Freemantle and Watt (1994) suggest dissemination is the mechanisms and strategies by which specific groups become aware of, obtain, and make use of information. This definition introduces the notion of targeting specific groups with information that may be relevant, but also highlights the necessity of such groups being able to make use of the information once received. A goal of the researcher according to Pellecchia (1999) should be “to disseminate the findings, thereby adding new knowledge to the field”. Researchers have an array of presentational styles and formats to choose from that best fit their research purposes (Sandelowski, 1998) but the key point is to choose the most appropriate method for displaying particular research findings (Saldana, 2003).
In paying attention for the above research, the most popular way to reach desired target audiences is to give a paper or show a poster in lobby influential individuals through conferences, seminars or meetings, write press articles for publications that are read by policy-makers, send a targeted mailings containing relevant findings and recommendations in the form of a newsletter, letter or leaflet and by using visual and multimedia formats such as DVD’s can enhance the impact of research findings however, the costs associated with multimedia production can be higher than other methods of dissemination.
Freemantle N, Watt I (1994) Dissemination: implementing the findings of research Health Libraries Review; 11: 2, 133-137. Pellecchia LG (1999) Dissemination of research findings: Conference presentations and journal publications. Topics in Geriatric Rehabilitation; 14: 3, 67-79. Sandelowski, Margarete (1998). Writing a good read: Strategies for re-presenting qualitative data. Research in Nursing and Health, 21(4), 375-382 Saldana, Johnny (2003). Dramatizing data: A primer. Qualitative Inquiry, 9(2), 218-236.
Research Design -1500
Methodology refers to the philosophical framework, the fundamental assumptions and characteristics of a human science perspective van Manen (1997). It is the theory behind the method, including the study of the method one should follow and why. To answer the research question, this study was guided by the philosophy of hermeneutic phenomenology that sought to address the experiences of women regarding reconstructive surgery. According to Rossman and Rallis (1998), phenomenology pursues to develop an understanding of lived experience. The first-hand report or description of one’s experience of the phenomenon is central to the understanding of the phenomenon. The focus of a phenomenological study according to Patton (1990) lies in the “descriptions of what people experience and how it is that they experience.”
The goal of phenomenological research is to describe and identify precisely the essence of a person’s lived experience in relation to what is being studied and not to develop a model or describe a grand theory (Oiler, 1982). Phenomenology, as a research method, is a rigorous, systematic investigation of phenomena which approach is descriptive, retrospective, in-depth analysis of a conscious lived experience, which is everyday experiences that are real and true to the individual. Every time a participant’s view is expressed, the researcher may see the interpretation as an answer to the question that is being asked (van Manen, 1997). Thus, the conversation has a hermeneutic orientation “to sense-making and interpreting of the optic that drives the conversation”(van Manen, 1997, p.98).
The adoption of hermeneutic phenomenology was based on several factors. Since the objective of the study was to determine how satisfied women are with the reconstructed breast after surgery. Hermeneutic principles facilitated the interpretation and meaning of these women’s experiences and took into account the influences of social factors. It acknowledges that understanding is influenced by both internal and external factors, and is guided by language which leads to the creation of new meanings or understanding through dialogue (Vis, 2005).
Hermeneutic phenomenology involves the process of interpretation and the interaction between the researcher and the participants, requiring the researcher to be reflective, insightful, sensitive to language and open to new experiences (van Manen, 1997). It afforded the opportunity to explore and gain better appreciation of the researcher‟s cultural heritage, which enriched the depth of interpretation and understanding of the phenomenon.
The study was conducted at the Spire Cardiff Hospital, which caters specialist cancer care within Wales. Nurses and psychosocial professionals identified the potential participants who met the eligibility criteria and provided the researcher with their telephone numbers. The researcher approached identified participants during clinic visits or contacted them by telephone to introduce herself and provide a detailed explanation of the study. Ten participants will be recruited since there is a limited number of women that have undergone breast reconstruction within the specified year.
A number of eight to ten sample size was appropriate for a phenomenological study (Morse, 2000; Starks & Trinidad Brown, 2007) and achieved the goal of obtaining a varied, rich and deep understanding, or essence, of their lived experience (Creswell, 1998). The specific criteria for selecting the participants include women who received any type of breast reconstructive surgery due to breast cancer, who are older than 18 years of age, can speak and write English, and had no history of major mental illness, and those who have received breast reconstructive surgery from last year (2011) up to this year (2012). Purposive sampling will be used in this study. Verbal consent was obtained from those willing to participate in the study.
Thereafter, an interview was scheduled at a mutually suitable time at the hospital or the participant’s home at which time written consent was obtained following review of the consent form. The consent form was written in English and describes the study and its objectives, outlines the potential risks and benefits to participants, as well as the safeguards to maintain confidentiality of data. The consent form also advises participants they may withdraw from the study at any time without compromising their clinical care.
Data collection consisted of patient demographic profiles and audio-taped face-to-face interviews which were subsequently transcribed. A semi-structured interview guide was constructed to facilitate data collection; the questions were partially derived from existing psychosocial literature on the concept of self-identity (Mathieson & Stam, 1995) and modified for the purpose of this study. These questions were constructed to seek meaning and significance of a phenomenon (van Manen, 1997). The interviews were digitally audio-taped and transcribed. Each interview lasted about 1 – 1 ½ hour.
In hermeneutic phenomenology, an interview serves as a vehicle to explore, gather and develop a conversation with the participants to gain an understanding of the meaning of the lived survivorship experience (van Manen, 1997). According to van Manen (1997), the art of the researcher in a hermeneutic interview is to keep open the question of the meaning of the phenomenon and as well to keep the researcher and the participant oriented to the idea of being questioned. As Gadamer (1975) states, “The art of questioning is that of being able to go on asking questions, i.e. the art of thinking” (as cited in van Manen, p.330). In keeping with the hermeneutic inquiry, the interview began with a broad question which asked each participant to describe what it was like around the time of breast cancer diagnosis. Thereafter, the researcher sat back and listened, allowing the participants to tell their story and the process to evolve.
Following the hermeneutic circle of questioning, the researcher went back and forth, deconstructing and reconstructing meanings, while paying particular attention to not only what was said, but also and more importantly, to what was not said to uncover the true essence of the experience (McConnell-Henry et al., 2009a). Additionally, the researcher introduced ideas and concepts expressed from one interview to the next to validate common or varied themes. Attention was directed to whole or overall meanings, and at the same time, the whole or overall meanings were examined by its parts (van Manen, 1997).
Field notes and memos were recorded immediately following each interview, with notations on the location of the interview, the participant’s home environment, as well as participant’s body language, facial expressions and emotional responses, such as tone of voice and affective changes observed during the interview. The researcher’s impressions and feelings during the interview and preliminary thoughts on emerging themes and theoretical assumptions were recorded in a reflexive journal.
Nvivo 2.0 qualitative software was used for coding of the data. Descriptive statistics (mean, median, SD) were calculated for all demographic variables.
Data analysis was conducted based an inductive iterative approach.
In qualitative research, a transcript is necessary to achieve the research goal of capturing participants‟ reconstruction of their lived experience in their own words (Sandelowski, 1994) and to complement the level of analysis involved (Drisko, 1997). Sandelowski (1994) believes that a transcript becomes the researcher‟s raw data by preserving the interview event and which could be utilized for member checking and expert peer review.
If the focus of an analysis is to provide an in-depth description of the knowledge, attitudes, values, beliefs or experiences of an individual, or a group of individuals, then a lengthier and more extensive text is required for the transcript. The interest of researchers goes beyond identifying patterns and salient themes; they also seek to demonstrate variations in the way a phenomenon is framed, articulated and experienced, as well as the relationships within and between particular elements of such a phenomenon (MacLean, Meyer, & Estable, 2004).
As the aim of this hermeneutic phenomenological research was to gain a deeper understanding of women’s feeling after breast reconstruction, every effort was made to capture not only spoken words but also the emotional content of the interviews. Transcripts were transcribed verbatim and included mispronunciations, grammatical errors, vernacular expressions, intonations, slang, and emotional sounds; these were denoted in the transcripts as [crying softly], [laughing softly] or [sounds like nervous laughter] (MacLean et al., 2004). Attention to the expression of idioms is particularly important in phenomenology as they are born out of lived experience (van Manen, 1997).
To improve understanding of the content and affect of the interviews, transcripts included contextual information such as silences or pauses in conversation and background noises, as well as inaudible segments, which were documented in the transcripts as [cannot hear] or [inaudible] (MacLean et al., 2004; McLellan, MacQueen, & Neidig, 2003). Interviews conducted in English were transcribed verbatim by an English-speaking transcriber, The researcher clarified and verified the English transcripts against each interview and made changes as required. For accuracy and quality control purposes, spot-checks were conducted on all transcripts and translated transcripts (McLellan et al., 2003).
Preparation for data analysis begins by orienting oneself to the phenomenon (van Manen, 1997). To accomplish this, the researcher emerged herself in the data by listening to each tape purposefully and reflectively, paying attention to each participant‟s human existence. While listening, the researcher mentally re-lived the interview process; Multi-layered readings allowed a wholistic feeling of the „big picture‟ and ensured no aspects of the phenomenon were omitted.
The researcher individually coded all the transcripts. During the readings, significant phrases, sentences and statements were highlighted and coded, with particular attention paid to recurrent images, repeated words, metaphors or analogies, and contradictions and transitions in the narratives (Ryan & Bernard, 2003); emerging themes were categorized according to the four structures of the lifeworld. Interpretation and meanings were proposed for each statement employing words as close as possible to those voiced by the participants.
Common themes were integrated into the four existential structures that describe the phenomenon , thereby generating a clear structured cognitive framework of the emergent themes; a distinction was made between incidental themes versus essential themes(van Manen, 1997). Constant comparison of the text was undertaken to identify negative cases and compare thematic patterns and commonalities that characterized the phenomenon being studied, and to explain individual variations within each interview as well as all interviews as a whole (Thorne, Kirkham, & O’Flynne-Magee, 2004). Phenomenological investigation entails the art of sensitivity to the subtle undertones of language; this requires the researcher to be a true listener to attune to the deep tonalities of language that normally fall out of the range of accustomed hearing (van Manen, 1997).
5.3.1 Thematic Analysis
This study employed thematic analysis to describe and interpret the internal meaning structures of lived experience or lifeworld. In qualitative research, thematic analysis is the most common approach for data interrogation (Creswell, 1998). According to Luborsky (1993), the significant benefit of utilizing thematic analysis is its direct representation of an individual‟s point of view and descriptions of experiences, beliefs and perceptions.
In phenomenology, themes, or existential themes, are viewed as the structures of experience and often described and interpreted within the structures of the four existentials of lifeworld – lived space (spatiality), lived time (temporality), lived body (corporeality), and lived relation (relationality) as the means to ground human experience (van Manen, 1997). In other words, recognizing how and where the data was to be categorized thematically not only helped to integrate the themes into a structured meaning, but also provided a clear structured cognitive framework for the researcher and the reader to understand the textual data (Vis, 2005).
Unlike quantitative research which seeks causal determination, prediction and statistical generalization of findings, the aim of a naturalist, constructive and interpretative inquiry is to solicit rich illumination, understanding and extrapolation from the data generated (Hoepfl, 1997; Polkinghorne, 1989). The issues of validity and reliability are just as important in qualitative studies as in quantitative research to establish truth-value; in qualitative investigations, however, validity and reliability are achieved through the concepts of credibility, transferability, dependability and confirmability (Guba & Lincoln, 1985).
For hermeneutical research, the multiple stages of interpretation that allow patterns to emerge, the discussion of how interpretations arise from the data, and the interpretive process itself are critical ways to ensure rigor (Koch, 1995).Rigor was further enhanced by having two English transcripts randomly selected and reviewed by the thesis supervisor (CW) and a committee member (DH). They each read the transcripts to verify coding accuracy, reviewed the extracted statements as well as the formulated meanings and themes, and provided additional interpretation of the coded data as necessary.
In this study, trustworthiness was addressed through reflexivity, prolonged engagement, interdisciplinary triangulation, negative case analysis, peer debriefing/support and audit trail (Padgett, 1998). Prior to detailed discussion of the techniques employed to establish trustworthiness, I pause to acknowledge the current debate and tension regarding the appropriateness of applying quantitative terminology to establish rigor in qualitative research (Golafshani, 2003) . While prolonged engagement, triangulation and negative case analysis are acceptable techniques to establish rigor in qualitative research (Guba & Lincoln, 1985), there is, however, an acknowledged need for qualitative researchers to define the meanings of these techniques within the paradigm (Babour, 1998). Therefore, interpretation of the techniques applied in this hermeneutic phenomenological research is explained.
Ethics approval was sought and obtained from the Research Ethics Board to conduct the thesis research at Spire Cardiff Hospital. Administrative ethics approval was also sought and obtained from the Office of Research Ethics in Wales for thesis research.
Participants who met the inclusion criteria were contacted by the researcher to introduce the study, provide written details of the investigation and obtain their consent to participate in the study. The consent form in English described the study and its objectives, the potential risks and benefits to participants, and the safeguards to maintain confidentiality of data. The consent form also advised participants that they could withdraw from the study at any time without compromising their clinical care.
The risk to the participants in this study was limited to possible psychological or emotional discomfort when sharing their experiences; in such cases, the interview would be suspended and participants offered the option of continuing or terminating the interview, as well as a referral to the Spire Cardiff Hospital Psychosocial Oncology and Palliative Care Program for professional support. Benefits of the study are its contribution to both the development of culturally sensitive psychosocial/supportive care interventions and the knowledge-building process regarding the women’s
experiences after breast reconstruction.
To protect the confidentiality of participants, an identifying number was assigned to digitally recorded interviews. All patient identifying information was deleted before they were forwarded to a secured e-mail account for transcription. To ensure security, digital audio recordings were stored in the researcher’s locked office and transcribed data password protected. Participants were assured that their decision to participate, or not would in no way affect their follow up or future treatment and care at the hospital. Participants were referred to another breast site social worker for psychosocial care as appropriate.
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