Team data analysis
At significant points during the process of data analysis, the researchers most closely involved in data collection and the early stages of analysis (YB, RH, KB) met with members of the wider research team with extensive qualitative (VE) and clinical (IW) experience, to discuss emerging codes and categories, the interpretation of key texts and potential new lines of enquiry, thereby drawing on the combined insights of those ‘handling’ the data closely and members of the team with a wider perspective of methodological and open disclosure issues.
Reflexivity relates to sensitivity to the ways in which the researcher and the research process may shape the data collected, including the role of prior assumptions and experience.
Prior assumptions and experience
Within the context of the current study, the members of the research team involved in face-to-face contact with study participants needed to consider the ways in which their interactions with participants might be influenced by their own professional background, experiences and prior assumptions. The two interviewers (RH and KB) were both academic research fellows from non-clinical backgrounds. An important question we needed to address in drawing conclusions from the data concerned whether or not knowing about our professional background could have impacted on participants’ willingness to talk openly about experiences, or how this knowledge might have shaped what was said.
Awareness of social setting and the social ‘distance’ between the researcher and the researched
The majority of interviews were conducted in participants’ workplaces or homes (for patients), either face to face or over the telephone, as this was usually more convenient for them. Although we were invited in as researchers, we were also mindful that we were guests in the participants’ work or living spaces; respondents were therefore given the lead in ‘setting the pace’ of the interview. By deliberately adopting a ‘back seat’ approach in setting the scene for the interview to take place, the researchers hoped that participants would feel they were exercising a measure of control over the interview process.
Dingwall247 has suggested that one way of reducing bias in qualitative research is to ensure that the research design explicitly incorporates a wide range of different perspectives, so that the viewpoint of one group is never presented as if representing the sole truth about any situation, an analytic technique he has referred to as ‘fair dealing’.
Our study was designed to elicit contributions from a broad range of stakeholders in open disclosure. During the analytic process no particular group’s views were ‘privileged’ over those of others; that is to say, data analysis included a process of constant comparison between accounts of each group of participants, to uncover similarities and differences, which were subsequently highlighted (for example, health professionals identified a lack of certainty around what should be disclosed to a patient or carer, more so than other participants).
A main goal of data analysis was the identification of common themes that emerged from comparison across cases (individual interviews). However, equal importance was attached to focusing on the minutiae of individuals’ accounts relating to specific incidents of disclosure; in the analysis, we sought to identify the views and experiences of individuals, as well as the majority, where these were divulged.
Awareness of wider social and political context
As a research team, we discussed the fact that participants recruited from a policy level, professional organisation or national ‘consumer’ group might show a strong commitment to a particular personal or political agenda, or wish to raise particular issues during group discussions which may relate only tangentially, or not at all, to the main purpose of the discussion. We discussed how we might handle this situation if it arose and decided to emphasise the purpose of the research prior to interview and through the questions and probes used. This strategy appeared to be successful in keeping participants engaged in the research process.
The role of the research team as collaborators in knowledge production
Collaborative research is highly valued for its ability to bring together multiple researchers with distinctive and specialist perspectives to tackle large or complex research problems, though frequently the ‘putting together’ of multiple perspectives in the construction of knowledge is not described.248
Within the Being Open research team, there was a strong commitment from the outset to work collaboratively in the collection, analysis, interpretation and reporting of the qualitative data, though individual involvement with the various stages of the research process necessarily varied. The three team members most closely involved in fieldwork (YB, RH, KB) met frequently (on average at least once per week) to discuss the progress of fieldwork and reflect on data collection; meetings intensified during the early stages of analysis, when themes and codes were beginning to be identified. At this crucial stage, input was sought from other members of the research team with extensive experience of qualitative research and a broad knowledge of patient safety research (VE, IW) to assist with ‘firming up’ the coding framework. During the early stages of analysis, an all-day meeting was convened in a location away from the interruptions of the office environment, which served as a kind of ‘interpretative retreat’. Throughout the day, we explored a sample of transcripts to gain a sense of the data that were emerging, the effectiveness of the topic guides and whether or not there may be additional participants who we wanted to invite to take part. A more intense focus on a subset of transcripts (which had been sent to VE in advance) in a further half-day analysis session was used to draw up the coding framework that would serve to underpin the analysis (and interpretation) of all the interview data. This endeavour resulted in an analytic strategy that was informed by insights from team members with a broad understanding of the research field and methodological issues, and those with field-based contextual and experiential understanding.
Potential for psychological harm
Members of the research team involved in fieldwork (RH, KB) were acutely sensitive to the possibility that focusing on the research topic could potentially provoke anxiety in the research participants concerning the disclosure of adverse events. At the end of each interview, researchers took time to ensure that participants were not feeling distressed by their participation; in these interviews, none of the participants expressed such concerns or appeared to be distressed or uneasy.