Qualitative research methodology

This section discusses in detail the methodology applied to the study and, in parallel, introduces qualitative research methods. The findings of the pilot and main studies, along with the findings of the documentation analysis, are presented in the following chapter. The research questions, as specified in chapter 3, section 3.13, informed the choice of data collection and analysis. Strauss and Corbin (1998:41) argued that the questions in a study set the tone for the research project and help the researcher to stay focused.

The following table presents some of the research questions briefly, as they were adjusted to the Dialectical Relationships Model and the methods applied in this study:

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Table 4.1: Research questions and Data collecting methods

Research components Methods used

Verify the existence of a policy network on healthcare policy and identification of its actors (who is the network?)

In-depth interviews and document Analysis

What are the relationships between the actors within the network? How do they interact? What resources do they have?

In-depth interviews and Document Analysis

How does individuals‟ behaviour influence the process?

In-depth interviews and Document Analysis What factors influence the network‟s structure and

context within which it operates?

In-depth interviews and Document Analysis How has the relationship between the network and

other networks changed?

In-depth interviews and Document Analysis How policies emerge? How does the network affect

outcomes?

Application of the Model and case study

How the Dialectical Relationships Model on policy networks applies to the current research

In-depth interviews and data analysis policy networks

Mason (1998:11-13) argued that, initially, a researcher should ask themselves two important questions and introduced the concepts of ontology and epistemology. The first difficult questions a researcher should ask are what is “their research about, in a fundamental way, and what is the nature of the phenomena or entities, or social „reality‟ to be investigated”? It

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involves asking what a researcher “sees as the very nature and essence of things in the social world or, in other words what is (the researcher‟s) ontological position or perspective”? Secondly, a critical question for a researcher refers to what is regarded as knowledge or evidence of things in the social world - epistemological questions that are designed to explore the nature of evidence and knowledge “generated” from data (Mason, 1998:13). Epistemology is a theory of knowledge and concerns the principles and rules by which a researcher decides whether and how social phenomena can be known and how knowledge can be demonstrated. As Mason discussed (1998:13), “epistemological questions should direct a researcher to a consideration of philosophical issues involved in working out exactly what would be counted as evidence or knowledge of social things”. Answers to both these epistemological and ontological questions should be consistent.

Qualitative methods were appropriate in this research, given the exploratory setting of the study in accordance with the researcher‟s personal interests and the nature of the applied Dialectical Model on policy networks considered above. Qualitative research is largely an investigative process that intends to understand a particular situation, event, role or interaction

(Creswell, 2003:181). It can be distinguished from quantitative methodology by numerous

unique characteristics that are inherent in the design. A synthesis of those characteristics is presented by Creswell (2003:186-187) illustrated by the work of various researchers, some of which is presented here. To summarize briefly, qualitative research occurs in natural settings and typically does not establish a priori hypotheses; instead, the focus is on participants‟ perceptions and experiences and the way they make sense of their lives (Creswell 2003:199). It is based on the collection of narrative data which are not quantifiable in the traditional sense of the word.

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In qualitative analysis, the reference point is not the quantification of the data - although this can happen at some point - but rather a non-mathematical process of interpretation carried out with the purpose of discovering concepts and relationships in raw data and then organising these into a theoretical explanatory scheme (Strauss and Corbin, 1998:10-11).

Qualitative methods can be used to explore substantive areas about which little is known or about which much is known to gain novel understandings (Stern, 1980; cited in Strauss and Corbin, 1998:11).

There have been many attempts to define qualitative research in the social sciences; Mason (1998: 3) stated that such research does not represent a unified set of techniques and philosophies, and indeed has grown out of a wide range of intellectual and disciplinary traditions. Denzin and Lincoln (2000:3) characterised qualitative research as a situated activity that locates the observer in the world. It consists of a set of interpretive, material practices that make the world visible and, in doing so, transform it. Qualitative research deploys a wide range of interconnected interpretive practices, hoping always to get a better understanding of the subject matter at hand. Strauss and Corbin (1998:11-12) identified three major components in qualitative research. Firstly, there are the data, which can come from various sources; interviews, documents, records. Secondly, there are the procedures that researchers can use to interpret and organize the data. These usually consist of conceptualizing and reducing data, elaborating categories in terms of their properties and dimensions and relating these through a series of prepositional statements. Conceptualizing, reducing, elaborating and relating are often referred to as coding. Other procedures are part of the analytical process. These include non-statistical sampling, the writing of memos and diagramming. Lastly, there are written and verbal reports (Strauss and Corbin, 1998:11-12).

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For Denzin and Lincoln (2000:18), the researcher‟s personal characteristics and background are important to the setting of the research, its progress and development and the data analysis as well as to the final outcomes. It has an impact on the way that the research is conducted: she or he speaks from a particular class, gender, racial, cultural and ethnic community perspective and approaches the world with a certain set of ideas. Those characteristics have an impact on the way the results would be analysed and understood.

The fundamentals of interviews and interviewing as a feature of qualitative research constitute the methods of maintaining and generating conversations with people on a specific topic or range of topics and the interpretations which social researchers make of the resultant data (May, 2003:120). In a qualitative research interview, the aim is to discover the interviewee‟s own framework of meanings and the research task is to avoid imposing the researcher‟s structures and assumptions as far as possible. Furthermore, a researcher needs to remain open to the possibility that the concepts which emerge may be very different from those that might have been predicted (Britten, 1995:252).

Creswell (2003: 186-187) outlined the advantages and limitations of interviews as a data collection method (Table 4.2).

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Table 4.2: Data Collection types: Interviews

Option within types Advantages of the type Limitations of the type ▪Face to face: one on one,

in person interview ▪Telephone: researcher interviews by phone ▪Group: researcher interviews participants in a group

▪Useful when participants cannot be observed directly

▪ Participants can provide historical information ▪Allows researcher “control” over the line of questioning

▪Provides “indirect” information filtered through the views of interviewees

▪Provides information in a designed “place” rather than the natural field setting

▪Researcher‟s presence may bias responses ▪People are not equally articulate and perspective Source: Creswell, 2003:186-187

Many types of interviews are used in social research. While there are characteristics that appear to demarcate one method strictly from another, a research project may apply a mixture of two or more of the following (May, 2003: 120-121).

Structured interviews refer to the collection of data through surveys. In structured interviewing, the interviewer asks all respondents the same series of pre-established questions with a limited set of response categories. There is generally little room for variation in responses (Fontana and Frey, 2000:649).

Unstructured interviewing (in-depth interviews) can provide a greater breadth of data than any other type, given its qualitative nature. The respondent does not employ a specific set of questions but discusses with the interviewer ideas and meanings attached to a topic. Moreover, it is a dialogue between a skilled interviewer and an interviewee. Its goal is to elicit

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rich, detailed material that can be used in analysis (Lofland, 1971; quoted by Fontana and Frey, 2000: 652)

Semi-structured interviews are conducted on the basis of a loose structure consisting of open ended questions that define the area to be explored, at least initially, and from which the interviewer or interviewee may diverge in order to pursue an idea in more detail (May, 2003:123).

Group interviews constitute a valuable tool of investigation, allowing researchers to explore group norms and dynamics around issues and topics which they wish to investigate. The extent of control of the group discussion will determine the nature of the data produced by this method. One method within this category that has become more widely known is focus groups. Group interviews and focus groups differ mainly because, in the latter, participants are explicitly encouraged to talk to one another, as opposed to answering questions of each person in turn (Kitzinger and Barbour, 1999 quoted by May, 2003:125). Interviews have been used in an attempt to access interpretations, such as what people think about the world they live in, how they evaluate their experiences within it and why they behave as they do. Put simply, the choice to use interviews to collect data can be interpreted as “If you want to understand what people do, believe and think, ask them” (Murphy et al., 1998:112). However, they cannot be treated as providing unproblematic access to information and must always be analysed in relation to the circumstances of their production (Murphy et

al., 1998:123). At this point, other methods of collecting data, such as observation, could be

discussed. Mason (1998: 69) argued that researchers should ask themselves the same questions no matter which method they are going to use to collect their data; interviews or observation, documents or visual data. Every method has its pros and cons and relates not only to the research questions but also to issues such as the researcher‟s experience, the time

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limits and the available resources. Observation (for example, being present at meetings and hearings of the NICE AC in this case) might have been a very interesting way to collect data. Mason (1998) argued that observation is time and resource consuming. However, there were practical issues since it was not permissible for the public to participate in meeting of the NICE AC due to issues of confidentiality and this was confirmed by the poor turnout of interviewees for this research. Moreover there was no funding to cover any expenses and the researcher did not have the experience. It could be argued though that the researcher‟s ontological and epistemological questions and preference was interviewing via face to face communication.

Asking questions and getting answers is a much harder task than it might seem at first. The spoken or written word always has a residue of ambiguity, no matter how carefully the questions are worded and how carefully the answer is reported or coded (Fontana and Frey in Denzin and Lincoln, 2000:645). Yet interviewing is one of the most common and powerful ways in which researchers try to understand fellow human beings.

A document analysis was performed for a second time after the interviews to deal with the issue of very low response rates in the interviews. The documents were qualitatively analysed, using the method of content analysis, in order to enrich and enlarge the quantity of the collected data and in support of the thesis.

4.2.1 Qualitative research studies in health care

In the past decades, qualitative methods have become more commonplace in areas such as health services research and health technology assessment and there has been a corresponding rise in the reporting of qualitative research studies (Mays and Pope, 2000:50-52). The complexity of the issues that health professionals have to address and increasing recognition

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by policy makers, academics and practitioners of the value of case studies in evaluating health service interventions, suggest that the use of such studies is likely to increase in the future. In policy research, qualitative methods can be used within a case study to address many practical and policy questions, particularly where those questions are concerned with how or why events or initiatives take a particular course (Keen and Packwood, 1995 cited in Mays and Pope, 2000:51).