Qualitative Research Critical Analysis Paper: The Lived Experience of Healthy Behaviors in People with Debilitating Illness

Qualitative Research Critical Analysis Paper:The Lived Experience of Healthy Behaviors in People with Debilitating Illness

The purpose of this paper is to summarize the study “The lived experience of health behaviors in people with debilitating illness” (Haynes & Watt, 2008). Within this summary it will critique and describe the qualitative methodology used in the study, the appropriateness and relevance of the design for the study purpose, the study purpose, the target population, the study participants, and the setting the study participants are in. This paper will critique and describe ethical issues mentioned in the study and ethical issues not mentioned in the study, but are of importance to the study population. It will also critique and describe the data quality methods used, the research findings, the limitations as they relate to the study purpose, the implications for nursing practice, and conclude with a brief summary.

The selection of this research article was because of the interest in understanding how individuals with incapacitating illnesses can continue with living a health centred lifestyle. Thoroughly analyzing the selected research via a critical lens, as well as reflecting on professional practice, assists the healthcare professional in applying holistic, client-centered care.
Method

The study, “The lived experience of health behaviors in people with debilitating illness” (Haynes & Watt, 2008), uses phenomenology as its qualitative research tradition. Phenomenology “is a qualitative research tradition, with roots in philosophy and psychology, that focuses on the lived experience of humans” (Loiselle, Profetto-McGrath, Polit & Tatano Beck, 2004, p. 508). Phenomenology can be used when there is little known about a phenomena, when there is a need to understand the phenomena in the context of the lived experience for an individual(s), and where it is difficult to measure a given phenomena (Loiselle et al., 2004). In this study, the areas of phenomena are feelings of coping, guilt, courage, and hope (Hayes & Watt, 2008). Evidence supporting that the researchers are using phenomenology is where the study states “a phenomenology research design was utilized to explore the participants’ lived experience dealing with a chronic illness” (Hayes, 2008, p. 45). By the researchers conducting one on one semi-structured interviews with the aim of gaining understanding from an individual’s perspective in relation to their ability to cope with illness that is chronic, they are illustrating methods of phenomenology. The title of the study also makes it clear that it is focused on the lived experience, and therefore pertains to phenomenology. More specifically, it is Descriptive phenomenology using the Van Kaam (1996) method (Loiselle et al., 2004). It falls under this category because the research identifies common themes and uses other researchers to come to consensus on the similar concepts and themes. However, it is unclear whether the additional researcher was an expert in the field. This, as well as other methodology utilized in the study needs to be clarified to ascertain if it is using the Van Kaam (1996) method of descriptive phenomenology (Loiselle et al., 2004).
Purpose

The research purpose was made explicitly known and was easy to identify. The study’s purpose was to “obtain the individual’s psychological, physical, and spiritual view points from an edic (“lived experience”) perspective regarding their quality of life despite having chronic debilitating illness” (Hayes & Watt, 2008, p. 45). After stating the purpose of the study, the researchers focused in on the specific aims, which is considered commendable. Without question, the phenomena being explored are of relevance to nursing as well as other healthcare professionals caring for clients with debilitating illnesses. This is because in nursing as well as other health care professions, understanding the way clients cope with deficits or hardships caused by illnesses is part of the framework that guides practice. Since the study is concerned with the lived experience within the context of a group of individuals, it is then logical to conclude that the purpose of the study is consistent with the naturalistic paradigm and the qualitative research tradition of phenomenology.
Literature Review

The literature review is a solid source for indentifying gaps in knowledge and reasons for current research under two major concepts. The two major concepts are Spirituality and Chronic Illness and Focus/Adaptation. It was made clear that there were several gaps in knowledge that need to be explored, such as assessment tools of personal spirituality, family spirituality and further studies on interventions to improve illness perspectives in clients. Other gaps in knowledge, brought out in the Recommendations for Future Research section, included further studies focused on individuals struggling with their chronic illness, studies focused on enhancing the adaptation process, and studies regarding parenting/caregiver models that impact early brain development. It used relevant up to date research and provided a summary of research from 1979 through 2007, which is commendable. One may question why research as far back as 1979 was utilized. However, because there is a lack of research on the phenomena it is acceptable for it to be included in the literature review.

Sample

The participants were collected through a non-probability sampling process called snowballing, which is where participants are referrals of other participants (Loiselle et al., 2004). In this study, the referrals were also from local healthcare professionals, family and peers. Using the snowballing method in qualitative research is praiseworthy, despite being subjected to the bias of the participants and other members in the sampling network when making referrals for more participants to enter the study. Snowballing is an effective method in qualitative research because it helps the researcher obtain information thick in description pertaining to the area the researchers wish to study. Participants who know what the researchers are looking for are able to help collect others who will be suitable for the study (Loiselle et al., 2004). This method of sampling is cautioned because the sample may not contain what the researchers require. This limitation in snowballing is illustrated by the sample not containing participants that were specific recommendations for the study. Healthcare professionals recommended that the each of the participants were eligible for Social Security disability benefits and none of them had applied for this. After six participants data saturation was accomplished and researchers stopped when a total of eight participants were gathered. Data saturation is a praiseworthy feature of the sampling method as it is the guiding principle for the size of a qualitative research study (Loiselle et al., 2004).

The research population consisted of participants from Western, North and South Carolina, in which all were successful at coping with debilitating illness. Clients with similar levels of impact from the illness on their lives were gathered after a comprehensive review of the participants’ health history and the amount of time having to manage chronic disease. Five participants were females, three were males and ages varied from thirty-nine to eighty years. The study stated the age span and male to female ratio was reflective of the chronic disease general population. However, the data to determine this statement was not provided in the study. Including the data needed to determine if the participants’ age span and the male to female ratio were reflective of the chronic disease population would have been useful. A description of the setting of where the interviews took place was not included and would have been useful as well.

The types of debilitating illnesses in participants varied, education level ranged from diploma to doctorate level, and the duration of chronic disease varied from six months to seventy-four years. This is praiseworthy as it allows analysis of a broad range of characteristics in people with debilitating illnesses, which is the target population of study. Commendably, it was explicitly stated that there was homogeneity of race and religious beliefs. More specifically, participants in the study were White and of Christian belief, which limited the studies’ sample. The research sample contained relevant details of the participants such as aspects of their support systems, debilitating illness, levels of education, employment status and living conditions.
Ethics

There are two goals in the ethical framework specified by the Tri-Council Policy statement (1998). These goals are to uphold respect for human dignity and to come to ethical research goals via ethical means (Loiselle et al., 2004). Although the study did not explicitly state the specific methods by which the study maintained its ethical standards established by the Tri-Council Policy, one can assume the article followed the necessary ethical protocol. This can be assumed because as stated by Hayes & Watt (2008), the study has undergone scrutiny by a local institutional review board and has adhered to the principles of Beneficence, Respect for Human Dignity, and Justice (Loiselle et al., 2004). No evidence conflicting with any of the ethical principles in indicated.

Data Analysis & Quality

Haynes and Watt interviewed participants in a manner that is acceptable for a study of phenomenology using the Van Kaam (1966) method. A principal investigator conducted the interview using a semi-structured interview questionnaire for guidance during the interviews. This method is best used in this style of research because it enables the researchers to gain as much information, rich in description, as possible. It also allows flexibility for the researcher to probe into the participants’ minds to gain better understanding of their experience (Loiselle et al., 2004).

The study did not elaborate in great detail on methods to maintain data quality, content analysis, and trustworthiness. For instance, the stated methods providing credibility did not include using multiple data sources, and using multiple theories to interpret data. The study also did not state how long the researchers spent collecting data. This makes it difficult to determine the authenticity of the qualitative data collected. In addition, the study did not discuss how bracketing was done prior to the study.

There are praiseworthy methods explicitly stated in the study that the researcher used to maintain credibility and overall trustworthiness. These methods included highlighting significant ideas, using investigator triangulation internally and externally for consensus on themes as well as concepts. Researchers used multiple methods of addressing the research problem such as transcribed taped interviews that included expressions and attitudes. Also, direct quotes from participants were used, the semi-structured interview tool used for the interviews is attached in the appendix, and emergent themes were separated as well as categorized for review. It can be assumed the literature review was done after the common emergent concepts were defined in order to minimize researcher bias although it was not clearly stated. Making this explicit would have been even more beneficial to the study. Another commendable aspect to the study is that it states there is research indicating decreased validity and reliability with respect to coping.

Dependability is questionable as the researchers did not state that they duplicated the study and research to compare the study to is limited. However, with respect to adaptation they compared the findings to other studies and found similar results. In addition, the Recommendations for Future Research section, mentions the need for replication of the study to strengthen its dependability, which is praiseworthy. Conformability was also limited because there was no mention of two or more independent reviews (Loiselle et al., 2004). This would have been helpful to add to the study or the studies recommendation. Limitations in the data analysis previously discussed, limits the study’s degree of auditability.

Findings

The study failed to provide in depth analysis of the findings, and how emergent concepts and themes were managed. Even though it is likely that the researchers followed a method of content analysis that included tasks such as gathering narrative notes, constantly comparing data, and coding data, it is not discussed in the study. This would have enhance the study and been useful to the reader.

The study provided useful insightful as to how the participants coped and dealt with debilitating illness. The findings were able to highlight five common themes for the participants. The themes identified were spiritual and family support are the key mechanisms to successful coping, illness is not the focal point of the participants, participants are committed to living life successfully, and comparatively for the participants things could be worse. The remaining theme was that the participant’s personality make-up and role models are the key factors in being successful. The two key concepts that emerged were spirituality and focus/adaptation. Along with describing common themes, the researchers also identified areas of disagreement. Areas of disagreement included the decision to get rid of the illness if they could and the degree to which participants felt they controlled and dealt with their illness in their lives

As a result of the studies homogeneity, the findings may only be applicable to other situations in populations within the race and religion included in the study. Because of the studies homogeneity and lack of evidence supporting transferability it is logical to say that transferability is limited. Duplication of research and/or comparison of findings to other research is needed in order to increase the studies degree of transferability. Providing more information regarding the samples representation of the target population, more detail regarding the methods used to analyze data, and more information related to the trustworthiness of the study is recommended. A discussion of how bracketing was done prior to the study would have helped to convince the reader that researcher bias was minimized (Loiselle et al., 2004). Graphs or visual presentations of information are also recommended. For example, the use of a pie graph could have been used to illustrate the make-up of the target population and help the reader ascertain the representativeness of the sample.

Implications

The researchers in the study offered excellent insight into future use of spirituality, understanding what individuals focus on with respect to debilitating illness, and understanding how individuals adapt to shape health care in traditional Western medicine. Specific recommendations in nursing practice included addressing spirituality, the importance of holism, empowering the patient as a focus, and promotion of the individual’s support system. Other implications for nursing practice suggested but not included in the study are having individuals connect with other individuals in a group therapy setting incorporating spirituality, holism, empowerment and support systems. As another implication for nursing practice, nurses can conduct research examining how individuals in a group setting that focused on spirituality, holism, empowerment and support systems respond to group therapy of this nature. Results from this study should then be tested in practice with the goal of improving group therapy.

Summary

After critiquing the study, “The lived experience of health behaviors in people with debilitating illness” (Haynes & Watt, 2008), one can say that it provided excellent insight into how participants in the study coped with having a debilitating illness. The researchers could have elaborated more on the sample, the data analysis, and trustworthiness of the study. Overall the study was well written and offered good insight into knowledge gaps. The study not only offers good recommendations for implications in nursing practice, it can also be utilized by other healthcare professionals dealing with clients who have debilitating illnesses. Healthcare professionals can use this study as insight into an evolving healthcare system as it examines holistic approaches to healthcare.

References

Haynes, D., Watt, P. (2008). The lived experience of healthy behaviors in people with debilitating illness. Holistic Nursing Practice, 22(1), 44-53.

Loiselle, C.G., Profetto-McGrath, J. Polit, P.D., & Tatano Beck C. (2004). Canadian Essentials of Nursing Research (2nd ed). Philadelphia: Lippincott Williams & Wilkins.