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INVITEDREVIEWQualitativeresearchinnutritionanddietetics:gettingstartedJ.A.Swift*&V.Tischler*DivisionofNutritionalSciences,SchoolofBiosciences,TheUniversityofNottingham,SuttonBoningtonCampus,Loughborough,Leicestershire,UKDivisionofPsychiatry,SchoolofCommunityHealthSciences,TheUniversityofNottingham,Queen’sMedicalCentre,Nottingham,UKIntroductionDespiteclaimsofaqualitativerevolutioninsomedisci-plines(Denzin&Lincoln,2005),healthresearch,includ-ingresearchinnutritionanddietetics,continuestobedominatedbyquantitativeapproaches(Fade,2003;Broom&Willis,2007).Clearlymoreneedstobedonetoengagehealthresearcherssuchasdietitiansandnutrition-istswithqualitativeresearch.Althoughtherearemanyexcellenttextsanddedicatedjournalsavailable,thosenewtothistypeofresearchcanÞndtheliteratureandqualita-tiveterminologyimpenetrable.ThisreviewistheÞrstinaseriesthatseekstodemystifyqualitativeresearchforthosewhofeelmorecomfortablewithconductingandevaluat-ingquantitativeresearch,orareinexperiencedinusingqualitativeapproaches.Inaddition,qualitativeresearch,onthewhole,isnotproducedbypassivelyfollowingpredeÞnedÔrecipesÕ.Itcanbemoreaptlyconsideredasanadventure;exciting,challengingandalittleunsettling(Willig,2008).Thisserieswillnotthereforeprovideanexhaustivehow-toguidetoconductingorevaluatingqualitativeresearch.Instead,itaimstoempowerthosedietitiansandnutritionistswhowishtodelvedeeper.ThepresentreviewaimstodiscusswhatqualitativeresearchhastooffertheÞeldofnutritionanddietetics.Furthermore,ittakesadetailedlookatwhatismeantbythetermÔqualitativeresearchÕ,andoffersadviceonhowtodevelopaqualitativeresearchstrategyfromaresearchquestionrelatingtonutritionanddietetics.Overall,thisreviewpresentsamodelforembarkingonqualitativeresearchinthisarea.Otherreviewsinthisserieswillprovideanoverviewoftheprincipaltechniquesofdatacollectionandsamplingthatmaybeusedforqualitativeresearchinnutritionanddietetics(Draper&Swift,2010),describeanumberoftechniquesandpracticalstepsthatcanbetakentoprovidesomestructureandfocustotheintellectualworkofqualitativeanalysis(Fade&Swift,2010),andintroducesomeofthekeyscientiÞcdebatesKeywordsdietetics,epistemology,food,methodology,mixedmethods,nutrition,ontology,qualitativeresearch,theoreticalgeneralisability.CorrespondenceDrJ.A.Swift,DivisionofNutritionalSciences,SchoolofBiosciences,TheUniversityofNottingham,SuttonBoningtonCampus,Loughborough,LeicestershireLE125RD,UK.Tel.:+44(0)1159516178Fax:+44(0)1159516122E-mail:judy.swift@nottingham.ac.ukdoi:10.1111/j.1365-277X.2010.01116.xAbstractQualitativeresearchiswellplacedtoanswercomplexquestionsaboutfood-relatedbehaviourbecauseitinvestigateshowandwhyindividualsactincertainways.TheÞeldofqualitativehealthresearchisundoubtedlygainingmomen-tumand,increasingly,thereisarecognitionthatitshouldbeavitalpartofthedecision-makingprocessesthatdirectthedevelopmentofhealthpolicyandpractice.Muchoftheguidanceavailable,however,isdifÞculttonavigateforthosenewtoÔqualitativeresearchÕ,andthereislittlediscussionofqualitativeresearchissuesspeciÞcallyinrelationtonutritionanddietetics.Thisreview,theÞrstinaseries,outlinestheÞeldofqualitativeenquiry,itspotentialuseful-nessinnutritionanddietetics,andhowtoembarkuponthistypeofresearch.Furthermore,itdescribesaprocesstoguidehigh-qualityqualitativeresearchinthisareathatproceedsfromtheresearchquestion(s)andconsidersthekeyphilosophicalassumptionsaboutontology,epistemologyandmethodologythatunderpintheoveralldesignofastudy.Otherreviewsinthisseriesprovideanoverviewoftheprincipaltechniquesofdatacollectionandsampling,dataanal-ysis,andqualityassessmentofqualitativework,andprovidesomepracticaladvicerelevanttonutritionanddietetics,alongwithglossariesofkeyterms.JournalofHumanNutritionandDieteticsª2010TheAuthors.Journalcompilationª2010TheBritishDieteticAssociationLtd.2010JHumNutrDiet,23,pp.559–566559
aroundqualitycriteriathatcanbeappliedtoqualitativeresearch(Pilnick&Swift,2010).Inaddition,allreviewsintheseriesprovidesomepracticaladviceforthosewish-ingtoengagewithqualitativeresearchinnutritionanddieteticsandaglossaryofkeyterms.Whatdoesqualitativeresearchhavetooffernutritionanddietetics?ÔFood[is]acomplexentity,repletewithcontradic-tionsandoppositions,fullofconfusionsandapotentialsourceofanxiety,particularlyinrelationtohealthÕ(Chamberlain,2004:468)Perhapsthemostbasicapproachtothestudyoffoodistoconsideritsimplyasasourceofenergyandnutrients:afuelforliving.However,asChamberlaineloquentlypointsout,thisapproachisverylimiting;fooddoesmorethanfulÞlabiologicalneed(Chamberlain,2004).Foodcanbeasourceofgreatpleasure,although,formany,itcanalsocauseguiltandanxiety(Coveney,2006).Foodcanbeusedtohelpcopewithstressfulsituationsandnegativeemo-tionalstates(Conner&Armitage,2002).Foodalsoplaysavitalroleinhowhumanscommunicatewithintheirsocialworld.FoodmightbeusedtoestablishafÞliationtopartic-ulargroupsandengenderpeeracceptance,toexpresslove,sociabilityandhospitality,todemonstratecivilisationandself-control,andtoexpresspowerwithinrelationshipsandsocialstatus(Fieldhouse,1996;Ogden,2003;Coveney,2006).Toborrowtermsfromsociologyandpsychology,itcouldbesaidthatfoodisÔ…constructed,negotiated,socializedandcontex-tualisedÕ(Chamberlain,2004:468)Dietitiansworkattheheartofthiscomplexity.Theyarerequiredtobridgethegapbetweenlogical,unambigu-ousscientiÞcdataandthecomplicated,multiplefunc-tionsthatfoodhasintheirclientsÕlives.Forexamplewhenworkingwithaclientwithobesity,adietitianwillnotsimplyadvisetheclienttocreateastateofnegativeenergybalancebyreducingtheamountofcaloriestheyconsume,andbyincreasinghis/herphysicalactivitylev-els.TheymightalsodealwithhowtheclientcouldachieveweightlossatthesametimeascontinuingtodineoutwithfriendsorhowtodealwithstressfulsituationswithoutÔcomfortÕeating.Qualitativeresearchisparticularlyrelevantforhealthresearchthatinvestigateshumanbehaviourandrelation-ships,asdescribedabove,becauseitinvestigateshowandwhypeoplebehaveincertainways.Muchoftheworkcon-ductedindieteticsandnutritionhealthpromotionisaimedatchangingpeopleÕseatingbehaviourtoimprovetheirhealth.Qualitativeresearchthatinvestigateshowandwhypeopleeatincertainwaysthereforeappearsideallyplacedtosupportthiswork.Theresearchquestionsamenabletoqualitativeresearcharenumerousanddiverse.ExamplesincludeÔWhydosomeclientswithrenaldiseasefailtoadheretoalow-potassiumdiet?ÕorÔHowdomothersonlowincomesfeelaboutbuyingeconomy-brandfood?ÕItisalsoimportanttorecognisethatqualitativeresearchinnutritionanddieteticsisnotonlylimitedtoeatingbehav-iour.Equally,itcanbeusedtoinvestigatehowandwhyhealthcareprofessionalsbehaveinparticularwaysinprac-tice;forexample,ÔHowdodietitiansdealwithaggressiveclientsduringconsultations?ÕorÔWhydonursesfailtofeedin-patientswhoareunabletofeedthemselves?ÕFurther-more,thereareapplicationsineducationandtrainingsuchasÔWhatarethetrainingneedsofcommunityfoodworkersemployedinChildrenÕsCentres?ÕorÔHowdoexperienceddietitiansmentorandsupportnewly-qualiÞedstaff?ÕAttheheartofquestionsabouttheusefulnessofresearchevidenceistheissueofgeneralisability(Morse,2008).Thetypeofevidenceproducedbymostqualitativeresearch(describedinmoredetailbelow)isnotempiri-callygeneralisable(i.e.theÞndingscannotbeusedtoinferaboutthecharacteristicsofawiderpopulation)(Mason,2002).Thissituationmayhaveleadsometoquestiontheroleofqualitativeresearchinevidence-basedpractice.Qualitativeresearchevidencecan,however,betheoreti-callygeneralisable(i.e.theÞndingscanbeusedtodevelopconcepts,understandphenomenaandtheoreticalproposi-tionsthatarerelevanttoothersettingsandothergroupsofindividuals)(Draper,2004;Yardley,2008).Althoughhealthresearchcontinuestobedominatedbyquantitativeapproaches(Broom&Willis,2007),theÞeldofqualitativehealthresearchisundoubtedlygainingmomentum.TheNationalInstituteforHealthResearchÕsCentreforReviewsandDissemination(CRD)hasrecentlydedicatedawholechapteroftheirguidanceonundertak-ingsystematicreviewsinhealthcare,totheroleofquali-tativeevidence(CentreforReviewsandDissemination,2009).TheCRDÕspositionisthatqualitativeresearchhelpstoensurethatreviewsofquantitativeevidenceareofmaximumvalueinthedecision-makingprocessesthatguidethedevelopmentofhealthpolicyandpracticeby:lshapingquestionsofimportancetoendusers,linvestigatingthemechanismsbehind(in)effectiveness,lexplainingheterogeneousresults,lidentifyingfactorsthatimpactonimplementationofinterventions,ldescribingtheexperiencesofpeoplereceivingtheintervention,ldetailingparticipantsÕsubjectiveevaluationsofout-comes(CentreforReviewsandDissemination,2009).GettingstartedinqualitativeresearchJ.A.SwiftandV.Tischlerª2010TheAuthors.Journalcompilationª2010560TheBritishDieteticAssociationLtd.2010JHumNutrDiet,23,pp.559–566
Thisisquiteadeparturefromthetraditionalviewthattheonlyusefulevidenceregardingeffectivenesscomesfromrandomisedcontrolledtrials(Victoraetal.,2004)andqualitativeresearchbeingconsignedtothelowestlevelofevidencehierarchies,alongsideconsensusandopinion(Grypdonck,2006).IntheÞeldofnutritionanddietetics,theFoodStan-dardsAgencyhasalsodemonstratedtheircommitmenttoqualitativeresearchbycommissioninganumberofquali-tativeprojectsthatinvestigate,forexample,peopleÕsuseoffoodlabellinginformation(FoodStandardsAgency,2010a)andpublicunderstandingofsodiumandsaltlabelling(FoodStandardsAgency,2010b).Whatisqualitativeresearch?Aspreviouslystated,qualitativeresearchinvestigateshowandwhypeoplebehaveincertainways.Althoughthisisausefulpositiontostartfrom,itobscuresthediversityofthisarea.Qualitativeresearchmightbebestviewedasanumbrellaterm;itencompassesavastrangeofapproachesandtechniques,manyofwhichhavedevelopedfromdiffer-entdisciplines,suchasanthropology,philosophy,sociologyandpsychology(Giles,2002;Denzin&Lincoln,2005).Inaddition,thescopeofqualitativeresearchiscontinuallyevolving(Lincoln&Denzin,2005);forexample,therecentdevelopmentofQmethodology(e.g.vanExel&deGraaf,2005).Assuch,thereisnosingle,universallyaccepted,pre-cisedeÞnitionofqualitativeresearch(Flick,2007).Tobegintounderstandwhatqualitativeresearchis,itisimportanttoÞrstconsiderthephilosophicalassump-tionsthatunderpinit.Thismayappeartobeanunneces-sarydiversion(afterall,researchersarepracticalanimals,theydoresearch)butanawarenessoftheseassumptionswillensurethatchoicesaboutmethodsofdatacollectionandanalysiscanbefullyjustiÞedandanswerthestudyÕsresearchquestion(s)(Carter&Little,2007).Ultimately,failuretounderstandtheseassumptionsmayresultinpoorqualityresearch(Yardley,2006).Creswell(1998)suggeststhattherearethreemainassumptionsthatunderpinqualitativeresearchrelatingto:(i)ontology;(ii)epistemology;and(iii)methodology.Heproposesthat,broadlyspeaking,qualitativeresearchtendsto:(i)havearelativistontology;(ii)belocatedinaepistemologythatembracessubjectivity;and(iii)favourresearchdesignsbasedoninductivereasoning(Creswell,1998).Becausethesephilosophicalassumptionsmaybeunfamiliartoreaders,adetaileddescriptionisofferedbelow.Ontology:whatistheretoknow?OntologyrelatestoapersonÕsunderstandingofthenat-ureoftheworld.TypicalresponsestothequestionÔwhyengageinresearch?Õmightbe;tosearchforknowledge,toestablishfacts,tosystematicallyinvestigatewhetherpartic-ularideasabouttheworldaretrueorfalse.Alloftheseresponsesassumethatthereisasingle,stablerealityÔoutthereÕwaitingtobeunderstoodandthatitcanbeunder-stoodifitissubjecttorigorousinvestigations.Research-erswhosubscribetoasingle,stablerealitycanbedescribedashavingarealistontologicalposition(Willig,2008).Bycontrast,arelativistontologydoesnotrelyontherebeingasingle,stablerealityÔoutthereÕwaitingtobedis-coveredbutconsidersrealitytobesociallyconstructed.ThismeansthathowtheworldisperceivedandapersonÕsthoughtsaboutitarealwaysinßuencedbysocialfactorssuchasculture,historyandlanguage(Willig,2008).Nomatterhowcontrolledresearchtechniquesare,therewillalwaysbebiasbecausetheyareconductedandinterpretedbyhumanbeings,andhumanbeingsareincapableofbeingcompletelyobjective.Researchersinevitablyhavearelationshipwiththesubjecttheyarestudying;theychoosetheresearchquestions,decidewhattomeasure,howtomeasure,whentomeasure,howtointerpretandhowtocommunicateÞndings.Imaginea100-mLßaskcontaining50mLofwaterÐtheßaskcouldequallybedescribedashalffullorhalfempty.Qualitativeresearcherstendtobereßexive(i.e.explicitabouttheirroleanditsimpactupontheresearchthattheyundertake).Researcherswhocon-siderrealitytobesociallyconstructedcanbedescribedashavingarelativistontologicalposition.Epistemology:howcanpeopleknow?Justasitispossibletohavedifferentideasaboutwhatthereistoknow(i.e.differentontologicalpositions),therearealsodifferentideasabouthowknowledgecanbeproduced(i.e.differentepistemicpositions).Epistemol-ogyreferstoabranchofphilosophyconcernedwiththetheoryofknowledge.Asdescribedabove,animportantcharacteristicofasociallyconstructedrealityistherecog-nitionthatresearchersinevitablyhavearelationshipwiththesubjecttheyarestudyingthatmakesobjectivemea-surementsimpossible.Aresearcherwitharelativistonto-logicalpositionmightthereforeholdanepistemicpositioninwhichhe/shedoesnotattempttoproduceobjectiveÞndingsbutinsteadembracessubjectivity(Ezzy,2001).SoratherthanattemptingtoÞlteroutandcontrolsourcesofbias,suchasthegenderandprofessionalback-groundoftheresearcher,thesewouldbereßecteduponandwelcomedasaddingvitallyimportantcontext.Thequalitativeresearcherthereforeneedstobereßexive;torecognisehis/herroleintheresearchprocessviacriticalself-scrutiny(Mason,2002;Draper&Swift,2010).Study-ingsocialphenomenainnatural,real-lifesettingsratherJ.A.SwiftandV.TischlerGettingstartedinqualitativeresearchª2010TheAuthors.Journalcompilationª2010TheBritishDieteticAssociationLtd.2010JHumNutrDiet,23,pp.559–566561
thanexperimental,idealsituationshelpsresearchersclaimthattheyarebeingtruetothenatureofthephenomenonunderinvestigation(Bryman,2004).Althoughitaddstotherichnessofthedata,acknowledgingandworkingwithsubjectivitycanleadtoresearchersbeingaccusedofbeingunscientiÞcandanecdotal(Abusabha&Woelfel,2003).Itis,however,stronglyarguedthatthequalityofqualitativeresearchshouldbecritiquedasrigorouslyasanyotherkindofresearch,albeitagainstappropriatecriteria(Seale,1999;Pilnick&Swift,2010).Methodology:howshouldresearchproceed?Knowledgeproductioninhealthresearchhasbeendomi-natedbydeductivereasoning(Broom&Willis,2007)andthetraditionalprocessistoconsultanestablishedtheoryregardingthephenomenaofinterest,inordertodevelopaclearhypothesis.Thishypothesisisthentestedbycol-lectingdatafromwhichconclusionsregardingtheverac-ityofthetheoryareinferred;aprocesscalledhypothetical-deductivismordeductivereasoning.Thecon-clusionsareconsideredtobeundeniableifthedataarederivedusingobjective,unbiasedmethods.Todothis,theresearcherisrequiredtopositionhisorherselfÔout-sideofÕthesubjectmatterandemploysarangeoftech-niquestoensurethatheorshedoesnotinadvertentlyinßuencetheresultsobtained.Techniquesincludetheuseofreliableandvalidmeasurementdevices,standardisedprotocols,anddouble-blindrandomisedcontrolledtrialstudydesigns.However,asnotedabove,notallresearch-ersaimtoproduceobjectiveÞndingsaboutasingle,sta-blereality.Thosewhoconsiderrealitytobesociallyconstructed,andaimtoproducesubjectiveÞndings,favourtheprocessofinductivereasoning.ThisreferstoÞndingsthatarederivedfromthedataitselfandcontrastswithdeductioninwhichresearchhypothesesareusuallyappliedtothedataandthedataareusedtoconÞrmorrejectthehypotheses.InsteadofcollectingdatatotestspeciÞchypotheses,datacollectionandanalysisisguidedbyoneormore,open-endedresearchquestions(Willig,2008).Theimportantdistinctionisthatresearchques-tionsdirectthestudyratherthanpredictwhatmaybefound.Forexample,someresearcherswillaskhowsome-thinghappensandaimtoproducedetaileddescriptionsofparticipantsÕfeelingsandexperiences,whereasotherswillalsoaskwhysomethinghappensandaimtoproduceexplanationsorarguments(Fade&Swift,2010).Althoughattitudesandbehaviourcanalsolegitimatelybeinvestigatedusingquantitativeresearchmethods,suchassurveys,psychometricscalesandstatisticalanalysis,num-bersareunlikelytoproducedatathatprovidedetaileddescriptionsorgenerateexplanations.Qualitativeresearchthereforenormallydealswithwords;indeedqualitativeresearchisoftendeÞnedasÔresearchbeyondnumbersÕ(Greenhalgh&Taylor,1997).Asnotedabove,Creswelldescribesqualitativeresearchastendingtorecognisemultiplerealities(relativistontology),embracesubjectivityandfavourinductivereasoning(Creswell,1998).Qualitativeresearchisthereforeoftenpre-sentedasoppositetoquantitativeresearch(e.g.Abusabha&Woelfel,2003).Althoughthedistinctionbetweenquanti-tativeandqualitativeresearchisaconvenientdeviceforintroductorytexts,ithasbeencriticisedasoverlysimplisticandmisleading(e.g.Green&Thorogood,2004;Rolfe,2006;Holliday,2007).Qualitativeresearcherscanvaryintheirontological,epistemologicalandmethodologicalposi-tions(Willig,2008).Forexample,aresearcherconductingGroundedTheorycantakeeitherarealistapproachinwhichtheyattempttocapturesocialreality,orarelativistapproach,whichviewstheanalysisasasocialconstructionofreality(Willig,2008).QualitativestrategiesofinquiryManyqualitativeresearchersworkwithinaparticularstrategyofinquiry(alsotermedtraditionofinquiryorqualitativemethodology).Strategiesofinquiryvaryintheextenttowhichtheypromotetheuseofparticularresearchmethods(i.e.thetechniquesforcollectingandanalysingdata)butallprovidetheresearcherwithanoverallstrategyforformulating,articulating,analysingandevaluatingtheirmethods(Carter&Little,2007).Workingwithindifferentstrategiesofinquirywillpro-ducedifferentÞndingsbecausetheyactasaÔlensÕbywhicharesearcherdiscoversaparticularaspectofthephenomena(Wu&Volker,2009).ThemostcommonlyusedstrategiesofinquiryinhealthresearchincludePhenomenology,GroundedTheory,DiscourseAnalysis,Ethnography,Ethnomethod-ologyandActionResearch(seeGlossary)(Dew,2007).Thereare,however,manydifferentstrategies,ofwhichtherearemanydifferentvariations(Denzin&Lincoln,2005)and,unfortunately,nosinglecategorisationsystemisdeÞnitive(Madill&Gough,2008).Thisdiversityoffersrangeandßexibilitywhendesigningaresearchproject,althoughmayequallybeoverwhelming(Easterby-Smithetal.,2008),particularlyfornoviceresearchers.Sohowshouldaresearchergoaboutchoosingapartic-ularstrategyofinquiry?Thereareanumberofapproachestotake;forexample,theresearchermightbedrivenbyhis/herdisciplinarybackgroundortheaimofthestudymightbetodevelopatheoryfromthedata(Giles,2008).Acommonapproachistoproceedfromtheresearchquestion(Madill&Gough,2008)andthisßexiblemethodappearstobeparticularlyrelevantforhealthresearch.ItisbeyondthescopeofthepresentGettingstartedinqualitativeresearchJ.A.SwiftandV.Tischlerª2010TheAuthors.Journalcompilationª2010562TheBritishDieteticAssociationLtd.2010JHumNutrDiet,23,pp.559–566
reviewtodescribeallpossiblestrategiesofinquiry;indeed,wholetextsaredevotedtothisenterprise(e.g.Denzin&Lincoln,2005;Stainton-Rogers&Willig,2008).Inaddition,articleshavedetailedthemostcommonstrategiesinqualitativehealthresearch(e.g.Dew,2007),whereasothershavediscussedtheminrelationtohumannutritionanddietetics(e.g.Harrisetal.,2009).Instead,thepresentreviewillustratestheprocessbywhicharesearchermightchooseaparticularstrategyofinquiryandensuresthatthechoicesaboutmethodsofdatacol-lectionandanalysiscanbefullyjustiÞedanddonotclashwiththeassumptionsunderpinningtheoveralldesignofastudy.Thisprocessshouldbeconsideredexplicitlybecauseitimpactsonthequalityoftheresearchpro-duced(Carter&Little,2007;Dew,2007)andqualitativeresearchisoftencriticisedforlackofrigour(Maggs-Rapport,2001).Table1describestheprocessusingahypotheticalresearchquestionrelatedtonutritionanddietetics.Theapproachofproceedingfromtheresearchques-tion,however,requirestheresearchertocriticallyappraisethenumerousstrategiesavailableandchoosetheÔbestÞtÕ(Wu&Volker,2009).Qualitativehealthresearchersarenot,however,alwaysexpertsinqualitativestrategiesofinquiry(Willisetal.,2007;Harrisetal.,2009).Thiscanleadtomethodslurringwherearesearcherclaimstoadheretoaparticularstrategyofbut,inpractice,failstodoso(Holloway,1997).Somestudieshavesuggestedthataseasonedqualitativeresearchershouldbeincludedaspartoftheresearchteam(e.g.Willisetal.,2007;Harrisetal.,2009).Althoughapprenticeshipcanplayanimpor-tantroleinlearningaboutqualitativeresearch(Robson,1993),experiencedqualitativeresearcherscanpassionatelyadvocateparticularapproaches.Concernsaboutqualitymayleadnoviceresearcherstoconformtorecommendedand/orhighlyspeciÞedstrategiesofinquiry(Lambert,2006)withoutfullyappreciatingthephilosophicalassumptionsthatunderpinit.ItisthereforecrucialthatanyoneembarkingonqualitativeresearchÐnoviceandexperiencedresearchersalikeÐthinksindependentlyabouthisorherownviewsanddevelopsanepistemologi-calpositionfromwhichtogroundthemostappropriatestrategyofenquiry.Itisalsoworthconsideringthatsomeresearchersarguethatqualitativeresearchdoesnothavetobeconductedwithinaparticular,highlyspeciÞedstrategyofinquiry(e.g.Avis,2003;Braun&Clarke,2006).ThisisrelevantintheÞeldofhealthresearchwhereresearchersoftencrossdisciplinaryboundariesandwhereresearchisapplied,makingitusefultohavetheßexibilitytoselectfromarangeofappropriateresearchmethods(Braun&Clarke,2006).ThisiscompatiblewithapragmaticTable1Developingaqualitativeresearchstrategyfromaresearchquestion:anexamplefromnutritionanddieteticsResearchquestionThestartingpointistheresearchquestion,whichinthishypotheticalexampleis‘Whatistheexperienceofobeseadolescentswhoaccessadultweightmanagementservices?’OntologicalpositionTheresearcher,inthiscase,aNationalHealthServicedietitian,mightassumearelativistontologicalposition.Thismeansthathe/sheacceptsthattheexperienceofobesityinthispopulationissociallyconstructed(i.e.isinfluencedbyfactorssuchastheindividual’scultureandfamilyhistory).Otherconsiderationswouldbetheconcernsandbackgroundoftheresearcher.Inthiscasethedietitian’sprofessionalpositionandworkcontextwillimpactonhowthedataareapproachedandanalysed(e.g.thedatamaybeanalysedwithaviewtodevelopingnewservicesforthepopulationofinterest)EpistemologicalpositionInkeepingwithhis/herrelativistontologicalposition,theresearchermightholdanepistemicpositioninwhichhe/shedoesnotattempttoproduceobjectivefindingsbut,instead,embracessubjectivity.He/shemayviewsubjectivityasbeingcrucialtothisparticularpieceofresearchbecauseitacknowledgesthatdifferentindividualswillexperiencethe‘same’environmentdifferently.Forexample,oneparticipantmayfindadultservicesintimidatingandtheadvicegivenirrelevant,whereasanotherparticipantmightfindsuchservicesselfaffirmingbecauseitvalidateshis/herburgeoningstatusasanadult.Correspondingly,theresearcherwouldreflectonfactorsthatmightinfluencetheparticipants’experienceandtheimpactoftheresearcher’sownviewsandvalues,asoutlinedaboveMethodologicalpositionBecausetheresearcherconsidersrealitytobesociallyconstructedandaimstoproducesubjectivefindings,he/shefavourstheprocessofinductivereasoning.Ratherthansettingupaseriesofhypotheses,theresearchisguidedbyanopen-endedresearchquestion.Inthisway,theresearcherdoesnotmakeanypredictionsabouttheexperiencesofparticipants,insteadhe/sheusesthedatatogenerateexplanationsQualitativestrategyofinquiryTheresearchquestionfocusesontheexaminationofexperienceitself,whichsuggeststhataphenomenologicalstrategyofinquiryisappropriate.Thephilosophicalbranchofphenomenology(seeHusserl)suggeststhatexperienceisseparatefromrealityandisconcernedwithindividualmeaningsandinterpretations,theso-calledlifeworldofanindividual(Ashworth,2008).AnappropriatequalitativetechniquewouldthereforebeInterpretativePhenomenologicalAnalysis(IPA)(Fade,2004;Smithetal.,2009).IPAisrootedinphenomenology,thatis,itisconcernedwithindividuals’livedexperienceandhowtheymakesenseofthatexperience.Itadoptsadoublehermeneuticposition,whichmeansthatitforegroundsthereflexivepositionoftheresearchermakingsenseoftheparticipant’sexperiencesJ.A.SwiftandV.TischlerGettingstartedinqualitativeresearchª2010TheAuthors.Journalcompilationª2010TheBritishDieteticAssociationLtd.2010JHumNutrDiet,23,pp.559–566563
approach;forexample,thepromotionofqualitativeresearchersasbricoleurs(i.e.multiskilledindividualswhoassemblethetoolsandmaterialsnecessarytogetthejobdone)(Denzin&Lincoln,2005).Flexibilitydoesnot,however,excuseanadhocapproachtotheresearchpro-cess(Mason,2002).Asalways,choicesaboutresearchmethodsmustbeappropriatefortheresearchquestion(s)andmustnotclashwiththeassumptionsunderpinningtheoveralldesignofastudy.Flexibilityalsodoesnotexcusepoorreportingoftheoreticalissues.MixingqualitativeandquantitativeresearchAlthoughsomeresearcherswillchampionexclusivelyquantitativeorqualitativeresearch,alessdivisiveandmorepragmaticstanceisthatneitherissuperiorandthat,dependingontheresearchquestion,bothquantita-tiveandqualitativeresearchmethodscouldappropriatelybeemployed;anapproachtermedmixedmethods(Broom&Willis,2007).Increasingly,healthresearchersaretakingaÔsoftÕconstructivistapproachbyacknowl-edgingboththesubjectiveandpurelyphysicalaspectsofdiseaseandillness,andarecombiningquantitativeandqualitativemethods(Broom&Willis,2007).Althoughthismayappeartobeaneatwaytonavigatebetweentwodifferentviewsofresearch,mixedmethodsresearchisnotwithoutitscritics.Thoseengaginginsuchworkmustbeabletoappreciateandbringtogethertheassumptionsunderpinningbothqualitativeandquantita-tiveresearch(Yardley&Bishop,2007).GlossaryActionresearchBothresearchandintervention.Thegoalsofactionresearchersaretounderstandsomethingaboutthesocialworldandchangeit(Dew,2007).Takesintoaccountthecharacteristicsofthecommunity,culture,researcherandresearchmethodswhenevaluatingtheintervention’simpact(Harrisetal.,2009)DiscourseanalysisFocusesonfeaturesoflanguage,stylesofargumentationandthewaylanguageisusedtorepresentaparticularphenomenonorissue(Dew,2007)EmpiricalgeneralisabilityTheextenttowhichresearchfindingscanbeusedtoinferaboutthecharacteristicsofawiderpopulation(Mason,2002)EpistemologyThebranchofphilosophyconcernedwiththetheoryofknowledge(Carter&Little,2007).EpistemicpositionreferstoadherencetoaparticularideaabouthowresearcherscanproduceknowledgeEthnographyDerivedfromanthropologyandfocusesonculturalbeliefsandpractices.Ittypicallyinvolvescloseobservationandoftenparticipationinthesociallifeofthegroupbeingresearched,oftenreferredtoasfieldwork(Dew,2007)EthnomethodologyDerivedfromsociologyandfocusesonsocialpractices.Theprimaryquestionforethnomethodologyis‘howistheorganisationofsocietyachieved?’(Dew,2007)GroundedtheoryDerivedfromsociologyandfocusesongeneratingtheorythatexplainsthedata(Dew,2007)Hypothetico-deductivismTheprocessbywhichahypothesisistestedbycollectingdatafromwhichconclusionsregardingtheveracityofthetheoryareinferredInductivereasoningTheprocessbywhichresearchfindingsarederivedfromthedataitselfwithnoconsiderationtopre-existingtheoryMethodologyTheoriesabouthowresearchshouldproceed(Carter&Little,2007)NaturalisticBeingtruetothenatureofthephenomenonunderinvestigation(Bryman,2004)OntologyRelatestopeople’sunderstandingofthenatureoftheworld(Willig,2008)PhenomenologyDerivedfromphilosophyandseekstocapturephenomenaastheyareimmediatelyexperienced(Dew,2007)QmethodologyAmethodappliedtothestudyofsubjectivity,includingaperson’sviewpoint,opinion,beliefsandattitude.Involvesrankingofstatements,theresultsofwhicharesubjecttofactoranalysis(vanExel&deGraaf,2005)RealismBeliefinasingle,stablereality‘outthere’waitingtobediscovered(Willig,2008)RelativismBeliefinasociallyconstructedreality.Relativismacceptsthathowpeopleperceivetheirworldandtheirthoughtsaboutitarealwaysinfluencedbysocialfactorssuchasculture,historyandlanguage(Willig,2008)ResearchmethodsResearchaction;thetechniquesforcollectingandanalysingdata(Carter&Little,2007)ResearchquestionAnopen-endedquestionthatguidesdatacollectionandanalysis(Willig,2008).AnimportantdistinctionisthatresearchquestionsdirectthestudyratherthanpredictwhatmaybefoundReflexivityConsiderationoftheresearcher’sownroleintheresearchprocessviacriticalself-scrutiny(Mason,2002)StrategiesofinquiryProvidetheresearcherwithanoverallstrategyforformulating,articulating,analysing,andevaluatingtheirmethods(Carter&Little,2007).CommonstrategiesofinquiryinhealthresearcharePhenomenology,GroundedTheory,DiscourseAnalysis,Ethnography,EthnomethodologyandActionResearch(Dew,2007)SubjectiveAsubjectivefactisonethatisonlytrueundercertainconditions,atcertaintimes,incertainplaces,orforcertainpeople.ThisisopposedtoanobjectivefactthatistrueineverycircumstanceTheoreticalgeneralisabilityTheextenttowhichresearchfindingscanbeusedtodevelopconcepts,understandphenomenaandtheoreticalpropositionsthatarerelevanttoothersettingsandothergroupsofindividuals(Draper,2004;Yardley,2008)GettingstartedinqualitativeresearchJ.A.SwiftandV.Tischlerª2010TheAuthors.Journalcompilationª2010564TheBritishDieteticAssociationLtd.2010JHumNutrDiet,23,pp.559–566
ConclusionsQualitativeresearchundoubtedlyhasmuchtooffernutri-tionanddietetics.Foodhasmultiplefunctionsinaper-sonÕslifeandqualitativeresearchisparticularlywellplacedtodealwiththiscomplexitybecauseitinvestigateshowandwhypeoplebehaveincertainways.Historically,qualitativeresearchhasbeenpositionedlowdownhierar-chiesofevidence,althoughthereisagrowingrecognitionthatitshouldbeavitalpartofthedecision-makingpro-cessesthatguidethedevelopmentofhealthpolicyandpractice.Despitethis,qualitativeresearchhasyettobefullyembracedbynutritionanddietetics.Thisisperhapsunsurprisingbecausethosenewtothistypeofresearchcanstrugglewithanimpenetrableliteratureandalackofconsensusregardingwhatconstitutesappropriateresearchmethods.Theadvicepresentedhereispragmatic:proceedfromtheresearchquestion(s)andensurethatchoicesaboutresearchmethodsareappropriateanddonotclashwiththephilosophicalassumptionsaboutontology,epis-temologyandmethodologythatunderpintheoveralldesignofastudy.Conßictofinterests,sourceoffundingandauthorshipBothauthorswereinvolvedinthepreparationofthismanuscript.Theauthorsreportnoconßictofinterest.ReferencesAbusabha,R.&Woelfel,M.L.(2003)Qualitativevsquantita-tivemethods:twooppositesthatmakeaperfectmatch.J.Am.Diet.Assoc.103,566Ð569.Ashworth,P.(2008)Theoriginsofqualitativepsychology.InQualitativePsychology.APracticalGuidetoResearchMethods.edJ.A.Smith,pp.4Ð24.London:SagePublications.Avis,M.(2003)Doweneedmethodologicaltheorytodoqualitativeresearch?Qual.HealthRes.13,995Ð1004.Braun,V.&Clarke,V.(2006)Usingthematicanalysisinpsychology.Qual.Res.Psychol.3,77Ð101.Broom,A.&Willis,E.(2007)Competingparadigmsandhealthresearch.InResearchingHealth.Qualitative,Quantita-tiveandMixedMethods.edsM.Saks&J.Allsop,pp.16Ð31.London:SagePublications.Bryman,A.(2004)SocialResearchMethods,2ndedn.Oxford:OxfordUniversityPress.Carter,S.M.&Little,M.(2007)Justifyingknowledge,justify-ingmethod,takingaction:epistemologies,methodologies,andmethodsinqualitativeresearch.Qual.HealthRes.17,1316Ð1328.CentreforReviewsandDissemination(2009)Chapter6:incorporatingqualitativeevidenceinoralongsideeffectivenessreviews.In:SystematicReviews:CRDÕsGuidanceonUndertakingReviewsinHealthCare[Internet].Availableathttp://www.york.ac.uk/inst/crd/systematic_reviews_book.htm(accessedon19February2010).Chamberlain,K.(2004)Foodandhealth:expandingtheagendaforhealthpsychology.J.HealthPsychol.9,457Ð481.Conner,M.&Armitage,C.J.(2002)TheSocialPsychologyofFood.Buckingham:OpenUniversityPress.Coveney,J.(2006)Food,MoralsandMeaning:ThePleasuresandAnxietyofEating,2ndedn.London:Routledge.Creswell,J.W.(1998)QualitativeInquiry&ResearchDesign.ChoosingAmongFiveApproaches,2ndedn.ThousandOaks,CA:SagePublications.Denzin,N.K.&Lincoln,Y.(2005)Introduction.Thedisciplineandpracticeofqualitativeresearch.InTheSageHandbookofQualitativeResearch,3rdedn.edsN.K.Denzin&Y.Lincoln,pp.1Ð32.London:SagePublications.Dew,K.(2007)AhealthresearcherÕsguidetoqualitativemethodologies.Aust.NZJ.Pub.Health31,433Ð437.Draper,A.(2004)Theprinciplesandapplicationofqualitativeresearch.Proc.Nutr.Soc.63,641Ð646.Draper,A.&Swift,J.A.(2010)Qualitativeresearchinnutritionanddietetics:datacollectionissues.J.Hum.Nutr.Diet.,inpress.doi:10.1111.j.1365-277X.2010.01117.xEasterby-Smith,M.,Golden-Biddle,K.&Locke,K.(2008)WorkingwithpluralismÐdeterminingqualityinqualitativeresearch.Organ.Res.Methods11,419Ð429.vanExel,N.J.A.&deGraaf,G.(2005)Qmethodology:asneakpreview.Availableathttp://www.qmethodology.net(accessedon25March2010).Ezzy,D.(2001)Arequalitativemethodsmisunderstood?Aust.NZJ.Pub.Health25,294Ð297.Fade,S.A.(2003)Communicatingandjudgingthequalityofqualitativeresearch:theneedforanewlanguage.J.Hum.Nutr.Diet.16,139Ð149.Fade,S.A.(2004)Usinginterpretativephenomenologicalanalysisforpublichealthnutritionanddieteticresearch:apracticalguide.Proc.Nutr.Soc.63,647Ð653.Fade,S.A.&Swift,J.A.(2010)Qualitativeresearchinnutritionanddietetics:dataanalysisissues.J.Hum.Nutr.Diet.,inpress.doi:10.1111.j.1365-277X.2010.01118.xFieldhouse,P.(1996)FoodandNutrition.CustomsandCulture,2ndedn.Cheltenham:StanleyThornes(Publishers)Ltd.Flick,U.(2007)DesigningQualitativeResearch:SageQualita-tiveResearchKit.London:SagePublications.FoodStandardsAgency(2010a)QualitativeResearchtoExplorePeopleÕsUseofFoodLabellingInformation:FinalReport.Availableathttp://www.food.gov.uk/multimedia/pdfs/qualilabelres.pdf(accessedon23March2010).FoodStandardsAgency(2010b)QualitativeResearchtoExplorePublicUnderstandingofSodiumandSaltLabelling.Availableathttp://www.food.gov.uk/multimedia/pdfs/saltlabellingre-portmarch2010.pdf(accessedon23March2010).Giles,D.C.(2002)AdvancedResearchMethodsinPsychology.London:Routledge.J.A.SwiftandV.TischlerGettingstartedinqualitativeresearchª2010TheAuthors.Journalcompilationª2010TheBritishDieteticAssociationLtd.2010JHumNutrDiet,23,pp.559–566565
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