Quantitative methods

Qualitative- and quantitative methods, according to Durrheim (2006) complement each other and can be regarded as equal and capable to answer different questions about the same topic. These combined methods can be applied where the study requires measurement of some kind (quantitative method), but also deeper understanding of the nature of an issue (qualitative method) (Ormston, et al., 2014). Although this study has relied more on qualitative research to obtain rich and detailed information, the researcher has used a combination of these two

26 methods by applying two standardised questionnaires together with the qualitative information methods.

This was done before the start of the therapeutic process in order for the researcher to evaluate the psychopathological status of the study patient during her specific phase of cancer trajectory when intervention starts. It was also to compare what the patient genuinely experienced and was willing to verbalise during an open interview as opposed to what a “scientific” questionnaire reveals about the same topic. The researcher kept in mind that quantitative methods are more rigid and more concerned about objective facts, prediction, generalization and the establishment of universal law-like findings in tightly controlled research environments (Denzin & Lincoln, 2000; Rule & John, 2011; Ormston, et al., 2014;

Thomas & Magilvy, 2011). The following instruments were used:

(a) The Female Sexual Functioning Index (FSFI). Female sexual dysfunction is common among women with breast cancer. The most frequently used instrument to assess sexual functioning in this population is the Female Sexual Function Index which was found a reliable and valid instrument for measuring levels of sexual functioning and cancer-related female sexual dysfunction (Baser, & Carter, 2012). The FSFI is a 19 item inventory and is divided into 6 elements: desire, arousal, lubrication, orgasm, satisfaction and pain (Rosen, Brown, Leiblum, Meston, Shabsigh, 2000; Sheridan, 2005). The FSFI has shown to have good reliability properties with test-related reliability.

(b) The Hospital Anxiety and Depression Scale (HADS). The HADS has been recognised as a much applied and convenient self-rating instrument for anxiety and depression with both somatic and mental problems and has been validated in cancer populations (Costanini, 1999; Michopoulos et al., 2008; Montel, 2010; Moorey et al., 1991). The HADS consists of 14 items and contains two subscales namely anxiety and depression (Valdaninia, Omidvari & Montazeri, 2010).

27 1.12.4.4 Strategies for ensuring trustworthiness in qualitative research

designs

Qualitative researchers have developed a unique language that is more suitable to qualitative research and increases credibility, transferability, dependability (consistency) and confirmability (proof) which is the naturalist equivalents for internal validation, external validation, reliability and objectivity that are the concepts used in quantitative research (Creswell, 2007; Guba & Lincoln, 1985;

Koro- Ljungberg, 2010; Morrow, 2005). In the scientific context, trustworthiness refers to the replicability of a study’s findings (Lewis, Ritchie, Ormston, & Morell, 2014). For the purpose of this study, the proposed criteria, developed by Lincoln and Guba (1985) will be used to address the trustworthiness of the qualitative research. The four criteria agree with the positivist researcher and include credibility, transferability, dependability and confirmability (Guba, 1981; Lincoln &

Guba, 1985; Shenton, 2004).



Credibility, which refers to the trustworthiness and reliability of the research findings, demonstrates that the subject was accurately identified and described.

Credibility can be seen as the alternative to internal validity and is an important criterion for the trustworthiness of a study and can be viewed as an in-depth explanation of the data within their natural setting, population and theoretical framework (Bezuidenhoud, 2014; Shenton, 2004; Tracy, 2010). Detailed description through a literature study and methodology help to communicate the actual context of the problem being studied (Bezuidenhoud, 2014). During this study, I have gained detailed and vivid information from the lived experiences of the five breast cancer patients using their voices to describe their experiences and needs against the background of a complete literature study. I have also used thick, detailed and vivid descriptions of the data with the purpose for credibility and enabling the reader to make decisions about the applicability of the findings to other settings or similar contexts (Denzin, 1989).

• Dependability /Reliability

28 Dependability refers to the stability of data over time and under different conditions with the main goal to minimise the errors and biases in a study. To address this matter, the positivists apply techniques such as thoroughly documenting the procedures followed during the study to demonstrate that if the work were repeated, in the same context, with the same methods and study participants similar results would be attained (Coetzee, 2007; Elo, Kääriäinen, Kanste, Pölkki, Utriainen, & Kyngäs, 2014; Shenton, 2004; Thomas & Magilvy, 2011; Yin, 2014).

To enable readers of the research report to develop a thorough understanding of the methods and their effectiveness, the researcher has in this study included the next elements as described by Shenton (2004):

 Describing in detail the research design and its application in terms of what was planned and implemented on a strategic level.

 The operational detail of the data gathering in the field through providing all of the information from the five patients gathered during the therapeutic sessions (that will be displayed in Appendix A).

 Meticulous assessment and analysis of the study data and assessing the effectiveness of the data gathering.



Confirmability relates to the traditional concept of objectivity and means that the data accurately represents the ideas and the experiences of the participants and interpretations of those data are not invented by the inquirer (Elo, Kääriäinen, Kanste, Pölkki, Utriainen, & Kyngäs, 2014; Polit & Beck, 2012; Shenton, 2014).

Triangulation, which is a validity procedure that was used in this study, represents the search for integration among multiple and different sources, methods and theories to provide supporting evidence and form categories or themes in a research study (Creswell, 2007; Creswell & Muller, 2000; Lewis et al., 2014). The role of triangulation (Creswell, 2007; Creswell & Muller, 2000; Lewis, et al., 2014) in enhancing confirmability is to reduce the effect of investigator bias and prejudice, as well as detailed methodological description to enable the reader through an “audit trail” to determine the credibility of the data and construct of the study (Shenton, 2004).

29



Transferability can be viewed as the alternative to external validity or generalizability, and indicates that a study’s findings must be generalisable beyond the immediate case, regardless of the research method used. In qualitative studies, the aim is more to provide a rich and contextualised understanding of some aspect of lived experience through the intensive study of particular cases, than to generalise (Elo et al., 2014; Merriam, 1998; Polit & Beck, 2010; Yin, 2014). Although most qualitative studies represent a small number of cases, and is not possible to prove that the findings and conclusions are applicable to other situations and populations (Stake, 1994) it is important for the researcher to apply techniques to adhere to the rules of transferability as described by Elo and colleagues (2014). This will include: to communicate the boundaries of the study to the reader, the number of cases that will be included, the principles and criteria used to select participants, the variables, the number of field workers, data collection methods, the number and length of the data collection sessions and the time period over which the data was collected.

In an attempt to meet the above mentioned criteria and to ensure trustworthiness, various strategies such as suggested by Lincoln and Guba (1985), Schurink and Schurink, (2012) and Shenton, (2004) have been employed during this study, included the following:

 As the researcher, I have developed a familiarity with the breast cancer population through working in the industry for many years plus an understanding of the participating establishments (private sector and government hospitals) and went through a process of gaining permission to conduct the study before collecting data (Bezuidenhoud, 2014).

 I have examined previous research studies by conducting a literature study on cancer research both internationally and in South Africa to provide a framework for the findings (Venter, 2014).

 I was engaged with prolonged observation in the field through psycho-therapeutic sessions with the breast cancer patients over a period of a year in weekly and monthly sessions.

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 Triangulation of different methods were used where a systematic process of sorting through data to find general themes by eliminating overlapping areas, through the interpretation of only the researcher (Creswell & Muller, 2000).

 I have given an in-depth and detailed methodological description of the phenomenon.

 I have assuring sufficient and suitable data by conducting in-depth interviews with five breast cancer patients and survivors, undergoing adequate interpretation through transcribed interviews (Morrow, 2005).

 I have tried to be as transparent and detailed as possible, which is central to interpretive analysis and represent a thorough explanation of the characteristics, developments and surroundings that represent the experience of the phenomenon being studied (Burr, 2003). Transparency was also presented through detailed descriptions of the selection of participants, composed interview questions, and steps of data analysis. As the researcher, I have used generously quotations from the participants’

own words to support interpretations of the data.



The fundamental principle of research involving human subjects is to protect the well-being and safety of the research participant (Creswell, 2007; Yin, 2014). Prior to the study, the Ethics Committee of the Psychology Department of UNISA has reviewed and approved the presented proposal to insure the safety and appropriateness of the study (see Appendix D). Because of the two participating state hospital patients, ethical approval was also obtained from the National and Provincial Health Research & Ethics Committees of South Africa (NHRD), who serve as the gatekeeper for monitoring and managing health research for the National Health Research Committee, Provincial Health Research Committees and Research Ethics Committees across South Africa (see Appendix D).

Proper ethical consideration was given to the study through following the ethical requirements described by Creswell, (2007), Koro-Ljungberg, (2010) and Webster and colleagues, (2013).

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 The researcher has clearly explained the purpose of the research to the five participants.

 Written and verbal consent form the participants was attained (see Appendix C).

 The study participants understood that their participation will be voluntary and free from any pressure and that they can without any explanation stop their participation from the study.

 Confidentiality and anonymity were guaranteed by the researcher through using pseudonyms and which were explained as such to the participants.

 As the researcher, I believed that the research will be useful and valuable and did not make unreasonable demands on the study participants.

 The commitment of the researcher to accommodate the participant’s requests and needs that goes beyond social norms.