PI 4: ¿Cómo han sido evaluadas estas habilidades?

This study explores the experiences of fathers of children with cancer from within a qualitative framework, which emphasises the understanding of each personal account and the uniqueness of the individual (Speziale & Carpenter, 2003). Qualitative methods can be particularly suited for psychological research questions, such as those of the current study, which involve exploration and analysis of subjective or constructed meaning (Camic, Rhodes, & Yardley, 2003). This chapter lays the foundations for the current study, which has been positioned within social constructionism and narrative theory, by outlining the theoretical background of social constructionism, and the methodology of narrative theory and analysis. The specific methods employed for the current study are then described and finally, the process of data analysis is discussed.

Theoretical Framework: Social Constructionism

This study employs a social constructionist approach. Social constructionism is interested in the ways in which social phenomena are constructed: how people go about describing and understanding themselves and their surroundings (Gergen, 1985). The focus is on understanding what is achieved by constructing a phenomenon in a particular way, rather than understanding objectively exactly what a phenomena

‘is’.

Social constructionism emphasises the importance of culture and context in the construction of knowledge and an individual’s understanding of society. Meaning is

constructed by drawing on one’s social, cultural, and historical contexts, normative

rules (shared understandings in the community), and through interactions among people (Gergen, 1985; Squire, 2000). These influences act firstly on the person telling their story, and secondly on the researcher as they create the research. In this way, language is understood to be a social action and consequently cannot passively or objectively reflect reality in a way that is free from societal values (Gergen, 1985; Gergen, 1999). This complex and multifaceted approach to meaning making is particularly relevant in an exploration of human experience. The purpose of knowledge then is to make clear the processes by which people come to represent their world and to describe common versions of understanding (Gergen, 1985).

25 There were three main reasons for choosing a social constructionist approach. Firstly, I wanted to explore how fathers of children with cancer chose to shape their narratives and to examine their use of language as a tool in the meaning-making process. Secondly, I wanted to be able to acknowledge the impact of cultural and

societal views on fathers’ narratives and how perceived expectations about fatherhood

and masculinity might influence the way narratives were shared and whether they were deemed acceptable or not. Thirdly, I had an interest in the social construction of a

sense of self throughout fathers’ accounts of their experiences. I wanted to explore the ways in which fathers’ constructed a sense of themselves as a father and as a man, and how this was challenged and shaped throughout the cancer journey.

Methodology: Narrative Inquiry

The construction of narratives is a means by which people make sense of their experiences (Bruner, 1990). Accordingly, narrative inquiry aims to explore the ways in which participants use narratives to understand and create meaning around their lives (Parker, 2005). Narrative inquiry methodology was chosen as it provided the opportunity to go beyond a thematic analysis of the data, and to examine the ways in which fathers used narratives to develop a coherent account of their experiences, position themselves in relation to others, and reconstruct a sense of self through becoming the main character in their own narrative. Narrative methodology also provided an opportunity to look at narratives within their social, cultural, and historical context.

What are narratives?

The term ‘narrative’ encompasses far more than the term ‘story’ as it takes into

account the purpose, context, and features of the narrative. A narrative has a number of distinctive features: it is an account of events that have occurred, or are expected to occur, and it is coherent, causal, and structured (Denzin, 1989; Murray, 2003). A narrative is a story which constructs a series of past events to give them meaning for the narrator and his or her listener (Denzin, 1989). Narratives are often regarded as the primary means through which human experience and identity are constructed, described, and understood (Linde, 1993; Maitlis, 2012). As such, narratives represent a

social construction of the narrator’s world, and a way of establishing connections

between thoughts, feelings, actions, and events (Gergen, 1999). Therefore, within

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numerous accounts are possible (Dean, 1998). Events are continually re-scripted in light of new experiences and understandings of the world (Andrews, 2008) and thus narratives provide a window into the narrator’s representation of an event at a particular point in time. Interpretations are unavoidable because narratives are

personal representations of what happens in the world, and the narrator’s agency and

imagination determines the plotline and what is emphasised and excluded in the stories they tell (Riessman, 2003).

Narratives are not merely a reflection of experiences in the world, they are constructed, creative, rhetorical, and full of assumptions (Riessman, 2001). Narrative methodology acknowledges that an account of experiences cannot be separated from the context, culture, and language it is created in. Narratives are constrained by

societal and cultural structures, as well as an individual’s linguistic skills and available

resources (Berger & Luckmann, 1967). Within the narrative framework, all stories are assumed to have been shaped by societal and cultural influences (Squire, 2000). Narratives can also be seen to have a dramatic quality: they are comprised of settings, actors, plot, conflict, and resolution (Gergen & Gergen, 1984; Mishler, 1986). Narrators select these narrative features in relation to their own understanding of the event and also how they would like their listeners to understand the event.

Narratives can be useful in creating connections between the ordinary and the extraordinary (McCance, McKenna, & Boore, 2001), and are often formed to explain

particular experiences in a person’s life where they have experienced a breach between their ideals and reality, or their self and society (Riessman, 1993). In light of this, narratives are particularly relevant in the context of disruptive or life-altering events such as chronic illness, infertility, or divorce, when a person may feel compelled to create meaning as a means of coping with hardship or suffering (Riessman, 2003). Accordingly, narratives are an opportunity to gain a greater understanding of the experiences of chronically ill patients and their families (McCance et al., 2001). Chronic illnesses, such as paediatric cancer, can severely disrupt lives and there is often a demand from friends and family to know what happened and what this all means (Charmaz, 1991; Riessman, 2001). Patients with incurable diseases and their families may construct restitution plots suggesting an optimistic end, or chaos narratives suggesting no continuity between the past and a blurred future (Riessman, 2001). In turn, health professionals may create narratives of hope or of a foreshortened future (Good, Munakata, Kobayashi, Mattingly, & Good, 1994).

The use of narrative methodologies to explore illness experiences (and inform

27 stories, capturing the complex and contextual nature of their experiences (McCance et al., 2001). Personal narratives can provide a unique window into the meanings a person has constructed around their experiences, and the ways they conceptualise what has happened to them. In the case of childhood cancer, narratives from fathers of children with cancer may provide insights into how they experienced their child’s cancer, and how they see the future and themselves.

Narrative interviews

Within the research context, personal narratives are predominantly collected through the use of one-on-one interviews between the researcher and participants. In some interviews, researchers often dictate the ideas and themes explored through careful wording and selection of questions and topics to be directed at the participant. Conversely, during a narrative interview a potentially more unstructured and in-depth approach is taken in which the interviewer asks open-ended and broad questions

inviting a participant to tell a story about a significant event in their life: “Can you tell me about…” or “What happened then?” (Riessman, 2001). In this way, narrative accounts are prioritised and the participant is given freedom to share as little or as much as they would like and are invited to guide the ideas and themes discussed within the interview. This largely unstructured interview format is perceived as one of the best ways to

reveal a participant’s narrative perspective, as the spontaneous language they use to narrate events is viewed as a medium of exchange that works to construct and convey their worldview (Riessman, 2001).

While narrative interviewing is not a suitable approach when canvassing large groups of participants, its strength is in providing in-depth accounts of lived experience, a strength which is well-suited to the current study. Furthermore, the narrative interviewing process brings an awareness of the process of creating and re-creating ourselves through talk, and the importance of understanding ourselves through stories. Narrative interviews can also encourage both the narrator and the listener to challenge their view of themselves and the world around them.

Narrative analysis

In the human sciences, narrative analysis refers to a diverse group of approaches that have in common their focus on narrative texts (Riessman, 2003). Narrative analysis investigates the story itself and asks, what was told and why was it told that way? This kind of research aims to explore patterns of meaning making and

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interpretations of events across narratives. It examines participants’ narratives and

analyses how they are constructed, the social, linguistic, and cultural resources they draw upon, and how the storyteller convinces the audience of authenticity (Riessman, 2003). Traditional approaches to qualitative analysis often fragment participants’ accounts, taking pieces out of context and removing the structure and sequence of events (Riessman, 2003). In contrast, a narrative approach identifies longer stretches of storied talk to analyse, recognising that details are embedded within a cultural context and structured in a particular way to create meaning for the storyteller and their listeners (Riessman, 2003). Thus an investigator’s job is to respect, examine, and

analyse a participant’s storied construction of meaning. Narrative analysis can highlight

personal and collective meanings, as well as some of the social and interactional processes that shape life and human relationships (Laslett, 1999). Essentially,

narrative analysis is an interpretation of a narrator’s account of their experience.

Narrative analysis is governed by a number of founding assumptions about the nature of narratives (Riessman, 2001). Firstly, narrative analysis is subjective and positional, rather than objective. Researchers do not have direct access to the

experiences of participants, but deal with the participant’s interpretation of events - an ambiguous representation of that person’s reality (Riessman, 2003). Creating a narrative requires an interactive process between the narrator and listener, and likewise, analysis of that narrative requires interpretation by the researcher (Riessman, 2003). Secondly, narratives are fluid, evolving, and influenced by subsequent life

events. Each narrative provides a unique window into a person’s formations at a

particular point in time. Consequently, understandings generated by narrative analysis are seen to be bounded by the context of the narrative, and are not assumed to be true across different times, places, and cultures. Thirdly, it is assumed that the trustworthiness of narratives cannot be determined by traditional criteria, as there is no established or formulaic approach to the validation of interpretative work. Thus care must be taken in narrative analysis to establish trustworthiness in other ways

(discussed below in the ‘Issues of reliability and validity’ section). Finally, narrative analysis is seen to enable the systematic study of individual meaning and experience through narratives. Researchers are able to study the self-shaping and active characteristics of human storytelling and the expression of personal identity through the powerful medium of narratives (Hinchman & Hinchman, 1997; Polkinghorne, 1995).

Narrative analysis can work to generate an integrated story as well as individual case studies of each participant in the study (McCance et al., 2001; Polkinghorne, 1995). For the purposes of data analysis, a full transcription of interviews is recorded.

29 Then, the boundaries, context, and structure of each narrative are identified (Riessman, 2004). Each element of a narrative’s structure can be seen to have a function. According to Riessman (2003), a fully formed narrative has six structural elements: an abstract, orientation, complicating action, evaluation, resolution, and coda. These elements can be used to construct a sequential story and an evaluation of

events within the narrator’s world, and therefore may provide a useful lens for

dissecting and evaluating narratives during analysis.

Alongside a possible focus on structure, an analysis can focus on an exploration of themes across narratives (Riessman, 2004). A thematic-based analysis of narratives can provide useful information about similarities and differences in content and what the narrator deems important to convey to the listener. Furthermore, the language of each narrative can also be analysed and compared, as language is seen as a major cultural resource that participants strategically use to construct an account of their identity and reality through social interaction (Riessman, 2004). Finally, a narrative analysis can also focus on the concept of character – the ways in which narrators portray themselves as performing particular roles, or establish and express different identities through particular actions, choices, behaviours, or relationships with other characters in the narrative. Narrative analysis through this lens can provide a dynamic approach to understanding identity and the process of creating meaning in our ever- changing world (Murray, 2003). Examining narratives through an analysis of character

may provide rich insight into the narrator’s constructed sense of self, identities, roles,

and the influences that their cultural context may have on these constructions. In the

current study, participants’ understandings of what it means to be a father and a man may be embedded within narratives of their experiences during their child’s cancer

diagnosis and treatment.

A narrative analytical approach assumes that a storyteller has strategically created their narrative and it is up to the researcher to uncover and analyse the story

as a reconstruction of the narrator’s lived experience (Riessman, 2004). Consequently,

the development of an overarching, integrative narrative from a number of participants’

narratives may involve a consideration of how different elements shape their stories: the use of structure, themes, and character by the narrator, as well as the broader influence of cultural context. Narrative research enables the systematic collection and analysis of remarkably rich data that focuses on personal experiences (Lieblich, Tubal- Maschiach, & Zilber, 1998). The analysis of personal narratives can lead to the discovery of underlying principles which may be applied to a broader population and

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can be an explorative base for research and theory development that follows (Riessman, 2008).

Narrative analysis is an appropriate methodology for the investigation of the experiences of fathers of children with cancer because it encourages the researcher to look deeply into not only the content of narratives a participant chooses to share, but also how they construct their narratives, and what this says about their view of themselves and the world. The use of narrative analysis in the current study may provide considerable insights into the meaning-making process for fathers of children with cancer, and greater understandings about the cultural context within which their narratives were formed.

Use of objects in narrative analysis

While interviews are the primary means of data collection in qualitative research, interest in the use of visual methods to deepen and enrich the research process has grown (Sheridan & Chamberlain, 2011). Visual methods may include the use of material objects such as photographs, meaningful personal items, clothing, or diaries. Sheridan and Chamberlain (2011) argue that the use of objects can enhance the interviewing process by providing tangible representation of the past, increasing narrative depth, producing change in narratives, and shifting the interview process and the relationships within that. The addition of objects to interviews may engage other

senses and add further dimensions to a participant’s narratives.

Objects of significance are items which have meaning and worth beyond their intrinsic value assigned to them by the participant. For example, objects of significance may trigger memories, represent personal ideals or achievements, symbolise a time, place, or feeling, commemorate life events, or have implications for identity (Morgan & Pritchard, 2005; Pink, 2004). In the context of an interview, focusing on objects can encourage an increase in the depth and breadth of narratives, thus bringing about opportunities for further insight and interpretation by the researcher. More specifically, the use of objects can provide a prompt for past memories, sharpen a participant’s focus, and be an everyday way to provide a visual representation of past experiences to the researcher (Sheridan & Chamberlain, 2011). Photographs in particular are often kept for long periods of time as they can provide a link to special memories and are easy to accumulate and store.

Objects can be used during an interview to provide visual representation of the

31 journey throughout cancer treatment, objects such as photographs can provide a glimpse into the highs and lows of treatment, physical symptoms such as weight loss, medical interventions, and conjure up a sense of life in a hospital room. Objects can also be used to illustrate events, document or justify actions, and support participant’s narratives, thus bringing a sense of authenticity.

The use of objects in interviews can also extend and shift the flow of narratives. The presence of significant objects in an interview, such as a child’s most treasured soft toy during the treatment period, or a meaningful gift, have the ability to draw a person back into the past and push vivid and emotive memories into the present (Morgan & Pritchard, 2005). In this way, significant objects can serve as a magnifying glass, prompting participants to examine and scrutinise memories of scenes, places, or people in greater detail, by bringing a focus to a broader event or a reconnection to a moment in time (Sheridan & Chamberlain, 2011). Thus, allowing talk to be informed by objects can add significantly to the intricacy of narratives shared. Photographs and other objects can also conjure up emotions and serve as a vehicle for reflection for participants, as they may experience a visual reminder of past realities for themselves and their child, reflect on what was at stake, and compare this to their current life.

As participant and researcher engage in a collaborative process of sharing and discovery, the use of objects can change the dynamics of the interview and relationships. Talk about significant items can reduce physical and emotional space between the researcher and participant by fostering a sense of shared experience. Facilitating a change in focus, by bringing attention to the objects, can also position the researcher as a third party in the interview, taking pressure off the participant (Collier &