Pilot Study

The significance of pilot studies has been given very little recognition in research literature, the value of pilot studies help to facilitate the researcher to collectively reflect in greater depth on the nature of the activity in which they are about to engage (Thabane et al., 2010). It is essential that pilot studies help to direct the correct lines of enquiry in research and should not be used solely to adapt research instruments or as a background in order to inform research questions (Sampson, 2005). Pilot studies can prove useful to the researcher in several ways, for example the internal validity of a questionnaire can be improved, and they can help to assess the viability of the main study, determine the effectiveness of the sampling frame and technique and give definitive evaluation to the logistics of data collection.

Despite these definitive statements pilot studies are open to misuse and research may be undertaken on the basis of results or a hypothesis incorrectly derived from pilot study data (Coffey and Kairalla, 2008; Loscalzo, 2009; Nyatanga, 2005). The pilot study was performed to improve the quality of this research study by using the process and results to direct the research pathway, and reduce resource wastage and risk.

4.7.2. Questionnaires

A questionnaire is essentially a structured technique comprising a list of written questions for the collection of primary data (Beiske, 2007). Questionnaires are a quantitative method of data gathering and are many and varied in design and in terms of purpose, size and appearance (Denscombe, 2007). Due to their simplicity and ease of use they are amongst the most commonly employed techniques for the collection of information in clinical studies (Saw and Ng, 2001).Although not all modalities of information can be

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collected through questionnaires, a unique and wide range of data can be captured (Kumar, 2008).

Questionnaires can be designed to enable the researcher to target a particular audience regardless of geographical spread. The use of the questionnaire method as an instrument of scientific enquiry can achieve (a) measurement (b) description and (c) inference. Measurement aims to measure the sociological variables and gather information about individual and group characteristics e.g. age, height. Description describes a given population and inference helps to infer about the given population based on sample studies (Kumar, 2008).

Table 4.6: Advantages and disadvantages of written questionnaires.

Advantages Disadvantages

1. Cost effective compared to face-to-face interviews, particularly where large sample sizes or geographical areas are involved. 2. They are easy to analyse particularly with

computer software packages.

3. Questionnaires are familiar to most people. 4. Questionnaires reduce bias as the

researcher’s opinion will not influence the respondent answer, no verbal or visible clues.

5. Questionnaires are less intrusive than face- to-face or telephone surveys.

6. The respondent can answer the questionnaire at their own pace.

1. Possibility of low response rate.

2. Questionnaires responses cannot be explored further.

3. As a structured instrument questionnaires do not have flexibility in respect to response format.

4. Questionnaires may not be suitable for certain individuals or groups.

5. The researcher can never be certain that the person to whom the questionnaire is sent actually fills it in.

6. Where the researcher is not present, it is difficult to know whether or not a respondent has understood a question correctly.

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There are a number of advantages and disadvantages to using questionnaires and these are listed in table 4.6. The use of questionnaires in this research study allowed participants to respond to the survey in their own time and provided the researcher with an opportunity to review and analyse the results so that the subsequent participant observation and semi-structured interview instruments could follow-up on significant responses.

4.7.3. Observation.

Observation is a method that allows researchers to directly observe individuals in their natural setting (Carlson & Morrison, 2009) or in a controlled environment (Langdridge & Hagger-Johnson, 2009). Observation has been defined as:

‘A tool of social inquiry in which activities and relationships of people in the study community are perceived through the five senses of the researcher’, (Angrosino, 2007, p.98).

Observational methods require the researcher to watch and record human behaviour and related events and objects, interpreting and evaluating the data gathered (Waltz et al. 2009). Observational studies in nursing and healthcare research play a pivotal role when information is sought on the effectiveness of treatment and care, patient reported outcomes and costs in real-life locations (Langham et al. 2011).

Observation as a research method has the distinct advantage of directly accessing the ‘lived experience’ of the individual. Frequently referred to as field research or fieldwork (Spradley, 1980) the method is often used by anthropologists, sociologists and political scientists. It can provide a rich detailed description of the phenomena that is unconstrained by predetermined concepts and categories. Observation methods can be particularly helpful when describing complex observations, and formulating hypotheses about them and about relationships between different components or elements (DeWalt and DeWalt, 2010) such as, for example, a patient’s perception of staff behaviour.

Observational studies focus on the direct observations of the researcher, who in turn aims to immerse him or herself in the world of the subject being studied; with the intention of seeing the world as the subject sees it, rather than as the researcher perceives it to be. The

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researcher records observed events, conversations and behaviours by compiling field notes, the primary method of capturing data from observation (DeWalt and De Walt, 2010). The aim of observational research is to produce knowledge (empirical and theoretical) about distinct issues, which can be used by others in a number of ways, for example, the measurement of resource use in hospitals. In healthcare, observation is considered the most important data collection method particularly in studies focusing upon human behaviour and can be used as a stand-alone method or in conjunction with others (Parahoo, 2006).

Observational studies are considered non-interventional, in healthcare this means that the care and treatment of patients is performed naturally in practice without influence from the researcher or study. Observational settings reflect naturalistic as opposed to artificial circumstances (Carlson & Morrison, 2009). As such individual lives, conversations and behaviours are not regulated by particular rules or regulations, allowing for improved observation of the natural progression of disease processes (Bang, 2010). This is important as the ability to observe natural events and occurrences enables healthcare professionals to evaluate the effectiveness of care and treatment in patient populations. The observation employed in this study was unstructured, this involved recording what was seen or heard. Unstructured observation is a way of looking at a situation to observe something that is naturally occurring. The researcher approaches unstructured observation with no predetermined ideas. The process begins with the selection of a setting and obtaining access to it, observations are made then recorded. As the study evolves so the nature of the observation changes becoming sharper and more focused. This in turn leads to the formulation of purer research questions and selected observations until theoretical saturation is reached (Adler and Adler, 1994).

In unstructured observation researchers are usually acting from a ‘critical’ perspective, as the focus is on understanding the meaning study participants attribute to behaviour or events within the contexts observed (Gillham, 2008). Observation conducted as part of qualitative research is often unstructured.

The environmental opportunities for observers are many, Gold (1958) developed a typology of participant roles in which he discusses the variations which exist in the role

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undertaken by the researcher ranging from, complete observer; the participant as observer; the observer as participant and finally to complete participant.

The role that the researcher chooses to adopt is subject to change throughout the fieldwork and can be influenced by the study setting and the research (Hammersley and Atkinson, 2007). Gold (1958, p.217) provides a description of the four observed categories as follows:

Role Advantages Disadvantages

Complete participant:

The true identity and purpose of the researcher is kept hidden

 Does not influence natural events  Data validity is increased  Reduce problems associated with observer effect

 May become involved in dangerous practice or behaviours

 Practices a level of deceit

 Risk of over-identification with the study participant known as “going native” (Frankenberg, 1982).  Infringes the principle of ‘informed

consent’

Participant as observer: Researcher gains access to the research setting. Usually has a non-research reason for being part of the research environment.

 Observation as a full group member

 More observation than participation

 Researcher and participant aware that relationship is founded on research activity

 Time needed to build trust between researcher and participant

 Informant may become too much of an observer

 Researcher may over-identify with informant

Observer as participant: Observing without being a member  Ability to concentrate on data collection  Improved observation and understanding of events  Researchers role is research focused  Less risk for the

researcher to “go native”

 Level of information is controlled  Trust in the

researcher is needed

 Observed events are sporadic-can cause poor data interpretation

Complete observer:

The researcher does not take part in the research setting

 Discreet observation

 Unknown to participants

 Lower data validity

 Purpose of observation is not revealed

Given the aim of this study was to explore perceptions of care and caring in a hospital orthopaedic setting the role of observer as participant was the most appropriate role to assume.

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Ethnographic methodology is further strengthened by combining observation and interviews, by doing so the phenomena being studied can be more fully understood (Parahoo, 2006). This combination allows the ethnographer to question why individuals act like they do and then explain inconsistences that arise from what people say and do. One of the most important features of ethnographic approach is that study participants may ask questions of the researcher, to which Frankenberg (1982) remarks, that the questions the researcher is asked are more important than the ones the researcher asks. One of the criticisms of participant observation is the risk of over identification of the researcher with the study participants, often referred to as ‘going native’ (Frankenberg, 1982).

Participant observation employed the study of caring behaviours and commentary in order to test the theory emerging from Stage One. Nachmias and Nachmias, (1996) observe that the norms of objectivity, validity and reliability, as well as the designs for causal inferences are, mostly, implicitly embodied in this method It is desirable in participant observation to ensure that these remain unstructured and flexible to maximize the understanding of empirical phenomena (Wax, 1968). From the previous stage of this study, conceptualizations regarding caring were anticipated and so participant observer stage was employed to test out such concepts. It is stated by Bernard (2011, p.153) that ‘objectivity does not mean (and has never meant) value neutrality … we recognize that the power of the documentation is in its objectivity, in its chilling irrefutability, not in its neutrality’. Thus, the conceptualizations can be examined through the participant observer method.