Consideraciones acerca del impacto y éxito del Proyecto

Interpretative phenomenological analysis was chosen as the research approach for the primary research study, where the lived experience of falls among older people with dementia and their carers is explored. Interpretative phenomenological analysis (IPA) is a relatively recent hermeneutic phenomenological research approach of increasing popularity in the UK, especially in health care research. It was developed by Smith in the 1990’s as an alternative approach to quantitative research approaches in psychology (Smith 1996). Smith argued for the need to understand the micro-perspective rather than the macro-perspective of a phenomenon, so that the experiences of individuals and their perceptions of events/phenomena are explored rather than their social or cultural construction (Smith 1996).

Even though IPA is an approach developed within health psychology, it is attractive to allied health care professionals as it allows a deeper exploration and understanding of the perspectives of individual clients as well as complementing bio-psycho-social theories of health and functioning (Reid et al 2005, Biggerstaff and Thompson 2008, Clarke 2009). The adoption of IPA by

“applied psychological” disciplines such as occupational therapy, is acknowledged by Smith et al (2009) as it is recognised that these disciplines have “a core interest in the human predicament” (Smith et al 2009 p5). As a hermeneutic research approach, interpretation in IPA is reliant upon the ability of participants to articulate their thoughts and experiences and also by the

researcher’s ability to reflect, analyse and interpret these appropriately (Brocki and Wearden 2006). IPA also has a strong idiographic emphasis in that it aims for a detailed analysis of one case before attending to analysis of further cases analysed in the same detailed way. The aim is for “thick” interpretation of participants’ accounts so that both the unique and the shared perspective is communicated, which Osborn and Smith (2008) consider of particular relevance where the topic under scrutiny is under-researched, multifaceted and contextual. The emphasis of IPA on trying to uncover or illuminate the unique and shared subjective experiences of individuals experiencing a phenomenon such as falls, dementia or caring has made IPA an appropriate approach to address the primary research question.

As an approach, IPA is continuously developing. Indeed since starting this study and collecting data, the corpus of IPA studies and literature has expanded considerably, the guidelines for sample size and data analysis have also changed subtly and a recent publication of quality criteria for IPA research has been proposed by Smith (2011). Initial publications focussed on the method of carrying out an IPA study (e.g. Smith 1996, Smith et al 1997, Smith et al 1999), and more recently the philosophical basis of IPA has been discussed within the literature (Smith 2004, Larkin et al 2006, Eatough and Smith 2008, Smith et al 2009). Consequently there are some studies published which emphasise IPA as a method of thematic data analysis (Chapman and Ogden 2009, May and Rugg 2010) with little evidence of the idiographic nature of an IPA study or a basis in a phenomenological research approach. Indeed Smith et al (2009) suggest that the data analysis method used is similar to that used in other approaches and is not specific to IPA. However, Smith and colleagues (2009) have more clearly defined the interpretive emphasis of IPA and along with this have developed their guidance on how and where to use IPA in research. Different methods of data analysis from the original description by Smith (1996) are now suggested alongside a recommendation for smaller numbers of participants. The method used in this primary study reflects the earlier recommended sample size and method of data analysis, because of the timescale of the project and the inter-relationship of this study with the secondary study (to be discussed in section 4.4). However, Smith et al (2009) emphasised that no one method of analysis is

preferable. Traditionally IPA research has used one to one (face to face) interviews with participants, and early IPA work using repeat interviews and focus groups could be seen to be exploratory in their design and undertaking (for example, Flowers et al 2003). As IPA research studies are published, so they evolve, with Smith and colleagues more recently advocating the single case and smaller numbers of participants to allow for a deeper and more idiographic and linguistic interpretation of the data (Eatough and Smith 2008, Smith et al 2009). These data collection methods will be discussed in more detail in both the methods and findings chapters.

Early IPA literature identifies Husserl, Heidegger, symbolic interactionism, social cognition and idiography as providing the theoretical basis for the approach (Smith 1996, 2004). Smith et al (1997) identified the influence of Bruner (1990), an early symbolic interactionist within IPA research on the meanings individuals make of, and what can be interpreted from their experiences. As already stated, the idiographic emphasis has been strengthened in more recent discussions of ways of carrying out IPA research, with smaller numbers of participants recommended and more in depth analysis of each case (Eatough and Smith 2008, Osborn and Smith 2008, Smith et al 2009, Smith 2011).

Larkin et al (2006) identified the theoretical underpinning of IPA as being mainly Heideggerian but state that this is not prescriptive. More recent literature also cites influences from Merleau-Ponty, Gadamer and Sartre (Smith et al 2009).

Even though Smith (2004) considered IPA as part of a phenomenological research ‘stable’, many of these approaches differ from IPA in that they are based upon more specific phenomenological philosophies as already discussed in section 4.2.2. IPA draws from Husserl in his concern for the lifeworld and the importance of bracketing or epoché, even if this has different relevance in IPA research. Heidegger has perhaps provided the major influence to IPA (as he has to other hermeneutic phenomenological research approaches) in the contextual understanding of dasein, in proposing that we are beings in the world with others and therefore our experiences are always open to interpretation.

Whereas Husserl and Heidegger are perhaps the crucial influences on how an IPA study is constructed, how participants are selected, the data collected and analysed; the influences of other philosophers may vary. For example an IPA

study that explores the experiences of relationships (being a daughter, carer, mother), may draw more on the philosophy of Sartre, whereas an IPA study carried out by a psychoanalytic researcher may be influenced by Ricœur. These philosophers, along with Gadamer also influence how an IPA study is carried out and especially how the hermeneutic circle influences how data are analysed. For IPA research that considers the embodied experience of living with a health condition such as dementia (Clare 2003), multiple sclerosis (Reynolds and Prior 2003) and back pain (Osborn and Smith 1998) the influence of Merleau-Ponty reminds the researcher that they can be empathic to the participant but never fully share their experience. Merleau-Ponty’s philosophy enables the researcher to interpret and communicate the subjective and idiographic nature of the experience from an empathic perspective.

In conclusion, IPA has been chosen to answer research question one, where the experiences of falling by older people with dementia and their carers are to be explored. It is felt that IPA as a research approach enables a deeper understanding of individual and unique experiences as well as common themes of meaning. It also acknowledges the role of the researcher in the interpretation of the data presented. IPA, like other hermeneutic phenomenological approaches (and indeed other qualitative approaches), does not seek to generalise to other contexts but has been identified as a useful tool to “reflect upon and evaluate practice” (Taylor 2007 p90). It sits between the realist and idealist/relativist divide (Larkin et al 2006, Eatough and Smith 2008) and indeed is perceived as taking a contextualist position (Larkin et al 2006). Even though IPA research has an interest in language (like discourse analysis), the IPA researcher is more interested in understanding the meanings within the language used by participants when talking about their experiences rather than construction or social discourses of language (Flowers et al 2003). However, there could be considered to be many similarities between IPA and narrative analysis, as both consider the meaning making within a narrative or story.

Conversely, narrative analysis differs from IPA in that it has many different forms of analysis including that which focuses on story, plot, and characters and therefore looks very different from an IPA study (Holloway 2010).

As someone more familiar to quantitative and positivist research prior to commencing the study, the clear guidance in carrying out a specific approach provided by qualitative researchers can be important, and both grounded theory and IPA provided this when this study was being planned and initiated.

However, grounded theory attempts to generate a general and theoretical account of a topic and does not allow for the unique and individual converging and diverging experiences of individuals to be presented (Smith et al 2009). It is suggested that although there are similarities in the method of data analysis between IPA and grounded theory, IPA seeks to explore psychological questions through its interest in the nature of a phenomenon whereas grounded theory asks sociological questions and considers the social processes that create or are associated with a phenomena (Willig 2008).

This section has introduced interpretative phenomenological analysis (IPA) as the research approach of choice to answer the primary research question “What are the experiences of falls by older people with dementia and their carers?”

The processes involved in carrying out an IPA study will be discussed in the next chapter.

4.4 Justification of methodology for secondary research question - “How