Nurse Researcher
Conducting qualitative longitudinal research using interpretative phenomenological analysis Cite this article as: Snelgrove SR (2014) Conducting qualitative longitudinal research using interpretative phenomenological analysis. Nurse Researcher. 22, 1, 20-25. Date of submission: August 18 2013. Date of acceptance: November 4 2013. Correspondence to Sherrill Ray Snelgrove [email protected] Sherrill Ray Snelgrove PhD, MPhil, BSc(Hons) is a senior lecturer at the College of Human and Health Sciences, Swansea University, Swansea, UK
Abstract Aim To discuss the methodological and epistemological challenges experienced when conducting a longitudinal interpretative phenomenological analysis (IPA) of patients’ experiences of chronic low back pain (CLBP).
Peer review This article has been subject to double-blind review and checked using antiplagiarism software
Background The author draws on experiences of managing interpretive analysis while undertaking an IPA of patients with CLBP for more than two years.
Author guidelines rcnpublishing.com/r/ nr-author-guidelines
Data sources Semi-structured interviews were conducted at three points in time from a purposeful sample of ten patients. Review method There was a recognition that prolonged contact between researcher and participant increases the challenges related to minimising bias and managing researcher emotionality and empathy. Discussion Two main challenges are discussed: the usefulness of ‘bracketing’ in longitudinal qualitative research and maintaining an inductive approach; and
Introduction QUALITATIVE LONGITUDINAL research (QLR) is a general term encompassing different research designs. QLR can include planned prospective studies, follow-up studies, evaluation, and tracking studies that use interviews, observation, field notes, and diaries, and it can be used in mixed-methods designs. Despite little agreement about timelines, a fundamental characteristic is that the same sample of participants is investigated more than once, with change and continuity a focus of attention (Saldana 2003). While policy and practice development are increasingly informed by qualitative data, there 20 September 2014 | Volume 22 | Number 1
consideration of the emotionality of interviewing and the role of empathy. Conclusion A longitudinal design adds potential analytical pitfalls, including a priori theorising and emotional involvement. Interpretative and emotional safeguarding included reflection and reflexivity, an iterative approach and the role of phenomenological strategies such as the hermeneutic circle. The efficacy of these is discussed, along with the ambiguity surrounding concepts such as bracketing. Implications for research/practice Although the topics discussed relate specifically to this methodology and a particular research project sample, they are applicable to qualitative research designs in similar populations. Keywords Longitudinal study, interpretative phenomenology analysis, methodological challenges, bracketing, semi-structured interviews, minimising bias continues to be a lack of QLR documenting the ‘natural evolvement of change’ (Murray et al 2009, Osborn and Rodham 2010, Snelgrove and Liossi 2013). This is surprising, because engaging with temporality has distinct advantages over ‘snapshot’ techniques. QLR offers multiple vantage points and valuable insights into how changing environmental, physical and psychological contexts can influence experiences over time (Thomson and Holland 2003). It helps to identify the determinants and direction of change (Snelgrove and Liossi 2013), yields an understanding of people as dynamic rather than static entities (Osborn and Rodham 2010), © RCN PUBLISHING / NURSE RESEARCHER
Downloaded from RCNi.com by ${individualUser.displayName} on Aug 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Minimising bias and promotes knowledge of patients’ needs during long-term illness (Murray et al 2009). However, researchers might avoid undertaking QLR because of the expense and difficulty in recruiting and retaining participants. Retaining skilled researchers and involuntarily sensitising participants through repeated collection of data may also be drawbacks (Thomson and Holland 2003). The aim of this paper is to advance understanding of the methodological and epistemological challenges that may be encountered when undertaking QLR. Qualitative methodologies support an idealist ontology that acknowledges the subjective construction of reality. From this perspective there is no single reality, rather there are multiple realties relative to context (Bailey 1997, Hill-Bailey 1997). From this perspective, the epistemological approach adopted is that expressed meanings are a valid form of knowledge and may be best represented by an inductive approach that includes sensitive and openended questioning and an appreciation of the interpretative nature of the enquiry. This calls for rigorous monitoring of the researcher’s role in the interpretation of qualitative data. This paper draws on the author’s personal experiences of conducting QLR using interpretative phenomenological analysis (IPA) to gain understanding of the subjective meaning of chronic low back pain (CLBP). The account begins with an overview of IPA and a brief discussion of the research design and analytical processes, before discussing: ■■ Being inductive and managing formal knowledge. ■■ Being inductive and managing personal knowledge. ■■ Being inductive and managing emotional boundaries. These challenges may be familiar to qualitative researchers but the intention is to show how a longitudinal design promotes tensions and highlight the strategies used to maintain analytical integrity.
IPA is committed to an ideographic paradigm where the focus is on the ‘particular’ rather than the ‘universal’ as in large scale quantitative studies. The aim is therefore to present detailed in-depth analysis of the experiences of particular people in particular settings. To achieve this, IPA studies use small samples, semi-structured interviews, and an inductive (drawing meanings from the data rather than imposing a priori constructs on them) and reflexive approach (researchers monitor their responses and critically examine their methods throughout the research) (Larkin et al 2006, Smith et al 2009). IPA applies the descriptive and interpretative philosophies of Husserl (1981) and Heidegger (1962) to investigate significant experiences (Smith et al 2009), with Heidegger’s emphasis on temporality and revealing ‘what is’ at a particular ‘time’ especially pertinent to longitudinal designs because of the recognition that experiences are contextual (Smith et al 2009).
The study
Interpretative phenomenological analysis
The aim of the research was to understand living with CLBP, to identify appropriate ways of helping patients manage their conditions. The study was a response to the preponderance of quantitative, cross-sectional studies that hardly touch on the subjectivity of experiences of chronic pain (Lamé et al 2005, Mercado et al 2005, Koleck et al 2006). Ethical approval was obtained for purposeful sampling of ten patients with CLBP recruited from a chronic pain clinic. Participants were followed up on three separate occasions at yearly intervals over two years. Participants each took part in face-to-face, in-depth, semi-structured interviews in their homes. The sample was selected according to the following inclusion criteria: experiencing unrelieved, benign CLBP; no neurological problems or recent surgery; English-speaking; more than 18 years old; and had attended the pain clinic before the study. Participants’ interviews were recorded, transcribed and analysed using the detailed guide for IPA provided by Smith and Osborn (2003, 2007).
IPA is embedded in psychology but used increasingly across disciplines including nursing research (Smith et al 2009). Its epistemological position is rooted in an assumption that subjective data can inform us about people’s understandings of their experiences. It is phenomenological because it makes enquiries into consciousness, mental life or how things seem to individuals. It is interpretative because there is recognition of the central role of interpretation in negotiating meaning (Smith et al 2009).
Analytical design The analytical procedure was guided by the work of Smith and Osborn (2003). An ideographic stance was adopted, with each transcript examined in detailed, analysed and reread before the researcher moved onto the next script. Each transcript was treated independently, which helped to maintain an inductive approach. A table of superordinate themes representing related topics was produced for each participant before moving onto the next transcript. The themes
© RCN PUBLISHING / NURSE RESEARCHER
September 2014 | Volume 22 | Number 1 21
Downloaded from RCNi.com by ${individualUser.displayName} on Aug 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Nurse Researcher for each individual were then compared across the dataset, which allowed different concepts and meanings to be identified as either new manifestations of existing themes or new themes, and integrated into super-ordinate themes that represented the sample as a whole (Willig 2008). This was repeated for each of the three sets of interviews, with super-ordinate themes from each study compared with those previously elicited. This enabled continued themes and any new themes to be identified. The aim was to maintain a ‘bottom up’ approach throughout, without imposing a priori theories on the data (Smith 2004). To be inductive by its very nature is open-ended and exploratory. The challenges of sustaining an inductive approach and the associated task of managing emotionality are discussed below. Pre-research stage: being inductive and managing formal knowledge An epistemological challenge in QLR is to resist an increasingly analyst-led focus and continue to capture subjective experiences without imposing previously learned information (Flowers 2008). Ideally, the phenomenological researcher should approach the topic with an open mind from the start. Van Manen (1990) claims that: ‘The problem of phenomenological inquiry is that we know too much. Our common sense pre-understandings, our suppositions, assumptions, and the existing bodies of scientific knowledge, predispose us to interpret the nature of the phenomenon before we have come to grips with the significance of the phenomenological question.’ This calls attention to what we are supposed to be as qualitative researchers and what we actually are able to do. Likewise, in this research project, an initial challenge related to my role as a university lecturer and the important but oft-missed point that much inductive research is conducted by academics and, similarly, clinicians, who by the nature of their role, really do know ‘too much’. The implications are that repeated exposure to formal academic theories can lead to what I term ‘theoretical sensitivity’ and a priori theorising, which may unintentionally occlude subjective meanings. Such a possibility was amplified in the present research, as the longitudinal design meant I would have to maintain a check on premature theorising and academic knowledge at different points in time. I judged that it would be a useful first step to acknowledge and manage my academic knowledge so as to gain a relatively untainted insight into participants’ experiences. In keeping with the tenets of phenomenological research, this necessitated 22 September 2014 | Volume 22 | Number 1
clearing my mind and attempting to set aside or ‘bracket’ pre-existing formal knowledge to gain entry to the ‘phenomenological attitude’ (Moustakas 1994). IPA, in common with other phenomenological methodologies, draws on reflexive techniques such as Husserl’s ‘descriptive eidetic reduction’ or ‘bracketing out’ of the ‘natural attitude’ (Husserl 1981) – that is, putting aside one’s habitual way of thinking, so as to engage closely with the participant’s view. Although bracketing is seen as a way of demonstrating rigour, it is one of the more contested concepts in phenomenological research. LeVasseur (2003) described bracketing as ‘perplexing’ and frequently prone to misunderstanding and misapplication in health research. Fouché (1984) questioned the difference between bracketing and the non-phenomenological researcher’s attempts to reduce bias. For Giorgi (2009), bracketing the researcher’s natural attitude or pre-understanding was essential for close engagement with participants’ perceptions. Although Husserl’s original conception of bracketing referred to a near-total exclusion of all internal and external suppositions (Gearing 2004), some IPA researchers argue that to put aside all suppositions and experiences is almost certainly impossible (Larkin et al 2006, Smith et al 2009). This latter view broadly concurs with the interpretative phenomenology of Heidegger, who argued that it is impossible to find untainted cognitions or perceptions, as we are already part of the world and inseparable from it (Heidegger 1962). Nevertheless, to engage with subjective meanings, it appears reasonable to attempt to put aside known presuppositions and acknowledge their role in the analysis. I began by bracketing my formal, academic knowledge, which is consistent with the views of existentialists such as Merleau-Ponty (1962), who advocated researchers put aside theories, research presuppositions, ready-made interpretations and so forth (Gearing 2004). The implementation of ‘bracketing’ remains a conundrum, and there is little guidance about taking it forward. Pragmatic measures may be useful, with reflection having a role to play in revealing researchers’ views and prejudices: ‘Husserl’s work has helped IPA researchers to focus centrally on the process of reflection’ (Smith et al 2009). Conversely, reflection is also viewed as being at odds with the intuitive, reductionist nature of Husserlian bracketing and gaining entry to the phenomenological attitude (Giorgi 2011). Mindful of these contrasting views, I concluded that to document my reflections upon my pre-existing knowledge and perspectives, I could effectively © RCN PUBLISHING / NURSE RESEARCHER
Downloaded from RCNi.com by ${individualUser.displayName} on Aug 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Minimising bias bracket them was congruent with IPA guidelines and an application of elements of Husserl’s work, rather than faithfully replicating his philosophy in practice. I am aware that by adopting a reflective stance I had interpreted bracketing contentiously and perhaps deviated from a purist ‘phenomenological science’, but there is little advice about ‘assuming the attitude of phenomenological reduction’ (Giorgi 2011). Subsequently, before collecting any data, I reflected on my pre-existing knowledge of CLBP in a research diary. Before, during and immediately after interviews, I added any emerging thoughts, perspectives and views (Burns and Grove 2003). This provided me with the opportunity to monitor the extent to which any theoretical frameworks might be imposing on the data (Hamill and Sinclair 2010). In addition, performing a preliminary literature review rather than an extensive review offered a framework for understanding the topic area and preserving the inductive enterprise (Creswell 2003, Hamill and Sinclair 2010). This brief review was followed by a strategy of ongoing, broadening searches throughout the writing up of the study. This is a traditional way of working with qualitative data; that is to ‘work backwards’ and conduct the literature review after analysing the data and maintain the inductive technique (Meloy 2002). In the field: being inductive and managing formal knowledge Despite my initial bracketing techniques, there remained an inclination to draw on existing knowledge and theorise during fieldwork. Participants’ accounts triggered automatic responses from my personal store of psychological theories. In-the-field analysis is congruent with methodological principles of qualitative research (Silverman 2000). Indeed, most qualitative research involves inductive and deductive reasoning. However, in this case, my initial observations had led me to inductively create tentative theoretical interpretations, which in turn led me to deductively create hypotheses and test these during further interviews. My view was that any immediate theorising and further testing of hypotheses posed an ongoing threat to the ‘bottom up’ nature of the research, but also highlighted the tension between Husserl’s descriptive phenomenology and notion of ‘to the things themselves’ (Husserl 1981) and Heidegger’s ‘being in the world’ (Heidegger 1962). This was pertinent in the research as any premature theorising and testing of hypotheses could influence the inductive or exploratory approach at subsequent interviews. For example, at one interview, I was aware of drawing on a well-known psychological theory to describe a participant’s experiences. My diary © RCN PUBLISHING / NURSE RESEARCHER
entries showed that during a second interview I continued to adopt this theoretical stance. In short, I was squeezing data into an existing theoretical framework. I attempted to overcome this by adopting ‘the phenomenological attitude’ through bracketing vis-à-vis reflection but also by focusing intently on the participants’ accounts so as to deliberately try to put a priori theorising to one side (Smith et al 2009). A phenomenological attitude necessitated engaging with the participants’ narrative ‘as it was’ and not thinking about what was already known – in other words, experiencing the moment rather than looking forward or backwards at other experiences (Willig 2008). I attempted to focus in this way throughout and thematically analysed each transcript before comparing it with the remainder of the dataset. It was not until the final analysis and after I had collected all the data that I stopped trying to bracket any formal knowledge (Figure 1). In the field: being inductive and managing personal knowledge I became increasingly aware that the public view of CLBP patients was one of scepticism (Glenton 2003). Societal attitudes towards CLBP patients intrigued me and I considered whether I too was making unacknowledged, negative assumptions about the participants. After all, I was part of wider society and I might have unintentionally influenced the analysis with judgemental views. Certainly, diary entries such as ‘SH does not appear to be in pain. Rather, she appeared fit and well’ reflected a judgement call. I had been previously unaware of these preconceptions and Figure 1
Bracketing in a longitudinal IPA study of patients’ experiences of CLBP
Time one
Time two
Time three
BRACKETING Academic knowledge Theoretical frameworks Known presuppositions
DEVICES Reflective diary Focused interviewing Reflective diary
Reflective diary Academic knowledge Theoretical frameworks Focused interviewing Reflective diary/ Personal knowledge Independent researcher Academic knowledge Theoretical frameworks Reflective diary Personal knowledge Focused interviewing Reflective diary/ Independent researcher
Final analysis
Bracketing ceased revisited
Hermeneutic circle/data
September 2014 | Volume 22 | Number 1 23
Downloaded from RCNi.com by ${individualUser.displayName} on Aug 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Nurse Researcher they highlighted the challenge of manoeuvring between the twin tasks of suspending my suppositions and using them in the final analysis (Smith et al 2009). A close inspection of the data showed that participants were aware of these prejudices and had to work hard to convince others of the legitimacy of their illness. Acknowledgement of my conceptions and engaging with the data led to new understandings of the participants’ motivations to participate in the study. The participants’ stories were rational responses to continued scepticism and constituted efforts to protect their identities as moral individuals with a valid right to being sick (Eccleston et al 1997). My diary accounts reminded me about the necessity of reflexive mindfulness and carefully monitoring my responses (Woolgar 1988), as well as how preconceptions could contribute to making sense of participants’ accounting. In the field: being inductive and managing emotional boundaries The longitudinal design also amplified my concerns about emotionally engaging with participants. Although the task of the qualitative researcher to capture the wide array of subjective experiences ‘involves non-propositional thoughts that may be unmediated and unfocused’ (Willig 2008), it necessitates close interpretive work and engaging with the thoughts, emotions and feelings of participants. Repeated contact allowed me increasing access to private and sensitive issues of the interviewees. My diary entries showed that as the research progressed, I was engaging with participants’ experiences to the extent that sometimes I felt
uncomfortable. I identified with one participant’s personal characteristics and felt a growing empathy and sympathy over the two years of research. The concept of identification is found in Freud’s writings and refers to the assimilation of attributes of others. Freud describes several types of identification, including partial (secondary) identification in which individuals are able to ‘feel the emotions’ experienced by others. Such closeness with participants might generate rich data but renders the researcher vulnerable to feeling emotionally drained and overwhelmed (Gregory et al 1997, McCosker et al 2001, Dickson-Swift et al 2006). My ongoing emotional engagement with participants meant that I required access to methodological, personal and emotional support (Smith and Osborn 1996, Elliott et al 1999). Subsequent sessions with an independent researcher resembled a ‘quasi debriefing’, where I was reassured about the maintenance of the boundaries with participants, that my feelings were ‘okay’ and reflected my closeness to the data, and that by reflective discussion and an iterative approach, any interpretation would be unlikely to showcase my feelings rather than the participants’ experiences. Although this made sense, I felt I was swimming in unknown waters. I considered that although empathy offered me a springboard to intuitive understanding, it was not only emotionally exhausting but promoted questioning about articulating its role in a research study. Much is written on researchers’ characteristics, such as age, social class, appearance, accent, gender, age and similarity with participants, and how they influence participants’ responses (Breakwell 2006, Bloor et al 2007); there is far less acknowledgement of the effect of researchers’ empathy and sympathy
References Bailey PH (1997) Finding your way around qualitative methods in nursing research. Journal of Advanced Nursing. 25, 1, 18-22. Bloor M, Fincham B, Sampson H (2007) Qualiti (NCRM) Commissioned Inquiry Into The Risk To Well-Being of Researchers in Qualitative Research. www.cf.ac.uk/scocsi/qualiti/ CIReport.pdf (Last accessed: July 18 2014.) Breakwell GM (2006) Interviewing methods. In Breakwell GM, Hammond S, Fife-Schaw C et al (Eds) Research Methods in Psychology. Third edition. Sage Publications, London. Brewer JD (2000) Ethnography. Open University Press, Buckingham. Burns N, Grove SK (2003) Understanding Nursing Research. Third Edition. Saunders, Philadelphia PA. Creswell JW (2003) Research Design: Qualitative, Quantitative, And Mixed Methods Approaches. Second edition. Sage Publications, Thousand Oaks CA.
Dickson-Swift V, James EL, Kippen S et al (2006) Blurring boundaries in qualitative health research on sensitive topics. Qualitative Health Research. 16, 6, 853-871. Eccleston C, Williams A, Rogers W (1997) Patients’ and professionals’ understandings of the causes of chronic pain: blame, responsibility and identity protection. Social Science & Medicine. 45, 5, 699-709. Elliott R, Fischer CT, Rennie DL (1999) Evolving guidelines for publication of qualitative research studies in psychology and related fields. British Journal of Clinical Psychology. 38, Pt 3, 215-229. Flowers P (2008) Temporal tales: the use of multiple interviews with the same participant. Qualitative Methods in Psychology. 5, 24-27. Fouché F (1984) Is the phenomenological reduction of use to the human scientist? Journal of Phenomenological Psychology. 15, 2, 107-124.
24 September 2014 | Volume 22 | Number 1
Gearing RE (2004) Bracketing in research: a typology. Qualitative Health Research. 14, 10, 1429-1452.
Hamill C, Sinclair H (2010) Bracketing: practical considerations in Husserlian phenomenological research. Nurse Researcher. 17, 2, 16-24.
Giorgi A (2009) The Descriptive Phenomenological Method In Psychology: A Modified Husserlian Approach. Duquesne University Press, Pittsburgh PA.
Heidegger M (1962) Being and Time. SCM Press, Norwich.
Giorgi A (2011) IPA and science: a response to Jonathan Smith. Journal of Phenomenological Psychology. 42, 2, 195-216. Giorgi A, Georgi B (2003) Phenomenology. In Smith JA (Ed) Qualitative Psychology: A Practical Guide To Research Methods. First edition. Sage Publications, London. Glenton C (2003) Chronic back pain sufferers – striving for the sick role. Social Science & Medicine. 57, 11, 2243-2252. Gregory D, Russell CK, Phillips LR (1997) Beyond textual perfection: transcribers as vulnerable persons. Qualitative Health Research. 7, 2, 294-300.
Hill-Bailey P (1997) Finding your way around qualitative methods in nursing research. Journal of Advanced Nursing, 25, 1, 18-22. Husserl E (1981) Pure phenomenology, its method, and its field of investigation. In McCormack P, Elliston FA (Eds) Husserl: Shorter Works. University of Notre Dame Press, Notre Dame IN. Koleck M, Mazaux JM, Rascle N et al (2006) Psycho-social factors and coping strategies as predictors of chronic evolution and quality of life in patients with low back pain: a prospective study. European Journal of Pain. 10, 1, 1-11.
© RCN PUBLISHING / NURSE RESEARCHER
Downloaded from RCNi.com by ${individualUser.displayName} on Aug 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Minimising bias on the analysis and management of their emotions. I continued to reflect on these matters throughout the remainder of the research and found that I responded to my concerns with an increasingly focused but relaxed approach that helped me to put aside more immediate, personal, emotional responses. Post research: the hermeneutic circle and authenticity The final analysis of the complete dataset involved what Smith et al (2009) termed ‘adopting a virtual mini circle’ or a modified hermeneutic circle away from the research field. At this point, I returned to each account to ensure I had ‘grounded’ the analysis in the participants’ accounts before becoming more interpretative. This involved working with my documented pre-conceptions by testing them against any evolving meaning or concept and going between these suppositions and the data until I came to an analysis compatible with the participants’ accounts (Willig 2008, Smith et al 2009). This supported the iterative element of IPA; that is, moving back and forth through the data to ensure open perspectives of the data. Such a procedure enabled me to clarify my relationship with the analysis and highlight any ‘fitting’ of data to a priori theoretical frameworks (Giorgi and Giorgi 2003, Willig 2008, Smith et al 2009). IPA, as with other qualitative methodologies, is vulnerable to questioning of the authenticity of the final analysis. For instance, if it is accepted in qualitative research that there are multiple versions of reality dependent on interpretation, there cannot be absolute certainty about what counts as valid truth or knowledge. Correspondingly, there is no claim that the analysis of this data was the definitive version.
Lamé IE, Peters ML, Vlaeyon JWS et al (2005) Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity. European Journal of Pain. 9, 15-24.x
However, readers require assurance about the authenticity of the final account. To address this, ‘validity’ checks advocated by Smith and Osborn (2003) and Smith (2011) were implemented. Smith (2011) advised using distinct criteria for evaluating IPA research, including evaluating the degree of coherence in the final account and leaving an audit trail to illustrate the degree of transparency surrounding the role of the researcher and the research. A check of the data by an independent researcher who was also an experienced pain specialist added support for the validity of my final interpretations (Smith 2011). Ultimately, I consider that the aim of the IPA researcher is not to gain a mirror image, but to offer a believable and confident representation of participants’ experiences, supported by meaningful data and well qualified themes.
Conclusion Experienced phenomenological nurse researchers will recognise the methodological challenges discussed in this paper. Similarly, researchers in long-term, ethnographic naturalistic enquiries engage with those being studied to capture social meanings without imposing external meanings on them (Brewer 2000). There is little written about the complexity of retaining a ‘phenomenological attitude’ and managing emotional engagement in phenomenological longitudinal studies. Although it has not been possible to provide an extensive discussion of the issues encountered, some of the methodological complexities of conducting QLR have been raised for debate and consideration.
Mercado AC, Carroll LJ, Cassidy D et al (2005) Passive coping as a risk factor for disabling neck or low back pain. Pain. 117, 51–57. Merleau-Ponty M (1962) Phenomenology of Perception. Routledge & Kegan Paul, London.
Larkin M, Watts S, Clifton E (2006) Giving voice and making sense in interpretative phenomenological analysis. Qualitative Research in Psychology. 3, 102-120.
Moustakas C (1994) Phenomenological Research Methods. Sage Publications, Thousand Oaks CA.
LeVasseur JJ (2003) The problem of bracketing in phenomenology. Qualitative Health Research. 13, 3, 408-420.
Murray SA, Kendall M, Carduff E et al (2009) Use of serial qualitative interviews to understand patients’ evolving experiences and needs. British Medical Journal. 339, b3702.
McCosker H, Barnard A, Gerber R (2001) Undertaking Sensitive Research: Issues and Strategies for Meeting the Safety Needs of All Participants. www.nbn-resolving.de/ urn:nbn:de:0114-fqs0101220 (Last accessed: July 18 2014.) Meloy JM (2002) Writing The Qualitative Dissertation: Understanding By Doing. Second edition. Lawrence Erlbaum Associates, Mahwah NJ.
Osborn M, Rodham K (2010) Insights into pain: a review of qualitative research. Reviews in Pain. 4, 1, 2-7. Saldana J (2003) Longitudinal Qualitative Research: Analysing Change Through Time. AltaMira Press, Walnut Creek CA. Silverman D (2000) Doing Qualitative Research: A Practical Handbook. First edition. Sage Publications, London.
© RCN PUBLISHING / NURSE RESEARCHER
Online archive For related information, visit our online archive and search using the keywords Conflict of interest None declared
Smith JA (1996) Beyond the divide between cognition and discourse: using Interpretative Phenomenological Analysis in Health Psychology. Psychology and Health. 11, 2, 261-271.
Smith JA, Flowers P, Larkin M (2009) Interpretative Phenomenological Analysis: Theory, Methods and Research. Sage Publications, London.
Smith JA (2004) Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology. Qualitative Research in Psychology. 1, 39-54.
Snelgrove S, Liossi C (2013) Living with chronic low back pain: a metasynthesis of qualitative research. Chronic Illness. 9, 4, 283-301.
Smith JA (2011) Evaluating the contribution of interpretative phenomenological analysis. Health Psychology Review. 5, 1, 9-27. Smith JA, Osborn M (2003) Interpretative phenomenological analysis. In Smith JA (Ed) Qualitative Psychology. A Practical Guide To Research Methods. First edition. Sage Publications, London. Smith JA, Osborn M (2007) Pain as an assault on the self: an interpretative phenomenological analysis of the psychological impact of chronic benign low back pain. Psychology Health. 22, 5, 517-534.
Thomson R, Holland J (2003) Hindsight, foresight and insight: the challenges of longitudinal qualitative research. International Journal of Social Research Methodology. 6, 3, 233-244. Van Manen M (1990) Researching Lived Experience: Human Science For An Action Sensitive Pedagogy. State University of New York Press, Albany NY. Willig C (2008) Introducing Qualitative Research In Psychology. Second edition. Open University Press, Berkshire. Woolgar S (Ed) (1988) Knowledge and Reflexivity. Sage Publications, London.
September 2014 | Volume 22 | Number 1 25
Downloaded from RCNi.com by ${individualUser.displayName} on Aug 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Conducting qualitative longitudinal research using interpretative phenomenological analysis Cite this article as: Snelgrove SR (2014) Conducting qualitative longitudinal research using interpretative phenomenological analysis. Nurse Researcher. 22, 1, 20-25. Date of submission: August 18 2013. Date of acceptance: November 4 2013. Correspondence to Sherrill Ray Snelgrove [email protected] Sherrill Ray Snelgrove PhD, MPhil, BSc(Hons) is a senior lecturer at the College of Human and Health Sciences, Swansea University, Swansea, UK
Abstract Aim To discuss the methodological and epistemological challenges experienced when conducting a longitudinal interpretative phenomenological analysis (IPA) of patients’ experiences of chronic low back pain (CLBP).
Peer review This article has been subject to double-blind review and checked using antiplagiarism software
Background The author draws on experiences of managing interpretive analysis while undertaking an IPA of patients with CLBP for more than two years.
Author guidelines rcnpublishing.com/r/ nr-author-guidelines
Data sources Semi-structured interviews were conducted at three points in time from a purposeful sample of ten patients. Review method There was a recognition that prolonged contact between researcher and participant increases the challenges related to minimising bias and managing researcher emotionality and empathy. Discussion Two main challenges are discussed: the usefulness of ‘bracketing’ in longitudinal qualitative research and maintaining an inductive approach; and
Introduction QUALITATIVE LONGITUDINAL research (QLR) is a general term encompassing different research designs. QLR can include planned prospective studies, follow-up studies, evaluation, and tracking studies that use interviews, observation, field notes, and diaries, and it can be used in mixed-methods designs. Despite little agreement about timelines, a fundamental characteristic is that the same sample of participants is investigated more than once, with change and continuity a focus of attention (Saldana 2003). While policy and practice development are increasingly informed by qualitative data, there 20 September 2014 | Volume 22 | Number 1
consideration of the emotionality of interviewing and the role of empathy. Conclusion A longitudinal design adds potential analytical pitfalls, including a priori theorising and emotional involvement. Interpretative and emotional safeguarding included reflection and reflexivity, an iterative approach and the role of phenomenological strategies such as the hermeneutic circle. The efficacy of these is discussed, along with the ambiguity surrounding concepts such as bracketing. Implications for research/practice Although the topics discussed relate specifically to this methodology and a particular research project sample, they are applicable to qualitative research designs in similar populations. Keywords Longitudinal study, interpretative phenomenology analysis, methodological challenges, bracketing, semi-structured interviews, minimising bias continues to be a lack of QLR documenting the ‘natural evolvement of change’ (Murray et al 2009, Osborn and Rodham 2010, Snelgrove and Liossi 2013). This is surprising, because engaging with temporality has distinct advantages over ‘snapshot’ techniques. QLR offers multiple vantage points and valuable insights into how changing environmental, physical and psychological contexts can influence experiences over time (Thomson and Holland 2003). It helps to identify the determinants and direction of change (Snelgrove and Liossi 2013), yields an understanding of people as dynamic rather than static entities (Osborn and Rodham 2010), © RCN PUBLISHING / NURSE RESEARCHER
Downloaded from RCNi.com by ${individualUser.displayName} on Aug 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Minimising bias and promotes knowledge of patients’ needs during long-term illness (Murray et al 2009). However, researchers might avoid undertaking QLR because of the expense and difficulty in recruiting and retaining participants. Retaining skilled researchers and involuntarily sensitising participants through repeated collection of data may also be drawbacks (Thomson and Holland 2003). The aim of this paper is to advance understanding of the methodological and epistemological challenges that may be encountered when undertaking QLR. Qualitative methodologies support an idealist ontology that acknowledges the subjective construction of reality. From this perspective there is no single reality, rather there are multiple realties relative to context (Bailey 1997, Hill-Bailey 1997). From this perspective, the epistemological approach adopted is that expressed meanings are a valid form of knowledge and may be best represented by an inductive approach that includes sensitive and openended questioning and an appreciation of the interpretative nature of the enquiry. This calls for rigorous monitoring of the researcher’s role in the interpretation of qualitative data. This paper draws on the author’s personal experiences of conducting QLR using interpretative phenomenological analysis (IPA) to gain understanding of the subjective meaning of chronic low back pain (CLBP). The account begins with an overview of IPA and a brief discussion of the research design and analytical processes, before discussing: ■■ Being inductive and managing formal knowledge. ■■ Being inductive and managing personal knowledge. ■■ Being inductive and managing emotional boundaries. These challenges may be familiar to qualitative researchers but the intention is to show how a longitudinal design promotes tensions and highlight the strategies used to maintain analytical integrity.
IPA is committed to an ideographic paradigm where the focus is on the ‘particular’ rather than the ‘universal’ as in large scale quantitative studies. The aim is therefore to present detailed in-depth analysis of the experiences of particular people in particular settings. To achieve this, IPA studies use small samples, semi-structured interviews, and an inductive (drawing meanings from the data rather than imposing a priori constructs on them) and reflexive approach (researchers monitor their responses and critically examine their methods throughout the research) (Larkin et al 2006, Smith et al 2009). IPA applies the descriptive and interpretative philosophies of Husserl (1981) and Heidegger (1962) to investigate significant experiences (Smith et al 2009), with Heidegger’s emphasis on temporality and revealing ‘what is’ at a particular ‘time’ especially pertinent to longitudinal designs because of the recognition that experiences are contextual (Smith et al 2009).
The study
Interpretative phenomenological analysis
The aim of the research was to understand living with CLBP, to identify appropriate ways of helping patients manage their conditions. The study was a response to the preponderance of quantitative, cross-sectional studies that hardly touch on the subjectivity of experiences of chronic pain (Lamé et al 2005, Mercado et al 2005, Koleck et al 2006). Ethical approval was obtained for purposeful sampling of ten patients with CLBP recruited from a chronic pain clinic. Participants were followed up on three separate occasions at yearly intervals over two years. Participants each took part in face-to-face, in-depth, semi-structured interviews in their homes. The sample was selected according to the following inclusion criteria: experiencing unrelieved, benign CLBP; no neurological problems or recent surgery; English-speaking; more than 18 years old; and had attended the pain clinic before the study. Participants’ interviews were recorded, transcribed and analysed using the detailed guide for IPA provided by Smith and Osborn (2003, 2007).
IPA is embedded in psychology but used increasingly across disciplines including nursing research (Smith et al 2009). Its epistemological position is rooted in an assumption that subjective data can inform us about people’s understandings of their experiences. It is phenomenological because it makes enquiries into consciousness, mental life or how things seem to individuals. It is interpretative because there is recognition of the central role of interpretation in negotiating meaning (Smith et al 2009).
Analytical design The analytical procedure was guided by the work of Smith and Osborn (2003). An ideographic stance was adopted, with each transcript examined in detailed, analysed and reread before the researcher moved onto the next script. Each transcript was treated independently, which helped to maintain an inductive approach. A table of superordinate themes representing related topics was produced for each participant before moving onto the next transcript. The themes
© RCN PUBLISHING / NURSE RESEARCHER
September 2014 | Volume 22 | Number 1 21
Downloaded from RCNi.com by ${individualUser.displayName} on Aug 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Nurse Researcher for each individual were then compared across the dataset, which allowed different concepts and meanings to be identified as either new manifestations of existing themes or new themes, and integrated into super-ordinate themes that represented the sample as a whole (Willig 2008). This was repeated for each of the three sets of interviews, with super-ordinate themes from each study compared with those previously elicited. This enabled continued themes and any new themes to be identified. The aim was to maintain a ‘bottom up’ approach throughout, without imposing a priori theories on the data (Smith 2004). To be inductive by its very nature is open-ended and exploratory. The challenges of sustaining an inductive approach and the associated task of managing emotionality are discussed below. Pre-research stage: being inductive and managing formal knowledge An epistemological challenge in QLR is to resist an increasingly analyst-led focus and continue to capture subjective experiences without imposing previously learned information (Flowers 2008). Ideally, the phenomenological researcher should approach the topic with an open mind from the start. Van Manen (1990) claims that: ‘The problem of phenomenological inquiry is that we know too much. Our common sense pre-understandings, our suppositions, assumptions, and the existing bodies of scientific knowledge, predispose us to interpret the nature of the phenomenon before we have come to grips with the significance of the phenomenological question.’ This calls attention to what we are supposed to be as qualitative researchers and what we actually are able to do. Likewise, in this research project, an initial challenge related to my role as a university lecturer and the important but oft-missed point that much inductive research is conducted by academics and, similarly, clinicians, who by the nature of their role, really do know ‘too much’. The implications are that repeated exposure to formal academic theories can lead to what I term ‘theoretical sensitivity’ and a priori theorising, which may unintentionally occlude subjective meanings. Such a possibility was amplified in the present research, as the longitudinal design meant I would have to maintain a check on premature theorising and academic knowledge at different points in time. I judged that it would be a useful first step to acknowledge and manage my academic knowledge so as to gain a relatively untainted insight into participants’ experiences. In keeping with the tenets of phenomenological research, this necessitated 22 September 2014 | Volume 22 | Number 1
clearing my mind and attempting to set aside or ‘bracket’ pre-existing formal knowledge to gain entry to the ‘phenomenological attitude’ (Moustakas 1994). IPA, in common with other phenomenological methodologies, draws on reflexive techniques such as Husserl’s ‘descriptive eidetic reduction’ or ‘bracketing out’ of the ‘natural attitude’ (Husserl 1981) – that is, putting aside one’s habitual way of thinking, so as to engage closely with the participant’s view. Although bracketing is seen as a way of demonstrating rigour, it is one of the more contested concepts in phenomenological research. LeVasseur (2003) described bracketing as ‘perplexing’ and frequently prone to misunderstanding and misapplication in health research. Fouché (1984) questioned the difference between bracketing and the non-phenomenological researcher’s attempts to reduce bias. For Giorgi (2009), bracketing the researcher’s natural attitude or pre-understanding was essential for close engagement with participants’ perceptions. Although Husserl’s original conception of bracketing referred to a near-total exclusion of all internal and external suppositions (Gearing 2004), some IPA researchers argue that to put aside all suppositions and experiences is almost certainly impossible (Larkin et al 2006, Smith et al 2009). This latter view broadly concurs with the interpretative phenomenology of Heidegger, who argued that it is impossible to find untainted cognitions or perceptions, as we are already part of the world and inseparable from it (Heidegger 1962). Nevertheless, to engage with subjective meanings, it appears reasonable to attempt to put aside known presuppositions and acknowledge their role in the analysis. I began by bracketing my formal, academic knowledge, which is consistent with the views of existentialists such as Merleau-Ponty (1962), who advocated researchers put aside theories, research presuppositions, ready-made interpretations and so forth (Gearing 2004). The implementation of ‘bracketing’ remains a conundrum, and there is little guidance about taking it forward. Pragmatic measures may be useful, with reflection having a role to play in revealing researchers’ views and prejudices: ‘Husserl’s work has helped IPA researchers to focus centrally on the process of reflection’ (Smith et al 2009). Conversely, reflection is also viewed as being at odds with the intuitive, reductionist nature of Husserlian bracketing and gaining entry to the phenomenological attitude (Giorgi 2011). Mindful of these contrasting views, I concluded that to document my reflections upon my pre-existing knowledge and perspectives, I could effectively © RCN PUBLISHING / NURSE RESEARCHER
Downloaded from RCNi.com by ${individualUser.displayName} on Aug 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Minimising bias bracket them was congruent with IPA guidelines and an application of elements of Husserl’s work, rather than faithfully replicating his philosophy in practice. I am aware that by adopting a reflective stance I had interpreted bracketing contentiously and perhaps deviated from a purist ‘phenomenological science’, but there is little advice about ‘assuming the attitude of phenomenological reduction’ (Giorgi 2011). Subsequently, before collecting any data, I reflected on my pre-existing knowledge of CLBP in a research diary. Before, during and immediately after interviews, I added any emerging thoughts, perspectives and views (Burns and Grove 2003). This provided me with the opportunity to monitor the extent to which any theoretical frameworks might be imposing on the data (Hamill and Sinclair 2010). In addition, performing a preliminary literature review rather than an extensive review offered a framework for understanding the topic area and preserving the inductive enterprise (Creswell 2003, Hamill and Sinclair 2010). This brief review was followed by a strategy of ongoing, broadening searches throughout the writing up of the study. This is a traditional way of working with qualitative data; that is to ‘work backwards’ and conduct the literature review after analysing the data and maintain the inductive technique (Meloy 2002). In the field: being inductive and managing formal knowledge Despite my initial bracketing techniques, there remained an inclination to draw on existing knowledge and theorise during fieldwork. Participants’ accounts triggered automatic responses from my personal store of psychological theories. In-the-field analysis is congruent with methodological principles of qualitative research (Silverman 2000). Indeed, most qualitative research involves inductive and deductive reasoning. However, in this case, my initial observations had led me to inductively create tentative theoretical interpretations, which in turn led me to deductively create hypotheses and test these during further interviews. My view was that any immediate theorising and further testing of hypotheses posed an ongoing threat to the ‘bottom up’ nature of the research, but also highlighted the tension between Husserl’s descriptive phenomenology and notion of ‘to the things themselves’ (Husserl 1981) and Heidegger’s ‘being in the world’ (Heidegger 1962). This was pertinent in the research as any premature theorising and testing of hypotheses could influence the inductive or exploratory approach at subsequent interviews. For example, at one interview, I was aware of drawing on a well-known psychological theory to describe a participant’s experiences. My diary © RCN PUBLISHING / NURSE RESEARCHER
entries showed that during a second interview I continued to adopt this theoretical stance. In short, I was squeezing data into an existing theoretical framework. I attempted to overcome this by adopting ‘the phenomenological attitude’ through bracketing vis-à-vis reflection but also by focusing intently on the participants’ accounts so as to deliberately try to put a priori theorising to one side (Smith et al 2009). A phenomenological attitude necessitated engaging with the participants’ narrative ‘as it was’ and not thinking about what was already known – in other words, experiencing the moment rather than looking forward or backwards at other experiences (Willig 2008). I attempted to focus in this way throughout and thematically analysed each transcript before comparing it with the remainder of the dataset. It was not until the final analysis and after I had collected all the data that I stopped trying to bracket any formal knowledge (Figure 1). In the field: being inductive and managing personal knowledge I became increasingly aware that the public view of CLBP patients was one of scepticism (Glenton 2003). Societal attitudes towards CLBP patients intrigued me and I considered whether I too was making unacknowledged, negative assumptions about the participants. After all, I was part of wider society and I might have unintentionally influenced the analysis with judgemental views. Certainly, diary entries such as ‘SH does not appear to be in pain. Rather, she appeared fit and well’ reflected a judgement call. I had been previously unaware of these preconceptions and Figure 1
Bracketing in a longitudinal IPA study of patients’ experiences of CLBP
Time one
Time two
Time three
BRACKETING Academic knowledge Theoretical frameworks Known presuppositions
DEVICES Reflective diary Focused interviewing Reflective diary
Reflective diary Academic knowledge Theoretical frameworks Focused interviewing Reflective diary/ Personal knowledge Independent researcher Academic knowledge Theoretical frameworks Reflective diary Personal knowledge Focused interviewing Reflective diary/ Independent researcher
Final analysis
Bracketing ceased revisited
Hermeneutic circle/data
September 2014 | Volume 22 | Number 1 23
Downloaded from RCNi.com by ${individualUser.displayName} on Aug 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Nurse Researcher they highlighted the challenge of manoeuvring between the twin tasks of suspending my suppositions and using them in the final analysis (Smith et al 2009). A close inspection of the data showed that participants were aware of these prejudices and had to work hard to convince others of the legitimacy of their illness. Acknowledgement of my conceptions and engaging with the data led to new understandings of the participants’ motivations to participate in the study. The participants’ stories were rational responses to continued scepticism and constituted efforts to protect their identities as moral individuals with a valid right to being sick (Eccleston et al 1997). My diary accounts reminded me about the necessity of reflexive mindfulness and carefully monitoring my responses (Woolgar 1988), as well as how preconceptions could contribute to making sense of participants’ accounting. In the field: being inductive and managing emotional boundaries The longitudinal design also amplified my concerns about emotionally engaging with participants. Although the task of the qualitative researcher to capture the wide array of subjective experiences ‘involves non-propositional thoughts that may be unmediated and unfocused’ (Willig 2008), it necessitates close interpretive work and engaging with the thoughts, emotions and feelings of participants. Repeated contact allowed me increasing access to private and sensitive issues of the interviewees. My diary entries showed that as the research progressed, I was engaging with participants’ experiences to the extent that sometimes I felt
uncomfortable. I identified with one participant’s personal characteristics and felt a growing empathy and sympathy over the two years of research. The concept of identification is found in Freud’s writings and refers to the assimilation of attributes of others. Freud describes several types of identification, including partial (secondary) identification in which individuals are able to ‘feel the emotions’ experienced by others. Such closeness with participants might generate rich data but renders the researcher vulnerable to feeling emotionally drained and overwhelmed (Gregory et al 1997, McCosker et al 2001, Dickson-Swift et al 2006). My ongoing emotional engagement with participants meant that I required access to methodological, personal and emotional support (Smith and Osborn 1996, Elliott et al 1999). Subsequent sessions with an independent researcher resembled a ‘quasi debriefing’, where I was reassured about the maintenance of the boundaries with participants, that my feelings were ‘okay’ and reflected my closeness to the data, and that by reflective discussion and an iterative approach, any interpretation would be unlikely to showcase my feelings rather than the participants’ experiences. Although this made sense, I felt I was swimming in unknown waters. I considered that although empathy offered me a springboard to intuitive understanding, it was not only emotionally exhausting but promoted questioning about articulating its role in a research study. Much is written on researchers’ characteristics, such as age, social class, appearance, accent, gender, age and similarity with participants, and how they influence participants’ responses (Breakwell 2006, Bloor et al 2007); there is far less acknowledgement of the effect of researchers’ empathy and sympathy
References Bailey PH (1997) Finding your way around qualitative methods in nursing research. Journal of Advanced Nursing. 25, 1, 18-22. Bloor M, Fincham B, Sampson H (2007) Qualiti (NCRM) Commissioned Inquiry Into The Risk To Well-Being of Researchers in Qualitative Research. www.cf.ac.uk/scocsi/qualiti/ CIReport.pdf (Last accessed: July 18 2014.) Breakwell GM (2006) Interviewing methods. In Breakwell GM, Hammond S, Fife-Schaw C et al (Eds) Research Methods in Psychology. Third edition. Sage Publications, London. Brewer JD (2000) Ethnography. Open University Press, Buckingham. Burns N, Grove SK (2003) Understanding Nursing Research. Third Edition. Saunders, Philadelphia PA. Creswell JW (2003) Research Design: Qualitative, Quantitative, And Mixed Methods Approaches. Second edition. Sage Publications, Thousand Oaks CA.
Dickson-Swift V, James EL, Kippen S et al (2006) Blurring boundaries in qualitative health research on sensitive topics. Qualitative Health Research. 16, 6, 853-871. Eccleston C, Williams A, Rogers W (1997) Patients’ and professionals’ understandings of the causes of chronic pain: blame, responsibility and identity protection. Social Science & Medicine. 45, 5, 699-709. Elliott R, Fischer CT, Rennie DL (1999) Evolving guidelines for publication of qualitative research studies in psychology and related fields. British Journal of Clinical Psychology. 38, Pt 3, 215-229. Flowers P (2008) Temporal tales: the use of multiple interviews with the same participant. Qualitative Methods in Psychology. 5, 24-27. Fouché F (1984) Is the phenomenological reduction of use to the human scientist? Journal of Phenomenological Psychology. 15, 2, 107-124.
24 September 2014 | Volume 22 | Number 1
Gearing RE (2004) Bracketing in research: a typology. Qualitative Health Research. 14, 10, 1429-1452.
Hamill C, Sinclair H (2010) Bracketing: practical considerations in Husserlian phenomenological research. Nurse Researcher. 17, 2, 16-24.
Giorgi A (2009) The Descriptive Phenomenological Method In Psychology: A Modified Husserlian Approach. Duquesne University Press, Pittsburgh PA.
Heidegger M (1962) Being and Time. SCM Press, Norwich.
Giorgi A (2011) IPA and science: a response to Jonathan Smith. Journal of Phenomenological Psychology. 42, 2, 195-216. Giorgi A, Georgi B (2003) Phenomenology. In Smith JA (Ed) Qualitative Psychology: A Practical Guide To Research Methods. First edition. Sage Publications, London. Glenton C (2003) Chronic back pain sufferers – striving for the sick role. Social Science & Medicine. 57, 11, 2243-2252. Gregory D, Russell CK, Phillips LR (1997) Beyond textual perfection: transcribers as vulnerable persons. Qualitative Health Research. 7, 2, 294-300.
Hill-Bailey P (1997) Finding your way around qualitative methods in nursing research. Journal of Advanced Nursing, 25, 1, 18-22. Husserl E (1981) Pure phenomenology, its method, and its field of investigation. In McCormack P, Elliston FA (Eds) Husserl: Shorter Works. University of Notre Dame Press, Notre Dame IN. Koleck M, Mazaux JM, Rascle N et al (2006) Psycho-social factors and coping strategies as predictors of chronic evolution and quality of life in patients with low back pain: a prospective study. European Journal of Pain. 10, 1, 1-11.
© RCN PUBLISHING / NURSE RESEARCHER
Downloaded from RCNi.com by ${individualUser.displayName} on Aug 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Minimising bias on the analysis and management of their emotions. I continued to reflect on these matters throughout the remainder of the research and found that I responded to my concerns with an increasingly focused but relaxed approach that helped me to put aside more immediate, personal, emotional responses. Post research: the hermeneutic circle and authenticity The final analysis of the complete dataset involved what Smith et al (2009) termed ‘adopting a virtual mini circle’ or a modified hermeneutic circle away from the research field. At this point, I returned to each account to ensure I had ‘grounded’ the analysis in the participants’ accounts before becoming more interpretative. This involved working with my documented pre-conceptions by testing them against any evolving meaning or concept and going between these suppositions and the data until I came to an analysis compatible with the participants’ accounts (Willig 2008, Smith et al 2009). This supported the iterative element of IPA; that is, moving back and forth through the data to ensure open perspectives of the data. Such a procedure enabled me to clarify my relationship with the analysis and highlight any ‘fitting’ of data to a priori theoretical frameworks (Giorgi and Giorgi 2003, Willig 2008, Smith et al 2009). IPA, as with other qualitative methodologies, is vulnerable to questioning of the authenticity of the final analysis. For instance, if it is accepted in qualitative research that there are multiple versions of reality dependent on interpretation, there cannot be absolute certainty about what counts as valid truth or knowledge. Correspondingly, there is no claim that the analysis of this data was the definitive version.
Lamé IE, Peters ML, Vlaeyon JWS et al (2005) Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity. European Journal of Pain. 9, 15-24.x
However, readers require assurance about the authenticity of the final account. To address this, ‘validity’ checks advocated by Smith and Osborn (2003) and Smith (2011) were implemented. Smith (2011) advised using distinct criteria for evaluating IPA research, including evaluating the degree of coherence in the final account and leaving an audit trail to illustrate the degree of transparency surrounding the role of the researcher and the research. A check of the data by an independent researcher who was also an experienced pain specialist added support for the validity of my final interpretations (Smith 2011). Ultimately, I consider that the aim of the IPA researcher is not to gain a mirror image, but to offer a believable and confident representation of participants’ experiences, supported by meaningful data and well qualified themes.
Conclusion Experienced phenomenological nurse researchers will recognise the methodological challenges discussed in this paper. Similarly, researchers in long-term, ethnographic naturalistic enquiries engage with those being studied to capture social meanings without imposing external meanings on them (Brewer 2000). There is little written about the complexity of retaining a ‘phenomenological attitude’ and managing emotional engagement in phenomenological longitudinal studies. Although it has not been possible to provide an extensive discussion of the issues encountered, some of the methodological complexities of conducting QLR have been raised for debate and consideration.
Mercado AC, Carroll LJ, Cassidy D et al (2005) Passive coping as a risk factor for disabling neck or low back pain. Pain. 117, 51–57. Merleau-Ponty M (1962) Phenomenology of Perception. Routledge & Kegan Paul, London.
Larkin M, Watts S, Clifton E (2006) Giving voice and making sense in interpretative phenomenological analysis. Qualitative Research in Psychology. 3, 102-120.
Moustakas C (1994) Phenomenological Research Methods. Sage Publications, Thousand Oaks CA.
LeVasseur JJ (2003) The problem of bracketing in phenomenology. Qualitative Health Research. 13, 3, 408-420.
Murray SA, Kendall M, Carduff E et al (2009) Use of serial qualitative interviews to understand patients’ evolving experiences and needs. British Medical Journal. 339, b3702.
McCosker H, Barnard A, Gerber R (2001) Undertaking Sensitive Research: Issues and Strategies for Meeting the Safety Needs of All Participants. www.nbn-resolving.de/ urn:nbn:de:0114-fqs0101220 (Last accessed: July 18 2014.) Meloy JM (2002) Writing The Qualitative Dissertation: Understanding By Doing. Second edition. Lawrence Erlbaum Associates, Mahwah NJ.
Osborn M, Rodham K (2010) Insights into pain: a review of qualitative research. Reviews in Pain. 4, 1, 2-7. Saldana J (2003) Longitudinal Qualitative Research: Analysing Change Through Time. AltaMira Press, Walnut Creek CA. Silverman D (2000) Doing Qualitative Research: A Practical Handbook. First edition. Sage Publications, London.
© RCN PUBLISHING / NURSE RESEARCHER
Online archive For related information, visit our online archive and search using the keywords Conflict of interest None declared
Smith JA (1996) Beyond the divide between cognition and discourse: using Interpretative Phenomenological Analysis in Health Psychology. Psychology and Health. 11, 2, 261-271.
Smith JA, Flowers P, Larkin M (2009) Interpretative Phenomenological Analysis: Theory, Methods and Research. Sage Publications, London.
Smith JA (2004) Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology. Qualitative Research in Psychology. 1, 39-54.
Snelgrove S, Liossi C (2013) Living with chronic low back pain: a metasynthesis of qualitative research. Chronic Illness. 9, 4, 283-301.
Smith JA (2011) Evaluating the contribution of interpretative phenomenological analysis. Health Psychology Review. 5, 1, 9-27. Smith JA, Osborn M (2003) Interpretative phenomenological analysis. In Smith JA (Ed) Qualitative Psychology. A Practical Guide To Research Methods. First edition. Sage Publications, London. Smith JA, Osborn M (2007) Pain as an assault on the self: an interpretative phenomenological analysis of the psychological impact of chronic benign low back pain. Psychology Health. 22, 5, 517-534.
Thomson R, Holland J (2003) Hindsight, foresight and insight: the challenges of longitudinal qualitative research. International Journal of Social Research Methodology. 6, 3, 233-244. Van Manen M (1990) Researching Lived Experience: Human Science For An Action Sensitive Pedagogy. State University of New York Press, Albany NY. Willig C (2008) Introducing Qualitative Research In Psychology. Second edition. Open University Press, Berkshire. Woolgar S (Ed) (1988) Knowledge and Reflexivity. Sage Publications, London.
September 2014 | Volume 22 | Number 1 25
Downloaded from RCNi.com by ${individualUser.displayName} on Aug 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
