Validity
An action research group provided the opportunity to focus on a phenomenon of interest. Discussion and understanding of the subject, from multiple perspectives then occur whilst collaborative working relationships were established. It is these complexities of social interactions between individuals and professional groups, which have been explored to establish the validity of action research (Anderson & Herr 1999). Analysis of PAR needed to encompass an understanding of how an effective pre-dialysis
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educational toolkit is created. Equally important however, was the process by which this is achieved and policy was formulated and implemented.
Adaptation by Newton & Burgess’s (2008), of Anderson & Herr’s (1999)
action research validity framework, identified specific primary and secondary validation issues, which were specific to the research mode. These are defined in Table 4.0.3 Action Research Mode Primary Validity Secondary Validity Knowledge generating
Outcome validity Democratic validity
Dialogic
Va
lid
ity
Process Validity Catalytic validity Practical
(improvement of practice)
Catalytic validity Process validity Outcome validity Democratic validity Emancipatory Democratic validity Process validity
Catalytic validity Outcome validity
Newton & Burgess’s (2008) adapted from of Anderson & Herr’s
(1999)
Table 4.0.3 Action research modes & corresponding validities
The validity framework offers a clear and transparent approach to detailing the PAR or practical mode. Primary validities aimed to establish to what extent the primary goals of the PAR have been achieved. Catalytic validity focused on the process whereby participants deepen their understanding and are motivated to social action. Outcome validity identified the extent to which the research outcomes were successful. Secondary validity focused on the research mode domain. Process validity was concerned with the evidence needed to sustain assertions. Finally, democratic validity recognized the extent of collaboration amongst stakeholders. Though action research is not
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a traditional positivist paradigm, use of such a framework aimed to maintain and make explicit the rigour of a systematic approach.
On-Going Cyclical Analysis
Participant action co-researchers did not represent a homogenous group and it was this diversity, which was key to reflecting the disparate interests of local stakeholders (Boser 2006). Action research meetings provided a forum where experiences was described, qualified, contextualised, interpreted and conclusions drawn about their meaning, implications and the actions generated. Thus, a decision trail was created, to enable key points in the cyclical process to be identified, and if required, revisited. In this way the analysis and interpretation derived from the meeting was taken back into the educational intervention. Implementation over an identified period and further experiences were brought back to the action research meeting. This process was one of collectively and continuously acting on reflection and then reflecting on the action for the duration of the study. The cyclical nature of action research allowed the knowledge and skills that pre-dialysis educators have or need, to emerge and indicated where there are gaps between theory and practice. Some processes were unsuccessful, while others were implemented effectively.
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Reflexivity and Objectivity/subjectivity
An additional challenge for PAR study validity was the influence the researcher as an individual brought to bear upon how the research was conducted. As an experienced renal nurse with an interest and active role in dialysis patient education, I was aware that I had preconceived notions about education and the role it can play in care delivery. It is vital that any influence this may have brought to bear upon the research was recognised and acknowledged. The researcher employed reflexivity, an overarching process of critical self-awareness in qualitative methodologies. As a consideration for all qualitative research paradigms, reflexivity required careful deliberation in relation not only to the PAR methodology described but indeed the interview and grounded theory approaches employed within this study.
Reflexivity can be defined as the researcher’s awareness of their influence, upon the research process, gained through critical self-awareness. This occurred on multiple levels and reflexive complexity was increased in this mixed methods study. The on-going process of critical self-awareness aimed to make explicit the influence of the researcher on the research, and conversely the influence of the research on the researcher.
At one time emphasis was on the need for researcher objectivity, and this was influenced by traditional positivist stance, whereas contemporary qualitative research approaches acknowledge that such neutrality is not feasible. The shift in belief from researcher objectivity, to acknowledgement of subjectivity and the need for transparency of reality, is advocated by
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Marcus (1994). It was the use of reflexivity that recognised and made explicit reciprocal relationships in the research (Lamb & Huttinger 1989).
Dowling (2006) highlights how epistemological reflexivity requires the researcher to question the ways in which the research questions could have been defined and investigated differently. Epistemological reflexivity, it could be argued, is central to grounded theory where experiences from previous interviews are bought to, and influence the on-going, research data collection. As the research data influences the researcher, in turn the researcher then influences the research. Throughout the research process,
the use of a reflexive diary facilitated exploration of one’s subjective attitudes
and beliefs. It can be argued that this was further enhanced by a clinical supervisory relationship, able to explore the tension between being an object and a subject (Dowling 2006). Within the PAR arena similar tensions were achieved through the interplay with critical friends established to challenge the researcher’s self-deceptions (Northway 2000b).
The feminist experiential stance was particularly appropriate with its reflexive approach to conducting unstructured interviews and in collaborative PAR. The necessity for engagement rather than detachment (Sandelowski 1986), expected reciprocal knowledge sharing, by the researcher and the researched, to enable creation of a research partnership endeavour (Dowling
2006). Engaging openly and honestly with participants’ gave them greater
understanding of the researcher as a person and this began to build trust in the motives and the research aims.
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As an experienced renal nurse, the researcher possessed knowledge, that the interviewees want to explore and the balance between researcher and renal nurse in interviews needed to be achieved. It would have been disingenuous to deny my renal experience. However, it was possible to negotiate at the start of interviews that should participants have any renal specific questions these would be addressed following interview completion. It has been argued that if researchers are not willing to be open, then they should not expect participants to be open (Furman 2004). A critical methodological approach that embraces the reflexive needs, of collaborative and non-hierarchical relationships, is advocated (Fontana 2004). Such an approach corresponded well to the interviewer-interviewee and PAR relationships within this study. Hence, the construction and validation of data was promoted and came about through the active role that participants played (Fontana 2004).
As a central concept in qualitative research, reflexivity adds credibility (Dowling 2006). By making the research process transparent and clearly identifying the reflexive procedure explicitly, the researcher aimed to add rigour to the qualitative research.
Insider/Outsider Researcher
The issues associated with ‘insider’ and ‘outsider’ research were complex.
The relationship of the researcher to research subjects and collaborators had the potential to influence research findings and their validity. Issues were
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therefore fully considered and practical steps taken, prior to commencement of the study, to limit if not completely negate, these potential effects. In this study the researcher was an insider which raised epistemological considerations relating to the focus of the research and its understanding. The ability of the researcher to engage critically, when they bring their own framing assumptions is questioned by BERA (British Educational Research Association, online 2009), asking:
How does the insider make the familiar strange? (Stenhouse cited BERA 2009).
It was therefore important to consider what effect the insider status would
have on the research process. A critique of the ‘insider’ and ‘outsider’ action
research model was explored by Titchen & Binnie (1993). They offer an ethical and philosophical discussion on the advantages and simultaneous
disadvantages of being an ‘insider’. Both models, they argue, present
tensions and issues.
In terms of achieving a desired change, the insider model was found to be
more effective. Being an ‘insider’ researcher brings the benefits associated
with the authority vested in the researcher; this was found to be influential in Action Research success (Titchen & Binnie 1993). However, when the study of a phenomenon of interest is associated with the researchers attainment of a graduate award this was found to have a negative influential effect (Titchin
& Binnie 1993). This was associated more so with the ‘outsider’ research,
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To counter this issue, potential participant input into the original study proposal prior to ethics submission would be judicious.
The focus of the PAR was on practice and the potential to improve pre- dialysis education and its delivery and was the philosophical foundation of the whole study. Having extensive experience of dialysis patients and the wider renal environment at the study site identified my position as an insider researcher. However, having not worked directly in the pre-dialysis care environment resulted in the researcher not being viewed as experienced in this particular area, within the renal environment. Additionally, this also meant that the researcher, as main interviewer, was not known to the participants. Some of the potential tensions associated with insider research were reduced, as a degree of naivety was balanced against a comprehensive understanding of the wider service demands. Current practice could be explored for understanding and clarity, rather than as a challenge.
The potential to be perceived as academically elite within nursing circles was tempered by my lack of knowledge in relation to the phenomenon of interest and by having established working relationships with the multidisciplinary team. Involvement of the multidisciplinary team at the proposal development stage further reduced tensions and cultivated engagement.
However, having espoused the benefits of pre-proposal input, conflict aroses between PAR methodology and the requisite demands of the Universities Up-grade process and Ethical Committee approval process. In PAR methodology the study focus develops from the collaborative group. Yet, when PAR forms the foundation of a PhD Up-grade process and Ethical
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Committee approval needs to be sought, prior to collaboration formation, a degree of pre-determination in study direction has to exist to satisfy these regulatory bodies. The skill lay in the identification of a specific area of interest, in this study pre-dialysis education, but with a clear identification of the collaboration-led nature of decision-making, congruent with PAR ethos. To satisfy Ethics Committee requirements, potential options identified were based on the literature review, patient needs assessment and influenced by
the researcher’s pre-conceived notions. The suggestions for study focus were based around the introduction of pre-existing pre-dialysis education components, not currently in use at the study site.
Resistance associated with change had the potential to raises tensions in PAR and needs to be addressed (Titchen & Binnie 1993). The pre-dialysis study clearly identified participants as co-researchers and aimed to bring
equity to collaborative practice. The researcher’s role was to facilitate the action research, as guided by collaborative group decisions. Ownership of change focused on collaboration members from the outset with control over the implementation, cyclical evaluation and adaptation of change residing in collaborative decision-making. The aim was to diminish resistance so that integration into practice becomes established. With ownership of the PAR process, the changes affected were likely to be maintained beyond study conclusion. Such a unified approach to changing practice is argued to result
from individual HCPs’ reflective professional practice (Elliott 1991), a
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Rooney (2005) identifies the insider researcher’s potential to negatively impact on participants’ behaviour through; misinterpretation of data due to
tacit knowledge;; the researcher’s politics, loyalties and agendas;; subconscious distortion of data due to the researcher’s moral, political or
cultural standpoints; and assumptions based on insider knowledge. The establishment of participants’ co-researcher roles and the researcher as facilitator worked to combat these tensions. It has been argued by anti-
positivists that these issues are equally as applicable to the ‘outsider’ and
indeed all researchers (Rooney 2005) and co-researchers. However, ‘insider’
researchers, to their advantage, have a potential wealth of specialist knowledge and understand jargon; participants may have felt freer to talk to a known researcher; and the added richness and authenticity of information acquired, it could be argued, increased the depth of understanding.
It was not anticipated that organisational change would be required beyond
the level of the participants involved in the PAR. Therefore, the researcher’s
role as facilitator was affirmed and the participants were the agents of change. However, it was acknowledged that establishing the roles participants took to facilitate change was a slow process. Nursing AR studies
of less than a year’s duration have been found less likely to succeed (Titchen & Binnie 1999). In response to this issue, the PAR study was of 18 months duration, which aimed to provide the requisite time frame to address role
issues and resistance to change. The diversity of the proposed HCPs’ input
into pre-dialysis education delivery, was to an extent, pre-defined by their
existing specialist expertise. Thus role definition was limited to participants’
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These potentially positive factors associated with insider research, counter- balanced, but did not negate, the negatives highlighted. Hence, it was imperative that vigilance of these issues was maintained. One could argue that a degree of subjectivity is impossible to circumvent in research. However, the awareness of tensions and actively working to overcome them, strove for objectivity. Honesty and transparency in the research process arguably allows readers perspectives to be constructed, and as Cohen & Manion (2007) identify, the validity of these perspectives is equal to our own.
Ethical Issues
Action research participants in the healthcare environment provide a unique insight into the social conditions within which they exist, providing invaluable information for healthcare organisations and planners. However, Oliver (2003) questions the moral acceptability and the ethical dilemma raised, in seeking help with a research programme, from those living in adverse conditions. One could argue that without such insight, as defined by those
affected, patient’s needs cannot be catered for and understood.
The nature of the research project itself can be perceived with varying levels of significance and value to individuals. This had the potential to affect willingness to participate. Cognisance of power differentials or perceived differentials and their potential influence was recognised. PAR is concerned with the realities of others and the power to frame their reality (Chambers 2008), by hearing their voices and democratising research. The participatory
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approach was adopted with the intention of supporting HCP’s and renal service users, and to develop their own awareness.
The concept of power being a multi-dimensional dynamic network of shifting relationships (Foucault 1980), was fostered within the action research collaboration, whereby, each member had the potential to influence proceedings. The challenge lay in achieving a balance in the way influence was exercised (McNiff & Whitehead 2006). With PAR forming the underlying collaborative philosophy for this research study, it was recognised that numerous challenges to achieving this existed. Greenwood & Levin (2007) elucidates these challenges as; the joint influence of the study phenomenon, environmental circumstances, the aims and abilities of the participant collaborators, and, most importantly, the professional researcher’s
proficiency.
Power cannot be assigned or imparted within a collaborative group. Collaboration was the ideal to aspire to and work towards. It is not, as Hart & Bond (1995) indicate, something capable of being imposed. Rather the philosophy of PAR identified power in the relationships that define collaboration and facilitated its practical and theoretical development (McNiff & Whitehead 2006). The notion that power is not a thing, but exists within relationships, was defined by Foucault (1980). Accordingly, power is a dynamic entity intrinsically linked to knowledge (Foucault 1980). Hence it could be argued that power transferred and fluctuated as the knowledge base within the collaboration shifted. Cognisance and acknowledgement of