Qualitative methods

Guidance for the qualitative studies within this thesis was sought from an experienced qualitative researcher (Dr Hilary McDermott). A qualitative approach was deemed appropriate in tackling research questions where limited previous literature existed and thereby the nature of the research was exploratory. In addition, the qualitative approach offered an alternative perspective, by focusing on individual experiences, as opposed to risk factor research with large groups, which has been criticised for dominating much of the literature in this area (Papathomas & Lavallee, 2012). In particular, a qualitative approach was used to explore coach experiences of identifying eating disorders among athletes and their approaches in managing and working with athletes who are affected by eating psychopathology. Qualitative methods were also employed to explore experiences of athletes currently receiving treatment for an eating problem. In particular, their experiences of disclosing an eating disorder, and their treatment experiences and expectations were explored. This section therefore explains why a qualitative approach was taken for these studies. A description of the procedure and the analytical approach is also provided.

2.8.1 Justification of the research method

Qualitative methods are commonly employed to answer research questions that focus on the ‘what’, ‘how’ , or ‘why’, as opposed to questions of ‘how many’ or ‘how much’ (Willig, 2013). Qualitative methods can therefore be used to identify areas for further exploration, including constructs that may have been previously overlooked in quantitative research (Kelle, 2008). In addition, qualitative approaches can also be used to explore expressive information such as the beliefs, values, feelings and motivations that underlie behaviour, which are not as easily conveyed in quantitative data (Smith, 2008).

Indeed, the current focus of the literature on the prevalence of eating psychopathology among athletes and on identifying athletes who are most at risk, favours the group perspective over the individual experience (Papathomas & Lavallee, 2012). Qualitative approaches emphasise the individual experience, and place equal value on the experiences of athletes from traditionally ‘low- risk’ and ‘high risk’ sports. Instead, it is acknowledged that both perspectives offer an important insight into the experience of eating psychopathology in the sporting context (Papathomas & Lavallee, 2012). In contrast, quantitative research in the literature has focused primarily on ‘high- risk’ groups, with a view to developing specific prevention and intervention programmes for these

athletes (Striegel-Moore & Bulik, 2007). However, it is also important to recognise the value of understanding the experiential element of eating disorders in sport, and to explore this from the perspective of a variety of stakeholders, in addition to athletes themselves (Papathomas & Lavallee, 2012).

Indeed, over the past decade there has been an increase in the amount of qualitative and experiential research that has been conducted in the area of eating disorders in sport. The majority of this research has been conducted from the perspective of the athlete (e.g. Arthur-Cameselle & Baltzell, 2012; Jones et al., 2005; Papathomas & Lavallee, 2006; 2010; 2012a; 2013). In addition, autoethnographic accounts provide a unique insight into the experiences of weight and body shape pressures that are experienced within the sporting context (e.g., McMahon & Dinan-Thompson, 2008; McMahon & Penney, 2012; Stone, 2009). However, qualitative research in the area of eating psychopathology in sport is still limited, with many questions still to be explored. For example, previous research has tended to focus on the development of eating psychopathology and experiences of living with an eating disorder (e.g., Jones et al., 2005; McMahon & Dinan- Thompson, 2008; McMahon & Penney, 2012), but is yet to explore disclosure or treatment seeking experiences. In addition, limited qualitative research has been conducted with stakeholders other than the athletes themselves (Nowicka et al., 2013).

Qualitative research does not aim to prove or disprove a hypothesis, or to generalise results beyond the sample with which it was conducted, but it can offer a unique perspective on a topic that can open up new avenues for exploration. It can also serve to facilitate a greater level of understanding of phenomena among researchers and clinicians alike.

2.8.2 Philosophical position

In qualitative research it is necessary for the researcher to recognise their own potential influences on both the data collection and data analysis processes (Willig, 2013). This perspective on the researcher’s influence will vary according to the philosophical position adopted (Willig, 2013), and will also influence the methods chosen and analytical strategy used (Hignett, 2005). In this thesis, a critical realist perspective was adopted. Critical realism is a philosophical approach that was developed in response to the perceived limitations of positivism and relativism (Bhaskar, 1989). This approach supports the position that experiences can be explored through speech, hence interviews are commonly utilised to gain an insight into participant experiences. However, critical realism recognises that representations of reality are affected by language and culture; hence the impact of sociocultural factors is also acknowledged and explored. In addition, the knowledge produced by ordinary people is considered valuable and of equal importance to that of experts (Pilgrim & Rogers, 2002).

could have on the data collection and analysis process. It was deemed that being an ‘insider’ could offer many advantages, primarily in terms of facilitating a rapport with the participants through shared knowledge of the sporting context (Douglas & Carless, 2012), which would have been more challenging to achieve by researchers from outside of the unique sporting environment. Previous research has suggested that participants may be more willing to disclose their experiences with ‘insiders’, due to assumed mutual understanding and knowledge (Corbin Dwyer & Buckle, 2009). There are some potential disadvantages with insider research that it is important to acknowledge. My own experiences are likely to shape the research questions developed, the line of questioning taken in the interviews and perspectives on the data collected. This was acknowledged and reflected upon in the reflective diary that was maintained throughout the qualitative studies (Appendix J; Appendix K). In addition, the interview schedule was developed in consultation with experts from within the field. Finally, the outcomes of the analysis were regularly discussed and reflected upon with the other members of research team, to ensure that the analysis reflected the data as closely as possible.

2.8.3 Qualitative data collection: Semi structured interviews

Semi-structured interviews were chosen as the method of data collection for the qualitative studies within this thesis. This method was considered to be concordant with the philosophical position of critical realism, which accepts that experiences can be explored through participant accounts (Bhaskar, 1989). Semi-structured interviews are loosely structured, with a list of topics (and potential prompts) that the researcher wishes to cover, however the order in which these topics are covered is not predefined. The inclusion of additional questions is encouraged, to explore in-depth the individual participant’s experiences and to probe interesting issues that arise (Smith, 2008). As such, this method can facilitate the discovery of novel areas of enquiry that might otherwise be difficult to discover through structured interviews or questionnaire techniques. Focus groups were not deemed suitable for the research questions explored within this thesis given the highly sensitive nature of the topic explored, and also the focus on the individual experience. Focus groups are particularly useful in exploring consensus and interactions between participants (e.g. Kitzinger, 1994); however with patients and coaches it was deemed more appropriate to explore their experiences at an individual level. Unstructured interviews were also not deemed appropriate for investigating the research questions posed within this thesis. Unstructured interviews are commonly used with narrative, life history and individual case study research (Willig, 2013). As specific research questions about certain elements of athlete and coach experiences were posed, a semi-structured interview schedule was adopted to ensure that the interviews covered these elements, but also retained some flexibility to explore other issues raised within the discussions.

The semi-structured interview schedules that were utilised for the qualitative studies within this thesis are provided in Appendices L and M. Semi-structured interviews offer a flexible research method, as the data can be analysed in numerous ways, depending on the research question and the researcher’s philosophical position (Willig, 2013). Semi-structured interviews are the method of choice for researchers wishing to conduct either thematic analysis or interpretative phenomenological analysis (Smith, 2008). Interviews were conducted either on the phone or face to face. All of the interviews with athletes currently seeking treatment for an eating disorder took place in a therapy room in the service in which they were currently seeking treatment.