Against methodolatry: some comments on Elliott, Fischer, and Rennie

Is thematic analysis used well in health psychology? A critical review of published research, with recommendations for quality practice and reporting

Despite the persistent dominance of a 'scientific psychology' paradigm in health psychology, the use of qualitative research continues to grow. Qualitative approaches are often based on fundamentally different values from (post)positivistempiricism, raising important considerations for quality, and whether qualitative work adheres to, and is judged by, appropriate publication standards. Thematic analysis (TA) has become a particularly popular method in qualitative health psychology, but poor practice is widespread. To support high quality, methodologically coherent TA practice and reporting, we critically reviewed 100 systematically selected papers reporting TA, published in five prominent health psychology journals. Our review assessed reported practice, and considered this in relation to methodological and quality recommendations. We identified 10 common areas of problematic practice in the reviewed papers, the majority citing reflexive TA. Considering the role of three 'arbiters of quality' in a peer review publication system - authors, reviewers, and editors - we developed 20 recommendations for authors, to support them in conducting and reporting high quality TA research, with associated questions for reviewers and editors to consider when evaluating TA manuscripts for publication. We end with considerations for facilitating better qualitative research, and enriching the understandings and knowledge base from which health psychology is practiced.

“Not Sure Sharing Does Anything Extra for Me”: Understanding How People with Cardiovascular Disease Conceptualize Sharing Personal Health Data with Peers

As people deal with cardiovascular disease (CVD), they are to self-monitor routinely and be aware of complications and the corresponding course of action. Engaging in these self-care behaviors is conducive to gaining knowledge of health status. Even so, knowledge of the self may be insufficient in making sense of chronic conditions. In constructing a new normal after health-related life disruptions, people often turn to peers (others facing similar health issues) and share personal health information with each other. Although health information-sharing behavior is well-documented, it remains underexplored what attitudes individuals with chronic conditions, such as CVD, have toward disclosing personal health data to peers and exploring those of others with similar conditions. We surveyed 39 people who reported being diagnosed with CVD to understand how they conceptualize sharing personal health data with their peers. By analyzing qualitative survey data thematically, we found that respondents expressed themselves as uncertain about the benefits of interacting with peers in such a manner. At the same time, they recognized an opportunity to learn new ideas to enhance CVD self-care in mutual data sharing. We also report participants’ analytical orientation toward this sort of data sharing herein and elaborate on what sharing a range of personal health data could mean. In light of the existing literature, this study unpacks the notion of sharing in a different population/pathology and with more nuance, particularly by distinguishing between disclosing one’s data and exploring others’.

Experiments make a good breakfast, but a poor supper

Cesario's analysis has three key flaws. First, the focus on whether an effect is "real" (an "effects flaw") overlooks the importance of theory testing. Second, obsession with effects (a "fetishization flaw") sidelines theoretically informed questions about when and why an effect may arise. Third, failure to take stock of cultural and historical context (a "decontextualization flaw") strips findings of meaning.

OUP accepted manuscript

In order to design appropriate antimicrobial stewardship (AMS) programmes, it is crucial to understand challenges to tackling antibiotic resistance (AMR) specific to each healthcare setting. Antibiotic prescribing in primary care accounts for most prescriptions with a significant proportion considered clinically inappropriate. Qualitative research has a long history in social sciences, but its value and contribution are still contested in medical journals including in the AMR/AMS field. However, through its focus on understanding, meaning making and explaining, qualitative research can offer insights in how to improve AMS efforts in primary care. This paper provides an overview of unique considerations, contributions and challenges related to using qualitative research in AMS to help the AMS community new to qualitative research to utilize its potential most fully. First, we discuss specific considerations for AMS in relation to the stages of conducting a qualitative study, including identifying a research question and choosing a suitable methodology; sampling appropriate participants; planning a recruitment strategy; choosing a method of data collection; and conducting data analysis. These are illustrated with examples of qualitative AMS studies in primary care. Second, we highlight the importance of patient and public involvement throughout all stages of the project and ensuring quality in qualitative AMS research. Finally, drawing on these considerations, we make a further case for the value and contribution of qualitative methodologies in AMS/AMR research while outlining future directions for both AMS and qualitative research, including the need for studies with diverse actors; interdisciplinary collaborations; and complex decisions on methodologies and timelines.

Value, challenges and practical considerations when designing, conducting and analysing a longitudinal qualitative study in family medicine

Qualitative longitudinal design has a long tradition in a variety of social science disciplines and is increasingly used in applied healthcare research, including family medicine. While there are many definitions of longitudinal qualitative research (LQR), its most common characteristics are multiple data collection points and its focus on temporality, which prioritise the study of change and continuity. Thus, LQR can provide insights into the nature, causes and consequences of change (or its absence). In this paper, we discuss the key steps and considerations related to designing and conducting LQR in family medicine and community health. These include (1) deciding on the length of data collection and timing and number of interviews, (2) planning recruitment: attrition versus oversampling, (3) approaching data collection: asking the same or different questions, (4) planning and conducting the analysis and writing up findings, and (5) conducting ethical LQR. We also highlight what LQR can offer family medicine and community health, including (1) allowing exploration of views and experiences of a variety of participants over time; (2) following participants through important transitions; (3) studying implementation of new practices, processes or interventions; (4) exploring the importance of historical change and/or macro context on individuals’ lives; and (5) developing a deeper understanding of phenomena under study. While a lot of attention has been paid to using LQR when studying patients’ and/or carers’ experiences, we highlight its value when studying a variety of actors relevant to family medicine, including healthcare professionals and policy makers.

Mass meets mosh: Exploring healthcare professionals' perspectives on social identity processes and health risks at a religious pilgrimage and music festivals

RATIONALE

The field of mass gathering medicine has tended to focus on physical factors in the aggravation and mitigation of health risks in mass gatherings to the neglect of psychosocial factors.

OBJECTIVES

This study sought to explore perspectives of healthcare professionals (HCPs) on (1) implications of social identity processes for mass gathering-associated health risks; and (2) how social identity processes can be drawn on to inform and improve healthcare practices and interventions targeted at mitigating health risks in mass gatherings.

METHODS

Semi-structured interviews, complemented by a brief survey, were conducted with 17 HCPs in the United Kingdom operating at a religious pilgrimage and music festivals.

RESULTS

The findings from a thematic analysis suggest that HCPs recognise that social identity processes involved in identity enactment in mass gatherings are implicated in health risks. HCPs also perceive value in drawing on social identity processes to inform and improve healthcare practices and interventions in mass gatherings. The findings from the survey corroborate the findings from the interviews.

CONCLUSION

Taken together, the research highlights avenues for future research and collaboration aimed at developing healthcare practices and interventions informed by the social identity approach for the management of health risks in mass gatherings.

Altered Meanings of Home Before and During COVID-19 Pandemic

Home came into focus immediately upon learning that COVID-19 is highly contagious and spread by human contact. Precautions people can take to safeguard themselves included physical distancing, social isolation, and staying at home. Despite phases of loosening or tightening precautions in most parts of the world, home retained its safe space status, almost irrespective of geographical location. Recent studies have shown that safety, security, and familiarity are the most referred positive attributes of home. Challenging this attenuation by scholars, negative or mixed meanings of home were highlighted in literary work and critics. Based on our integrative perspective bringing scientific and literary work together, we argue that pandemic might lead to changes in the meaning of home both in positive and negative directions simultaneously, inducing an ambiguous experience or even engendering a situated ambivalence. In this regard, we retrospectively inquired about the changes in home’s meaning in its social, personal, and symbolic attributes. A data set of 66 participants from 15 cities in Turkey revealed that there are not only alterations in the existing connotations of home but also additional ones, in positive, negative, and both directions. Results obtained in the pandemic context were discussed in the light of home studies through a constructionist perspective.

How to Measure Behavioral Spillovers: A Methodological Review and Checklist

A growing stream of literature at the interface between economics and psychology is currently investigating 'behavioral spillovers' in (and across) different domains, including health, environmental, and pro-social behaviors. A variety of empirical methods have been used to measure behavioral spillovers to date, from qualitative self-reports to statistical/econometric analyses, from online and lab experiments to field experiments. The aim of this paper is to critically review the main experimental and non-experimental methods to measure behavioral spillovers to date, and to discuss their methodological strengths and weaknesses. A consensus mixed-method approach is then discussed which uses between-subjects randomization and behavioral observations together with qualitative self-reports in a longitudinal design in order to follow up subjects over time. In particular, participants to an experiment are randomly assigned to a treatment group where a behavioral intervention takes place to target behavior 1, or to a control group where behavior 1 takes place absent any behavioral intervention. A behavioral spillover is empirically identified as the effect of the behavioral intervention in the treatment group on a subsequent, not targeted, behavior 2, compared to the corresponding change in behavior 2 in the control group. Unexpected spillovers and additional insights (e.g., drivers, barriers, mechanisms) are elicited through analysis of qualitative data. In the spirit of the pre-analysis plan, a systematic checklist is finally proposed to guide researchers and policy-makers through the main stages and features of the study design in order to rigorously test and identify behavioral spillovers, and to favor transparency, replicability, and meta-analysis of studies.

Overgeneral autobiographical memory predicts higher prospective levels of depressive symptoms and intrusions in borderline patients

Overgeneral memory (OGM), the tendency to retrieve categories of events from autobiographical memory instead of single events, is found to be a reliable predictor for future mood disturbances and post-traumatic symptom severity. Patients with borderline personality disorder (BPD) often report co-morbid episodes of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Therefore, we investigated whether OGM would predict depression severity and (post-traumatic) stress symptoms in BPD patients. At admission (N = 54) and at six-month follow-up (N ≥ 31), BPD patients completed the Structured Clinical Interview for DSM-IV Disorders, the Assessment of DSM-IV Personality Disorders, the Autobiographical Memory Test, the Beck Depression Inventory-2nd edition (BDI-II), and the Impact of Event Scale. OGM at baseline predicted (a) higher levels of depressive symptoms at follow-up and (b) more intrusions related to a stressful event over and above baseline levels of borderline symptoms, depressive symptoms, and intrusions, respectively. No association was found between memory specificity and event-related avoidance at follow-up. Despite previous findings suggesting that OGM in BPD is less robust than in MDD and PTSD, our results suggest that memory specificity in BPD patients may have some relevance for the course of depressive and stress symptomatology in BPD.

Conceptualizing the therapist's role in therapy in psychosis

OBJECTIVES

This paper reports on a subset of findings from a wider ranging grounded theory analysis of therapy and recovery processes in psychosis. It describes therapist activities involved in maintaining an observational perspective during therapy and the links between these and other therapist activities.

DESIGN

Grounded theory was used to examine the qualitative data collected.

METHODS

An initial sample of 19 taped therapy sessions and 23 interviews with psychologists and their clients was collected. This sample was extended through the collection of three further interviews with psychoanalytically aware psychologists. The data were analysed using grounded theory.

RESULTS

A grounded theory model of therapy processes in psychosis was developed that conceptualized therapist actions as providing an observational scaffold to support the client's efforts in moving to new perspectives on their situation. Consistent with the understanding of the core therapy activity as a dialogical process, this set of therapist actions was understood as occurring alongside other therapist activities involved in managing emotion and building a relationship in therapy.

CONCLUSIONS

The central activity of therapy in psychosis was understood as a dialogical process continuously negotiated between therapist and client in conversation and was conceptually summarized in the grounded theory as 'building bridges to observational perspectives'. However, the active and strategic efforts of psychologists to sustain the dialogue implied a particular assumption of responsibility for maintaining this process. In particular, therapists appeared to be 'working to maintain observational perspectives', 'managing emotion', and 'doing relationship' during the therapy conversation as part of the joint effort with clients to build bridges to new observational perspectives on distress and psychosis.

Stop ‘helping’ me! Identity, recognition and agency in the nexus of work and care

This article explores what it is like to be a ‘working carer’—that increasingly common category of employee who combines paid work with unpaid care.1 We draw on phenomenology for our initial motivation, epistemological assumptions and method of data analysis, and on critical sensemaking as a template for interpretation and theorization. In line with critical sensemaking, we see identity as a central feature of personhood, and we examine our participants’ identity work through the specific refractions of plausibility, context and agency. These highlight the inconsistencies and oscillations of identity work, and the ways in which it is influenced by competing discourses of the right kind of employee and the right kind of woman. We foreground the existential aspects of sensemaking, as participants struggle to come to terms with the impact of care on their own life-projects and search for meaning. This reflects our belief that experiential approaches to work-related issues have a vital part to play in a ‘turn to meaning’ in critical organizational research. Key implications for practitioners and campaigners are discussed, and policy makers urged to address the issue of working carer identification, recognition and support with greater sensitivity to the label’s psychological and existential implications.

The language barrier?: context, identity, and support for political goals in minority ethnolinguistic groups

In two studies, we tested the hypothesis that not having a potentially group-defining attribute (e.g., in-group language) can affect social identification and support for group goals (e.g., national autonomy). Focusing on the Welsh minority in the UK, Study 1 provided evidence that Welsh language fluency predicted Welsh identification and support for national autonomy, and that identification accounted for the language-autonomy association. Study 2 extended this by (1) examining British and English as well as Welsh identification; and (2) quasi-manipulating the surrounding context (Welsh speaking vs. non-Welsh speaking). As predicted, low Welsh language fluency predicted stronger British and English identification, but only where language was criterial (Welsh-speaking regions). British identification, in turn, predicted lower support for national autonomy. Implications and prospects for future research are discussed.

Maternal perceptions of overweight and obesity in children: a grounded theory study

OBJECTIVES

To develop a theoretical framework for understanding maternal perceptions of overweight and obesity in children.

METHOD

Semi-structured interviews with 12 mothers of overweight or obese children recruited via the paediatrician or local weight management group. Interviews were transcribed and analysed using Grounded Theory methodology.

RESULTS

Using Grounded Theory, a theoretical understanding of maternal perceptions of overweight and obesity in children was developed using the two over-arching core categories of 'Good mum/bad mum' and 'Resilience'.

CONCLUSION

Results supported findings uncovered in previous research and also expand on these findings by offering explanations about the psychological mechanisms that may mediate maternal misperceptions of overweight.

Towards an integrative reflexivity in organisational research

Purpose

The purpose of this paper is to offer a more integrative and inclusive conceptualisation of reflexivity as a way of identifying, understanding and managing some of the risks associated with reflexivity's potentially solipsistic “inward turn”.

Design/methodology/approach

The paper draws on the authors' experience of empirical qualitative research with working carers. This experience is grounded within the traditions of interpretative phenomenology and critical epistemology.

Findings

Two reflexive risks: an unintended focus on researcher rather than participant; and process at the expense of substance are discussed and the first of these, reflexive narcissism, is associated with the recognition of biographical similarity between researcher and participant, and the second, a kind of reflexive “process‐ism”, with certain research designs involving meta‐reflection with participants on the research experience. The paper advocates the use of multiple reflexivities and an intrinsic sensibility to reflexive possibility throughout the duration of a research programme.

Research limitations/implications

The paper offers an alternative model of reflexivity and some practical guidelines, which may be of value to researchers working across a range of different qualitative methodologies.

Practical implications

The paper makes some preliminary observations about the phenomenon of the working carer, which may be of value to organisational practitioners.

Originality/value

The approach to reflexivity outlined in this paper helps to clarify some of the issues and difficulties associated with the reflexive thesis, and in particular, will help less experienced qualitative researchers to avoid some common pitfalls of reflexive practice.

Managing the impact of psychosis: A grounded theory exploration of recovery processes in psychosis

OBJECTIVES

There has been little conceptual bridge building between what individuals report as helpful in recovery and how psychological therapy might impact on recovery in psychosis. This study explores the links between therapy and recovery in psychosis.

DESIGN

Grounded theory was chosen as an appropriate methodology to distil an explanatory account across the qualitative data collected.

METHODS

An initial sample of 19 therapy session tapes and 23 interviews with psychologists and clients engaged in psychological therapy in psychosis was collected and analysed using grounded theory. This data set was extended through the additional sampling and analysis of 31 published personal accounts of the experience of psychosis.

RESULTS

The study reports on specific elements of a larger grounded theory study that particularly relate to recovery processes in psychosis. Specific categories of activity were conceptualised to theorise the key activities involved in managing the impact of psychosis.

CONCLUSIONS

Therapy in psychosis appeared to be aimed at enhancing clients' functioning in the social world. In an effort to achieve this, it seemed that clients engaged in an ongoing effort to manage the impact of psychosis on both their subjective experience and on day to day life. The conceptualisation of this effort as an active, ongoing, and individually-directed process was consistent with other examinations of service user accounts.

`Automatically you become a polygamist': `culture' and `norms' as resources for normalization and managing accountability in talk about responses to infertility

In the developing world, infertility is a serious problem. It leads to both psychological and social hardship, in part because childless marriages often result in divorce, men taking another wife or extramarital relationships. Such responses have been attributed to cultural norms that mandate procreation. However, there are theoretical, methodological and moral issues with treating cultural norms as behavioural determinants. They have been insufficiently acknowledged in health research. Therefore, I demonstrate an alternative discursive approach, which examines how people actively mobilize `culture' or `norms' in interactions, and the interpersonal functions thereby fulfilled (e.g. blaming or justifying). Analysis is presented of interviews on (responses to) infertility in Malawi. I show how respondents construct polygamy and extramarital affairs as culturally and normatively required, `automatic' and normal solutions for fertility problems and play down people's accountability for these practices. These accounts and constructions appear to facilitate engagement in affairs and polygamy when people face fertility problems, which seems problematic from a health and gender perspective. Thus, detailed analysis of how people use `culture' and `norms' in situ is important because it provides insights into its potentially undesirable consequences. Moreover, such analysis provides a starting point for culturally and gender sensitive interventions, since it highlights people's agency, and creates a space to re-construct and change practices.

'I was like a wild wild person': understanding feelings of anger using interpretative phenomenological analysis

This paper is concerned with illuminating how emotion (anger) and emotion-related phenomena such as feelings, thoughts and expressions appear to the individual person. In particular, it focuses on the role of feelings in emotion experience. It does this through the qualitative analysis of interview material from a single person case study using interpretative phenomenological analysis. The paper examines how the participant feels and experiences anger, the defining characteristics of anger episodes, and how the typical pattern of these episodes is disrupted by life-changes. The findings are examined in light of phenomenological ideas and the utility of these ideas for psychology's understanding of emotion argued for.

Quality criteria under methodological pluralism: implications for conducting and evaluating research

Many community psychologists adhere to a methodological pluralist orientation to research; however, it is often unclear what such a position means in practice. This paper draws out the practical implications of methodological pluralism for community research. It proposes four sets of criteria for how research might be appraised under a pluralistic ethos: criteria applicable to all research, research-relevant community psychology values and principles, criteria specifically applicable to quantitative research, and criteria specifically applicable to qualitative research. The paper also addresses how pluralistic community research may be conducted, at each of three levels: integrating methods within a single study, using different approaches within a research program, and pluralism in the field as a whole.

'Does my bump look big in this?' The meaning of bodily changes for first-time mothers-to-be

Research on the impact of bodily changes during the transition to motherhood is contradictory. The aim of the study reported here was to provide more useful insights by employing an inductive qualitative approach. Interviews with six women in the latter stages of pregnancy were analysed drawing upon aspects of interpretative phenomenological analysis and Foucauldian discourse analysis. These analyses suggest generally negative consequence, and discursive constructions that have a greater potential to be limiting than empowering. The impact of gender ideologies on women's ways of being while pregnant is highlighted, as is the importance of developing alternative representations of the female, and the pregnant body, which do not pathologize women.

Patient and nurse accounts of violent incidents in a medium secure unit

Most studies examining violence in a forensic setting have adopted a statistical approach to associate relevant predictors and the likelihood of violence. Views of patients and nurses have been a relatively neglected research area. This study explored patients' and nurses' accounts of violent incidents, considering similarities and differences in their narratives. Permission was obtained from the local National Health Service Research Ethics Board and the Research Ethics Committee of University of East London. Anonymized transcripts were produced from semi-structured interviews conducted in a Medium Secure Unit with four nurses and four patients, who consented to talk at length with the first author about violent events they had witnessed on the Unit. Grounded theory analysis of the data generated a core category, 'control', and five constituent themes: the construction of identity of the perpetrator of violence; nurses' dual role of caring and controlling; aspects of parentalism involved in control; following set policies and procedures; and segregation from mainstream society. Because of widespread social interest and media coverage in the topic, discursive examination was made of aspects of social context arising within the data. This study was small scale and exploratory, and further confirmatory research is needed. Nevertheless, clear contrasts between the nurse and patient accounts indicated tentative suggestions for training (including user involvement) and intervention in managing violent behaviour.