Trustworthiness of the data

All knowledge is provisional and contestable and all accounts are local, and historically and culturally specific (Burr, 2005). The conventional criteria for judging trustworthiness are internal validity, external validity, reliability and objectivity. The naturalistic paradigm questions such criteria to demonstrate robustness of qualitative research (Liamputtong & Ezzy, 2006; Tobin & Begley, 2004). Tobin and Begley (2004) use criteria like goodness and trustworthiness to evaluate the robustness of naturalistic inquiry.

As a single case study, the emphasis is on uniqueness or particularisation, not generalisation (Stake, 1995; Van Wynsbergh & Khan, 2007; Zucker, 2001). The case is tied to a specific situation and location making it less generalisable than other qualitative research (Flyvbjerg, 2004). Therefore, the suggestion that the findings may be applied more widely is contradictory and therefore invalid. The results are not generalisable to other locations and populations however, this is an instrumental case study and I sought to understand the impact of the Primary Health Care Strategy on primary health care nurses. The results will invite connections to similar situations. The case is of secondary interest and therefore the results will help inform other DHBs facing similar issues. In order to achieve this, the results need to accurately reflect the opinions of the people in the study (Zucker, 2001). The emphasis is on the description of things to which the reader of the research ordinarily pays attention, particularly places, events and people.

Qualitative research demonstrates trustworthiness when the researcher has shown that they have worked to understand the nature of the participant’s interpretations and meanings (Ezzy, 2002). Being explicit about the purpose and operationalising definitions and procedures establishes the trustworthiness of the data (Griffiths, 2004). In this research trustworthiness was established using the terms: credibility, auditability, fittingness, transferability and

i. Credibility

One of the major criteria qualitative researchers use is credibility (Hays & Singh, 2012). Credibility refers to the truth and believability of the findings and is achieved when participants recognise and acknowledge the researchers understanding and account of their viewpoints (Cooney, 2011; Roberts & Taylor, 2002). Claims to credibility were strengthened in this research through forwarding data collected from the individual interviews and focus groups to my supervisors to recheck themes and confirm interpretation, and through individual interview participant checks and audio taping of the interviews and focus groups.

The trusting relationship between me as researcher and the participants encouraged the disclosure of genuine information at that moment in time. Sharing the results with participants enabled them to feedback on their perceptions of the plausibility of the findings. I returned the transcripts back to each individual participant for editing and verification, and because of the sensitive nature of the information they had provided. Known as member checking this can be time consuming and problematic for a number of reasons (Holloway & Wheeler, 2010). I chose not to return the transcripts to focus group participants due to the complexity of focus group interactions and the potential inability to identify individual responses.

ii. Auditability

Auditability is established when the adequacy of the information leads the reader from the research question and raw data, through the steps of analysis, to the interpretation of the findings (Cooney, 2011). Maintaining and reporting an audit trail of methodological and analytical decisions enables an external observer to trace the steps in either direction, from conclusions back to the initial research questions or from questions to conclusions (Tobin & Begley, 2012; Yin, 2003). This was achieved in the study by describing the processes in full and providing a rationale for the methodology and methods chosen.

iii. Fittingness

Fittingness is a logical consequence of supplying a substantial amount of information about the entity studied and the setting in which that entity was found (Schofield, 2000). It includes describing the phenomena in enough detail so others in the discipline can evaluate the importance of their own practice, research, and theory development. Fittingness is also about being faithful to the everyday reality of the participants. Guided by Creswell (2009), I used rich, thick descriptions to convey my findings. Verbatim data outlining participant dialogue is included in Chapters Six, Seven, and Eight, in combination with both local and national literature about the implementation of the Primary Health Care Strategy.

All research reflects the interests of the researcher (Hays & Singh, 2012). Therefore, researchers should make known their personal stance in relation to the subject under investigation as well as their relationships with the participants (Fade, 2003). Whilst I made every effort to remain impartial, I acknowledge my knowledge, interest, and experience influenced the research. I concede my position as nurse leader-primary and community position at TDH may have influenced some of the participants and their responses. What could be seen as coercion in obtaining the desired feedback was a potential threat and is discussed in more detail in the section on reflexivity.

iv. Transferability

Lincoln and Guba (1985) use the term transferability in qualitative research as opposed to generalisability. Generalisability is a term used in quantitative research and addresses the ability to replicate the research, including findings and conclusions, from one study and apply them to another setting (Fendler, 2006). Alternatively, the knowledge gained from qualitative research can be transferred to a similar situation. Transferability does not imply broad claims but invites connections. It depends on the congruence between the context in which the research is conducted and the context where the research findings can be applied (Carcary, 2009; Koch, 2006). The rich description and detailed findings from this instrumental case study will inform on similar issues primary health care nurses face in other DHBs.

v. Confirmability

Confirmability takes the place of objectivity and the researcher must declare their background and feelings for the research and maintain an audit trail (Holloway & Wheeler, 2010). My research decisions and influences are declared throughout the study as were my beliefs and assumptions. Reflexivity support confirmability as presented next.