A qualitative study on health and social care

The purpose of the study has been outlined in the summary, which was to explore physiotherapist’s experiences and understanding of evidence based practice (EBP) from various clinical settings within the Wessex area of England. The author further states how they examined the appropriateness of EBP within physiotherapy and what factors physiotherapists felt promoted or discouraged it.

EBP has been defined as “integrating individual clinical expertise with the best available external clinical evidence from systematic research” (Sackett et al, 2006 p???). Clinical EBP not only gives value to the way we do something and its result, but also the effect the intervention has on a person (McKenna et al, 1996).. Several references have been made to how EBP is key to identifying clinical effectiveness. This is further supported by (Alsop, 1997).

Literature:

From reading the article; it is not clear if a literature review was carried out. Several references in the introduction relate to EBP and its importance in physiotherapy, which is further supported with guidelines and requirements from both professional bodies and government commissioning. However it does not fully explain why or how the need for this study arose. The purpose of a literature review is to provide a background and rationale so as to orientate the reader (Marshall, 2004). The author quotes (Newham, 1997) “The physiotherapy profession has been slow to research its intervention” Newham also found six perceived problems surrounding research and physiotherapists attitudes to EVP, more detail about this could have helped to provide background.

Another reference made by the author in relation to the limitations of physiotherapy EBP was twenty years old; this could be considered of little relevance to attitudes of EBP in 2001. The author did make reference to one similar and up to date study and highlighted that this helped to validate their findings. This study by (Jaramazovic and Curtin, 2000), used mixed methodologies to capture the views and perceptions of Occupational Therapists in the Wessex region of the UK. Unfortunately this paper was not mentioned until the discussion section.

Study Approach:

Critically appraise the approach (paradigm) selected for this study.

Research is mainly divided into two categories; qualitative and quantitative. Quantitative research, also known as positivist research, uses numbers to obtain its findings in a precise and systematic way (Aveyard 2011p56). Whereas qualitative research is about understanding, meaning and phenomenology (Taylor 2007p89)

Was it appropriate for the study question? (e.g. for knowledge level about this issue, outcomes)

This study’s main aims were to understand the attitudes and experiences of physiotherapists surrounding EBP. It also sought to explore their views on what potentially facilitated or became a barrier to effective clinical practice. From this one can deduct that a qualitative paradigm was appropriate due to its phenomenological approach.

Could this question have been investigated using a quantitative approach There is no real question; rather a descriptive statement of what the study sought to explore….While a qualitative approach was the most appropriate for this enquiry a quantitative approach could be employed by constructing a questionnaire composing of closed-ended items. This qualitative approach would be useful after for a larger sample size, once key themes or trends had been identified in the smaller qualitative methods and could be used to form the questions for a quantitative postal questionnaire (Curtin & Jaramazovic, 2001p215). One of the drawbacks of a postal questionnaire is that one runs the risk of failing to capture any real depth or subjectivity. Never the less, it is quite possible and a more appropriate title for a quantitative approach could read “The future of evidence based practice in physiotherapy: Are you facilitating or inhibiting its progress?”

Study Methodology:

What was the study methodology (Study/Research design)? Was it appropriate for the study question? (e.g., for knowledge level about the issue, ethical issues)

Research methodology is divided into four main categories. The Design; how you went about doing what you did and why. The Sampling; the types of people you used to carry out and investigate your research on. Including Data collection and data analysis; how you collected and made sense of your information (

The research design study was clearly of a phenomenological nature due to the researchers desire to understand the phenomenon of a lived experience by an organisation or group (Letts et al, 2007) including the notion of multiple realities (Polgar, 2008). This way the authors can gain a subjective insight into the physiotherapist’s attitudes rather than an empirical one.

based on focus groups, interviews and observations to best collect and

Discuss the theoretical perspective for this study. There was no theoretical perspective for this study

Discuss the method(s) used to answer the research question.

Sampling:

The sample size of has been clearly stated of 56 physiotherapists from various grades and settings. This type of sampling is known as random purposive sampling which selects participants for specific reasons and helps to provide information rich data (Aveyard, 2011p57) and (Polgar & Thomas, 2008p38) rather than that of theoretical sampling which seeks to capture the views of a larger population (Kitzinger,1995). They have also described how participants were allocated to their categories in accordance with focus group methodology (REF) The authors have clearly mentioned some of the internal limitations of their intended sample size of 78 and have

Whilst the both the workplace setting and grade of the physiotherapist were clear the independent specialities were not. One could argue that not only environmental culture impacts on the value given to EBP but also the specialities. Identifying this could help prioritise favoured It could be considered useful to recognise this to identify any specific shortfalls in specialities needing more support as it is clear that can be made As Physiotherapy culture and attitudes towards EBP may vary from general community to specialist neurology. (REF) Shortfalls in the low number of volunteers were identified; however this factor had little impact of the reliability due to its phenomenological approach. One cannot be sure why the gender ratio was relevant including the men’s grades? Ratio of 98:14 is not

Discuss the sampling methods used.

Was flexibility in the sampling process demonstrated?

This seems to be an appropriate sample size at this stage as it eliminates variation due to institutional differences and also makes the volunteers to be adequately prepared for the type of questionnaires they are going to be subjected to. Although a larger sample size could have been more indicative of the results but as this study was the first effort of its kind, the novelty of the idea compensates for the small sample size.

Discuss the ethics procedure.

Signed consent was obtained from the participants prior to the commencement of the focus groups, but no reference has been made to any approval from the ethics board or the Chartered Society of Physiotherapists, (CSP) It is clear that at the time of the research that the Research governance framework for health and social care had not yet come into place (Department of Health, 2001) However some agreement would need to have been made with the trust managers. Actually this was identified in the author’s bio on page 118…no mention of confidentiality or if anyone else would see the raw results? ((Finlay and Ballinger, 2006-p103)

Data Collection:

Discuss the context of the study.

The study was carried out by conducting various focus groups across the hospitals, lack of participants in focus groups meant that individual style interviews were carried out, and this can be supported by (REF) does not mention type of observation? Participatory

Was it sufficient for understanding of the “whole” picture? The authors have attempted to use a process called triangulation (Greenhalgh & Taylor, 1997) Triangulation means cross checking the data through more than two methods. The focus groups, individual and group interviews demonstrated this to some extent. However some reliability in the triangulation process could be lost due to the fact that the data was not analysed by an independent researcher (Greenhalgh & Taylor, 1997).

Discuss how elements of the study were documented. Audio taped and transcribed, typed notes of observations, but only of focus groups…not group interviews or one 2 ones. Does not state what was observed.

What was missing? Doesn’t state if two facilitators were present in both group and individual interviews? This could lead to bias and Hawthorne effect (REF). Other considerations such as cultural or colloquial expressions have not been mentioned as well as sarcasm, which is significant when interpreting the true meaning of a person’s opinion (REF). Also did the responses from the key findings develop through discussion or spontaneously? (Finlay and Ballinger, 2006-p81)

Discuss data collection methods. How were the data representatives of the “whole” picture?

Discuss any flexibility in the design & data collection methods.

Observation is often avoided because it poses special problems such as “selective recording” and “intrusions” (Finlay p38)

Data Analysis:

Discuss method(s) of data analysis. Were the methods appropriate? What alternative explanations were explored?

Thematic Analysis, examining the transcripts line by line for emerging themes, validity was strengthened by having their data carried out by two independent researchers. However it is not clear why this was done on only the first 2 focus groups and first two interview transcripts. Possibly issues arose due to funding, timing or other personal reasons. The fact that this is not clear could impact on the credibility (REF)

Reflexive reading of the transcripts

Findings were presented at a consensus conference to physiotherapy managers including some who had participated in the focus groups and interviews. Contribute to the recommendations arising from the study co

Reflexivity involves “Critical self-reflection, focusing on the ways a researcher’s social background, assumptions, positioning and behaviour affect the research process” (Finlay and Ballinger, 2006-p21)

So it’s about become more self aware and insightful.

Conclusion? WHAT RECOMMENDATIONS? Reflexivity??

Table3: factors perceived to promote and discourage evidence-based practice

No prioritisation of finding, if some areas were seen to be more of a problem than others

Trustworthiness:

Discuss the strategies used to promote trustworthiness in the processes of data collection and analysis for this study.

Rigour and Trustworthiness in Qualitative

Internal Validity = Credibility: subjective, perceptual, say, think, experience of the participants.

External Validity = Transferability positive due to aiming to seek quality and depth, not a snapshot or representation of larger population.

Reliability = Dependability .Think about relationship between physio, any conflicts of interest, working relationships?? Was it a Monday morning or Friday afternoon, environment etc?

Objectivity = Confirmability… member checking… article states that both researchers/facilitators

CONCLUSION:

CONCLUSIONS & IMPLICATIONS: Discuss the study’s key conclusions and their implications. Consider the conclusions in the light of the main limitations of the study.

This article bases its conclusion mainly from the findings and keeps it brief as this was explained in detail in both the six key themes and the discussion of findings. However despite the very positive, results, it lacks any real conclusion or sense of where the author wants to take you from there. Could sound exciting but leaves reader feeling flat, lacks credibility.

Methodology was appropriate for sample and design.

Further lack of a literature review provides poor rational for the study including statements about recommendations in the discussion of findings, however none are given..

Would be useful to know Physiotherapists views, if they were expected to take findings back to workplace as EBP was seen as everyone’s responsibility.

Makes valid contributions to the understanding of EBP within Physiotherapists re 6 key themes, which will help to share responsibilities.

Informative but no validity////what now???