which host transplant programmes. This is especially relevant because a number of the contextual factors which have been found to influence transplant in South Africa are also evident in other countries. However, my research may most accurately be applied to other South African provinces which have transplant

programmes. The internal validity of my research also seems to have been achieved, as the study sufficiently addressed my research objectives and also identified

unexpected trends.

It has been argued that careful and uniform reporting of qualitative research studies can also help to improve rigour (Tong, Flemming, McInnes, Oliver & Craig, 2012; Tong et al., 2007). In light of these arguments and in order to enhance the rigour of my research I have described and explained my methodology in particular detail in this thesis. I have paid careful attention to explaining every aspect of my data collection process thus promoting research transparency and the concept of transferability.

I undertook member checking where results and themes were discussed with some participants and their views were sought (Green & Thorogood, 2014). However,

according to Green and Thorogood (2014), member checking requires circumspection because it relies on the notion that respondent agreement with the research

interpretation confirms a valid finding. However, the findings of qualitative studies are subjective and do not purport to be absolute truths upon which there is universal consensus. Hence, I treated these feedback sessions in terms of overall agreement, not based on individual sentiment. I also presented sections of my findings in various forums attended by health professionals, some of whom were involved in organ transplant. These sessions invoked substantial discussion and served to confirm some research results and analysis, especially those related to hierarchy and continuity of care. This engagement with peers and participants assisted me in promoting

reflexivity, as I was able to discuss my attitudes towards the topic with others, some of whom expressed differing personal positions and opinions.

7.16. SUMMARY AND CONCLUSION

This chapter has described the process followed when undertaking the fieldwork and analysis for my study. It has addressed my methods in substantial detail in order to promote transparency and trustworthiness. It has examined methodological choices in detail and located these within the paradigms of pragmatism and constructionism.

Data analysis methods have been described and finally the chapter has addressed the concept of rigour and how it was promoted in my research.

CHAPTER 8 – RESULTS