Práctica médica: cuidado de la salud como su fundamento

The quantitative data were statistically analysed and the findings were presented thematically. As indicated in the chapter, the data collected from the survey provided a general understanding about the nail biters and parents of nail biting children regarding their perceived causes of nail biting, associated health issues, and possible treatments of nail biting.

From the perspective of the participating nail biters and parents of nail biting children on the common causes of nail biting, the results showed that psychological imbalances, such as anxiety, nervousness, or stress, were believed by the largest proportion of the respondents to mainly lead to the development of nail biting habit. For them, other factors include mineral deficiency, poor diet, and

psychological disorders. Further statistical details pertaining to their perceived causes of nail biting are as follows. The third primary issue of interest in the survey was related to the treatment of nail biting from the experiences of the surveyed nail biters. The results showed that the most widely used treatment for nail biting was the use of bitter nail polish, followed by mineral supplements and punishment. Medication and other psychotherapies were also used. The respondents also mentioned other treatments used only occasionally, which included the use of fake nails, Oroxine, Pedisure formula, ceasing drinking coffee, will power, and gluten free diet.

From the perspective of health professionals regarding the perceived causes of nail biting, associated health issues, and possible treatment of nail biting. The results showed that they strongly believed the main possible cause of nail biting was psychological imbalances, such as anxiety, nervousness and stress. Interestingly, a high proportion of the respondents attributed nail biting to psychological

imbalances. Psychological disorder and poor diet were also seen as the causes of nail biting. However, a low number of participants were not so sure about this relationship. Mineral deficiency came fourth in the list of perceived causes of nail biting. Genetic disorder was cited by 32% of the health professionals to be the main cause of nail biting. While 28% did not reject the link between genetic disorders with nail biting, 40% were not sure about the association between them.

In relation to the associated health issues that were experienced by their nail-biting patients in the past five years, according to the health professionals, the most prevalent health issue among nail biters was the existence of parasites/worms. Bacterial/viral infections were also very popular. Other health problems were gingivitis, fungal infections, and diarrhoea.

In relation to their recommended treatment methods for nail biting, the results indicated that a very large proportion of the health professionals recommend the use of bitter nail polish as a treatment method for nail biting. Nearly half of health professionals suggested the use of mineral supplements and a smaller proportion were in favour of psychotherapy and hypnosis. Medication and punishment were found to be unpopular treatment methods. Regarding the recommended mineral supplements, the health professionals highly recommended Calcium. Other frequently recommended minerals were Magnesium, Silica, Iron, Schuessler Potassium Phosphate in the form of Tissue Salts or Celloid, and Zinc.

4.9 Conclusion

This chapter has reported the findings of the questionnaire data from health professionals, nail biters and parents of nail biting children, including participants’ demographics. As the focus of the discussion presented in this chapter is on quantitative data analysis, the research tools used in the data collection were revisited and the findings were described and explained in terms of descriptive and inferential statistics, particularly in relation to the possible links between a number of quantitative variables. Though the insights gained from the statistical revelations are interesting and valuable, they are only one part of the research endeavour. The next chapter will be complementary as its focus is on the qualitative side of the coin where participants’ perception, experience, and attitudes towards nail biting are examined in terms of meaning instead of numbers.

5

Qualitative Data Analysis

5.1 Introduction

As indicated in the methodology chapter, this study used the mixed methods

approach to deal with the complex issue of nail biting. The key rational is that such a combined methods approach can enrich the findings and interpretation. Both quantitative and qualitative methods are powerful in its own way as each provides a specific aspect of the research problem, whereas a combination of both methods provides further insights into the complexity of the research issue. They are mutually complementary in research exploration. Chapter 4 has outlined and highlighted the analysis results of the survey questionnaires for health

professionals, nail biters and parents of nail biters. This chapter provides a different side of the research issues in which personal expressions, ideas, attitudes, feelings and thoughts reflect the inner world of the participants that statistics could not adequately present.

5.2 Data analysis

This chapter reports the analysis of the qualitative data collected from the interviews conducted with 23 past/current nail biters or parents of nail biters, 14 health professionals, and 15 written comments from the questionnaires.

The interviews and written comments were used to provide further insights to RQ1 and RQ2 of the study.

RQ1. What are the views of nail biters and parents of nail biting children in Tasmania, Australia on the possible causes, associated health issues, and treatment of nail biting?

RQ2. What are the views of Australian health professionals on the possible causes, associated health issues, and treatment of nail biting?

The data from the interviews, particularly with the parents of nail biters, nail biters and health professionals, shed interesting lights on the researched issue with their first hand experiences from the perspectives of both patients and health experts. The data were analysed and presented in terms of the pre-defined

themes/subthemes related to the RQs as well as those emerging from the extensive conversations. The themes that emerged from the nail biters or parents of nail biters and health professionals were reported in separate sections, and will be discussed in reference to each other in the next Discussion chapter to highlight and reinforce identified themes.

Initially, the characteristics of the participants are presented, which are followed by the presentation of themes from the data analysis. In addition to each major theme, additional sub-themes and sub-sub themes were developed and are presented in this chapter.

The qualitative data collected from the interviews and comments from the open question of the questionnaires were organised and analysed using NVivo v10.0, a software package for qualitative research (QRS International, 2012). As part of the analysis, the data were coded and organised by being placed into ‘nodes.’ The nodes at the beginning stage provided some indication about key semantic features which had the potential connections among the nodes. In this way, conducting a research involves meaning making in the data analysis as it attempts to create nodes from a wealth of qualitative data and arrange them in a thematic structure. Meaning making also designates the way in which participants express their own thoughts and feelings about a social issue in context. They were also the base on which themes and subthemes emerged and were identified. In a sense, it was the meaning making process in qualitative research. Initially the researcher needed to sketch out a framework of themes and subthemes and finally examined the nature of the relations between nodes and themes. This thematic process involved sorting, rearrangement, identification, classification and final thematic construction.

Within thematic analysis, the results were presented in terms of themes, including positive and negative attitudes and views of the interviewees as outlined in Table 5.1 and Table 5.2.

Table 5-1: Coding used within thematic analysis of health professionals

Themes Sub-themes

Nail biting behaviour

Causes of nail biting  Mental health illness

 Mineral and vitamins deficiency  Family welfare or domestic issues  Parasites

Methods used to diagnose nail biting

 Diagnostic approach  Diagnostic tests used

 Mental health and other methods

Recommended treatments  Psychological treatment

 Iron deficiency and thyroid disorders  Bitter nail polish

 Mineral and vitamin supplements  Worm treatment

 Specialist referrals

Advice on treatment and prevention of nail biting

 Awareness of infections and other confounding symptoms

 Screening for other/confounding health issues

 Healthy diet

 Early intervention for better health outcomes

Table 5-2: Coding used within thematic analysis of nail biters

Themes Sub-themes

Reasons of nail biting  Emotion  Dietary  Lifestyles

Nail biting and associated health issues

 Psychological disorders  Frequent eye twitching  Muscle cramp and joint pain  Vitamin and mineral deficiency  Constipation and gastric disorders  Other associated health issues

Commencement of nail biting habit Persistence to stop nail biting Parental influence

Types of treatment received  Bitter nail polished  Psychotherapy

 Vitamin and mineral supplements  Cessation of caffeine consumption  Parasite detox

 Other types of treatment

Health professional’s assistance