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Quantitative data from the questionnaires will be subject to two forms of analysis: (a) descriptive statistics to summarise data and determine the sample characteristics, and (b) a basic form of exploratory data analysis which uses techniques of visual representation to gain insights into data and identify relationships and features within it.272 Qualitative data will be subject to content analysis to derive an observer-independent account of the interview texts. In contrast to ordinary readings of a text, in which material may be selected to support a hypothesis, content analysis aims to be a systematic method to give equal treatment to all parts of the text, “…to support inferences that go beyond the unaided understanding of a text…”.273

Figure 5: Deductive Content Analysis Process

The purpose of this study is to test the Synoptic Model and we therefore have an existing theoretical model of spirituality that predetermines the

Phenomena of Spirituality Pa ents' Interviews (data) Synop c Model Categories Drawing Inferences Data Coding

variables of interest. This is the basis of Deductive Content Analysis (DCA) and it can be distinguished from inductive forms of content

analysis274(p.404) in which information and insights are derived directly from the data and then compared to relevant theories.275 The Synoptic Model provides a system of categories and their operational definitions that can be applied as codes to the transcribed interview texts that

constitute the units of analysis (see Figure 5). The DCA process followed a close reading of transcripts and the attribution of codes to segments of text that contained information related to the category. Following completion of a first cycle of coding it was evident from the data that a number of sub-categories could be delineated and a remainder of uncoded text could be categorised as ‘Discussing Spirituality’ (see Table 7). All texts were subsequently subject to a second cycle of coding276 to attribute these categories. However, we did not allow what Gläser & Laudel refer to as “inductive corrections” to resolve contradictions between the Synoptic Model and segments of data but noted these for a later stage when decisions could be grounded in all data and theory.277 Finally, the consistency and reliability of coding was checked by an academic supervisor reviewing a sample of coded material.

Primary Categories Sub-Categories

Behaviour and Practice Prayer

Personal Experiences Experiences of God

Experiences of Health Services

Social Engagement Social Experiences

Disease Values and Goals Ways of seeing & responding to the world

Personal Beliefs Belief in God

Discussing Spirituality

Table 7: Primary & sub-categories for coding

Content Analysis is one of the research methods that is supported by the Dedoose application. Texts are imported to the application and then segments of text are coded by the investigator. The application

automatically builds an index of codes, a compilation of excerpts and summary descriptive statistics. Dedoose also supports quantitative data that are imported to the system and connects quantitative and qualitative data by establishing a set of relationships, in this case based upon data relating to individual patients (see Figure 6). A major advantage of using a computer-based system is that it automatically organises data, provides a single place for it all to be stored securely, and enables data to be easily navigated and viewed, thus contributing to the rigour of the analysis. In the early years of what became known as Computer Assisted Qualitative Data Analysis (CAQDAS) there were debates about whether

disadvantages of the software outweighed the advantages, particularly in terms of the time required to become familiar with software and input data, and whether the system imposed constraints on the method. Software has now become increasingly user-orientated and an almost ubiquitous tool of data analysis providing that, “The software is the loom that facilitates the knitting together of the tapestry, but the loom cannot determine the final picture on the tapestry.”278

Qualitative content analysis is highly dependent on the interpretation and the selection of texts to build up the tapestry, and this requires practice in the art of understanding, or hermeneutics. Gadamer, a philosopher of hermeneutics, considers that the human capacity for communication must be understood as more than the ability to signal to one another, but to listen and attend to one another in order to reach an understanding. A concern with things that are not understood lies at the heart of

Gadamder’s explanation of hermeneutics, not just in terms of the

incomprehensible, but the enigmatic human questions about life that the arts and humanities respond to. Gadamer therefore argues that:

Herein consists the universal dimension of hermeneutics, a dimension which encompasses and supports all our reason and thought. It is for this reason that hermeneutics is not an ancillary discipline, serving merely to provide an important methodological framework for various other science. Rather, it extends into the

heart of philosophy, which is not only the study of logical thinking, and the method of inquiry, but a pursuit of the logic of

dialogue.279(p.70)

Hermeneutics as an interpretative art between the text and the reader is therefore an important consideration in content analysis. Ricoeur’s theory of interpretation reminds us that text is removed from the live discourse event (the interview in the case of this study) and that the interpreter is far from naïve but draws upon intuition, experiences, beliefs and prior

knowledge in approaching an understanding.280 Understanding without distortion is a primary aim of content analysis but we should

acknowledge that whilst we seek to be faithful to the text and let it ‘speak’, all hermeneutics involves suspicion (Ricoeur)281 in the sense of being critical of our interpretations and aware that they remain corrigible and incomplete.

In this study the analysis of the qualitative data is driven by a prescribed deductive content analysis process that provides an explicit framework within which to interpret the transcribed interview text. The codes used in the data analysis are derived from the Syntopic Model, which provides both functional and descriptive content to the elements of spirituality being studied, and supports interpretative correspondence between data and the phenomena’s constructs. The attribution of coding through the two cycles of coding are subject to verification by academic supervisors to ensure robust procedural validity and a high level of consistency and reliability in the research findings.

Chapter 6

Findings