This study will implement a mixed methods sequential exploratory design consisting of two distinct phases: a qualitative phase (Phase 1) followed by a quantitative phase (Phase 2). The qualitative phase involves the researcher conducting semi-structured interviews with CWE and their parents. The interviews will be audiotaped, transcribed verbatim, and thematically analysed. Phase two comprises a cross sectional survey of CWE and their parents; the development of which will be informed by the findings of the qualitative phase. Quantitative data will be statistically analysed, whereby descriptive statistics, correlations and group comparisons will be performed. The two phases of this mixed methods study are first reported separately. Subsequently, the findings are considered integratively.
3.4.1 Rationale for Using a Sequential Exploratory Design
Several factors informed the decision to employ a sequential exploratory design in the present study inclusive of consideration of: 1) various types of mixed method designs; 2) the timing of phases; 3) the weighting of phases; 4) the data integration approach; and 5) advantages and disadvantages of a sequential exploratory design. Each factor is discussed below.
3.4.1.1 Type of Design
According to Creswell & Plano Clark (2007), there are four major types of mixed methods research designs, with decisions regarding which type of design to utilise contingent on the purpose of the mixed methods research. First, a mixed methods approach can facilitate complementarity via a triangulation design, whereby different but supplementary data on the same topic is collected and analysed. Second, the embedded design is a mixed methods design that involves each component of the project addressing different aspects of the research question under investigation. Third, mixed methods research can act as explanatory, whereby the intention is to use qualitative methods and data to explain the results from the first quantitative phase of a study. This type of mixed methods research design is appropriate when the quantitative results are insufficient in explaining the outcomes and therefore qualitative
37
data is required to supplement and explain the quantitative findings. Fourth, mixed methods research can serve as exploratory, whereby qualitative data from the first method can be utilised to assist in developing or informing the second method which is quantitative in nature.
In the present study, the mixed methods research will serve as exploratory with the qualitative findings from phase one informing the development of a quantitative measure to capture the epilepsy disclosure behaviours of CWE and their parents, as well as the constructs to be examined in phase two of the study.
3.4.1.2 Timing of Phases
Mixed methods research designs can involve exploring a phenomenon via concurrent phases or sequential phases (i.e. first examining quantitative data and then qualitative data or vice versa). In the present study, the decision was made to first explore CWE’s and parents’
disclosure behaviours and experiences qualitatively, and subsequently to conduct a quantitative investigation. This decision was primarily based on the dearth of empirical evidence pertaining to the epilepsy disclosure behaviours and experiences of CWE and/or parents of CWE as identified in the systematic review (see chapter 2). The previously limited empirical evidence was insufficient in establishing which aspects of CWE’s and parent’s epilepsy disclosure behaviours and experiences warranted quantitative investigation. The absence of psychometrically sound, reliable and valid instruments with which the disclosure behaviours of CWE and their parents could be measured further informed this decision (see section 2.3.3). In addition, there was a lack of evidence of guiding theory or frameworks that could be utilised in order to select the quantitative variables to be examined in relation to the epilepsy disclosure behaviours adopted by CWE and their parents. Therefore, the qualitative data from the first phase of this sequential exploratory mixed methods study will serve four purposes:
it will act as a rich source of qualitative information pertaining to the disclosure behaviours and experiences of CWE and their parents;
it will enable the identification of the aspects of CWE’s and parents’ epilepsy disclosure behaviours and experiences to be examined in phase two of the study;
it will inform the development of instruments that measure the disclosure behaviours of: (i) CWE and (ii) their parents, as no such measures previously exist; and
it will allow for the identification of constructs that may be related to disclosure and thus warrant further investigation in the second phase of the study.
The utility of conducting a quantitative phase subsequent to the qualitative phase was based upon three factors. First, it will allow the researcher to test the results of the first qualitative phase with regard to aspects of CWE’s and parents’ epilepsy disclosure behaviours and experiences which will determine the generalisability and salience of specific findings.
Second, the quantitative phase will facilitate psychometric testing of newly developed scales
38
that measure CWE’s and parents’ epilepsy disclosure behaviours. Third, prior to the conduct of this study there was a scarcity of guiding theory available pertaining to the impact of specific epilepsy disclosure behaviours engaged in by CWE and parents of CWE. Thus, the new scales will not only enable the quantitative assessment of CWE’s and parents’ epilepsy disclosure behaviours, but also the assessment of the relationships between CWE’s and parents’ epilepsy disclosure behaviours and demographic, clinical, psychosocial and illness attitude variables.
This in turn, will facilitate the development of preliminary theory pertaining to the relationships between CWE’s and parents’ epilepsy disclosure behaviours and other variables.
3.4.1.3 Weighting of Phases
In considering the weighting of phases, phases can be equally weighted or unequally weighted, with the findings from one phase deemed more important than the findings of another (Creswell & Plano Clark, 2007). In the present study, equal priority is given to the qualitative and quantitative data as it was anticipated that both data sources would address specific (but distinct) research questions and yield rich findings, thus meriting “stand alone” status.
3.4.1.4 Data Integration Approach
Integration is critical in the context of mixed methods research (Johnson, Unwuegbuzie &
Turner, 2007). However, as previously mentioned, it is often overlooked (Creswell & Plano Clark, 2007). In the present study, the findings will be integrated in two ways. First, the qualitative findings will be utilised to inform the design of the survey to be implemented in phase two; thus, data across the phases will be connected in this way. Second, subsequent to analysing the data from each phase separately, the data across both phases will be integratively discussed. In doing so, the findings will be triangulated, adopting an approach in accordance with the recommendations of O’Cathain, Murphy & Nicholl (2010) and Farmer, Robinson, Elliott & Eyles (2006). The integrative discussion will involve considering the findings across both phases of the study and elucidating whether specific findings are convergent (i.e.
consistent), dissonant (i.e. discrepant) or complementary (i.e. they further elaborate, enhance, illustrate and/or clarify knowledge and/or understanding of the phenomenon under investigation). Silences in findings across study phases (i.e. instances where no data on a specific theme are collected using a specific method) will also be identified and discussed.
3.4.1.5 The Advantages and Disadvantages of a Sequential Exploratory Design
According to Hanson, Creswell, Plano Clark, Petska & Creswell (2005), there are a number of advantages to using a sequential exploratory design. Firstly, the design is useful when developing a new psychometric instrument as the data from the first qualitative phase of the study can be utilised to inform the design of the measure to be employed and psychometrically evaluated in the second quantitative phase of the study. Second, the design facilitates theory
39
development in the absence of pre-existing theories or conceptualisations of the topic under investigation. Both aforementioned advantages were particularly salient in considering the appropriate research design for the present study. However, there are also a number of disadvantages related to employing a sequential exploratory design. For instance, such an approach to research is extremely time-consuming as a consequence of the sequential nature of the phases and the time required for integration (Creswell & Plano Clark, 2007). A second disadvantage relates to the issue of obtaining ethical approval (Creswell & Plano Clark). As the procedure and research questions to be addressed in the quantitative phase of such studies are largely contingent upon the findings from the qualitative phase, researchers adopting such a design will often have to apply for ethical approval for each phase separately. This only adds to the time consuming nature of using a sequential exploratory research design. Therefore, in order to utilise this research design effectively, the researcher is required to ensure to incorporate an adequate amount of time into the research schedule for each phase, the preparation of ethics applications and the integration and discussion of findings (Creswell &
Plano Clark, 2007).
3.4.1.6 Summary
Taking into consideration the various types of designs, the timing and weighting of study phases, integration approaches and the advantages and disadvantages of utilising a sequential exploratory design, a sequential exploratory design was deemed the most appropriate research design to adopt for the present study. Collectively, the qualitative and quantitative data from both phases of this study will enable an enriched understanding of the complex phenomenon of disclosure of a CSI (i.e. epilepsy) by CWE and parents of CWE; a topic that previously was underexplored and under-researched in epilepsy literature.