Phase III. The results from the two strands were compared and integrated. Grounded on the results from the second phase, the substantive model from the first phase was reviewed and
CHAPTER 4: PHASE I - EXPLORATORY PHASE: MODEL GENERATION
5.5 Qualitative Strand .1 Objectives .1 Objectives
The qualitative research questions for phase II were:
• What are the factors and mechanisms of dance/movement therapy in building resilience for people living with chronic pain?
• What is the experience of people with chronic pain as they participate in a 10-week group dance/movement therapy?
5.5.2 Design of the Qualitative Strand
To get qualitative answers to the above question a grounded theory study approach (Glaser & Strauss, 2009) was used for the data collection and analysis processes.
5.5.3 Data Collection
Qualitative data were collected from four types of sources: a) weekly journal by participants about their experience of participating in each DMT session, b) post-treatment individual in-depth interviews with participants about their experience of partaking in the 10-week group DMT intervention, c) participants’ responses to reviewing the video recordings of the movement-based narratives, and d) the reflective writings by the dance/movement therapist (e.g., session notes and memos).
5.5.3.1 Weekly journal. At the end of each DMT session, participants were asked to briefly write about their experience of participating in the particular session. They had an option of doing free-style writing or answering four semi-structured questions. The questions were:
1) How did/do you feel about your body and your self?
2) What have you noticed/learned about yourself or others today?
3) Are there any specific thoughts or feelings about yourself or others that came up during the session? If yes, please describe.
4) Please write about any other observations or reflections about today’s session.
The answers were transcribed into an excel document and analyzed soon after the session to enable theoretical sampling, which is a process of data collection for generating theory
whereby the researcher jointly collects, codes, and analyzes the data and allows the analysis of
initially collected data to inform future data collection (Strauss, 1987). The information and lessons learned from these journal writings guided me in modifications of session content for the next DMT session as well as to formulate questions to ask during the post-treatment interviews.
5.5.3.2 Post-treatment in-depth interview. Upon the completion of the 10-week DMT intervention, I met with individual participants for about 60 minutes. During this meeting, a semi-structured, open-ended, in-depth interview was conducted. Individuals were asked to describe their experience of participating in DMT sessions, and if/how it had affected their ways of coping with pain. The questions and probes aimed to yield in-depth responses about the participants’
behaviors (what the individual has done), opinions/values (what the individual thought about the topic), feelings (what the individual felt), knowledge (the fact about the topic), and sensory experience (what the individual has seen, heard, smelled or touched) (Campion, Campion, &
Hudson, 1994). (See Appendix C for the list of questions) All interviews were audio recorded.
5.5.3.3 Video interpretation. All DMT sessions and group discussions were video recorded. Two specific videotaped DMT session fragments, namely the two movement-based illness narratives from session 3 and 9, were used to elicit qualitative data during the post-treatment meeting. At the end of the meeting (i.e. following the interview described above), each participant and I watched the video recording of the two movement-based narratives performed by the specific participant together. After reviewing each narrative, the participant was asked to describe his/her thoughts, emotional reactions, discoveries, or opinions (s)he had while watching the film. I also asked them if they noticed any differences between the two narratives. I
furthermore asked questions related to certain movement expressions that, in my clinical opinion, seemed to be significant to understand and clarify the meaning of it. The participants’
interpretations of their own movement narratives were audio recorded, transcribed, and included in the qualitative data set. I also wrote my own observation and interpretation about the
movement, as well as my emotional reaction toward the movement narratives in theoretical memos.
5.5.3.4 Researcher’s reflective writings. I wrote session notes after each DMT session to keep record of the session structure and contents, particular group themes, significant
comments the participants made, as well as my personal reflection on each session. Theoretical memos (memos about ideas or concepts related to the developing theory) and procedural memos (memos about methodological aspects of the study) were also created in the course of the data collection period to refine and keep track of ideas as they developed, and to name concepts and relate them to each other (Glaser, 1998).
5.5.4 Data Storage and Security
Following the interview and video interpretation, the recorded audio file was
transferred onto a secure computer as described before. After transcription of the audio file, the audio file was permanently deleted from the computer. The de-identified interview transcription was saved on a CD and stored as permanent records of the research in a locked cabinet in a locked office in the Department of Creative Arts Therapies at Drexel University, in compliance with IRB regulation.
5.5.5. Data Analyses
Qualitative data collected through various sources (weekly journals, post-treatment interview transcripts, session notes, and memos about emerging concepts and theory) were analyzed by grounded theory procedure. Glaserian grounded theory method was used as a guiding principle for the procedure. (Glaser, 2007, 2013; Glaser & Strauss, 2009) The collected data were imported into a qualitative data analysis software Atlas ti. for data management and analysis.
5.5.5.1 Open coding. Codification of the text data started by ‘open coding’ in which I carefully looked into the raw data line-by-line to first gain a general feel of the data, and started generating codes everyway possible (Strauss & Corbin, 1998). This involved reading every comment each participant had made and considering them to find similarities between concepts.
These concepts were then coded according to their meaning and relevance to the research questions. I began to identify concepts, patterns, processes and emerging categories. The
categories began to accumulate, and those that were most dense became major categories. I went back and forth across data while comparing, modifying, and sharpening the growing pattern, which is known as a process of constant comparison. During this process I used memos to reflect and conceptualize the data, which helped me to develop hypotheses and a substantive theory.
Constant comparison process continued until there was no new concept emerging (data saturation) and all the major categories had become apparent.
5.5.5.2 Selective coding. Once initial major categories were identified, open coding was halted and I sought for the core category that “explains the most of the variation which represents the participants’ major concern and the focus of this study?”(Glaser, 2007). After identifying the core category I started delimiting coding to only those categories that are relevant to the core category in sufficiently meaningful ways. The main analytic process in selective coding was to integrate and refine the major categories to form a larger theoretical scheme so that the findings take the form of theory. Therefore the focus was on refining and integrating the major categories, exploring the inter-and intra-relationships of the categories and then generating hypotheses and theories to bring insight into the process of resilience building through DMT experience in people living with chronic pain.
5.5.5.3 Memos and Diagrams: Throughout the data collection and analysis process, I wrote memos and drew diagrams about emerging ideas and findings. Different types of memos - code notes, theoretical memos, and procedural memos- were written to record the products of analysis and provide directions for analysis. Code notes contained the analytical product from three tiers of coding: open, selective, and theoretical coding. Theoretical memos were written whenever a new idea or relationship was found during the coding so that I could concentrate on creatively generating ideas about the data and develop the idea (Urquhart, 2001). In procedural memos, I kept any procedural reminders or ideas. Diagrams were drawn as often as possible to
visualize the relationship between categories and to enable non-linear conceptualization of the ideas, providing a different vantage point from which to view the developing theory (Kawamura, Ivankova, Kohler, & Perumean-Chaney, 2009).
5.5.5.4 Theoretical coding: Once the saturation of categories and properties were reached, I moved on to theoretical coding during which I tried to conceptualize the interrelations between the categories and sought for the theoretical code – “code that conceptualizes how the substantive codes will relate to each other as interrelated multivariate hypotheses in accounting for resolving the main concern” (Glaser, 1998, p.163). Conceptual mapping, sorting memos and artistic exploration (creative processing of the data through drawing and movement exploration) assisted in identifying the theoretical code and constructing a visual representation of the model.
5.5.6 Validity/Legitimation for the Qualitative Arm
Trustworthiness or plausibility is the qualitative equivalent concept for the quantitative concept of validity (Miller, 2006). Validity assessment in qualitative research means checking whether the information obtained through the qualitative data collection is accurate (Creswell &
Plano Clark, 2011). Among many approaches aimed at increasing trustworthiness of the qualitative findings, three strategies were used in this study namely triangulation of data drawn from several sources, peer debriefing, and rich and thick description. For triangulation, the evidence for codes and themes was built on various qualitative data sources such as participants’
weekly journal, researcher’s session notes and theoretical memos as well as in-depth interviews.
Peer debriefing was utilized by asking one committee member to code sections of text data to establish the inter-coding reliability, obtaining feedback on the emerging model diagrams and concepts from a colleague as well as committee members, and brainstorming with them during the process of interpretation and integration. Thick and rich descriptions for the emerging theory were provided to achieve transparency of the process and rationales.
Trustworthiness can be also strengthened by exploring negative cases that can add more
varied and sophisticated dimensions of the phenomenon (Glaser, 1978). Negative case analysis involves examining the cases of individuals who appear to be the exceptions in the research (Lincoln & Guba, 1985). Exploration of these cases can help a researcher to identify the differences and incorporate them into the model, which can strengthen a grounded theory model by providing the flexibility and variation (Strauss & Corbin, 1998). This was done in this study through conducting a secondary analysis of the qualitative data thereby identifying contextual conditions related to the exceptional/negative findings. Negative or discrepant findings were included in the results.
To increase the likelihood that the theory developed in a study is truly grounded in the data and participants’ experiences, member checking should be used. Unfortunately in this study, member checking was not conducted due to the limitation of the study time frame.