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QUALITATIVE METHODOLOGY

Qualitative Research Proposal: a model to help novice researchers

Cristina G. Vivar,¹ Ana Canga Armayor,¹ Navidad Canga Armayor ^1
1Escuela de Enfermería, Universidad de Navarra. Pamplona, Navarra, España

Mail delivery: Dra. Cristina G. Vivar. Escuela de Enfermería, Universidad de Navarra. C/ Irunlarrea 1. Pamplona, 31008, Navarra, España

Manuscript received by 5.3.2010
Manuscrito accepted by 6.7.2010

Index de Enfermería [Index Enferm] 2011; 20(1-2): 91-95

How to cite this document

Abstract

Nurses make an important contribution to extending and updating knowledge through research with the purpose of improving the quality of nursing care. Students and novice researchers, however, may find it difficult to initiate investigation and may require supervision during the research process. This paper focuses on the practicality of designing a qualitative research proposal by presenting an example/model, in the hope that it may be of benefit to beginners using a qualitative methodology.
Key-words: Qualitative Research/ Research Proposal/ Example/model.

Introduction

    In Spain, the restructuring of nursing education, within the European Space of Higher Education framework, has established the academic status of Degree, Master, and PhD for all graduate qualifications, including nursing. This has been vital in promoting the profession¹ and crucial in responding to the reforming health care system. An important initiative to enhance the quality of nursing care has been the fostering of nursing research so as to develop evidence-based practice.^2-5
    The development of nursing research capability is now a reality in many Schools of Nursing in Spain. However, nursing research in the Spanish context requires further improvement. Specific capacity strategies identified in the literature include the creation of infrastructure, the promotion of research culture, and the facilitation of training and collaboration.⁶ This may be achievable through the integration of nursing research networks and the improvement of teaching in nursing research. While these suggestions are key to the creation, extension and updating of nursing knowledge so as to improve nursing care in Spain, getting started in research, especially in qualitative research that has received less attention in nursing research,⁷ may be a challenge for students and novice researchers.
    "How to start qualitative research"? The first step in the research process is the development of an outstanding project.^8,9 A proposal is required for several purposes, such as for grant applications, academic degrees (MSc, PhD), conferences or seminars, or ethical approval as part of a research project.^10,11 In order to help research novices, an article on the theoretical bases of designing a qualitative research proposal in nursing and health care has been published elsewhere.¹² Vivar et al.¹² presented a 17-step process to describe the development of a qualitative research project. The steps are: (1) selecting an interesting topic; (2) introducing the background to the problem; (3) presenting the significance of the study; (4) defining the concepts; (5) establishing the research aim(s); (6) deciding on the research paradigm; (7) finding a theoretical framework; (8) choosing the data collection method; (9) planning the data collection; (10) describing the procedure of data analysis; (11) enhancing the quality of the data; (12) reporting the ethical issues; (13) presenting the limitations of the study; (14) disseminating the findings; (15) planning the time frame; (16) concluding; (17) presenting the references [See Table 1].
    On the basis of the theoretical guidelines designed by Vivar et al.¹² to develop a qualitative research proposal by using a 17-step process, the present article focuses on the practicality of designing a research proposal, in the hope that it may be of benefit to researchers new to a qualitative methodology. According to Bandura's Social Learning Theory,¹³ people may learn by observing and imitating the behaviours of others. While Bandura's theory was initially applied to the understanding of behaviour modification, his theory was later applied to the technique of behaviour modelling that has been widely used in training and education programmes. Modelling is also observed as a novice passes through Benner's five levels of proficiency to become an expert.¹⁴ To some extent, a similar way of learning can be adopted by novice researchers who may model themselves on more experienced researchers, drawing on their expertise and publications in the field. This paper aims to present an illustration of a qualitative research proposal in nursing so as to be instructive and helpful for novices. The intention is not to be "the definitive example" but "simply one example" of a qualitative research project.

Development of a Qualitative Research Proposal

    The following sections examine the sequence of steps involved in developing a qualitative research proposal. The example presented is an abbreviated and modified version of a dissertation entitled Perceived needs of young and older long-term survivors of breast cancer,¹⁵ which set out to understand the impact of breast cancer on long-term survival. The references used in this research proposal are presented in Table 2.
    Step 1. Selecting the topic. The interest in cancer patients began when the author of the original proposal worked in an oncology unit. In addition to giving physical care to cancer patients, she became aware of the importance of providing supportive care to the patients and their family members. Her curiosity regarding breast cancer survivors, however, grew when, together with some colleagues, she conducted a literature review about the quality of life of women surviving breast cancer and realised that cancer survival was a relatively recent area of nursing that needed further exploration.
    Step 2. Background of the problem. A growing number of authors have become aware of issues in the long-term survival of breast cancer, a stage in the cancer trajectory identified by Mullan¹ as "a permanent season of survival". However, little empirical research has been carried out on the supportive needs of young and older long-term survivors of breast cancer. A literature review discloses that though long-term breast cancer survivors may be disease-free, this does not mean they are "need-free".² Many breast cancer survivors expressed continued menopausal symptoms and other physical effects as a result of treatment;³ problems related to body image,⁴ sexuality, and fertility;⁵ concerns relating to employment and health insurance coverage;⁶ changes in family life;⁷ and ongoing concern about cancer recurrence.⁸ This increasing number of long-term breast cancer survivors in developed countries^9,10 should also be noted. Future study is required to investigate the unmet needs of long-term survivors of breast cancer, and to explore the kind of support women would like to receive from oncology teams.²
    Step 3. Significance of the study. Understanding the impact of breast cancer on long-term survival is crucial to enable health and social professionals strengthen strategies to enhance the quality of life of women surviving breast cancer. No previous study has attempted to explore the personal experience of young and older long-term breast cancer survivors using a qualitative approach.² However only through a study of this sort can a holistic picture of the age-related needs of cancer survivors be understood and initiatives taken to address unmet needs.
    Step 4. Definition of concepts. Young and older survivors of breast cancer:Young survivors are women who are forty-four years or younger, and older survivors are women who are forty-five years or older.²
    Long-term survivor of breast cancer: This refers to people who have lived at least five years after their diagnosis of cancer and are disease-free.
    Supportive needs: These include the informational, physical, spiritual, psychological, and social needs of long-term survivors of breast cancer.¹¹
    Step 5. Research aims. The aims of this cross-sectional descriptive study are:
    1.To identify the supportive needs of both young and older long-term female survivors of breast cancer; and
    2.To explore women's perceptions concerning the support they receive from healthcare professionals in relation to managing long-term sequelae of breast cancer during survival.
    Step 6. Research paradigm. Qualitative research will be chosen in this study because it is often used when little is known about a phenomenon,¹² and theories are not available.¹³ A qualitative approach would facilitate documentation and description of the scarce information, currently available on the supportive needs of long-term breast cancer survivors. Besides, qualitative research, capturing the individual aspects of the human experience in their entirety,¹⁴ appears advisable in the endeavour to achieve a holistic picture of the lived experience of long-term cancer survivors with regard to their supportive needs.
    Phenomenology aims to produce an exhaustive description of the lived experience of individuals in relation to a phenomenon,^14,15 and may convey what long term survival means to a woman who is surviving breast cancer. Some authors have suggested that the holistic approach applied in nursing provides an ideal setting for phenomenological research.¹⁶ A holistic approach involves a multidimensional understanding of health that is related to a state of physical, psychological, social and spiritual well being.¹⁷ In the study of lived experience, this holistic approach provides the foundation for phenomenological research.
    Step 7. Theoretical framework. The Supportive Care Framework¹¹ is used to guide this study. According to this theoretical framework, individuals with cancer experience different needs, over the course of the disease. These needs change over time and are influenced by many factors, such as age, gender, socio-economic status, culture, education, religion, coping resources, and social support.¹¹
    For the purpose of this research, though this framework encompasses the complete spectrum of the cancer experience, attention will be paid only to the supportive needs during survival. The framework will be used as the basis for an assessment of the informational, physical, spiritual, emotional, psychological, social, and practical needs of young and older breast cancer survivors during long-term survival.
    Step 8. Method of data collection. Face-to-face interviews will be the main data collection method to ensure the collection of detailed data which may not be accessed when questionnaires are used.¹⁸ Semi-structured interviews have been chosen for several reasons. Firstly, this method will enable the researchers to gain subjective and narrative descriptions of the perceived supportive needs of long-term survivors of breast cancer. Secondly, in semi-structured interviews respondents are asked the same questions, thus the information can thus be organised around areas of particular interest to address the research aims. There is also considerable flexibility, allowing respondents to talk and freely express their feelings and perceptions.¹⁹ Finally, the fact that researchers can ask for clarifications enhances validity.¹⁸
    Step 9. Collection of data. Stratified purposeful sampling that illustrates subgroups and facilitates comparisons¹³ will be used to recruit long-term survivors of breast cancer. This method of sampling allows phenomenological researchers to choose deliberately who to include in the study on the basis of predetermined characteristics relevant to the research.²⁰ The findings of this study cannot be generalised to the whole long-term breast cancer population, as this type of sampling is not representative of the target population.²¹ However, this limitation is acceptable as the main goal of this research is to describe the full nature of the experiences of long-term breast cancer survivors rather than to develop a precise estimate of what percentage of breast cancer survivors behave or feel in a certain way. The sample will be selected on the basis of the following criteria:
    1.Participants are between five and ten years post-diagnosis. Women who have survived for more than ten years are excluded from the study because they may have a different perspective of survival, influenced by the longer time interval involved.
    2.There is no documented recurrent disease at the time of the interview.
    3.They are between thirty-four and eighty-nine years old. This age interval is selected according to the sample characteristics outlined in the study by Cimprich and colleagues.²²
    A major concern is the number of subjects needed in a sample. In a phenomenological study, ten subjects have been reported as comprising a reasonable size.¹³ For the purpose of this study, five young women and five older long-term survivors of breast cancer will be recruited.
    Potential participants will be identified through a Spanish self-help group which operates in the city where the study will be conducted. Because unexpected problems can arise in the course of the study, two interviews will be piloted with two long-term survivors of breast cancer who frequently participate in the self-help group. This will confirm whether the women understand the research questions, and will record their individual impressions of the project. Furthermore, this pilot will show whether the study design, data collection, and data analysis are appropriate or if they require modifications. It will also give the researchers opportunity to reflect on their interviewing skills and to be sure the technical aspects of recording the interviews are satisfactory.
    After obtaining consent from the participants, explanation about the purpose of the study and its development will be individually given to them. The interviews will be held in a room where women currently meet for the self-help group. It seems to be an appropriate place because the women are familiar with this environment, and this will encourage them to express their feelings and experience of survival. Furthermore, the room lends itself to audio-taping, an essential aspect as the interviews will be recorded if the women give permission.
    Semi-structured and face-to-face interviews, expected to take about fifty to eighty minutes, will be conducted individually with both young and older women. To ensure that women express their experience of the perceived supportive needs during long-term survival, they will be asked to reflect on the time period beginning at their five-year anniversary since diagnosis and proceeding to the present. Tape-recording will increase the accuracy of data collection, as tapes contain the exact words of the interviews.²³ If participants refuse permission to be recorded, the interviewer will ask permission to take notes during the interview.
    The interview will begin with an open question such as, "please can you tell me about your experience since your five-year anniversary of the diagnosis of breast cancer?" Further questions will address supportive needs of a long-term survivor and allow women to express their own experiences. In addition, questions will be asked to explore and clarify the points raised by the women. All interviews will close by thanking women for their participation and by assuring them of the confidentiality of their responses. Field notes will be taken after the interviews are concluded to write down all remarks that may be relevant to the data analysis.
    Step 10. Analysis of the data. Prior to analysis, the audio-tapes will be transcribed verbatim and field notes will also be organised. NUD*IST computer programme will be used to aid in the analysis and representation of data by storing, organising files and searching for themes, so as to enable quick and easy access to material.^13,24 Bracketing will be used throughout the data analysis with a view to limiting expectations and presuppositions on the interpretation of data, so that the researchers will remain neutral in relation to the phenomenon under study.²⁵
    Transcriptions of the interviews will be analysed using Colaizzi's method of phenomenological analysis.^26,27 Separate descriptions for young and older long-term survivors will be developed to identify any differences between the two age groups.
    Step 11. Quality of the data. To assess trustworthiness, the criteria of credibility, transferability, dependability, and confirmability will be used to achieve methodological rigour in this proposal. Credibility, referring to the authenticity of the data, can be ensured by giving findings to participants to validate results.¹³ Women will be requested to have a second meeting after the first interview, once the initial analysis has been carried out, so that they can confirm the accuracy of the analysis of the interview. Transferability will be guaranteed by recruiting information from women at different ages. The different experiences of women will allow a clearer understanding of the phenomenon of survival and may contribute to a higher quality in the study. Dependability and confirmability will be strengthened by presenting an in-depth description of how the study progresses, how and what decisions are made, and any issues that occur during the interviews and over the course of the study.
    Step 12: Ethical issues. Prior to initiative the research, ethical approval will be obtained. The issue of informed consent will be addressed through the provision of information sheets and consent forms to the women, as well as the communication of verbal information about the aims and development of the research. The women participating in the study will be provided with a copy of the signed consent form in order to remind them of the conditions agreed. All the women will be informed that their involvement is voluntary and they can withdraw from the study at any time.
    With regard to confidentiality and anonymity, the researchers acknowledge that the interviews can reveal intimate information about the women, and that sharing thoughts and emotions about the cancer experience can be distressing. Every effort will be made to safeguard the privacy and comfort of the participants. The women's descriptions of their experiences will not be stored with any identifying labels, and codes will be used to replace names.
    A final ethical issue is to discuss what happens to the data after it is collected. The researcher has an ethical responsibility to report the findings accurately.²³ Although every effort will be made to do so, the interpretation of the data is never wholly objective.¹⁸ That is why, as discussed previously, women will be contacted so that they can validate their own experiences. Another responsibility is that of ensuring that the data is used appropriately and in the best interests of the studied population.²⁸ Thus, the proposed research will contribute to our understanding of long-term survival and related supportive needs among long-term survivors of breast cancer.
    Step 13. Limitations of the study. Caution must be taken when drawing firm conclusions from this research. The fact that the women of this study are interviewed at the time of their participation in the self-help group may influence their responses, in that they may experience more supportive needs and poor support from health care professionals than women who do not attend self-help groups during long-term survival.²⁹ Further studies are therefore needed to address this limitation and identify participants who do not belong to a self-help group at the time of the study.
    Generalisation of findings is limited because of methodological aspects. Examples of these are the small sample size, the use of non-random sampling techniques, and the implementation of cross-sectional design, which limit the discovery of any changes in the supportive needs over the course of long-term survival. As a result, it may be suggested that longitudinal research using a larger number of participants should be carried out to identify the needs of long-term survivors of breast cancer over a longer period.
    Despite theses limitations, the findings of this study will provide in depth understanding of the lived experience of survivorship for both young and older long-term survivors of breast cancer. This will be valuable data as preliminary work for further studies.
    Step 14. Dissemination of the findings. After carrying out this project, the findings will be presented in nursing academic journals. It is also intended that the results of this research are presented in the form of a conference paper to benefit the nursing and medical team's understanding of the concerns and needs experienced when coping with long-term breast cancer survival.
    Step 15. Research timetable. This study is to be conducted between January 2008 and January 2010. From January to February 2008 the pilot study will be carried out; from March to November 2008 data collection; from December 2008 to April 2009 the literature review will be conducted; from May to December 2009 the analysis of data; and finally from January 2009 to January 2010 the report of the research will be written.
    Step 16. Conclusions. As the study progresses, it is anticipated that modifications may be necessary in order to provide a deep understanding of the experiences of young and older cancer long-term survivors.
    Step 17. References. The references used in this proposal are presented in Table 2.

Conclusion

    Conducting research starts by developing a proposal, which is required for several purposes, such as funding applications, academic degrees or ethical approval prior to start a project. Writing the proposal for a qualitative study is a challenge for many Spanish nurses because of the emerging awareness about research. This paper has followed a 17-step process that reviews the main aspects to be taken into consideration when developing a qualitative project in nursing. The example is intended to serve as a point of departure for novice researchers who may need guidance and practical assistance during the research process. Further reading on writing a research proposal is recommended prior to getting started with qualitative research.

References

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