School of Health And Life Science

Trustworthiness

According to Bloor & Wood (2006), a trustworthy qualitative research is one that is credible, transferable, confirmable and dependable. A credible study is one in which the researcher is confident that the research findings are true and accurate. According to Wiles et al (2016), credibility questions whether the researcher can confirm that the study’s findings are accurate and true. Contrastingly, transferability evaluates whether the study findings can be applied to other contexts, thus ascertains the generalizability of the study findings (Van den Berg & Struwig, 2017). Conformability defines the level at which the study findings are free of the researcher’s bias – to ensure that the researcher’s interpretations are not skewed to fit their purpose. It assures of the neutrality of the study findings (Wiles et al, 2016). Lastly, dependability defines the extent to which the study findings would be similar if the same research was repeated by other researchers (Penelope et al, 2018). It assures other researchers of enough information to repeat the same study and achieve the same/consistent findings.

Research Rigour

A rigorous qualitative research is one whose data analysis is carefully and thoroughly done to ensure that the results are valid and reliable (Gisselle & Lotte, 2018). According to Suzanne (2016), it is more challenging to establish the reliability of a qualitative study especially due to the researcher’s need to include creativity and subjectivity while conducting the study. Nonetheless, Cessell (2018) states that the reliability of a qualitative study defines the manner in which the same study can be replicated to obtain the same results. However, Tappen (2010) argues that ‘reliability’ in a qualitative study is misleading and may not be relevant to qualitative studies because human notions and behaviours are ever changing. Thus, if reliability is applied to qualitative studies, the researcher must thoroughly describe the research procedure to allow for inter-subjectivity for determining the study quality (Given, 2008). On the other hand, according to Apan et al (2012), a valid study is one that is justifiable, logical, meaningful, and well-founded. Similar to reliability, validity in the context of qualitative research is surrounded by a lot of controversies. According to Maxwell (2013), this is because validity is based on truth, objectivity, evidence and mathematical data. Moreover, a valid data must be accurate and based on true scientific findings. Hence, some qualitative researchers have attempted to replace ‘validity’ with several other terms such as adequacy, authenticity, and goodness (Lincoln & Guba 1985). Others have argued that validity is validity is not applicable to qualitative research and instead replaced it with other terms such as trustworthiness, rigor, and quality. However, Speziale & Carpenter (2011) argue that validity is a construct that can be used in both qualitative and quantitative research because ideally, to validate means theorize, question, and investigate, which are all activities that determine the rigour of a qualitative study.

The researchers explicitly state that the study applied convenience sampling to select the study participants. The use of convenient sampling might have made it easier for the researchers because of the relatively low costs involved in it, and consumes less time. Being an exploratory research, a major advantage of convenience sampling is that it enables the researcher to conveniently access the samples (Padgett, 2008). Moreover, according to May (2002), convenient sampling enables researchers to access the samples in a fast and cheaper manner. Nonetheless, a major disadvantage of convenient sampling is that the study is likely to suffer from a number of biases that are inherent with it. For instance, in the article example, although the study intended to know the perceptions of head and neck cancer (HNC) patients on alternative medicine, selecting the sample from one health canter may have led to an underrepresentation of the entire targeted population (Atkinson & Coffey, 2002). However, conducting research only in one cancer care institution, the researcher may have missed out on the differences in perceptions and attitudes of HNC patients in other care centres. Consequently, according to Bloor & Wood (2006), this underrepresentation of the entire cancer population has serious ramifications on the transferability of the study. Convenient sampling is less likely to be a representative of the entire population under study and thus the study findings cannot be generalized to the entire population.

Nonetheless, two important characteristics of Hendershot et al (2014) are that there was a negotiation of access to the sample, and an informed consent of the participants. Negotiating access to the sample was important in ensuring that the study does not interfere with the institution’s daily activities. However, the researchers might have undergone a rigorous scrutiny before being granted access to the sample. This is supported by Apan et al (2012) who point out that negotiating access to sample is based on a simple ethical consideration that the study endeavours might inconvenience the institution or organization within which the study is conducted. Hence, negotiation helps in liaising with the people in authority so that a convenient time is allocated for the exercise (Leavy, 2014). The study was conducted in a private setting at an HNC canter called Winship Cancer Institute. Being a cancer centre, it provided the best setting for carrying out the study because the researcher was able to access cancer patients in a range of disease stages. Moreover, conducting the interviews in a private setting was useful in ensuring the privacy and anonymity of the

respondents. Hence, respondents are not worried about any retribution and therefore are likely to give truthful answers (Lincoln & Guba 1985). On the other hand, while the study gives little details of how the informed consent was gained from participants, gaining informed consent is a fundamental ethical consideration especially when the study involves human subjects (Given, 2008). An advantage of informed consent is that it gives the potential participant information about the study, thereby giving them the capacity to make an informed decision to participate. This is because informed consent discloses to the potential participants' details such as the potential risk of the study, the purpose of the study, benefits of the study to the respondents, any potential risks, and informs them that they are liberty to withdraw participation at their discretion. This promotes the credibility of the study because participants are more likely to be actively involved in providing sufficient information when they participate willingly than when they are forced into it (Leavy, 2014). However, potential participants may not be at a position to understand the research purpose thus the researcher may have to spend more time explaining the details of the study (Atkinson & Coffey, 2002).
Part C: Data Collection The researchers clearly indicate that the study used structured interviews as the method of data collection. Moule & Goodman (2009) defined structured interviews as a method qualitative data collection where all the participants are asked exactly the same questions. A major strength of structured interviews is that the questions are standardized and therefore all respondents will

answer the same questions. This allows comparability of the findings for purposes of effective data analysis (Ridenour & Babbie, 2010). Moreover, the researcher’s presence inhibits misinterpretation of the research questions by the respondent as the researcher could always explain them to the respondent (Guba & Lincoln, 1989). Worryingly though, with structured questions, the researcher’s tone and body language have a potentiality of affecting the respondent’s answers (Van den Berg & Struwig, 2017).
Moreover, data from the interviews were noted in verbatim using the interview note-taking tool. Atkinson & Coffey (2002) argue that note taking is more advantageous than tape recording because sometimes transcribing recorded interviews may be tedious. Also, with note taking, it is easier to remember whatever was discussed and to pinpoint the useful information. According to Bloor & Wood (2006), interviews are useful in gaining information on perception and attitudes. Therefore, it emerges as the most appropriate method of data collection for Hendershot et al’s study, considering the fact that the study sought to investigate the perceptions and attitudes of HNC towards alternative cancer medicine.
However, during the interviews, the interviewer can understand and interpret the information differently from what the interviewer might have intended to communicate, thus distorting the information and affecting the credibility of the findings (Leavy, 2014). Furthermore, an issue with in-depth interviews is the challenge of status and hierarchy in interviews involving professionals. According to Apan et al (2012), the researcher’s deeper knowledge in the research topic (i.e. alternative cancer medicine) contributes to a feeling of inferiority within the respondent, and this might contribute to an intimidating interview experience. Likewise, the fact that the interviewer is privileged to control the interview’s agenda intimidates the interviewee

and may have a methodological implication on data obtained. When data is not accurate, the validity of the study is compromised. The researchers have also given details of data collection, which serves offer transparency of the research procedure (Atkinson & Coffey, 2002). For instance, it is indicated that the interview was conducted at the Winship Cancer Institute of Emory University and the participants were recruited into the study regardless of the status of their disease. The study was conducted using open-ended questions; thereafter all the 12 respondents were probed for additional information on CAM usage. A major advantage of open-ended questions, according to Bloor & Wood (2006), is that it provides an opportunity for the interviewee to freely and openly express themselves thus providing more varieties of information. But, a major disadvantage of open-ended questions is that the researcher must undertake an additional process, content analysis – in order to classify the data and derive meaningful information from it. Only one researcher conducted the interviews in all the 12 sessions. According to Suzanne (2016), using one researcher in all the interviews, especially in structured interviews enables an easier identification of the point of saturation because it is easier for one person identify new and repeated information.
The researchers have also identified and illustrated the concept of saturation of data. Tappen (2010) defines the saturation of data as a situation when no more data sampling will lead to additional information that is useful to the research questions. Specifically, it is indicated that the interview continued until the pre-defined codes were saturated. Simply put, the researchers used saturation of data to determine the sample size (n=12) and to mark the end of data

collection based on the number of pre-defined codes. The respondents were interviewed and probed until they no longer revealed any new information. Ideally, according to Given (2008), saturation is achieved when no additional useful information is obtained from any further interviews and probing. A major advantage of data saturation as a methodological application in qualitative research is that it helps the researcher prevent the inclusion of any counter-productive information in the study (Leavy, 2014). According to Apan et al (2012), it also serves the purpose of saving time for both the interviewer and the interviewee because ideally, it marks the end of an interview session. Nonetheless, Apan et al (2012) argue that the researcher might find it difficult to determine the point of saturation because there is always a potentiality of new information emerging. In this study though, the use of saturation may have limited the amount of information the researchers could have gained if more respondents were interviewed.

Part D: Data Analysis

The study applied qualitative data analysis. The researchers describe all the steps involved in the qualitative analysis. For instance, they describe that the quantitative analysis involved an analysis of the frequencies of different types of CAM usage both indirect questions and in probes. The qualitative analysis involved the use of a codebook in analysing the two open-ended questions regarding the participant’s attitudes towards and comfort with CAM use. The codes were then combined into three major themes. This clearly illustrates how the researchers derived the themes from the data collected. The codebooks were useful in developing categories of data and support a clear interpretation of themes thereby enabling the development of valid result discussions (Wiles et al, 2016). However, according to Suzanne (2016), codebooks may make it difficult for researchers to identify and verify themes when codes are combined. This affects the reliability of the research outcomes because the researcher may not be able to make valid conclusions.

On the other hand, the use of themes enabled the researchers to accurately support their results based on the collected data and to situate their findings within a large data set of interviews provided by 12 respondents (Wiles et al, 2016). For instance, classifying the theme enabled the researchers to identify and distinguish between negative and positive attitudes of the respondents towards CAM. Worryingly though, according to Tappen (2010), the use of themes limited the researcher’s ability to interpret the results because themes are not based on a theoretical framework.

It also emerges that the researchers included a third party into the research for purposes of resolving any disputes during code derivation. According to Bloor & Wood (2006), this helps eliminate researcher bias by solving the difference in the interpretation of data between the original researchers. It also saves time in agreeing over which codes to be included or eliminated from the analysis (Atkinson & Coffey, 2002).
The researchers also use extracts from the interviews to support their discussion of the results. For example, in discussing the positive attitudes of the participants towards CAM, the researchers quote a respondent who said that CAM “… had a positive impression and if it helped, he would give it a try… ” This promotes coherence between the collected data and the researcher’s interpretation of data, thereby improving the reliability of the results discussed (Given, 2008).
The researchers also used a numbering system to identify the specific source of quotes used in the analysis section. For instance, in referring to one of the quotes: “cannot say if it helps or not (f6)”. Here, (f6) denotes the particular respondent being quoted. According to Apan et al (2012), this technique improves the verifiability of the results because any reader would verify whether such words were specifically derived from the interview. However, the technique may not be useful if the researcher fails to accurately denote each quote with the exact quoted respondent. Therefore, there should be an accurate representation of the quotes using numbers, preferably by one researcher throughout the study to avoid confusions.
Newell & Burnard (2011) emphasize that research findings must be supported with sufficient data. This improves the reliability of the study because it implies that the conclusions made are based on the specific evidential data collected by the study. Considering Hendershot et al’s (2014) study, the discussion of every theme is backed by actual extracts of the interviews, reinstating the interviews and justifying the conclusions made. For instance, to justify the respondents’ negative attitudes towards CAM, the researchers quoted a respondent who claimed that “CAM was less effective than what the doctor would prescribe”. Ultimately, supporting the findings with sufficient data not only improves the reliability of the findings but also validates the conclusions made out of those findings because they are supported by actual data collected by the study. These quotes were used properly to evaluate and discuss the study findings because each point of discussion was supported by actual data from the interviews. There was no

mismatch between the numbers and the quotes, which reveals the accuracy with which the researchers discussed their results. In fact, any reader could make a reference to the quotes and confirm that each point of discussion was related to the study findings. This improved the verifiability and consequently the trustworthiness of the study.

References

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