Critiquing a Qualitative Study

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Chen, K.-H., Chen, M.-L., Lee, S., Cho, H.-Y. & Weng, L. -C. (2008). Selfmanagement behaviors for patients with chronic obstructive pulmonary disease: A qualitative study. Journal of Advanced Nursing, 64(6), 595-604. doi 10.1111/j.1365-2648.2008.04821.x Introduction This was a study carried out to investigate the self-management habits of people suffering from chronic pulmonary disease. The study was informed by the knowledge that this disease is associated with higher levels of mortality and morbidity worldwide.

Considering the increased risk factors such as smoking and the higher life expectancy, the prevalence and incidence of chronic obstructive pulmonary disease is anticipated to increase. The researchers, therefore, wanted to establish a patient-based approach in managing the disease.

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They would then propose appropriate disease management plans in order to improve the quality of life for the affected individuals. The researchers are respectable members of academia from various universities and others are practitioners in the health care field. The study was carried out on a sample of 18 patients who were admitted or were attending a medical facility in Taiwan. The researchers reported that the participants practiced various disease management habits aimed at enhancing health (Chen et al, 2008).

Research tradition In studying the self-management patterns of patients with chronic obstructive pulmonary disease, the researchers used a grounded research theory tradition. They used inductive analysis to identify the self management behaviors of the participants when they experience bouts. The researchers conducted the study with a presumption of knowing little about the disease management behaviors in patients with chronic obstructive pulmonary disease. In this case, participants identified as having the condition for more than a year were selected, and then through semistructured face-toface interviews, the researchers collected data that they used to form linkages. The interviews were in-depth, taking approximately 30-70 minutes (Chen et al. 2008).

Research question and congruency with grounded research theory The researchers investigated the various self-management behaviors until the data obtained reached saturation, and thus no more new ideas were forwarded by the participants. Significant contributions were identified and coded based on their similarities and variations. Subsequently, diagrams were created to show the relationships between the codes before the codes were grouped based on self-

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management habits (Chen et al. 2008). The researchers were able to perform theoretical sampling by carrying out data collection and analysis simultaneously. This helped in building their concepts towards identifying the self-management behaviors.

The researchers broke down the data into smaller fragments while labeling the data for easy comparisons in order to analyze the data collected. This enhanced comprehensibility of the data and the ability to explain the variations.

The researchers performed data reduction and this was necessary for coding it manually. After coding the data, the researchers went through the interview transcripts to gain more insight so that they would avoid making assumptions. The next step was data display whereby the researchers used diagrammatic representations to show the relationships existing thereby. Drawing diagrams reflected the level of stimulation and abstract thinking which is necessary to arrive at abstract concepts. The codes were integrated and linked to each other to form abstract ideas. In accordance to grounded theory, theoretical sampling based on coding, comparisons and diagrammatic representations were performed. This strategy was critical in formulating the concepts regarding self management behaviors. In depth analysis was necessary in realizing the gaps existing in the data set hence helped the researchers to fill the gaps existing and stratify the emerging concepts.

The study population of 18 participants was appropriate in achieving data saturation; hence it could be assumed that further sampling could not have yielded any new information. However, being a descriptive study that targeted one medical facility, it is possible that researchers did not achieve data saturation. The researchers may, however, not have rationalized fully on the grounded theory because by conducting a

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literature review before collecting data, the concepts underlying the data may have been blurred. This may affect the validity of the theory derived later on in the course of the study (Ryan, Coughlan & Cronin, 2007).

Research question To identify the self-management behaviors for patients with chronic obstructive disease, the researchers started with open questions that focused on understanding the way these patients cope with the disease. The open questions gave the patients more independence to express themselves, hence the researchers were unlikely to obstruct or influence patient responses. This is because the researchers may have been perceived to be having little knowledge about the disease (Polit & Beck, 2008). Having obtained general data, specific questions helped in generating the core themes regarding disease management.

Research design and the Grounded Theory Study The researchers used “a qualitative, descriptive design, involving in-depth interviews to collect data” (Chen et al 2008, p. 597). This design was congruent with the grounded theory study which is more inductive, and the researchers need to determine when saturation is achieved to be able to advance a substantive theory (Polit & Beck, 2008).

Sampling design The researchers used purposeful sampling to recruit their participants, whereby participants identified as having chronic obstructive pulmonary disease for more than one year were selected for the study. This population enhanced the richness of the data collected (Ryan, Coughlan & Cronin, 2007). The sample population was 18 elderly

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patients drawn from various settings in a medical facility, in Taiwan. The participants had varying severity of the disease, with “three participants having mild stage, five in the moderate stage, and eight in the severe stage and one on the very severe stage” (Chen et al. 2008, p.597).

Data collection and Analysis Data was collected by the administration of semi-structured, face-to-face interviews. Tapes were also used in capturing the data, and they were “transcribed by a research assistant and checked by the first author” (Chen et al. 2008). This data collection method was appropriate with the grounded theory approach. The interviews were comprehensive, lasting 30-70 minutes. Data collection ran simultaneously with data collection, and it involved data reduction, “data display and conclusion drawing” (Chen et al 2008, p. 598). As the researchers were the one involved in interviewing the participants, the role of the researcher was solicit information from the participants by encouraging them to open up. It was also the role of the researcher to ensure that the participants were comfortable during the interview (Ryan, Coughlan & Cronin, 2007).

Quality and integrity of the study The research was approved by the regulatory body, while the interviewer sought permission before interviewing the participants. The participants were also informed on the intent of the study hence the research had ethical rigor (Ryan, Coughlan & Cronin, 2007). To ensure trustworthiness of the data, the researchers adhered to defined standards of “consistency, prolonged engagement, peer debriefing, dependability and confirmability” (Chen et al 2008, p. 598). Consistency was achieved by reviewing of the interviews by two researchers while prolonged exposure was by re-interviewing the

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participants deemed to have significant suggestions. Participants confirmed the research findings, hence validating the interpretations.

Summary The research established that self-management practices were based on behaviors that had helped the patients maintain stable health. These practices were classified into five themes, including, “symptom management, activity and exercise implementation, environmental control, emotional adaptation and maintain a healthy lifestyle” (Chen et al 2008, p. 598).

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References Chen, K.-H., Chen, M.-L., Lee, S., Cho, H.-Y. & Weng, L.-C. (2008). Self-management behaviors for patients with chronic obstructive pulmonary disease: A qualitative study. Journal of Advanced Nursing, 64(6), 595-604.

Polit, D., & Beck, C.T. (2008). Nursing research generating and assessing evidence for nursing practice, 8th edition. New York, NY: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Ryan, F., Coughlan, M., & Cronin, P. (2007). Step-by-step guide to critiquing research.

Part 2: Qualitative research. British Journal of Nursing, 16(12), 738-744.