Reflexivity – A process of reflexivity was undertaken, in order to create an awareness of myself within the data analysis, with the aim of producing a more objective

outcome.

Further steps in ensuring quality were: to ensure that the interviews were transcribed accurately; that sufficient time was given to ensure each research stage was completed adequately; and that the written findings were a product of a thorough approach (Braun &

Clarke (2006). Consideration was also given to the use of quotation in the report to ensure that they reflected the views of the participants rather than, for example, picking out striking quotes (White, Woodfield and Richie 2010). In addition by describing the epistemological stance, and methods of data collection and analysis, the reader can make their own judgements about the quality of the study (LeCompte & Goetz 1982, Mason 2002).

4B.16 Methodologies for the Validation Exercise, Heart Failure Specialist Nurses Research, and the Technology Key Informant Interviews

The following section describes in brief the methodologies used for the support group validation exercise, the research with the HFspNs, and the key informant interviews. The methodologies are not expanded on due to the fact that these were small elements of the whole project, and word constraints prevent full elaboration. The following tables summarise the methodologies:-

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Table 4B.3 Validation Exercise with the Heart Failure Support Group 1. Justification for

this Element of the Project

This element of the research was undertaken to validate and test the initial themes and theoretical propositions developed from the first thirteen interviews with participants with heart failure, before an audience with the same condition; and to gain additional insights.

In addition, the group was visited in order to recruit further participants with heart failure for interview

2. Research Method A focus-group discussion was chosen on the basis that it would be an efficient method of gaining both individual views, and responses emanating from the interplay between group members (Finch & Lewis 2003).

3. Topic Guide The topic guide (appendix - Participant Interview Topic Guide (Validation Exercise at the Support Group) was based on the initial analysis of the participant interviews, and group members were asked their response to these initial theoretical propositions that were presented to the group in the form of a statement.

4. Practical Issues The research took place at the hall used regularly for group meetings;

and therefore the participants were in a familiar situation, and were not required to travel further to participate.

5. Recruitment Ethical approval was gained, and permission was sought from the Chair of the support group to attend a meeting, and this was readily given.

6. Sample The sample was based on chance, on which members happened to attend. In the event there were 27 attendees: with a gender split of 19 males and 8 females. There were 7 partners present, and these were mainly female (5). The participants were not asked their age, as this was thought to be too intrusive; but the age-range was estimated to range from 60 to over 80, with the majority in their 70s. It also became apparent that the majority of attendees had been living with the condition for some time, although there were two members who had been recently diagnosed.

7. Ethics The same ethical issues previously described in section 4B.9 applied to this project. In addition there were potential ethical issues around the disclosure of information in a group situation; in order to mitigate this, participants were assured that they would not be identified in any

109 reports, and participants made their own choices about what to disclose.

8. Consent Consent was sought before commencing the focus-group. In order to ensure informed choice was made, the key issues were explained (see previous section on consent). Consent was also sought to record the session.

9. Data Recording and Transcription

The session was recorded via a digital recorder, and was transcribed by myself, with checks made to ensure that the transcription was accurate. Transcription was a challenge because of the large number of people in the group (Finch & Lewis 2003).

10. Reflection on the Focus Group

The group was larger than the typical focus-group, and this presented challenges in terms of controlling the group (Finch & Lewis 2003). My previous focus group experience was invaluable in ensuring that the participants were given an opportunity to speak. Within large groups there are risks that the discussion may lack depth (Finch & Lewis 2003); however in reality the depth of discussion varied more

according to what sparked interest in the group, rather than this being an issue across the discussion.

11. Field Notes Notes were taken immediately after the validation exercise, and these were invaluable in clarifying and shaping ideas about the relationship between activity and health.

12. Reflexivity Aware that I was an outsider of the group, I presented myself as seeking help to understand about heart failure, saying this is what I thought but is it true? I think this acknowledgement, helped participants to be more candid.

13. Data Analysis The data analysis followed the structure of the topic guide (Appendix Information Sheet 3), with responses summarised under each heading. The data was considered more a validation to explore pre-existing themes, and therefore no further thematic analysis was undertaken. Advice had been sought from NK about whether this data should be added to the template, and he recommended keeping the data separate. However during the write-up of the interview findings, any relevant data was incorporated.

14. Quality Checks The focus group was discussed at the monthly supervision meeting,

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where the interpretation in the summary was checked against the transcript.

111 Table 4B.4 Research with Heart Failure Specialist Nurses (HFspNs)

1. Justification for this Element of the Project

This element of the research was undertaken to seek an alternative perspective on the relationship between activity and health from health professionals caring for people with heart failure; and the data was also used to validate and check some of the key findings from the participant interviews.

2. Research Method This section of the research took place as part of a focus-group undertaken for the parent project. The rationale for choice of focus-group was the same as the previous project. For pragmatic reasons two nurses were interviewed individually using the same topic guide.

3. Topic Guide The topic guide (appendix Information Sheet 4) sought to explore issues arising from the literature, and the quantitative findings.

4. Practical Issues The initial focus group participants declined to have the interview recorded, and therefore extensive notes were taken. This meant that as it was not possible to record the conversation verbatim, decisions had to made on the spot about what to record; and the subtleties of the conversation were not captured (such as tone of voice).

5. Recruitment Five nurses were recruited by AH, and the sixth by myself (after a chance encounter).

6. Sample The nurse participants were purposively selected to encompass experience of services provided for different case-loads, with the Sheffield service caring for patients with severe heart failure (4 nurses), Barnsley less severe patients (1 nurse), and the Nottingham service focused at the time of the nurse’s experience on case management of symptomatic patients (1 nurse).

7. Ethics The additional ethical issues were around potential breaches of confidentiality which may arise when nurses were discussing individual patients; however this did not arise as no individual identifiers were included in the conversations. Pseudonyms were used in the write-up.

8. Consent Consent was taken as previously described. Consent was not given to record the Sheffield focus group.

9. Data Recording and Transcription

Extensive notes were taken at the focus group. The interviews were recorded and transcribed verbatim.

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10. Reflection on the Focus

Group/Interviews

The questions for this project were asked at the end of the focus group, and there was awareness that the participants should not be detained too long. The final interview where the only these questions were asked, felt much more relaxed and there was time to explore the issues.

11. Field Notes Field notes were taken and these were useful in forming ideas about the range of factors influencing activity levels; and the role of the nurses themselves in either encouraging or discouraging activity.

12. Reflexivity The Sheffield nurses appeared suspicious of the research, and this seemed to relate to the on-going NHS reorganisation. The nurses were reassured that the research would not compromise their situation.

13. Data Analysis For the following reasons the HFspN data was summarised, rather than subjecting it to thematic analysis. Firstly, a full transcript of the focus group was not available; secondly, this was a small element of the total research, and thirdly, time constraints prevented full analysis.

14. Quality Checks The findings were discussed with AH who led the focus group and interviewed the Barnsley nurse, in order to check interpretation.

113 Table 4B.5 Lifestyle Monitoring Technology - Key Informant Interviews

1. Justification for this Element of the Project

This element of the research was undertaken as a quick means to gain an understanding of the key issues around lifestyle monitoring: the purpose of the technology, and the state of the art in terms of the technologies utilised, data analysis, and the strengths and weaknesses of the technology. In addition the interviews were also utilised to gain an understanding of the purpose of the Barnsley lifestyle monitoring project, and the sensor platform utilised; as this data was analysed for this study (chapter 5). The results of the interview data is chiefly reported in chapter 9.

2. Research Method Two lifestyle monitoring experts were interviewed, as this gave the opportunity to explore a complex subject area in general, and the specifics of the Barnsly LM project.

3. Topic Guide The topic guide (appendix Information Sheet 5) sought firstly to explore the set-up of the Barnsley lifestyle monitoring project; and secondly to present the interviewees with a list of strategies used by people with heart failure to deal with changes in heart failure

symptoms, in order to explore whether LM technology could indirectly capture these changes in home activity. Additional ad-hoc questions were also asked.

4. Practical Issues The recording device ran out of power during the recording of one of the interviews, and after a failed search to find replacement batteries, notes were taken instead.

5. Recruitment The experts were colleagues in the same university department where this study took place.

6. Sample The key informants were purposively selected to encompass

knowledge of the set-up of the Barnsley lifestyle monitoring project, and more general knowledge of the subject state of the art.

7. Ethics Ethical approval was not sought as the participants were university colleagues.

8. Consent No consent was taken.

9. Data Recording and Transcription

Where possible the interviews were recorded and transcribed verbatim, and in the case where the recording device broke down extensive notes were taken.

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10. Reflection on the Interviews

The participants were colleagues, and initially the process felt a bit uncomfortable perhaps for all parties but this soon passed.

11. Field Notes Field notes were taken in order to reflect on the interviews, both in terms of the understanding of the technology, and insights on ideas about the relationship between activities within the home and health.

12. Reflexivity I was very aware that I was interviewing colleagues about a subject matter that they are experts in, and thus initially felt some concerns about my relative lack of knowledge. However I took the opportunity to learn, and followed up issues I did not understand; and allowed the interview to develop naturally.

13. Data Analysis For the following reasons the key informant data was summarised, rather than subjecting it to thematic analysis. Firstly this was a small element of the total research, and secondly, time constraints

prevented full analysis.

14. Quality Checks The findings were discussed with Mark Hawley the supervisor with expertise in technology, in order to check interpretation and understanding of technological issues.

4B.17 Conclusion

This chapter therefore reflects and justifies the inclusion of qualitative elements in the research, and describes the methodological approaches to each aspect.

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Chapter 5: Findings from the Analysis of the Barnsley Lifestyle