Resultados del diagnóstico

The selection of an appropriate methodology requires the evaluation of differing methodological perspectives for suitability in relation to the

research question. Firstly, this study is focusing on how the paramedic, as an individual, experiences emergency preparedness. Secondly, the study is examining how motivations, barriers and enablers impact on the process of individuals’ involvement in the emergency preparedness process.

The next section provides an overview of two alternative qualitative methodologies, with a focus on the justification of an interpretative

phenomenological approach to address the research questions of this study.

2.2.1 Consideration of ethnography

As the study focuses on developing understanding of experience, ethnography was a possible methodology.

Exploration of culture is a key feature of ethnographic research. The methodology was initially used within anthropology and sociology to investigate unique social and cultural characteristics but in recent years, numerous disciplines have utilised ethnography to focus and develop the theory of cultural beliefs and behaviours (Lambert et al, 2011). This

development has resulted in “diversification” and “re-contextualisation” (Welford et al, 2012) of ethnography and has created a field-orientated approach often used within health-care research.

Due to the changing nature of ethnography, there is no one agreed definition and its implications vary, depending on the context (Hammersley &

Atkinson, 2007). This results in a methodology with no singular operational approach. Its appropriateness is dependent on the chosen discipline and research aims, so to determine applicability the researcher must identify the defining characteristics.

Key elements of ethnography include naturalism and contextualisation, focusing on “detailed descriptions of different ways of life” (Lambert et al, 2011; p19), but these are not defining features as they are often seen in other qualitative research methodologies such as phenomenology. The following characteristics distinguish this methodology from other qualitative approaches:-

 The research occurs within the participant’s natural environment.  There is a recognition of the complexities of the culture, including

acknowledgment of rituals, behaviours and customs.  Research is holistic in nature.

 Culture is central to the research, and the research improves comprehension of a group’s dynamics and distinctiveness.

Applying an ethnographic methodology to the area of paramedics working in emergency preparedness is reflected in the following research question:-

What is the relationship between the culture of the ambulance service (and their workers) and emergency preparedness? How does this culture impact on

emergency preparedness?

While ethnography offered an interesting perspective, its focus on studying culture in relation to groups did not fully align with the idiographic focus of this study that explores understanding of individual experience. This study, to address the research questions, requires an idiographic focus, with a discussion on the unique lived experience of the individual health-care worker, and how they make sense of a phenomenon.

Thus, ethnography was not selected for this study. Consideration will now be given to another qualitative methodology, grounded theory.

2.2.2 Consideration of grounded theory

Generating new theory through the dynamic interaction between research subject and researcher is a key feature of grounded theory methodology (Welford et al, 2012. Strauss & Corbin, 1998). This participant orientated approach was traditionally used in sociological research, but has achieved increasing prominence in health-care research in areas such as patient experience, patient satisfaction and patient evaluation (Van Dover & Pfeiffer, 2012. Häggström et al, 2012. Mottram, 2011a. Mottranm 2011b). These

areas are compatible with a methodology where the researcher must continuously reinterpret the subject matter and the research topic as the study progresses, in response to participant involvement using a subjective research framework.

Developed by Glaser & Strauss (1967), grounded theory is based on a ‘pragmatic’ philosophical position, aiming to understand previously

unexplored social groups through the generation of theory ‘grounded’ in the obtained data. However, Strauss later developed this grounded theory methodology to incorporate elements of ‘symbolic interaction’ philosophy, where researchers study the theory of ‘human group life and human conduct’ (Blumer, 1969) to describe how participants act or engage with their world (Licqurish & Seibold, 2011). Grounded theorists believe that meaning is derived from social interactions, with comprehension through this

methodology of verbal and non-verbal socio-cultural symbols (Licqurish & Seibold, 2011).

Whilst numerous styles of grounded theory are acknowledged in the literature, this methodological approach can be distinguished from other qualitative methodologies by its inductive and pragmatic direction, generating new theory that is ‘grounded’ in the research data. This new theory can then be applied to healthcare practice. The following

1) The constant data comparison during a consolidated approach to data collection and analysis.

2) The researcher remains open to the data to generate theory. 3) The integration of the researcher into the process.

4) The participation of participants within the research process.

Summarised from Hunter et al (2011) & Licqurish & Seibold (2011)

Grounded theory focuses on the process of a social phenomenon, rather than on how individuals make sense of a phenomenon, using an exploratory methodology, enabling theory generation. Studies using grounded theory, as a research methodology, intend to generate an overview of a phenomenon, through a larger sample size (Smith et al, 2009), rather than an idiographic and detailed account that IPA offers.

Applying a grounded theory methodology to the area of paramedics working in emergency preparedness is reflected in the following research question:-

What can the paramedics reveal about emergency preparedness, to generate new theory?

This captures the process of recognising the phenomena amongst the group, but does not offer the in-depth, individual insight, description and

understanding of human experience that other methodologies such as phenomenology and interpretative phenomenological analysis can offer.

This understanding is important in an area with limited theoretical and conceptual foundation, such as emergency preparedness.

For these reasons grounded theory is a less suitable methodology for this study and further discussion will occur examining a more appropriate methodology to meet the study aims.

2.2.3 Summary

The reviewed methodologies could be utilised to determine factors involved when examining the interaction between the paramedic and their

experience of being involved with emergency preparedness. Each has the potential to make a contribution, however, the aim of this study is to develop an in-depth understanding of individual’s experiences, in order to build future clinical practice. This individualistic perspective of experience is a significant factor when deciding an appropriate methodology.

The selection of Interpretative Phenomenological Analysis (IPA) (p93 - 111), as the chosen methodology to answer the research aims and questions is now discussed.

2.3 The selection of Interpretative Phenomenological Analysis (IPA)