In this part of my thesis I state my philosophical position in relation to my study, which has informed the chosen methodology.
Epistemology is concerned with the nature of knowledge; how knowledge can be acquired and created and what is regarded as true knowledge about the social world.
Within social research there are some fundamental philosophies which need to be considered and which oppose one another; positivism and interpretivism. Positivism advocates that the application of the methods of the natural sciences to social sciences is appropriate (Bryman 2016). This is based on the assumption that human behaviour is regulated by law and patterns and can be standardised. A positivist philosophy assumes that there is a ‘stable reality out there’ with a ‘potential right explanation,’
meaning that phenomena exist whether they are being investigated or not and their existence does not change if humans either have a ‘flawed’ understanding of them or understand them fully (Green and Thorogood 2009, page 13).
Interpretivism suggests that natural sciences methods cannot be used for social investigation as human behaviour does not follow set regulations and orders.
Therefore, social researchers need to investigate and comprehend the world through the shared experiences of their participants and explanations can only be offered at the level of meaning rather than causation (Ormston et al 2014). This supports the
learners’ knowledge is developed via interaction such as discourse and there is no absolute right answers (Reusser and Pauli 2015). Interpretivism is concerned with understanding reality, accepting the subjective nature of it, rather than being able to explain reality (Green and Thorogood 2009). In my study I was seeking to understand individual HCPs thoughts and experiences of working with women with PNA, hence why I chose to take an interpretivist approach.
Qualitative research firmly aligns with interpretivism (Ormston et al 2014) and research questions that seek to explore, in order to understand, individual perceptions of the world rather than to explain the ‘reality of the world’ in objective terms (Green and Thorogood, 2009 page 14). With regards to the link between theory and research, there is debate surrounding the relevant roles of induction or deduction to guide information gathering and processing to support our understanding. A deductive approach builds upon previously established theoretical hypotheses, where new findings can be tested against an available body of data around that subject (Murphy and Dingwall 2003; Charmaz 2006). In contrast, an inductive approach uses a process of observation in order to consider and examine the presence of possible patterns and links (Ormston et al 2014).
Inductivism states that by gathering facts, knowledge can be accumulated which will subsequently inform laws (Bryman, 2016). Charmaz (2006, page 188) states that inductivism ‘begins with study of a range of individual cases and extrapolates patterns from them to form conceptual categories.’ As there are relatively few theories and hypotheses around PNA, due to a lack of research on the topic, a deductive approach would not have been possible in my study. An inductive approach was appropriate for
my study as it allowed for the exploration of potential common elements to individuals shared experiences in order to develop themes within the data (Ormston et al 2014).
In my study, I was seeking to explore the perceptions held by individual HCPs about PNA, whether different HCPs held shared understandings or not, and how they applied this understanding in a healthcare setting.
The aim of my study was to explore the perspectives of HCPs working with women with PNA. Although producing a definitive way of classifying qualitative methods is challenging (Patton 2002), generally they are accepted as ways to collect and analyse data that are ‘interpretative or explanatory in nature and focus on meaning’ (Noble and Smith 2014 page 2). Researchers with qualitative methods expertise conduct studies to better understand processes or phenomenon in their natural settings in order to try and understand them and studies aim to understand and present the participants’
perspectives and experiences (Hallberg 2006).
It is recognised that qualitative studies frequently produce large volumes of data to be analysed (Noble and Smith 2014) which are often required in health services research to be able to fully understand the complexity of a phenomena being studied (White, Oelke and Friesen 2012). Large volumes of data can lead to challenges in ‘establishing trustworthiness of the study’ (White, Oelke and Friesen 2012, page 244) so it is important to keep data well organised and follow a structured approach when analysing the data.
There are certain topics and research questions that are more suited to being
little current understanding, in order to make sense of complex situations or to gain insights and develop greater understanding of a phenomena (Morse and Richards 2002). It has been acknowledged for a number of years that qualitative research can identify the areas that need to be further investigated or explored and can also serve to provide context to results that quantitative methods cannot (Black 1994). It has been suggested that when researchers use qualitative methods to explore a research question they often learn more about a topic than they anticipated (Hammarberg, Kirkman and Lacey 2016).
In healthcare research qualitative methods can be helpful to understand phenomena such as patient experiences of health and illness, relationships and interactions with HCPs and the culture of an organisation (Barbour 2000). Qualitative methods were therefore an appropriate choice for investigating the research question posed in my study.