Choice of research methods is dependent on their appropriateness for the purpose and nature of the study. Both quantitative and qualitative approaches are suitable for use when children are directly involved (Greig et al. 2007, p59). Quantitative
methods for research with children include observation, structured interviews and questionnaires. Quantitative techniques can vary according to children’s ages; their conceptual abilities; their relationship with the researcher and the purpose of the research. Observational research techniques, for example, are particularly helpful for research that involves very young children who may not be able to communicate in other ways (Greig et al. 2007, p119).
Qualitative approaches present opportunities to capture children’s experiences and understandings through rich description, that can incorporate actual words of children and also because such research is participatory in nature. Having said this however, qualitative research with children has its own difficulties and limitations. Real world research takes place in complex, messy and poorly controlled settings, and real world research with children is often even messier (Greig et al. 2007, p140).
Flexible, participatory, child centred research tools can be used with children and young people. These include photographs taken by children of places and things important to them; guided tours documented through tape, drawings and maps; mapping; individual interviews; focus groups and observation. Such methods may not be truly emancipatory, however, for numerous reasons. Children might not enjoy drawing for example; there may be a mismatch in tasks and children’s literacy skills; participants may feel burdened by the level of participation asked of them; and there is a risk of over or misinterpretation of children’s meanings (Greig et al. 2007, p159, 164). The way that methods are used, and the concepts and intent that underpin their use will influence their success and the research findings.
Page | 64 Childhood middle years – from 5 to 12 years is little researched and an oversight of the usefulness of qualitative methods applies for research with children in this age group (Greig et al. 2007, p161). One explanation for this is that by researching those who have few words (infants) and those who have many (adolescents) the problem of linguistic competence perceived to be associated with middle childhood is reduced (James et al. 1998, p177). In terms of child development, research has largely focused on the pre-school years and adolescence as these age groups have been viewed as being critical phases of development (Greig et al. 2007, p162). Because there has been little research with children aged between 5 years and 12 years, there is a gap in understanding. This current research is with primary school children aged between 6 and 12 years and so this study helps to address this lack and adds to the body of research with children of this age.
Grounded theory as a research approach with children
Grounded theory is especially useful in situations where little is known about a topic or where a new outlook is needed. It is therefore a method suitable for research into the world of children, where researchers can utilise innovative ways of conducting the research (Greig et al. 2007, p141). Whilst grounded theory is a recommended approach for exploring children’s perceptions of their experiences (Woodgate 2000, p194), there is only a limited, albeit growing, number of studies where a grounded theory method has been used in conducting research with children. One reason for the limited number of studies may be that in general, we do not have a well
established research tradition with children as participants. Of the limited grounded studies with children, there are nurse researchers who have used the approach with hospitalised children. These grounded theory studies enable the experiences of children to be explored in their richness with a result that understandings of the phenomenon of children’s healthcare, their hospitalisation and illness are improved.
Hospitalised children’s perceptions of their pain experiences were explored in a grounded theory study conducted by Woodgate and Kristjanson (2000). The very young children in the study were aged between 2 1/2 years and 6 1/2 years, and data collection techniques used by the researchers included participant observation, interviews, play and drawings. The authors found that through the use of qualitative research methodologies, it was possible to enter the world of young children and
Page | 65 learn of the meanings children assign to their experiences, in this instance, their experiences of pain.
A grounded theory approach was used to explore children’s, parents’ and health professionals’ experience of childhood chronic illness in research by Sartain, Clarke and Heyman (2000). Child participants in this study were aged between 8 and 14 years and data collection techniques used with the children included interview and drawing. This study found that children are capable of giving an opinion and that their views can lead to significantly greater understandings of biography in childhood chronic illness.
Stewart (2003) conducted a grounded theory study with 11 children aged between 9 and 12 years who were undergoing treatment for cancer. The two themes consistently identified in the analysis were the ‘uncertainties’ inherent in the children’s illness experience and the process the children described was that of ‘getting used to it’ (p398).
A grounded theory study involved children’s, parents’ and nurses’ views on participation in care in the healthcare setting was conducted by Coyne (2006). The findings of the study revealed that parents and children experienced considerable disruption to their worlds and experienced difficulties in their participation in care (p65). The core concept of Coyne’s study was ‘finding a balance’ that described a process ‘used by children, parents and nurses to achieve equilibrium between their social worlds and the social order of the ward’ (p65). Coyne’s grounded theory incorporated the child, the parent and the nurse.
Wennstrom et al’s (2008) grounded theory study involved 20 children aged 6 to 9 years who attended hospital for day surgery. Data collection techniques included observation, interviews and drawings. This interventional study used perioperative dialogue that involved extensive pre-operative preparation, recognition and support throughout the entire perioperative experience. The core category identified in the research was ‘enduring inflicted hospital distress’.
These studies are from the discipline of nursing. In sociology, Greig and Taylor (1999) refer to the appropriateness of a grounded theory approach for research with children:
Page | 66 The notion that theory is created from or emerges from data is consistent with the view that the child is subjective in nature, and that his understanding, knowledge and meanings are subjective, and emerges in interaction with others in a given context. Hence, the qualitative framework entails a methodology in which theory is ‘grounded’ in data such as observations, interviews, conversations, written reports, texts and their interpretations (p43).
Grounded theory is a recognised approach for learning more about an area of study, and what research participants’ lives are like. Grounded theory is an appropriate method to use when research involves children and the aim is to learn about children’s lives (Greig et al. 2007, p141).
Conclusion
Whilst children are increasingly acknowledged as social actors in their own right, traditionally, there has been little attention given to children as active participants in research. However, children are the primary source of knowledge about their own experiences. This work adds to the small but growing body of nursing research with children where children’s experiences of healthcare are explored from children’s own perspectives.
Children’s participation in research involves changes in emphasis and approaches so that children are recognised as subjects rather than objects of research. Children’s special needs in the research process need to be acknowledged so that they are not adversely affected by their participation. Understanding of children’s development, their language skills and the ways children develop understandings through
experience is important in research that directly involves children as participants. In this study, child development theory informed the research process and methods, the way information was provided to children and the ways children were questioned in interviews. Child centred research approaches acknowledge these issues and provide strategies to address them. Attending to the specific ethical considerations for
research with children helps to protect children from exploitation. Obtaining children’s voluntary and informed assent to participate is one way of protecting children from harm and also demonstrates respect for children.
Research methods suitable for research with children aged 6 to 12 years were essential to this research. A constructivist grounded theory approach that
Page | 67 incorporated child centred research techniques was chosen to achieve the research aim. Grounded theory has been shown to be a suitable method for use with children and child centred techniques facilitate children’s participation; acknowledge the competence and abilities of different children; and address specific ethical aspects of research with children. The aim of this current research was to explore children’s experience of admission for surgery, through listening to them and hearing what they have to say. In doing so, this is an example of research with children, rather than on them.
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Chapter 4: The research strategy and design
Let’s go to the palace said one blind man… a friend of the six blind men met them at the palace and an elephant was standing in the courtyard. The six blind men touched the elephant with their hands… ‘An elephant is like a wall’ said the first blind man. ‘A wall?’ said the second bind man. ‘You’re wrong, an elephant is like a snake.’ The third blind man said ‘You’re wrong, an elephant is like a spear.’ The fourth blind man said ‘No, you’re wrong, an elephant is like a tree’ …
The Rajah looked out and saw the blind men arguing in the courtyard. ‘Stop’ said the Rajah. ‘The elephant is a big animal. Each man touched only one part. You must put all the parts together to find out what an elephant is like’ (From The Blind Men and the Elephant retold by Lilian Quigley 1959).
The purpose of this chapter is to give an account of the research design, strategies and methods used in this study, and so provide judges of the work a guide that assists in their assessment of its integrity. In this qualitative study a constructivist
interpretive perspective provided the general orientation for the work. This approach was chosen because it suited the research aim and because it reflects my own
perception of the world. Grounded theory conducted from a constructivist
perspective (Charmaz 2000, 2005, 2006) was the methodological approach used to explore the experiences of primary school age children admitted to hospital for surgery. This research design therefore involved the ‘intersection of philosophy, strategies of action and specific methods’ (Creswell 2009, p5). The design reflects the research aims, questions, and epistemological understandings appropriate to this study.