policy in their areas. They come from the Cancer Control Council, Palliative Care Council, Central Cancer Network, supportive care and DHB organisations. As well as providing a research and policy overview, many of the Case 4 participants have also worked in care giver roles andthus, many also have a community perspective.
The key data collection method for the study is semi-structured interviews with participants from each case perspective. With the cases defined, the next step for outlining the case study design is to consider the research methods. The
following section will explain why qualitative methods were most appropriate for this study, given my research questions and methodology.
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Qualitative research
The case approach was qualitative and the predominant method of data collection was semi-structured interviews. This method was considered appropriate for this study, in order to describe four distinct parts of the cancer care system, and to capture an in-depth understanding of the cancer journey from the perspectives of the participants (Green & Thorogood, 2009). To show how a qualitative approach was the best way of answering the research question, a brief explanation of quantitative methods and their fundamental difference to qualitative methods, is required.
Denzin and Lincoln (2005) have described the focus of quantitative research as: “emphasising the measurement and analysis of causal relationships between variables” (p. 10). Quantitative studies set out to prove or disprove a hypothesis, and emphasise statistical power, reproducibility and generalizability (Patton, 2002). Qualitative research, on the other hand, is concerned with investigating the: “socially constructed nature of reality, the intimate relationship between the researcher and what is studied, and the situational constraints that shape inquiry” (Denzin & Lincoln, 2005, p. 10).
Qualitative methods are best suited to this study as the Māori-centred, critical feminist theory paradigm the research is based on has both transactional and subjectivist epistemology, with recognition that findings are value mediated (Lincoln, Lynham & Guba, 2011). To undertake this study using quantitative methods would place the research in a positivist or post-positivist frame, with objectivist epistemology. Given the subject matter of this study, I would have found it very difficult to keep my own values out of this research. It would be somewhat dishonest to place myself outside the research and pretend that I am not ‘in it’. Indeed, critical theory allows me to be part of the research and to acknowledge my own influences throughout the process (Olesen, 2011).
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Therefore, a case study approach, using semi-structured interviews with a range of participants from different parts of the cancer control continuum, were the chosen methods for this study. The way in which the data were collected is outlined in the following section.
Methods
The final part of this chapter considers the methods used to undertake the study. The data collection methods, analyses and ethical considerations of the research will be outlined.
3.3 Data collection methods
Patton (2002) lists in-depth, open-ended interviews, direct observation and written documents as sources of evidence for qualitative studies. The primary data collection method for this research was in-depth, semi-structured interviews. I also recorded my thoughts about the research as it developed in a reflective journal. The data collection will be presented in two parts, first the patient and whānau case (Case 1) and second, the policy, management, and community cases. All four cases will be brought back together for outlining the transcription, data management and analysis sections.
The reason for breaking the data collection outline into two parts is that this thesis stems from work undertaken as part of a larger project, the Health Research Council funded study ‘Māori with cancer – the role of primary care’ (HRC
09/092B). The patient and whānau interviews were conducted by co-investigators from Kokiri Marae during the early stages of the project and as a member of the project team, I was privileged to analyse this data and be the lead author on the two papers published to date, based on this work (Slater et al, 2013, 2015) (attached as Appendices 2 & 3). At the outset of my doctoral work, it was not
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anticipated that the patient and whānau data would be included in this thesis. However, as the ethic of care framework and cultural safety theory were chosen for this research, it became apparent that the voices of patients and whānau were critical in providing a holistic picture of cancer care for Māori.
After some discussion with the Māori health provider collaborators in the overall study, it was decided that with the verbal consent of the surviving patients and whānau, their findings could also be reported in this thesis. As can be seen in Appendix 5, the patient and whānau consent form does not specify the types of publications their data will be used for, however it was important to me as the author of this work that the participants and their interviewers were happy about the different forums their stories would be presented in. Feedback from this showed that there was support for the findings to be shared through further dissemination in addition to the peer reviewed journal papers and conference proceedings. Therefore, the findings from the patient and whānau interviews were included in this piece of work, so that their stories could be shared and a full picture of the cancer care system presented, with the voices of those at the core of cancer care heard.
The patient and whānau recruitment and interview processes differed from Cases 2-4 in that the interviews were undertaken by interviewers from a Māori health provider organisation, and there were differences in the data collection tools such as the information sheet (Appendix 4), consent form (Appendix 5) and interview schedule (Appendix 6). The interview schedule focussed specifically on the patient and whānau experiencesbased on work conducted by Doherty and Associates (2006), which investigated cancer service availability and experiences of patients and providers
.
Because of the different process used for Case 1, this is first described separately, followed by the process undertaken for Cases 2- 4. For clarity, the data collection process for each case is shown in Table 6.121
Table 6: Data collection process for each case
Process Case 1 Patients and whānau Case 2-4 Community, Managers and Policy
Recruitment Participants identified and contacted by Māori health providers. Information provided by Māori health providers, and interview set up at a time and place convenient to the participants. Consent form completed before interview. Participants identified and contacted by TS
*
Information provided by TS, and interview set up at a time and place convenient to the participants.Consent form completed before interview.
Interviews Interviews conducted by CD and HT from Māori health provider.
All interviews audio recorded.
Interviews conducted by TS following pilot interview.
All interviews audio recorded.
Transcribing Interviews
transcribed by TS
Interviews transcribed by TS
Checking Transcripts checked by participants.
Transcripts checked by participants.