Using a Qualitative Vignette to Explore a Complex Public Health Issue.

570119

research-article2015

QHRXXX10.1177/1049732315570119Qualitative Health ResearchJackson et al.

Article

Using a Qualitative Vignette to Explore a Complex Public Health Issue

Qualitative Health Research 1–15 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049732315570119 qhr.sagepub.com

Michaela Jackson1, Paul Harrison1, Boyd Swinburn1,2, and Mark Lawrence1

Abstract This article discusses how qualitative vignettes were combined with interviews to explore a complex public health issue; that is, promoting unhealthy foods and beverages to children and adolescents. It outlines how the technique was applied in practice and the combination of vignette-based interviews with a broader approach involving Gadamerian hermeneutics. Twenty-one participants from the public health community and the marketing and food and beverage industries took part in vignette-based interviews between March and September 2012. Overall, the qualitative vignette method afforded an efficient, generally well-received technique that effectively explored the issue of promoting unhealthy foods and beverages to children and adolescents. The vignette provided structure to interviews but allowed certain responses to be investigated in greater depth. Through this research, we argue that qualitative vignettes allow researchers to explore complex public health issues. This article also provides a valuable resource for researchers seeking to explore this technique. Keywords adolescents/youth; children; research, qualitative; research, interdisciplinary; interviews; knowledge transfer; social issues; obesity / overweight

Background and Context Over the past 40 years, global rates of overweight and obesity have risen dramatically (World Health Organization [WHO], 2014), with rates among children in some countries tripling since 1970 (May, Freedman, Sherry, & Blanck, 2013). In exploring causes for the current situation, the WHO (2006) declared “a robust evidence base to support the fact that exposure to the commercial promotion of energy-dense, micronutrient poor foods and beverages adversely affects children’s diets” (p. 26). The WHO highlighted significant amounts of food and beverage promotion targeting children, children’s engagement with this promotion, that the majority of this promotion was for unhealthy foods and beverages, and that such promotion influences children’s awareness, attitudes, behavior, and consumption (WHO, 2006). In response, it has been argued that the food industry, and to a lesser extent the marketing industry, has attempted to defend its behavior and respond to calls for action while still seeking profit (Grimm, 2004; Moodie et al., 2013; Wansink & Huckabee, 2005). Among both public health and marketing literatures, there is evidence that some members of the food industry feel threatened by the prospect of statutory regulation, taxation, fines, and restrictions regarding food marketing to children

(Grimm, 2004; Lewin, Lindstrom, & Nestle, 2006; Sharma, Teret, & Brownell, 2010; Wansink & Huckabee, 2005). While industry representatives defend their actions, the issue continues to generate public interest and debate (Hilton, Patterson, & Teyhan, 2012). There have been increasing calls for governments to regulate against forms of marketing such as television advertising and the use of cartoon characters (e.g., Donjen, 2011; Hope, 2011; Lavelle, 2004). Among analyses of how obesity has been reported, the media have been criticized for moralizing, oversimplifying, and sensationalizing the matter (Boero, 2013). Competing perspectives seek to position obesity as either an individual or societal problem (Hawkins & Linvill, 2010; Hilton et al., 2012). Differences have also been observed in the way the media reports different stakeholder groups’ preferred responses to this issue (Henderson, Coveney, Ward, & Taylor, 2009). More 1

Deakin University, Burwood, Australia University of Auckland, Auckland, New Zealand

2

Corresponding Author: Michaela Jackson, Deakin Graduate School of Business, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia. Email: [email protected]

Downloaded from qhr.sagepub.com at UNIV OF MEMPHIS on January 28, 2015

2

Qualitative Health Research

recent coverage of this issue continues to feature combative, adversarial language, for example, “War of deepfryer heats up” (Julian, 2009), “The battle over taxing soda” (Leonhardt, 2010), and “CI demands tobacco-style plan to fight obesity” (Consumers International, 2014). As such, it can be argued that childhood obesity presents a complex and controversial public health issue. Qualitative research accommodates a range of theoretical perspectives, assumptions, and circumstances that shapes the research process and outcome (Denzin & Lincoln, 1994). Qualitative research is acknowledged for explaining how meaning and social experience are created (Denzin & Lincoln, 1994). Likewise, public health researchers have recognized the possible contribution of this form of enquiry to food- and health-related research questions (e.g., Canning, Hird, & Smith, 2010; Harris et al., 2009; Jack, 2006). Among qualitative data collection methods, vignettes have been used by social and health researchers to explore issues that might be sensitive, painful, or controversial (e.g., Barter & Renold, 2000; Borell, Asaba, Rosenberg, Schult, & Townsend, 2006; Brondani, MacEntee, Bryant, & O’Neill, 2008; Dobkin de Rios et al., 2005; Hughes, 1998). Qualitative vignettes have been combined with interviews to explore public health topics including pre-natal HIV testing (Medley, Mugerwa, Kennedy, & Sweat, 2012), mental health problems (Medina, Kullgren, & Dahlblom, 2014), and childhood immunization (Leask, 2009). Of closer alignment to the issue of promoting unhealthy foods and beverages to children and adolescents, Ludwig, Cox, and Ellahi (2011) combined qualitative vignettes with interviews to explore the health-related perceptions and social constructions of obesity among Pakistani women in the United Kingdom. Qualitative vignettes have also been combined with interviews to explore student food choices, from a consumer perspective (Van der Merwe, Kempen, Breedt, & de Beer, 2010). Most recently (while this article was under review), Mah, Taylor, Hoang, and Cook (2014) also combined qualitative vignettes with interviews to investigate moral reasoning and policy debate associated with the issue of food advertising to children in Canada. While both papers offer valuable insights, this article provides a more detailed account of how qualitative vignettes and interviews have been combined as part of comprehensive qualitative methodology, involving a constructivist epistemology, critical paradigm, and Gadamerian hermeneutics. In contrast, Mah et al. (2014) focus more heavily on the search and analysis of documents that informed their vignette. In addition, it can be argued that this article is broader in focus—while the issue of promoting unhealthy foods and beverages to children and adolescents comprises moral and ethical aspects, this was not the sole focus of our study. Differences associated with geography and sample participants are also evident.

This article makes a valuable contribution to the small body of literature documenting the application of the qualitative vignette method to public health issues associated with childhood and adolescent overweight and obesity. It uses the issue of promoting unhealthy foods and beverages to children and adolescents to highlight the suitability and contribution of qualitative vignettes for exploring public health issues. It first explains how the vignette technique was included as part of a broader qualitative approach and provides a brief outline of vignettes as a data collection method. It then discusses how this method was applied in practice. Benefits and challenges associated with this study are also included. Although results of the vignette-based study are discussed, the emphasis of this article remains on the research method used. This article proposes that qualitative vignettes offer a viable technique for investigating public health issues while accommodating complexity and context. In doing so, this article provides a valuable guide for researchers interested in applying the qualitative vignette technique to such public health issues.

Methodological Approach Researchers are encouraged to reflect upon and acknowledge assumptions implicit in the choice of issue being studied, as well as assumptions within theories, paradigms, and research contexts (Manning, 1997). Figure 1 summarizes the philosophical and theoretical influences that informed and shaped this study, and connects the qualitative vignette technique to other elements within the methodology. These elements are discussed, briefly, as follows. This project is associated with a relativist ontological position, which assumes the existence of multiple realities (Denzin & Lincoln, 1998), rather than a single objective truth (Hugly & Sayward, 1987). Adopting this perspective produces a complex view on reality in which truths exist in several, alterable forms and are constructed by individuals or groups (Guba & Lincoln, 1998). A relativist ontology is closely associated with a constructivist epistemology (Guba, 1992; Guba & Lincoln, 1998). Where relativism assumes the existence of multiple realities, constructivism assumes that truth and knowledge are created as a result of perspective (Denzin & Lincoln, 1998). This research approach combines a constructivist epistemology with the critical paradigm. The adoption of a certain paradigm affects other aspects of a research design—the way questions are asked, how data are interpreted, and the relationship between subject and researcher (Patton, 1990). The critical approach is interdisciplinary and experimental (Given, 2008), and is associated with scholars and theories that question, rather


3

Jackson et al.

Ontological and Epistemological Alignment Ontology - Relativist Assumes the existence of multiple realities rather than a single objective truth, or belief that realities exist external to the mind. Epistemology – Constructivist Assumes that truth and knowledge are created as a result of Research Paradigm - Critical perspective. Critical researchers are not satisfied with understanding; change is the desired outcome. Methodology – Qualitative Understanding, explaining and exploring research problems, holistic perspectives, understanding and explaining social settings and relationships within them. Methodological Framework – Gadamerian Hermeneutics Understanding as the interpretation of meaning. Generated through the analysis of texts.

• •

Data Analysis Hermeneutic analysis of interviews from Study 1 and 2 NVivo analysis of interview data for areas of consensus between research populations

Data Collection • Study 1 – semistructured interviews • Study 2 – vignette-based interviews

Figure 1. Methodological schema.

than accept, tradition and absolute claims (Bronner, 2011). Researchers working within the critical paradigm are not satisfied with understanding—change is the desired outcome (Bleicher, 1980; Crotty, 1998). Associated with this motivation is analysis and critique of forces or ideologies that underpin action (Given, 2008). Critical theorists maintain that groups within society occupy a more or less favorable status as afforded by their possession, or lack, of power (Kincheloe & McLaren, 2000). Progress comes from those who can step outside the normalized social context and question dominant understandings (Bronner, 2011). Critical theory’s influence on this project is evident in the theoretical concepts and phenomenon on which scenarios within the vignette were based. It also shaped the interpretation of data generated through the vignette-based interviews. Both aspects are discussed later in this article. Critical theory has been associated with an ontological position of historical realism and understanding based on structures that have crystallized over time to be perceived as real in their current form (Guba & Lincoln, 1998). In this sense, the combination of a constructivist epistemology with the critical paradigm might seem atypical. However, each of these constructs can be perceived as broad family groups, with a range of individual approaches within them (Flick, 2008). It has also been argued that aspects of different paradigms and traditions

can be combined on the proviso that careful consideration is given to the compatibility of chosen components (Maxwell, 2005). As the field of qualitative research continues to mature, it has been claimed that new theoretical and philosophical connections will emerge, making it possible to cautiously combine elements of different paradigms (Lincoln, Lynham, & Guba, 2011). The methodological framework selected for this project—Gadamerian hermeneutics—was based chiefly on its appropriateness to the research question. Methodological frameworks reflect traditions in qualitative research (Maykut & Morehouse, 1994) and provide guidance for the collection and analysis of data (Patterson & Williams, 2002). Hermeneutics is concerned with the interpretation of meaning as generated through the analysis of texts (Schmidt, 2006). Texts can exist in written form, as images, interviews, films, or observation of behaviors. Understanding is the main goal of hermeneutic research, rather than causal explanation or definitive analysis (Kinsella, 2006; Patterson & Williams, 2002; Schmidt, 2006). Among his contributions, Gadamer outlined key principles of philosophical hermeneutics, namely, the hermeneutic circle, question and answer dialogue, and fusion of horizons (Schmidt, 2006). Through the application of these interrelated concepts, the author’s intended meaning can be recreated, providing deep understanding and potentially revealing insights overlooked by


4


scientific methods (Schmidt, 2006). Hermeneutics provided the opportunity for depth of understanding on the topic of food marketing to children and adolescents in a way that would complement, not replicate, existing work conducted in a positivist-quantitative tradition. Critical hermeneutics was also considered as a methodological framework for this project. Unlike Gadamerian hermeneutics, critical hermeneutics seeks not just understanding but also to reveal hidden meanings that help to establish or reinforce power (Prasad & Mir, 2002). It assumes that principles, such as the exercise and imbalance of power, as manifested through language (Kinsella, 2006), are correct and that their presence distorts meaning (Bleicher, 1980). Given the relative paucity of qualitative data related to the research topic, starting with a critical approach risked omitting a valuable step in understanding this issue. To establish this understanding while critiquing the interpretation appeared impractical, and at odds with the hermeneutic foundation that rejects the notion of a single, correct meaning (Bleicher, 1980). As noted by Bleicher (1980) and Kinsella (2006), Gadamerian hermeneutics can include critical aspects—allowing researchers to recognize their own pre-understanding, which they bring to the interpretation of texts. Researchers are justified in acknowledging influence from the critical paradigm, as they are any other form of knowledge or experience. Similarly, a critical approach can be accommodated within the flexibility of the question and answer dialogue of philosophical hermeneutics. Through this process, researchers can probe deeply for meaning and understand the influences behind texts. Overall, Gadamerian hermeneutics allowed for the possibility of critical analysis without making this the overriding purpose of investigation. As outlined in Figure 1, it is within this broader methodological context that qualitative vignettes were selected as a data collection technique.

Qualitative Vignettes as a Data Collection Technique Vignettes are short stories, hypothetical scenarios, or descriptions of incidents (Finch, 1987; Schoenberg & Ravdal, 2000). Although most common in written form, vignettes have been used in audio, video, avatar, or picture format (Alahuhta, Korkiakangas, Keränen, Kyngäs, & Laitinen, 2011; Hughes, 1998; Johnson, 2000). Vignettes are used as a stimulus to generate a reaction, discussion, or opinion from participants (Finch, 1987; Jenkins, Bloor, Fischer, Berney, & Neale, 2010; Schoenberg & Ravdal, 2000) and should resemble realistic situations. Complementing the constructivist epistemological alignment of this project, the vignette technique recognizes that values, decisions, and judgments occur within context, rather than in isolation (Finch, 1987;

Grønhøj & Bech-Larsen, 2010). Social researchers have used vignettes to examine actions within a specific context, to elucidate judgments, and to assist in researching sensitive subjects (Barter & Renold, 1999). These characteristics have led to their application across a range of social topics and problems, as well as to the study of cultural norms, and moral and ethical frameworks (Barter & Renold, 1999, 2000). Drawing from a tradition of use among psychologists (Hughes, 1998), vignettes have been used within the fields of social work (e.g., Wilks, 2004), education (e.g., Lieberman, 1987; Veal, 2002), medical care and treatment (e.g., Welch, Lutfey, Gerstenberger, & Grace, 2012), and nursing (e.g., Gould, 1996). Marketing researchers have likewise used vignettes to explore issues associated with consumer vulnerability (e.g., Broderick et al., 2011) and racial profiling (Sierra, Heiser, Williams, & Taute, 2010). The majority of published studies have approached the vignette technique from a quantitative perspective (Barter & Renold, 1999, 2000); that is, scenarios have been used in conjunction with surveys that quantify participants’ responses. Describing new applications of the vignette method is consistent with the aim of conducting research that can be distributed and used in a variety of contexts (Malterud, 2001). It similarly reflects the essential role of documentation in qualitative research (Holloway, 2005). Ultimately, the decision to apply the vignette technique was based on their suitability for researching sensitive subjects, their acknowledgment of context, and their ability to capture opinions and perspectives (Barter & Renold, 1999). The capacity for vignettes to be combined with individual interviews was considered an additional strength. The work of authors, such as Thompson (1997), similarly provides a precedent for combining interviews with a hermeneutic framework. Within this framework, interviews facilitate the co-construction of meaning by researcher and participant through the form of guided conversations (Crist & Tanner, 2003). The focus on individual respondents, rather than a group of participants, also reflects the researcher’s alignment to a constructivist epistemology (Given, 2008). Individual interviews likewise eliminate issues, as well as benefits, associated with focus groups or group interviews, such as those discussed by Hyde, Howlett, Brady, and Drennan (2005) and Patton (2002). Practical difficulties associated with arranging a meeting time and place common to all participants were also avoided. Developing the vignette. Researchers are encouraged to consider the nature of the research topic, participants, relevance, interest, and timing in developing a vignette (Hughes & Huby, 2004). Researchers can modify an existing vignette (Grønhøj & Bech-Larsen, 2010), or choose from several styles of vignette, including a series


5

Jackson et al. of scenarios that unfold as a story (Jenkins et al., 2010). Finch (1987) and Hughes and Huby (2004) emphasized the importance of vignette scenarios that are realistic and believable. Heeding this advice, and owing to the lack of existing examples of qualitative vignettes on this particular topic at the time, this study looked to practical examples in trade and professional literature (e.g., Neff, 2011). It likewise drew from academic literature across public health, marketing, and related disciplines regarding food marketing to children, as well as elements of social and critical theory (e.g., Zwick, Bonsu, & Darmody, 2008). The process of developing the qualitative vignette is summarized in Box 1 and described as follows. Box 1. Steps Taken to Develop the Qualitative Vignette. 1. Evaluate the appropriateness of the qualitative vignette technique in light of the research question, broader methodological approach, research population, and practical considerations. 2. Establish topics of interest. In this case, such topics drew from academic literature and theoretical concepts. 3. Consider the form of the vignette and method of delivery, for example, video, interviews. 4. Become familiar with practical examples that would be relevant and realistic to members of your sample population. 5. Begin to craft scenarios that are reflective of reallife situations and involve theoretical concepts, questionable behaviors, or phenomena of interest. 6. Review the qualitative vignette in light of the research question. Seek feedback on the vignette from experienced researchers. 7. Test the qualitative vignette, paying attention to practical considerations such as timing and method of delivery, as well as the effectiveness of the vignette in generating insightful data. 8. Revise and retest the vignette as necessary.

Immersion in relevant academic and professional literature enabled the researcher to identify topics that could be explored using the vignette technique. Through this process, the researcher similarly became familiar with recent examples of industry practice. At this stage, practical considerations, such as how the vignette would be delivered and how long participants would be willing to participate in the exercise, were also considered. The researcher began to craft scenarios that were reflective of real-life situations and involved the theoretical concept, questionable behavior, or phenomenon of interest. Draft versions of these scenarios, and the vignette exercise as a whole, were reviewed by experts in the field of consumer behavior, obesity, and food policy. Permission to engage participants in vignette-based interviews was obtained from the Deakin University Human Ethics Committee during this stage. Once approval was granted, the vignette-based

interviews were piloted with members of the research populations. Refinements were made prior to participant recruitment. The vignette was based around the marketing activities of a fictional multinational confectionery company, called Delice. The vignette aimed to explore the challenges, threats, and opportunities associated with the food and beverage industry’s promotion of unhealthy foods and beverages to children and adolescents. It aimed to explore this subject as perceived by marketers and members of the food and beverage industry, and public health professionals. The vignette was designed so that the same scenarios would be presented to participants from both research populations, outlined below. Scenarios within the vignette reflected a range of marketing practices, from more established and commonplace to scenarios that could be regarded as more controversial. Table 1 outlines the theoretical concepts associated with each scenario in the vignette, as well as references to literature or practical examples that informed or influenced the scenarios. Evidence of the critical paradigm is apparent in concepts such as hegemony and the power disparity between the food and beverage industry and children, as well as promotional activities involving co-creation. Research populations and participant recruitment. Purposive sampling (Maykut & Morehouse, 1994; Robinson, 2014) was used to identify participants with professional involvement in the issue of promoting unhealthy food and beverages to children and adolescents and who would be willing to discuss this issue. Preliminary reading and immersion in this issue within an academic setting contributed to two research populations being identified— public health professionals, and marketing and food and beverage industry professionals. Public health professionals comprised individuals employed in public health and related professions. It included people working for public health advocacy groups, academics, bureaucrats, and public policy makers. Professionals from the marketing and food and beverage industries included individuals employed to market food and beverage products, or organizations that supported this end. Guided by the principle of maximum variation sampling (Maykut & Morehouse, 1994; Patton, 2002), individuals occupying a range of roles within these research populations were sought. This included participants from a variety of sub-sectors within each industry, participants at different stages of their career or levels of seniority, or participants associated with different fields of expertise within each research population. For example, participants from the marketing and food and beverage industries included strategists, consultants, researchers, and creative directors. This approach enabled a range of understandings and perspectives related to the issue of


6


Table 1. Qualitative Vignette and Concepts. Vignette Scenario

Concept or Issue

Scenario 1 Delice Candy and Beverage is a major international confectionary company. The company attributes recent financial success to its expansion into the Asian market. To bring this venture to fruition, Delice conducted significant research into the culture and consumer preferences of its target audience of children and teenagers aged 2 to 17 years, including focus group and ethnographic research. Scenario 2 Delice executives also worked to form relationships with identified government staff and industry advocates in the lead up to their expansion into the Asian market, including forming joint-venture agreements with local companies and making donations to industry associations and political parties, all of which were legal and disclosed in company reports. Scenario 3 Delice developed the Share the Joy marketing campaign to coincide with its launch in the Asian region. The campaign featured several of the company’s most popular candy products and sought to build the brand’s reputation as desirable. It built on the target audience’s (children and teens) likely previous encounters with the brand through Western popular culture: Delice has for several years invested in product placement in popular film, television programs, and more recently, music videos. Regional celebrities were recruited to star in the campaign and the brand has also featured in a television series popular in the region. Scenario 4 The campaign also featured promotion on several websites popular with the target audience, as well as extensive radio, outdoor and ambient media (e.g., bus shelter advertising) and point-of-sale promotions near store checkouts. Scenario 5 The Share the Joy campaign invited members of the target audience to upload photos that depict scenarios or situations in which they will share the joy of Delice products when they arrive in their market. Examples on the website included hanging out with friends and family celebrations. The best 30 entries will be selected for use in the company’s post-launch marketing campaign and will receive a month’s supply of Delice products. Celebrities’ involvement in competition has attracted media coverage from local radio and television networks. Scenario 6 To upload an entry, individuals need to create a log in and submit details such as their age, suburb where they live, and contact details in case they win. These details are stored by the company and data will be analyzed for future marketing campaigns. Most countries in the region do not have privacy legislation in place, but Delice outlines that customers can contact them if they have concerns about their privacy or how the information they provided will be used.

Discussed by

Globalization Nutrition transition Targeting young children Power disparity

Grimm (2004); Hawkes (2004, 2006, 2007, 2008); John (1999); Lobstein, Baur, and Uauy (2004); McGinnis et al. (2006); Olds et al. (2009)

Megamarketing

Humphreys (2010), Kotler (1986)

Hegemony of Western culture Product placement (subtlety in marketing) Celebrity endorsement (subtlety in marketing)

Knuttila (2005); McCracken (1989); McGinnis et al. (2006); Mehta, Coveney, Ward, and Handsley (2010); Nairn and Fine (2008)

Use of multiple promotional channels

Cheyne, Dorfman, Gonzalez, and Mejia (2011); Ewing (2009); Layton (2011); Preston (2004); Schor and Ford (2007)

Co-creation Establishing brandconsumer relationships Nature of the product Publicity (subtlety)

Asquith (2009); Elliott (2007); McGinnis et al. (2006); Mehta, Coveney, Ward, and Handsley (2010); Neff (2011); Preston (2004); Scaraboto (2011); Zwick, Bonsu, and Darmody (2008)

Privacy

Caudill and Murphy (2000), Petty (2000), Wang, Lee, and Wang (1998)

(continued)


7

Jackson et al. Table 1. (continued) Vignette Scenario

Concept or Issue

Scenario 7 In light of concerns about the increase of childhood obesity, all Delice products contain nutritional information on pack and more dietary tips and nutrition and exercise advice is available via the Delice brand website. Scenario 8 Delice also offers an in-school nutritional training program for all children in primary schools in countries where Delice operates. The program is conducted by a Delicesponsored nutritionist who educates students on sound nutrition practices and the importance of regular physical activity. At the conclusion of the hour-long session students will receive a “goody bag” including take-home nutrition information and healthy recipes, a plastic Frisbee, and two treat size Delice chocolate bars, all branded with the Delice logo or product packaging. Scenario 9 Delice also became a signatory to the International Food Manufacturer’s Alliance pledge to reduce by 50% the amount television advertising of food and beverage products directed at children. The pledge requires participating companies to commit to a series of principles, such as not using cartoon characters in marketing campaigns, and enables consumers and other stakeholders to register their concerns with the Alliance for consideration. Scenario 10 Delice has since shifted the balance of its promotional spend away from television advertising toward other methods, chiefly the Internet. Striving to maintain its reputation as a sound corporate citizen, Delice is aware that two countries within the Asian region have recently introduced more stringent statutory regulations regarding food marketing to children. In light of this decision, Delice decided to modify creative elements of promotional campaigns for these countries only, such that they comply with legislation.

Discussed by

Labeling

Betterhealth (2013), Sacks et al. (2011)

Marketing in schools Sponsorship of nutrition education Subtlety in marketing

George and McDuffie (2008), Hawkes (2010), Levine (2000), Lucas (2004), McGinnis et al. (2006), Neff (2011), Sweet (2009)

Industry self-regulation Television as dominant focus Use of cartoon characters

Garretson and Burton (2005); Hawkes and Harris (2011); Kraak, Story, Wartella, and Ginter (2011); Wang, Lee, and Wang (1998); Weber, Story, and Harnack (2006)

Regional variance in regulation Navigating regulations Letter of the law versus spirit of the law.

“Companies ‘Exploit’ Junk Food Loopholes” (2007); Keiper (2011), Lee (2010), MacMullan (2009)

Note. Supplemental Reference List S1 is available online at qhr.sagepub.com/supplemental and includes details of all references listed in Table 1.

unhealthy food and beverage marketing to children and adolescents to be captured (Maykut & Morehouse, 1994). Three recruitment methods were used: direct contact with potential participants using previously obtained contact details or direct contact facilitated by publicly available information. Snowballing (Maykut & Morehouse, 1994), whereby the researcher sent information about the research project to third-party contacts and asked them to forward this information on to potential participants, was also used. All three approaches included an information kit that contained a copy of the Plain Language and

Consent Form as per Deakin University Human Ethics requirements. Completed consent forms were collected from interview participants prior to interviews commencing. The vignette in action. Interviews were conducted either face-to-face or by phone. Although face-to-face interviews were preferred, phone interviews accounted for around a third of all interviews conducted. In the case of phone interviews, participants were sent a copy of the vignette by email just prior to the scheduled interview


8


start time. Interview participants were invited to read or listen to the first section of the vignette, after which they discussed perceived challenges, threats, or opportunities associated with the particular scenario. This process was then repeated until all scenarios had been discussed. In responding to the scenarios, interview participants were advised to draw on their professional background, as well as personal opinions or experiences. Participants were also told that there were no correct or incorrect answers, or that they may not be able to identify any challenges, threats, or opportunities associated with a particular scenario. Where permitted by the participant, written notes and audio recordings were made during interviews. Following the interviews, the researcher recorded observations and thoughts about the interview. These notes and reflections supplemented audio transcriptions and notes taken during the interviews and were used throughout the analysis process (Harris et al., 2009; Tesch, 1990). Hughes and Huby (2004) advocated that imprecision in vignette scenarios can be used as an opportunity to investigate the reasons behind a participant’s response. Accordingly, rather than attempting to provide all details within a scenario, participants were advised that if they felt a scenario lacked detail, they should respond as best they could, highlighting any assumptions that led them to that conclusion. In this way, the vignette design both acknowledged and used lack of detail as an opportunity to further explore participants’ perceptions and reactions (Hughes & Huby, 2004). Similarly, in instances where participants focused on challenges or threats associated with the vignette scenarios, the researcher prompted whether the participant saw any opportunities or whether any changes could be made to improve the scenario. During data analysis, a tendency for some participants to focus on challenges and threats rather than opportunities was highlighted. Unlike quantitative research in which emphasis is given to the sample size or number of respondents to help ensure generalizability, qualitative research is guided by principles such as saturation and adequacy (Denzin & Lincoln, 1994; Guest, Bunce, & Johnson, 2006). Adequacy refers to the total amount of information that is collected (Denzin & Lincoln, 1994), regardless of the number of sources. Hence, qualitative inquiry can gain depth of understanding from comparatively few sources (DiCicco-Bloom & Crabtree, 2006). Saturation is said to have occurred when multiple sources—not necessarily in the same form, for example, interview participants, written documents, or observations might all be used—repeat the same information (Denzin & Lincoln, 1994). A total of 21 interviews comprised this study. This included 10 interviews with members of the public health community and 11 interviews with members of the marketing and food and beverage industries. Together, the principle of saturation, the work by Guest and colleagues (2006), and

practical considerations guided the number of interviews that were conducted. Data analysis. Data analysis for this study involved detailed reading of vignette-based interview transcripts and notes made in a research journal. Consistent with a hermeneutic approach (e.g., Adamson, 2011; Trede, 2007), data analysis involved several rounds of questionand-answer dialogue in which the researcher probed interview transcripts and notes in greater depth. Three cycles of hermeneutic question-and-answer dialogue focused on the following: •• Round 1—the meaning the researcher constructed from the interview notes and transcripts •• Round 2—how the issue was being framed, connections to social forces or theoretical concepts, and whether an alternative interpretation could be constructed •• Round 3—how the comments of a particular participant aligned to those made by others Although a protracted process, this enabled the researcher to understand certain topics or themes within the data. NVivo software helped to manage and organize interview transcripts, and to verify and refine hermeneutic analysis. Writers, such as Manning (1997), Lincoln (1995), and Lincoln and Guba (1986), make several recommendations for enhancing the quality of qualitative research that are consistent with a relativist paradigm (Manning, 1997) and a constructivist epistemology (Lincoln, 1995; Lincoln & Guba, 1986). Several measures were adopted throughout this project to enhance the trustworthiness and authenticity of this research, for example, peer debriefing with other members of the research team, analyzing data using both NVivo and via hermeneutic analysis to facilitate triangulation, and prolonged engagement with data. The potential of this project to shape policy regarding the issue of food marketing to children also provided a strong motivation for the researcher to provide accurate and honest analysis and interpretation of the data. The following two questions guided the construction of hermeneutic texts and publications that comprise the outputs of this project: “Are these findings sufficiently authentic that I may trust myself in acting on their implications? Would I feel sufficiently secure about these findings to construct social policy or legislation based on them?” (Lincoln & Guba, 2000, p. 178).

Results As noted above, the vignette exercise was specifically used to explore the challenges, threats, and opportunities associated with the food and beverage industry’s


9

Jackson et al. promotion of unhealthy foods and beverages to children and adolescents. Given this article’s focus, this section presents results that demonstrate certain characteristics of the qualitative vignette approach, as observed through this study.

Provided Insights Into What Participants Understood and the Way They Approached the Vignette As discussed in greater depth below, the vignette was successful in stimulating discussion around perceived challenges, threats, and opportunities associated with the vignette scenarios. However, the qualitative vignette method also provided insights into the way participants engaged with the vignette exercise. For instance, participants from the marketing and food and beverage industries were understood as more inclined to address the vignette from a marketing management perspective. Such participants displayed a tendency to raise tactical concerns, or frame threats as negative impacts to the business that featured in the vignette, rather than implications to society as a whole. Comments were received regarding the broad nature of the target audience, lack of information about the timing of radio advertising, and the appeal of celebrities to an older audience. Among such comments, one marketing participant commented, You don’t talk about the times they want to run these radio ads. The outdoor and ambient media, bus shelter advertising. Bus shelter advertising says to me that they are talking to an older demographic. Bus shelter advertising, if they’re talking to kids, they’re not going to be doing metro lights. (Marketing/Food and Beverage Industry Participant 15B)

Comments such as this were interpreted as evidence of managerialism (e.g., Considine & Painter, 1997; Entman, 1993) and its impact on the professional practice and perspective of several marketers interviewed. However, it could alternatively suggest greater technical knowledge and proficiency in managing those elements that comprise a successful marketing campaign. Some marketing and food and beverage industry participants also appeared careful and deliberate in their choice of words, particularly when discussing circumstances that could be regarded as problematic. The example in which a participant substituted the term areas of concern with shades of grey highlights this propensity— “this is where you start to get into areas of concern . . . um well sorry, areas where there is more shades of grey” (Marketing/Food and Beverage Industry Participant 9B). Marketers’ professional responsibilities provide a possible explanation for this finding. Marketers craft meaning through verbal and visual signs and symbols for a range

of products and brands, including food (Tresidder, 2010). It is possible that marketers practiced at selecting and using language to achieve a desired response were transferring these skills, not necessarily consciously, to the interview situation. Alternatively, such behavior could have been interpreted as reluctance by some interviewees to acknowledge that marketing can have negative or ethically dubious elements. Members of the public health community interviewed were more inclined to make judgments, usually negative, about the scenarios within the vignette than were participants from the marketing and food and beverage industries. As stated by one participant, “Yeah, look, I’m probably just going to keep talking about problems, which is so negative and I feel terrible” (Public Health Participant 5B). Research participants from this population were also understood as viewing the vignette scenarios as more of a statement of fact, rather than an opportunity to critique campaign mechanics. That public health participants would likely have a less sophisticated understanding of marketing management than their marketing or food and beverage industry counterparts might explain this observation. Alternatively, this could suggest that these participants perceived the vignette to portray real-life situations. However, comments were also made by some participants from this population about the size or extensiveness of the campaign. Members of the public health community were more inclined to discuss the vignette from a society-wide level, along with associated macro-level consequences and antecedents. This was understood to be consistent with this sample group’s remit, that is, where marketers might work with a specific company or companies, members of the public health community work with populations. This same reason could explain why participants from the public health community made more references to broader socio-economic theories or phenomenon—such as the nutrition transition, globalization, or neoliberalism—during vignette-based interviews. These participants could be more attuned to exploring determinants that underlie trends or shifts at a population level (Lawrence & Worsley, 2007). However, the researcher observed that members of this sample group were more attuned to those concepts that had been discussed in public health literature—such as globalization and the nutrition transition—yet made little reference to concepts in the vignette that were drawn from the macro-marketing discipline, that is, megamarketing (Humphreys, 2010; Kotler, 1986) or co-creation (Bonsu & Darmody, 2008; Zwick et al., 2008). As such, this observation might simply reflect a stronger familiarity by participants from this sample group with their own discipline’s literature or topics of research.


10


Balance Between Flexibility and Structure As noted earlier in this article, imprecision in vignette scenarios can be used to investigate the reasons behind a participant’s response (Hughes & Huby, 2004). However, an unexpected benefit of the vignette was that it provided a natural set of parameters for interview discussions. Although not a common occurrence, there were instances whereby participants drifted off the topic of investigation or were interpreted as trying to guide the conversation. In one instance, a participant appeared particularly passionate about cultural sensitivity, whereas another discussed at length the proactive response of their organization to this issue. In these circumstances, the scenarios provided a way for the interviewer to observe the participant’s interest in the topic being discussed, and then politely remind the participant about the scenario and their responses. Although variables within a vignette can be altered to focus on specific points of interest (Barter & Renold, 1999; Finch, 1987), in this study, the vignette was kept consistent between research populations—the responses of populations became the focus of analysis, rather than variables within the vignette. For example, regulation (including government policy and bans) of unhealthy food and beverage marketing to children and adolescents was the opportunity most frequently raised by public health professionals during vignette-based interviews. By comparison, among marketing/food and beverage industry participants, opportunities were more likely to be identified that were beneficial for the company or represented mutual benefit for business and community. The following quote demonstrates this perspective: I think the opportunity here is—we’ve talked about gathering data before and developing a dataset of—to be used in a CRM [Customer Relationship Management] program. I think something like this is interesting because it would be great to actually form a community around kids that are eating a healthy—living a healthy lifestyle, as you say. When it was just, say, upload a photo and we might send you a month’s supply of this stuff, that felt a bit odd, as we talked about. I think this one feels like more of a credible situation to actually engage—develop and engage your community around living the practices here that this nutritionist and the data that they would be putting forward to these kids can actually go and live by. (Marketing/Food and Beverage Industry Participant 6B)

Opportunities that served to benefit the community or society more broadly, but not business, were rarely noted during interviews with members of this sample group. Overall, the vignette highlighted complexity associated with the food and beverage industry’s promotion of unhealthy foods and beverages to children and adolescents.

Provided a More Comfortable Way of Discussing a Controversial Issue The “distance” provided by vignettes has been found to make an interview experience less threatening (Barter & Renold, 2000; Hughes, 1998) and can result in a creative and enjoyable experience for participants (Hughes, 1998). The majority of vignette-based interviews conducted provided support for these arguments. For example, most participants from the marketing and food and beverage industries, which have been noted for their political lobbying activities (e.g., Hawkes, 2007; Nestle, 2002; Nieburg, 2013), were willing to discuss the scenario involving donations to political parties. At other times, participants revealed that they had previously worked with companies that had engaged in marketing unhealthy foods and beverages to children and adolescents, or revealed examples of current practice that they felt were unacceptable. For example, one participant commented, “I worked on the [name of company] account, probably shouldn’t name companies but, um, you know, the funny thing about that is kids don’t really care about the chocolate, they care about the toy” (Marketing/Food and Beverage Industry Participant 5B). This example demonstrates the capacity of the vignette technique to encourage participants to draw on their own experiences or examples. It likewise suggests that the vignette assisted to develop a sense of rapport between participant and researcher (DiCicco-Bloom & Crabtree, 2006). Some participants from both research populations remarked spontaneously at the conclusion of the vignettebased interview that they enjoyed the exercise or that it “made me think.” However, a small number of participants, chiefly from the marketing or food and beverage industries, were interpreted as more guarded in their responses. One participant commented that they were not sure what the vignette was trying to provoke them to say (Marketing/Food and Beverage Industry Participant 15B), whereas another responded to the scenario about the fictitious company’s commitment to a self-regulatory pledge by asking, “What do you want me to say about this?” (Marketing/Food and Beverage Industry Participant 4B).

Efficiency—Allowed a Range of Issues to Be Explored As outlined in Table 1, the qualitative vignette comprised 10 different scenarios. These scenarios made sense independently, but combined to form a more comprehensive account of the company’s actions. More than a dozen concepts, issues, or concerns could also be associated with these scenarios. By comparison, semistructured


11

Jackson et al. interviews that comprised a parallel study addressed three topics within a similar 45-to-60-minute timeframe. In some interviews, the researcher observed that additional time to explore issues in greater detail would have been beneficial (Finch, 1987). Criticisms regarding the length of the vignette-based interviews by participants were comparatively few. One participant commented during a pilot interview that there appeared to be many scenarios to cover in the time available. Another participant commented that the exercise seemed like a rather protracted way to explore the topic. Despite this, the number of variables included in the vignette was perceived to be a limitation, that is, too many scenarios were included. Reducing the number of scenarios within the vignette would also address an associated challenge, namely, Eskelinen and Caswell’s (2006, p. 500) observation that the abundance of data collected can produce feelings of “analytical overdose.” The amount of data gathered, combined with the broader research framework of Gadamerian hermeneutics, resulted in a rich, yet protracted process of data analysis.

Discussion: The Value of This Method to Health Researchers The “need for dynamic and innovative methodological approaches that circumvent shortcomings in existing measures” (Schoenberg & Ravdal, 2000, p. 72) has been highlighted by social researchers. Likewise, there is recognition of the complexity of public health problems and the acknowledgment that qualitative research could facilitate more a comprehensive understanding of public health issues (Canning et al., 2010; Harris et al., 2009; Jack, 2006). Obesity researchers recognize the importance of broader environmental factors (Swinburn, Egger, & Raza, 1999). Qualitative vignettes offer an established method for exploring sensitive social, moral, or cultural issues, in a way that acknowledges their broader context (Broderick et al., 2011). The qualitative vignette used in this study afforded an efficient, generally well-received technique that enabled the researcher to effectively explore the issue of promoting unhealthy foods and beverages to children and adolescents with two distinct research populations—both involved in shaping policy responses. In addition to responding to the scenarios, the qualitative vignette technique provided valuable insights into the way participants approached vignette as a whole. The vignette also provided structure to interviews, while allowing the capacity to explore certain responses in greater depth. However, several challenges were revealed. This study highlights the need to balance the range of concepts included in the vignette exercise with adequate time to explore responses

in greater depth. Likewise, this study confirmed the need for researchers using the qualitative vignette technique to craft scenarios that generate a response, but are not too extreme. The contributions of this study are twofold. The primary contribution of this work is that it demonstrates that the qualitative vignette technique can successfully be adapted to explore controversial public health issues. The vignette enabled the researcher to capture participants’ responses to the scenarios presented, broader issues they felt relevant, and insights into the way they approached the issue in a manner that exceeded expectations. Second, in describing the qualitative vignette method, the steps taken to create the vignette, and presenting selected results, this article provides a valuable guide for other public health researchers motivated to explore this technique. Finally, this study also demonstrates the effectiveness of the qualitative vignette method to reflect the complexity and context of a current public health issue. Data collected through the vignette-based interviews added nuance on a range of topics, depth of perspective, and understanding. In contrast to the positivist perspective that has influenced public health research (Williams & Popay, 1997), this study did not provide a clear, concise answer. Although sacrificing clarity, it is arguable that this study captured a more accurate depiction of the way this issue is understood by participants.

Conclusion The qualitative vignette method offered a viable approach to exploring a controversial public health issue. In combining academic literature and practical scenarios, the vignette approach enabled the discussion of marketing and public health dilemmas in a theoretically grounded, yet accessible form. By keeping the structure of the vignette consistent between research populations, responses highlighted areas of commonality and disagreement within and between research populations. This article has aimed to transfer knowledge to public health researchers interested in expanding their repertoire of qualitative data collection techniques. Existing literature on the use of qualitative vignettes within other fields, and the study on which this article is based, have been used to argue that qualitative vignettes present a feasible option for public health researchers. Overall, the qualitative vignette technique provided an efficient way of collecting data, provided balance between flexibility and structure, and enhanced the researcher’s depth of understanding about the food and beverage industry’s promotion of unhealthy foods and beverages to children and adolescents.


12


Declaration of Conflicting Interests The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Mark Lawrence is a researcher within a NHMRC Centre for Research Excellence in Obesity Policy and Food Systems (APP1041020) and within Healthway, the Western Australian Health Promotion Foundation, research into practice project, “Food Law, Policy and Communications to Improve Public Health Project.”

Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Michaela Jackson was the holder of an Australian Postgraduate Award (November 2010–May 2014).

References Adamson, L. (2011). Towards an understanding of occupational therapy professional practice knowledge in mental health services (Doctoral thesis, The University of Sydney, Sydney). Retrieved from http://ses.library. usyd.edu.au/handle/2123/8048?mode=full&;submit_ simple=Show+full+item+record Alahuhta, M. A., Korkiakangas, E. E., Keränen, A.-M., Kyngäs, H. A., & Laitinen, J. H. (2011). Using pictures as vignettes to assess stages of change in weight management. Scandinavian Journal of Public Health, 39, 403–409. doi:10.1177/1403494810395822 Barter, C., & Renold, E. (1999). The use of vignettes in qualitative research. Social Research Update, 25(9), 1. Barter, C., & Renold, E. (2000). “I wanna tell you a story”: Exploring the application of vignettes in qualitative research with children and young people. International Journal of Social Research Methodology, 3, 307–323. Bleicher, J. (1980). Contemporary hermeneutics: Hermeneutics as method, philosophy, and critique. London: Routledge & Kegan Paul. Boero, N. (2013). Obesity in the media: Social science weighs in. Critical Public Health, 23, 371–380. doi:10.1080/0958 1596.2013.783686 Bonsu, S., & Darmody, A. (2008). Co-creating second life: Market-consumer cooperation in contemporary economy. Journal of Macromarketing, 28(4), 355-368. doi:10.1177/0276146708325396 Borell, L., Asaba, E., Rosenberg, L., Schult, M.-L., & Townsend, E. (2006). Exploring experiences of “participation” among individuals living with chronic pain. Scandinavian Journal of Occupational Therapy, 13(2), 76–85. doi:10.1080/11038120600673023 Broderick, A. J., Demangeot, C., Adkins, N. R., Ferguson, N. S., Henderson, G. R., Johnson, . . . Zúñiga, M. A. (2011). Consumer empowerment in multicultural marketplaces: Navigating multicultural identities to reduce consumer vulnerability. Journal of Consumer Research, 1(19), 1–13. Brondani, M. A., MacEntee, M. I., Bryant, S. R., & O’Neill, B. (2008). Using written vignettes in focus groups among older adults to discuss oral health as a sensitive

topic. Qualitative Health Research, 18, 1145–1153. doi:10.1177/1049732308320114 Bronner, S. E. (2011). Critical theory: A very short introduction. New York: Oxford University Press. Canning, C. G., Hird, M., & Smith, G. (2010). The pitfalls of the “add-and-stir” approach to transdisciplinary public health research. Critical Public Health, 20, 145–155. Considine, M., & Painter, M. (Eds.). (1997). Managerialism: the great debate. Carlton, Vic.: Melbourne University Press. Consumers International (2014). CI demands tobaccostyle plan to fight obesity. Retrieved from http://www. consumersinternational.org/news-and-media/news/ 2014/05/global-obesity-report/ Crist, J., & Tanner, C. (2003). Interpretation/analysis methods in hermeneutic interpretive phenomenology. Nursing Research, 52(3), 202-205. Crotty, M. (1998). The foundations of social research: Meaning and perspective in the research process. St Leonards, NSW: Allen & Unwin. Denzin, N. K, & Lincoln, Y. S. (Eds.). (1994). Handbook of qualitative research. Thousand Oaks, CA: SAGE. Denzin, N. K, & Lincoln, Y. S. (Eds.). (1998). The landscape of qualitative research: Theories and issues. Thousand Oaks, CA: SAGE. DiCicco-Bloom, B., & Crabtree, B. F. (2006). The qualitative research interview. Medical Education, 40, 314–321. Dobkin de Rios, M., Grob, C. S., Lopez, E., da Silviera, D. X., Alonso, L. K., & Doering-Silveira, E. (2005). Ayahuasca in adolescence: Qualitative results. Journal of Psychoactive Drugs, 37, 135–139. Donjen, B. (2011). Ban the cartoon figures on food. Retrieved from http://www.dailytelegraph.com.au/news/ban-thecartoon-figures-on-food/story-e6freuy9-1226133850436 Entman, R. (1993). Framing: Toward clarification of a fractured paradigm. Journal of Communication, 43(4), 51-58. Eskelinen, L., & Caswell, D. (2006). Comparison of social work practice in teams using a video vignette technique in a multi-method design. Qualitative Social Work, 5, 489–503. doi:10.1177/1473325006070291 Finch, J. (1987). The vignette technique in survey research. Sociology, 21, 105–114. doi:10.1177/0038038587021001008 Flick, U. (2008). Designing qualitative research. London: SAGE. Gadamer, H.-G. (1994). Truth and method (2nd ed.). New York: Continuum. Given, L. M. (Ed.). (2008). The Sage encyclopedia of qualitative research methods. Los Angeles, CA: SAGE. Gould, D. (1996). Using vignettes to collect data for nursing research studies: How valid are the findings? Journal of Clinical Nursing, 5, 207–212. Grimm, M. (2004). Is marketing to kids ethical? Brandweek, 45(14), 44–48. Grønhøj, A., & Bech-Larsen, T. (2010). Using vignettes to study family consumption processes. Psychology & Marketing, 27, 445–464. Guba, E. G. (1992). Relativism. Curriculum Inquiry, 22(1), 17–23.


13

Jackson et al. Guba, E. G., & Lincoln, Y. S. (1998). Competing paradigms in qualitative research. In N. K. Denzin & Y. S. Lincoln (Eds.), The landscape of qualitative research (pp. 195220). Thousand Oaks, CA: SAGE. Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59–82. doi:10.1177/152 5822x05279903 Harris, J. E., Gleason, P. M., Sheean, P. M., Boushey, C., Beto, J. A., & Bruemmer, B. (2009). An introduction to qualitative research for food and nutrition professionals. Journal of the American Dietetic Association, 109(1), 80–90. Hawkes, C. (2007). Regulating and litigating in the public interest: Regulating food marketing to young people worldwide: Trends and policy drivers. American Journal of Public Health, 97, 1962–1973. Hawkins, K. W., & Linvill, D. L. (2010). Public health framing of news regarding childhood obesity in the United States. Health Communication, 25, 709–717. doi:10.1080/104102 36.2010.521913 Henderson, J., Coveney, J., Ward, P., & Taylor, A. (2009). Governing childhood obesity: Framing regulation of fast food advertising in the Australian print media. Social Science & Medicine, 69, 1402–1408. doi:10.1016/j. socscimed.2009.08.025 Hilton, S., Patterson, C., & Teyhan, A. (2012). Escalating coverage of obesity in UK newspapers: The evolution and framing of the “obesity epidemic” from 1996 to 2010. Obesity, 20, 1688–1695. Holloway, I. (2005). Qualitative research in health care. Maidenhead, UK: Open University Press. Hope, E. (2011, May 5). State to target junk food ads. The Mercury. Hughes, R. (1998). Considering the vignette technique and its application to a study of drug injecting and HIV risk and safer behaviour. Sociology of Health & Illness, 20, 381–400. doi:10.1111/1467-9566.00107 Hughes, R., & Huby, M. (2004). The construction and interpretation of vignettes in social research. Social Work & Social Sciences Review—An International Journal of Applied Research, 11(1), 36–51. Hugly, P., & Sayward, C. (1987). Relativism and ontology. The Philosophical Quarterly, 37, 278–290. Humphreys, A. (2010). Megamarketing: The creation of markets as a social process. Journal of Marketing, 74(2), 1–19. doi:10.1509/jmkg.74.2.1 Hyde, A., Howlett, E., Brady, D., & Drennan, J. (2005). The focus group method: Insights from focus group interviews on sexual health with adolescents. Social Science & Medicine, 61, 2588–2599. Jack, S. M. (2006). Utility of qualitative research findings in evidence-based public health practice. Public Health Nursing, 23, 277–283. Jenkins, N., Bloor, M., Fischer, J., Berney, L., & Neale, J. (2010). Putting it in context: The use of vignettes in qualitative interviewing. Qualitative Research, 10, 175–198. doi:10.1177/1468794109356737

Johnson, B. (2000). Using video vignettes to evaluate children’s personal safety knowledge: Methodological and ethical issues. Child Abuse & Neglect, 24, 811–827. Julian, L. E. (2009). War of deep-fryer heats up. Retrieved from http://ezproxy.deakin.edu.au/login?url=http://search. ebscohost.com/login.aspx?direct=true&;db=n5h&AN=SYD5QT0BHJCVL01FC81YF8P&site=eds-live&scope=site Kincheloe, J., & McLaren, P. (2000). Rethinking critical theory and qualitative research. In N. Denzin & Y. Lincoln (Eds.), Handbook of qualitative research (pp. 279-314). Thousand Oaks, CA: SAGE. Kinsella, E. A. (2006, May). Hermeneutics and critical hermeneutics: Exploring possibilities within the art of interpretation. Forum: Qualitative Social Research, 7(3), Article 19. Kotler, P. (1986). Megamarketing. Harvard Business Review, 64, 117–124. Lavelle, P. (2004). Ban junk food ads from kids’ TV? The Pulse: ABC Health & Wellbeing. Retrieved from http://www.abc. net.au/health/thepulse/stories/2004/11/25/1251181.htm Lawrence, M., & Worsley, T. (Eds.). (2007). Public health nutrition: From principles to practice. Sydney: Allen & Unwin. Leask, J. (2009). How do general practitioners persuade parents to vaccinate their children? A study using standardised scenarios. New South Wales Public Health Bulletin, 20, 119–124. Leonhardt, D. (2010, May 18). The battle over taxing soda. The New York Times. Retrieved from http://www.nytimes. com/2010/05/19/business/economy/19leonhardt.html?_ r=0 Lewin, A., Lindstrom, L., & Nestle, M. (2006). Food industry promises to address childhood obesity: Preliminary evaluation. Journal of Public Health Policy, 27, 327–348. Lieberman, A. (1987, April). Documenting professional practice: The vignette as a qualitative tool. Paper presented at the annual meeting of the American Educational Research Association, Washington, DC: American Educational Research Association. Retrieved from http://ezproxy. deakin.edu.au/login?url=http://search.ebscohost.com/ login.aspx?direct=true&;db=eric&AN=ED287866&site= ehost-live&scope=site Lincoln, Y., & Guba, E. (1986). But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New directions for program evaluation, 30, 73-84. doi:10.1002/ev.1427 Lincoln, Y., & Guba, E. (2000). Paradigmatic controversies, contradictions, and emerging confluences. In N. Denzin & Y. Lincoln (Eds.), Handbook of qualitative research (pp. 163-188). Thousand Oaks, CA: SAGE. Lincoln, Y. S. (1995). Emerging criteria for quality in qualitative and interpretive research. Qualitative Inquiry, 1(3), 275-289. doi:10.1177/107780049500100301 Lincoln, Y. S., Lynham, S. A., & Guba, E. G. (2011). Paradigmatic controversies, contradictions, and emerging confluences, revisited. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (4th ed., pp. 97–128). Thousand Oaks, CA: SAGE.


14


Ludwig, A., Cox, P., & Ellahi, B. (2011). Social and cultural construction of obesity among Pakistani Muslim women in North West England. Public Health Nutrition, 14, 1842– 1850. Mah, C. L., Taylor, E., Hoang, S., & Cook, B. (2014). Using vignettes to tap into moral reasoning in public health policy: Practical advice and design principles from a study on food advertising to children. American Journal of Public Health, 104, 1826–1832. doi:10.2105/AJPH.2014.302005 Malterud, K. (2001). Qualitative research: Standards, challenges, and guidelines. Lancet, 358, 483–488. Manning, K. (1997). Authenticity in constructivist inquiry: Methodological considerations without prescription. Qualitative Inquiry, 3(1), 93–115. doi:10.1177/107780049700300105 Maxwell, J. A. (2005). Qualitative research design: An interactive approach (2nd ed.). Thousand Oaks, CA: SAGE. May, A. L., Freedman, D., Sherry, B., & Blanck, H. M. (2013). Obesity—United States, 1999-2010. Morbidity and Mortality Weekly Report Surveillance Summaries, 62, 120–128. Maykut, P., & Morehouse, R. (1994). Beginning qualitative research: A philosophic and practical guide. London: The Falmer Press. Medina, C. O., Kullgren, G., & Dahlblom, K. (2014). A qualitative study on primary health care professionals’ perceptions of mental health, suicidal problems and help-seeking among young people in Nicaragua. BMC Family Practice, 15(1), 2–15. doi:10.1186/1471-2296-15-129 Medley, A. M., Mugerwa, G. W., Kennedy, C., & Sweat, M. (2012). Ugandan men’s attitudes toward their partner’s participation in antenatal HIV testing. Health Care for Women International, 33, 359–374. doi:10.1080/07399332.2012.6 55392 Moodie, R., Stuckler, D., Monteiro, C., Sheron, N., Neal, B., Thamarangsi, T., . . . Casswell, S. (2013). Profits and pandemics: Prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet, 381, 670–679. Neff, J. (2011). AAF’s ethics code takes on brand integration, endorsements. Advertising Age, 82(12), 2–4. Nestle, M. (2002). Food politics: How the food industry influences nutrition and health (Vol. 3). Berkeley, CA: University of California Press. Nieburg, O. (2013). Mars reaches reformulation limits and calls downsizing the only option. Retrieved from http://www. confectionerynews.com/Manufacturers/Mars-reachesreformulation-limits-and-calls-downsizing-the-only-option Patterson, M. E., & Williams, D. R. (2002). Collecting and analyzing qualitative data: Hermeneutic principles, methods, and case examples. Champaign, IL: Sagamore. Patton, M. Q. (1990). Qualitative evaluation methods (2nd ed.). Beverly Hills, CA: SAGE. Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: SAGE. Prasad, A., & Mir, R. (2002). Digging deep for meaning: A critical hermeneutic analysis of CEO letters to shareholders

in the oil industry. Journal of Business Communication, 39(1), 92–116. doi:10.1177/002194360203900105 Schmidt, L. K. (2006). Understanding hermeneutics. Stocksfield, UK: Acumen. Schoenberg, N. E., & Ravdal, H. (2000). Using vignettes in awareness and attitudinal research. International Journal of Social Research Methodology, 3(1), 63–74. Sharma, L. L., Teret, S. P., & Brownell, K. D. (2010). The food industry and self-regulation: Standards to promote success and to avoid public health failures. American Journal of Public Health, 100, 240–246. Sierra, J. J., Heiser, R. S., Williams, J. D., & Taute, H. A. (2010). Consumer racial profiling in retail environments: A longitudinal analysis of the impact on brand image. Journal of Brand Management, 18(1), 79–96. Swinburn, B., Egger, G., & Raza, F. (1999). Dissecting obesogenic environments: The development and application of a framework for identifying and prioritizing environmental interventions for obesity. Preventive Medicine, 29, 563– 570. doi:10.1006/pmed.1999.0585 Tesch, R. (1990). Qualitative research: Analysis types and software tools. New York: Falmer Press. Thompson, Craig, J. (1997). Interpreting consumers: A hermeneutical framework for deriving marketing insights from the texts of consumers’ consumption stories. Journal of Marketing Research, 34, 438–455. Trede, F. (2007). A critical practice model for physiotherapy (Doctoral thesis, University of Sydney, Sydney). Retrieved from http://ses.library.usyd.edu.au/handle/2123/1430?mode =simple&;submit_simple=Show+simple+item+record Tresidder, R. (2010). Reading food marketing: The semiotics of Marks & Spencer!? International Journal of Sociology & Social Policy, 30(910), 472-485. doi:10.1108/01443331011072244 Van der Merwe, D., Kempen, E. L., Breedt, S., & de Beer, H. (2010). Food choice: Student consumers’ decision-making process regarding food products with limited label information. International Journal of Consumer Studies, 34(1), 11–18. Veal, W. R. (2002). Content specific vignettes as tools for research and teaching. Electronic Journal of Science Education, 6(4). Wansink, B., & Huckabee, M. (2005). De-marketing obesity. California Management Review, 47(4), 6–18. Welch, L. C., Lutfey, K. E., Gerstenberger, E., & Grace, M. (2012). Gendered uncertainty and variation in physicians’ decisions for coronary heart disease: The double-edged sword of “atypical symptoms.” Journal of Health and Social Behavior, 53, 313–328. Wilks, T. (2004). The use of vignettes in qualitative research into social work values. Qualitative Social Work, 3(1), 78–87. Williams, G., & Popay, J. (1997). Social science and public health: Issues of method, knowledge and power. Critical Public Health, 7(1–2), 61–72. doi:10.1080/09581599708409079 World Health Organization. (2006). Marketing of food and nonalcoholic beverages to children. Geneva, Switzerland: Author.


15

Jackson et al. World Health Organization. (2014). Obesity and overweight. Retrieved from http://www.who.int/mediacentre/ factsheets/fs311/en/ Zwick, D., Bonsu, S. K., & Darmody, A. (2008). Putting consumers to work. Journal of Consumer Culture, 8, 163–196. doi:10.1177/1469540508090089

Author Biographies Michaela Jackson, Bachelor of Communication (Honours) (Professional Communication), at the time of writing, is a

final-year PhD candidate at the Deakin Graduate School of Business, Deakin University, Melbourne, Australia. Paul Harrison, PhD, is a senior lecturer at the Deakin Graduate School of Business, Deakin University, Melbourne, Australia. Boyd Swinburn, PhD, is a professor of Global Health and Nutrition at the School of Population Health, University of Auckland, New Zealand. Mark Lawrence, PhD, is a professor of Public Health Nutrition at the School of Nutrition and Exercise Science, Deakin University, Melbourne, Australia.


Public health: A burning issue.

Transport: a public health issue.

Handgun control: a public health issue.

Food Insecurity: A Public Health Issue.

Homelessness is a public health issue.

Approaching suicide as a public health issue.

Is housing a public health issue? A survey of directors of public health.

Teratogens: a public health issue - a Brazilian overview.

Women's health: the making of a powerful new public issue.

Legionella spp. in UK composts--a potential public health issue?

Alcohol Screening and Brief Intervention: A Clinical Solution to a Vital Public Health Issue.

Introduction to the Special Issue: Public Health Genetics and Genomics.

Acceptability of financial incentives for health behaviour change to public health policymakers: a qualitative study.

Public sexual health promotion interventions and strategies: A qualitative study.

Ethical issues in public health surveillance: a systematic qualitative review.

Considerations for Public Health Organizations Attempting to Implement a Social Media Presence: A Qualitative Study.

Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting.

'Understanding' as a practical issue in sexual health education for people with intellectual disabilities: a study using two qualitative methods.

A Qualitative Study to Explore Patients', Carers' and Health Professionals' Views to Culturally Adapt CBT for Psychosis (CBTp) in Pakistan.

WAVE: A complex issue.

Immigrant Mental Health, A Public Health Issue: Looking Back and Moving Forward.

A special issue dedicated to a complex tissue.

Wildfire smoke exposure and human health: Significant gaps in research for a growing public health issue.

A public health approach to musculoskeletal health.