Locating this study within a constructivist-interpretive paradigm

The primary aim of this study, described in Section 1.2 was to identify, analyse and describe the self-perceived professional identities of pharmacy educators within the South African context. Furthermore, its objectives were to describe the many factors which might have contributed to the formation of their professional identities, including participation in multiple communities of practice and to determine the attitudes, beliefs and behaviours of the participants with respect to the philosophy and practice of pharmacy, pharmaceutical care and pharmaceutical education. In essence the study was seeking to provide or reflect an in- depth understanding of a complex concept – the professional identities of pharmacy educators. Although professional identity is a form of social or collective identity, it remains an individual-based perception of what defines the “us” associated with group membership (Onorato & Turner, 2004, p. 259) (see Section 3.1.1). The focus of the study was therefore on the individual participants and idiographic in nature and there was no intention to create universal or generalisable theories.

Within the context of the identity literature reviewed in Chapter 3, it became apparent that by its very nature identity is contextual, relational, dynamic and constructed through narrative (Rodgers & Scott, 2008) (see Section 3.1.2). Identity is a social construct that is dependent

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on the “personal, ethnic and national context” within which it is constructed (Billot, 2010, p. 711). Moreover, identity is formed through and in relationship and therefore “necessarily becomes a multiple and shifting affair, in process and changeable” (Rodgers & Scott, 2008, p. 736). And it is through the ability of narrative to transform “knowing into telling” that identities can be constructed (Dyer & Keller-Cohen, 2000, p. 284)

Furthermore, as described in Chapter 1, the study emerged from my own personal story, experiences, and beliefs, and as the researcher I recognised the subjective nature of the study. I also acknowledged that through the study I was not only looking to deepen collective understanding of the professional identities of pharmacy educators, but to provide opportunity for the study participants, and myself, to do what Smith (2000, p. 10) describes as the “heavy mental work” of deep reflection on “who” we are as educators.

For all of these reasons, it seemed appropriate that this study should not only be located within the qualitative research tradition but more specifically be situated in a constructivist- interpretive paradigm. Within this paradigm, the focus is primarily on understanding and producing descriptive analyses that highlight deep, interpretive understandings of multiple perceptions and experiences. This is consistent with the aims and objectives of the study which sought to understand and describe the perceptions and beliefs of pharmacy educators. Moreover the underlying intentions of this study and the assumptions regarding the nature of identity which became evident in the literature review are congruent with the philosophical foundations underpinning the constructivist-interpretive research paradigm.

4.3 Research design and process

Research design is concerned with translating the epistemological and ontological assumptions of the research paradigm into “distinct methodological strategies” which support the research objectives (Krauss, 2005, p. 764). When the research objectives are concerned with describing deep understanding of complex human experience and perceptions, such as identity, it is as Denzin and Lincoln (1994, p. 2) propose, useful to employ a “wide range of interconnected methods” in an effort to get “a better fix on the subject matter at hand”. Furthermore, the use of diverse methods of gathering data from various sources “can provide richer data, encourage reflexivity and help to increase the comprehensive understanding of phenomena” (Johnson & Waterfield, 2004, p. 126).

Therefore in order to both enhance understanding and provide for a level of “completeness”, and in keeping with the notion underlying qualitative research that there is no single truth and consensus is not the goal, methodological triangulation was employed in this study (Johnson

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& Waterfield, 2004, p. 126). Triangulation involves the researcher gathering data from different sources or from using different research methods. Denzin (1978) identifies four basic types of triangulation: 1. data triangulation where a variety of data sources are used; 2. investigator triangulation which makes use of several different researchers; 3. theory triangulation which makes use of multiple theories in the interpretation of a single set of data, and; 4. methodological triangulation in which multiple methods are used to study a single problem.

This study was conducted in three phases (Figure 4.1), and each phase made use of a different method. The first phase employed narrative interviews and narrative analysis (Clandinin & Connelly, 2000) to gain an in-depth understanding of pharmacy educators’ perceived professional identity and to explore how their lived experiences, across various communities of practice, formed their self-concept. A focus group approach was used in the second phase, to explore, within a broader interactive context, some of the factors and communities of practice identified by participants in the first phase, as contributing to development of professional identity. The third phase of the study made use a purpose- designed qualitative questionnaire, developed from the insights gained in the first and second phases, to further explore the self-perceived professional identity, attitudes, beliefs and practices related to pharmaceutical care and the socialisation of students into the pharmacy profession, with a wider base of pharmacy educators in South Africa. The emphasis on widening the participation base throughout the three phases was on deepening understanding rather than trying to explore universals in order to develop generalisable theories.

Phase One Narrative Analyisis

•In-depth narrative interviews and email follow-up •n=8

Phase Two Focus groups

•Two focus groups (n=10)

•Explored the factors which emerged from Phase One

Phase Three Questionnaires

•Questionnaire survey with pharmacy educators (n=32) •Open-ended qualitative survey constructed with factors

emerging from Phases One and Two

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Throughout these three phases, as the researcher, I adopted an emergent or flexible approach to the research. In adopting this approach, I reserved the right to explore unexpected findings that may have contributed to the understanding of the participants’ experiences, if and when they materialised. This feature of qualitative research that allows unexpected discoveries to be explored by the researcher if they emerge is called “emergent design flexibility” (Patton, 2002, p. 244).

4.3.1 Phase 1: Narrative analysis

This first phase of the study employed a thematic narrative method of analysis of in-depth narrative interviews in order to explore the self-perceived professional identity of eight pharmacy educators and to determine how their experiences, as lived and told through stories, formed the basis for their professional identity. Narrative analysis is a cluster of analytical methods used for analysing texts that have a storied format in common (Riessman, 2008). Riessman (2008) classifies these narrative analysis approaches into two broad types, thematic and structural. The thematic approach seeks to explore and uncover meaning within a story or stories, while the structural approach focuses on the composition of a story or stories to identify “particular communicative aims” (Riessman, 2008, p. 539).

Narrative analysis is a form of qualititative research which Clandinin and Connelly (2000, p. 20) define as

T a way of understanding experience. It is collaboration between researcher and participants, over time, in a place or series of places, and in social interaction with milieus. An inquirer enters this matrix in the midst and progresses in this same spirit, concluding the inquiry still in the midst of living and telling, reliving and retelling, the stories of the experience that make up people’s lives, both individual and social. Simply stated T narrative inquiry is stories lived and told.

They further suggest that it is a research method that uses a variety of field texts, including: stories, autobiography, journals, field notes, letters, conversations, interviews, family stories, photos, other artefacts, and life experience, as data sources (Clandinin & Connelly, 2000). Narrative analysis recognises the extent to which the stories which people tell provide insights into their lived experiences, perceptions and beliefs (Thorne, 2000). Furthermore, the narrative approach, as a qualitative research method has been recognised for its acknowledgment of the subjective experiences of individuals (Parker, 2005).

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Since identity can be considered to be constructed through narrative (see Section 3.1.2.4), as Robertson (1998, p. 1) proposes, narrative analysis provides a tool “for getting at the relationship between ideas, experience and action; for understanding how identities are constructed and reconstructed in specific contexts and over time; for explicating ‘how things are connected’”. Furthermore McCormack (2009, p. 142) suggests that it is through stories that individuals “construct and reconstruct their sense of self as they learn to ‘be’ in the world”. Therefore, narrative analysis is not only a tool for understanding identity, but it is also a means by which the storytellers or participants can also fashion their identity and learn about themselves (Larsson & Sjöblom, 2010). Singer (2004, p. 438) goes so far as to suggest that: “To understand the identity formation process is to understand how individuals craft narratives from experiences, tell these stories internally and to others, and ultimately apply these stories to knowledge of self, other and the world in general”.

Stories are characterised by ordering and sequence and therefore they not only have the potential to impart knowledge but to provide insights into how they evolved (Larsson & Sjöblom, 2010). Thus, in addition to revealing and even creating identity, stories have the potential to provide insights into the factors and processes which contributed to the development of identity:

The individuals and how they position themselves according to agency and their imagination determine what gets included and excluded in the story, how events are put together and what they mean. Individuals piece together past events and actions in their personal narratives to claim identities and construct their lives. (Larsson & Sjöblom, 2010, p. 276).

The words “story” and “narrative” are often used interchangeably, but they are essentially different. As Riley and Hawe (2005, p. 227) suggest, the difference relates to “where the primary data ends and where the analysis of that data begins”. The told stories are the primary data, but it is the analysis of the stories through interpretation by the researcher that transform them into narratives. Narrative analysis involves the eliciting and collection of stories and also the analysis or interpretation of these into narratives to make known the meaning.” Therefore in narrative analysis, not only is the process of eliciting stories, and the methods used to analyse them important but the relationship between the researcher and the researched is an integral part of the study and can have a significant impact on the narrative interpretation and outcomes (Johnson & Waterfield, 2004; Larsson & Sjöblom, 2010).

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In the current study stories were elicited through narrative interviews and analysed using thematic analysis. The emphasis was on what the narratives communicated, rather than on the structure of the narratives. A more detailed account of thematic analysis will be provided in the sections that follow. However, prior to providing a more detailed account of the research process and the specific research methods employed in this study, the role of the researcher needs to be explained.

4.3.1.1 Role of the researcher

Maykut and Morehouse (1994, p. 123) suggest that:

The qualitative researcher’s perspective is perhaps a paradoxical one: it is to be acutely tuned-in to the experiences and meaning systems of others - to indwell - and at the same time to be aware of how one’s own biases and preconceptions may be influencing what one is trying to understand.

This is especially true when the researcher is an “insider” and shares the distinctive characteristics, roles, involvements or practices under study with the participants (Corbin Dwyer & Buckle, 2009, p. 55). Being an “insider” can be beneficial since it may provide the researcher “access, entry and common ground” from which to begin the research (Corbin Dwyer & Buckle, 2009, p. 58). However, in order to prevent undue bias and influence on participants’ responses and on interpretation of findings the “insider” researcher needs to develop and maintain an acute awareness of his or her personal standpoint and possible predisposition and preconceptions. Furthermore, Connolly (2007, p. 453) proposes that in reporting on narratives, an explicit elucidation of the researcher’s stance, social location, personal experiences, and subjectivity, assists in understanding “where the voice of the researcher exists in the narrative”. Similarly, Patton (2002) contends that a qualitative researcher needs to maintain a reflexive stance throughout the research process, in order to balance their understanding of the perceptions of participants with that of their own. Citing several authors Nollet (2009, p. 55) argues that a qualitative researcher has to make explicit and “bracket” her preconceptions and biases in order to fully comprehend the research participants’ points of view or stories.

Researcher reflexivity which can be defined as “an attitude of attending systematically to the context of knowledge construction, especially to the effect of the researcher, at every step of the research process” is an important aspect of the qualitative research process (Cohen &

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Crabtree, 2008). Angen (2000) explains that reflexivity attempts to identify, understand, and value the researcher’s seminal participatory role in shaping the data rather than attempting to objectively maintain distance from the research. Citing Sim and Wright (2000), Johnson and Waterfield (2004, p. 128) propose that researcher subjectivity can serve as a research resource, rather than be viewed as a source of bias or error, and that reflexivity can “lend plausibility to the findings”. This argument supports the proposal of Mays and Pope (2000) who contend that the explicit disclosure of personal and intellectual biases by the researcher can enhance the credibility of research findings.

Citing Hawes (1998), Russell and Kelly (2002, p. 3) suggest that the goal of reflexivity is to "turn the researcher's gaze back upon oneself for the purpose of separation and differentiation”. They further suggest this can be achieved through self-examination of one’s personal assumptions and goals, and the elucidation of one’s belief systems and biases through the keeping of self-reflective records and journals. In addition, Connolly (2007, p. 453) suggests, that reporting on participants’ narratives in a narrative analysis should include an auto-ethnographic report in which the “researcher provides an account of his or her own voice, stance, assumptions, and analytic lens so that the reader is abundantly clear on whose story is whose.”

Since this research arises, in part, out of my own (the researcher’s) personal interest and questions about my professional identity as a pharmacy educator, it was important in the context of this study to tell and explore my own narrative. Therefore, in Chapter One I provide an auto-ethnographic report. In this manner, my experiences, position and subjectivities have been “bracketed” or made explicit. This not only served to enhance my own awareness of my preconceptions and biases but will hopefully assist the reader in being able to better identify my voice in the reporting and analysis of participant narratives.

Furthermore, in the interests of researcher reflexivity, throughout the research process I maintained a reflective research journal (Ortlipp, 2008). This created a means of critical self- reflection throughout the research process and allowed for examination of my own personal assumptions and beliefs. It also assisted in making the “messiness of the research process” visible to myself and supported understanding and implementation of the research design, methods and approaches.

4.3.1.2 Narrative analysis participants

Eight pharmacy educators, one from each school, department or faculty of pharmacy in South Africa were included as participants in this phase. A maximum variation, purposeful

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sampling approach was adopted (Patton, 2002). As Johnson and Waterfield (2004, p. 124) advocate, the aim of the sampling approach in qualitative research is not to achieve “statistical representativeness”, but rather to reflect the diversity within the study population. The participants were therefore, as far as possible, diverse in age, gender, race and teaching experience, and representative of the various disciplines within pharmacy.

A summary of the participants’ demographic details is provided in Table 5.1, however in the interests of maintaining participant confidentiality, some details, for example race have not been included in the table. There were five female and three male participants and the ages ranged from 29 to 55+. Each of the four traditional subject disciplines within pharmacy: pharmacology, pharmaceutics, pharmaceutical chemistry and pharmacology were represented, as were all of the major racial groups. As indicated in Table 5.1, each participant was allocated a pseudonym. These pseudonyms were allocated by myself after analysing each interview and were chosen to reflect some aspect of the participants’ professional identity. In the interpretation of each of the stories in Chapter 5 an explanation of the origin and meaning of each pseudonym is provided. The choice of pseudonym was also checked with each of the participants. All participants indicated that they were satisfied with the selected pseudonym.

The study was aimed specifically at pharmacy educators, who were themselves registered pharmacists and who were not only working within a university environment, but were also teaching on an undergraduate pharmacy programme. The inclusion criteria therefore required participants to be registered with the South African Pharmacy Council as a pharmacist and to be teaching on an undergraduate pharmacy programme.

A general letter requesting permission to invite participation in the study was sent to all the heads or deans of each of the pharmacy departments, schools or faculties at the universities which offer an undergraduate pharmacy programme (Appendix B). These included: Rhodes University, North-West University, University of Limpopo, University of the Western Cape, Nelson Mandela Metropolitan University, University of Kwazulu-Natal, University of Witwatersrand, North-West University, University of Limpopo – Medunsa Campus, and Tshwane University of Technology. A further letter outlining the study and inviting participation was sent, via email, through the heads or deans to all pharmacy educators. (Appendix C). This general invitation only elicited one spontaneous offer of participation. Further potential participants at each university were then identified and personally invited by the researcher via email, to participate. Prior to the interview the participant was asked to complete and sign the consent form (Appendix D).

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4.3.1.3 Narrative analysis process

The approach to this phase of the study was based on that outlined by Clandinin and Connelly (2000) and essentially employed a movement between three sets of questions: the transition from field experience to field texts (the interviews and email communication), from field texts to research texts (preparing interview data and email communication for analysis, including transcription from oral speech to written text), and finally from research texts to the research account (including analysing, verifying and reporting).

4.3.1.3.1 The interview process

The field experience consisted of eight in-depth interviews, conducted by the researcher with the participants. Following the interviews, the participants were invited to keep the interview process on-going, through email communication. It was felt that this would provide the participants the opportunity to add any thoughts which might emerge on reflection, after the interview. However, none of the participants did so, and beyond their email responses to the “member checking” process employed to verify the trustworthiness of the data (see Section 5.10) no further email correspondence was included as field text.