Fluent Essays

Qualitative Methodologies & Qualitative Validity Week 2 - Discussion 1 Qualitative Methodologies Qualitative methodologies involve collecting non-numerical data, usually through interviews or observation. There are many approaches to qualitative research and no fully agreed upon “list” of methodologies. The text (Malec and Newman, 2013) describes six approaches in Section 3.1. The Frank and Polkinghorne (2010) article also describes three main qualitative approaches. The best way to learn about a variety of qualitative research methods is to read reports or articles of research around a topic you are interested in. Instructions: Elderly For your initial post, choose two articles that use a qualitative research method to answer a research question on your topic of interest. Remember that qualitative research is exploratory in nature, and is used to go deeper into issues of interest and explore nuances related to the problem at hand. Common data collection methods used in qualitative research include group discussions, focus groups, in-depth interviews, and uninterrupted observations. Data analysis typically involves identifying themes or categories, or providing in- depth descriptions of the data. Use the Anderson (2006) and Lee (1992) articles to obtain a better understanding of what qualitative research includes. · Briefly describe the particular qualitative research approach/methodology utilized in each of the two articles you selected (e.g. case study, ethnographic study, phenomenological study, etc.). · Refer to the week’s readings (or recommended articles) to help you explain. · Compare and contrast the two qualitative methods used: · What is the same and what is different and why? · Does either methods seem a good fit to explore your topic of interest? · Why/why not?  Lima MCSC, Bitencourt MLS, Diniz ERS, et al. Care for the elderly in the urgency sector: a qualitative study. MOJ Gerontol Ger. 2018;3(5):385-387. DOI: 10.15406/mojgg.2018.03.00151 Wu, Y.-H., & Lu, Y.-C. (2014). Qualitative research on the importance and need for home-based telecare services for elderly people. Journal of Clinical Gerontology and Geriatrics, 5(4), 105–110. https://doi-org.proxy-library.ashford.edu/10.1016/j.jcgg.2014.04.001 Post should be at least 300 words.  Week 2 - Discussion 2 Qualitative Validity Many researchers, particularly those from the hard sciences like mathematics or physics, consider quantitative research, with the ability to determine “statistical significance,” as more rigorous than qualitative research. Qualitative research does not lend itself to such mathematical determination of validity, rather it is highly focused on providing descriptive and/or exploratory results. However, this does not relieve the qualitative researcher from designing studies that are rigorous and high in “trustworthiness,” often the word used to describe validity in a qualitative study. There is no agreed upon set of criteria for ensuring a quality qualitative study, but there are a number of models of quality criteria. Instructions: After reading the assigned articles by Shenton (2004) and Freeman, deMarrais, Preissle, Roulston, and St. Pierre (2007), discuss at least three things a qualitative researcher can consider to increase the validity of a study’s results. · Give at least one example from one of the qualitative study articles you have found on your own topic of how a claim (reported result) is supported. · How does that article report on the validity of the study’s results? · Do the authors do a good job of demonstrating validity? If not, what could/should they have done differently? · Post should be at least 300 words. Resources Required Text Malec, T. & Newman, M. (2013). Research methods: Building a knowledge base. San Diego, CA: Bridgepoint Education, Inc. ISBN-13: 9781621785743, ISBN-10: 1621785742. Section 1.6 Writing a Research Proposal Chapter 3: Qualitative and Descriptive Designs – Observing Behavior Section 5.3: Experimental Validity: A Note on Qualitative Research Validity and Reliability Appendix: Example of a Research Proposal Required References Anderson, J. D. (2006). Qualitative and quantitative research. Available at  http://web20kmg.pbworks.com/w/file/fetch/82037432/QualitativeandQuantitativeEvaluationResearch.pdf (Links to an external site.) Conway, A. (2014). Circuit court involved youth in Virginia: A descriptive, cross-sectional, quantitative research study. London: SAGE Publications Ltd. doi: 10.4135/978144627305014535709 Frank, G., & Polkinghorne, D. (2010). Qualitative research in occupational therapy: From the first to the second generation. OTJR: Occupation, Participation and Health, 30(2), 51-57. (ProQuest Document ID: 2021456651). Freeman, M., deMarrais, K.,  Preissle, J.,  Roulston, K., &  St Pierre, E. A. (2007). Standards of evidence in qualitative research:  An incitement to discourse. Educational Researcher, 36(1), 25-32.  doi:10.3102/0013189X06298009. Park, J., & Park, M. (2016).  Qualitative versus quantitative research methods: Discovery or justification?    download Journal Of Marketing Thought, 3(1), 1-7. Polkinghorne, D. E. (2005). Language and meaning: Data collection in qualitative research. Journal of Counseling Psychology, 52(2), 137-145. doi:10.1037/0022-0167.52.2.137    [Retrieved from EBSCOhost] Shenton, A.K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22(2), 63-75. Educational Researcher, Vol. 36, No. 1, pp. 25–32 DOI: 10.3102/0013189X06298009 25JANUARY/FEBRUARY 2007 Standards of Evidence in Qualitative Research: An Incitement to Discourse by Melissa Freeman, Kathleen deMarrais, Judith Preissle, Kathryn Roulston, and Elizabeth A. St. Pierre In a climate of increased accountability, standardization, federal con- trol, and politicization of education research and scholarship, this article briefly reviews various positions outlined by qualitative researchers about quality in qualitative inquiry, showing how these are implicated in the acquisition, conceptualization, and use of quali- tative evidence. It concludes by identifying issues in and challenges to setting standards of evidence for qualitative researchers in education. Keywords: qualitative research; quality; standards of evidence; validity T his article addresses standards of evidence in qualitative research in education. Our premise is that it is neither desirable nor possible to reach consensus about or pre- scribe standards of evidence in this diverse field. Such prescriptions, we believe, amount to disciplinary action (Foucault, 1975/1979) that constrain the generation of knowledge rather than improve it. We do argue, however, that qualitative researchers both accomplish research of high quality and have a long tradition of demonstrating quality in reports of their investigations. We begin by discussing the importance of this conversation at this historical and political moment in the United States. We then review how validity, a preferred term for the overall merit of a study, has been discussed by qualitative researchers. In this discussion, we consider commonalities in practice across qualitative research com- munities, describe how qualitative researchers have treated validity in relation to data and evidence, and explain how they have justified their claims. We conclude our review by emphasizing the hetero- geneity of qualitative research and cautioning against recent calls for restrictive and disciplinary standards of evidence. The Context of the Discussion The culture of science and academic scholarship is heteroge- neous,1 with multiple, overlapping communities of practice and knowledge that split into specialties or combine into interdisci- plinary and cross-disciplinary areas of study. Within disciplinary communities such as education or sociology and across commu- nities such as the anthropology of education, scholars have a long history of disagreeing and challenging one another about how to ensure the quality of qualitative work and even how to catalog and categorize the various kinds of qualitative research. Qualitative research is open and supple, and one of its strengths is that it incorporates philosophies, theories, and research designs and methods as diverse as postpositivist multi- methods approaches and postmodernist social critiques.2 Rather than being prescriptive about what qualitative research is and what makes it good (true, valid) across all instances of research, qualitative researchers have tended to (a) study what researchers who say they are doing qualitative research are doing and then (b) encourage those who do that work to develop those practices considered excellent. Although discussions of quality in qualita- tive work have always been intense, they have usually been civil. We believe that this respect for one another’s conventions is the result of the heterogeneity in qualitative design and the absence of an enduring hegemonic presence. We situate our response to the call for standards of evidence in qualitative research in a pervasive discourse that describes educational research in general as historically and presently bro- ken and in need of repair (e.g., Lagemann, 2000; Kaestle, 1993). Whether the situation is as dreary as it is made out to be is beside the point; today’s fix is to make educational research scientific, and the federal government has taken the lead in this project by mandating scientific method into law (for scientism, see Lather, 2006; Ruccio & Amariglio, 2003). The fundamen- tal idea is that rigorous science will make better schools, that quality science will enable us to finally reengineer schools so they work. The National Research Council (NRC) has taken a leadership role in this conversation. Having defined the nature of science in its 2002 and 2005 reports, the NRC has received funding to begin a new “broad, long-term initiative related to the quality of evidence” (The National Academies, Division of Behavioral and Social Sciences and Education, 2006) in the social and behavioral sciences. With the NRC prepared to define evidence and the American Educational Research Association (AERA; 2006) imposing standards for reporting on research methods in its pub- lications, qualitative researchers may feel under siege. Top-down efforts such as these to legislate scientific practice and mandate research design threaten to harden the boundaries of what counts as science, to devalue many qualitative research endeavors, and to limit creative research practice of all kinds. Research News and Comment EDUCATIONAL RESEARCHER26 Commonalities in Standards of Practice Across Qualitative Research Communities All sciences emphasize innovation and boundary breaking as well as standardization and systemization. Conventions themselves evolve and develop through trial and error and other kinds of assessment. Self-correction among communities of scientific practitioners has been the strength of science across alternative knowledge systems, and attempts to legislate standards have sometimes shut down scientific activity; the Soviet suppression of genetics research in the 20th century is a case in point (Soyfer, 1994). The tension between innovation and conventionalizing practice is, we believe, a sign of healthy inquiry. Overconvention- alizing can lead to mindless recipes for research and limiting scholarly orthodoxies. Underconventionalizing has its own pit- falls: intellectual fads, a lack of continuity, fragmentation, and intellectual alienation. One way to achieve a balance here is to assess the status of conventions such as standards of evidence against what researchers actually do. A key source, then, of standards of evidence and quality throughout the history of the scientific method and its applica- tion in qualitative inquiries has been the systematic and careful documentation of all procedures—an account of practice—to pro- vide a record for a researcher’s ongoing contemplation as well as for peer review. This is descriptive work. The documentation of procedure is crucial if we want to know what exemplary researchers whose methodology is innovative and effective do and how they make their work convincing. Examining expert researchers’ practices, then, contributes to establishing agreed-on, albeit ever changing, standards of quality and rigor. Of course, working with such experts is much to be desired (e.g., Wolcott’s [1994] version of how Louis Agassiz taught careful observation), and such conventionalizing not only lends confidence to results but also provides models for novices. As novices acquire experi- ence and develop refined judgment, however, some come to pre- fer methodological uncertainty (e.g., Lather, 2004), and most come to rely less frequently on routine protocols than they did as newcomers (e.g., Benner, 2001; Flyvbjerg, 2001). Completely entangled with practice is a second source of guidelines for exemplary qualitative research: theory, the various philosophical and theoretical traditions that both support com- munities of practice and develop from them. This work can be prescriptive because a priori theory may impose a structure of assumptions. Each community of practice using qualitative research traditions adheres to its own particular theoretical assumptions. For example, one of the standards of the Chicago school of qualitative sociology, begun in the 1920s, is to develop social science theory through research participants’ descriptions of their own experiences, thus making explicit the “invisibility of everyday life” (Erickson, 1986, p. 121). In this tradition, the practice of checking a researcher’s interpretations and represen- tations with participants prior to publication is valued (e.g., Duneier, 1999). More recently, the interdisciplinary nature of qualitative inquiry allowed it to welcome the epistemologies (e.g., queer the- ories, feminist theories, race-based theories) and accompanying methodologies of groups who organized the social movements of the 1960s and 1970s to protest their absence from public policy, academic scholarship, and positions of power and influence throughout our culture. These as well as more mainstream epis- temologies, such as critical and interpretive theories, vary both in what they consider standards of evidence and the priorities they give to shared standards. In recognition of these variations, AERA (2002), in a com- mentary on its own ethical standards for editing, reviewing, and appraising research, has emphasized that it is important “to ensure fair treatment of those who submit manuscripts for pub- lication and to promote the advancement of educational research through attention to the quality of research and the preservation of the robust methodological pluralism of educational inquiry [ital- ics added]” (p. 103). Thus, the “methodological adequacy of a piece of work” must be judged in relation to the “methodologi- cal requirements of its type . . . [and] the significance of its results in the context of the problems internal to its own tradition, and not the requirements and aspirations of types to which it does not belong” (p. 105). And, of course, philosophies and theories, like scientific beliefs and research practices, change over time; thus, AERA valorizes emergent traditions in its commentary. In qualitative inquiry, the last century’s “linguistic turn” (e.g., Rorty, 1967) that critiqued the stability and transparency of lan- guage contributed to the proliferation of critical theories and the development of postmodern and poststructural approaches to sci- ence, research, and scholarship. These critiques question and unsettle our notions of truth and knowledge, objectivity and sub- jectivity, and science and evidence and warn of the danger of calls for norms and standards. As we have noted, such theories have their own logics that can in turn be interrogated for implicit and explicit standards of practice. It is difficult to keep practice and theory from norming each other and thus shutting down innovation in methods of inquiry. Communities of practice inevitably develop and enforce standards. But if these communities are to thrive, they must establish pro- cedures for the ongoing interrogation of those standards. Working in the tension of simultaneously doing science and trou- bling it is not always easy, and this approach requires curiosity and generosity as we encounter different and what may seem at the time incommensurable, threatening, and even dangerous the- ories and practices, with their accompanying standards. Yet this balancing act enables conditions for good science. How then, have qualitative researchers discussed what good science is and how to assess the quality of their work? Validity Qualitative researchers have always discussed how to evaluate their science, the quality of their analyses and theoretical interpretations of data. They disagree, however, over the terms used in these dis- cussions: validity, reliability, rigor, and parallel terms such as trust- worthiness, credibility, transferability, verisimilitude, relevance, plausibility, and confirmability. The literature contrasts qualitative quality standards to those used in the scientific method (Eisenhart & Howe, 1992; Howe & Eisenhart, 1990); discusses validity in general (Kvale, 1995; Lincoln, 1995; Maxwell, 1996; Miles & Huberman, 1984; Seale, 2004; J. K. Smith & Deemer, 2000; J. K. Smith & Hodkinson, 2005); and considers it within specific qualitative traditions, such as ethnography (Altheide & Johnson, 1994; LeCompte & Goetz, 1982; Willis & Trondman, 2000), action research (Anderson & Herr, 1999; Melrose, 2001), alter- native ethnographic designs (Denzin, 2000; Ellis, 2000; Richardson, 2000), mixed theory designs (Koro-Ljungberg, 2004), postmodern, feminist, critical, and poststructural designs (Lather, 2001; Lenzo, 1995; Scheurich, 1993), and self-study designs (Bullough & Pinnegar, 2001; Feldman, 2003). Lather (1993) has even claimed to be obsessed with validity. Validity has been defined and described in a variety of ways and for a variety of purposes (LeCompte, Preissle, & Tesch, 1993; Maxwell, 1992; Talburt, 2004). Because validity as a term has been discussed, debated, contested, and redefined by qualitative researchers, we focus on validity as characteristic of the standards of evidence dis- course as it relates to qualitative inquiry. Validity is generally understood by educational researchers as “the trustworthiness of inferences drawn from data” (Eisenhart & Howe, 1992, p. 644). Indeed, Scheurich (1993) remarked that validity is the boundary line (that differs among epistemologies) for what is acceptable and not acceptable in research. Both Moss (1996) and Mishler (1990) echoed Scheurich’s point that valid- ity is an epistemological issue that methodological procedures can barely begin to address. Thus, Moss warned of the imposition of “a priori criteria abstracted from existing practice” (p. 26) because of the very different theoretical work done under the umbrella of qualitative research. Lather (2001) summarized these cautions with her reminder that ever since the publication of “Cronbach and Meehl’s 1955 essay on the problems with construct validity in psychological testing, validity has been the problem, not the solution” (p. 243). Driving these discussions is the need for researchers to address a central question in any kind of research inquiry: “Why should I believe this?” (Wallace & Wray, 2006, p. 28). How then do qualitative researchers deal with validity in their research? In the following sections, we show how qualitative researchers use data as evidence to warrant claims within different theoretical frameworks and specific communities of practice. These activities are separable only heuristically; in research prac- tice, they intertwine and implicate one another throughout the course of any study. Data and Evidence Qualitative researchers’ concerns about the quality of their work are evident in discussions about formulating both research design and questions within explicit theoretical and philosophical tradi- tions; accessing and entering settings; selecting, collecting, and analyzing data; and building a case for conclusions. Quality is constructed and maintained continuously throughout the life of a research project and includes decisions that researchers make as they interact with those they study and as they consider their analyses, interpretations, and representations of data. Qualitative researchers in education have used, generated, and redefined var- ious terms that relate to the assessment of quality shared with other social, human, and professional science researchers: credi- bility, validity, triangulation, trustworthiness, truth, and verifica- tion. Qualitative scholars have seldom used the terms standards, evidence, claims, and warrants, terms derived from formal logic that are currently used in policy documents and reports (for a notable exception, see Morse, Swanson, & Kuzel, 2001).3 In methodological writing, the term qualitative data is gener- ally taken to encompass the “rough materials researchers collect from the world they are studying” (Bogdan & Biklen, 2006, p. 117), including field notes, documents, transcriptions of interviews and interactions, and artifacts. Data are produced from social interactions and are therefore constructions or inter- pretations. There are no “pure,” “raw” data, uncontaminated by human thought and action, and the significance of data depends on how material fits into the architecture of corroborating data. “Data analysis leads to a reconstruction of those constructions” (Lincoln & Guba, 1985, p. 132). In other words, qualitative data and information are always already interpretations made by participants as they answer questions or by researchers as they write up their observations. Neither research participants nor researchers can be neutral, because, as emphasized earlier, they are always positioned culturally, historically, and theoretically. There is no Archimedean standpoint outside human activity (Alexander, 2006; Hartsock, 1983) from which to claim neutrality and pro- duce value-free data. In a now classic consideration of qualitative methods in edu- cation, Erickson (1986) asserted that the corpus of materials collected in the field are not data themselves, but resources for data. Fieldnotes, videotapes, and site documents are not data. Even interview transcripts are not data. All these are documentary materials from which data must be constructed through some formal means of analysis. (p. 149) Nevertheless, most qualitative textbooks now use a definition of data similar to Bogdan and Biklen’s preceding formulation. Although Bogdan and Biklen claimed that “data are both the evi- dence and the clues” (p. 117), Lincoln (2002) cautioned that “data and information are not evidence until two things happen: first, someone recognizes it as data, and second, an inquirer sub- jects it to some form of systematic analysis, which turns it into evidence directed toward some question or argument” (p. 6). Claims and Interpretations In research, claims are statements of meaning grounded in evidence and theory. Claims describe, interpret, deconstruct, critique, predict, and explain lived experience. Claims are state- ments that connect the world bounded by our data to our inter- preted understanding of that data. In 1962, Raoul Naroll, an anthropologist, working from con- cerns about the misuse of data, called for data quality control. Naroll tried to assess information by the conditions under which it was generated and the extent to which it compared and con- trasted with other information. Because he studied patterns of cross-cultural behavior and experience, he was concerned about the accuracy of reports describing cultures across the world and whether they were biased by incomprehension, misapprehension, or downright malice. Although in the 21st century, people are better equipped to record information almost everywhere about almost everyone, misunderstandings, alternative understandings, 27JANUARY/FEBRUARY 2007 and conflicting standpoints continue to complicate the genera- tion of knowledge, and most scholars recognize that the multiple layers of meaning in human experience can be inconsistent, inco- herent, and even incomprehensible as well as sometimes consis- tent, coherent, and comprehensible. The material that constitutes data and the constituting of the data are limited and fallible, and the scholar’s task is to identify the limitations and faults of infor- mation along with its value. Justifying claims also depends on demonstrating and report- ing appropriate and adequate methods of data generation. Naroll (1962) discussed sets of general criteria that might characterize competent work (for critiques of what is called criteriology, see, e.g., Schwandt, 1996; J. K. Smith & Deemer, 2000; J. K. Smith & Hodkinson, 2005). From expectations of careful documentation of systematic fieldwork such as those developed by Naroll, suc- ceeding scholars have developed expectations for the conduct of quality research. These include attention to (a) thorough descrip- tion of design and methods in reports, (b) adequate demonstra- tion of the relationship of claims to data, and (c) thoughtful consideration by the researcher of the strengths and limitations of the study. Next, we consider each of these issues in turn. Thorough description of design and methods is the effort to represent decisions, procedures, and researcher thinking in ways that audiences find recognizable and comprehensible. Practices that support this effort can be contrasted with the mystique fos- tered among some artists who fear that demystifying or describ- ing their work in detail might threaten the product rather than enhance it. Thus, researchers commonly provide detailed descrip- tions of how they went about their studies, the problems they encountered, and the reasoning on which they based their deci- sions (e.g., Fine, 1991; Fordham, 1996; Peshkin, 1986; Valenzuela, 1999). These methodological explorations often appear in anthologies of researchers’ accounts of their studies (e.g., Behar & Gordon, 1995; Lareau & Shultz, 1996; St. Pierre & Pillow, 2000). The relationship of data and claims is demonstrated in research reports by offering adequate and appropriate information for readers to reexamine and assess a researcher’s assertions and inter- pretations. At a minimum, sufficient data are cited in reports to support each claim (e.g., Lortie’s [1975] study of teachers demon- strates the patterns he claimed by extensive quotations from what the teachers had to say); at a maximum, researchers make data available to others for secondary research (e.g., Goldman-Segall, 1998, has made video data from her digital ethnography available to readers on the Web). How much material is provided and whether entire collections of field notes, interviews, and docu- ments are made available to the public are conventions that vary by qualitative tradition. Oral historians and ethnographers often archive their data, for example. Finally, how researchers address the strengths and limitations of their studies includes issues about the relationships of researchers and participants, the roles of researchers in their stud- ies, and the ethics and politics of representation. Of course, these decisions intersect with decisions about how much detail to dis- close about methods and design and how to select data to support assertions. For example, researchers may decide to limit access to material from their research studies for ethical reasons. In particular, researchers working with indigenous groups whose traditional knowledge and lore have long been exploited by researchers are well advised to consider the ethical and political implications of decisions concerning all aspects of doing research (e.g., L.T. Smith, 1999, 2005). Only recently have some qualitative scholars begun to explic- itly address the issue of quality using the terminology of “stan- dards of evidence.” For example, Wilson (1994) proposed five criteria that address the nature of the information, how it is acquired, and how it is interpreted: “evidence should be consis- tent with a researcher’s chosen epistemology or perspective” (p. 26), “evidence should be observable” (p. 28), “evidence should be gathered through systematic procedures” (p. 29), “evi- dence should be shared and made public” (p. 30), and “evidence should be compelling” (p. 30). Lincoln (2002) offered another set of criteria: (a) “researchers should have been deeply involved and closely connected to the scene”; (b) “researchers should achieve enough distance from the phenomenon to permit recording action and interpretations relatively free of the researcher’s own stake”; (c) “claims should be based on an adequate selection of the total corpus of data”; (d) “data should come, at least partly, from publicly accessible observation records”; and (e) “data and analysis should include consideration of inferences and interpretations, as well as con- crete phenomena” (p. 9). These are two possibilities for assessing standards of evidence that may fit some qualitative traditions. The introductory texts scholars use to teach qualitative inquiry also offer suggestions for how researchers use evidence to support their claims. Because the relational aspects of qualitative work are so important, scholars value extended time in the field, what Wax (1971) called immersion. “Being there” matters. Qualitative methodologists also encourage member checks: going back to participants and asking them, “Have I got it right?” Working with other researchers—peer debriefers and research groups—to help think about the complexity and ethics of the work is also rec- ommended (Lincoln & Guba, 1985). And because most qualita- tive research is grounded in descriptive claims about the work, not only are sufficient data to support claims crucial, but researchers must be able to, in Geertz’s (1973, p. 10) words, “con- trive somehow first to grasp” what is going on before they can represent it for others. Writing of anthropological ethnography, Geertz added, Doing ethnography is like trying to read (in the sense of “construct a reading of”) a manuscript—foreign, faded, full of ellipses, inco- herencies, suspicious emendations, and tendentious commentaries, but written not in conventionalized graphs of sound but in tran- sient examples of shaped behavior. (p. 10). Geertz has explained elsewhere (as cited in an interview with Olson, 1991) that description as a rhetorical marker of validity surfaces in representations of research with a “sense of circum- stantiality and of power in reserve [italics added] (if an anecdote or an example doesn’t sound strained but sounds like you’ve got fifty others and this is the best one you chose)” (p. 249). Using multiple researchers, multiple methods of data collec- tion, and multiple theoretical analyses to complicate rather than simplify knowledge production also provide warrants for our claims. And, of course, peer review both during the research process and prior to publication has been standard practice. There EDUCATIONAL RESEARCHER28 is no single marker of validity in qualitative inquiry, and the best qualitative research uses many of the strategies just described and invents others specific to the particular study. Thus, validity can- not be defined in advance by a certain procedure but must be attended to at all times as the study shifts and turns. In contrast to the emphasis on what qualitative researchers ought to do, Erickson (1986) offered “five major types of evi- dentiary inadequacy [italics added]”: (a) “inadequate amounts of evidence,” (b) “inadequate variety in kinds of evidence,” (c) “faulty interpretive status of evidence,” (d) “inadequate dis- confirming evidence,” and (e) “inadequate discrepant case analy- sis” (p. 140). Researchers, of course, must establish an evidentiary warrant for assertions or claims they make. Erickson wrote that assertions generated during fieldwork “are tested and retested against the data base: the corpus of fieldnotes, interview proto- cols, site documents” (p. 146), and so forth. Here, Erickson did use the language of warrants and evidence to discuss the impor- tance of disconfirming cases: To test the evidentiary warrant for an assertion the researcher con- ducts a systematic search of the entire data corpus, looking for dis- confirming and confirming evidence. . . . If the discrepant cases outnumbered those that fitted the assertion, the assertion would not be warranted by the data. Even if most of the cases fitted the assertion, the discrepant instances would be noted for subsequent analysis. (p. 146) Yet qualitative researchers working from other theoretical per- spectives disagree that there is such a thing as a disconfirming case (e.g., Lather, 1993; Scheurich, 2001). Another way to think about data or evidence that fail to fit emerging patterns is to rework the patterns to better represent the data. This work pro- duces general statements, interpretations, and theories. Generalizing and Theorizing The way claims are warranted in qualitative research typically cen- ters on the data, but researchers also use the literature relevant to studies, information collected by other scholars, and a variety of other sources to justify their claims. People unfamiliar with qualita- tive research assume that knowledge produced is not generalizable in the sense that it does not make what Kaplan (1964), a philoso- pher of science, called nomological generalizations, assertions that are “truly universal, unrestricted as to time and space . . . always and everywhere the case, provided only that the appropriate conditions are satisfied” (p. 91). Kaplan himself, however, distinguished among a variety of generalizations, assertions, and claims. Nomological or lawlike generalization rarely carries the weight in interpretive research that it does in positivist research, because the goal is not to generalize to predict and control but rather to describe what people do and say within local contexts. These particularistic generaliza- tions or assertions on the basis of the direct experience of observa- tion and interviewing, called generic propositions by Kaplan and naturalistic generalizations by Stake and Trumbull (1982), are the goal of much … Submit Manuscript | http://medcraveonline.com Introduction It is known that the need for emergency care for the elderly is increasing significantly, some events are considered essential, as well as the aging of the population and the change in the profile of epidemics. A study conducted in the emergency departments of a foreign country shows that older people, especially those over 70 years of age, have a higher entry rate in urgency compared to other age groups, which tends to increase As the population ages over time.1 It is pointed out that the increase in life expectancy allows the occurrence of problems arising from morphophysiological changes, inherent to the aging process. Therefore, there is an increase in chronic diseases, morbidity and functional disability. Therefore, the elderly are more likely to seek emergency care, and are often admitted to the hospital twice as often as young individuals. Because they present more complex health problems, the elderly need specialized care, constituting the largest consumers of the main health services.2 This is due to the clinical heterogeneity of these types of patients, which is associated with the depletion of physiological reserves and the factor of decreased cognition that result in the uncommon manifestation of “common” diseases, generating doubts about the effectiveness of the standard approaches and constituting as a challenge for the implementation of care by urgency nurses.3n In this perspective, the present study aimed to identify the nursing practices performed by the nurse to the elderly in the emergency services for a better understanding of the thematic and problematization of the study. Methods It is a study of the character of integrative revision, following the six integrative stages suggested by Mendes et al.4n the first step, the following research guiding question was defined: What are the nursing care practices for the elderly attended at the emergency service addressed in national and international Nursing publications? In the second stage, inclusion criteria were established: articles in English, Portuguese and Spanish available online in full, published from January 2011 to September 2018, to address nursing care for the elderly assisted in the emergency services. And the exclusion criteria: systematic, integrative reviews, case studies, reports of experiences and editorials.4,5 In the third step, it was defined that the online search platform of the Coordination of Improvement of Higher Level Personnel (CAPES) for the research of scientific productions would be used, since it covers several national and international databases and be available for public access.4–6 The online search occurred in September 2018, using the following descriptors: Emergency Nursing. Geriatric Nursing. Health Services for the Aged. Elderly. Nursing Care. To search for articles, the English descriptors were used according to the following combination: “Emergency Nursig” AND “Elderly”, “Emergency Nursing” AND “Health Services for the Aged”, “Emergency” AND “Elderly”, “Emergency” AND “Geriatric Nursing”, “Nursing Care” AND “Elderly”.4,7,8 Firstly, two researchers independently evaluated the titles and abstracts of the publications in the database for selection of potentially eligible studies. From these, full texts have been traced for a thorough reading. After exclusion, those who did not meet the inclusion criteria.4 In the fourth stage the data analysis was performed, organized by categories. In the fifth stage the discussion was developed according to pertinent literature and in the sixth stage elaborated the synthesis of the review.4,8 The integrative review includes the analysis of relevant research that supports decision making and improvement of clinical practice, enabling the synthesis of the knowledge state of a given subject, and pointing out knowledge gaps that need to be fulfilled with the accomplishment of new studies.4,6 This research method allows the synthesis of multiple published studies and allows general conclusions MOJ Gerontol Ger. 2018;3(5):385‒387. 385 © 2018 Lima et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Care for the elderly in the urgency sector: a qualitative study Volume 3 Issue 5 - 2018 Maurício CS Cunha Lima, Maria do Livramento Silva Bitencourt, Edienne Rosângela Sarmento Diniz, Cecília NGA Valença Master of Nursing, Lauro Wanderley University Hospital, Brazil Correspondence: Maria do Livramento Silva Bitencourt, Master of Nursing, Lauro Wanderley University Hospital, Brazil, Email [email protected] Received: September 30, 2018 | Published: October 04, 2018 Abstract Goal: To identify the care practices performed by the nurse to the elderly in the emergency services. Method: Integrative review carried out in the CAPES database, selecting publications in English, Portuguese and Spanish from January 2011 to September 2018. The descriptors used were: Emergency Nursing. Geriatric Nursing. Health Services for the Aged. Elderly. Nursing Care. Results: Fifteen articles were analyzed in English, being the majority of the qualitative approach (55.2\%). Australia stands out as the country with the highest number of publications (30.2\%). Conclusion: The care practices performed by nurses are aimed at identifying their main problems in relation to the care of the elderly, adaptation and planning of their work routine. Another strategy has been the implementation of specific evaluation instruments for the elderly patient and the involvement of the family in all stages of care. Keywords: emergency nursing, geriatric nursing, health services for the aged, elderly. nursing care MOJ Gerontology & Geriatrics Research Article Open Access Care for the elderly in the urgency sector: a qualitative study 386 Copyright: ©2018 Lima et al. Citation: Lima MCSC, Bitencourt MLS, Diniz ERS, et al. Care for the elderly in the urgency sector: a qualitative study. MOJ Gerontol Ger. 2018;3(5):385‒387. DOI: 10.15406/mojgg.2018.03.00151 regarding a particular area of study. It is a valuable method for nursing, since professionals often do not have the time to read all available scientific knowledge due to the high volume, besides the difficulty to perform the critical analysis of the studies.4,5,8 Although the inclusion of multiple studies with different research designs may complicate the analysis, a greater variety in the sampling process has the potential to increase the depth and breadth of the review findings. The richness of the sampling process may also contribute to a comprehensive picture of the topic of interest.4 Results and discussion It is noteworthy that the emergency and emergency services follow a curative model that aims at quick treatments and short stays of the patient. This model is inconsistent in the management of elderly care with chronic and complex conditions, requiring health services more integrated to multidisciplinary health care models.9,10 In order to change the model of care there is a period of time, which begins when professionals become aware of the drawbacks. A study of nurses in an emergency sector in a given country in 2016 showed that although there was no specific evaluation for the elderly, these professionals knew that their main problems with care were adequate control of pain, hygiene, psychosocial care and maintenance self-reliant patient.11 In order for new practices to take place, nurses had to make decisions about new problems, such as using appropriate language when talking to the elderly without forgetting them as a person, promoting patient independence and providing close observation. Another key role is that of the key element such as trust and self- efficacy, which need to be stratified by nurses in the emergency department to ensure correct targeted care.12 Respectful actions, honest and understandable information, allowing patients to express their opinions, anxieties, are some key actions in the emergency sector. The approach of nurses to the family is essential, because often the elderly can not provide accurate information about their health status and participate in the decision- making process, the family assumes this role.13 Two-thirds of patients admitted to the emergency room have cognitive impairment and are unable to report their personal history, medications in use, as well as allergies, dates, and reasons for recent hospitalizations. The use of forms, such as high summaries that contain records of the history of the visits by the elderly, improves the transmission of essential information to the nurse who admits the patient to the emergency room.14 Access to accurate patient information can help nurses identify their limitations and plan care with an emphasis on promoting autonomy. Even if they spend more time, the benefits of this practice are vital to prevent the patient from becoming dependent on intensive care.15 In this process the elderly and their families can be considered active agents in the construction of care, the family assumes the role of supervising the state of health, making decisions and accompanying their loved one.15,16 Therefore, the elderly and their family need special attention of the nurse, which contributes to the development of a relation of trust and respect and to a quality and humanized care.17 It is known that the use of evaluation tools of the elderly has also been reported in the studies as an element that can contribute to the improvement of the care in the emergency sector and in the direction of the interventions to which the elderly must be submitted. One of the tools identified in the studies is the Timed Up and Go test, which evaluates the gait and balance of the elderly, which are predictive factors for the risk of falls. The author points out that approximately one third of individuals over 65 years old will fall at least once a year, such falls may result in fractures, surgeries, hospital admissions, prolonged rehabilitation and death.17 These events are considered common among elderly people, which increases even more over the years due to decreased muscle strength, gait changes and maintenance of posture, resulting in a greater chance of stumbles and falls. They represent a public health problem, since they can result in fractures and injuries, which implies in the care of the elderly in the emergency room and even in hospitalization.15,16 The emergency department can act to prevent these events and alter the trajectory of the functional decline of the elderly, identifying those with a high risk of falls at the moment they seek care. Emergency nurse care One of the important aspects in the provision of nursing care is the creation of a therapeutic environment, understood by the author as a place without stimuli, protected by nursing and with a minimum of comfort. He adds that establishing dialogues with patients can contribute to the therapeutic environment.14 The following measures should be considered to be general in emergency care: Rapidly assess the situation • Serve patient support • Listen carefully • Ask for help when necessary Carefully assess the situation Before any intervention, situation as a whole. Evaluate the physical condition of the patient to verify that the patient is not in danger of life or requires any immediate somatic intervention.15,16 Make sure the patient is very anxious or aggressive before give any guidance or even try to reassure you verbally. Remember that anxiety causes decreased attention, memory and orientation, which will not allow them to memorize or remember guidance or even give information very complex.17 In order to guarantee the success of the implementation of the nursing process in a service, it is essential the participation and adherence of the entire nursing team. There has been a degree of resistance on the part of nurses’ technical and auxiliary categories to perform the interventions prescribed by the nurse, which may be related to the lack of capacities that promote the understanding of the process. The nursing team organizes the service and optimizes the care to be provided.17 Conclusion Faced with the increase of the elderly population with multiple comorbidities and chronic diseases, the emergency service has been the main access of these patients to health care, evidencing the need to change the paradigm of care. Thus, nursing care practices carried out by nurses in these services are directed to the adaptation of routine and work organization to meet the needs of these patients. In general, environmental risk factors are present in most of the falls, irregular surfaces, wet/slippery, loose objects/rugs and unevenness on the floor/ problems with steps were the most prevalent in the studies analyzed. The place occurrence of falls seems to be influenced by of intrinsic factors, since the active elderly physically tend to fall in outdoor environments, while elderly people with functional impairment fall within their own home. The difficulties identified in the study Care for the elderly in the urgency sector: a qualitative study 387 Copyright: ©2018 Lima et al. Citation: Lima MCSC, Bitencourt MLS, Diniz ERS, et al. Care for the elderly in the urgency sector: a qualitative study. MOJ Gerontol Ger. 2018;3(5):385‒387. DOI: 10.15406/mojgg.2018.03.00151 have challenged nurses to perform an incisive systematization in their care. The starting point has been the identification of the main problems related to care for the elderly, the implementation of specific evaluation instruments and the involvement of the family in care. Communication stands out as the main tool used. Acknowledgements None. Conflict of interest Author declares that there is no conflict of interest. References 1. Silva NC, Nogueira LT. Evaluation of operational indicators in a mobile emergency care service. Cogitare Enferm. 2012 17(3):7. 2. Donabedian A. La dimensión internacional de la evaluación y garantía de la calidad. Salud Publica Mex. 1990 32(2):5. 3. O’dwyer G, Matta IEA, Pepe VLE. Evaluation of emergency hospital services in the state of Rio de Janeiro. Ciênc Saúde Coletiva. 2008;13(5):1–11. 4. Mendes KDS, Silveira RCCP, Galvão MG. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto Enferm. 2008;17(4). 5. Barros LM, Araújo TM, Neri MFS, et al. Internação em uma unidade de emergência hospitalar: vivência. Cogitare Enferm. 2013;13(5). 6. Moher D, Liberati A, Tetzlaff J, et al. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;151(4):264–269. 7. Santos MT, Lima MADS, Zucatti PB. Elder-friendly emergency services in Brazil: necessary conditions for care. Rev Esc Enferm USP. 2016;50(4):592–599. 8. Deasey D, Kable A, Jeong S. Results of a national survey of australian nurses’ practice caring for older people in an emergency department. J Clin Nurs. 2016;25(19-20):3049–3057. 9. Huded JM, Dresden SM, Gravenor SJ, et al. Screening for fall risks in the emergency department: a novel nursing-driven program. West J Emerg Med. 2015;16(7):1043–1046. 10. Caldas CP, Veras RP, Motta LB, et al. Atendimento de emergência e suas interfaces: o cuidado de curta duração a idosos. J Bras Econ Saúde. 2015;7(1):62–69. 11. Tenório DM, Camacho ACLF. Identificação dos agravos de saúde que levam os idosos ao serviço de emergência. Rev Enferm UFPE on line. 2015;(13)2. 12. Bailey CJ, Murphyb R, Porockc D. Dying cases in emergency places: caring for the dying in emergency departments. Soc Sci Med. 2011;73(9):1371–1377. 13. Taylor BJ, Rush KL, Robinson CA. Nurses’ experiences of caring for the older adult in the emergency department: a focused ethnography. Int Emerg Nur. 2015;23(2):185–189. 14. Connel B, Hawkins M, Considine J, et al. Referrals to hospital emergency departments from residential aged care facilities: stuck in a time warp. Contemp Nurse. 2013;45(2):228–233. 15. Coimbra V LMM. Ermelinda MBGM, et al. Community Intervention In Elderly Population: A Fall Prevention Project. International Archives of Medicine. 2018;(11):1755–7682. 16. Dantas RAN, Costa IKF, Nóbrega WG,et al. Occurrences performed by the service of metropolitan emergency mobile attendance. Rev Enferm UFPE on line. 2014;8(4):8. 17. Reis CCA, Sena ELS, Menezes TMO. Vivências de familiares cuidadores de pessoas idosas hospitalizadas e a experiência de intercorporeidade. Escola Anna Nery on line. 2016;20(3). lable at ScienceDirect Journal of Clinical Gerontology & Geriatrics 5 (2014) 105e110 Contents lists avai Journal of Clinical Gerontology & Geriatrics journal homepage: www.e-jcgg.com Original article Qualitative research on the importance and need for home-based telecare services for elderly people Yung-Hung Wu, PhD a, b, Ya-Chen Lu, MS c, * a Superintendent Office, Taipei Veterans General Hospital, Taipei, Taiwan b Department of Business Administration, Takming University of Science and Technology, Taipei, Taiwan c Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan a r t i c l e i n f o Article history: Received 24 December 2013 Received in revised form 21 March 2014 Accepted 6 April 2014 Available online 28 June 2014 Keywords: Aging society Elderly Health care Telecare * Corresponding author. Institute of Health Policy Taiwan University, Number 17, Xu Zhou Road, Taipei E-mail address: [email protected] (Y.-C. Lu). http://dx.doi.org/10.1016/j.jcgg.2014.04.001 2210-8335/Copyright © 2014, Asia Pacific League of C a b s t r a c t Background/Purpose: Aging society has become a worldwide issue in recent years. Elderly people are considered to have higher risks of contracting multiple chronic diseases and comorbidities, thus increasing the need for care. Currently, efforts to develop long-term care for elderly people thrives more than before. Telecare has the potential to improve intractable problems in health care, such as limited access, uneven quality of care and cost inflation. The main purpose of this research is to investigate the key service items of home-based telecare that are important to elderly people and to identify their needs to make a more specific blueprint for future development. Methods: A qualitative study was conducted by applying the expert panel method and a questionnaire survey. The purpose of the expert panel was to clarify and unify the scope and the main objectives of this research which would help to develop the structure of the questionnaire so as to manipulate and conduct analysis in the research. Results: Through the expert panel, 15 service items and products were selected and unified. The average showed that the present performance was generally considered good. There were some differences between the scores of the three members of the panel, which revealed the existence of contrary opinions to each stakeholders party. Conclusion: The study provided a closer inspection of the issue of the nonegalitarian reality of telecare. Based on the INA matrix, service items and products were narrowed down to eight, which is half of the original service items and products provided. In addition, it was easy to observe the priorities among service items and products when providing service items and products to elderly people. Copyright © 2014, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Elsevier Taiwan LLC. Open access under CC BY-NC-ND license. 1. Introduction Aging society has become a worldwide issue in recent years. According to the definition of the World Health Organization (WHO), a country is considered to be an aging society when the proportion of the population over 65 reaches 7\%, as aged society when the proportion reaches 14\%, and as superaged society at 20\%. Due to economic growth and medical improvements, Taiwan now faces dramatic demographic changes. The percentage of elderly people in Taiwan exceeded 7\% in 1993, and reached 11\% in 2011. It is estimated that Taiwan will become an aged society in 2018 and super-aged in 2025.1,2 and Management, National 100, Taiwan, ROC. linical Gerontology & Geriatrics. P Elderly people are considered to have higher risks of contracting multiple chronic diseases and comorbidities, thus increasing the need for care. Many study results show that age is one of the major affective factors in health care utilization.3,4 Based on reports from the Department of Health in Taiwan, elderly outpatients over 65 years old accounted for 33\% of total services. In addition, the annual health care expenditure of the 60e69-year-old group in Taiwan was 81,677 NT dollars (approximately 2720 U.S. dollars) in 2006, which is almost twice that of the 50e59-year-old group, or four times more than the 40e49-year-old group. Both health care utilization and expenditure in Taiwan are consistent with these findings. In this climate, development of long-term care for elderly peo- ple thrives more than before. In the 1960s, European countries proposed the idea of aging in place. The concept was to let elderly people stay in a familiar environment as long as possible in order to slow down malfunctioning. Community and home-based care ublished by Elsevier Taiwan LLC. Open access under CC BY-NC-ND license. Y.-H. Wu, Y.-C. Lu / Journal of Clinical Gerontology & Geriatrics 5 (2014) 105e110106 gradually earned its own value and prestige in many countries. Taiwan also followed this trend and transitioned to long-term care policy adopting community and home-based care. In 1999, the Department of Health in Taiwan declared that long-term care pol- icies should focus on community and home-based development. Community and home-based care is the future goal in Taiwan. According to the report conducted by the UN in 2005, it was shown that living with a child or grandchild is the most common type of living arrangement among older persons in Latin America and the Caribbean, Asia, and Africa. In particular, living with a child is considered the top preference of living arrangements in Taiwan, Japan, and South Korea. In Taiwan, this preference has remained the same since 2005.5 The overview of elderly peoples living status in 2011 shows that the ideal living status for an elderly person is living with a child; living with a spouse takes second place. Living in in- stitutions accounts only for 3\% of preferences. In this given situa- tion, most elderly people who keep or wish to keep their daily lives at home need different degrees of health care. Some may need mild assistance such as medication guides, whereas others may need multiple functions to sustain their basic activities of daily living. However, the environment at home, unlike in institutions which have sufficient facilities and well-trained staff, cannot always pro- vide professional help in time and can consequently influence health maintenance.6 Due to technological innovation, there are more and more ap- plications available across different expert fields, and the medical field is no exception. Home-based telecare was first developed for patients with chronic diseases such as heart failure, diabetes, asthma, and chronic obstructive pulmonary disease (COPD).7 Thereafter, its application was expanded to include other vulner- able populations.8 Considering the close relationship between care needs and underlying medical conditions, we adopt an extended definition of home-based telecare. In this paper, we regard home- based telecare as all kinds of integrated health care services that use information and communication technology (ICT) to maintain safety and autonomy in the living environment.9e11 Telecare may combine all kinds of assistive or enabling technologies to provide a total care package that requires very little of the person-to-person interaction currently associated with care in and by the community.12 With the rise in the home-based care population in recent de- cades, many companies and organizations in the health care field have become prosperous through emerging service items and products that target elderly people. According to a report by the Ministry of Economic Affairs in Taiwan, profit from the application of wireless health care in America continues to increase from 0.3 billion United States dollars in 2009 to 4.4 billion United States dollars. In Taiwan, Executive Yuan also launched a Health cloud project in 2013, whose aim was to create a ubiquitous health care environment by connecting associated systems among the medical, care, health protection, public health promotion, and disease con- trol services. Rising demand for combined ICT technology and personalized health care services has created a huge business market for home-based telecare.13 In view of this trend, the main purpose of this research is to discover the key service items of home-based telecare that are important to elderly people in the hope of identifying their needs so as to make a more specific blueprint for future development. 2. Methods A qualitative study was conducted by applying the expert panel method and a questionnaire survey approach. The expert panel was to clarify and unify the scope and main measure objectives of this research and help to construct the questionnaire. The expert panel was then asked to fill in the questionnaire in order to manipulate and conduct analysis in the research. 2.1. Expert panel Service items and products were first collected through sec- ondary data by reviewing published research papers. Other avail- able documents such as industry reports were also taken into account as reference.14e17 However, service items and products were developed and manufactured individually. Consequently, it brought to light the fact that similar types of service items or products provided roughly the same service contents, but each had some distinct details when closely inspected. In order to provide a basic widespread concept toward each home-based telecare service and to ensure the consistent conception and definition of each service item or product, the expert panel method was introduced and applied in this research. Expert panels are used to systemati- cally solicit, organize, and structure collective judgments and opinions on particularly complex subject matters by an authorita- tive group. In accordance with the essence of the expert panel, a heterogeneous group provides comprehensive perspectives and reduces bias.18,19 Therefore, diversity stakeholders in telecare should be taken into consideration. Three distinguished but asso- ciated authorities were assembled in the expert panel. They were product manufacturers in the industry, medical suppliers in the health care system, and the end-users e elderly people. Two senior managers who work in one of the major companies in telecare in Taiwan agreed to represent their field in our interview. Three medical directors of geriatrics and gerontology in one of the largest medical centers in Taiwan were represented in this research. Two elderly people who had experience and constantly used one of those service items or products over the past 2 years were pre- sented as end-users. However, it should be noted that selection of our panel members was not random, but designed to enhance collective knowledge. Two researchers reviewed and revised expert panel open-ended questions until an agreement was reached. Each panel received a manuscript that contained descriptions of the others. Panel members were contacted individually when re- searchers needed clarification regarding their comments. 2.2. Data analysis Based on the results of the previous stage, a provisional ques- tionnaire was constructed to determine the importance and degree of need for all service items and products. The questionnaire was developed with a likert-type scale to discover the difference in importance of and the degrees of need for service items. In this research, importance was defined as the value or influence of a particular item when providing health care to elderly people. However, the definition of the degrees of need was the perception of lack of a particular item for elderly people. Open-ended ques- tions were also included in the questionnaire to record responses and details that were not reflected on the scale. After finishing interviews, we applied a descriptive statistic method to analyze the score of the likert-type scale questionnaire. As there is little known about the different perspectives of the three parties in previous studies in the area of telecare, descriptive statistics were suitable for exploratory investigation and provided a grasp of the new field. Secondly, we developed an importance-need analysis matrix (INA) based on the average score of each item and product. Through the INA matrix, service items were relocated to corresponding posi- tions. By this means, we could explain more thoroughly the rela- tionship between importance and the degree of need of each service item and determine individual value and actual perfor- mance as perceived by the expert panel. Table 1 Home-based telecare service items and products. Category Service item Operation process Function Functional oriented Medical reminder (1) Reminder to take medicine on time according to the prescriptions through internet platform or ICT device (2) Send medication information to elderly people or their family members via the internet or text Prevent the wrong dosage or taking medications at the wrong time Vital sign detector A wearable device that observes and records a persons basic body condition which may include heart rate, body temperature, etc. Real-time monitoring of physiological conditions to help disease prevention at early stage Abnormal event reporter A wireless system with sensors located at different points in the users home to identify any abnormal activity patterns to a monitor center or family members Alert unpredictable accidents at home, take necessary measures, and prevent more severe situation in advance Tracking monitor A wearable device that monitors and tracks users location via wireless or GPS in community or around a certain area Ensure security of elderly and enable them caution- free on movements Home care assistant A platform providing arrangements to all kinds of daily life services by trained staff such as house cleaning and grocery shopping Supplementary service for elderly people or family members to ease their load Healthy diet delivery A platform providing meal ordering and delivering including healthy and special diets Supplementary service for elderly or family members to ensure elderly people have appropriate nutrition Socialepsychological oriented Communicable network An interaction media allowing patients and families to interact with other patients with the same or similar health problems or interests Enhance information exchange and create a supportive social network in the group Social supportive network A link between elderly people and social supportive network which provides adequate social welfare and social aid in the community Acknowledge elderly people of their equity on social welfare and provide alternatives for elderly people if needed Educational oriented Medication guide An interactive surface for inquiry medication guide including usage and possible side effects Increase knowledge of medication and prevent potential medication abuse Health knowledge education A platform providing all kinds of basic, correct, and new health information via media Health promotion for elderly people intention to raise health awareness of elderly people Self-rehabilitation A platform providing home rehabilitation guide to assist elderly people who have needs Enhance self-rehabilitation knowledge, improve completion of rehabilitation course, and reduce unnecessary visits to hospital Integrated function Outpatient arrangement A link between ambulatory services and elderly people in need of help arranging and reminding them of visits (1) Make arrangement to doctors easier for elderly people (2) Keep regular ambulatory services for elderly people with chronic diseases 24 hrs Call center A single tab or trigger device connected to well-trained staff whenever needed An immediate connection to solve or prevent unpredictable accidents Visual health consultation A camera system providing visual consultations with professional medical staff such as nurse or nutritionist Provide an interactive connection with visuals to solve non-emergency, medical relevance and specific problems Health cloud A multiple resources integrated interface with storage, inquiry, and interactive functions to systematically sort information out from data Provide effective and efficient health management for elderly people Y.-H. Wu, Y.-C. Lu / Journal of Clinical Gerontology & Geriatrics 5 (2014) 105e110 107 3. Results After processing by the expert panel, 15 items were sorted out and selected for research. The expert panel agreed that each element selected was unique and could represent its own type of service. Furthermore, they were classified into four categories: function-oriented, sociallyepsychologically-oriented, education- oriented, and integrated function. The operation process and function of each telecare service item or product are shown in Table 1. We analyzed the likert-type questionnaire. The result is summarized in Table 2 below. The overall average of the importance was from 3.14 to 4.57.Among all service items, the highest score of importance was “Abnormal event reporter” (4.57), and the lowest were “Healthy diet delivery”, “Communi- cable network”, and “Socially supportive network” (3.14). The average of the degree of need was from 2.86 to 4.29. The service items with the highest scores were “Medication guide”, “Health knowledge education”, and “Self-rehabilitation” (4.29), and the lowest was “Communication network”. The mode of importance and degree of need showed a similar trend with the average. Both the average and mode had higher scores in importance than in the degree of need for most items. However, there were a few items contrary to the majority such as “Healthy diet delivery”, “Social supportive network”, “Health knowledge education”, and “Health cloud”. In summary, all items showed a score of 3 out of 5 in importance and most of them were also the same in the degree of need. The present performance was at least considered good. Secondly, the three parties displayed some difference when comparing the average score with each other. In the function- oriented dimension, “Home care assistant” and “Health diet de- livery” received lower scores in the end-users’ perception of both importance and the degree of need, whereas they were viewed as being of higher value for medical suppliers and industry. In the sociallyepsychologically-oriented dimension, the end-users’ opin- ions showed the same contrary condition in both “Communicable network” and “Social supportive network” in comparison with medical suppliers and industry. However, the expert panel dis- played most consistency toward items in the education-oriented dimension. Finally, in the integrated function-oriented dimension, two items, “24-hr Call center” and “Health cloud”, showed contra- dictory results when comparing scores. “24-hr Call center” received a lower score from end-users, but “Health cloud” from industry by contrast. In conclusion, the differentiation of the scores for the items revealed the contrary opinion of each stakeholders party. Table 2 The average of service items and products. Category Service item End user Medical supplier Industry Total Importance Degree of need Importance Degree of need Importance Degree of need Importance Degree of need Functional oriented Medical reminder (S1) 4.00 4.00 4.33 4.00 4.00 4.00 4.14 4.00 Vital sign detector (S2) 4.00 3.50 3.67 4.00 4.00 4.00 3.86 3.86 Abnormal event reporter(S3) 5.00 3.50 4.33 4.00 4.50 4.50 4.57 4.00 Tracking monitor (S4) 5.00 3.50 3.33 3.33 3.00 3.00 3.71 3.29 Home care assistant (S5) 2.00 2.50 4.00 3.67 4.00 4.00 3.43 3.43 Healthy diet delivery (S6) 1.50 3.00 3.67 3.67 4.00 4.00 3.14 3.57 Socialepsychological oriented Communicable network (S7) 2.50 2.50 3.33 3.00 3.50 3.00 3.14 2.86 Social supportive network(S8) 2.50 2.50 3.67 4.00 3.00 3.00 3.14 3.29 Educational oriented Medication guide (S9) 4.50 4.00 4.00 4.33 4.50 4.50 4.29 4.29 Health knowledge education (S10) 4.00 5.00 4.00 4.00 4.50 4.00 4.14 4.29 Self-rehabilitation (S11) 4.50 4.50 4.00 4.33 4.50 4.00 4.29 4.29 Integrated function oriented Outpatient arrangement (S12) 4.00 3.00 4.00 4.00 4.00 4.00 4.00 3.71 24 hrs Call center (S13) 2.00 2.00 4.00 4.00 4.50 4.50 3.57 3.57 Visual health consultation (S14) 4.00 4.00 4.00 3.67 3.00 3.00 3.71 3.57 Health cloud (S15) 4.50 4.00 4.00 4.00 3.50 2.50 4.00 3.57 Total 3.60 3.43 3.89 3.87 3.90 3.73 3.81 3.70 Y.-H. Wu, Y.-C. Lu / Journal of Clinical Gerontology & Geriatrics 5 (2014) 105e110108 Thirdly, we set up a matrix of importance and degree of need based on the average scores of service items. In Fig. 1, all service items could be classified by distribution pattern into two groups. Seven items were considered to be one group that represented relative importance and a high degree of need. These items were “Medical reminder” (S1), “Vital sign detector” (S2), “Abnormal event reporter” (S3), “Medication guide” (S9), “Health knowledge education” (S10), “Self-rehabilitation” (S11), and “Outpatient arrangement” (S12). In addition, “Health cloud” (S15), though slightly lower in degree of need, could be regarded as part of the same group. However, the other group with relatively lower importance and degree of need were “Tracking monitor” (S4), “Home care assistant” (S5), “Healthy diet delivery” (S6), “Commu- nicable network” (S7), “Social supportive network” (S8), “24-hr Call center” (S13), and “Visual health consultation” (S14). 4. Discussion Telecare has the potential to improve intractable problems in health care such as limited access, imbalanced quality of care, and cost inflation.20 From the end-users perspective, many studies have proved that elderly people hold an optimistic atti- tude toward acceptance of telecare. The results also showed consistency with previous research by viewing the importance and the degree of need for elderly people with an average high Fig. 1. INA score among end-users, medical suppliers, and industry. It also provided more solid evidence of this. In 2007, the EU started a project called The Active and Assisted Living Joint Programme (AAL JP), which is a funding activity that aims to create better living conditions for older adults and to strengthen industrial opportunities in Europe through the use of ICT. At least 20 countries have since become involved in this project. With this trend, we can foresee telecare becoming a fast developing health care service in the 21st century. Many research studies have found that the content of service items or products was one of the crucial factors that influence elderly people when deciding which service or product to use.21 Figs. 2 and 3 show the contradictions perfectly among end-users, medical suppliers, and industry. The area of end-users was signif- icantly different from the other two components on the radar graphic both in importance and the degree of need. On the contrary, medical suppliers and industry manufacturers showed a high similarity. This provided a reasonable explanation for the fact that elderly people evaluated service items and products on the basis of their own concerns. Furthermore, some research show that many elderly people display a high level of acceptance of home-based telecare services in trials, but when acknowledging the expense of real application, such as initial facilitating and monthly main- tenance, their willingness to use telecare drops sharply, especially for those who could not obtain subsidies from the government after matrix. Fig. 3. Radar of the degree of need. Fig. 2. Radar of importance. Y.-H. Wu, Y.-C. Lu / Journal of Clinical Gerontology & Geriatrics 5 (2014) 105e110 109 testing.22 Moreover, retail prices for home-based telecare remain relatively high because of the initial costs. At this stage, home- based telecare still costs a fortune for a middle-class family when compared with seeing a doctor directly. The retail price of home- based telecare services may be one of the key factors that affect the end-user’s motivation for applying.23 In fact, how to build up a reasonable charge would be another challenge for most companies in the industry in Taiwan. If manufacturers cannot respond to the core values in elderly peoples minds, service items and products will not earn value and build a reputation among end-users.21 When creating service items, gaps resulting in unequal situations keep pushing potential users away. The potential benefits of home- based telecare could fail to be fully realized despite a well-equipped technology environment. When examined from the national level, we found that medical organizations in Taiwan usually encourage people to see doctors more to keep certain profits in response to global budgets and pay- for-services under the health care policy. However, this is contra- dictory to the main purpose of home-based telecare, which is believed to help people enhance abilities to provide health man- agement and reduce unnecessary medical expenses. This inevitably highlights the limitations of developing home-based telecare. To show true efficacy in home-based telecare, the government needs to rethink its own policies; let medical organizations take more responsibility for health promotion and proper responses to peo- ples needs in the region. 5. Conclusion This study focused on the importance and the degree of need for telecare service items and products. To achieve the main purpose, the expert panel method was applied. Based on the INA matrix, the number of service items and products were narrowed down to eight, which is half of the original service items and products provided. In addition, it is easy to view the priorities among service items and products when providing service items and products to elderly peo- ple. The future developmentof home-based telecare services needs to be more focused. Further research mayconcentrate on understanding in more detail the function of each service item and product that will actually trigger elderly people to start using services in telecare. Conflicts of interest The authors have no conflicts of interest to declare. References 1. Hu YN, Hu GC, Hsu CY, Hsieh SF, Li CC. Assessment of individual activities of daily living and its association with self-rated health in elderly people of Taiwan. Int J Gerontol 2012;6(2):117e21. 2. Kuo RJ, Wu YH, Hsu TS, Chen LK. Improving outpatient services for elderly patients in Taiwan: a qualitative study. Arch Gerontol Geriatr 2011;53:e209e17. 3. Markides KJ, Levin JS, Ray LA. Determinants of physician utilization among MexicaneAmericans: a three-generations study. Med Care 1985;23:237e45. Y.-H. Wu, Y.-C. Lu / Journal of Clinical Gerontology & Geriatrics 5 (2014) 105e110110 4. Mutran E, Ferraro KF. Medical need and use of services among older men and women. J Gerontol 1988;43:S162e71. 5. United Nations. Living arrangements of older persons around the world; 2005. New York. 6. Huang CH, Ho ZS, Guan XS. A study of the lives demand assessment for old man living alone e Take Gukeng Township Yunlin county of Taiwan as an example. J DR 2009;3:121e35. 7. Lamothe L, Fortin JP, Labbe F, Gagnon MP, Messikh D. Impacts of telehomecare on patients, providers, and organizations. Telemed J E Health 2006;12:363e9. 8. Gagnon MP, Lamothe L, Hebert M, Chanliau J, Fortin JP. Telehomecare for vulnerable populations: the evaluation of new models of care. Telemed J E Health 2006;12:324e31. 9. Clark M, Goodwin N. Sustaining innovation in telehealth and telecare. WSD Action Network 2010:1e32. 10. Celler BG, Lovell NH, Basilakis J. Using information technology to improve the management of chronic disease. Med J Aust 2003;179:242e6. 11. Eysenbach G. What is e-health? J Med Internet Res 2001;3(2):e20. 12. Draper H, Sorell T. Telecare, remote monitoring and care. Bioethics 2013;27: 365e72. 13. Department of Industrial Technology, Ministry of Economic Affairs. White paper on Taiwan Industrial Technology 2013. Available at http://www2.itis.org. tw/pubreport/PubReport_Detail.aspx?rpno¼83159609. [accessed 24.10.13]. [in Chinese]. 14. Van den Berg N, Schumann M, Kraft K, Hoffmann W. Telemedicine and telecare for older patientsda systematic review. Maturitas 2012;73:94e114. 15. Almunawar MN, Wint Z, Low KC, Anshari M. Customer expectation of e-health systems in Brunei Darussalam. J Health Care Finance 2012;38(4):36e49. 16. Wong MK, Chang WH, Ke PC, Huang CK, Tsai TH, Chang HT, et al. Technology acceptance for an intelligent comprehensive interactive care (ICIC) system for care of the elderly: a surveyequestionnaire study. PLoS ONE 2012;7:e40591. 17. Finkelstein SM, Speedie SM, Zhou X, Potthoff S, Ratner ER. Perception, satis- faction and utilization of the VALUE home telehealth service. J Telemed Telecare 2011;17:288e92. 18. Anderson JC, Rungtusanatham M, Schroeder RG. A theory of quality manage- ment underlying the deming management method. Acad Manag Rev 1994;19: 472e509. 19. Linstone HA, Turoff M. The Delphi method. Boston, MA: Addison-Wesley; 1979. 20. Bushur RL. On the definition and evaluation of telemedicine. Telemed J 1995;1: 19e30. 21. Sugarhood P, Wherton J, Procter R, Hinder S, Greenhalgh T. Technology as system innovation: a key informant interview study of the application of the diffusion of innovation model to telecare. … Education for Information 22 (2004) 63–75 63 IOS Press Strategies for ensuring trustworthiness in qualitative research projects Andrew K. Shenton∗ Division of Information and Communication Studies, School of Informatics, Lipman Building, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK Received 14 November 2003 Accepted 6 January 2004 Although many critics are reluctant to accept the trustworthiness of qualitative research, frameworks for ensuring rigour in this form of work have been in existence for many years. Guba’s constructs, in particular, have won considerablefavour and form the focus of this paper. Here researchers seek to satisfy four criteria. In addressing credibility, investigators attempt to demonstrate that a true picture of the phenomenon under scrutiny is being presented. To allow transferability, they provide sufficient detail of the context of the fieldwork for a reader to be able to decide whether the prevailing environment is similar to another situation with which he or she is familiar and whether the findings can justifiably be applied to the other setting. The meeting of the dependability criterion is difficult in qualitative work, although researchers should at least strive to enable a future investigator to repeat the study. Finally, to achieve confirmability, researchers must take steps to demonstrate that findings emerge from the data and not their own predispositions. The paper concludes by suggesting that it is the responsibility of research methods teachers to ensure that this or a comparable model for ensuring trustworthiness is followed by students undertaking a qualitative inquiry. Keywords: Qualitative methods, research 1. Introduction The trustworthiness of qualitative research generally is often questioned by posi- tivists, perhaps because their concepts of validity and reliability cannot be addressed in the same way in naturalistic work. Nevertheless, several writers on research methods, notably Silverman [1], have demonstrated how qualitative researchers can incorporate measures that deal with these issues, and investigators such as Pitts [2] have attempted to respond directly to the issues of validity and reliability in their own qualitative studies. Many naturalistic investigators have, however, preferred to use different terminology to distance themselves from the positivist paradigm. One such author is Guba, who proposes four criteria that he believes should be considered ∗Address for correspondence: 92 Claremont Road, Whitley Bay, Tyne and Wear, NE26 3TU, UK. E-mail: [email protected] 0167-8329/04/$17.00 2004 – IOS Press and the authors. All rights reserved 64 A.K. Shenton / Strategies for ensuring trustworthiness in qualitative research projects by qualitative researchers in pursuit of a trustworthy study [3]. By addressing sim- ilar issues, Guba’s constructs correspond to the criteria employed by the positivist investigator: a) credibility (in preference to internal validity); b) transferability (in preference to external validity/generalisability); c) dependability (in preference to reliability); d) confirmability (in preference to objectivity). Although as recently as the mid 1990s Lincoln wrote that the whole area of qualita- tive inquiry was “still emerging and being defined” [4], Guba’s constructs have been accepted by many. This paper considers the criteria in detail and suggests provisions that the qualitative researcher may employ to meet them. The strategies advocated are based on the experience gained by Shenton when undertaking a qualitative PhD study devoted to the information-seeking behaviour of school-aged children [5]. 2. Credibility One of the key criteria addressed by positivist researchers is that of internal valid- ity, in which they seek to ensure that their study measures or tests what is actually intended. According to Merriam, the qualitative investigator’s equivalent concept, i.e. credibility, deals with the question, “How congruent are the findings with real- ity?” [6] Lincoln and Guba argue that ensuring credibility is one of most important factors in establishing trustworthiness [7]. The following provisions may be made by researchers to promote confidence that they have accurately recorded the phenomena under scrutiny: a) the adoption of research methods well established both in qualitative inves- tigation in general and in information science in particular. Yin recognises the importance of incorporating “correct operational measures for the concepts being studied” [8]. Thus, the specific procedures employed, such as the line of questioning pursued in the data gathering sessions and the methods of data analysis, should be derived, where possible, from those that have been suc- cessfully utilised in previous comparable projects. In terms of investigation of information-seeking behaviour, the work of Dervin has proved particularly influential in this regard. In their study of the information needs of Seat- tle’s residents, Dervin et al. initially invited participants to reflect on situations “where you needed help. . . where you didn’t understand something. . . where you needed to decide what to do. . . or, where you were worried about some- thing” [9]. Dervin’s respondents then described in detail a particular instance within one of these categories. Similar strategies have been used subsequently by Chen and Hernon [10], Poston-Anderson and Edwards [11] and Shenton [12] amongst others; A.K. Shenton / Strategies for ensuring trustworthiness in qualitative research projects 65 b) the development of an early familiarity with the culture of participating or- ganisations before the first data collection dialogues take place. This may be achieved via consultation of appropriate documents and preliminary visits to the organisations themselves. Lincoln and Guba [13] and Erlandson et al. [14] are among the many who recommend “prolonged engagement” between the investigator and the participants in order both for the former to gain an ade- quate understanding of an organisation and to establish a relationship of trust between the parties. The danger emerges, however, that if too many demands are made on staff, gatekeepers responsible for allowing the researcher access to the organisation may be deterred from cooperating. The investigator may also react with some suspicion to the notion of prolonged engagement in view of the undesirable side effects that have been noted by Lincoln and Guba [15] and Silverman [16]. The former draw particular attention to the way in which investigators may become so immersed in the culture under scrutiny that their professional judgements are influenced; c) random sampling of individuals to serve as informants. Although much quali- tative research involves the use of purposive sampling, a random approach may negate charges of researcher bias in the selection of participants. As Preece notes, random sampling also helps to ensure that any “unknown influences” are distributed evenly within the sample [17]. Furthermore, it may be that a random method is particularly appropriate to the nature of the investigation. The work may, for example, take the form of a “collective case study” of the type described by Stake, in that multiple voices, exhibiting characteristics of similarity, dissimilarity, redundancy and variety, are sought in order to gain greater knowledge of a wider group [18], such as a more general population, rather than simply the individual informants who are contributing data. This form of research is also recognised by Hamel, Dufour and Fortin, who dub it a “macroscopic” case study, and emphasise the importance of appropriate selection tactics if the investigator is to be confident that informants are typical of members of a broader, “selected society” [19]. According to Bouma and Atkinson, “A random sampling procedure provides the greatest assurance that those selected are a representative sample of the larger group” [20]. A signifi- cant disadvantage of random method, however, stems from the fact that, since the researcher has no control over the choice of informants, it is possible that quiet, uncooperative or inarticulate individuals may be selected; d) triangulation. Triangulation may involve the use of different methods, es- pecially observation, focus groups and individual interviews, which form the major data collection strategies for much qualitative research. Whilst focus groups and individual interviews suffer from some common methodological shortcomings since both are interviews of a kind, their distinct characteristics also result in individual strengths. According to Guba [21] and Brewer and Hunter [22], the use of different methods in concert compensates for their individual limitations and exploits their respective benefits. Where possible, 66 A.K. Shenton / Strategies for ensuring trustworthiness in qualitative research projects supporting data may be obtained from documents to provide a background to and help explain the attitudes and behaviour of those in the group under scrutiny, as well as to verify particular details that participants have supplied. Opportunities should also be seized to examine any documents referred to by informants during the actual interviews or focus groups where these can shed more light on the behaviour of the people in question. Another form of triangulation may involve the use of a wide range of in- formants. This is one way of triangulating via data sources. Here individual viewpoints and experiences can be verified against others and, ultimately, a rich picture of the attitudes, needs or behaviour of those under scrutiny may be constructed based on the contributions of a range of people. Van Maanen urges the exploitation of opportunities “to check out bits of information across informants” [23]. Such corroboration may, for example, take the form of com- paring the needs and information-seeking action described by one individual with those of others in a comparable position. In addition, the investigator may draw informants from both users of an information service and the pro- fessionals who deliver it. Even in a user study, where the thrust of the work is likely to lie in analysing the ideas and experiences of users themselves, data provided by those responsible for the management and delivery of the service under scrutiny may well prove invaluable in order to check that supplied by the users, to help explain their attitudes and behaviour and to enhance the contex- tual data relating to the fieldwork site(s). Just as triangulation via data sources can involve the use of a diversity of informants, a range of documents may also be employed as source material. For example, documents created corporately by each participating organisation may be examined, as well as those relating to the organisation but produced externally. Further data dealing with the wider context in which the organisation is operating may be elicited from official publications. Where appropriate, site triangulation may be achieved by the participation of informants within several organisations so as to reduce the effect on the study of particular local factors peculiar to one institution. Where similar results emerge at different sites, findings may have greater credibility in the eyes of the reader. The sampling of a range of people in different organisations may be employed to provide the diversity that underpins Dervin’s concept of “circling reality”, which she defines as “the necessity of obtaining a variety of perspectives in order to get a better, more stable view of ‘reality’ based on a wide spectrum of observations from a wide base of points in time-space” [24]; e) tactics to help ensure honesty in informants when contributing data. In partic- ular, each person who is approached should be given opportunities to refuse to participate in the project so as to ensure that the data collection sessions involve only those who are genuinely willing to take part and prepared to offer data freely. Participants should be encouraged to be frank from the outset of each session, with the researcher aiming to establish a rapport in the opening A.K. Shenton / Strategies for ensuring trustworthiness in qualitative research projects 67 moments and indicating that there are no right answers to the questions that will be asked. Where appropriate, the independent status of the researcher should also be emphasised. Participants can, therefore, contribute ideas and talk of their experiences without fear of losing credibility in the eyes of managers of the organisation. It should be made clear to participants that they have the right to withdraw from the study at any point, and they should not even be required to disclose an explanation to the investigator. In many instances, such an unconditional right for subjects to withdraw may be a requirement that must be accepted by the researcher when seeking approval for the work; f) iterative questioning. In addition to the “preventative” strategies outlined above, specific ploys may be incorporated to uncover deliberate lies. These might in- clude the use of probes to elicit detailed data and iterative questioning, in which the researcher returns to matters previously raised by an informant and extracts related data through rephrased questions. In both cases, where contra- dictions emerge, falsehoods can be detected and the researcher may decide to discard the suspect data. An alternative approach and one that provides greater transparency lies in drawing attention, within the final research report, to the discrepancies and offering possible explanations; g) negative case analysis, as recommended by commentators such as Lincoln and Guba [25], Miles and Huberman [26] and Silverman [27]. One form of negative case analysis may see the researcher refining a hypothesis until it addresses all cases within the data. If the study includes the production of typologies, on completing the initial categories the investigator may revisit the data in order to confirm that these constructs do indeed account for all instances of the phenomenon involved, even if some of the types embrace only one instance; h) frequent debriefing sessions between the researcher and his or her superiors, such as a project director or steering group. Through discussion, the vision of the investigator may be widened as others bring to bear their experiences and perceptions. Such collaborative sessions can be used by the researcher to discuss alternative approaches, and others who are responsible for the work in a more supervisory capacity may draw attention to flaws in the proposed course of action. The meetings also provide a sounding board for the investigator to test his or her developing ideas and interpretations, and probing from others may help the researcher to recognise his or her own biases and preferences; i) peer scrutiny of the research project. Opportunities for scrutiny of the project by colleagues, peers and academics should be welcomed, as should feedback offered to the researcher at any presentations (e.g. at conferences) that are made over the duration of the project. The fresh perspective that such individuals may be able to bring may allow them to challenge assumptions made by the investigator, whose closeness to the project frequently inhibits his or her ability to view it with real detachment. Questions and observations may well enable the researcher to refine his or her methods, develop a greater explanation of the research design and strengthen his or her arguments in the light of the comments made; 68 A.K. Shenton / Strategies for ensuring trustworthiness in qualitative research projects j) the researcher’s “reflective commentary”. In addition to the outside scrutiny discussed above, the investigator should seek to evaluate the project, again as it develops. This may be done through a reflective commentary, part of which may be devoted to the effectiveness of the techniques that have been employed. The reflective commentary may also be used to record the researcher’s initial impressions of each data collection session, patterns appearing to emerge in the data collected and theories generated. The commentary can play a key role in what Guba and Lincoln term “progressive subjectivity”, or the monitoring of the researcher’s own developing constructions, which the writers consider critical in establishing credibility [28]. Ultimately, the section of the commentary dealing with emerging patterns and theories should inform that part of the research report that addresses the project’s results, and any discussion in the report of the effectiveness of the study maybe based on the investigator’s methods analysis within the reflective commentary; k) background, qualifications and experience of the investigator. According to Patton, the credibility of the researcher is especially important in qualitative research as it is the person who is the major instrument of data collection and analysis [29]. Alkin, Daillak and White go so far as to suggest that a scrutineer’s trust in the researcher is of equal importance to the adequacy of the procedures themselves [30]. The nature of the biographical information that should be supplied in the research report is a matter of debate. Maykut and Morehouse recommend in- cluding any personal and professional information relevant to the phenomenon under study [31], and Patton adds that arrangements by which the investigator is funded should also be addressed [32]. Any approvals given to the project by those providing access to the organisation and individual participants should also be made explicit; l) member checks, which Guba and Lincoln consider the single most important provision that can be made to bolster a study’s credibility [33]. Checks relating to the accuracy of the data may take place “on the spot” in the course, and at the end, of the data collection dialogues. Informants may also be asked to read any transcripts of dialogues in which they have participated. Here the emphasis should be on whether the informants consider that their words match what they actually intended, since, if a tape recorder has been used, the articulations themselves should at least have been accurately captured. Another element of member checking should involve verification of the investigator’s emerging theories and inferences as these were formed during the dialogues. This strategy has been employed by Pitts [34] and is recommended by Brewer and Hunter [35] and Miles and Huberman [36]. Where appropriate, participants may be asked if they can offer reasons for particular patterns observed by the researcher. The importance of developing such a formative understanding is recognised by Van Maanen, who writes that A.K. Shenton / Strategies for ensuring trustworthiness in qualitative research projects 69 “analysis and verification. . . is something one brings forth with them from the field, not something which can be attended to later, after the data are collected. When making sense of field data, one cannot simply accumulate information without regard to what each bit of information represents in terms of its possible contextual meanings” [37]; m) thick description of the phenomenon under scrutiny. Detailed description in this area can be an important provision for promoting credibility as it helps to convey the actual situations that have been investigated and, to an extent, the contexts that surround them. Without this insight, it is difficult for the reader of the final account to determine the extent to which the overall findings “ring true”. Moreover, if the researcher employs a reporting system in which he or she defines a series of types within a typology and illustrates these types using real qualitative episodes, the inclusion of the latter enables the reader to assess how far the defined types truly embrace the actual situations; n) examination of previous research findings to assess the degree to which the project’s results are congruent with those of past studies. Silverman considers that the ability of the researcher to relate his or her findings to an existing body of knowledge is a key criterion for evaluating works of qualitative inquiry [38]. In this respect, reports of previous studies staged in the same or a similar organisation and addressing comparable issues may be invaluable sources. 3. Transferability Merriam writes that external validity “is concerned with the extent to which the findings of one study can be applied to other situations” [39]. In positivist work, the concern often lies in demonstrating that the results of the work at hand can be applied to a wider population. Since the findings of a qualitative project are specific to a small number of particular environments and individuals, it is impossible to demonstrate that the findings and conclusions are applicable to other situations and populations. Erlandson et al. note that many naturalistic inquirers believe that, in practice, even conventional generalisability is never possible as all observations are defined by the specific contexts in which they occur [40]. A contrasting view is offered by Stake [41] and Denscombe [42], who suggest that, although each case may be unique, it is also an example within a broader group and, as a result, the prospect of transferability should not be immediately rejected. Nevertheless, such an approach can be pursued only with caution since, as Gomm, Hammersley and Foster recognise, it appears to belittle the importance of the contextual factors which impinge on the case [43]. Bassey proposes that, if practitioners believe their situations to be similar to that described in the study, they may relate the findings to their own positions [44]. Lincoln and Guba [45] and Firestone [46] are among those who present a similar argument, and suggest that it is the responsibility of the investigator to ensure that sufficient contextual information about the fieldwork sites is provided to enable the 70 A.K. Shenton / Strategies for ensuring trustworthiness in qualitative research projects reader to make such a transfer. They maintain that, since the researcher knows only the “sending context”, he or she cannot make transferability inferences. In recent years such a stance has found favour with many qualitative researchers. After perusing the description within the research report of the context in which the work was undertaken, readers must determine how far they can be confident in transferring to other situations the results and conclusions presented. It is also important that sufficient thick description of the phenomenon under investigation is provided to allow readers to have a proper understanding of it, thereby enabling them to compare the instances of the phenomenon described in the research report with those that they have seen emerge in their situations. Authors disagree on the nature and extent of background information that should be offered but few would dispute the need for “a full description of all the contextual factors impinging on the inquiry”, as recommended by Guba [47]. Nevertheless, the situation is complicated by the possibility, noted by Firestone, that factors considered by the researcher to be unimportant, and consequently unaddressed in the research report, may be critical in the eyes of a reader [48]. Many investigators stop short of the course of action advocated by Denscombe that the researcher should demonstrate how, in terms of the contextual data, the case study location(s) compare(s) with other environments [49]. This reluctance is based on the fact that the process would demand a considerable knowledge of the “receiving contexts” of other organisations, and the researcher is in no position to comment on what Merriam calls the “typicality” of the environment(s) in which the fieldwork took place [50]. The work of Cole and Gardner [51], Marchionini and Teague [52] and Pitts [53] highlights the importance of the researcher’s conveying to the reader the boundaries of the study. This additional information must be considered before any attempts at transference are made. Thus information on the following issues should be given at the outset: a) the number of organisations taking part in the study and where they are based; b) any restrictions in the type of people who contributed data; c) the number of participants involved in the fieldwork; d) the data collection methods that were employed; e) the number and length of the data collection sessions; f) the time period over which the data was collected. It is easy for researchers to develop a preoccupation with transferability. Ulti- mately, the results of a qualitative study must be understood within the context of the particular characteristics of the organisation or organisations and, perhaps, geo- graphical area in which the fieldwork was carried out. In order to assess the extent to which findings may be true of people in other settings, similar projects employing the same methods but conducted in different environments could well be of great value. As Kuhlthau [54] and Gomm, Hammersley and Foster [55] recognise, however, it is rare for such complementary work to be undertaken. Nevertheless, the accumulation of findings from studies staged in different settings might enable a more inclusive, A.K. Shenton / Strategies for ensuring trustworthiness in qualitative research projects 71 overall picture to be gained. A similar point is made by Gross, in relation to her work on imposed queries in school libraries. She writes of the “multiple environments” in which the phenomenon of her interest takes place and believes her study to provide a “baseline understanding” with which the results of subsequent work should be compared [56]. As Borgman [57] and Pitts [58] have acknowledged, understanding of a phenomenon is gained gradually, through several studies, rather than one major project conducted in isolation. Even when different investigations offer results that are not entirely consistent with one another, this does not, of course, necessarily imply that one or more is untrustworthy. It may be that they simply reflect multiple realities, and, if an appreciation can be gained of thereasons behind the variations, this understanding may prove as useful to the reader as the results actually reported. Such an attitude is consistent with what Dervin considers should be key principles within information-seeking research, namely: “To posit. . . every contradiction, every inconsistency, every diversity not as an error or extraneous but as fodder for contex- tual analysis. To ask and re-ask what accounts for this difference or this similarity and to anchor possible answers in time-space conceptualizings” [59]. It should thus be questioned whether the notion of producing truly transferable results from a single study is a realistic aim or whether it disregards the importance of context which forms such a key factor in qualitative research. 4. Dependability In addressing the issue of reliability, the positivist employs techniques to show that, if the work were repeated, in the same context, with the same methods and with the same participants, similar results would be obtained. However, as Fidel [60] and Marshall and Rossman [61] note, the changing nature of the phenomena scru- tinised by qualitative researchers renders such provisions problematic in their work. Florio-Ruane highlights how the investigator’s observations are tied to the situation of the study, arguing that the “published descriptions are static and frozen in the ‘ethnographic present’ ” [62]. Lincoln and Guba stress the close ties between credi- bility and dependability, arguing that, in practice, a demonstration of the former goes some distance in ensuring the latter [63]. This may be achieved through the use of “overlapping methods”, such as the focus group and individual interview. In order to address the dependability issue more directly, the processes within the study should be reported in detail, thereby enabling a future researcher to repeat the work, if not necessarily to gain the same results. Thus, the research design may be viewed as a “prototype model”. Such in-depth coverage also allows the reader to assess the extent to which proper research practices have been followed. So as to enable readers of the research report to develop a thorough understanding of the methods and their effectiveness, the text should include sections devoted to a) the research design and its implementation, describing what was planned and executed on a strategic level; 72 A.K. Shenton / Strategies for ensuring trustworthiness in qualitative research projects b) the operational detail of data gathering, addressing the minutiae of what was done in the field; c) reflective appraisal of the project, evaluating the effectiveness of the process of inquiry undertaken. 5. Confirmability Patton associates objectivity in science with the use of instruments that are not dependent on human skill and perception. He recognises, however, the difficulty of ensuring real objectivity, since, as even tests and questionnaires are designed by humans, the intrusion of …