Fase de Planificación

“Qualitative research illuminates the less tangible meanings and intricacies of our social world. Applied to the therapy field it offers the possibility of hearing the perceptions and experience of service users.”

(Finlay 2011p8)

The review of the literature in chapter three identified that little research has been carried out into the experiences of falling described by older people with dementia, or their carers. However, the review of the literature in chapter three did identify how the use of a qualitative approach provided greater understanding of older people’s perceptions and uptake of falls interventions.

Evidence from the literature provided in section 4.1 also indicates the advantages of using a qualitative methodology with older people, in terms of recruitment and data collection. In conclusion, it is said that qualitative research allows the researcher to understand the everyday experiences of their participants, offers a brief glimpse of their daily lives, and may challenge assumptions of others (Pope and Mays 2000, Finlay 2011).

In both the primary and secondary studies presented in this thesis, the lived experiences of older people with dementia and their carers of falling are explored. Therefore, a qualitative methodology is the approach of choice within this thesis. The exploration of the participants’ subjective or lived experience (or lifeworlds) of falling are compatible with phenomenological research methods (Langdridge 2007, Holloway and Wheeler 2010, Finlay 2011). Both the primary and secondary studies will be placed within an ontological and epistemological position and the methods of choice will be justified.

4.2.1 Stating the ontological and epistemological position

Choosing an appropriate research method within health and social care research, like any other, is determined by the research question and the ontological beliefs (i.e. views about the nature of the world) that the researcher holds (Finlay 2006). Research has traditionally been considered as residing in two opposing paradigms, and this has been termed as the paradigm or epistemological ‘war’ (Robson 2002 p43). These two paradigms have been classified in differing ways, for example, by methodology as qualitative and quantitative, or by epistemology such as positivist and interpretivist perspectives, or by ontology as realist or relativist (Bhaskar 1979, Finlay 2006).

Whereas quantitative research is said to take place in a positivist or post-positivist paradigm (where the researcher strives for objectivity, impartiality and

truth), qualitative research takes a more interpretivist-constructionist stance where the subjective experiences and meanings of the world are understood to be multiple and contextual and influenced by the researcher’s involvement (Finlay 2006, 2011). Interpretivists are said to trace their roots back to phenomenology and hermeneutics, and focus on how people interpret and make sense of reality (Miller and Crabtree 1999). Intepretivists consider that experiences are contextual, temporal and subjective (Holloway 2008), with “our situatedness determining our understanding” (Finlay 2006 p19).

Constructionists believe that social reality is constructed out of different social perspectives (Avis 2005) and doubt “in the existence of ‘objective’ knowledge”

(Holloway 2008 p48), considering that all knowledge is relative to who and where the knowledge is held. Interpretivists believe in pluralism rather than relativism, so that it is considered that there are multiple and subjective realities and understandings (e.g. of health conditions), with constructionists believing that all social facts (including medical diagnoses) are discovered and created through the application of social norms, which may differ from one social group to another (e.g. dementia, schizophrenia, bipolar disorder) (Avis 2005).

These epistemological beliefs are also informed by the ontological position of the researcher and it is this view of the world that also influences the research approach taken. The ontological stances of realism and relativism are said to be at opposing poles of the ontological debate in research (Finlay 2006).

Researchers that hold a realist position believe that reality exists independently of what we as human beings believe and perceive it to be, and therefore tend to adopt a quantitative approach to research, which links to the view that variables exist independently of human beings and can therefore be measured objectively (Finlay 2011). Whereas relativists consider there are multiple realities that are always open to variation and are socially constructed (Holloway 2008).

Whereas qualitative researchers tend not to adopt a realist position, many do not adopt a relativist position either, and more recently, some researchers have considered that there is a paradigm continuum (Finlay 2011) and have adopted a middle ground in their approaches. Some may have a realist ontological perspective but an interpretivist epistemological perspective. Such researchers would identify themselves as contextualists (Henwood and Pidgeon 1994,

Madill et al 2000, Larkin et al 2006). Madill et al (2000) suggests that contextualist research acknowledges that all knowledge is local, provisional and dependent upon the situation; which varies depending on the context of both data collection and analysis. However, contextualism also accepts that there is a desire for some underlying logical understanding of the phenomenon under scrutiny (Madill et al 2000). For example, there is an acceptance that falls are real events, however how they are experienced are determined by the meanings the individual attributes to their fall and also how they make sense of what has happened. The middle ground perspective has been adopted in this study, and more specifically, contextualism has been adopted as the epistemological basis for this research.

Contextualism could be perceived to be more compatible with health care research, and especially bio-psycho-social models of health and illness such as the ICF (WHO 2001), where it is considered that the experiences of a health condition is determined by who the individual is, what they do, who they have relationships with and where they live. This model is pertinent to the more recent approaches to dementia care (O’Connor et al 2007), and also in falls management where the uptake and adherence of individuals to falls interventions are influenced by their attitudes, their sense of identity and autonomy (Yardley et al 2006a, 2006b).