Descripción de los instrumentos de recogida y análisis de datos

Trustworthiness is an important concept in establishing the quality and worth of a qualitative research study. Lincoln and Guba (1985) highlighted the importance of the following four items in establishing the trustworthiness in qualitative research, credibility, transferability, dependability, and confirmability. The following section describes the strategies utilized to address these important issues throughout this study.

3.4.1. Credibility (internal validity)

Credibility is concerned with the degree of confidence in the ‘truth’ of the study findings (Holloway and Wheeler 2002; Macnee and McCabe 2008). It addresses how plausible the research findings are in representing the perspectives of the participants (Graneheim and Lundman 2004; Lincoln and Guba 1985) and as such addresses issues of rigor in the research process and the accuracy of presenting what was done (Gasson 2004). Polit and Hungler (1999) suggest that issues of credibility start with the study focus and on how well the design, conduct, and analysis address this intended focus.

3.4.1.1. Prolonged engagement and persistent observation

Prolonged engagement was an important strategy used to ensure a rich and thick description of the case study site could be elicited. Prolonged engagement involves the researcher spending sufficient time at the study site to gain appropriate insight into the phenomenon under study.

This can involve time observing, meeting and developing relationships and rapport with individuals at the site. Such rapport can be important in facilitating the co-construction of meaning that occurs when a researcher and participant engage in the interview process. An important aspect of prolonged engagement is that it opens the researcher to the multiple perspectives, participants, and contextual factors at play within the site.

The researcher attended the study site repeatedly throughout the year. The duration of site visits ranging from 3-7 days. The initial visits involved meetings with the site gatekeeper, university personnel, clinic personnel, and included a tour of the facilities at the student-run clinic. The purpose of this visit was to develop trust, discuss the study and address any questions. Three visits, spread over a six-month period, involved data collection in the form of interviews with key stakeholders and document retrieval. The final visit involved feedback to the study site.

3.4.1.2. Triangulation

Triangulation involves the use of multiple data sources to enhance understanding of the phenomenon of interest (Denzin 1978). The use of triangulation can assist in ensuring the researcher’s account is both comprehensive and rich, developing both breadth and depth of understanding of the phenomenon.

Several types of triangulation have been identified including; triangulation of methods, sources, analyst, and theory/perspective (Denzin 1978; Patton 1999).

This study has used triangulation of methods and sources to assist with study credibility Using both semi-structured interviews and document analysis provided opportunity to examine the consistency of findings generated by these different data collection methods. Faculty interviews were used for the purpose of triangulation of the student data. Choosing participants with varied experiences allowed the researcher to explore different aspects of the clinic, and different viewpoints and perspectives (Adler and Adler 1987) potentially adding a richer variation in the data (Graneheim and Lundman 2004). Triangulation of sources allowed the opportunity to examine the consistency of different data sources within the same data collection method (Patton 1999).

3.4.1.3. Peer debriefing

“A process of exposing oneself to a disinterested peer in a manner paralleling an analytical session and for the purpose of exploring aspects of the inquiry that might otherwise remain only implicit within the inquirer’s mind” (Lincoln and Guba 1985, p.308). It is argued that this has been an on-going process throughout the planning and conduct of this study. The role of the de-briefer has been played by the research supervisors and has been conducted through research supervisory meetings. The research supervisors have challenged the researcher’s perspectives and assumptions, and afforded opportunities for testing and defending the process, justifications for, and product of the study design, data collection, and analysis. This has provided opportunity for the researcher to reflect upon their decisions throughout the research process and defend their stance on emergent concepts and ideas.

3.4.1.4. Negative case analysis

This involves searching for and discussing elements of the data that do not support or appear to contradict patterns or explanations that are emerging from the data. This is an interesting topic with regards to the empirical realist stance adopted in this study. Such an approach accepts the diversity of outcomes that can be generated by a programme and is innately focused on the search for that which is specific and that which may be

generalizable. The unique and different experiences and outcomes of individuals triggered the search for explanation, involving an examination of the interaction of mechanisms and contexts that may produce diverse outcomes. As such the search for an explanation of deviant cases is an essential component of the realist approach adopted in this study.

The process of CMO theory development started with identification of programme outcomes. These were then traced back within the data to identify the mechanisms and contexts that produced these outcomes. This approach was thought to permit the identification of potentially different responses for participants to the same context or

mechanism resource. Holding to a realist approach, alternate responses were sought out and all identified responses were recorded through the analysis process.

3.4.2. Transferability (external validity)

Transferability addresses the degree to which the study findings are applicable to other times, settings, situations, groups, or people (Polit and Hungler 1999). Gasson (2004) suggests that it pertains to the extent to which a researcher can claim that his/her findings may be generally applicable. To address this issue it is imperative that the researcher provides a clear and detailed description of the study including the setting, participants, data collection, and analysis process (Lincoln and Guba 1985).

3.4.2.1. Thick description

In this study the issue of transferability was addressed through the strategy of thick description. Originating in the work of Ryle (1949) the term thick description is used to describe the rich and detailed account provided by the researcher. Such an account details the study and the phenomenon in such a manner that it allows others to evaluate the degree to which the study findings may be transferable.

3.4.3. Dependability (reliability)

Dependability asks if the findings are shown to be consistent and repeatable (Lincoln and Guba 1985). It involves careful documentation of the research process. Detailing the emerging design, research activities, and paying careful attention to consistency in the data collection and analysis (Gasson 2004) and requires an explicit description of how the study findings were attained. In discussing the issue of trustworthiness in qualitative content analysis Graneheim and Lundman (2004) highlight the potential risk involved in the data reduction and abstraction process and the need for the researcher to be clear in describing the process used to examine the data. The use of framework analysis in this study provided a comprehensive, systematic, and auditable approach to detailing the data analysis

process.

Dependability was also addressed through the provision of a thick description of the research process. As discussed earlier, this involves the presentation of a detailed and comprehensive description of the research process and justifications for the decisions made. The external audit of the process and product of the research study provided by the research supervisors also assisted in addressing the issue of dependability.

3.4.4. Confirmability (objectivity)

Confirmability addresses the degree to which the study findings are shaped by participants and not by the researcher. It is concerned with neutrality and the degree to which the study findings represent the phenomenon being studied rather than the interests or biases of the researcher (Lincoln and Guba 1985; Gasson 2004). Triangulation and external audit can

assist in addressing confirmability and were used in this study. In addition, reflexivity was an important strategy adopted in the study.

3.4.4.1. Reflexivity

Reflexivity is described as an attitude of the researcher involving the systematic

examination of the context in which knowledge construction is occurring and the impact of the researcher herself on the research process and product. Malterud (2001) suggests that innate characteristics, beliefs, values and experiences the researcher brings to any

investigation will inevitably impact the study topic selection, approach, methods, conduct, interpretation, and representation. A reflexive diary was used throughout the entire research process. This diary contains records of decisions made and the reasoning for such

decisions, information on the process of the study, reflections on how various stages of the study were progressing, assumptions that were uncovered, notes on the relationship between the researcher and the participants during data collection, questions that occurred to the researcher and possible answers to such questions, along with general thoughts, ideas, and annotations. This diary has been of immense value to the researcher in the writing of this thesis as it details the research journey from the inception of the original research idea to the completion of the thesis.