Observation

As a method of data collection, observation has been used in qualitative research for a long time, most often in ethnography, yet is regarded as being applicable to other

methodologies and has been considered by some as being underused (McNaughton Nicholls et al., 2014). It is regarded as a means of understanding a group of people as it affords the researcher the opportunity to record first-hand what they perceive of human interaction and behaviour, a particular setting and events in situ (Simons, 2014) (Yin, 2012). It is used as a stand-alone method of data collection but it is often seen as an adjunct to interviews (Holloway and Wheeler, 2013). It can be used to triangulate data, but it can also illustrate that there is dissonance between the two.

4.4.1

Types of observation

Whilst observation is frequently used as an all-encompassing term, there are different types of observation in which the observer undertakes different roles. The choice of which form of observation is used is dependent on a number of factors such as epistemological perspective, the research question and the role in which the observer feels they can play. Gold (1958) defined four types of observation roles (Gold, 1958), categories which continue to be used today.

91 1. Complete participant – a covert role which can be controversial as the identify and

actions of the observer are concealed (Holloway and Wheeler, 2013)

2. Participant as observer – the observer is known to the group and may develop a close relationship with the group.

3. Observer as participant (non-participant observation) – this is a more formal

involvement for a limited amount of time. The observer is not as involved with actions. 4. Complete observer – no interaction between the observer and those being observed

e.g observation takes place through a two way mirror (McNaughton Nicholls et al., 2014).

The third category, observer as participant is the form of observation that is most commonly used (Creswell, 2013), whereby the observer is known to the group and on a very limited basis interacts with them. It is this type of observation that is to be used in this case study, to observe a discussion regarding the implementation of the created guideline with the purpose being to see whether the understanding of evidence based practice is the same in the wider community and whether barriers and facilitators to implementation can be identified. Observations will also be made and recorded during the guideline

development meetings, during which the evidence reviews will be discussed and

recommendations made to create the clinical guideline. Participants will be informed that observations of the proceedings and discussions will be made. This is similar to a model of data collection used by Conklin et al (2015) who used non participant observations of guideline development meetings as an adjunct to interviews (Conklin et al., 2015). In a study protocol by Grove et al (2015), to look at barriers and facilitators to implementing elective orthopaedic surgery clinical guidelines, they similarly propose the use of

observation, in a range of settings to establish an understanding of how the department either uses or prevents the use of clinical guidelines (Grove et al., 2015). A further study of relevance here, whereby non participant observation was used as well as interviews is by Nzinga (2009) who looked at barriers to guideline introduction and improvements in neonatal care in Kenya (Nzinga et al., 2009 ).

In regards to Gold’s four types of observation there is a clear delineation between being an insider or an outsider to the group being observed (Allen, 2010). As an insider the observer becomes a part of the group they are observing, they may be absorbed into that group and develop an enhanced understanding and relationship with group participants, and as an outsider they are more detached from the group and thus see things from a more objective

92 position (Allen, 2010). The observer may be known to participants and this underpins the debate about the extent to which the presence of an observer has an effect on the actions of the participants, whether positively or negatively. In turn, this has been attributed to the underuse of observation as a method however conversely, it has been argued that it is exactly this that is, the presence of the researcher, what they observe, the effect it has on them, that adds to the richness of the data (McNaughton Nicholls et al., 2014).

A further influence on the role of the observer is that a person cannot divorce themselves from reality and the situational context as an observer comes to the situation with their own perspectives; personal, religious and cultural (Yin, 2012). The transparency of the observation process; the researchers role, why a particular observation focus was chosen, how events were interpreted, how they are influenced by the context they are in and how they influence the study all need to be recorded (Allen, 2010). Observation in this study will be used during the focus group and the guideline development group meetings. The form that it will take will be in keeping with Gold’s (1958) identification of the observer being a participant as the researcher will be the facilitator in both circumstances (Gold, 1958). The focus of observation is to look at the importance of culture; personal, group,

organisational, country, and the role it plays in the healthcare system and the effect it has on evidence based practice.

4.4.2

Recording the observation

The data which is recorded is also influenced by the observer as human nature dictates that they will be selective in what they record. As with the selection of the type of observation, Yin (2010) has identified three ways in which field notes can be recorded and a narrative written as; the researcher trying to recount from a perspective of neutrality, the researcher relaying the participants view or the researcher’s interpretation of events (Yin, 2012). They are all acceptable methods of reporting observational data and their use is dependent on the aim of the data being collected. It is important to have a clear understanding of what will be observed to ensure that there is focus and the observer does not try to capture everything (McNaughton Nicholls et al., 2014). To assist in data collection, some suggest using an observational protocol to guide the data collection process to maintain focus and prevent the observer from being overwhelmed with information (Creswell, 2013). Clarity about the type of data being presented is paramount (Yin, 2009). As a continuation of this, selectivity of what is to be observed is also said to be dependent on the purpose and timing of the observation e.g. whether it is at the beginning of a study, is being used to develop a

93 general understanding or if it is further down the study programme and is for data

collection or triangulation (McNaughton Nicholls et al., 2014).

The method of taking field notes also has an effect on the recorded observation. They need to be detailed and not over summarised to be a representation of the setting and what is seen and heard (McNaughton Nicholls et al., 2014). Notes are generally written, sometimes recorded and later transcribed and in some context they are filmed (Allen, 2010), although filming is not advised by some (Holloway and Wheeler, 2013). It is

important to acknowledge the difficulty of writing all notes as the observation takes place and therefore if additional notes are to be written, they must be done immediately afterwards (Holloway and Wheeler, 2013). Reflexivity plays an important role in

observation as it is advisable that the observer is self-reflective, but not too introspective, as a means of ascertaining why certain events have or have not been captured (Allen, 2010). In this study, the researcher will record the observations during the meetings and add any further observations immediately afterwards. It is important that reflexivity occurs in parallel (Allen, 2010) and therefore the researcher’s self-reflections in this study will also include the reasoning behind observations.

4.4.3

Practicalities of observation

There are a number of practical considerations that need to be addressed when embarking on observation including identifying how access to participants will be achieved. This is most often done through a gatekeeper i.e. the person from whom permission is needed to conduct the observation and also whom may provide access to the people needed to be involved (Green and Thorogood, 2014). Informed consent needs to be granted from participants and from the place in which the observation is to take place (Holloway and Wheeler, 2013). The principles of data protection are the same as in all other research methods (and are outlined further in this chapter). If undertaking non participant

observation, it has been suggested that the observer needs to be sensitive to the situation and maintain a low profile by placing themselves out of the way (Holloway and Wheeler, 2013) and making sure that they are introduced to the group by a group member (Creswell, 2013). Consent will be asked for in this study.

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