Qualitative research

A qualitative method of enquiry was used so that both the BCW framework and the UCD methodologies could be used simultaneously to achieve all three research objectives (Table 1, Section 2.9.1). In addition, qualitative research allows an examination of the social context and may ‘be a way to reinvigorate current health psychology theories’ (Lyons, 2011:5), including with respect to this study which involves harnessing digital technologies for health promotion. Hence, for the current study, qualitative enquiry was valuable for assessing which components of the TDF and COM-B model are most important to target in the intervention as well as providing insights into parental preferences for app features.

Qualitative research may be defined as ‘the exploration of meanings of social phenomena as experienced by the individual themselves, in their natural context’ (Malterud, 2001:483), which employ non-quantitative methods to increase knowledge and build new perspectives in an area (Tong et al. 2007). Qualitative research not only encompasses techniques of data collection and analysis but also a paradigm (beliefs, practices and assumptions held by the research community), providing an overarching framework for research (Braun & Clarke, 2013).

3.4.1 Qualitative research as a paradigm

According to Braun and Clarke (2013), extensive collections of features and assumptions form a non-positivist qualitative research paradigm where it is not assumed that there is only one correct version of reality. Essentially, it originates from the idea that there are multiple realities (even within one person) which depend

77 on the context they ensue in. Therefore, most qualitative researchers maintain that knowledge should not be considered outside of the research context, including both data generation (e.g. focus group setting) and the wider environmental context (e.g. sociocultural and politcal contexts) of the research. The authors also make the point that qualitative research is not simply a complementary approach to the quantitative research paradigm.

The role of the researcher involves subjectivity and reflexivity where findings are continually questioned at each step in the research process instead of taking them at face value. According to Creswell and Miller (2010), the ‘lens’ used by the

researcher establishes the validity of the study, where validity is referred to in terms of the inferences drawn from the data, as opposed to the data itself. For example, one lens to determine the credibility of a study may range from decisions as to whether data saturation has been reached, to the process of re-analysing data to check if constucts and interpretations make sense. Altheide and Johnson (1994) refer to this as ‘validity-as-reflexive-accounting’ (1994:489) where there is an interaction between the researcher, research topic and the analytic process (Creswell & Miller, 2010).

3.4.2 Focus groups

Data for study one and two was collected using a focus group study design, which allowed an exploratory approach to help to identify relevant theoretical constructs and user preferences to target in the intervention. Focus groups also helped to facilitate interactions among participants that stimulated rich data for analysis (McLafferty, 2004), where the researcher played an active role in guiding the discussions for data collection (Morgan, 1996).These ‘group processes’ helped participants to exchange and clarify their ideas and experiences that are not always

78 amenable in a one to one interview (Kitzinger, 1995). Open-ended, semi-structured questions allowed for more in-depth responses around issues that were important to participants and using their own terminology and language (Kitzinger, 1995).

For study one, the Theoretical Domains Framework (TDF) was used to structure questions. According to Francis et al. (2012), opponents may criticise the use of the TDF as a topic guide with regards to only eliciting responses in those particular areas, which could be seen by some as too restrictive. However, one study conducted randomised designs to make direct comparisons of studies conducting focus groups, interviews and questionnaires using the TDF compared to those studies employing atheoretical methods (Dyson et al., 2011). The findings revealed that TDF based studies were able to elicit beliefs that could not be stimulated in those studies using atheoretical methods. Furthermore, the TDF based studies were able to generate more data on the emotional determinants of behaviour, rather than limiting its reach to only reflective cognitive processes (Dyson et al., 2011).

Focus groups also helped the researcher to gain access to a variety of forms of communication such as humour and anecdotes which is beneficial because ‘people’s knowledge and attitudes are not entirely encapsulated by responses to direct

questions’ (Kitzinger, 1995:299). Humour helped participants to feel more at ease and lightened the mood in a sensitive topic area. In addition, the focus group discussions were sensitive to participants’ levels of education; cultural issues (allowing identification of social norms); and allowed discussion of the difficult subject of childhood overweight which may be perceived as a particularly sensitive issue for some parents (Kitzinger, 1995).

79 According to Tong, Sainsbury, Craig (2007), focus groups involve semi-structured group discussions ranging from around four to 12 participants that aim to explore a certain set of topics. For the current research, only one out of the nine focus groups came below this threshold with only three participants. A possible reason for this is identified later on (section 6.2).

Arguably, focus groups are a vehicle for empowering individuals and provide a supportive environment for individuals to share a common problem or goal (Basch, 1987). Parents were integral to the design process and a focus group design

facilitated their role as experts (Levine & Zimmerman, 1996) in deciding which components should be in the app to support their dietary behaviours with their children. However, there are a number of limitations in using this research design. There is always the potential for some focus group members to feel intimidated and dominated by other group members which may impede their ability to share their opinions and ideas, which is may reduce its generalizability (Basch, 1987; A. Lewis, 1992). However, the researcher made it clear at the start of the focus groups, that individuals who are talking more than others may be asked to stop in order to give other individuals a chance to contribute. Likewise, individuals who are silent will be probed to share their thoughts, in line with Krueger & Casey's (2000) principles to conducting focus groups. Participants were also encouraged to interact with each other so they could explore their own and shared experiences of the issues (Krueger & Casey, 2000). Another disadvantage of focus groups is that they may involve largely participants who are willing to share their ideas and opinions for research purposes (Basch, 1987). However, for the current research, the majority of

participants were parents with overweight children who were already taking part in a family weight management programme which allowed direct access to a hard to

80 reach population. By conducting the focus groups while parents took part in this programme meant that they did not need to travel to another location and could share their ideas in a familiar and trusting environment (Basch, 1987). Furthermore, to help participants to feel more at ease and accustomed to the focus group process, the researcher followed principles in focus group research and ensured that broad

questions were asked before moving onto more specific questions (Krueger & Casey, 2000).

3.4.3 Qualitative research aims

The empirical studies described in the previous section comprised four qualitative research questions shown in Figure 9, relating to all three research objectives (Section 2.9.1).

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