Qualitative methods rationale

This section discusses the methods an rationale behind adopting each of the methods used in this thesis.

3.4.1 Focus groups

Over the past two decades focus groups have been used increasingly in health care research to evaluate the satisfaction of clients with particular services (Parsons & Greenwood, 2000) and for promoting public health matters (Kitzinger, 1993). Focus groups have also been used to develop surveys or questionnaires (Nassar-McMillan & Borders, 2002) in order to find appropriate terminology for a certain population; applying either an unstructured agenda with the aim of generating hypotheses (e.g. item generation) or a structured agenda for those groups conducted to test

hypotheses (e.g. item refinement). Open-ended questions are used as a means of gathering further information (Henderson, 1994). Krueger (1994) suggests that a minimum of two or three groups be held with groups sized between 4-6

participants thus, large enough to generate discussion, yet small enough to maintain adequate control over the agenda.

Focus groups - strengths

Focus groups are suggested in the FDA guidance (2009) as a method to ensure understanding and completeness of the concepts under discussion. In addition, focus groups make the most of communication between the participants in order to generate data and, therefore, use group interaction as part of the method

(Kitzinger, 1995). Group interaction is useful for examining how people think and why they think the way they do, based on their knowledge and experiences.

83

While providing the researcher with rich experiential data (Morgan, 1988) focus group processes can help people to explore and clarify their views as participants exchange anecdotes and comment on each other’s experiences and ideas about a pre-identified topic, here the topic of CST.

Kitzinger suggests that focus groups are used to reveal ‘dimensions of

understanding that often remain untapped by more conventional data collection techniques’ (1995). Nassar-McMillan and Borders (2002) imply that there are no definite rules for the use of focus groups, making their use a flexible method which can be adapted to suit the needs of the researcher and, therefore, focus group methods lend themselves to the aims of this research. According to Morgan (1988), careful planning and attention to detail are necessary if useful data are to be

collected from focus groups. Focus groups – limitations

The results gathered from a focus group study cannot be generalized due to the small number of participants and lack of random sampling (Stewart & Shamdasani, 1990). Yet, utilizing the experience of those who have experienced CST provides what Patton (2015) calls “information rich” cases. Focus groups can be time consuming due to the facilitation of data collection, transcription and data analysis and, therefore, expensive. Some participants can dominate the discussions if not facilitated well and focus groups are not such a useful method for individuals who are less comfortable speaking in a group setting.

3.4.2 Interviews

Interviews can be used to explore subjective meanings and issues that may be too complex to investigate through quantitative means (Banister et al., 1994). There are many different styles of interviews. In this thesis both semi-structured

84

3.4.3 Semi-structured interviews

Semi-structured interviews rely on the interaction between the interviewee and interviewer and, although the interviewer has a topic guide, the interviews unfold in a conversational manner to allow the participant to explore issues that are important to them. The strengths of semi-structured interviews include: their informal and conversational nature, they allow for open responses in the participants own words, they can be carried out in a location convenient for the participant, and can be flexible for the interviewer to change questions to follow the direction of the conversation.

However, limitations can be like those experienced by focus groups. For instance, typically, only a small number of participants are involved, the sample may not be representative of the study population, the content may be difficult to compare as each interview is unique, and they can be time consuming in terms of data

collection and analysis.

3.4.4 Cognitive interviews

Cognitive interviews were developed using theories of cognitive psychology as part of a multi-stage approach to questionnaire design (Drennan, 2002). They can be used to explore the intricacies of questionnaire design such as the use of irrelevant questions to respondents, the use of intrusive or insensitive questions and the number of potential problems in relation to understanding and successfully

completing a questionnaire. Cognitive interviews allow the interviewer to find out how the responder has answered a question. Two techniques used for conducting cognitive interviews are ‘think-aloud’ and ‘verbal probing’ (Collins, 2003). Table 13 shows the key differences between the think-aloud and probing techniques as reported by Collins (2003, pg. 235).

85

Table 13: Key differences between think-aloud and probing techniques

Think-aloud Probing

- Respondent-driven - Interviewer driven - Lower burden on interviewer as

respondent does all the talking

- Lower burden on respondent, as respond to interviewer asks questions

- Can make the interview more difficult for the respondent

- Can make the interview easier for the respondent

The strengths of cognitive interviews can include: identifying problems with questionnaires such as misunderstandings and incomplete concept coverage, a useful method of identifying potential sources of measurement error such as problems of comprehension, processing or communication can be used to assess existing questions and to test proposed revisions to the original questions. The limitations of cognitive interviews include: they cannot provide quantitative information about the impact an issue might have or provide quantitative evidence that revised questions might be better than the originals, they may discriminate against less communicative participants and are time-consuming (data collection, transcription and analysis).