Reporting qualitative studies; guidance for Clinical Rehabilitation. 12 October 2006 Page 3

Reporting qualitative research in Clinical Rehabilitation

Guidance

Clinical Rehabilitation is keen to publish high quality qualitative research concerning any aspect of rehabilitation. This document gives some guidance on the presentation of qualitative research. It is derived from published material but should not be seen as a definitive text. Reviewers might also use it.

The introduction - appropriateness

As usual the introduction should establish the need for the research through reference to existing research and clinical practice.

However the introduction should also establish why a qualitative approach is necessary and appropriate, and should if appropriate establish why the particular method used is the best approach. Reasons might include lack of data on:

· The content of a treatment or therapy

· The phenomenology and content of some particular experience (e.g. spasticity), clarifying a construct

· What really matters to patients (or others); opinion

Generally qualitative research will answer questions about what or how.

The method – data range

Any research project should collect data from the whole spectrum of people it concerns; this helps in generalisation to other people.

Generally qualitative research studies a small number of people and so more effort is needed to cover the range. Thus, in contrast to much quantitative research, a deliberate policy of selecting participants is required to ensure that data comes from a representative range of people. Furthermore a deliberate policy of collecting a full range of data from each individual is needed, because relying on spontaneously generated information risks missing important data.

The method – data collection

Any research project should ensure that all data available are collected for analysis; selective loss of data can bias findings, and random loss (if known to be random, which is rarely the case) increases the uncertainty associated with any results.

In qualitative studies the data are the words and ideas generated by individual participants. These are usually spoken, and it is improbable that an interviewer will be able to remember and record all ideas expressed. Furthermore the interviewer will inevitably introduce bias into their immediate record. Consequently it is usually preferred that interviews are recorded electronically and are then transcribed onto paper for further analysis.

The method – data handling and analysis

As stated above, recorded speech should be transcribed preferably by an unbiased person who is unlikely to introduce systematic errors (e.g. mishearing ambiguous words).

Analysis consists of abstracting information from the words recorded. This obviously depends upon the researcher and she or he inevitably will have some initial hypothesis that might bias analysis. The usual method for overcoming this is ‘triangulation’, a process whereby one interpretation of the dataset is compared with another interpretation of the same dataset, and/or interpretation of a different dataset appertaining to the same person and topic. Discussion with final agreement on an interpretation is usually needed. Further validation of the interpretation may be gained by asking the person or people who provided the data whether the abstracted ideas are consistent with their intention.

Once the core ideas have been abstracted it may additionally be necessary to group these. This could be considered the qualitative analogy to factor analysis. Again, this should be done independently by at least two people, and again it should be validated against the opinions of the subjects if at all possible.

The results

Presentation of the results takes two forms. First there is the result of the data analysis. Second there is presentation of example data items that characterise the main themes or ideas reported.

Presenting results takes expertise, balancing detail against space. However the result are presented, authors should ensure that a reader can gain an overview early on, and that they can understand what the themes or ideas are. Quantification may be helpful in terms of relative importance between ideas, but it cannot be interpreted as the actual frequency in any other population.

The results section usually includes quotations from participants, and it is usual to identify the participant in some way such as age, gender, group or whatever.

The journal suggests that quotations are best presented in italics within the text.

“The man, .. I mean the nurse .. who came was helpful. He. We talked about my arm.” [F, 68]

Please be careful that no individual participant can be identified.

Quotations should be used to illustrate important points. They are data items.

Discussion

This should be structured around the same headings as any other article. It is especially important to emphasise that qualitative research cannot usually comment on the relative importance or the relative frequency of ideas in the general population precisely because the sample has usually been deliberately selected to cover the whole range which means that ‘statistical outliers’ will be over-represented. Consequently the implications of the research must take this into account.

Please always discuss the weaknesses and limitations of qualitative research in general and your project in particular.

Derick Wade

Editor

11th November 2006