Enhancing Healthcare and Rehabilitation

The Impact of Qualitative Research

Christopher M. Hayre, Dave J. Muller

• Publisher: CRC Press
• Year: 2019
• ISBN:
  9781351116800
• Edition: 1
• Topic: Medicine
• Subtopic: Physiotherapy, Physical Medicine & Rehabilitation

Summary Description

This book is primarily a celebration of the qualitative work undertaken internationally by a number of experienced researchers. It also focuses on developing the use of qualitative research for health and rehabilitative practitioners by recognizing its value methodologically and empirically. We find that the very nature of qualitative research offers an array of opportunities for researchers in being able to understand the social world around us. Further, through experience and discussion, this book identifies the multifaceted use of qualitative methods in the healthcare and rehabilitative setting. This book touches on the role of the researcher, the participants involved, and the research environment. In short, we see how these three central elements can affect the nature of qualitative work in attempts to offer originality. This text speaks to a number of audiences. Students who are writing undergraduate dissertations and research proposals, they may find the myriad of examples stimulating and may support the rationale for methodological decisions in their own work. For academics, practitioners, and prospective qualitative researchers this book also aims to demonstrate an array of opportunism in the field of qualitative research and how they may resonate with arguments proffered. It is anticipated that readers will find this collection of qualitative examples not only useful for informing their own research, but we also hope to enlighten new discussions and arguments regarding both methodological and empirical use of qualitative work internationally.

Features

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• Encompasses the importance of qualitative research and how it can be used to facilitate healthcare and rehabilitation across a wide range of health conditions.

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• Evaluates empirical data whilst critically applying it to contemporary practices.

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• Provides readers with an overview with future directions and influence policy makers in order to develop practice.

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• Focuses on an array of health conditions that can affect groups of the population, coincided with life issues and the care and family support received.

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• Offers innovative methodological insights for prospective researchers in order to add to the existing evidence base.

Section II

Enhancing Healthcare and Rehabilitation

Contemporary Applications of Qualitative Research

3

Exploring the Value of Qualitative Comparison Groups in Rehabilitation Research: Lessons from Youth with Disabilities Transitioning into Work

Sally Lindsay

CONTENTS

Introduction

Youth with Disabilities Transitioning into Work – The Importance of Qualitative Research

Personal Reflections

Qualitative Comparison Groups

Summary

References

Introduction

The growing qualitative literature within rehabilitation is helping to inform evidence-based practice and clinical decision-making (Gibson & Martin 2002; Grypdonck 2018; O’Day & Killeen 2002; Vanderkaay et al. 2018). Qualitative research sheds light on the in-depth experiences and perspectives of patients, which can facilitate improvements to the rehabilitation services they receive (Vanderkaay et al. 2018). A benefit of this type of research is that it can address the increasing focus on patient-centred care – referring to the needs, values, and preferences of individual patients who should be viewed as informed decision-makers in their care (Hammell 2004; Institute of Medicine 2001; Rathert et al. 2012). Understanding patient’s perspectives can enhance their satisfaction with the services they receive and their outcomes (Rathert et al. 2012). Further, qualitative research can provide explanations about why certain outcomes occurred (e.g., employed, unemployed), the perceived impact of a program or intervention, and shed light on complex processes such as self-care at work or disclosure of a condition to employers (Grypdonk 2006). Applying qualitative methodology encourages us to look beyond the condition or disability and to consider the whole person, their needs, and experiences in an effort to facilitate their integration into their community (Gibson & Martin 2002).

Given that the aim of rehabilitation is to help patients to participate in the community whilst improving their quality of life, it is critical to understand their lived experiences through qualitative approaches (Gibson & Martin 2002). We can do this by considering the unique circumstances, goals, values, and challenges that people with disabilities may encounter. For example, qualitative research can enhance our knowledge of occupational rehabilitation by exploring such things as meaning, lived experience, and process of enabling occupational engagement (Gewurtz et al. 2008). In this chapter, I draw on examples from my qualitative research exploring youth with disabilities transitioning into work.

Youth with Disabilities Transitioning into Work – The Importance of Qualitative Research

Qualitative researchers increasingly recognise the importance of exploring youth’s experiences (Garth & Aroni 2003; Kramer et al. 2012; Lindsay & Cancelliere 2018). Until recently most research on youth with disabilities focused on the perspectives of healthcare providers, or their parents, whilst little was known about youth’s first-hand experiences (Darbyshire 2000; Lindsay et al. 2013, 2015a, 2015b, 2015c). Research examining youth’s perspectives, particularly on the topic of transition to employment, is relatively sparse (Foley et al. 2012; Lindsay et al. 2013, 2015a, 2015b, 2015c). Most research on transitions amongst youth with disabilities concentrates on their healthcare needs, even though youth frequently mention wanting more assistance with vocational and employment goals (Lindsay 2014; Lindsay et al. 2015a, 2015b, 2015c, 2018a, 2018b). Drawing attention to youth with disabilities is salient because they are at a critical stage in their development and may need additional support, particularly with social development and role functioning (Lindsay et al. 2016a, 2016b, 2016c, 2016d). For example, disadvantages are often compounded for youth who start life with a disability (Lustig & Strauser 2003), therefore, gaining early employment experience is critical for enhancing their future employment outcomes (Lindsay et al. 2013).

Understanding youth’s perspectives is essential because there are often discrepancies between parent and clinician reports of their functioning and well-being (Lindsay et al. 2017a, 2017b, 2017c; Schiariti et al. 2014). Further, listening to youth’s experiences about transitioning to work can help to highlight potential gaps and areas for improvement in the programs and services they receive. Therefore, drawing on qualitative research can add to our knowledge about how youth with disabilities transition into work by providing rich descriptions of their lived experiences regarding how their condition affects their participation in everyday life.

Enhancing employment opportunities of youth with disabilities is important given that their employment rate for those aged 20 years old–24 years old is 63.7% and 81.5% for those without disabilities (Statistics Canada 2006). Employment rates are even lower for youth aged 15 years old–19 years old (i.e., 40.1% for those with disabilities vs 51.4% for those without disabilities) (Statistics Canada 2006). Using qualitative methodology can help to uncover the experiences behind these trends and show us where youth may need further support. This type of research can help us to move beyond focusing only on employment outcomes (i.e., employed, not employed) and to explore in further depth how youth seek and maintain employment and other meaningful occupations during their transition to adult life.

Most transitions to employment programs for youth with disabilities are often a one-size-fits-all and do not account for the varying needs that youth with specific types of disabilities have (i.e., accessibility, accommodations, self-care, and personal support needs) (Foley et al. 2012; Lindsay et al. 2013). Further, little is known about what supports are required to assist youth in their decisions about transitioning to employment and when they should receive such supports (Lindsay et al. 2018a, 2018b). Research shows that transition programs for youth with disabilities have had little impact on improving post-high school transition experiences (Foley et al. 2012). Therefore, more work is needed to consider youth’s experiences of transitioning to work so we can support them in optimising successful outcomes.

Personal Reflections

My inspiration for using qualitative comparison groups stemmed from my social location of having my office and lab physically located within a paediatric rehabilitation hospital. Here, researchers are encouraged to have patients, and in my case youth with disabilities, actively involved in all stages of their research. Our hospital has been leading the way in regards to patient-engaged research (Anderson et al. 2018). Most of my projects involve youth as advisors, mentors, or facilitators. I have hired 10 youth and young adults with disabilities in paid positions within my lab over the past 9 years. At first, my motivation was to help them gain valuable employment experience and skills, but now, I find that their insight into project design and implementation is invaluable. I have learned so much from working with these youth – not only in my day-to-day projects, but I have the opportunity to see the abilities and future potential of these young people. In working closely with them I have learned that we (as researchers, employers, and clinicians) often have many incorrect assumptions about their capabilities and particularly how they compare to youth without disabilities. As such, I started to build comparison groups into my qualitative studies, not only to further my own understanding, but also to showcase to others that we often have many biases and inappropriate assumptions about people with disabilities.

The objective of this chapter is to provide an overview of why it is important to have qualitative comparison groups and examples of how to do this within the context of youth with disabilities transitioning into employment. Next, I describe why we should use qualitative comparison groups and highlight three different types of comparison groups that I have used within the context of transitioning to work amongst youth with disabilities.

Qualitative Comparison Groups

Control and comparison groups are often used in quantitative research, but rarely in qualitative. In quantitative studies, control groups can help to assess the effect of an intervention (e.g., Horder et al. 2013; Le et al. 2013; Lindsay et al. 2009; Thomas et al. 2004). Although some studies have a qualitative component alongside a randomised controlled trial, there are surprisingly few qualitatively driven studies that use a comparison group. Having comparison groups embedded within a qualitative design can benefit our understanding of lived experiences, and processes, whilst highlighting how phenomena vary between groups (Lindsay et al. 2015a, 2015b, 2015c, 2017a, 2017b, 2017c; Ritchie et al. 2014; Lindsay 2019). For example, within rehabilitation research, a comparison group could support us in exploring the similarities and differences between those who have a particular condition and those who do not (Lindsay et al. 2015a, 2015b, 2015c).

Qualitative research that uses comparison groups in their design often cite it as a strength of their study (e.g., Dickie et al. 2009; Lindsay et al. 2015a, 2015b, 2015c, 2017a, 2017b, 2017c). Meanwhile, others note that lacking one is considered a limitation (e.g., Deitrick et al. 2010; Heugten 2004; Rodriquez 2013). For example, one qualitative researcher said, ‘…we have no comparison group. As a result, we cannot draw any conclusions about differences and similarities’ (Davey et al. 2012, p. 1267). Not having a comparison group makes it is challenging to determine whether any differences exist between those with and without a particular characteristic (i.e., health condition). Further, lacking a comparison group could potentially introduce bias into your study. For instance, researchers often make assumptions about their participants by adding their own interpretations about how they think their sample compares to others. Some have noted this as ‘pink elephant bias’, where researchers tend to see what is anticipated (Morse & Mitcham 2002; Spiers 2016). Having a comparison group could help to address some of the biases common within qualitative research by enhancing rigour and credibility (i.e., internal validity) of the findings through persistent observation and negative case analysis (Morse 2015). Further, comparison groups can enhance the dependability (i.e., reliability) of the findings through a splitting of the data and duplicating the analysis (see example 2 below) (Guba & Lincoln 1989; Morse 2015).

Applying comparison groups in qualitative research could also facilitate the incorporation of varying perspectives from people who have different social positions (e.g., youth with and without disabilities, clinician, and parent perspectives). Further, having qualitative comparison groups can help to advance rehabilitation science (e.g., opportunities and challenges) by adding to the rigour, quality, and credibility whilst potentially enhancing the uptake of research by clinicians to improve clinical practice (Vanderkaay et al. 2018).

I argue that qualitative health researchers should consider using qualitative comparison groups to enhance the rigour of their work and to develop a better understanding of how their sample compares with healthy controls. Using a comparison group encourages researchers to think of other possibilities and also negative cases. Through using qualitative comparison groups in my own work, I have often found several surprising similarities and differences between groups with and without a particular condition (Lindsay et al. 2015a, 2015b, 2015c, 2017a, 2017b, 2017c). In the next section, I provide examples of three different types of comparison groups: (1) with and without a condition; (2) split sample comparison; and (3) multiple perspectives comparison group (see Table 3.1 for overview).

TABLE 3.1

Overview of Characteristics of Qualitative Comparison Groups

	Healthy Comparison	Split Sample Comparison	Multiple Perspectives Comparison
When to use	• When you want to understand differences between those who have the condition and those who do not	• When you want to understand differences based on 1 characteristic among a similar group (e.g., gender)	• When you want to understand perspectives of different groups on the same issue (e.g., patients, caregivers, health providers)
Sample	• Both groups should be homogeneous (similar ages, gender, and other aspects associated with the inclusion criteria) • Have at least 10–15 participants per group or until thematic saturation achieved (within and between groups)	• Homogenous sam...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• Acknowledgements
• Editors
• Contributors
• Section I Introductory Perspectives
• Section II Enhancing Healthcare and Rehabilitation: Contemporary Applications of Qualitative Research
• Section III Methodological Considerations for Qualitative Researchers
• Index