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Qualitative research methods are a robust tool for chaplaincy research questions. Similar to much of chaplaincy clinical care, qualitative research generally works with written texts, often transcriptions of individual interviews or focus group conversations and seeks to understand the meaning of experience in a study sample. This article describes three common methodologies: ethnography, grounded theory, and phenomenology. Issues to consider relating to the study sample, design, and analysis are discussed. Enhancing the validity of the data, as well reliability and ethical issues in qualitative research are described. Qualitative research is an accessible way for chaplains to contribute new knowledge about the sacred dimension of people's lived experience.
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Overview of Qualitative Research
Daniel H. Grossoehme a
a Division of Pulmonary Medicine, Department of Pastoral Care ,
Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio ,
Published online: 13 Jun 2014.
To cite this article: Daniel H. Grossoehme (2014) Overview of Qualitative Research, Journal of Health
Care Chaplaincy, 20:3, 109-122, DOI: 10.1080/08854726.2014.925660
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Research Methodology
Overview of Qualitative Research
Division of Pulmonary Medicine, Department of Pastoral Care, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio, USA
Qualitative research methods are a robust tool for chaplaincy
research questions. Similar to much of chaplaincy clinical care,
qualitative research generally works with written texts, often tran-
scriptions of individual interviews or focus group conversations
and seeks to understand the meaning of experience in a study
sample. This article describes three common methodologies: eth-
nography, grounded theory, and phenomenology. Issues to con-
sider relating to the study sample, design, and analysis are
discussed. Enhancing the validity of the data, as well reliability
and ethical issues in qualitative research are described. Qualitat-
ive research is an accessible way for chaplains to contribute new
knowledge about the sacred dimension of people’s lived experience.
KEYWORDS chaplaincy, ethnography, grounded theory,
phenomenology, qualitative research
Qualitative research is, ‘‘the systematic collection, organization, and
interpretation of textual material derived from talk or conversation. It is used
in the exploration of meanings of social phenomena as experienced by indi-
viduals themselves, in their natural context’’ (Malterud, 2001, p. 483). It can
be the most accessible means of entry for chaplains into the world of
research because, like clinical conversations, it focuses on eliciting people’s
stories. The stories can actually be expressed in almost any medium: conver-
sations (interviews or focus groups), written texts (journal, prayers, or
Address correspondence to Daniel H. Grossoehme, Division of Pulmonary Medicine,
Department of Pastoral Care, Cincinnati Children’s Hospital Medical Center, MLC 2021, 3333
Burnet Avenue, Cincinnati, OH 45229, USA. E-mail:
Journal of Health Care Chaplaincy, 20:109–122, 2014
Copyright #Taylor & Francis Group, LLC
ISSN: 0885-4726 print=1528-6916 online
DOI: 10.1080/08854726.2014.925660
Downloaded by [] at 12:28 17 July 2015
letters), or visual forms (drawings, photographs). Qualitative research may
involve presenting data collected from a single person, as in a case study
(Risk, 2013), or from a group of people, as in one of my studies of parents
of children with cystic fibrosis (CF) (Grossoehme et al., 2013). Whole books
are devoted to qualitative research methodology and, indeed, to the individ-
ual methods themselves. This article is intended to present, in rather broad
brushstrokes, some of the ‘‘methods of choice’’ and to suggest some issues
to consider before embarking on a qualitative research project. Helpful texts
are cited to provide resources for more complete information.
Although virtually anything may be data, spoken mediums are the
most common forms of collecting data in health research, so the focus of
this article will mainly be on interviews and to a lesser extent, focus groups.
Interviews explore experiences of individuals, and through a series of
questions and answers, the meaning individuals give to their experiences
(Tong, Sainsbury, & Craig, 2007). They may be ‘‘structured’’ interviews,
in which an interview guide is used with pre-determined questions from
which no deviation is permitted by the interviewer, or semi-structured
interviews, in which an interview guide is used with pre-determined ques-
tions and potential follow-up questions. The latter allows the interviewer to
pursue topics that arise during the interview that seem relevant (Cohen &
Crabtree, 2006). Writing good questions is harder than it appears! In my
first unit of CPE, the supervisor returned verbatims, especially our early
efforts, with ‘‘DCFQ’’ written in the margin, for ‘‘direct, closed, factual ques-
tion.’’ We quickly learned to avoid DCFQs in our clinical conversations
because they did not create the space for reflection on illness and the
sacred the way open-ended questions did. To some extent, writing good
open-ended questions that elicit stories can come more readily to cha-
plains, due perhaps to our training, than to investigators from other disci-
plines. This is not to say writing an interview guide is easy or an aspect of
research that can be taken lightly, as the quality of the data you collect, and
hence the quality of your study, depends on the quality of your interview
Data may also be collected using focus groups. Focus groups are nor-
mally built around a specific topic. They almost always follow a
semi-structured format and include open discussion of responses among
participants, which may range from four to twelve people (Tong et al.,
2007). They provide an excellent means to gather data on an entire range
of responses to a topic, or on the social interactions between participants,
or to clarify a process. Once the data are collected, the analytic approach
is typically similar to that of interview data.
Qualitative investigators are not disinterested outsiders who merely
observe without interacting with participants, but affect and are affected by
their data. The investigator’s emotions as they read participants’ narratives
are data to be included in the study. Simply asking ‘‘research’’ questions
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can itself be a chaplaincy intervention: what we ask affects the other person
and can lead them to reflect and change (Grossoehme, 2011). It is important
to articulate our biases and understand how they influence us when we col-
lect and analyze data. Qualitative research is often done by a small group of
researchers, especially the data coding. This minimizes the bias of an individ-
ual investigator. Inevitably, two or more people will code passages differ-
ently at times. It is important to establish at the outset how such
discrepancies will be handled.
Ensuring Rigor, Validity, and Reliability
Some people do not think qualitative research is not very robust or signifi-
cant. This attitude is due, in part, to the poor quality of some early efforts.
Increasingly, however, qualitative studies have improved in rigor, and
reviewers of qualitative manuscripts expect investigators to have addressed
problematic issues from the start of the project. Two important areas are
validity and reliability. Validity refers to whether or not the final product
(usually referred to a ‘‘model’’) truly portrays what it claims to portray. If
you think of a scale on which you weigh yourself, you want a valid read-
ing so that you know your correct weight. Reliability refers to the extent to
which the results are repeatable; if someone else repeated this study,
would they obtain the same result? To continue the scale analogy, a
reliable scale gives the same weight every time I step on it. A scale can
be reliable without being valid. The scale could reliably read 72 pounds
every time I step on it, but that value is hardly correct, so the measure
is not valid.
Swinton and Mowat (2006) discussed ensuring the ‘‘trustworthiness’’ of the
data. N narrative data which are ‘‘rich’’ in their use of metaphor and descrip-
tion, and which express deeper levels of meaning and nuance compared to
everyday language are likely to yield a trustworthy final model because the
investigators have done a credible job of completely describing and under-
standing the topic that is under study. Validity is also enhanced by some
methodologies, such as grounded theory, which use participants’ own
words to name categories and themes, instead of using labels given by
the investigator. The concept of ‘‘member checking’’ also enhances validity.
Once the analyses are complete and a final model has been developed,
these findings are shown to all or some of the participants (the members)
who are invited to check the findings and give feedback. Do they see
themselves in the words or conceptual model that is presented? Do they
offer participants a new insight, or do they nod agreement without really
reengaging the findings?
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One means of demonstrating reliability is to document the research decisions
made along the way, as they were made, perhaps in a research diary
(Swinton & Mowat, 2006). Qualitative methodologies accept that the investi-
gator is part of what is being studied and will influence it, and that this does
not devalue a study but, in fact, enhances it. Simply deciding what questions
to ask or not ask, and who you ask them to (and not) reflect certain decisions
that should be consciously made and documented. Another researcher
should be able to understand what was done and why from reading the
research diary.
Elisa Sobo (2009) defines ethnography as the presentation of, ‘‘...a given
group’s conceptual world, seen and experienced from the inside’’ (p. 297).
Ethnography answers the question, ‘‘what’s it like to be this person?’’ One
example of this kind of study comes from the work of Fore and colleagues
(Fore, Goldenhar, Margolis, & Seid, 2013). In order to design tools that would
enable clinicians and persons with pediatric inflammatory bowel disease
(IDB) to work together more efficiently, an ethnographic study was underta-
ken to learn what it was like for a family when a child had IDB. After 36 inter-
views, the study team was able to create three parent-child dyad personas:
archetypes of parents and children with IDB based directly on the data they
gathered. These personas were used by the design team to think about how
different types of parents and children adapted to the disease and to think
what tools should be developed to help different types of parents and chil-
dren with IDB. An ethnographic study is the method of choice when the goal
is to understand a culture, and to present, or explain, its spoken and unspo-
ken nature to people who are not part of the culture, as in the example above
of IDB. Before ‘‘outsiders’’ could think about the needs of people with IDB, it
was necessary to learn what it is like to live with this disease.
Determining the sample in ethnographic studies typically means using what
is called a purposive sample (Newfield, Sells, Smith, Newfield, & Newfield,
1996). Purposive samples are based on criteria that the investigator estab-
lishes at the outset, which describe participant characteristics. In the afore-
mentioned IDB example, the criteria were: (1) being a person with IDB
who was between 12 and 22 years old or the parent of such a child; (2) being
or having a child whose IDB care was provided at one of a particular group
of treatment centers; (3) being a pediatric gastrointestinal nurse at one of the
centers; or (4) a physician=researcher at one of five treatment centers. Having
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a sample that is representative of the larger population, always the goal in
quantitative research, is not the point in ethnographic studies. Here, the goal
is to recruit participants who have the experience to respond to the ques-
tions. Out of their intimate knowledge of their culture, the investigator can
build a theory, or conceptual model, which could later be tested for
generalizability in an entire population.
Ethnographic study designs typically involve a combination of data collection
methods. Whenever possible, observing the participants in the midst of what-
ever experience is the study’s focus is desirable. In the process of an ethno-
graphic project on CF, for instance, two students spent a twelve-hour period
at the home of a family with a child who had CF, taking notes about what
they saw and heard. Interviews with participants are frequently employed
to learn more about the experience of interest. An example of this is the work
of Sobo and colleagues, who interviewed parents of pediatric patients in a
clinic to ask about the barriers they experienced obtaining health care for
their child (Seid, Sobo, Gelhard, & Varni, 2004). Diaries and journals detailing
people’s lived experience may also be used, alone, or in combination with
other methods.
Analysis of ethnographic data is variable, depending on the study’s goal. One
common analytic approach is to begin analysis after the first few interviews
have been completed, and to read them to get a sense of their content. The
next step is to name the seemingly important words or phrases. At this point,
one might begin to see how the names relate to each other; this is the begin-
ning of theory development. This process continues until all the data are
collected. At that point, the data are sorted by the names, with data from
multiple participants clustered under each topic name (Boyle, 1994). Similar
names may be grouped together, or placed under a larger label name (i.e.,
category). In a sense, what happens is that each interviewer’s voice is broken
into individual fragments, and everyone’s fragments that have the same name
are put together. From individual voices speaking on multiple topics, there is
now one topic with multiple voices speaking to it.
Grounded theory is ‘‘grounded’’ in its data; this inductive approach collects
data while simultaneously analyzing it and using the emerging theory to
inform data collection (Rafuls & Moon, 1996). This cycle continues until
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the categories are said to be ‘‘saturated,’’ which typically means the point
when no new information is being learned (Morse, 1995). This methodology
is generally credited to Glaser and Strauss, who wanted to create a means of
developing theoretical models from empirical data (Charmaz, 2005).
Perhaps, more than in any other qualitative methodology, the person of
the investigator is the key. The extent to which the investigator notices subtle
nuances in the data and responds to them with new questions for future part-
icipants, or revises an emerging theory, is the extent to which a grounded
theory research truly presents a theory capturing the fullness of the data from
which it was built. It is also the extent to which the theory is capable of being
used to guide future research or alter clinical practice. Grounded theory is the
method of choice when there is no existing hypothesis to test. For instance,
there was no published data on how parents use faith to cope after their
child’s diagnosis with CF. Using grounded theory allowed us to develop a
theory, or a conceptual model, of how parents used faith to cope
(Grossoehme, Ragsdale, Wooldridge, Cotton, & Seid, 2010). An excellent
discussion of this method is provided by Charmaz (2006).
The nature of the research question should dictate the sample description,
which should be defined before beginning the data collection. In some cases,
the incidence of the phenomena may set some limits on the sample. For
example, a study of religious coping by adults who were diagnosed with
CF after age 18 years began with a low incidence: this question immediately
limited the number of eligible adults in a four-state area to approximately 25
(Grossoehme et al., 2012). Knowing that between 12 and 20 participants
might be required in order to have sufficient data to convince ourselves that
our categories were indeed saturated, limiting our sample in other ways: for
example, selecting representative individuals spread across the number of
years since diagnosis would not have made sense. In some studies, the goal
is to learn what makes a particular subset of a larger sample special; these
subsets are known as ‘‘positive deviants’’ (Bradley et al., 2009).
Once the sample is defined and data collection begins, the analytic process
begins shortly thereafter. As will be described in the following paragraphs,
interviews and other forms of spoken communication are nearly always tran-
scribed, typically verbatim. Unlike most other qualitative methods, grounded
theory uses an iterative design. Sometime around the third or fourth inter-
view has been completed and transcribed and before proceeding with
further interviews, it is time to begin analyzing the transcripts. There are
two aspects to this. The first is to code the data that you have. Grounded
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theory prefers to use the participants’ own words as the code, rather than
having the investigator name it. For example, in the following transcript
excerpt, we coded part of the following except:
INTERVIEWER: OK. Have your beliefs or perhaps relationship with God
changed at all because of what you’ve gone through the
last nine and 10 months with N.?
INTERVIEWEE: Yeah, I mean, I feel that I’m stronger than I was before
INTERVIEWER: Hmm-hmm. How so? Can you put that into words? I
know some of these could be hard to talk about but ...
INTERVIEWEE: I don’t know, I feel like I’m putting his life more in God’s
hands than I ever was before.
We labeled, or coded, these data as, ‘‘I’m putting his life more in God’s
hands,’’ whereas in a different methodology we might have simply named it
‘‘Trusting God.’’ Focus on the action in the narrative. Although it can be dif-
ficult, you as a researcher must try very hard to set your own ideas aside.
Remember you are doing this because there is no pre-existing theory about
what you are studying, so you should not be guided by a theory you have in
your mind. You must let the data speak for themselves.
The second point is to reflect on the codes and what they are already
telling you. What questions are eliciting the narrative data you want? Which
ones are not? Questions that are not leading you to the data you want prob-
ably need to be changed. Interesting, novel ideas may emerge from the data,
or topics that you want to know more about that you did not anticipate and
so the interviewer did not’ follow up on them. What are the data not telling
you that you are seeking? All of this information flows back to revising the
semi-structured interview guide (Charmaz, 2006). This issue raised mild con-
cern with the IRB reviewer who had not encountered this methodology
before. This concern was overcome by showing that this is an accepted
method with voluminous literature behind it, and by showing that the types
of item revisions were not expected to significantly alter the study’s effect on
the participants. From this point onward you collect data, code it, and ana-
lyze it simultaneously. As you code a new transcript and come across a state-
ment similar to others, you can begin to put them together. If you are using
qualitative analysis software such as NVivo (‘‘NVivo qualitative data analysis
software,’’ 2012), you can make these new codes ‘‘children’’ of a ‘‘parent’’
node (the first statement you encountered on this topic). The next step is
called ‘‘focused coding’’ and in this phase you combine what seems to you
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to be the most significant codes (Charmaz, 2006). These may also be the most
frequently occurring, or the topic with the most duplicates, but not necessar-
ily. This is not a quantitative approach in which having large amounts of data
is important. You combine codes at this stage in such a way that your new,
larger, categories begin to give shape to aspects of the theory you think is
going to emerge. As you collect and code more data, and revise your
categories, your idea of the theory will change.
Axial coding follows, as you look at your emerging themes or
categories, and begin to associate coded data that explains that category.
Axial coding refers to coding the words or quotations that are around the
category’s ‘‘axis,’’ or core. For example, in a study of parental faith and cop-
ing in the first year after their child’s diagnosis with CF (Grossoehme et al.,
2010), one of the categories which emerged was, ‘‘Our beliefs have chan-
ged.’’ There were five axial codes which explain aspects of this category.
The axial codes were, ‘‘Unchanged,’’ ‘‘We’ve learned how fragile life is,’’
‘‘Our faith has been strengthened,’’ ‘‘We’ve gotten away from our parents’
viewpoints,’’ and ‘‘I’m better in tune with who I am.’’ Each of these axial
codes had multiple explanatory phrases or sentences under them; together
they explain the breadth and dimensions of the category, ‘‘Our beliefs have
The next step is theoretical coding, and here the categories generated
during focused coding are synthesized into a theory. Some grounded theor-
ists, notably one of the two most associated with it (Glaser), do not use axial
coding but proceed directly to this step as the means of creating coherence
out of the data (Charmaz, 2006). As your emerging theory crystallizes, you
may pause to see if it has similarities with other theoretical constructs you
encountered in your literature search. Does your emerging theory remind
you of anything? It would be appropriate to engage in member-checking
at this point. In this phase, you show your theoretical model and its sup-
porting categories to participants and ask for their feedback. Does your
model make sense to them? Does it help them see this aspect of their
experience differently (Charmaz, 2005). Use their feedback to revise your
theory and put it in its final form. At this point, you have generated new
knowledge: a theory no one has put forth previously, and one that is ready
to be tested.
Perhaps the most chaplain-friendly qualitative research approach is phenom-
enology, because it is all about the search for meaning. Its roots are in the
philosophical work of Husserl, Heidegger and Ricoeur (Boss, Dahl, &
Kaplan, 1996; Swinton & Mowat, 2006). This approach is based on several
assumptions: (1) meaning and knowing are social constructions, always
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incomplete and developing; (2) the investigator is a part of the experience
being studied and the investigator’s values play a role in the investigation;
(3) bias is inherent in all research and should be articulated at the beginning;
(4) participants and investigators share knowledge and are partners; (5) com-
mon forms of expression (e.g., words or art) are important; and (6) meanings
may not be shared by everyone (Boss et al.). John Swinton and Harriet
Mowat (2006) described the process of carrying out a phenomenological
study of depression and spirituality in adults and reading their book is an
excellent way to gain a sense of the whole process. Phenomenology may
be the method of choice when you want to study what an experience means
to a particular group of people. May not be the best choice when you want
to be able to generalize your findings. An accurate presentation of the experi-
ence under study is more important in this approach than the ability to
claim that the findings apply to across situations or people (Boss et al.). A
study of the devil among predominately Hispanic horse track workers is
unlikely to be generalizable to experiences of the devil among persons of
Scandinavian descent living in Minnesota. Care must be taken not to over-
state the findings from a study and extend the conclusions beyond what
the data support.
The emphasis on accurately portraying the phenomenon means that large
numbers of participants are not required. In fact, relatively small sample sizes
are required compared to most quantitative, clinical studies. The goal is to
gather descriptions of their lived experience which are rich in detail and ima-
gery, as well as reflection on its theological or psychological meaning. The
likelihood of achieving this goal can be enhanced by using a purposeful sam-
ple. That is, decide in the beginning approximately how large and how
diverse your sample needs to be. For example, CF can be caused by over
1,000 different genetic mutations; some cause more pulmonary symptoms
while others cause more gastrointestinal problems. Some people with CF
have diabetes and others do not; some have a functioning pancreas and
others need to take replacement enzymes before eating or drinking anything
other than water. Some CF adolescents may have lung function that is over
100%of what is expected for healthy adolescents of their age and gender,
whereas others, with severe pulmonary disease, may have lung function that
is just 30%of what is expected for their age and gender. A study of what it is
like for an adolescent to live with a life-shortening genetic disease using this
approach might benefit from purposive sampling. For example, lung disease
severity in CF is broadly described as mild, moderate or severe. A purposeful
sample might call for 18 participants divided into 3 age groups (11–13 years;
14–16 years; and 17–19 years old) and disease severity (mild, moderate, and
severe). In each of those nine groups there would be one male and one
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female. In actual practice, one might want to have more than 18 to allow for
attrition, but this breakdown gives the basic idea of defining a purposive
sample. One could reasonably expect that having the experience of both
genders across the spectrum of disease severity and the developmental range
of adolescence would permit an accurate, multi-dimensional understanding
to emerge of what living with this life-shortening disease means to adoles-
cents. In fact, such an accurate description is more likely to emerge with this
purposeful sample of 18 adolescents than with a convenience sample of the
first 18 adolescents who might agree to participate in the study during their
outpatient clinic appointment. Defining the sample to be studied requires
some forethought about what is likely to be needed to gain the fullest under-
standing of the topic.
Any research design may be used. The design will be dictated by what data
are required to understand the phenomena and its meaning. Interviews are
by far the most common means of gathering data, although one might also
use written texts, such as prayers written in open prayer books in hospital
chapels, for example (ap Sion, 2013; Grossoehme, 1996), or drawings
(Pendleton, Cavalli, Pargament, & Nasr, 2002), or photographs=videos
(Olausson, Ekebergh, & Lindahl, 2012). Although the word ‘‘text’’ appears,
it should be with the understanding that any form of data is implied.
The theoretical underpinnings of phenomenology, which are beyond the
scope of this article, suggest to users that ‘‘a method’’ is unnecessary or
indeed, contrary, to phenomenology. However, one phenomenological
researcher did articulate a method (Giorgi, 1985), which consists of the fol-
lowing steps. First, the research team immerses themselves in the data. They
do this by reading and re-reading the transcribed interviews and listening to
the recorded interviews so that they can hear the tone and timbre of the
voices. The goal at this stage is to get a sense of the whole. Second, the
texts are coded, in which the words, phrases or sentences that stand out
as describing the experience or phenomena under study, or which express
outright its meaning for the participant are extracted or highlighted. Each
coded bit of data is sometimes referred to as a ‘‘meaning unit.’’ Third, similar
meaning units are placed into categories. Fourth, for each meaning unit the
meaning of the participants’ own words is spelled out. For chaplains, this
may mean articulating what the experience means in theological language.
Other disciplines might transform the participants’ words into psychological,
sociological or anthropological language. Here the investigators infer the
meaning behind the participants’ words and articulate it. Finally, each of
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the transformed statements of meaning are combined into a few thematic
statements that describe the experience (Bassett, 2004; Boss et al., 1996).
After this, it would be appropriate to do member-checking and a
subsequent revision of the final model based on participants’ responses
and feedback.
Just as questionnaires or blood samples contain data, in qualitative research it
is the recording of people’s words, whether in an audio, video, or paper for-
mat which hold the data. Interviews, either in-person or by telephone should
be recorded using audio, video or both. It is important to have a device with
suitable audio quality and fresh batteries. Experience has shown me the
benefit of using two audio recorders so that you do not lose data if one of
them fails. There are several small recorders available that have USB connec-
tions that allow the audio file to be uploaded to a computer easily. To protect
participants’ privacy, all data should be anonymized by removing any infor-
mation that could identify individuals. The Standard Operating Procedure in
my research group is to replace all participants’ names with an ‘‘N.’’ During
the transcription process, all other individuals are identified by their role in
square brackets, ‘‘[parent].’’ Depending on the study’s goal and the analytic
method you have selected, you may want to include symbols for pauses
before participants respond, or non-fluencies (e.g., ‘‘ummm. ...’’, ‘‘well
...uh ...’’) or non-verbal gestures (if you are video recording). Decide before
beginning whether it is important to capture these as data or not. There are
conventional symbols which are inserted into transcriptions which capture
these data for you. After the initial transcription, these need to be verified
by comparing the written copy against the original recording. Verification
should be done by someone other than the transcriptionist. There are several
tasks at this stage. Depending on the quality of your recording, the clarity of
participants’ speech and other factors, some words or phrases may have been
unintelligible to the transcriptionist, and this is the time to address them. In
my research group our Standard Operating Procedure is to highlight unintel-
ligible text during the transcription phase, and a ‘‘verifier’’ attempts three
times to clarify the words on the original recording before leaving them
marked ‘‘unintelligible’’ in the transcript. No transcriptionist is perfect and
if they are unfamiliar with the topic, they may transcribe the recording inac-
curately. I recently verified a transcript where a commercial medical tran-
scriptionist changed the participant’s gender from ‘‘he’’ to ‘‘she’’ when the
word prior to the pronoun ended with an ‘‘s.’’ If this pattern had not been
caught during the verification process, it would have been very difficult dur-
ing the coding to know whether the pronoun referred to the participant or to
their daughter.
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Study Design
The issue of power and the possibility of subtle coercion is the concern here.
There is an inherent power differential between a research participant and
the investigator, which is exacerbated when the investigator is a chaplain.
Despite our attempts to be non-threatening, the very words, ‘‘chaplain,’’ or
‘‘clergy’’ connote power. For this reason, the chaplain-investigator should
not approach potential participants regarding a study. Potential participants
may be informed regarding their eligibility to participate by their physician
or a chaplain, but the recruitment and informed consent process should
be handled by someone else, perhaps a clinical research coordinator. How-
ever, as the chaplain-investigator, you will need to teach them how to talk
with potential participants about your study and answer their questions.
Choose a data collection method that is best-suited to the level of sensitivity
of your research topic. Focus groups can provide data with multiple perspec-
tives, and they are a poor choice when there may be pressure to
provide socially correct responses, or when disclosures may be stigmatizing.
In such cases, it is better to collect data using individual semi-structured
Develop a plan for assessing participants’ discomfort, anxiety, or even more
severe reactions during the study. For instance, what will you do when some-
one discloses his=her current thoughts of self-harm, or experiences a flash-
back to a prior traumatic event that was triggered during an interview?
How will you handle this if you are collecting data in person? By telephone?
You will need to be specific who must be informed and who will make deci-
sions about responding to the risk.
Privacy and Confidentiality
In addition to maintaining privacy and confidentiality of your actual data and
other study documents, consider how you will protect participants’ privacy
when you write the study up for publication. Make sure that people cannot
be identified by their quotations that you include as you publish data. The
smaller the population you are working with, the more diligently you need
to work on this. If the transcriptionist is not an employee of your institution
and under the same privacy and confidentiality policies, it is up to you to
ensure that an external transcriptionist takes steps to protect and maintain
the privacy of participants’ data.
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Qualitative research is an accessible way for chaplains to contribute new
knowledge regarding the sacred dimension of people’s lived experience.
Chaplains are already sensitive to and familiar with many aspects of qualitat-
ive research methodologies. Studies need to be designed to be valid and
meaningful, and are best done collaboratively. They provide an excellent
opportunity to develop working relationships with physicians, medical
anthropologists, nurses, psychologists, and sociologists, all of whom have
rich traditions of qualitative research. This article can only provide an over-
view of some of the issues related to qualitative research and some of its
methods. The texts cited, as well as others, provide additional information
needed before designing and carrying out a qualitative study. Qualitative
research is a tool that chaplains can use to develop new knowledge and con-
tribute to professional chaplaincy’s ability to facilitate the healing of broken-
ness and disease.
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Grossoehme, D. H. (1996). Prayer reveals belief: Images of God from hospital
prayers. Journal of Pastoral Care,50(1), 33–39.
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(2013). ‘‘I honestly believe God keeps me healthy so I can take care of my
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diagnosis with cystic fibrosis. Journal of Health Care Chaplaincy,16(3–4),
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... Twenty-three interviews, a group meeting, WhatsApp messages, and emails are regarded as a small sample, to draw general conclusions. Qualitative research, however, does not demand bigger samples since its reliability and validity are achieved through a deeper analysis of an existing sample with its multiplicity of voices [47,48]. In addition, the small sample enabled us to concentrate on the various voices and their intricate attitudes, illuminating the complexity of the situation at hand [48]. ...
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This paper presents a qualitative analysis of COVID-19′s impact on the development, delivery, and uptake of “Favoring Myself”, a school-based interactive wellness program conducted via Zoom during 2020–2021. “Favoring Myself” targets resilience, self-esteem, body-esteem, self-care behaviors, and media literacy among 5th-grade preadolescents. Data were obtained from meetings, 23 semi-structured interviews with parents, teachers, and principals, and other modes of correspondence. All data were transcribed and thematically analyzed. The analysis highlighted the barriers faced when delivering external programs during COVID-19. Parents’ difficulties in cooperating with the program, distrustful relationships between parents and the education system, as well as teachers’ overload and stress, were identified as barriers to the external program’s sustainability. These challenges are discussed in light of previous studies of school-based programs, the psychological and social contexts of an ongoing crisis and the impact of neoliberalism on education. This study concludes that school-based prevention programs and accompanying research should be more flexible and focus on understanding and relating to parents’ and schools’ fears, uncertainties, and resistance. It is the hope of the authors that knowledge created through this exploration will be helpful in future coping vis-à-vis prevention program teams and recipients in times of unpredictable, unmanageable, and overpowering crises.
... In addition, the organizations participating in this research effort are from different industries, and the interviewees have different positions within their organizations. Moreover, having a structured interview would pose a problem, since it will limit the number of responses or drive the research in a narrow direction (Grossoehme, 2014). Therefore, to achieve the research objective, a semi-structured interview was used. ...
Organizational change can be defined as an alteration of a core aspect of an organization’s operation, structure, or culture. Previous research on organizational change mainly has focused on different types of technical changes, such as alternative project delivery methods and strategies to adopt the design-build approach successfully. Also, previous studies have focused on the project level changes instead of organizational level responses. Here I show using a proposed change model and performing thematic, and analysis, that there exist common responses, and challenges across different types of capital projects organizations studied. The results show that responses to change will differ as a function of the type of change, and the organization’s capabilities and resources. Furthermore, when performing organizational changes, the impact on “people” within the organization should be closely studied and monitored, while taking into account other challenges that might impact the organization. For drivers of change, the main themes were related to Market shift. Clients/owners’ needs, and Sustainability. On the other hand, the organizational responses’ main themes were related to Restructuring, Communication, Partnerships, Training, Recruitment, Internal capabilities, organizational design, and supportive leadership. While for challenges, the main themes were mainly related to Resistance to change, the nature of the industry, and retaining the workforce. One of the major challenges faced during the research was motivating the organizations to participate. Various organizations showed interest and then decided not to join, while others that participated had to review their responses multiple times, and were concerned about revealing their “Trade secrets”. Future work should build on this effort and consider the responses and analyze them as a function of types of change, Moreover, future research should consider asking the interviewees to “weight” the responses to avoid wrong conclusions due to the low number of in-text mentions. This research will help capital project organizations to be aware of the main areas of concern during the journey of change and help them to learn from previous experiences from other organizations.
... In the current study, we sought to explore the experience of indecisiveness toward motherhood within the context of the above-described contemporary cultural perceptions. We, therefore, used a phenomenological approach, which focuses on the meanings ascribed by a particular group of people to the experience under study (Grossoehme, 2014). The specific aims of the study were to enhance our understanding of the issues and dilemmas involved in Israeli women's uncertainty about motherhood and to examine the meanings and experiences of participation in the presently studied pioneer group. ...
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This study focuses on women who define themselves as being undecided about becoming mothers. It addresses the question of how these women navigate their lives between two main conflicting cultural directives and perceptions: pronatalism and familism entwined in perception of linear time on one hand; and individualism and its counterpart, the notion of flexible liquid society, on the other. The research is based on group meetings designated for these women, which were facilitated by the first author. Ten women participated in the study—of whom, most were heterosexual, half were single, and half were partnered. Data were collected using (1) questionnaires completed during individual interviews that preceded the group encounter; (2) transcripts of the discussions held during the ten group sessions; and (3) questions regarding the status of the women’s doubts about motherhood asked 4 years after participating in the group. Our findings expand the existing typology of women’s reproductive decision-making, and demonstrate how categories that are commonly perceived as binary intersect when one challenges the rigid classifications of “active decisions” and “passive decisions”; “motherhood” and “non-motherhood,” and “want to be a mother” and “do not want to be a mother.” The findings also suggest that after becoming mothers, women can change their maternal status from “non-mother” to “mother,” yet still continue to view themselves as indecisive regarding motherhood. Based on our findings, we will argue that while indecisiveness about motherhood derives from individualized neoliberal rhetoric, it simultaneously undermines that same rhetoric and contradicts the injunction to “know, to decide, to strive.” It opposes the expectation in post-feminist discourse, that women will make choices about their bodies and exert them, while also opposing the pronatalist rhetoric, and the temporal linear discourse positing that women should “move forward” toward motherhood along with the ticking of the “biological clock.” Whereas some women sought to resolve their indecisiveness, other women found that the indecisiveness leaves all options open in a manner that expands their boundaries of autonomy in a society that seeks to limit it.
... We used a purposive sampling method (Grossoehme, 2014) to enroll adult women with non-specific CLBP treated at the Independencia Community Rehabilitation Center, located in the northern zone of the Metropolitan Region of Santiago. A typical case sampling technique was used to select archetypical or 'average' participants (Moser and Korstjens, 2018); in other words, women with non-specific CLBP treated in the public health system, whose were adult and elderly, low-middle schooled and low-middle income (Meucci et al., 2015;Gobierno de Chile and Fondo Nacional de Salud, 2020). ...
Background Women's pain is still poorly understood. Moreover, maladaptive pain beliefs contribute to the disability associated with low back pain and play a key role in the transition from acute to chronic symptoms. Objectives To explore the beliefs of women with non-specific chronic low back pain in terms of nature of symptoms, fears associated with pain, expectations for recovery, family, social and work-related limitations, and perceived self-efficacy. Design and methods A qualitative study with an interpretative approach was undertaken. Face-to-face, semi-structured individual interviews were performed. Study participants were 10 women with non-specific chronic low back pain living in the Metropolitan Region of Chile. Thematic analysis was used to analyze the data. A deductive process was used to code the text and categorize the data. Results Participants described maladaptive beliefs about pain, leading to fearful attitudes and low expectations for recovery. These beliefs seemed to perpetuate pain and limit engagement in daily tasks and meaningful activities. Some of these beliefs were associated with information provided by healthcare professions. Despite having maladaptive beliefs, women perceived themselves as self-effective. Conclusion Women with chronic low back pain described a range of different pain beliefs across a complex categorial structure. The contents of such structure may interfere with their decisions about therapeutic options. Their beliefs were often ungrounded in scientific principles, even if the information may have been provided by healthcare providers. Physical therapists would benefit from these findings to improve communication with their patients and assess the role of beliefs in decision-making.
Over 2.2 million individuals are currently incarcerated in prisons and jails across the United States. Having a family member incarcerated impacts the entire family system. Recent research has shown the relational consequences of incarceration, such as adjusting to and negotiating new rules and roles within the coparenting relationship. The coparenting relationship is multifaceted and necessitates empirical evidence that significantly honors the voices that are at the center of experience but typically silenced by the stigma and prejudice nature of incarceration and its coinciding consequences. Coparenting partners of incarcerated individuals were interviewed to understand the lived experience of incarcerated coparenting using a phenomenological approach. Four themes (positive relationship, stigma, seeking and providing support, and impact of incarceration) emerged from eleven interviews. Implications are provided on how to best advocate for this population through research, clinical work, and policy.
Study Objectives The shame reaction is a highly negative emotional reaction shown to have long-term deleterious effects on the mental health of clinicians. Prior studies have focused on in-hospital personnel, but very little is known about what drives shame reactions in emergency medical services (EMS), a field with very high rates of post-traumatic stress disorder, burnout, anxiety, and depression. The objective of this study was to describe emotions, processes, and resilience associated with self-identified adverse events in the work of prehospital clinicians.Methods We conducted a qualitative study using a modified critical incident technique. Participants were recruited from two EMS agencies in North Carolina: one urban and one rural. They provided an open-ended, written reflection in which they were asked to self-identify particular events in their EMS careers that felt emotionally difficult. In-person or video in-depth interviews about these events were then conducted in a semi-structured fashion using an iterative interview guide. The codebook was developed through a mix of inductive and deductive analysis strategies and discussed within the research team and a content expert for validation. Interviews were transcribed and data were analyzed following a thematic content analysis approach for types of cases identified as emotionally difficult, common emotional responses and coping mechanisms, and the lingering effects of these experiences on study subjects.ResultsEight interviews were conducted with EMS personnel: five from an urban agency and three from a rural agency. Participants commonly identified complex medical cases as being emotionally difficult, which led to the most robust shame reactions. Shame reactions were more common when EMS clinicians committed self-perceived errors in patient care, whereas guilt reactions were more common when patient outcomes seemed "inevitable" despite any intervention. Common themes related to coping mechanisms included both personal mechanisms, which tended to be less successful compared to interpersonal mechanisms, particularly when emotions were shared with colleagues. This reflected a perceived culture change within EMS in which sharing emotions with colleagues was seen as a departure from the "old school" where emotions tended to be kept to oneself. Feelings of inadequacy, low self-worth, and being "not good enough" were frequently identified as lingering emotions after difficult cases that were hard to move on from, corresponding to longstanding shame in these clinicians. Recovery and resilience varied but tended to be positively associated with a culture in which sharing with colleagues was encouraged, along with personal introspection on root causes for the sentinel event.ConclusionEMS clinicians often identify complex patient cases as those leading to emotions such as shame and guilt, with shame reactions being more common when a perceived error was committed. Coping mechanisms were varied, but individuals often relied on their co-workers in a sharing environment to adequately process their negative feelings, which was seen as a departure from past practices in EMS personnel. Our hope is that future studies will be able to use these findings to identify targets for intervention on negative mental health outcomes in EMS personnel.
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É um manual de metodologias de investigação que vai desde as metodologias qualitativas às quantitativas
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The government-mandated closure of U.S. restaurants for in-restaurant dining during the early stages of the COVID-19 crisis cast a spotlight on operators’ ability to effectively innovate, and re-imagine their product offerings. In this context, this research draws on the resource-advantage theory of competitive advantage, proposing that (1) an adhocracy culture is a key internal resource that operators can leverage to drive rapid incremental product innovation under forced change, and (2) firm size is a contextual factor that moderates the degree of incremental product innovation-firm performance relationship. Findings from two empirical studies indicate that adhocracy culture positively and indirectly effects firm performance through degree of incremental product innovation, and that this effect is moderated by firm size. Larger firms yield superior performance effects due to access to a network of interconnected resources for rapid innovation diffusion in a crisis.
Dependability (also known as consistency) is one of four criteria in rigor and trustworthiness in qualitative research. In this article, the process of establishing consistency is discussed through the lenses of constructivism and interpretivism, as the observed social reality is viewed as epistemologically counter-intuitive. Two strategies were used to establish consistency. First, method, source, and data triangulation were conducted concurrently to overcome differences in data collection methods from two qualitative intrinsic case studies. Second, code and meaning saturation were used in ATLAS.ti to identify similar meanings and interpretations despite different data collection methods. The findings showed that consistency can still be achieved, and similar meanings and interpretations can be established despite different data collection methods.
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A learning health system enables patients, clinicians, and researchers to work together to choose care based on the best evidence, drive discovery as a natural outgrowth of patient care, and ensure innovation, quality, safety, and value in health care; all in a more real-time fashion. Our paper describes how goal-directed design (GDD) methods were employed to understand the context and goals of potential participants in such a system as part of a design process to translate the concept of a learning health system into a prototype collaborative chronic care network (C3N), specifically for pediatric inflammatory bowel disease. Thirty-six one-on-one in-depth interviews and observations were conducted with patients (10/36, 28%), caregivers (10/36, 28%), physicians/researchers (10/36, 28%), and nurses (6/36, 17%) from a pediatric gastroenterology center participating in the ImproveCareNow network. GDD methods were used to determine the context and goals of participants. These same methods were used in conjunction with idealized design process techniques to help determine characteristics of a learning health system for this pediatric health care ecology. Research was conducted in a clinic and, in the case of some patients and caregivers, at home. Thematic analysis revealed 3 parent-child dyad personas (ie, representations of interviewees' behavior patterns, goals, skills, attitudes, and contextual information) that represented adaptation to a chronic illness over time. These were used as part of a design process to generate scenarios (potential interactions between personas and the learning health system under design) from which system requirements were derived. These scenarios in turn helped guide generation, prioritization, design, measurement, and implementation of approximately 100 prototype interventions consistent with the aim of C3N becoming a learning health network. GDD methods help ensure human goals and contexts inform the design of a network of health care interventions which reflect the shape and purpose of a C3N in pediatric chronic illness care. Developing online and in-person interventions according to well-documented context and motivations of participants increases the likelihood that a C3N will enable all participants to act in ways that achieve their goals with grace and dignity. GDD methods complemented quality-improvement methods to generate prototypes consistent with clinical and research aims, as well as the goals of patient disease management.
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Chronic illness is a significant stressor; the majority of Americans cope utilizing spirituality. Numerous studies demonstrate links between spiritual coping and health outcomes. The purpose of this study was to determine whether persons diagnosed with cystic fibrosis (CF) as adults use spirituality to cope and influence disease management. Semi-structured interviews were completed and analyzed using grounded theory. Data saturation was reached following twelve interviews (83% female); representing 100% participation of those approached and 48% of eligible adults. Persons with late-life CF diagnoses used spirituality to make meaning, understanding themselves in a collaborative partnership with their pulmonologist and God. Supporting themes were: (a) God's intervention depended on treatment adherence and (b) spiritual meaning was constructed through positively reframing their experience. The constructed meaning differed from that of adult parents of children with CF. Late-life diagnosed adults focused on personal responsibility for health. Clinical and research implications for chaplains are presented.
This study links two fields of empirical research. The first field (grounded in empirical theology) is concerned with ordinary prayer and that aspect of implicit religion discernable within explicit religious expressions. The second field (grounded in the psychology of religion) is concerned with private prayer as a significant method of coping in health-related contexts. Few previous studies, however, have focussed on the specific components comprising the content of such prayers and their concern for health issues relating to others, such as family and friends. The present study addresses this gap by employing the analytical framework for health and well-being devised previously in a content analysis of 583 prayers left in the chapel of a children's hospital in England. The conceptual and practical applications of the new research findings are discussed.
This article presents the case study of spiritual care for a patient suffering from Parkinson's disease who was referred to the chaplain in an out-patient depression research program. The chaplain's interventions were informed by an application of narrative theory, and the article demonstrates how this theory enabled the chaplain to help a patient develop new coping strategies for dealing with chronic disease. Using narrative theory, the chaplain assisted the patient to develop a new sense of identity as a spiritual, contingent self as the disease eroded his physical self and former life. The article includes a description of a patient's spiritual needs, chaplain interventions, and an outcomes measure of those interventions. The author argues that narrative theory provides chaplains with a language to identify and craft the unique intervention that spiritual care has in the life trajectory of this Parkinson's patient and other patients dealing with chronic illnesses.
A limited number of studies address parental faith and its relationship to their children's health. Using cystic fibrosis as a disease exemplar in which religion/spirituality have been shown to play a role and parental health behaviors (adherence to their child's daily recommended home treatments) are important, this study explored whether parents with different levels of adherence would describe use of faith differently. Twenty-five interviews were completed and analyzed using grounded theory methodology. Some parents described no relationship between faith and treatment adherence. However, of those who did, higher-adherence parents believed God empowered them to care for their child and they used prayer to change themselves, while lower-adherence parents described trusting God to care for their child and used prayer to change God. Clinical implications for chaplains' differential engagement with parents are presented.