Methodology

Research paradigms are frameworks based on philosophical beliefs that are shared by groups of researchers.⁽¹⁴⁶⁾ Paradigms provide a basis for understanding the nature of reality, they guide how researchers approach research and will impact research design.⁽¹⁴⁸⁾ A variety of paradigms are discussed in the literature, each with differing viewpoints. It is important to state which paradigm individual research studies belong in, to acknowledge that the approach taken for the study is one of many and that there are other ways to carry out the research.

67

The pragmatic paradigm was the approach taken for the PoW as it is orientated toward solving practical problems in the ‘real world’^(149,150) and endorses theory that informs practice.^(143,150) Pragmatism lends itself well to this PoW and the personal views of the researcher. The research area was identified from known problems with the current discharge process, both anecdotal and from existing evidence. The pragmatic paradigm was appropriate to explore issues with the current discharge process and use this information to develop a new model of care to improve practice. It is important to note that the pragmatic approach views current knowledge as tentative and changing over time.⁽¹⁴³⁾ As systems and technologies develop with time, knowledge previously collected regarding the discharge process can become invalid and this was taken into account during the study.

Another methodology important to this PoW is grounded theory. This qualitative methodology’s purpose is to construct theory grounded in data.⁽¹⁾ There are several unique features of grounded theory, namely that the concepts out of which the theory is constructed are derived from the data collected during the research process and not chosen prior to beginning the research. Secondly, in grounded theory, research analysis and data collection are interrelated. After initial data are collected, the researcher analyses that data and the concepts derived from the analysis form the basis of subsequent data collection.⁽¹⁾ Regardless of the type of data used, they are analysed by means of a process called constant comparisons. In doing constant comparisons, data are broken down into manageable pieces with each piece compared for similarities and differences. Similar data are grouped together under the same conceptual heading.

Through further analysis, concepts are grouped together by the researcher to form themes. These themes are integrated around a core theme which provides the structure of the theory.

Within the qualitative phases of this PoW the principles of grounded theory were utilised to carry out data analysis and develop themes based on the data. However for the purpose of this PoW a theory was not constructed as is usual for grounded theory.

Within the qualitative phases of the PoW, topics discussed during data collection

68

developed based on the findings from the analysis of the initial data collected from participants. Analysis was also grounded in the data, using the principles of constant comparisons to establish emerging themes.

Different methodologies exist for carrying out research. These broadly fall under either quantitative or qualitative approaches. Quantitative research is used to measure the research problem by generating accurate numerical data. Qualitative research is usually exploratory, involving in-depth discussions with participants leading to rich data sets. As such, qualitative data can be seen as more subjective than quantitative research. The qualitative approach is used to understand opinions and reasons and tends to address the questions what, why and how. The type of method chosen will depend on the research problem and what type of data would be most appropriate to address the problem.

In some circumstances, a combination of both qualitative and quantitative would be the most appropriate approach. Mixed methods research is the use of quantitative and qualitative methods in a single study or series of studies.⁽¹⁵¹⁾ This methodology is increasingly used by health researchers, especially within health services research.⁽¹⁵¹⁾ The underlying assumption of mixed methods research is that it can address some research questions more comprehensively than by using either quantitative or qualitative methods alone.⁽¹⁵⁰⁾ Research questions that profit most from a mixed methods design tend to be broad and complex, with multiple facets that may each be best explored by quantitative or qualitative methods.⁽¹⁵¹⁾ The research problem of discharge from hospital is a broad and complex issue and requires a combination of quantitative and qualitative methods to resolve.

Pragmatism, the paradigm adopted by the PoW, lends itself to mixed methods as it frees the researcher to use a range of approaches to best understand the research problem.⁽¹⁵⁰⁾ Mixed methods were appropriate to address the overall aim of the PoW, as each phase required different research strategies to enable a thorough understanding of the research problem from different perspectives, either confirming or providing an

69

alternative explanation, enhancing trustworthiness of the data. A range of methods were therefore employed to use the appropriate method for each individual phase, to meet the aim of each phase. The methods complemented each other and benefited from the strengths of each method whilst allowing the biases from individual methods to be overcome by the strengths of the other methods. The subjective bias of the researcher was a disadvantage, which cannot be removed. Reflexivity was adopted by the researcher to identify if her views influenced the research.

The individual methods used throughout this PoW have been discussed within their respective sections in this chapter. Triangulation is a well-documented advantage to mixed methods research, whereby the same research problem is explored using different methods. The PoW followed a concurrent triangulation design whereby both exploratory qualitative and explanatory quantitative methods were used separately, independently and concurrently in different phases.⁽¹⁴³⁾ The findings were then compared to assess their convergence⁽¹⁴³⁾ to form a clearer picture of the research findings.