Methodological implications

This thesis contains several methodological implications for synthesising qualitative research. The five stages of the meta-synthesis (Walsh & Downe, 2005; Hammell, 2007; Thomas & Harden, 2008) appeared at the outset to be straightforward and in essence easy to follow. There were however some limitations that arose due to the methodology of the meta- synthesis, which may have importance in future work. Firstly, studies that included other

156 disabilities outside of SCI were excluded because the results did not always identify the participants’ quotes with their disability. Secondly, some original data points were not included in the data extraction process because the authors did not explicitly relate participant quotes to LTPA. Therefore there could be other benefits, barriers and facilitators to LTPA that remain to be addressed, but which could not be definitely identified. Whilst the meta- synthesis in chapter three does not claim to have identified all of the barriers, benefits and facilitators to exercise, it has recognised the relationship between these factors and PA promotion. Therefore researchers in the future need to be clearer when presenting their research findings to avoid these issues.

Thirdly, in regards to the conduct of a meta-synthesis, I would recommend that authors of future meta-syntheses keep a detailed reflexive journal of their decision making process throughout the five stages. A highly developed reflexive ability is required when conducting a meta-synthesis (Walsh & Downe, 2005) to enable the researchers to apply the same standards of quality to their work as they expect of the papers they are synthesising. Comparing and synthesising different data sets between different qualitative methodologies was not easy. However I aimed to preserve the meaning from the original text in the form of raw data as far as possible. As Walsh and Downe (2005) explain, this is because the “goal is to increase understanding, leading to a greater explanatory effect, rather than to aggregate and merge findings” (p.209). I first compared and synthesised the data for barriers, benefits and facilitators of PA individually before generating analytical themes across the data sets. I therefore presented the final themes as a collective of barriers, benefits and facilitators of PA.

The fourth implication relates to judging the quality of the research papers. As stipulated in chapter three, this stage has been proposed as vital in a meta-synthesis to avoid including studies with methodological deficiencies and drawing unreliable or misleading conclusions (Hammell, 2007; Thomas & Harden, 2008; O’Connell & Downe, 2009; Gough et al., 2012). This is however not a straightforward task. There is no agreed method by which to make this assessment for quality and rigour which is reflective of the larger issue around judging qualitative research in general (see chapter four). Many meta-syntheses use a pre- determined universal list to appraise quality which is potentially problematic if this does not take into account the different philosophical positions and epistemological assumptions underlying different qualitative research methods (Sparkes & Smith, 2009). For example, pre- determined lists of criteria have been used to judge the quality of research studies within both sports (Jefferies et al., 2012) and health literature (Hammell, 2007; O’Connell & Downe,

157 2009). Having a pre-determined set of quality criteria can limit meta-syntheses in two further ways:

Firstly, studies including important and robust findings may often utilize unorthodox yet perfectly valid methods. Such studies would be excluded from many systematic reviews. Secondly, some studies, whilst perhaps being methodologically flawed in part, or with overall findings that do not appear important or relevant, may still be able to offer important insights into phenomena, or may contain important findings in part, whilst not doing so as a whole (Weed, 2006, p.130).

Alternative criteria should be used to judge qualitative research whereby judgements are made based upon lists of criteria that are appropriate to the form of inquiry (Sparkes & Smith, 2014). These criteria are not universal or static in nature, but are lists of characterising traits that can change over time and in different contexts. To compensate for differences in methodology, I drew upon the considerations for judging qualitative research in meta- syntheses as proposed by Garside (2014). Garside recommends that papers in qualitative systematic reviews should be appraised based on criteria of trustworthiness (epistemological aspects), theoretical considerations and practical (technical) considerations. Garside suggests that rather than using one checklist, this method allows for “careful consideration of the study within its own terms” (2014, p.11).

All that said, difficulties did arise when judging the quality of the research papers because some did not explicitly identify their conceptual/theoretical framework and form of inquiry. As Garside (2014) notes, qualitative papers frequently focus on the research findings at the expense of detailing their methodology. Overall there is a lack of consensus in the qualitative community over the methodological detail required for a research article (Garside, 2014; Sparkes & Smith, 2014). By ignoring the methodological detail of the research, researchers are not providing the specificity or reflexivity that is required to reflect on such issues as the strengths and weaknesses of their chosen qualitative methodology (see Sparkes & Smith, 2014). It would be of benefit for future qualitative research to therefore include details of their methodology and the conduct of their work. This is because “without a picture of what was done, it is difficult to make any judgement about whether this is likely to produce meaningful, trustworthy findings” (Garside, 2014, p.10).

Lastly, this thesis contains methodological implications that extend our knowledge and understanding of narrative inquiry. In particular, this thesis advances the methodological

158 application of narrative by drawing upon a range of data sources in a dialogical narrative analysis (see chapter nine). A dialogical narrative analysis is an innovative approach that treats stories as actors in people’s lives. Therefore the primary concern is with how stories act (Frank, 2010, 2012). Through observational and reflective data I was able to record and deliberate on the actions of the clients at Neurokinex as they acted out elements of their stories in interactions with their trainers, family, friends and peers. Applying Frank’s (2010, 2012) dialogical questions to all three data sources (i.e. interview, observational and reflective data) lead to novel findings regarding people’s motivation to participate in ABR. For example, through a dialogical narrative approach I was able to conceptualise a narrative typology regarding the clients’ stories of hopes and expectations of ABR. The first two narrative types – exercise is restitution and exercise is medicine – were conceptualised through both what was said in interviews and what was done in narrative’s everyday practice (Gubruim & Holstein, 2009). Stories of exercise is restitution aligned with hopes of walking again while stories of exercise is medicine conveyed a hope for living well with SCI. However, I was also observing stories in action whereby hopes and expectations were not defined and in some instances remained unexpressed, or silent. It was only after further dialogical analysis and reflection of this observational data, I was able to identify a third narrative type; exercise is undefined possibilities. In this instance the field notes were critical in identifying a narrative thread that was silenced from both interviews and everyday interactions (see dialogical narrative analysis in chapter four and critical reflections: Box 9.2 in chapter nine).