The methodological limitations thought to affect each phase of the PoW are discussed.
Each of the methods used within the individual phases have their own limitations.
However as discussed in section 3.9 Robustness of research across PoW, the strengths of each phase offset the limitations of others, which is one of the benefits of using a mixed methods approach to research. Despite the strengths of the mixed methods approach, there are also challenges. Using a mixed methods approach meant that the researcher required training to learn a new set of skills for different methods both
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qualitative and quantitative. This was time consuming, but necessary to ensure that each phase of the PoW was carried out correctly.
There is an inherent risk of bias during qualitative interviews or focus groups. This was particularly relevant in phases 1 and 4 where qualitative interviewing techniques were used. The researcher has worked as a hospital pharmacist and having experience in the field under investigation, leads to the researcher having preconceptions. This was also a consideration in phase 4, due to the researcher’s involvement in the development of the new model of care. Although this bias can not be removed, numerous strategies were employed throughout the PoW to reduce the risk of bias. These have been discussed throughout this thesis. One particular strategy to reduce bias was the inclusion of the supervisory team throughout planning and data analysis. The team included three pharmacists from varied backgrounds, one with a background in psychology. This variety helped to provide differing viewpoints throughout the process.
The interviews were conducted in a way to minimise bias from the interviewer which could adversely affect the study. The researcher kept an open manner throughout each interview, setting aside any preconceptions as much as possible. Questions were asked in an impartial manner and properly explained to all participants to avoid being misleading. The researcher’s background as a hospital pharmacist was beneficial to assist with understanding of any terminology used by the expert participants during the interviews.
Reflexivity of the researcher was a key component of carrying out the qualitative phases of the research. This is introduced earlier in this chapter (see section 3.10 Reflexivity). A reflexive paragraph within the findings chapters for phases 1 and 4 will overview the specific impact of the researcher on the findings and vice versa within the individual phases.
A common problem with research is that participants may be reluctant to discuss certain issues because they are concerned about confidentiality, causing problems or distress
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for themselves or others. Equally, participants may want to give socially desirable responses to be viewed favourably by others. These types of responses from participants could lead to misrepresentative data being collected. This could apply to the interviews or focus groups, but also when respondents are completing questionnaires. This was not a serious threat to this study, as the topic was not considered sensitive. Nevertheless, during all correspondence and at the beginning of each interview, focus group or prior to respondents completing the questionnaire, the researcher ensured that participants knew information was confidential. During all phases, participants were informed how their responses may impact future models of discharge care to encourage honest responses.
Response bias can also be an issue if questions are not carefully constructed. Care was taken when developing the questionnaire to avoid leading questions and minimise bias.
Care was also taken by the researcher during the interviews and focus groups to follow the wording of questions on the interview schedule or topic guide to ensure all questions were asked clearly and consistently.
Not all participants answered every question, which could lead to some response bias for individual questions. It is not possible to know whether all possible patients were approached to participate. This is due to the fact that individual ward gatekeepers directed the researcher to the appropriate patients. This may have affected the study response rate and contributed some response bias. However, a representative sample of patients awaiting discharge was thought to have been achieved.
Achieving true integration of the different types of data, both qualitative and quantitative, can be difficult. It requires innovative thinking to move between different types of data and make meaningful links between them.(151) The findings from phases 1 and 2 were from different sources and used different methods and therefore made comparisons challenging during triangulation. Reflecting on the PoW findings, the results complement each other enough to have informed the development of the new model of care and integration of data has therefore been achieved.
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Finally, the PoW has addressed the overall aim of the study, which was to provide the evidence to develop an innovative model of care for patient discharge from hospital.
This PoW was not the only way that the aim could have been achieved. The most appropriate and feasible methods were chosen by the researcher to carry out the study at the time. Other options were available, for example, further information could have been sought about the current discharge process from other stakeholders in the early phases of the PoW. This however would not have been manageable within the time constraints of this PhD. The researcher chose the participants from phases 1 and 2 as they were thought to provide the most important and useful information.
Chapter summary
This chapter gave an overview of the PoW, before describing how the individual phases within the PoW were undertaken and the rationale for each. This included ethical issues and limitations of the study. The following four chapters will discuss the four individual phases of the PoW, along with their findings in detail. This begins with phase 1 findings, which is described in chapter 4.
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