Cambios que se producen a consecuencia del cáncer

Documentary analysis is the first of six methods used in this study for researching

the pre-travel health consultation. Each method builds sequentially upon the

others to answer the research questions, and documentary analysis is therefore a

foundation for the subsequent methods. This method draws on the official

guidance for pre-travel health care produced by three national and one

international health departments for health professionals. It therefore represents

Justification for this method comes from Blaxter et al (2001:171), whose reasons

for the use of existing data, include: “Because they may confirm, modify or

contradict your findings”. May (1993), cited in Blaxter et al (2001:207) claims that

documents “...do not simply reflect, but also construct social reality...”, and one

purpose of analysing these documents was to determine the extent to which

expert opinion influences the pre-travel health consultation led by nurses. A benefit

of documentary research in this instance is the ease of availability of official

guidance on pre-travel health services, which are in the public domain and freely

accessible through the Internet. Other advantages include cost effectiveness for

the researcher, and the permanence of the data, which can strengthen the validity

of research findings because the documents are available for scrutiny by others.

Bowling (2002:417) refers to the “relative non-reactivity” of documents with the

researcher as an additional advantage, suggesting that researcher-induced bias is

minimised because the data already exists.

Despite such clear support and justification for documentary research, potential

pitfalls and problems can occur. Cohen and Manion (1994) cite issues of

availability, authenticity, sampling, inference and interpretation when using

documents as data, and these were duly noted. Inference and interpretation are

the two factors that are likely to be issues with the data, but that could be argued

to be the case for any method of data analysis. Sapsford and Abbott (1992:85)

question the validity of findings based on the “...use of what is available, even if it does not quite match up to what we need”.

This summarises a real issue for this research proposal: there is very little official

or research-based guidance on the management of pre-travel health care,

authors without particular justification. By analysing the official guidance, it is

possible to identify the priorities that have filtered their way up to government

health department level, to examine the congruence and differences between

countries, and the presence of any value-laden messages. These documents

represent what Sim and Wright (2000:61) call a “professional orthodoxy” framed in

“objective terms”, which lack scrutiny and are largely unquestioned in the travel

health literature.

Only a few official guidelines for pre-travel health care exist. In this sense, ‘official’

means that they are published by the government health department for a

particular country or by the WHO for many countries. They are intended to guide

pre-travel health service provision, are written by a group of experts rather than an

individual, and as such have been through processes of scrutiny and consensus-

gathering likely to exceed that of a peer-reviewed article.

The term ‘expert’ deserves definition here. There is no standard qualification that

bestows the status of ‘expert’ upon an individual within travel health. For the

purpose of this methodology, ‘experts’ were therefore taken to be the contributors

to the documents analysed in this method, and they are detailed in the findings of

Chapter 4, Phase One: What do the experts say?

Sampling and selection

The criteria for selecting the documentary sources were that they:

• were official publications by an official or government health department for a

region,

country or group of countries

• had a target audience of health care professionals

• made reference to structures, processes or outcomes associated with pre-

travel health care

• were published in the English language

• were obtainable by the researcher

• were currently in use and the most recent edition at the time of analysis.

Using these criteria, guidance documents from four different government agencies

were identified.

UK:

Department of Health (2001a) Health Information for Overseas Travel. London:

The Stationery Office.

USA:

Centres for Disease Control and Prevention (2005) Health Information for

International Travel 2005–2006. Atlanta: US Department of Health and Human

Services, Public Health Service.

Canada:

Committee to Advise on Tropical Medicine and Travel (CATMAT) (1999)

Guidelines for the Practice of Travel Medicine. An Advisory Committee Statement

(ACS). Canada Communicable Disease Report, Vol. 25 (ACS-6) 01/12/99, pp 1–6,

and an associated update: Committee to Advise on Tropical Medicine and Travel

(CATMAT) (2003) Statement on Ethics and Travel. An Advisory Committee

Statement (ACS). Canada Communicable Disease Report, Vol. 29 (ACS-9)

01/10/03, pp 1–8.

WHO:

Data collection and analysis

The data were collected and analysed between July and September 2006

employing content analysis, as derived from Glaser and Strauss (1967). The

process of analysis was to:

1. read each document, noting initial thoughts on any emerging categories, as

well as labelling content that fitted into Donabedian’s Structures, Processes,

Outcomes framework.

2. Re-read the documents to review and refine the categories.

3. Analyse each document against those categories to test and finalise them.

4. Compare and contrast findings of the different documents, looking for

commonalities and differences, gaps and overlaps.

5. Extract and identify over-arching themes, and to synthesise the findings.

6. Interpret the findings, relating them to the research questions.

Analysis was informed by Denscombe’s (2003:222) specifications on what content

analysis of documents can achieve, as identified in Table 2.

Table 2: Document content analysis (Denscombe, 2003:222).

Content analysis reveals... ...by measuring

What the text establishes as relevant

The priorities portrayed through the text

The values conveyed in the text

How ideas are related

What is contained (e.g. particular relevant words, ideas)

How frequently it occurs; in what the text order it occurs (sic)

Positive and negative views on things

Proximity of ideas within the text, logical association