Basics of qualitative research: Grounded theory procedures and techniques

How we Think

This new edition of Ann Bowling's well-known and highly respected text has been thoroughly revised and updated to reflect key methodological developments in health research. It is a comprehensive, easy to read, guide to the range of methods used to study and evaluate health and health services. It describes the concepts and methods used by the main disciplines involved in health research, including: demography, epidemiology, health economics, psychology and sociology.The research methods described cover the assessment of health needs, morbidity and mortality trends and rates, costing health services, sampling for survey research, cross-sectional and longitudinal survey design, experimental methods and techniques of group assignment, questionnaire design, interviewing techniques, coding and analysis of quantitative data, methods and analysis of qualitative observational studies, and types of unstructured interviewing. With new material on topics such as cluster randomization, utility analyses, patients' preferences, and perception of risk, the text is aimed at students and researchers of health and health services. It has also been designed for health professionals and policy makers who have responsibility for applying research findings in practice, and who need to know how to judge the value of that research.

Research Methods in Health. Investigating health and health services

Qualitative Research Methods: A Health Focus

Case Study Research in Educational Settings

The focus of this thesis is a module in interprofessional education (IPE) taught at a Higher Education Institution. The objective is to examine the potential within the module to identify new ideas for health and social care educators to consider in this challenging area of curricula as IPE remains a core element of the curricula of contemporary health and social care programmes in Higher Education Institutions. The rationale for the study is that the concept of attitudes in IPE has not previously been fully explored; it has often been suggested that IPE focuses on developing students’ knowledge, beliefs and attitudes but it could be thought that ‘attitudes’ have been recurrently used in very general terms, perhaps without conscious attention. The concepts of ‘attitudes’ and ‘collaboration’ are dual foci that have been used as lenses with which to examine the data. The study evolved from an ontological stance that any reality is based on a range of perceptions, and that with specific regard to IPE, consideration of the range of perceptions across the breadth of those involved is fundamental. As a practitioner, experienced in both healthcare and education, taking only my perceptions of IPE into account was insufficient to allow me to conduct credible research, an aim of which was to gain a greater understanding. The operational demands of being an IPE module leader are significant and inform the study throughout. Although the size of the student cohort is very large, the primary challenge is in the diversity of the group, as students from twelve different health and social care professions enrol on the module. Timetabling constraints also impact on the way the module is taught. Two unresolved challenges were identified. The first was the requirement to make the module as effective as possible for both staff and students. The second was the polarised feedback received from the student cohort against the background of the National Student Survey (NSS) as an influential driver in higher education. The research methodology employed has focused on a case study approach in the belief that such an organisational strategy is in concordance with inquiry into an acknowledged complex area of health and social care curricula. This is consistent with my epistemological and ontological stance that peoples’ day to day reality is based on a range of perceptions. The approach has enabled the use of my own knowledge and perceptions as carefully acknowledged influences. Although the research could have been conducted with a single cohort, the demands of leading this module had the consequence that it was not possible to collect all the data within a single semester. Another relevant rationale was the desire to develop the research iteratively, using previous findings to inform the future direction. Therefore, the case study encompassed successive cohorts over the study period. The initial tranche of data was collected using two questionnaires that enabled a greater understanding of the students’ perceptions of the module. The quantitative data collected was a useful initial foundation on which to build the case study. Analysis of the questionnaire data using descriptive statistics suggested that there was evidence of a need to influence students’ attitudes towards both other professions and collaboration The second element of data collection was based on a drawing activity on the topic of stereotypes and was designed to give some insight into students’ implicit attitudes towards other professions, and therefore to collaboration across professional boundaries. A content analysis approach was adopted whereby categorisation and creation of numerical data reduced the complexity of the images. It was evident that students were categorising professions, some with values-based assumptions. The objective of the third element of data collection was to investigate whether patient narratives had an influence on the students’ attitudes towards collaboration. The method of analysis encompassed features of discourse analysis with a detailed examination of the language used. Results demonstrated that the service user should be an integral part and equal partner in teaching and therefore scrutiny of the impact is both timely and an imperative. To this point the data collection methods had not yet afforded the opportunity for dialogue with either students or members of the teaching team and so, using purposive sampling, focus groups were conducted with staff and students. A model of thematic analysis was used and differing contexts and understandings of key concepts, such as collaboration became evident. Staff and student anxieties, with respect to both IPE and collaborative working, were identified as probable influences on the IPE module. The final aspect of data collection was individual interviews with students and the adoption of a purposive sampling method created opportunities for greater dialogue and depth of discussion. Using a content analysis strategy, tensions between students maintaining their own self-esteem and being able to equally value the attributes of other professions became apparent. A further challenge for students was that of finding common ground in mixed professional groups, unless conscious attention was paid to the composition of the groups. In conclusion it seems that the IPE module does influence students’ attitudes towards collaboration. Whilst some students experienced IPE as a positive learning experience the findings also showed that for some students and staff the IPE module proved to be a highly problematic and anxiety laden experience. The study suggests that tailoring aspects and activities of the IPE curriculum to the cognitive, affective and behavioural domains of attitude may ameliorate the variety of student experiences of IPE and therefore improve the potential for increased collaborative behaviours in student health and social care professionals. Acknowledgements and dedication My supervisors, Dr Michele Lloyd, Dr Diane Duncan and Dr Jon Berry have been supportive, encouraging and reliable sources of advice and reassurance throughout. I owe a debt of gratitude to my family, Richard, Adam, Jack and Alice. Throughout, they have been a wonderful presence, having faith in me, spurring me on, supporting me through the challenging times and never giving up. As an expert, my father Dr John Palfrey, has been a constant and constructive source of advice and support. I am grateful to the students and members of the teaching team for their willing contributions and co-operation as without them this work would not have been achievable. Colleagues within my own profession and across the School have been supportive. Professor Hugh Barr was generous in his time and support, with an enjoyable lunch at the Royal Society of Medicine. His endorsement of my work at the ‘All Together Better Health VIII’ conference at Oxford University in September 2016 was very much appreciated. I am dedicating this work to my lovely mum, Dr Ann Palfrey. As a doctor, she understood the challenges in successful collaboration between professions and the impact on patients. She was so proud of this undertaking, and it is so sad that she didn’t live quite long enough to see it completed.

Jane Elizabeth Marion Lorimer

Papers

The Influences of a Health and Social Care Interprofessional Education (IPE) Module on Students' Attitudes Towards Collaboration