Supporting methodological advance in rehabilitation research
As part of our commitment to rethinking rehabilitation, we draw on a diversity of methodologies which can help us to challenge taken-for-granted assumptions and explore questions in new ways. This sometimes includes applying methodologies and methods in new ways or developing new ways of doing rehabilitation research.
Foucauldian Discourse Analysis for health care practices
"Why can't our funders see the value of this different way of doing things?"
"This practice has lots of potential, research evidence is strong, so why is it so difficult for us to actually do it?"
"Why is it that we have particular approach, when there are lots of other ways to tackle the issue?"
Health care practices can quickly become 'taken for granted' and the knowledges and systems that underpin them become part of what they are. Based on the work of French philosopher Michel Foucault, Foucauldian discourse analysis delves into the patterns of thought and action that sustain particular ways of thinking and doing and exclude others. Dr Jo Fadyl's collaborative methodology-focused publications (derived from her PhD work) focus on the interpretation and application of Foucault's work to analyse specific health care practices.
- Fadyl, J. K., Nicholls, D. A., & McPherson, K. M. (2013). Interrogating discourse: the application of Foucault's methodological discussion to specific inquiry. Health, 17(5), 491-507. https://doi.org/10.1177/1363459312464073
- Fadyl, J. K., & Nicholls, D. A. (2013). Foucault, the subject, and the research interview: A critique of methods. Nursing Inquiry, 20(1), 23-29. https://doi.org/10.1111/nin.12011
Improving the real-world impact of rehabilitation reviews
In July 2018, Associate Professor Nicola Kayes contributed to a Cochrane Rehabilitation Methodology think tank organised by Associate Professor William Levack (University of Otago). Cochrane Rehabilitation aims to serve as a bridge between all the stakeholders in Rehabilitation and Cochrane. This methodology think tank brought leaders in rehabilitation review methodology today to debate, discuss and advance key methodological issues relevant to rehabilitation reviews. The outcome was a special issue of the Eurpean Journal of Physical and Rehabilitation Medicine devoted to papers targeted at addressing these key issues. Nicola led a paper in this special issue critically discussing key aspects of review design, production and dissemination in rehabilitation to that could improve real-world impact. Two strategies are proposed and discussed in detail including 1) involving stakeholders from the outset and 2) drawing on principles of realist review to increase relevance and usability of review findings. This paper is open access, along with all other papers in the special issue.
- Kayes NM, Martin RA, Bright FAS, Kersten P, Pollock A (2019) Optimising the real-world impact of rehabilitation reviews: increasing the relevance and usability of systematic reviews in rehabilitation. European Journal of Physical Rehabilitation and Medicine. doi: 10.23736/S1973-9087.19.05793-9.https://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y2019N03A0331
Managing large volumes of longitudinal qualitative data
In interview-based qualitative projects, sampling is about capturing diversity. A small participant sample (often between 5 and 25 people) produces a large volume of data because of the depth and complexity of the information contributed. As such, a small sample is usually sufficient to address the research question. However, sometimes because of the nature of a research question it is necessary to work with a much larger sample. In these cases, managing qualitative data for analysis can quickly become overwhelming. Our project following people recovering from a traumatic brain injury was a large sample qualitative interview study, with 52 participants and their significant others interviewed at 4 different time-points. Managing the data analysis on this project involved a lot of thought and innovation. This resulted in a contribution to a working paper on analysing large volumes of complex qualitative data published by the UK National Centre for Research Methods, and a methodological publication in Nursing Inquiry.
- ‘Analysing large volumes of complex qualitative data: Reflections from a group of international experts’
- Fadyl, J. K., Channon, A., Theadom, A., & McPherson, K. M. (2017). Optimising Qualitative Longitudinal Analysis: Insights from a Study of Traumatic Brain Injury Recovery and Adaptation. Nursing Inquiry, 24(2). https://doi.org/10.1111/nin.12170
Braun and Clarke’s Thematic Analysis
Dr Gareth Terry has led and co-authored a number of book chapters focusing on Braun and Clarke’s approach to thematic analysis spanning topics such as the history of thematic analysis, the hallmarks of Braun and Clarke’s approach, how to do undertake a thematic analysis, and applying thematic analysis to different data sets. Below is a brief synopsis of each of these book chapters. Gareth regularly runs thematic analysis workshops if you want to learn more about doing thematic analysis.
- Terry, G. & Hayfield, N. (in press). Thematic Analysis. In Ward, M & Delamont, S. (Eds.) Handbook of Qualitative Research in Education (2nd Edition).
This chapter described reflexive thematic analysis for the first time in an education textbook. It positions the method in relation to a number of other ‘theming’ approaches to analysis (e.g., content analysis), highlighting what makes it distinct. We identified how ever-increasing engagement with the data through the lens of a researcher’s theoretical perspective ensures rigour and quality in analysis. We also emphasise the problems with theming too early, which can lead to simplistic categories, and contrast this with the rigorous prototyping, testing, and refining processes that lead to meaningful, conceptually driven themes. Borrowing from design methods, the language of prototyping was used for the first time in this chapter.
- Braun, V., Clarke, V., Hayfield, N., & Terry, G. (2018). Thematic analysis. In Liamputtong, P. (Eds.) Handbook of Research Methods in Health and Social Sciences. Springer.
Thematic analysis is often misconceptualised as a single qualitative analytic approach. This chapter highlighted that it is better understood as an umbrella term, designating sometimes quite different approaches aimed at identifying patterns (‘themes’) in qualitative datasets. We defined key concepts, and map the terrain of, thematic analysis; we identified three distinct ‘schools’ of thematic analysis, highlighting differences between these, particularly in relation to underlying philosophy and approach to data analysis. We then provide practical guidance on completing thematic analysis, focused on one of the most popular approaches – developed by two of the authors of this chapter (Braun & Clarke, 2006, 2012, 2013). We used the men’s health data to illustrate theme development in the context of a pair or group work, rather than an individualised approach.
See: Men's health and embodiment
- Terry, G., Hayfield, N., Braun, V, Clarke, V. (2017). Thematic Analysis. In Willig, C. & Stainton-Rogers, W. (Eds.). The Sage handbook of qualitative research in psychology 2nd edition (p. 17-37). London: SAGE Publications.
This chapter introduced thematic analysis in the gold standard text for qualitative research in psychology. We outlined some of the history and context of thematic analysis from its inception during the 1970s, through to the current day. In doing so, we identified some of the issues that need to be considered when conducting thematic analysis. We then discuss the flexibility that thematic analysis offers, highlighting how important it is that researchers fully consider their approach and are consistent in applying it when analysing and reporting their data. This flexibility applies to theoretical approaches, research questions, and data collection methods, and also extends to choices in how you conduct the data analysis. The processes and procedures of undertaking a thematic analysis, using Braun and Clarke’s (2006) approach, are then outlined drawing on data collected from a study exploring the lived experiences of childfree women. We conclude the chapter by considering the limitations and applications of, and future directions for, thematic analysis.
- Terry, G., & Braun, V. (2017). Short But Often Sweet: The Surprising Potential of Qualitative Survey Methods. In Clarke, V, & Braun, V., & Gray, D (Eds.) Collecting qualitative data: A practical guide to textual and virtual techniques (p. 15-44). Cambridge:Cambridge Press.
This chapter was (as far as we can tell), the first chapter focusing on qualitative surveys and their development. In it, we highlighted the potential of qualitative surveys (and qualitative-dominated mixed surveys), and offered practical guidance for actually collecting data using such a method, including around ‘traps for young players.’ To illustrate points throughout, we drew on the qualitative elements of an online mixed survey we designed and used to examine body hair removal views and practices in New Zealand. This chapter was included in a text exploring new and innovative approaches to qualitative data generation and analysis.
- Terry, G. (2016). Doing thematic analysis.In Lyons, E. and Coyle, A. (Eds). Analysing Qualitative Data in Psychology (p.104-118). London: SAGE Publications.
This chapter uses the approach to thematic analysis described by Victoria Clarke and Virginia Braun to analyse the interview accounts of two men who had transitioned from the army to civilian life. It is a practical example of the ‘doing’ of thematic analysis that acted as a companion piece with the reflective commentary written by Braun and Clarke in the same volume. Using the six phases of thematic analysis to structure the chapter, Gareth demonstrated how I generated three themes from the data: 1) the superiority of army skills and values; 2) ‘translation’ as essential to success; and 3) neither soldier nor civilian. This example demonstrated the flexibility of thematic analysis as a method, its relative ease of use, and the rich, textured descriptions of a dataset a thematic analysis can produce.
- Braun, V., Clarke, V. & Terry, G (2014). Thematic analysis. In Rohleder, P. and Lyons, A. (Eds.) Qualitative Research in Clinical and Health Psychology (p. 95-113). Basingstoke: Palgrave MacMillan.
This was the first thematic analysis chapter Gareth wrote with Braun and Clarke on thematic analysis. It was also the first chapter that broke down the historical development of thematic analysis in detail. It also spoke to the proliferation of different approaches to thematic analysis, then outlined the hallmarks of Braun and Clarke’s approach to thematic analysis: its unique status as a method, rather than a methodology, its organic and reflexive orientation, and its theoretical flexibility. This chapter used data from a key informant project in Aotearoa/New Zealand and highlights its utility for analysing such data.
- The University of Auckland thematic analysis page contains additional resources associated with these chapters.
Using a Voice Centred Relational Approach
The Voice Centred Relational Approach is a qualitative methodology which emphasises the voices of research participants. It is based on the premise that a person’s ‘voice’ is ‘polyphonic and complex’, that an individual might experience multiple, sometimes contradictory ways of thinking about and understanding situations. In this approach, how a person speaks (and indeed, does not speak) of their experiences, themselves, others and relationships provides insight into their perceptions and experiences. A person’s voice is influenced, and potentially silenced by the contexts surrounding them, such as societal and cultural frameworks. It seeks voices that are unheard, silenced and suppressed. The Voice Centred Relational Approach sits within a relational ontology, holding that relationships are a fundamental part of being, and that people and objects exist in relation to others. Analysis is inherently relationally oriented, looking for relationships within and between voices, between people, and between people and the social context. The relationship between the researcher and participant is also foregrounded, and underpinned by a relational ethic of care. The primary analysis tool is the Listening Guide which involves a series of sequential ‘listening’ for voices. Researchers listen for the broad narratives, how the person speaks of themselves, how they speak of others and the relationships between them, and how they speak of the context.
The Voice Centred Relational Approach can be used with many data collection approaches and topics. For instance, we have used it to explore:
- how clinicians engage people experiencing communication disability in rehabilitation, gathering data through interviews, focus groups and observations
- how physiotherapy students conceptualise communication, analysing written assignments
- how clinicians construct themselves and their patients in clinical documentation, analysing patients’ clinical records
- Bright, F. A. S., Kayes, N. M., Worrall, L., & McPherson, K. M. (2018). Exploring relational engagement practices in stroke rehabilitation using the Voice Centred Relational Approach. International Journal of Social Research Methodology, 21(1), 35-48. https://doi.org/10.1080/13645579.2017.1316044
- Bright, F. A. S., & Bevin, M. E. (2019). Voice Centred Relational Approach. In R. Lyons & L. McAllister (Eds.), Qualitative Research in Communication Disorders: An Introduction for Students and Clinicians. (pp. 351-368) http://www.jr-press.co.uk/qualitative-research-communication-disorders.html
Our research benefits from methodological advance in rehabilitation research.